0:01

We cover a lot of ground in this deeply

0:03

holistic episode with Dr.

0:05

Sarah Gottfried. Dr. Gottfried

0:07

was a dream guest for me. I actually

0:09

cannot believe that she's on the show. She's

0:12

one of the most well known hormone

0:15

focused medical doctors in the world.

0:18

She's a scientist, a researcher, a seeker,

0:20

and she says that she practices medicine but doesn't

0:22

treat problems. Rather, she specializes

0:25

in what she calls root cause analysis,

0:27

functional medicine testing, as well

0:29

as tending to her patients' souls,

0:31

helping people feel fully alive

0:33

and balanced from their cells to their

0:35

souls. If you are struggling with

0:37

a hormone condition and you have no idea

0:40

where to begin, if you're struggling with PCOS,

0:42

my PCOS girls out there, you know that I have

0:44

all the love in the world for you. This episode

0:47

is for you. We're going to talk about

0:49

both the science and the energetics

0:51

of PCOS, how the masculine and feminine

0:54

and patriarchy all play a role. We're

0:56

going to look at hormonal conditions from a nature

0:59

and a nurture standpoint, the biology

1:01

of them and how diet of course plays a role,

1:03

but also the role of soul wounds

1:05

and intergenerational

1:06

trauma from our mothers and our grandmothers

1:09

and beyond. This is a doctor who actually

1:11

knows how to speak to the spiritual and energetic

1:13

side of medicine and sees that

1:16

trauma actually plays a role in

1:18

what we as women are experiencing. We're

1:20

going to talk about supplements and testing, but we're also going

1:22

to talk about tapping and breath work and what

1:24

to do if your nervous system is in freeze

1:26

mode. It was so refreshing to hear all

1:29

of these tips and all of this knowledge

1:31

from an actual medical doctor who gets

1:33

the holistic side and is trauma informed.

1:35

And I know that you guys are going

1:36

to love and feel so validated

1:39

as you listen to this episode. It's one of

1:41

my favorites. Thank you guys again, week

1:43

after week for listening to the show and supporting

1:45

it. If you love the show, please leave us a

1:47

review on iTunes in the podcast

1:50

app and send this episode to a friend who's struggling

1:52

with hormone conditions and needs to hear it. Thank

1:55

you guys for being a part of the What's the Juice family

1:57

and I hope you love this app.

1:59

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Okay. Are you ready?

4:28

We feel each other's emotions.

4:31

It's everything. It's living my life. That's

4:33

the message, right? Let's see exactly.

4:36

And further ado, let's get to the end.

4:44

Hello, Dr. Gottfried. Thank

4:46

you so much for being on the show today. How are you

4:48

doing?

4:49

Never been better, Olivia. How are you? I'm

4:52

very well. I'm very ready

4:54

to have this conversation that I think so

4:56

many women need to hear. Your voice is

4:59

so important in the space as an MD

5:01

who really validates our lived experience.

5:04

So I just want to get right into it.

5:06

First and foremost, can you share with

5:08

us the unique challenges that women

5:11

face? Why we not only struggle

5:13

with complex hormone imbalances,

5:15

but why being a woman in general is

5:17

a health hazard, as I've heard you put it. Because

5:20

I think the way that you speak about this is just so

5:22

validating to

5:23

women around the world. Well, there's

5:26

so many threads related to the answer to this

5:28

question. So the way I feel into

5:30

it is to start with some statistics.

5:33

We know that women have double

5:36

the rates of depression as does

5:38

their word mail. We've got double

5:40

the rates of insomnia. When

5:43

we're exposed to the same

5:45

or similar trauma, we've got

5:47

higher rates of post-traumatic stress disorder.

5:50

We've got

5:51

about fourfold more autoimmune

5:54

disease. And

5:56

metaphorically, this idea of our

5:58

body is attacking. are normal tissues.

6:01

That is not normal. We've

6:03

got double the rates of Alzheimer's disease,

6:06

which is not a condition of

6:08

old age. It's the condition of really

6:12

young age and middle age. So

6:14

there's all these statistics. And when you look

6:17

upstream, like I do

6:19

in my work in precision and

6:21

functional medicine,

6:23

we know that

6:24

women at these vulnerabilities were explicitly

6:27

sensitive to our environment. And

6:29

so when that environment includes patriarchy,

6:33

power over something that we've

6:35

been exposed to since

6:38

time began, it makes sense. You

6:41

know, I think a lot of us respond

6:44

to stress

6:44

in kind of classic masculine

6:47

ways, like fight, flight.

6:49

And it just doesn't work. We've

6:51

got unique ways that we need to dance with stress.

6:54

And hopefully we'll get into that today.

6:56

Absolutely. It's funny that you already

6:58

off the bat mentioned that many of us, I

7:00

think especially

7:01

in our modern world where

7:03

capitalism and survival plays

7:05

a role, that you just mentioned we respond

7:07

in masculine ways. Because I have a whole bunch

7:09

of questions for you about PCOS. And one

7:12

of my questions is from

7:14

almost a woo perspective, if we

7:16

put the science aside and just theorize for

7:18

a moment, how much of our

7:21

modern epidemic of PCOS

7:24

can be attributed to the way that

7:26

we are responding to patriarchy, responding

7:29

to continued lived trauma systems

7:31

that are not made to support us. And thus we're

7:33

being pushed so far into our masculine

7:36

to take care of ourselves since we don't have

7:38

the structure. And then we are overproducing

7:41

these androgens and having this hormonal

7:43

response that is quite literally in the masculine.

7:46

It's really a question. So I

7:48

can't answer it from a

7:51

purely scientific perspective.

7:53

But more from

7:55

maybe a priestess perspective

7:58

or just someone who's been. observing

8:01

women and has lived in a female body for

8:03

half a century. I

8:06

think that's it. I think

8:10

there's a constellation of things that happen.

8:12

So with polycystic ovary syndrome,

8:15

much like other hormone imbalances that

8:17

both men and women experience, the

8:21

start of it is that the control

8:23

system for hormones becomes

8:25

dysregulated. So that control

8:27

system, which is meant to be the

8:30

brain talking to adrenal glands,

8:32

talking to the gonads, so

8:35

ovary syndrome women, testes

8:37

to men, talking to the thyroid, talking

8:39

to the gut, that system is really

8:41

meant to be in

8:44

a state of harmony. Maybe

8:48

you have a threat that you're exposed to

8:50

like once a quarter, and then the system

8:53

goes into alert and responds to that.

8:56

But what happens in our modern

8:58

lives is that we have

9:00

constant daily threats. So

9:03

with PCOS, yes, the way that

9:06

the system responds

9:08

is that

9:09

for women, they start making more androgens,

9:11

they start making more DHEA, they start making

9:14

more testosterone, and

9:16

they make less of the hormones that

9:19

are quintessentially female, like oxytocin

9:21

and estrogen. So

9:25

it leads to the state

9:28

of dysregulation. It's

9:30

not just the sex hormones that are affected,

9:32

like the consequences,

9:35

high androgens, low progesterone.

9:39

Androgen can be variable, but

9:42

also insulin. So insulin gets

9:44

into the mix. About 75 percent

9:47

of women with PCOS have

9:49

high insulin, and high insulin

9:51

makes you hoard fat. And so it leads

9:53

to a number of different symptoms. The

9:56

high insulin is toxic

9:58

to the ovaries. makes the ovaries

10:01

overproduce testosterone. So

10:03

you get into this vicious cycle. So

10:05

yeah, the net consequence is what you're describing.

10:08

We become more mouthfulinized. We

10:11

get more rogue hairs in places

10:13

we don't want it, like our kin and

10:15

our face and our neck and our breasts. We

10:18

get acne and there's

10:21

a response that I think

10:23

feels out of sorts for

10:26

most women who experience

10:28

it. And it

10:31

leads to a greater risk of cardiac

10:34

metabolic disease. So metabolism

10:36

is hugely effective. You know, we look at how women

10:39

die at higher rates of

10:42

heart disease, number one killer. And

10:45

one of the key risk factors for that, non-traditional

10:47

risk factors, is PCOS and high

10:49

androgens. So yeah, it's

10:52

a way of responding to our environment that's

10:54

not working for us.

10:56

Absolutely. So much of what you're describing

10:58

and what I've witnessed in clients with PCOS

11:00

and what I've witnessed in my own experience

11:03

as someone who leans more towards that hormonal

11:05

picture, is this

11:08

lived experience of not feeling safe. You

11:10

know, that the metabolic dysregulation,

11:13

more hunger, more food, storing fat,

11:16

the stress hormones. It's really

11:18

interesting the way that I feel that PCOS

11:21

specifically is such a response

11:24

and such a mirror to where we're going

11:26

wrong in society as a whole.

11:28

And the way that we're living in the systems in which we're creating

11:31

to support women, even looking at the way that there's not

11:33

enough time off postpartum, there's

11:35

not enough paid maternal leave or paternal

11:37

leave. There's just not, we

11:40

no longer have communities. A lot of us feel

11:42

very alone. A lot of women that I know feel very

11:44

alone, very angry about it. And so much

11:46

of that lends itself to the

11:49

hormonal consequences of PCOS. So

11:52

there's a huge energetic aspect. And I think

11:54

that, you know, we'll get back to the science,

11:56

but I just appreciate your view and acknowledgement

11:59

there. With that being said though, in

12:01

terms of looking at that environmental

12:03

response, I do want to go back to hormone

12:06

conditions in general and just

12:08

ask you how much of the hormonal conditions

12:10

that we often struggle with, whether it is PCOS

12:13

or something like endometriosis, can

12:15

be attributed to environment and lifestyle

12:17

versus genetics. Is it 50-50? Is

12:20

it 80-20? Or does it totally depend

12:23

on the disorder?

12:24

A lot of it depends on the disorder.

12:27

I do precision medicine, which is basically

12:30

looking at the gene environment interface and

12:32

trying to understand how do we

12:35

address the root cause. So

12:38

when you look at chronic conditions of

12:40

which polycystic ovary

12:42

syndrome, PCOS, or PCOS,

12:45

endometriosis are chronic conditions.

12:48

Overall,

12:49

somewhere around 10-20% of

12:51

the cause is genetic. Certainly,

12:55

endometriosis runs in families. So

12:57

I've got a mother and a sister with endometriosis.

13:01

Personally I had adenomyosis and fibroids. That's

13:04

like a conversation for another time. We've

13:06

got a lot of PCOS in our family. And

13:09

so these things tend to cluster in

13:11

families, which usually means there's a genetic

13:13

component. But increasingly what we're learning

13:15

is that the gene set up

13:18

a blueprint that provides probabilities.

13:21

And then the question is, does the environment

13:24

match up with those probabilities

13:26

or not? So if you take someone

13:28

who's got a greater risk of

13:31

PCOS, a greater risk of insulin

13:34

resistance, and maybe more

13:36

sensitivity to the environment, and

13:38

you put them into a situation as

13:41

a child where they've got a high

13:44

ACE score at first childhood experiences,

13:46

they've got neglect to refuse, or

13:49

a family member with addiction, that

13:52

sets you up for greater risk. It sets you up

13:54

for dysregulation as a hypothalamic or two-degree

13:56

adrenal axis. It sets

13:58

you up for dysregulation. of not

14:01

just your hormonal system,

14:03

but if we take a step back and

14:05

think of it as the pine system,

14:08

which is the psycho-immuno-neuroendocrine

14:11

system. So all of those things can become

14:13

dysregulated related to your

14:15

environment, whether that environment

14:18

has trauma or even

14:20

if you experience trauma, what we know is that if

14:23

you experience trauma as a child or as

14:25

an adult, if you've got someone that you

14:27

can confide in who believes you, who

14:30

is a healthy mirror for you, it can

14:33

really make all the difference. So

14:35

it's a simple question.

14:37

The answer is kind of complex. The

14:40

way that I think Francis Collins first

14:42

described it is that James loads a

14:44

gun, but environment pulls

14:46

the trigger. So just because

14:48

he's loaded the gun doesn't mean that you're going to develop

14:50

PCOS. It has a lot to do with

14:52

your environment. And the more that you can adjust your

14:55

environment, you know, for instance, I

14:58

grew up in a very emotional eater. Right.

15:02

So I ate and saved myself. I

15:04

ate a lot of sugar as a kid. I

15:07

loved chocolate chip cookies. That was like the most

15:09

soothing thing that I could find. And

15:12

you know, my mother, my grandmother would tell me to

15:14

stop eating the dough and I wouldn't. I'd

15:17

sneak it. And that sugar

15:19

can really cause problems depending

15:21

on your genetics. A diet high

15:24

in refined carbohydrates can

15:26

make some of those PCOS

15:29

maybe detoxification genes, inflammation

15:31

genes become expressed

15:35

and lead to a greater risk of developing the

15:39

condition. And this is what I love so much about your work is

15:41

that you really zoom out on what environment

15:43

means. You know, it's, I love that we have

15:45

the piece of genetics. Sure. Some

15:47

of us may be more vulnerable to insulin resistance.

15:50

We may not respond to glucose

15:52

as efficiently as someone else who perhaps

15:54

their mother didn't have insulin resistance or their

15:57

mother wasn't a bit insulin resistant while they were in the

15:59

womb. what creates those epigenetic

16:01

changes or if it's just plain old genetics.

16:04

But I you know the fact that environment

16:07

is what really sets those genes off

16:09

or I mean sets turns them on

16:12

or turns them back off is so

16:14

important and environment is not just the

16:16

sugar and the diet and the chocolate chip cookies and the

16:18

exercise it is really the trauma especially

16:21

our traumatic experiences from childhood

16:23

and I've even heard you talk about intergenerational

16:26

trauma and I think that is so

16:28

important for us to look at you know the trauma

16:30

experienced by our mothers our

16:33

grandmothers and I wanted to ask you

16:35

is there any science the way that

16:37

we have the ACE scores and the ACE studies to

16:39

now show that trauma in our

16:41

lives impacts our hormones in our physical

16:44

health is there any science that shows

16:46

us that intergenerational trauma can have

16:48

a real impact on our physical health and our hormones.

16:51

We're still at the beginning stages

16:53

of that beta Olivia but

16:56

it's compelling so the person who's

16:59

kind of led the charge is a woman named Rachel

17:01

Yehuda who's at Mount Sane in

17:03

New York and she started

17:06

first with looking at Vietnam veterans

17:09

and she found something curious she found that

17:11

Vietnam veterans had really low cortisol

17:14

levels when they had post-traumatic stress

17:16

disorder and she started to dive

17:18

deeper she then looked

17:20

at the offspring of Holocaust

17:23

survivors and

17:24

she found that this

17:26

intergenerational trauma

17:28

is expressed in certain enzymes

17:32

going back to the adrenals and

17:34

the sex hormone production the way

17:36

that you make cortisol and

17:38

the way that you inactivate cortisol

17:40

the enzyme that's involved in that can

17:43

become changed by big C trauma

17:47

like the Holocaust. She found similar

17:49

results looking at she's

17:51

in New York during 9-11 so looking

17:54

at women who are pregnant during 9-11 you

17:57

know those kids are now much older And

18:00

she's found similar things in terms of

18:02

the way that genes are expressed, the

18:04

way that they're expressed in the mother, and the

18:06

way that they're expressed in the offspring. We're

18:09

not at the point yet where we're looking at great grandparents

18:11

and how soul wounds

18:13

are passed on, but certainly

18:15

in mother-baby dyads,

18:19

we're seeing that. Another thing that's

18:21

super interesting, which I think relates to PCOS,

18:23

although I haven't seen direct literature

18:26

on this. It might exist. I just haven't looked at it.

18:28

There was this really curious

18:31

thing that happened called the

18:33

ice storm in Canada. Have

18:35

you heard about this?

18:37

I did. I think I heard you talk about this on the Model

18:39

Health

18:39

show. So this is basically looking at epigenetics.

18:42

So there's the genes that you

18:44

inherit from your parents. And

18:47

then there's the experience

18:49

above the genes, which is

18:51

the way that trauma is often

18:54

expressed. And that's what we're talking about with intergenerational

18:56

trauma. So in Project

18:59

Ice Storm,

19:00

this was 1999, if

19:03

I'm remembering correctly, there

19:05

was this period of

19:08

a

19:08

severe ice storm

19:10

in a part of Canada

19:12

that was isolated by the

19:16

severe ice, a cold snap,

19:19

and people were stuck in their homes without heat.

19:22

So severe stress for a week,

19:24

longer, some period of time. And

19:27

so they then looked at the women who were pregnant

19:30

during Project Ice Storm. During

19:32

Ice Storm, we made a project out of it.

19:35

And they found that in their

19:37

offspring, and this was when

19:39

they were about 18 years old, the

19:42

genes that were most affected in

19:44

terms of expression

19:45

were their immune

19:47

system genes and

19:49

their metabolic chains. So those

19:51

were the two systems that were the most affected,

19:54

leading to this issue

19:57

of hoarding fat of metabolism.

20:00

that's not as flexible as someone

20:02

who wasn't exposed to that kind of trauma. And

20:05

this is starting to fill in some of the gaps that

20:07

we have. We know, for instance, that if

20:10

you have a higher ACE score,

20:13

if you had more adverse childhood experiences,

20:16

you've got a greater risk of developing diabetes.

20:19

You've got a greater risk of higher fasting

20:21

glucose. And

20:24

so this is starting to fill in the gaps

20:26

in terms of understanding those soul wounds of

20:28

which to speak that can be passed on from

20:30

generation to generation. So

20:33

the option is if you're experiencing

20:35

PCOS, if you've got insulin resistance,

20:37

if you've got the kind of clinician

20:40

that's measuring your insulin levels, and

20:42

you're not quite sure why because you feel

20:44

like you've got your food dialed in and you're exercising

20:47

regularly, you're doing everything right, sometimes

20:50

it can be intergenerational. It

20:53

can be this tendency that's passed on. And

20:56

for some people that can lead to autoimmune disease

20:58

like Hashimoto's or type 1

21:00

diabetes or multiple

21:03

sclerosis. And for other people, it can

21:05

be a problem with glucose,

21:07

insulin resistance, it just depends

21:09

on your particular matrix.

21:12

And it makes so much sense. I mean, even

21:14

with the ice storm example, when

21:16

the mother is in a situation

21:18

where there aren't resources or is not safety,

21:21

cortisol levels are skyrocketing, of course

21:23

her offspring would then learn, okay, I'm

21:25

getting all of this information from your hormones about

21:28

the environment, I better be really good

21:30

at using whatever glucose I can get to

21:32

store as fat so that I can survive. And

21:34

it's this adaptation that

21:37

puts us, it makes us really good survivors,

21:40

but it perhaps does not allow us to

21:42

thrive and be able to relax

21:45

and be able to get into parasympathetic

21:47

mode before we eat a meal. And we're always in fight or flight

21:49

and we're wondering why our hormones are off. And

21:52

so much of it can be coming from our parents,

21:54

our mothers, even for mothers who were

21:56

not in a huge event like an ice storm

21:58

or the Holocaust. So many

22:00

of our mothers went through trauma from what

22:04

you said, the patriarchy, or just the way

22:06

that I think for a very long

22:08

time we have not understood

22:11

how to validate the human experience and give

22:13

people tools that teach them how

22:15

to regulate their nervous systems. And I think even

22:17

more than genetics, we

22:20

essentially inherit nervous systems. You know,

22:23

we're humans. We co-regulate. So

22:25

when you're raised by a parent or parents

22:28

that never learned how to regulate their nervous

22:31

system, you pick up

22:33

on that. You read them, you mirror them, and you kind

22:35

of inherit the same state of dysregulation.

22:38

And it becomes, unfortunately, our...

22:41

Unfortunately, or fortunately, if you want to look at it

22:43

in an empowering way, it becomes our task

22:46

to

22:48

heal and learn nervous system regulation

22:50

for ourselves.

22:52

So you're co-regulating me just the way that you're

22:54

talking about this, Olivia, because your

22:57

description is so cogent. And

22:59

I just finished my

23:02

sixth book about trauma,

23:04

autoimmune disease, and novel solutions

23:07

like psychedelic therapy, Lotus Naltrexone,

23:10

and all the different immune modulators that

23:13

we now have identified, like DHEA. And

23:17

you are absolutely right. On the one hand,

23:19

you know, I'll just speak to

23:21

myself for a moment. I love

23:24

my mother. She did the best she could.

23:28

And she's someone who experiences

23:30

high perceived stress, regardless

23:33

of her environment. And

23:36

I assume she inherited that from my grandmother

23:40

and from my great-grandmother on

23:42

her mother's side. So I

23:45

grew up feeling under-regulated,

23:48

and I'm not playing

23:50

the victim here because recognizing

23:53

that, and I want our listeners

23:56

to like take an inventory

23:58

right now and see, is this... Is that

24:00

true for you? Like are you

24:02

under-regulated? Because then

24:04

it becomes this sacred

24:08

task

24:09

to learn how to regulate yourself, to

24:12

like learn the top five or ten ways

24:15

that you can create safety when

24:17

you are safe. Because that's the biggest problem

24:19

when you can't co-regulate is

24:21

that you don't feel safe when you are safe.

24:24

Yeah. And especially not feeling safe

24:26

when you're alone, I think that can lead us to look

24:28

to external relationships and develop

24:30

patterns of codependency with others because

24:33

we're looking for another to regulate

24:35

whereas it is this inside job. And

24:37

it takes years of, like you said,

24:39

learning. What are my top five, ten tools

24:41

that I can pull out at any moment that work

24:43

for me? And it's

24:46

such a long journey. And it's when

24:48

I first started my career in the health world,

24:51

I thought so much of, you know,

24:53

botanicals, herbs, digestive

24:55

tools, lab testing, all of this. And

24:58

I've shifted so far away

25:00

from that where all of that stuff is great. You need to know

25:02

your numbers, you need to have your baseline. There's a time and a place

25:04

for pharmaceuticals and botanicals. But so

25:07

much of it is that inside job

25:09

of learning different therapeutic

25:12

tools, whether it's breath work, whether

25:14

it's tapping, whether it's inner

25:16

child work with your therapist, where

25:19

you're going back and visualizing that little girl

25:21

who didn't feel safe and telling her that you're here

25:23

now, whether it's spending creative

25:25

time with yourself and just allowing yourself

25:28

to be in the feminine and changing

25:30

your relationship to rest. All

25:32

of that matters for our hormone health

25:35

just as much, if not more, than the diet

25:37

and the supplements and the exercise.

25:40

Exactly right. It's

25:42

about the wholeness. It's about

25:44

to the presence. So,

25:48

you know, I did a similar thing,

25:50

Olivia, in my career where when

25:53

I first kind of stepped

25:56

away from the conventional medical system

25:58

and I realized that I was a little bit of

25:59

all this amazing education that I got

26:02

was still failing some of my

26:05

patients. I became

26:07

obsessed with herbal

26:09

therapies and filling micronutrient gaps

26:12

and helping people with

26:14

lifestyle management and what are the

26:16

behavior change tools that really work. But

26:19

in some ways those things don't matter so much

26:22

if your system is dysregulated.

26:25

It really has to begin with

26:28

understanding the way that you dance with stress

26:31

and then finding how to co-regulate.

26:35

I think a lot of folks, one pattern

26:37

is that if you grew up with trauma,

26:40

often in your primary relationships

26:43

you develop these trauma bonds where

26:45

you kind of interlock. And

26:48

you're a person who likes to

26:50

rage and fight bonds with

26:52

someone who was abandoned. And

26:55

so you get into these trauma bonds where

26:57

you don't co-regulate. And

27:01

that is so essential for the we,

27:04

so essential as a couple to get

27:07

into a relationship where you co-regulate

27:09

each other. And

27:11

you do it not just for your private oasis

27:14

of love, but you do it

27:16

for the bigger service to the world.

27:19

So yeah, I think that's so

27:21

critical. You can't just take Vitex

27:24

and hope for the best. You

27:27

got to look at the bigger system, the bigger

27:29

network.

27:29

Yes, it's take Vitex

27:32

and look at your boundaries and your relationships.

27:35

Where are your boundaries leaky? Where are you looking

27:37

to another to make you happy or

27:40

to fix something within you

27:42

that you can provide for yourself? Where

27:45

are you letting someone take advantage

27:47

of you or enabling? The

27:49

relationship and the boundary element

27:52

has such an effect on our nervous system and

27:54

again thus has an effect on our

27:56

physical levels of hormones,

27:58

our digestive fluids. everything because

28:00

of that HPA plus access

28:03

that you mentioned earlier. And

28:05

that is one of the things that

28:07

I try to hammer home to people most is

28:09

that it really does start up

28:11

here. Everything that you're experiencing

28:13

in the system below the neck, from

28:15

your liver to your digestive

28:18

system, to your ovaries, it

28:20

is all starting with what your hypothalamus

28:23

or your brain is perceiving in the environment

28:25

around you. And I love that you use the term perceived

28:28

stress because what's stressful to

28:30

one isn't always stressful to another. And

28:33

that is why certain things affect one person

28:35

more than it affects the next. But

28:37

it all starts here. And then ultimately

28:39

it's your brain telling

28:41

your ovaries what to do. It's

28:42

your brain and the cortisol that you're

28:44

releasing that's making your glucose levels go high,

28:47

even when you ate the perfect meal. It's

28:49

all about kind of mastering it here. And

28:51

that's so much easier said than done. Just

28:54

knowing that it has to start at the brain is great. It's

28:56

the first step of empowerment. But then when

28:58

you go into what actually heals

29:01

your perceived stress response in the brain, what

29:03

actually starts to make you feel like a whole safe human,

29:05

what's the work you really need to do in

29:07

your relationships and those hard conversations you

29:09

need to have, it becomes a lifelong

29:12

body

29:12

of work. Totally,

29:14

totally. And I think that's a

29:16

critical point to emphasize

29:19

because I can tell you when

29:21

I was in my thirties and I was a hormonal hot

29:23

mess, like I didn't want to hear that. Right?

29:25

Like I was like, wait, no,

29:28

I want the simple answer. Can we start with

29:30

a simple answer? So I get that

29:33

and there's phases

29:36

to this work. As you said, it is

29:39

a lifelong project and

29:41

it can start with herbal therapies.

29:43

It can start with, you know, if

29:45

you have PCOS, it can start with a

29:48

low carb diet. It can start with a continuous

29:51

glucose monitor. It can start with

29:53

taking inositol. It

29:55

can start with maybe some

29:57

natural progesterone if you're not cycling. regularly.

30:01

So it can start with those things and those

30:03

can be really regulating so

30:05

that you're then open and have

30:08

a capacity for these bigger

30:10

projects.

30:12

I love that. That's actually something I warned

30:14

some of my PCOS clients about in the past

30:17

where I've said, okay, I'm gonna give you some

30:19

of these herbs for PCOS and some of these herbs

30:21

that, you know, in Eastern medicine are considered

30:24

to be damp draining. They drain

30:26

some of the dampness in the gut. But

30:28

what happens sometimes when you take these herbs

30:31

that clear the gut and clear the mind,

30:33

you start to see your relationships

30:36

differently. You start to see the things that need

30:38

to change in your life. You start to see that you're actually

30:40

really unhappy at your job and it's causing a

30:42

lot of your stress and you can't unsee

30:44

them. So these physical tools, these

30:47

herbal therapies, they open a door physically

30:50

but also sort of emotionally and spiritually

30:53

and they're the catalyst that helps you

30:55

to become aware of the deeper

30:57

changes you need to make and that's where so much

30:59

of the work is.

31:01

You're describing, if we could get meta

31:03

just for a moment, you're describing what

31:05

I do as well, which is the

31:07

person that you're working with, the group that you're

31:10

working with, you start where they are,

31:12

right? You meet

31:14

them where they are and so,

31:17

you know, maybe they let you know what their ACE

31:19

score is. Maybe they're

31:21

not quite ready to do trauma informed

31:23

therapy. Maybe they, you know,

31:26

just want to start cycling regularly

31:28

and do something about the acne on

31:30

their face. Like that's phase

31:32

one, that's fine. Like let's get

31:34

some little wins. Let's get some successes

31:37

because all of these baby

31:39

steps add to major transformation.

31:42

So yeah, we have to meet our clients

31:45

where they are.

31:46

So I'm gonna ask you in a moment how

31:48

you do often start with PCOS

31:51

patients or, you know, those easy

31:53

things you can do like eating a lower carb diet

31:56

or perhaps incorporating some insulin

31:58

sensitizing botanicals. But I'd love

32:00

to know first where you start

32:03

with kind of nudging

32:05

people towards tools to transform

32:08

their trauma and change their level of perceived

32:10

stress. Like what are a few things that people can start

32:12

to dabble with now that they're aware of

32:15

how much of an impact that trauma has on

32:17

them? And they're like, okay, I get it. I have trauma. It's

32:20

causing my hormone issues, but I feel like I'm

32:22

in freeze mode. Where do I even start? So

32:24

I think the first

32:25

step is awareness. A lot of people

32:27

who are in freeze mode, and I used to be

32:29

one of them, are unaware. They

32:33

just feel numb. They just feel kind of checked

32:35

out. They feel flat. They feel

32:37

depressed. Maybe they're being treated with,

32:39

you know, Lexapro or whatever the

32:41

weight is. Is this RI or SNRIs?

32:45

And so I like to start

32:47

with

32:48

assessments. Typically, the perceived

32:51

stress scale is something I like to use. You can

32:54

Google that. There's a PDF

32:56

that you can take and just see what your score is. I

32:59

do an ACE score. I live in California,

33:02

where we eat. At least pediatricians

33:04

and most clinicians are incentivized

33:07

to record an ACE score

33:09

for every person. And we

33:12

know that about somewhere around two-thirds

33:14

of people have a positive ACE score,

33:17

one or more. ACEs

33:19

are first childhood experiences they've been exposed

33:21

to. And then I typically look at

33:24

cortisol. So I run

33:26

a lot of different tests. I typically do

33:28

a blood test, genetic

33:30

testing. And then for cortisol,

33:33

I really think nothing works like saliva.

33:36

So I like to look at saliva because it gives

33:38

us the free level of cortisol, which

33:40

is a biologically available cortisol, whereas

33:43

blood tests your total cortisol,

33:45

some of which is free, some of which is bound. So

33:48

I like to run a combination

33:50

of saliva and urine testing so

33:52

that I'm looking at a four- or five-point

33:55

cortisol. So four points during

33:57

the day when they first wake up in the morning around

33:59

noon. around 4 p.m. and then

34:01

before they go to bed. And if they wake up

34:03

in the middle of the night, I'll do one in the middle

34:05

of the night along with melatonin. And

34:07

then I do dry urine to look at how they're

34:11

metabolizing cortisol. And that

34:13

gets back to the point I made about soul

34:15

wounds in Rachel Yehuda. So you

34:17

can look at how the enzyme is

34:19

functioning between cortisol

34:21

and cortisone. So

34:23

I like to measure those things. It's

34:26

called the diurnal cortisol.

34:28

That's the four points during the day. And then

34:31

you can also measure cortisol awakening response,

34:33

which is when you first wake up 30 minutes

34:36

later, 60 minutes later. So that's how

34:38

I like to assess the way

34:40

that trauma is living in the body. But

34:43

as we discussed, it's not just your

34:46

hormones that are affected. It's also the greater

34:49

pine system. So

34:52

you want to do some psychological assessments. You know,

34:55

a lot of people with trauma go in the direction

34:57

of anxiety, panic.

35:00

Some people go in the direction of depression. Some

35:03

people dissociate. I used to

35:05

be a functional dissociator. You

35:08

know, physicians are kind of selected for

35:10

that skill so that you can dissociate from

35:12

your body and go for, you

35:14

know, yep,

35:16

the more the more on on your plate, the better

35:18

because then you can just associate

35:19

harder. Great, great. Then

35:21

you don't have to think about all the stuff you have to work on. Yeah.

35:24

And then there are people who become

35:27

more somatic and have more physical

35:30

symptoms. So, you

35:32

know, like chronic pain, fibromyalgia

35:35

has a really high rate of trauma. Maybe

35:38

you asked, although I would say we're still in the early

35:40

stages of understanding that link. So

35:44

you asked, what do you do with

35:46

the trauma? So I think first, awareness.

35:50

And then I really like somatic based

35:52

ways of dealing with trauma. And

35:55

I'd love to maybe get into some of

35:57

the data with you. reviewing 2500

36:01

studies for my new book, I

36:04

was really impressed how

36:08

underwhelming talk therapy

36:10

is for trauma. I was just talking

36:12

about this on Instagram. I did

36:14

years of talk therapy and I was just talking about

36:17

how pissed I was at what happened to me over

36:19

and over again and then it was just sitting in

36:21

my body like it's time to see it.

36:25

It's so critical. I'm so glad you're talking

36:28

about it on Instagram because the efficacy

36:31

is like 30%. You

36:34

know, if I went in for that first

36:36

appointment when I was an

36:39

intern, so I was about whatever,

36:43

26, 27, and I wasn't sleeping

36:45

and I felt depressed and so I went and

36:47

saw a therapist. If

36:50

I had known then that the

36:52

efficacy was 30% of those

36:54

hour long appointments that went on for decades,

36:58

I would have been like, what the hell? I'm not spending

37:00

money on this. Like it's so much money. It's so much time.

37:02

Don't you want that money back? You know,

37:05

like it's,

37:06

but the part of the brain that

37:08

trauma gets lodged in is

37:11

not addressed by talk therapy because

37:13

trauma lives in the body. And

37:16

so somatic based solutions that

37:19

are trauma informed, I think are really

37:21

critical. So there's a lot of different

37:23

ways to do this. Things like EMDR.

37:27

I happen to like Hacomi, which is not specifically

37:30

designed as a trauma treatment, but I think

37:32

it's really effective as it's a

37:35

somatic based mindfulness

37:38

type of therapy that

37:41

is described by the founder as

37:44

assisted self study. Yoga,

37:47

you mentioned tapping, but

37:49

data on tapping isn't as good as it is with

37:52

EMDR and some other treatments, but

37:55

you know, the work of Bessel Vanderkolk and

37:57

some other things, of

38:00

the folks that have really developed effective strategies

38:02

like Paul Conte. These

38:04

are the folks that, you know, are in

38:07

the trenches really

38:10

trying to learn, okay, what's going to be effective.

38:12

So we've got that 30% efficacy with talk

38:14

therapy. And then you look at something

38:17

novel like MDMA

38:19

assisted therapy and the efficacy

38:21

is 67 to 80% for resolving PTSD with two to three

38:28

doses of MDMA in

38:30

a therapeutic container. So

38:33

with, you know, preparation,

38:35

intake preparation and integration.

38:37

So to me that's super

38:39

exciting.

38:40

That's like, yeah, we're in a psychedelic revolution

38:43

right now. Yeah. Yeah. But that,

38:46

for me, for looking at trauma,

38:48

that's super exciting.

38:49

I think that the part that I struggle with

38:51

the most, you know, hearing you talk about all

38:53

these potential incredible

38:55

therapies and the psychedelic revolution

38:58

and even knowing myself, the different practitioners

39:01

I've worked with that have taught me how to talk

39:03

to my body and dance trauma out of my hips

39:05

and, you know, really get my body involved is

39:08

the issue of access. I think it's,

39:11

you know, people here, psychedelic assisted therapy,

39:13

and they're like, where am I going to find someone in my

39:15

small town that I can afford to see who

39:17

is trained in administering psychedelics,

39:20

holding therapy, going through the integration process

39:23

and can do it properly? And how much

39:25

is it going to cost? And like, there's

39:27

just, there's so many facets to

39:29

this where I wish it was more accessible. And so I wonder

39:31

if you have any guidance on a database

39:34

or just a reference point

39:36

where people can start to look up therapists

39:38

that are trained in somatic therapies.

39:41

Yes. Well, access

39:43

is certainly the problem. And so

39:45

this becomes a public health

39:47

question. So yeah, the

39:50

people that can afford individual

39:52

therapy, I'm not worried

39:54

about them, right? Like they're gonna, they're

39:57

gonna find ways to do this. Academy

40:00

is really the only psychedelic right now that's

40:02

FDA approved at the time of this recording.

40:06

But we expect MDMA assisted

40:08

therapy will be FDA approved probably

40:10

mid 2024. So

40:12

I think a lot about this because I think

40:15

access is critical. The way

40:18

that you improve access is to do

40:20

it as a group so

40:22

that you can make it more affordable. And

40:26

then you have to have a

40:28

lot of fundraising and a lot of

40:30

like public health money that's poured into this.

40:34

So I just went to an event

40:36

on Sunday for

40:39

a group called the Open Mind

40:41

Collective. It's a

40:43

nonprofit that is focused

40:45

on first responders and

40:48

helping them with trauma. And

40:51

so you can just Google them and look

40:53

at their website. But what they're doing is fundraising

40:56

to offer to people

40:59

who fight fires, to cops,

41:01

to veterans, these

41:05

group sessions where

41:07

they initially starting with ketamine, but they're

41:09

also doing research with Viben

41:12

the ODMT with psilocybin

41:15

to address trauma. And

41:17

so to me, that's the way that you improve

41:19

access. You've got to make it so

41:22

that it's not just the wealthy and

41:24

have access to these novel

41:27

therapies that can really help you resolve

41:29

PTSD or just, you know, the garden

41:31

variety trauma that so many of us are exposed to.

41:34

So you asked about access to somatic

41:37

based therapy too.

41:39

So this group Open Mind Collective

41:42

is also working with some HACOMI

41:44

therapists that specialize in trauma.

41:47

So I would refer people to the HACOMI

41:49

Institute, you can find practitioners that

41:51

way. And then

41:54

also MAPS. Yes,

41:57

MAPS is a great way. It's a great resource.

42:00

You know, they'll, we're

42:02

at this point where there's so many people

42:04

who are interested in becoming trained and certified.

42:07

And so it's a little hard to find these folks, but

42:09

they are all over the country. They're all

42:11

over the world. And so

42:14

you want to be, you know, most people want to

42:16

go to someone that they feel like they can trust,

42:18

who's been vetted, who's had adequate

42:21

education, and it's going to be low

42:23

risk. Although I also want to say

42:25

that quick aside is that these

42:28

medicines we're talking about MDMA,

42:30

ketamine, sibonio, DMT.

42:33

Psilocybin,

42:34

they are so much safer than alcohol. They're

42:36

so much safer than alcohol. Yeah.

42:40

Yeah,

42:40

it's true. It's true. And I mean, I'm

42:42

I'm excited about what you said about 2024. We

42:45

interviewed Jose Mata, who I think

42:48

was part of the study that was done

42:50

either in collaboration with MAPS. I have to fact check

42:52

that, but he was doing a study

42:54

with a small group of patients with

42:56

MDMA assisted therapy. They were going

42:59

to be published. So hopefully

43:01

he can perhaps also provide some

43:03

resources for us once that happens. And there

43:05

becomes this great database. But it

43:08

really is just about, like you said, finding those

43:10

therapists, looking even in your network

43:12

for therapists that offer EMDR, people

43:15

who may be classically talk therapy trained,

43:17

but have now done some continuing education and are

43:19

starting to bring somatic therapies like EMDR

43:21

into their practice and seeing

43:24

what you can do where you are, whether it's insurance

43:26

covering it or it's in a group setting. We're

43:29

almost in the wild west right now where we have to

43:31

sort of take it into our hands and go underground in

43:33

that way. And I hate to recommend

43:35

that and ever make a sketchy

43:38

recommendation. Definitely don't go out and just take mushrooms

43:40

yourself without someone to facilitate. But

43:43

we're sort of at that point where we know that there's

43:46

data behind these plant medicines and

43:48

we know that they can help us to recover and make leaps

43:50

and bones. And there's

43:53

not really the structure just yet. So we have to

43:55

find it ourselves.

43:55

That's right. That's right.

43:58

And it's, you know,

43:59

one of the. Another resource that I want to

44:01

mention is I'm

44:03

on the faculty at the integrative psychiatry institute

44:06

and another faculty member

44:08

who's been hugely influential for me

44:10

is a woman named Arielle Schwartz.

44:14

And so if you Google Arielle Schwartz

44:17

and find her website, she's got a number of

44:19

books. She's one of the most

44:21

trauma informed therapists that I've ever

44:23

encountered. She's the most, I just had

44:25

dinner with her just sitting next to her, you get co-regulated.

44:28

It's like sitting next to you.

44:30

Well, thank you so much. I'm going to put

44:32

her name in the show notes and have people check

44:34

out her work. Maybe we could have a conversation

44:37

with her as well because it

44:38

really hurts my heart

44:40

that there is not better public health funding

44:43

and broader insurance coverage of these

44:45

therapies that we know can help so many people

44:48

and access is just such a huge issue. So

44:51

thank you for that. That's such a wonderful starting

44:53

point for people who are now becoming aware of

44:55

their trauma to look into therapies beyond

44:57

just CBT to help them

45:00

process what they've gone through. And

45:02

you asked about PCOS. I feel like I haven't

45:03

completely answered your question.

45:05

Let's dive into PCOS because

45:07

it's just something that's such a large portion

45:09

of our audience struggles with. And

45:12

I was pre-diabetic. I was starting to have high

45:14

DHT, irregular periods. My doctor

45:17

is Dr. Gabrielle Lyon and she was like, you

45:19

really need to get it together. And

45:21

so I went on a whole journey of reversing my

45:23

insulin resistance and normalizing my lab

45:25

that used a CGM. I used botanicals,

45:28

high protein diet, muscle building, all the things.

45:30

But I think sometimes that can feel very

45:33

overwhelming to people. And of course, it's just

45:35

my experience. So I'd love to know

45:37

your take as a clinician

45:39

in terms of root causes of PCOS

45:42

and where you start with unwinding

45:45

the puzzle pieces for people. My original

45:47

training is in

45:49

obstetrics and gynecology.

45:52

So my orientation is a little bit

45:54

different than hers in terms of

45:56

we both are going to do

45:59

a full work.

45:59

hormone panel,

46:01

and then personalizing

46:04

treatment. So, you know, what's

46:06

confusing is that

46:09

so many women with PCOS are

46:11

not diagnosed. About 70% of

46:13

the women living with PCOS right now are

46:16

not diagnosed. So there's

46:18

a lot of people who are listening to us right

46:20

now who don't

46:22

realize that they have PCOS. They just

46:24

feel like, I have to pluck my chin ears, or,

46:27

oh, I gotta go back

46:29

on the birth control pill because my acne is getting worse.

46:32

And so, you know, the

46:35

root cause of PCOS is

46:38

not fully understood because women's

46:41

health research is woefully underfunded.

46:44

But definitely sex hormones become unbalanced.

46:47

Some of the drivers of that, we understand,

46:50

like, insulin resistance, like trauma,

46:52

dysregulation of the hypothalamic, pituitary,

46:55

adrenal, thyroid, gonadal, gut

46:57

axis.

46:59

But what's confusing is that, you know,

47:02

women start to make more androgens, but

47:04

not all women with

47:07

excess androgens, like DHT

47:10

that you mentioned, like DHEA,

47:13

like testosterone, not all those

47:15

women have PCOS. And not

47:17

all women with PCOS have

47:19

excess androgens. So whenever

47:22

you hear the word syndrome in

47:25

the name of a condition, it's a little

47:27

clue, it's basically code, that

47:29

there's not a simple diagnosis here.

47:32

And that's why it can take years and years

47:34

to make an accurate diagnosis. I

47:37

do a lot of testing, because I run

47:39

precision medicine at the Marcus Institute of

47:41

Integrative Health in Philadelphia at Thomas

47:43

Jefferson University. So I'm doing

47:45

a genetic test. And what I

47:48

find with my PCOS patients, I'm looking

47:50

at the pathways that

47:52

are related to PCOS. And

47:55

there's a number of genetic pathways,

47:58

single nucleotide polymorphisms. that

48:01

increase the risk of PCOS.

48:03

So I'm looking at those. I'm

48:05

looking at the hormone

48:07

pathways. You

48:09

know, what's happening with aromatase, which

48:11

converts testosterone to estrogen. What's

48:14

happening with inflammation

48:17

in the body and the SNPs that

48:19

are related to that. What's happening with

48:22

the state of stress,

48:24

with methylation. What's

48:26

happening with detoxification.

48:29

Because I often find that detoxification is not

48:31

working properly in women

48:33

with PCOS. So those are some of the things

48:36

I look at. I run a genetic test.

48:38

I can talk about which tests I typically run because

48:41

a lot of them are available direct to consumer.

48:43

And most clinicians

48:46

don't know about some of these tests that are so helpful.

48:49

And then I do the biomarker testing. So hormones.

48:52

I'm also looking at cardiometabolic health

48:54

because we know that the group, you know, there

48:56

was just a study a few years ago showing that,

48:59

you know, we think that people are getting better in terms of

49:01

the number one killer, cardiovascular disease.

49:04

But admissions for hospitalization

49:07

for a heart attack are

49:09

increasing in women age 35 to 54.

49:13

Increasing. So this is a very

49:15

vulnerable population age 35 to 54 of

49:18

women who think that they're not at risk. They

49:21

think, oh, I don't have to worry about heart disease until

49:23

after I go through menopause. No,

49:26

there's significant risk. I mean, you look at just

49:29

how metabolically inflexible

49:31

our population is becoming. You

49:34

look at, you know, what's happening with insulin resistance

49:37

with being overweight and obese.

49:40

These are aggregating

49:43

and leading to significant risk

49:45

for younger women. So all that

49:47

to say, I'm looking to make the diagnosis.

49:49

A lot of people come to me either they've

49:51

already had the diagnosis or it's

49:54

clear they've got insulin resistance. And we're

49:56

trying to figure out, okay, do they have both excess

49:58

androgens and also.

49:59

So some of the signs of it, like the

50:02

pearl necklace sign on the ultrasound

50:04

with cysts on their ovaries.

50:07

The symptoms of high

50:09

endrogens.

50:11

The longer cycles, the lack of ovulation.

50:13

Longer cycles,

50:14

so like a 35 or longer, 35 day or longer

50:16

cycle. And

50:19

then I'm also looking at this regulation of phthalamic

50:21

procedure atrial axis. So

50:24

I'm also looking at a deep dive

50:26

on metabolism. And you talked

50:29

about the influence on cybers, so you can get this

50:31

out. And I'm looking at mental health symptoms

50:34

because there's much more mental health

50:36

issues in women with PCOS.

50:39

About 75% are overweight. And so that's

50:42

often a place where I begin. There's

50:44

often some body image, just Morphia,

50:47

that we need to talk about. There's a lot of emotional

50:49

eating. And then someone who's recovered

50:51

from disorder dating, I'm super sensitive

50:53

to this. And quick side note, there's

50:56

a lot of data suggesting that disorder

50:58

dating can be addressed with some

51:00

of these trauma informed treatments, including

51:03

psychedelics. So,

51:06

you know, if you're

51:08

someone with PCOS who's got insulin resistance

51:11

and high insulin levels in your body,

51:14

and you're hoarding fat, and it's triggering

51:16

hunger and carb cravings, you've

51:18

got to break the cycle. And

51:21

so that's where wearing

51:23

a continuous glucose monitor,

51:26

like you have, and

51:28

really dialing in a personalized food

51:30

plan that usually means that we're,

51:33

you know, two things, lower carbohydrates that

51:35

don't spike glucose. You know,

51:37

even just seven days of a low

51:39

carb diet has been shown to reduce testosterone.

51:44

So it can really make a difference. What is

51:46

the place I start in terms of

51:48

helping people?

51:48

And you're not saying keto,

51:50

right? You're saying like lower carb, because I know

51:53

that for some women, prolonged

51:55

ketogenic diets can perhaps affect thyroid

51:58

function. And sometimes it's very, very, very hard. helpful

52:00

for women especially who are training to have

52:02

those slower carbohydrates.

52:04

Yeah, so I

52:06

think it's important to define your carb

52:09

threshold. Mmm, that's a

52:11

good one. And protein

52:13

threshold too. I mean, you're Dr.

52:15

Lyon's patients for crying out loud, so

52:18

of course they have to define the protein. My

52:20

last book, Women's Food and Hormones, is about

52:22

this issue of, you know,

52:25

where's the line between low carb and

52:27

keto? What I generally recommend

52:30

is a pulse of a clean

52:32

ketogenic diet to reset

52:34

metabolism and improve

52:36

metabolic flexibility, but only

52:39

once you've got it detoxification in place,

52:42

as well as intermittent fasting so

52:44

that she can get into ketosis more easily.

52:47

And then after four weeks of it, I don't

52:50

like prolonged keto for the reasons you mentioned.

52:53

It causes more menstrual irregularity, it

52:55

causes more thyroid dysfunction. Women

52:57

need carbs. We need carbs to sleep. We

53:00

need carbs to make adequate thyroid. We

53:02

need carbs for a lot of reasons to, you

53:04

know, be connected to our purpose and

53:07

mission. And

53:10

so I recommend defining your

53:12

carb threshold and also

53:14

your protein threshold. So my book gets

53:16

into the details.

53:17

Okay, great. I was going to ask how can one begin

53:20

to find their carbohydrate threshold? Of

53:22

course, if they're wearing a CGM, they can sort

53:24

of track what's pushing them over the limit, but

53:27

we'll definitely link your book in the show notes so that people

53:29

can read more about that. But I'm

53:31

hearing more and more from experts in the field,

53:34

the therapeutic dosage

53:37

of a low carb diet. That's something that actually alongside

53:40

Dr. Lyon, I also worked with a nutritionist

53:42

who also put me on a therapeutic

53:45

low carb diet. I think it was one

53:47

and a half, two months total where I was eating

53:49

pretty low carb. I think it was like 50

53:52

to 75 grams of carbs per day, sometimes

53:55

a bit lower if I wasn't training that day. And

53:58

sometimes it felt a little stressful. Sometimes I had some

54:00

sleep issues. It was very hard to not be

54:03

metabolically flexible in the beginning and wake

54:05

up hungry in the middle of the night. I certainly

54:07

saw that my body was not able to tap into my fat

54:10

stores in the beginning, but as I went

54:12

on, I got better at that. And then

54:14

I was able to add carbs into my diet

54:16

and actually utilize them and not have

54:18

such high glucose spikes because of that therapeutic

54:21

pulsing

54:22

of a low carb diet.

54:24

That's the way to do it. So

54:26

you just described this

54:28

arc of becoming metabolically

54:31

flexible. I don't

54:33

want to minimize the pain that can

54:35

be associated with that in the beginning because I

54:38

also went through that and I was like, you

54:40

know, bloody hell, I'm

54:43

really hungry. The anxiety

54:46

in the middle of the night. Totally,

54:49

totally. Yeah. So it's

54:51

not easy, but you got to keep

54:53

your eyes on your future self. And

54:57

what you want your health for and that

54:59

why can pull you forward in

55:02

those moments, those dark moments of the soul

55:05

when you're craving carbs.

55:07

So what are the most important

55:09

lab tests for those with PCOS

55:11

or those who suspect that they have PCOS

55:14

to be tracking and hopefully

55:16

requesting from their clinician who

55:19

would be willing to run them? I know that you mentioned cortisol

55:22

earlier and your preference for salivary cortisol.

55:24

However, I know a lot of people do not

55:27

have access

55:29

to a practitioner that is able to run something

55:32

like a Dutch test or a test that collects

55:34

urine and saliva. So if someone were to just

55:37

be working with an insurance

55:39

covered provider who is maybe

55:41

willing to draw some labs, what should they be looking at?

55:44

So I'm going to divide this into

55:46

two categories. The first category is kind

55:48

of the basic labs. So I

55:50

would say with PCOS,

55:53

you want to look at pre and

55:55

total testosterone, sex hormone,

55:57

binglobulin, and we can get into why. I

56:00

like to look at DAT and DATAS, the sulfate.

56:06

I like to look at estradiol and progesterone.

56:09

See, you know, check if they're ovulating. I

56:12

used to run a lot of FSH and OH. I don't

56:14

do that as much anymore. Those

56:16

are the control hormones for the

56:20

hypothalamic, pitociraptor, adrenal axis.

56:23

And then I do a metabolic panel. So basic

56:25

would be hemoglobin

56:27

A1C, fasting glucose, fasting

56:30

insulin. I like to look at inflammatory

56:33

tone. So I would look at a high sensitivity

56:35

C-reactive protein. I would do

56:37

a CDC with a differential and

56:39

a comprehensive metabolic panel. So

56:42

that I would put in the basic category. The

56:44

more advanced category would be more

56:47

cardiac metabolic testing. So doing

56:49

like an advanced lipid panel, doing fractionation

56:52

of LDL, looking at A-B, looking

56:54

at like a little A, looking at all these things

56:56

that lead to a greater risk of cardiac

56:58

metabolic disease. I

57:01

use a lot of Cleveland Heart Labs. I do

57:03

an insulin resistant score that you can

57:05

track over time. And I like to do

57:07

continuing with glucose monitoring. So not

57:09

everyone can afford that, but there's

57:11

just nothing like the feedback loop of a CGM

57:14

to help you personalize your diet. So

57:16

that's typically where I start. There's a few other

57:19

things. I mentioned genetics. I would put that

57:21

in kind of the phase two. And

57:24

I also think that the Dutch test I would put

57:27

in phase two so that you're looking at metabolites,

57:29

you're getting a more comprehensive picture. I

57:31

do nutritional testing, usually

57:34

a tenova nutrient bowel or a metabolomics.

57:37

I do gut testing because the

57:39

gut is so critical in terms

57:42

of inflammation, what

57:44

the microbiome is doing, how it's talking

57:46

to your brain, how it's talking to the rest

57:48

of your body, including your hormones. So

57:51

there's a few different gut tests that I like to

57:53

run.

57:54

I was going to ask you if gut dysbiosis

57:58

was a puzzle piece in the etiology of P. as

58:00

a tree know for many it is, but more so

58:02

why? Yeah,

58:05

it's a good question. I would

58:07

say

58:08

we know a lot more about autoimmune disease

58:11

and dysbiosis and

58:14

how the microbiome shifts over time. But

58:17

women have double the rates of antibiotic

58:19

usage compared to men, probably

58:21

related to the length of our urethra

58:25

and bladder infections that we

58:27

get exposed to. So our microbiome is

58:29

different than the microbiome of men. How

58:32

that then maps to a greater risk of PCOS?

58:35

We don't really completely understand,

58:37

but there's certain bacteria

58:40

in the gut that can increase the amount of

58:42

estrogen that you have in your system. So that's you.

58:45

Instead of using estrogen, getting rid of it, pooping

58:47

and peeing it out the way that we're supposed to, you

58:50

can keep recirculating it in

58:52

a way that keeps stimulating the receptors,

58:54

gives you a higher risk of breast

58:57

and a mutual cancer. Women

59:00

with PCOS are at a greater risk of

59:03

endometrial cancer as are women with prediabetes

59:06

and diabetes. And so

59:08

some of it can be a stress.

59:11

Just having the high

59:13

perceived stress does a number

59:15

of things to the gut. Increases

59:18

intestinal permeability, so called leaky

59:20

gut. Also it leads directly to

59:22

dysbiosis. It decreases stomach

59:24

acid. So there's all

59:26

these direct effects on the gut. And

59:29

the way that you know it's the test. So

59:32

testing, I think, is really critical.

59:35

And is it the case that

59:37

as you perhaps find

59:39

some gut dysbiosis and work on gut

59:41

dysbiosis, PCOS improves? Or

59:44

is it also the case that as you improve your

59:46

PCOS markers and your insulin resistance, your

59:48

gut microbiome gets better? Like where do you start?

59:51

Yeah, it's

59:53

a bit of a chicken and egg question, isn't it?

59:55

And so what I typically do

59:57

is I assess about

1:00:00

for the client that I'm working with. And

1:00:03

for someone who has a tendency toward overwhelm,

1:00:06

and we have to kind of take it, you know, a few baby

1:00:08

steps at a time, I'm gonna do

1:00:10

that first set of tests, and

1:00:12

we're gonna focus on diet,

1:00:15

movement, maybe some

1:00:17

wearables, trackers, like an

1:00:20

aura, like maybe

1:00:22

a continuous glucose monitor, if that's something they

1:00:24

can afford. So I'm gonna start there.

1:00:26

Which can also be

1:00:27

prescribed, right? You can get that covered by insurance.

1:00:29

I remember Dr. Lane prescribing me one.

1:00:32

Yeah, so it depends on your insurance

1:00:34

coverage. I

1:00:36

would say for PCOS or for

1:00:39

prediabetes, about half

1:00:41

the time insurance will cover it.

1:00:43

So it really depends on your coverage. Okay.

1:00:46

So I'm gonna start there, and then I'll start

1:00:48

to layer in, you know, you know

1:00:50

those already. You can't take a poor

1:00:53

diet

1:00:54

and use

1:00:55

supplements to kind of make up

1:00:57

for a poor diet. So really a diet

1:00:59

is foundational. We start with food and

1:01:01

movement and sleep and a level

1:01:04

of accountability about how those

1:01:06

are going. And start with

1:01:08

trauma and addressing that. Even

1:01:10

if we don't address it, you know, that's a bigger project.

1:01:12

And so just kind of getting a sense of the

1:01:15

beginning about where someone is, their

1:01:17

base case. And then I'll

1:01:19

start to use some supplements. I use

1:01:21

a lot of anositol.

1:01:24

If someone's not ovulating, sometimes I'll

1:01:26

use phytax. If someone

1:01:29

needs insulin,

1:01:31

sensitizing, I'll use berberine. I'll

1:01:33

use omega-3s, usually

1:01:36

fish oil, because that's more proven as an insulin

1:01:38

sensitizer. Also, of cortisol.

1:01:41

If they've got

1:01:41

a lot of cortisol issues, they'll

1:01:44

use some supplements related to that.

1:01:46

Things like radiola, phosphatidylserine.

1:01:50

So this has to be personalized for

1:01:53

what we find with that particular person.

1:01:56

And then over time, we might do some additional

1:01:59

testing. that then allows us to tweak

1:02:01

the diet once we know about the genetics

1:02:03

of detoxification pathways for instance

1:02:06

and what's going on with estrogen

1:02:08

metabolism and androgen metabolism then

1:02:10

we can make some adjustments.

1:02:12

Yeah, I'm loving these tips

1:02:14

that are easy to enact

1:02:16

because I think a lot of our audience is hearing

1:02:19

this and saying, okay, those are pie in the sky

1:02:21

lab tests that my practitioner would

1:02:23

unfortunately never run. So

1:02:25

you know what can I do with just a cortisol,

1:02:28

like blood total level of cortisol,

1:02:31

just my maybe they're not even

1:02:33

willing to run free testosterone, you're just getting total

1:02:36

testosterone and just like my basic

1:02:38

metabolic labs. Okay, I know that my blood sugar is

1:02:40

high, I know my A1c is a little high and I

1:02:43

know that my cholesterol

1:02:45

is a little high. Where do I start there

1:02:48

if I have PCOS? And I think diet is number

1:02:50

one. So what are some of the immediate diet

1:02:52

recommendations that you make to patients that are

1:02:54

not overwhelming? Yeah, so let me add

1:02:56

thyroid. So a thyroid panel is essential

1:02:59

as a basic test too. So

1:03:01

the basic diet recommendations are,

1:03:04

you know, I like what you described with

1:03:06

the therapeutic low-carb approach.

1:03:09

And so what I talk about in my books

1:03:11

is net carbs because

1:03:14

I want people to not just start eating

1:03:16

bacon and you know, like

1:03:19

keto truffles, I want them

1:03:21

to make sure that they're getting a

1:03:23

lot of vegetables. So low-carb

1:03:26

vegetables, I recommend

1:03:28

about a pound a day, like that's how much you

1:03:30

need for detoxification, for methylation,

1:03:32

for taking your hormones and

1:03:35

inactivating them as appropriate. So

1:03:37

you know, I can tell you what I had for breakfast this

1:03:40

morning, I had some cabbage stir-fried

1:03:42

with super greens and

1:03:45

some pastured eggs and

1:03:48

some beet and cabbage sauerkraut

1:03:51

and I had the un-crested for us today and also

1:03:54

the high-foli. I've got issues

1:03:57

with my methylation pathway so I eat a lot

1:03:59

of.

1:05:42

really

1:06:00

a mess yet, you know, there were

1:06:02

problems with Acromancia, which is one of

1:06:04

the types of bacteria that's involved in

1:06:06

glucose regulation. So he

1:06:08

was really missing Acromancia. And

1:06:11

there's certain things that help you re

1:06:14

cultivate the population of Acromancia,

1:06:17

such as pomegranates and

1:06:19

cranberries. And so what

1:06:21

I encourage a lot of my patients to do is to go

1:06:23

to the farmer's market and make those ice cubes

1:06:25

that you just described, where you know,

1:06:28

maybe you take 25, 35 different

1:06:31

types of vegetables, herbs,

1:06:35

you know, just like a pinch of that, pinch of that, and

1:06:37

you puree it like in a Vitamix,

1:06:40

make ice cubes out of it, and then drop that

1:06:42

in your smoothie. And that's one of the best ways

1:06:45

to feed the benevolent bacteria

1:06:47

in your gut. And whether you've got PCOS,

1:06:50

or you've got Crohn's disease or some other autoimmune

1:06:52

disease, it's a beautiful way to do it.

1:06:55

And try to get, you know, five colors in the rainbow.

1:06:57

That's also really essential for immune

1:06:59

health.

1:07:00

Yeah, those highly pigmented fruits and berries

1:07:02

are just so wonderful because of the way

1:07:04

that polyphenols actually change

1:07:07

the environment of the gut and make it more

1:07:09

favorable to our good bacteria. You know, those

1:07:11

pigments are just so powerful. So color

1:07:14

is actually therapeutic, which is wild.

1:07:16

But I've heard you talk before also about just the

1:07:18

power of prebiotics, especially when we have

1:07:21

gut dysbiosis. And again, I'm, I'm really talking

1:07:23

to the listener that's never going to be able to get

1:07:25

a GI map because it's not covered

1:07:27

by insurance, never going to be able to get a

1:07:30

full panel of functional testing, unless

1:07:32

our system changes, which I hope that it does. But you

1:07:35

know, people who are like, I know, something's off in my gut, I've

1:07:37

had IBS for years, I know I have PCOS,

1:07:39

I know my blood sugar is high. What are

1:07:41

these little things that I can do? And I think that adding

1:07:43

in a wider variety

1:07:46

of fiber through these gut diversity bombs

1:07:48

and smoothies, but even just adding

1:07:50

in a greater total amount of

1:07:52

fiber, more grams of fiber per day can be

1:07:54

important. And I've seen you post in the

1:07:56

past about not just food fiber, but medicinal

1:07:59

fiber. So can you talk about what

1:08:01

medicinal fiber is, things like inulin,

1:08:04

and how those can perhaps

1:08:05

be helpful for women with PCOS? Yeah,

1:08:07

I like how you describe those kind

1:08:10

of more simply, which is get

1:08:13

fiber from your food. The

1:08:15

average woman in the US

1:08:17

gets somewhere around 14 grams of fiber

1:08:20

a day. The recommendation

1:08:22

for feeding your benevolent bacteria

1:08:25

is to get a minimum

1:08:27

of 25 grams, and I actually say more like 35

1:08:30

grams of fiber a day.

1:08:32

So that's

1:08:33

a lot of kale. It's

1:08:35

a lot of kale, so it's like two to three times

1:08:37

what the average woman is getting, and

1:08:40

you have to slowly adjust

1:08:43

the fiber. So even if you start

1:08:45

tracking your fiber, if you start tracking your net

1:08:47

carbs, which is your carbohydrates plus

1:08:49

the fiber that you're getting from each food, what

1:08:52

happens is that you don't

1:08:54

want to increase more than about five grams per day.

1:08:56

Otherwise, you'll have a lot of bloating, you'll

1:08:59

hate us, we don't want that, so

1:09:02

you want to slowly increase. So

1:09:05

my preference is definitely to get it from your food.

1:09:07

We know that our paleo-ancestors

1:09:09

got about 50 to 100 grams of fiber a

1:09:11

day. It was a lot. So

1:09:14

in terms of medicinal fiber, you know, this is a

1:09:16

place where adding a tear smoothie

1:09:18

can be so helpful. What I do is

1:09:20

I rotate different types of fiber.

1:09:23

So I'll use Inulin for a while. I'll

1:09:26

use Glucomannan for a while, and you

1:09:28

can get these from supplement companies,

1:09:30

you know, like Pure Encapsulations. You

1:09:33

mentioned Medigenix. Medigenix

1:09:35

also makes something with 2FL,

1:09:39

and 2FL is a really powerful prebiotic.

1:09:43

That's another great way to feed

1:09:45

the good bacteria. So I've

1:09:47

used different fiber products from

1:09:49

Pure Encapsulations. I've got like a lean

1:09:51

fiber that I like. I've used Thorne,

1:09:54

Fibermend. I've used fiber

1:09:57

from Designs for Health.

1:09:59

I've used fiber from Medigenics,

1:10:02

all of those companies I think have probably

1:10:04

the best quality control. Yeah.

1:10:07

But there's, you know, tons of different fibers

1:10:09

that are out there and available, even

1:10:11

to psyllium husk. Yeah,

1:10:13

you know, I use psyllium husk myself,

1:10:16

I'm not the best at metabolizing

1:10:19

my estrogen. So I've used

1:10:21

various different helpers, everything

1:10:23

from, you know, green tea

1:10:25

and curcumin all the way to fibers

1:10:28

like psyllium husk when I can tell that

1:10:30

I need some more estrogen detoxification support.

1:10:33

And plain old psyllium husk is cheap.

1:10:35

It is, you know, not the most

1:10:38

fun to take, but it's cheap,

1:10:40

it's accessible, and it's a great fiber to

1:10:42

rotate into your diet, especially if you are

1:10:44

someone who knows that you perhaps have some estrogen

1:10:47

dominance issues, some painful periods,

1:10:49

sore and tender breasts. So I just love the addition

1:10:52

of the supplemental

1:10:54

fiber. I think it's a very useful tool for

1:10:56

our modern world, for those of us who aren't

1:10:59

mindful of our vegetable intake

1:11:01

each and every day and just need a little bit of extra help.

1:11:04

It's a very worthy supplement in a world

1:11:06

where not all supplements are worth their weight. Are

1:11:09

there any specific nutrient deficiencies

1:11:11

that women with PCOS need to be very mindful

1:11:13

of, like magnesium or certain fatty acids?

1:11:16

I know you mentioned fish oil. Yeah, I mean, there

1:11:19

are certain micronutrients that are deficient

1:11:22

in almost in most Americans,

1:11:24

and I would say PCOS is no exception.

1:11:27

So vitamin D, magnesium.

1:11:30

You know, I like

1:11:32

to run a Nutribal or

1:11:34

a Metabolomics to be able to

1:11:36

assess micronutrient deficiencies

1:11:40

so that we can, you know, we

1:11:42

talked at the beginning about how so

1:11:44

many women with PCOS are

1:11:47

highly stressed. They've got high perceived

1:11:49

stress. And so that leads to missing

1:11:52

B vitamins, not having enough vitamin

1:11:55

C, not enough plant-based antioxidants,

1:11:58

maybe they're low in alpha light. maybe

1:12:01

their mitochondria are not working quite the way

1:12:03

that they need to be. And so those

1:12:06

are some of the common things that I see

1:12:08

on a Nutribal. And to your point, if

1:12:11

you don't have a clinician

1:12:13

who's going to order a Nutribal and you don't

1:12:16

have access to the funds to pay

1:12:18

for it out of pocket, then

1:12:20

you can just assume that you're going to

1:12:22

be low in some of these things. I mean, usually a clinician

1:12:24

will measure your vitamin D. Yeah.

1:12:28

You could get a blood cell magnesium. Some

1:12:30

clinicians know how to order that. So

1:12:32

you can measure some of these things and then track it

1:12:34

over time, or you can just assume you're

1:12:37

low and start taking out multivitamin,

1:12:39

multimineral.

1:12:40

Yes, I do love a multivitamin. I love a good B

1:12:43

complex to your point. I think many of us don't

1:12:45

realize, and my mind was blown when I learned

1:12:47

this, but we're essentially kind of burning through

1:12:49

our B vitamins via our stress

1:12:52

response. I always tie things back

1:12:54

to traditional Chinese medicine because they have

1:12:56

such interesting terms for things that I'm trying

1:12:58

to connect to modern

1:13:01

science. And so Chinese medicine talks a lot about

1:13:03

our fluids and

1:13:05

these reserves of fluids and blood that we

1:13:07

have. And when we're really stressed, we can become blood

1:13:09

deficient or fluid deficient. And I realize our

1:13:11

fluids are our reserves, our vitamins, our

1:13:14

mineral and nutrient reserves, because when we're stressed,

1:13:16

we use a lot of those B vitamins to cope,

1:13:19

to make the neurotransmitters that

1:13:21

are now overfiring because we're overstimulated

1:13:24

in fight or flight mode. So we sort of need to be replenishing

1:13:27

those micronutrients and specifically our B

1:13:29

vitamins and our calming minerals

1:13:31

or our vitamin C that's used

1:13:34

when we're making a lot of cortisol to refill

1:13:37

after periods of stress. And for some people, periods

1:13:40

of stress looks like a normal day in their life because

1:13:42

their perceived stress is so high.

1:13:44

Yeah, it's a critical point. And

1:13:46

just add insult to injury.

1:13:49

What happens with so many

1:13:51

PCOS clients

1:13:53

is that they get started on the birth control bill, right?

1:13:55

So in conventional medicine, when

1:13:57

you're finally diagnosed with PCOS, Often,

1:14:01

this really simple binary question

1:14:03

is asked, do you want to get pregnant or not? And

1:14:06

if you don't want to get pregnant, then you get put on

1:14:08

the birth control pill to regulate your cycle, regulate

1:14:10

your cycle. And if you do want to get pregnant,

1:14:13

you get given metformin to help you ovulate

1:14:16

and get pregnant at the start. We've

1:14:18

got millions of women with PCOS who

1:14:20

are on the birth control pill, which

1:14:23

also further depletes your

1:14:25

B vitamins, your magnesium, your

1:14:27

vitamin C, alters your

1:14:30

microbiome. So it just

1:14:32

compounds the problem. And that's

1:14:34

why, you know, if you're on a birth

1:14:36

control pill, I would say take a

1:14:39

multivitamin, multimineral, take

1:14:41

a B complex. And if you

1:14:43

don't know your genetics and what you specifically

1:14:46

need and what the gaps are, that

1:14:48

would help cover you.

1:14:50

Yeah. Why is it that so many

1:14:52

women initially when they're either

1:14:54

diagnosed, like you said, hopefully, or

1:14:56

just experiencing PCOS symptoms

1:14:59

and they're not diagnosed and they get put on the birth control

1:15:02

pill for five, 10, 15 years, and

1:15:04

then they get off of it when it's time to get pregnant, why are their

1:15:06

symptoms then so much worse? Is it these

1:15:09

micronutrient deficiencies? Is it

1:15:11

that they've been covering up sort of the

1:15:14

symptoms that their body was using

1:15:16

to tell them, hey, red alert, we're insulin

1:15:18

resistant, something's going on in our body, help

1:15:21

us, and that just got worse over

1:15:23

time?

1:15:23

Yeah, I don't know the answer.

1:15:27

It can give you a few speculations. So, yes,

1:15:29

one part could

1:15:32

be the micronutrient deficiencies because

1:15:34

your body is just not designed to be long-term

1:15:36

on these medications that deplete your micronutrients.

1:15:39

Pretty much all prescription

1:15:41

medications are designed

1:15:43

to block biochemical pathways in the body.

1:15:47

Vegetables don't do that. Pharmaceuticals

1:15:49

do. And so we've

1:15:51

got to be thinking about the consequences of

1:15:54

any pharmaceutical that we take. Even that hormone,

1:15:56

you know, it's got micronutrient

1:15:58

deficiencies.

1:17:38

understand

1:18:00

that women need to have reproductive freedom

1:18:02

and some always asked about what is an alternative

1:18:05

and so why do you like the copper IED? There's

1:18:08

so

1:18:08

many reasons. I mean the first

1:18:10

reason is that it's got the highest satisfaction

1:18:12

rate of any form of contraception.

1:18:15

The highest satisfaction rate. Why

1:18:18

isn't that plastered on every subway

1:18:20

in the United States, right? Because you

1:18:22

know, pysectomy also is very high.

1:18:24

That's my other favorite form of contraception but

1:18:27

for a you know 18 year

1:18:29

old or 20 something or 30 something that's not

1:18:31

always a viable option. So the IED

1:18:34

I think is a great choice. I would call myself an

1:18:36

IED crusader, not the

1:18:38

hormonal based one although there's time and place

1:18:40

for that. If you've got fibroids and heavy

1:18:42

bleeding you know that's a reasonable

1:18:45

approach but the copper

1:18:47

IED you put it in and you can basically

1:18:49

forget about it for 10 years. It's

1:18:52

as effective as getting your tube side. You don't

1:18:55

have to remember to take a pill every day. You know

1:18:57

there's some women who might have issues with the

1:19:00

copper so you have to be aware of that

1:19:02

but for the most part it's a really great

1:19:04

form of contraception. It can

1:19:07

cause increased bleeding. I had increased

1:19:09

bleeding when I first started on it and I

1:19:11

took a supplement called flow flow that totally

1:19:14

nipped it in the bud. It's made

1:19:16

by Vitanica, another little pearl. So that's

1:19:20

typically like the first three to six months and

1:19:22

then most women are good and

1:19:24

as long as you can feel the string then you

1:19:26

know it's in the right place. I've heard

1:19:28

some people talk about copper toxicity with

1:19:30

the copper IED. Is that a thing?

1:19:32

It's pretty rare. You know

1:19:34

one of the things that happens with the copper

1:19:36

IED is that there are you

1:19:38

know reproductive

1:19:41

freedom is under attack in the United

1:19:43

States and so I want to be careful with

1:19:45

my language here because I really believe that women

1:19:48

need more choice not less and

1:19:50

so there are a lot of political

1:19:53

camps that are very much against

1:19:55

the copper IED. There are

1:19:58

OBGYNs who refuse to put

1:20:00

in a copper IUD because of their

1:20:02

religious or political views. And

1:20:05

so you want to make sure that the clinician that

1:20:07

you see is giving you counseling about

1:20:10

an IUD versus the birth control bill versus

1:20:12

some of the other methods really

1:20:14

is giving you truthful information, not

1:20:17

from their values, but considering

1:20:19

your values. Yeah. So

1:20:22

copper toxicity, very rare, very

1:20:25

rare. I've been seeing patients for 30 years. I've

1:20:28

seen like two cases out of 30,000 patients.

1:20:32

Okay. That's very comforting to hear because

1:20:35

I've seen, I guess, a lot of misinformation

1:20:37

around copper toxicity

1:20:40

and how the copper IUD is just

1:20:42

as bad and all of this, but hearing you talk about

1:20:44

it sort of put me at ease. It's something that Dr.

1:20:47

Lyon has recommended to me as well, but I was

1:20:49

a little hesitant.

1:20:49

Well, one thing that I, you

1:20:52

know, this, I'm going to sound like a

1:20:54

super tester, but another thing you can do

1:20:56

is if you're worried about copper toxicity,

1:20:59

then do micronutrient testing.

1:21:02

Look at your copper and your zinc

1:21:04

levels and track

1:21:07

those over time, you know, if you're

1:21:09

really concerned about it. And

1:21:11

you know, the problem here is that we just don't have enough

1:21:13

choice. I mean, I love natural

1:21:16

family planning. I love how technology

1:21:19

is now making it easier to like track

1:21:21

your, you know, your skin temperature and link

1:21:23

up with like the natural cycles

1:21:26

app and figure out when your fertile window is

1:21:29

and that's when you have outer course, if you want to

1:21:31

prevent pregnancy and

1:21:33

intercourse, if you want to promote pregnancy. So

1:21:35

I think tuning into your

1:21:37

natural rhythms, that opportunity

1:21:40

is critical. It's so

1:21:42

important for women. Yeah.

1:21:43

A hundred percent. And we've talked about this

1:21:46

on the show as well. I've used the Daisy thermometer for

1:21:48

many years, but I'm also aware that

1:21:50

for some women that is simply not practical

1:21:52

and they're not going to be compliant and then something's

1:21:55

going to happen that they don't want. And that's

1:21:58

it's just not viable and it's just putting more stress. on

1:22:00

women. So it's really good to know our

1:22:02

full array of options so

1:22:04

that we can make the best choice for us. I think

1:22:07

the last question that

1:22:09

I have for you is just asking you to sort

1:22:11

of hammer home the importance

1:22:13

of taking action in terms

1:22:15

of PCOS and insulin resistance

1:22:18

today. Sort of this like closing message for

1:22:20

women not only in the lens of cardiometabolic

1:22:24

disease risk increase such

1:22:26

as heart disease and stroke in our 30s 40s

1:22:29

50s but also even the connection

1:22:31

between PCOS and insulin

1:22:33

resistance and Alzheimer's. Since that's

1:22:36

something you talked about at the top of the show that's something

1:22:38

that's in my family my mother is in late

1:22:40

stages right now and that

1:22:42

was sort of how Dr. Lyon woke me up where

1:22:44

she was like hey this is these are two

1:22:46

sides of the same coin you're dealing with here you

1:22:48

want to protect your brain you need to get your

1:22:50

waist line down like that is essentially the

1:22:53

terms that she put it like it's your metabolism

1:22:56

is your brain health so she was

1:22:58

just that was so powerful for me

1:23:00

to have my doctor say that to me and so I'd love for

1:23:02

you to kind of give that a similar message in your

1:23:04

own

1:23:05

words to our audience. So

1:23:07

yeah you know I would say

1:23:09

your metabolic health is your engine

1:23:12

what's so critical for living

1:23:15

your best fullest expression

1:23:17

of your spirit

1:23:19

of your soul's purpose on this planet is

1:23:22

to have your metabolism behind you.

1:23:26

If your metabolism is salty if it's sputtering

1:23:29

if you've got a high fasting glucose

1:23:31

like I did when I was in my 30s

1:23:34

turn that ship around right now.

1:23:36

Don't wait until it's convenient

1:23:39

don't wait until you're in

1:23:41

menopause do it now

1:23:44

because every day

1:23:46

that metabolic dysfunction

1:23:48

is having negative

1:23:50

effects on your brain negative effects

1:23:52

on your body it's not just your waistline

1:23:55

it's this whole biochemical

1:23:58

fraternity party that's happening.

1:23:59

in your body that you don't want.

1:24:02

So what's

1:24:03

so important to understand is that

1:24:06

the misery of having your metabolism

1:24:08

not work for you, the misery of your hormones

1:24:10

being out of balance is

1:24:12

so much worse than the work

1:24:14

that it takes to fix it. It's so much

1:24:17

worse. So when you look at those two

1:24:19

things, just decide, okay, I've

1:24:21

hit my bottom in terms of PCOS,

1:24:23

I've hit my bottom in terms of my metabolism,

1:24:26

I'm gonna turn this ship around right

1:24:28

now.

1:24:29

And to your point, it's gonna be hard to have the sugar

1:24:31

cravings. It's gonna be hard to be hungry

1:24:33

for a bit while you're learning how to tap into

1:24:35

your own fat as an energy reserve, rather

1:24:38

than eating a bunch of carbs before bed. It's

1:24:40

gonna be really hard to lift weights and build muscle.

1:24:43

All of these things are going to hurt, but

1:24:46

they're gonna pay off in the long run. And

1:24:48

it's a lot harder to not have the

1:24:51

energy to wake up every day

1:24:54

and live out your purpose and be who you

1:24:56

need to be than it is to

1:24:59

turn your metabolism around. And again, I wish there

1:25:01

were clinicians like you that were

1:25:03

more accessible to people that could dig into all

1:25:05

of the testing and be

1:25:08

a test crusader. But

1:25:10

I think there's a lot that people can start with where

1:25:13

they are if they have

1:25:14

PCOS or Metabolic System.

1:25:16

For sure. And I also wanna

1:25:18

call out that you and I are

1:25:21

metabolic refugees.

1:25:24

It's not like you and I had perfect metabolism

1:25:26

and we're sort of pulling these things out

1:25:29

of the literature. Like you and I lived

1:25:31

this experience of prediabetes

1:25:34

and correcting it

1:25:36

with the way that we eat, move, sink, and supplement.

1:25:39

And if we can do it, you can do it. Like

1:25:41

our viewers can do this.

1:25:43

Absolutely, absolutely. Thank

1:25:45

you so much, Dr. Gottfried. It's just

1:25:47

such a pleasure to speak with you. Can

1:25:50

you please let us know where we can find you and

1:25:52

what your next book is called?

1:25:54

So right now the next book is called The Autoimmune

1:25:57

Cure. Comes out in March

1:25:59

of... 2024. And the

1:26:02

best way to find me is sarahgoffreidmd.com.

1:26:05

I hang out a lot on Instagram, which

1:26:07

is at sarah goffreidmd.

1:26:09

Your Instagram is so informative, so

1:26:11

many good infographics, you guys and some really

1:26:13

wonderful articles on your blog. So thank

1:26:15

you. We will link that in the show notes. And

1:26:18

I hope you have a wonderful day. Thanks, Olivia.