← BETTER! with Dr. Stephanie Estima | Strength, Body Composition & Perimenopause
BETTER! with Dr. Stephanie Estima | Strength, Body Composition & Perimenopause
Perimenopause & Autoimmunity Look Identical. Here's How to Tell the Difference with Mickey Trescott, MSc
01:20:51
Is it perimenopause or autoimmunity? The symptoms are similar, and most women don’t ask. Mickey Trescott, founder of the Autoimmune Protocol movement, explains the overlap between hormonal changes and immune dysfunction in midlife. Watch the full episode at https://youtu.be/CA706_Z6clk
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- [00:00]
A
Hello, my friends. Welcome to another episode of better with Dr. Stephanie. It's me, as always, your host, Dr. Stephanie Esteema. And here's a question for you. Is it perimenopause or is it autoimmunity? They share a frighteningly similar presentation. And in my conversation today with Mickey Trescott, we are going to be able to pick apart how they are different and how they might be happening at the same time, and most importantly, what you can do about it.
- [00:31]
B
So over 50 million Americans are estimated to have autoimmune disease, in contrast to cancer, which affects 30 million people, heart disease 20 million. So it's actually more than those two categories combined.
- [00:45]
A
Mickey Trescott is an author, a recipe creator, a holistic nutritional professional, and she is recognized for her expertise in living well with autoimmune disease. She holds an MSc in Human Nutrition and Functional Medicine from the University of Western States and is a certified functional nutritional therapy practitioner. Trescott has been working in private practice as a functional nutritionist for over a decade and has written three award winning books. We are discussing two of them today. If Hashimoto's had a personality, how would you describe it?
- [01:17]
B
Ooh, Hashimoto's like you never know what you're gonna get. I think it's just like, you know those cans that they used to like, you used to get for like gag gifts and like you'd open it up and it was just like something would pop out. I feel like that's like every day with Hashimoto's. It's like, is it today gonna be in stable mood? Is it gonn a frozen shoulder? Is it going to be like not being able to poop? You know, who knows?
- [01:42]
A
So this is going to be so important for you to be able to understand because it has such a long timeline between the time that you're diagnosed and when the symptoms appear. What is one food most people think is healthy that you would remove from everyone's kitchen? Wow.
- [01:58]
B
I would say that I think each person knows that food for themselves and I would wish for you to do the work, to think about it and get that food out and, and I think everybody listening probably has one thing that they know. And if you think about it, you're going to be like, okay, I know, you know, and I'm gonna out my husband. It's for him it's ice cream.
- [02:19]
A
Yeah. And for some people it's potatoes.
- [02:22]
B
Exactly, exactly.
- [02:28]
A
If you've been following me for a while, you know that I am always looking for evidence based ways to support longevity, especially during perimenopause, menopause, and bey when we experience shifts in energy recovery and resilience, this is when it really starts to show up. One of the most fascinating compounds I've been exploring lately is spermidine. Terrible name, I know, but hang on. When we're younger, our bodies produce most of the spermidine that we need internally through our gut microbiome and our cells. But as we age, that production declines and we become much more reliant on dietary sources. Spermidine is part of a family of compounds called polyamines, and it's one of the most important roles in your body for activating autophagy, that is your body's cellular renewal and recycling system. But what's really exciting is that it also supports mitophagy, which is the process of cleaning out and clearing out damaged and old and slow mitochondria, making way for healthier, faster and more efficient ones. And since your mitochondria are responsible for producing energy in every single cell, this is going to have a direct impact on how you feel every day. So your energy, your stamina, and even that underlying fatigue that so many women often experience and complain about in midlife. This is where Primidine from Oxford Healthspan really stands out. It delivers food derived polyamines. So you're not just getting an isolated spermidine, you're getting it from the same form that naturally occurs in whole foods. And it also comes with complementary polyamines that work to support these longevity pathways. Spermidine has been associated with lots of benefits ranging from cognitive support and heart health to hormone balance and even visible changes like stronger hair, skin and nails. For me, one of the most noticeable shifts is the sustained energy and cellular vitality that I experience. It has become foundational in my daily routine. If you'd like to have these benefits and try it for yourself, you can head over to Oxford healthspan.com Dr. Stephanie. That's my name. And use code doct stephanie and you're going to get 20% off your order. That's Oxford health span.com Dr. Stephanie and use code D R S T P H A N I E. I saw this meme once. You've probably seen it as well. It says you either get an autoimmune condition or you have to be A is true or false. What do you think?
- [05:01]
B
You know, autoimmune conditions are really prevalent in women who just hold it all on our shoulders. Right? I just, I'm speaking from my own experience. People that I have worked with. It's just, I feel like we really hold a lot for other people, and we're really not great at setting boundaries and doing the things that make us feel good. So I think it's probably pretty accurate.
- [05:23]
A
Yeah, I've. I've also. I've had people on the show before. I've had Dr. Sarah Saul on the show when she. She wrote a book on autoimmunity, and she was talking about this. Aces, like, hold these, you know, adverse childhood events and the relationship between that and developing an autoimmune condition. And I remember the conversation with her, she was like, oh, what's your score? And I think my score was like, seven, which is. Or six or seven. It was. Which is very, very high on the score. And she was like, oh, okay. Well, mine is, you know, six. Or hers was, you know, the same number. And I thought that that was interesting that there is this trauma piece, like what you just said, like, not good at setting boundaries. We hold everything. There's this residue that sort of persists in the nervous system or elsewhere in the body where we end up starting attacking ourselves.
- [06:06]
B
Absolutely. I mean, I could definitely relate to that as, like, eldest daughter, you know, had a sibling with a chronic health issue. So my parents were definitely taking care of her and kind of becoming the adult of the family, being the good girl, taking care of everyone kind of became a role for me. So, yeah, I think that. That definitely tracks.
- [06:25]
A
Yeah. What is an autoimmune disease like? Is it the same as cancer? Is it the same as their familiar diseases?
- [06:33]
B
Yeah, so autoimmune disease is simply when your immune system that is supposed to be defending you from things that are outside our body that find their way in. So like viruses and pathogens and bacteria, things like that, instead of doing that job, it actually attacks our own tissue. And among the category of autoimmune diseases, there are over 100, if not, I think 140 when you count some of the more gray area expected conditions. And they can affect any organ or system or tissue in the body, which makes them very challenging to treat as a whole, because really it is the root causes this dysfunction of the immune system. But the result is that people get symptoms in all these different organs and systems in the body. So from thyroid to hair to digestive, really, if you have a cell in your body, it can be subject to an autoimmune attack. And once that process starts, it really doesn't stop. So it's kind of a source of a chronic, lifelong, sometimes very debilitating disease. And they're actually extremely prevalent. So over 50 million Americans are estimated to have autoimmune disease, in contrast to cancer, which affects 30 million people, heart disease, 20 million. So it's actually more than those two categories combined. We all know people with cancer and heart disease, but I think the reason why we don't really have as much awareness is because often these conditions are very private. People are not talking about them again, because there's over 100 of them. You know, we're in these different communities of maybe thyroid patients or neurology, you know, Ms. patients, and everyone's just kind of separated when really there's actually this root cause, which is the immune system.
- [08:18]
A
You mentioned 140 autoimmune conditions. What are some of the more common ones that someone might be like, oh, yeah, I know, I've heard of that before, or I know someone who's had that. And you mentioned that there's ones that are not as common. So what would be something that maybe there's debate about or there's conversation around classifying it under an autoimmune condition?
- [08:39]
B
Yeah. So for sure, the most common autoimmune condition is Hashimoto's thyroiditis, which is autoimmune thyroid disease. Most people that have hypothyroidism, so these are people who have a slow thyroid, actually have Hashimoto's, but have never been tested or told that. So that is one key thing for people to know. But this is extremely common. Over 10 million Americans. It also is the most common autoimmune condition to co occur with other autoimmune conditions. So it kind of tags along. So those other really common autoimmune conditions are rheumatoid arthritis, Crohn's disease, and ulcerative colitis, which together are known as inflammatory bowel disease. Psoriasis is incredibly common. I think I said rheumatoid arthritis, psoriatic arthritis, multiple sclerosis. These are kind of the most common buckets. Um, in terms of rare autoimmune conditions, there are conditions like myasthenia gravis, which affects the neuromuscular junction, you know, and a host of collection of different, very specific ways that the immune system can affect, you know, whatever organ or tissue. And then in terms of conditions that are kind of in that gray area, like endometriosis has some factors that it behaves very autoimmune like, but in a lot of conditions, researchers haven't really identified an antibody. So an antibody is really what the immune system is creating within the body to target that tissue. Some conditions, they behave like an autoimmune condition, but that antibody hasn't been identified. So it's kind of in that gray area. But like a lot of endometriosis patients, you know, they. They have this experience, this whole body inflammation that is very common to other autoimmune conditions. And so it's kind of in that. That gray area really needs more research.
- [10:33]
A
Well, what's wild around the numbers that you just gave me is Hashimoto's, you said is about 10 million people. And then just a couple of, you know, sentences before that, you said 50 million Americans have some type of. That's. So Hashi's is accounting for 20% of all. You know, if you have 10 million at hashis and 50 million total, it's like 20% of all autoimmune conditions are the thyroid. And of course, we know that happens more in women. Like, what is it about the thyroid that makes it so vulnerable to attack? Like, what is happening there?
- [11:04]
B
Yeah, I mean, I am not a thyroid researcher, so this is all just, you know, my theory. But really, I think the thyroid is kind of one of the organs in our body that is like a canary in the coal mine. When something is off, it really has to pick up the slack because it is responsible for metabolism. So really, that thyroid hormone goes into every cell in our body and it asks it to do more of whatever it does. So if that is, you know, skin cells or hair follicles, they're growing hair, they're making more skin. Our digestive are moving things through the gut and digesting things. You know, this is why people with thyroid disease have symptoms that seem kind of wild and all over the place. And it's because every person's experience of thyroid disease is unique. But to your point about how prevalent it is, I really think that, you know, what we know about how long it takes to develop autoimmune thyroid disease. So studies show that it's about 10 to 15 years. When somebody develops autoimmunity to their thyroid, meaning there are detectable antibodies in their blood. It's 10 to 15 years until they develop full blown hypothyroidism. And actually, one of the interesting features of autoimmune thyroid disease, Hashimoto's specifically, is that even when patients are treated to target, meaning their hormone levels are managed. The only treatment for Hashimoto's is thyroid hormone replacement to basically replace what the body doesn't make. When patients are correctly treated according to even functional medicine standards, 60% of patients report having symptoms that interfere with their daily life. So this is a very common feature of this condition. And it's because thyroid hormone levels don't tell us everything about how somebody feels when they have autoimmune thyroid disease. So I don't know if that was too, too deep maybe for the Dark roast Betties there, but for sure, you know, there's a lot of nuance and really the Hashimoto's community and, and really, I think a lot more awareness needs to happen for people who are hypothyroid. Maybe they've been taking thyroid medication for a long time, but have never really uncovered that the true source of that is autoimmune. It's extremely, extremely common. But a lot of people just don't even know that about their own health history.
- [13:24]
A
Well, the dark Roast bettys love you. Thank you for that. And feel free to do that for the rest of our conversation. You bring up a really interesting point, which is you get on the medication to replace the thyroid hormone that you're no longer able to produce, but that's not actually what caused the problem in the first place, because you were able to once produce the hormone and now you're no longer able to. So I understand the, I understand the thinking around that. Replace what is no longer there, but that doesn't actually target why it stopped producing it in the first place.
- [13:54]
B
Yeah. And actually, so to get nerdy again, in Hashimoto's, the enzyme that is targeted is called thyroid peroxidase, which is actually the enzyme within the thyroid that catalyzes. So it connects those pieces that makes the thyroid hormone. So when you have Hashimoto's, you have anti TPO antibodies, they go into the thyroid, they find that enzyme, your body starts destroying it, and you're basically dismantling the machinery that's supposed to make this compound that is necessary for every cell in your body to do whatever it does correctly. Right. So. So yeah, you're right. The. The thyroid hormone, it just kind of slaps a band aid on it. It is very helpful and I'm very pro everybody replacing. You know, it's like having low vitamin D. We would not even think twice about supplementing that because we know how important health. I feel the same way about thyroid hormone. If you're low, you need more taking it is going to be life changing. But it doesn't address the immune dysfunction, it doesn't address the inflammation, it doesn't address the systemic effects of what it's like to live with an autoimmune condition, which I think also have to be dealt with in order to live well with this.
- [15:03]
A
And can it be addressed? Like, how do you address the immune part directly?
- [15:08]
B
Yeah, I mean, so my thing is diet. I really believe in dietary and lifestyle approaches to manage managing autoimmune disease in conjunction with quality medical care. So the autoimmune protocol is what I've written my books and really spent the last 15 years developing after my own experience with three autoimmune conditions. And in a nutshell, it is a systematic process that each person can use to figure out what works for them in terms of diet and lifestyle.
- [15:40]
A
Which three did you. Which three from the lucky lottery of 140 did you end up with?
- [15:44]
B
With? Yeah, so I've got Hashimoto's, I've got celiac and I've got psoriatic arthritis.
- [15:52]
A
I saw a lot of arthrotis, I saw a lot of PA in the clinic. And it is incredibly destructive. It's incredibly painful. All right, so I want to come back to endometriosis for a moment because this is another, like you said, gray area. It doesn't quite qualify. And here's my nerdy question for you. Does, like lipopolysaccharides, does that count? Like, if you see those lp, like if you see LPS in the blood, is that something that people are looking for as an indicator of maybe there is an autoimmune condition happening? Or is that just sort of like a. It's just like pain. It's sort of like a generalized. Yes, lots of people produce it, but it's not indicative specifically of endo.
- [16:27]
B
Yeah, when I see lps, I think leaky gut. And when I think leaky gut, I think autoimmune. If it's not potential autoimmune, it could be full blown autoimmune. So like I said with Hashimoto's, there's this 10 to 15 years. Other conditions have a similar timeline. I think rheumatoid arthritis is about 10 years where if they track people and they have their blood tests from, you know, before somebody develops a condition, they can tell there's this period of time where people have dysfunction, where they maybe don't have the specific full blown joint damage. You can look on an X ray and see that ra or, you know, actually see the dysfunction and thyroid hormone. I actually think with Hashimoto's, if you do an ultrasound, you can see the swelling. And I definitely felt that way when as a young person. I always had kind of a swelling in my throat and I never really knew what it was from. And I'm sure it was like the early manifestation of that. But yeah, whenever I think leaky gut, which, you know, I'm sure you've talked to the Betty's all about leaky gut. But really this is. Leaky gut is present in every autoimmune disease tested. And credit for that goes to Alessio Fasano, who is a wonderful celiac and gluten researcher and really has shown that the link between all autoimmune diseases is in this gut dysfunction.
- [17:46]
A
Well, what does define leaky gut for us? What does that mean?
- [17:50]
B
Yeah, so our guts are basically one cell layer thick. Basically the immune system is on the other side of that one cell layer thick barrier. And that barrier is basically between us and the outside world. So a lot of people don't think of their gut as actually outside, but to your immune system it is. So everything we put in our mouth has to go through this check of like, is this a nutrient? Is this fiber that we can't digest? Is this a toxic thing that we have to process and get out? Your body is doing that and moderating that. And that's why so much of the immune system is in the gut. That's actually why so much of a lot of these health and diet and lifestyle things that help the microbiome actually really help autoimmune disease because of that immune involvement there. But really, leaky gut happens when that cell wal layer is open and those tight junctions open up and things get in there that actually shouldn't be exposed to the immune system. Again, 140 different conditions, the link is that wonky immune system. So whether or not something is affecting your brain or your thyroid or your skin, the dysfunction is all starting in the gut. And that immune activation is what is actually contributing to people feeling worse. Because we already have this immune activation going on in our body attacking know for me it's my tendons and my thyroid and my small intestine with celiac. And so when I, when you get that tight junctions opening, just more things are going through. They're stimulating the immune system. The immune system is already hyperactive and so it's going to make everything feel worse.
- [19:31]
A
It's kind of like someone sliding into your DMs on Instagram and sending you completely inappropriate things that you just never wanted to receive. That's sort of how I think of like an increase in leaky gut. You know, that's maybe that's inappropriate, but that's Sort of how I'm like, okay, leaky gut's just like someone sliding into your DMs, sending you like an inappropriate picture or message or whatever. And like, I never needed this. Please stop. Yeah. After spending years studying performance and nutrition, I can tell you with confidence that there is one area that most people completely overlook when it comes to body composition and feeling great. Your gut. And if your gut is not working, nothing works the way that it should. So for you, that might look like uncomfortable bloating after meals, meals or skin issues or sleep issues, energy crashes that just don't make any sense at all. Now, probiotics can be a great solution to transform your gut, but here's what most people miss. The probiotic that you're taking is probably already dead before it ever reaches your gut. Because most brands on the market cannot survive your stomach acid. And if a probiotic can't arrive alive in your gut, it can't really do much, can it? Right? Right. Just Thrive Probiotics is different and it's the only probiotic I have ever recommended. It uses four spore based strains that actually survive digestion and your stomach acid and arrive 100% alive, including one clinically studied strain that produces antioxidants directly in the gut. This means for you better nutrient absorption, less bloating and stronger immunity. And right now, I have a very special offer for you. When you start your first 90 day just thrive probiotic subscription, you're going to get a free 90 day supply of their new digestive bitters. That is too a $90 value. Now, bitter herbs have been used across cultures for centuries because they work when you take them before a meal. They signal to your body to produce stomach acid, bile and enzymes it needs so food actually gets broken down instead of sitting there undigested. They also support natural GLP1 production which is going to help you manage your appetite and your cravings. This is foundational gut support that makes everything else that you do pay off. And Just Thrive backs every single purchase with their bottom of the bottle, 100% money back guarantee. If you don't absolutely love the results, you get a full product refund even if the bottle is empty, no questions asked. Tap the link in the show notes or just go to justthrivehealth.com better and start your gut health journey today. That's justthrivehealth.com better. We've talked about one skin on this show before and it keeps coming back because it genuinely aligns with everything that we talk about here on the show, which is understanding the biology underneath what's happening to your body and actually doing something about it at the root level. As we are heading into the summer and fall, if you are not using a daily sunscreen, UV exposure is one of the single biggest accelerants of skin aging. One Skin's face, SPF has the OS 1 peptide built right in. So you're protecting your skin against future UV damage while also protecting the cellular aging that has already happened. So you're doing two things at once. You're protecting your future skin and you're reversing the damage that you've already done. And this is the thing I use every single day. This is probably my favorite product in their line. I don't actually like to wear a lot of foundation, so I will usually put this on, maybe some blush and highlighter if I'm feeling super motivated that day. But this is a foundation for my daily skin care. And the cool thing about One Skin is that the results are not just anecdotal. They are backed by four peer reviewed clinical studies and they also have over 10,000 five star reviews. Like the numbers don't lie. Bloomberg named One Skin a leader leader in skin longevity. So this is real science and this is the kind you actually want to be using on a daily basis. So born from over a decade of longevity research, OneSkin's OS1 peptide is proven to target the visible signs of aging, helping your skin unlock your healthiest skin now. And as you age, for a limited time, try one skin with 15 off using code better at checkout. When you head over to Oneskin forward slash better. That's 15 off at OneSkin Co forward slash better and use code better at checkout. Okay, so you talked about diet. So the leaky gut you said is present in all autoimmune conditions. So how can we use our diet to our advantage then?
- [24:24]
B
Yeah, so people with autoimmune disease have higher rates of food allergies, sensitivities and intolerances than healthy people.
- [24:34]
A
Wait, let's define, let's define those. Wait, we have to. Is a food allergy. What's an. Like what. What are those things?
- [24:39]
B
Yes. So there are so many ways that people can react to foods. And I just want to preface this discussion with like, a lot of people are very familiar with like igg, you know, the blood test that you get, they will tell you if you're sensitive to foods. This is just one way. And this is a food sensitivity test. There are also food allergies which has a Different immune pathway that, you know, a lot of allergies are a lot more severe. They're the people that, you know that have like peanut or shellf can be life threatening, they can be very fast. Then there's a spectrum of sensitivity where there's multiple different ways that people can react, including that IGG really gut mediated. And then there are more intolerances and more I would say, lesser known ways that people react to food. So these are things like you could have a digestive intolerance, you could have, you know, different enzymes that you lack, like lactose intolerance, fructose intolerance. But there are also ways that people react to foods that are in this gray area of. I like to call it intolerance, but I don't feel like there's really the right word. And researchers haven't really honed in on this. But what they know is that when people report, like people with ibs, they report that they have symptoms when they eat certain foods, they get reactions. And then when they go in with like endoscopy, colonoscopy, they actually visually inspect the tissue, they see that there is a reaction happening there, but they can't find, you know, that immune that E I G G. There's, there's no classical food allergy or sensitivity, but the tissue, those tight junctions is actually opening up and those people experience sensitivities. So whenever I talk about, you know, food allergy, food sensitivity, food intolerance, I'm talking about these very broad spectrum of how a food can react or how a food can affect each individual person. And an elimination diet is the best way to way. And still, even considering conventional medicine, the gold standard for identifying these more subtle sensitivities, and sometimes they're actually not even so subtle, they're just not able to be picked up by, you know, blood tests. This is the best way to figure out what somebody is truly sensitive to is trial and error, which I know. We live in this era of science and technology and we have so many tests. I love tests, but they can. There is no test that can tell you how precisely you are reacting to all of the foods and rule things in, in a way that is going to tell you that it's safe for you to consume. This is so important for people with autoimmune disease because our immune systems, which are. This is the part of our body that produces the reaction, it's already doing something it's not supposed to be doing. So we just have so many more food allergy, sensitivities and intolerances than the healthy population. So figuring that out is essential for figuring out what diet you should be eating long term.
- [27:44]
A
And isn't it hard though, from the time that you ingest a food to a reaction like if it's not a full blown anaphylactic, like, oh, no, I just had peanuts and now my throat's closing up. If it's a little bit on the spectrum, as you said, let's say you react the next day. It may be very difficult for you to chronologically, like, link, you know, the cheese or whatever, the milk that you had. Two days later, your nose is stuffy, your sinus, or is that a problem that a lot of people have is sort of drinking the food to. Because it's not so acute. Right. It can be three, four days later. And like, who knows what I had three days ago?
- [28:20]
B
Yeah, six days. So what I tell everyone is it can be up to six days. And this comes from a group of studies from a group called Fritzger, Ravens et al. I can send you the link for your show notes. They did studies in patients with ibs, excuse me, with a confocal laser. And what they did was they took people who specifically did not have IgG IgE. They did Basavil activation. They did six different tests. They, they screened them for, negative for everything. But they experienced a food reaction. They went in with a, and, and endoscope. They put, you know, this camera down, down the pipe. They applied the allergen that these people reported to their tissue. They watched the tight junctions open in real time. And then so they saw this person was having a real reaction. And then separately they had people do this elimination and reintrod introduction. They found some of these patients were having reactions starting six days after ingestion for foods that they could immediately see a change in the tissue when they went in and, you know, took those pictures. So that really reframed my concept of just validating. I think in the autoimmune community we sometimes are like, does this happen to you? And it's like, yeah, I'm talking to my friends, I'm talking to my clients. I'm taking my personal experience. Absolutely. Food, you can eat something and four days later it's like, what did I eat? Eat. You really need a systematic process for elimination and reintroduction. Otherwise, you know, your stress levels, the things that you combine in that meal. You know, we, we have yes or no foods that are much more black and white. You know, these are foods that we're reacting to. We have so many gray area foods. You mix a bunch of gray area foods together, which might look like something like eating alcohol and having something with a little dairy and a little nightshade and all of a sud. You don't realize what's affecting you. Right. Because you haven't really done the experiment to figure out which of those foods affects you in which way. So we can get more into that. But like alcohol I love to call basically like a amplifier of any other food reaction. So if you include alcohol, which is known on its own to open up those tight junctions, you combine alcohol with any other gray area food, and it's a no food for, you know, you can have such a bigger reaction because that alcohol is just priming your immune system to react to anything that it's just maybe a little borderline about, if that makes sense.
- [30:55]
A
Every crudite plate known to. It's like wine and cheese and some, you know, eggplants and a little bit of olives and like, it's all of that. You know, you have that with a glass of wine. That's so common.
- [31:07]
B
Exactly.
- [31:08]
A
Okay, so let's. Let's talk a little bit about. Okay, so we have a long delta for time, which can be incredibly frustrating. What are some of symptoms? So someone is now diligent. They're like, all right, I gotta have a food log or a food journal. What are some of the signs and symptoms that you might be able to see six days later? What are the common things to look out for?
- [31:30]
B
Okay, so I love people tracking in two categories. The first category is your primary autoimmune symptoms. So these are for the Betties that have autoimmune disease. You know, they've got, like, me, psoriatic arthritis. I've got a rash that shows up kind of on my scalp, back of my neck, my elbow, elbows. I'm going to be tracking for sure. Like, when I get gluten, that's the first place it's going to show up, is I'm going to get a rash. Really easy, right? When we have an autoimmune condition that shows up in a very specific way and that clears up and then it comes back, obviously you know the culprit, right? If you've also got an autoimmune condition that I have, Hashimoto's, it's not going to be so easy because I'm tired, my hands and feet get cold, I start shedding hair there. Those are really hard things to capture. So the way that I like to track is on a scale of 1 to 10, 10 being the worst. So I'm going to be tracking my fatigue levels, I'm going to be tracking my pain levels, I'm going to be tracking my moods, I'm going to pick out the primary symptoms of my condition. And whatever your condition, if it's rheumatoid arthritis, it's going to be, you know, your joint pain, you're going to be tracking those primary autoimmune symptoms so that when you re reintroduce food, foods, you know, if that comes back, you know the culprit. Right. But then second, and this is for, you know, maybe the Betty's that don't have autoimmune condition or maybe they're undiagnosed. They're feeling like they have a bunch of non specific symptoms. They haven't really found out what that's from. They're going to do an elimination diet. Great. You're going to track general health indicators. So it's going to be things like fatigue, your sleep, sleep, your recovery, your moods, you know, your digestion. Oh my gosh. I cannot tell you how important looking at your digestive process is to really providing a window into your general health. And often when digestion improves, so when you're less bloated, when your bowel movements are easy, you're not getting constipated or having diarrhea. You're just feeling like this is working and you know, my food is being absorbed. That is a sign that good things are coming. So for a lot of times, people have been chronically sick for a long time. I spent a really long period of my 20s and early 30s chronically sick. And I really can remember that when my digestion turned around, that was right at the beginning of things actually starting to be sustainably better. So kind of two buckets. Autoimmune symptoms and general health symptoms. The autoimmune folks I think should track in both areas because, because sometimes we don't see a change in like the rash or the joint pain. But then you will notice like the digestion or maybe like your skin seems brighter or clearer or you have less acne or maybe you're just in a really good mood, maybe you're just sleeping really well. Those are wins. Those are telling you that you're on the right track. And then when you reintroduce foods and things go back a couple clicks, you go, huh, maybe when I put dairy in and I notice that like my digestion is just not what it was a couple weeks ago, then you really know what the Culprit is.
- [34:44]
A
Okay, so I'm going to play a devil's advocate here. So with the secondary symptoms, you were saying these. Some of the general symptoms, like your fatigue recovery, mood, digestion. This all sounds like perimenopause.
- [34:56]
B
Oh, my gosh.
- [34:57]
A
Just sounds like a woman who's 44 and her digestion's changing. She can't sleep, she can't read, recover. How do we. How do we, you know, tease out the. The two?
- [35:06]
B
Yeah, And I am looking for the people who are studying autoimmune disease and perimenopause. Like, where are they? First of all, like, call out if anybody knows, Let us know who they are, because I will. Been looking under every rock I see, and I just can't find. I can't find the help. What I can tell you as someone who was diagnosed with autoimmune disease at 26 and now started perimenopause and started getting treated for perimenopause, just, it threw everything out of whack after a long time of smooth sailing. What I can tell you is the first sign that for me was that I started feeling vulnerable with my autoimmune symptoms in a cyclical fashion. So I think every woman should be aware if you are having cycles, you know, you should be tracking and aware of kind of where you're at with that. Because if you notice certain symptoms, like, I had uveitis starting at 39, and this is inflammation of the eye. It can actually cause blindness extremely quickly if not treated. I didn't know what it was. And it started happening to me right at the end of my cycle, right before I got my period. And I went into the doctor, you know, had it treated, got taken care of, the next month, literally to the day, it started happening in my other eye. And then I started asking the question, is this related to my cycle? Is this related to my hormones? Of course, my doctors were like, we don't know anything about that. But what I. I can tell you from my experience and experience of other women in the autoimmune community is that even if there has been a period of smooth sailing, autoimmune plus perimenopause means things are shifting. It means things are shifting in terms of food sensitivity. So sometimes people get more reactions. I personally been learning a lot just about how estrogen affects histamine release in the gut. Histamine is a big mediator food reaction. I wish I had perfect guidance to tell you exactly what to do, but all I can say is, we know about it. And it's hard, and it's something to be aware of. Autoimmune patients get symptoms depending on their hormonal status. So whether that is not having enough hormones, so going through late stage perimenopause, menopause, and really feeling the effects of depleted hormones, or even just early, like where I'm at, early perimenopause, not being able to sleep, I really think the low progesterone is causing some sort of autoimmune vulnerability. But that is a big question mark for this community. And I think, you know, I am delighted at all of the perimenopause and menopause advances that we're having. And I feel privileged as somebody who's 41 going through this time feeling like I have all these women that have gone before me that are really championing the quality cause. But I'm waiting for that autoimmune piece to kind of click into place, because you're right, those symptoms are the same, you know, And. And how do we know?
- [38:06]
A
And how do we know? Okay, so is there anything that we can even theorize that a low progesterone. Progesterone is usually the first hormone that starts to dip. They're like late 30s, early 40s. And lots of patients will talk about sleep disruptions, having trouble falling and staying asleep. Is there anything that we can theorize that may be increasing that, as you called it, that vulnerability in cyclical fashion? So do we think that there's anything that progesterone specifically, or lack thereof, is influencing with autoimmunity? And then obviously my next two questions are with estrogen and then testosterone.
- [38:41]
B
Yeah. So I'll. I can tell you my experience because this is very new for me in the last year, but. So I started having this uveitis last fa, you know, week before my period happened a couple times, went to rheumatology. I actually got my third autoimmune diagnosis this year. And I think in part due to perimenopause. And I think those changes really started to make me feel more vulnerable in that part of my cycle. So the other thing is that I have not been sleeping starting around 38, 39. I did a really big deep dive on this on my Instagram, where I had all my aura ring data, and I didn't actually know. I've been wearing this ring since 2017, but every year since I was 33, my sleep was getting worse and a little bit worse and like, 1% per year to the point where at 38, I'm sleeping one hour less per night. I'm having, you know, these periods of time where I'm sleeping five hours, maybe six hours, you know. So I started having this new autoimmune problem which got the diagnosis psoriatic arthritis. I know it's not a new condition for me because I've had psoriasis on my scalp. I've had joint pain for the last 15 years. I think that the perimenopause just caused something that made my eye start to flare up. I got a diagnosis. Great. And then I started seeing a menopause certified practitioner, and she put me on a small dose of progesterone. Second half of my cycle. Guess what happened? Have not had one flare in my eye. Don't get the psoriasis rash on my scalp. That was only happening in a cyclical fashion. And I am now sleeping for the second half of my cycle, which is when I was losing all that sleep. So n equals 1. Definitely not a study. But I can tell you that that experience has made me very pro exploring HRT especially. Like, I mean, everybody that I talk to is like, that's so early. And then all of the menopause influencers like yourself and everybody is just like, it's not. It's actually essential you do not have
- [40:39]
A
to wait until menopause to get on mhd.
- [40:41]
B
Yeah, absolutely. So. So that's just my experience. And you know, to be honest with my client group, I have been helping people figure out food sensitivities. But the perimenopause piece is really something that I'm referring to people to explore the way that I have working with someone that can really evalu weight that piece for them. Because I absolutely think that the way that that dovetails can be really challenging to figure out, as if we didn't have enough to try and figure out. Right.
- [41:13]
A
Perimenopausal women are notorious for being magnesium deficient, which can lead to lower hormonal production. More than 80% of us are deficient. And even just having suboptimal levels in the body can contribute to symptoms. And that's because magnesium is related to to over 600 biochemical and enzymatic reactions in the body. Many of these reactions influence the production of these key steroid hormones in the body, like estrogen and progesterone and testosterone. And insufficient magnesium levels also disrupt your thyroid function. Magnesium breaks down cortisol and other stress hormones as well. So if you don't have enough, you're going to have poor hormonal production and a poor stress Response Bioptimizers is my favorite magnesium supplement because it contains the seven best absorbed magnesiums along with with cofactors like B6 that are going to help enhance the absorption of the magnesium. It's a simple, effective solution to a very big problem that we face. I personally take two capsules every day. I take one in the morning and I take one in the evening. I want you to head on over to bioptimizers.com better and use code better during checkout to save 15% off. That's B, I, O P T I M I z e r s dot.com forward slash better. All right, so talk to me about estrogen. You mentioned estrogen and histamines. Talk to me about that mechanism and how that or the loss of estrogen in midlife can potentially remove the, the damper, we'll say. Or allow for histamines to kind of become a little bit more wild.
- [42:50]
B
Yeah, yeah. And you know, histamine intolerance is a big topic in the autoimmune community because a lot of people, you know, again with sensitive immune systems, we often have a lot of environmental allergies. So these are going to be things, things like pollens and things in our environment going through perimenopause and menopause. Absolutely. People have changing immune systems. It's kind of like the change sometimes that we also see in pregnancy where people will tolerate a lot more foods when they're pregnant and then they will not tolerate foods postpartum. I see a lot of people reporting that when they go through perimenopause and menopause is just that their food reactions have changed. And so I think we have a lot of learning to do to figure out. Exactly, exactly, you know, how that is working. But in terms of like histamine specifically, I think of symptoms like headache, rashes, flushing, sinus congestion, sore throat, that kind of feeling, if you're having any of those kind of feelings, that might actually be more of a histamine related reaction. And of course we know that in perimenopause estrogen is not declining. Right. It is kind of going on this roller coaster ride where sometimes it's actually really high and sometimes it's really low and sometimes in a very short window of time. So if a woman is having symptoms of eating something and then a few days later it's fine. Like you're not crazy. Right. Your hormones are, are doing this thing, which we really don't have a good way of quantifying. The only advice I can give people is to really identify when things are not right. Having that on your radar. I don't think we have the ability to say, you know, you can't predict when your window of tolerance is going to be good. Right. But having that information of knowing, like, sometimes this food really sets me back. If you're somebody who's on an autoimmune journey, you have a lot of pain, you are very motivated to work on your health. Maybe you're going to keep that h. That food out until, you know, further, you know, further knowledge comes up. Maybe you try it again consistently. Now you're like, you know what? This is working for me. Me, I actually recently had this experience where I have been allergic to dairy for most of my life. And I use the word allergic because I get swollen lips, swollen throat, you know, all of the phlegm and, like, my throat closes up and it happens immediately. And I've avoided dairy my, since childhood, since this started, you know, so I've done all this food sensitivity, you know, done the elimination diet. I never, ever tried to reintroduce dairy, but I would accidentally have it and then suffer the consequences that usually I'm in a restaurant, like, you know, having an asthma attack and, you know, being scared, needing an inhaler. Recently, I had dairy in Mexico. It was like a, a local cultured food. I thought it was coconut, and I had been eating it at this resort for like, three days in a row. And one of the servers was like, oh, aren't you the girl that's really worried about dairy? You know, that that's like our cheese? And I was like, it for sure. It's not like, like, you know, I think they've been putting this coconut yogurt or something, and they're like, no, no, no, no. That's like our local cheese. What was just like, oh, my gosh. And then I realized I'm obviously not reacting to it. So something has shifted where I can now tolerate dairy. I have no idea why. So that kind of goes against the. Maybe in perimenopause you have more food reactions. I also think that it can just change. Right.
- [46:26]
A
It might just be because there, everything is better in Mexico. It could also.
- [46:31]
B
I, I, I was on that train and then I came home and I tested, tested it, and it's okay.
- [46:36]
A
Yeah. You know, it was still okay when you came back home? Yeah. Yeah.
- [46:39]
B
Okay. I know because, Because I have had the clients that go on vacation. They're like, oh, all the foods that trigger me, like, don't trigger me on vacation. It's like, well, you're sleeping, you're walking. Like, you know, you're getting your stuff. Like, you're. You're just, like, having a great time. But no, I came home, I tried the dairy. I'm very skeptical. I'm not, like, eating it every day, but I'm like, huh, this is interesting. So I know I'm in a time of hormonal shift, and I wonder if, you know, now things are looking. Looking up for me and dairy.
- [47:06]
A
And I wonder. I'm totally throwing this out there. I don't know if this is right, but maybe there's some type of. How would you say it? Like inoculation. You know, that may. You know, we're talking about the immune system. Like, maybe priming it with something. Where I always think about whenever I go to Italy, for example, or Europe in general. Like, France is true. When I'm in Portugal, it's true. I find that I can have foods that I can't have back home. Like, I can't really have a lot of dairy here. Like ice cream in particular. Ice cream just does me in when I'm in North America. When I'm across the pond, I can have it ad libitum. I can have as much as I want. And I wonder if there's a. I mean, maybe there's just, like, the sourcing and, you know, like, the way. I mean, there's so many arguments that you can make that would be very difficult to tease down to one. Again, it's an N of one. It's just been my own observation, but I wonder if having the food in Mexico somehow. And it didn't, because it was cleaner or whatever, didn't, like, there was no immune reaction that was there. Maybe it's. Maybe it's your hormones. Like, maybe that's it. Or there's some type of priming where the immune system's like, yeah, this is fine. And then you come back home and you have the same type of cheese or you have the same food product, and there's no reaction.
- [48:17]
B
I'm just.
- [48:17]
A
I'm just spitballing. It could be. I could be off my rocker with that too.
- [48:21]
B
It literally is wild. And I haven't been able to figure it out. So if you have any thoughts. But I literally have been avoiding dairy my whole life. And every time I would just get accidentally dosed. Immediate reaction. And, you know, I'm not drinking milk or anything, but, you know, raw hard cheeses. I'm like, okay, I'm just gonna try a little bit of this. And it seems to be fine. So.
- [48:43]
A
And last question about testosterone. Do we have any theories or thinking around how testosterone might influence the immune system?
- [48:49]
B
Yeah, I don't. I don't know. I think that's a big question. I think there's just a lack of data on testosterone for women in general, and then asking for that for autoimmune disease, you know, we need to know this information. So the people. To the people who. Who are in. In charge of finding out, please.
- [49:06]
A
Yeah, it's 2026. Any clinician or researcher that's listening, let us study hormones, you know, perimenopause and autoimmunity. I made a note here to come back to the elimination diet, because you mentioned it before. There's yes and no foods. I have heard some people. And first, I'd like you to define elimination diet. And then again, I. I want you to speak to the nuance of, like, sometimes, you know, I have a. I'm thinking of my Italian. There's an aunt on my husband's side who just cannot have any eggplants, like, next day or that her joints are killing her. And then, you know, her sister, no problem. Tomatoes, nightshades, you know, whatever. Zucchini. All the things which are staples in the Italian, you know, kind of diet. So talk to us about what is an elimination diet. What are the absolute yeses and absolute nos? And then are things like the nightshade family, like the eggplants and the zucchinis? E. Are they. We're gonna break some hearts here, but are those on the yes or no? How do we. How do we know whether or not that's right for us?
- [50:05]
B
Yeah. So the elimination diet that I write about is called the autoimmune protocol, and it is a. Basically a systematic approach to discovering what foods work for you. This is done in three phases. There's a transition phase where you go from however you're eating right now to the elimination phase, which is the second part. And it's kind of the part that the protocol is most famous for. It's when you exclude all of those food. Foods strictly for one to three months. And we have two ways of doing the elimination phase. There's the core protocol, and this is the protocol that's been around for 15 years. It's been studied in eight different medical studies in Hashimoto's rheumatoid arthritis and IBD. And it's kind of the. Basically the original one. It's the one that I did 15 years ago when I got sick. Now there's a modified protocol. It includes more food. And it's actually inspired by the root results of the research. The clinician base that has been trained to use the autoimmune protocol. Basically everybody said, we think that we can make this more accessible and affordable and doable, but still get the same results. So depending on the pathway that you choose, you do that for one to three months. And when you start to feel a measurable improvement over baseline, which we kind of talked about a little bit with tracking, but basically, you do not need to be healed, you do not need to be in remission. This is a big misconception, but you do need to have some measurable improvement so that then in the third phase, reintroductions, you are systematically. And I say systematically because we are not just going eating a pizza, which is the trifecta of gluten, dairy, and nightshades. You are going to start with foods that are easiest to tolerate and most nutrient dense, like things like egg yolks. And you're going to move down the list to things that are much harder to tolerate. For the autoimmune community, you're going to see exactly how foods affect you, and then you're going to take that information and you're going to do what you want with it. So for a lot of people, they're going to discover foods that, you know are on their never list. You know, like gluten. For most of us, let's be real, we're not going to be eating that we have autoimmune disease. It affects us. But then those other foods, you know, like for me a long time, dairy was a never food. Now it's in this kind of gray area along with a lot of other gray area foods where you might find that you have a little reaction, but maybe that reaction is worth whatever type of celebration or experience you want to have. Maybe you're somebody that has spent so long with debilitating illness that you're like, I'm not going to take the chance. So the gray area foods are out. You get to live your life and do what you want with that information. But over time, hopefully that information helps you live your best life with autoimmune disease and gives you a personalized way of eating, because there are just so many ways of eating and we're all so different. And I really am a fan of everybody figuring out exactly what is supportive of their best health and going with that. And I really feel that that trial and error way is the way to do it. And the one thing I didn't mention is that we do pay attention to lifestyle factors too, because they are extremely important to people with autoimmune disease. So while you're in that elimination phase, we also encourage you to, to work on your sleep, work on your stress management, get a little movement. Not too much, not too little. We can kind of talk about that and also connect with other people with autoimmune disease. Finding a community, making sure that you're feeling supported as you go through this and not just doing this crazy thing on your own, not telling anybody about it. You know, we don't want that.
- [53:44]
A
What is the difference between the core elimination part and the modified? So how has it evolved over time? You mentioned that it was based on clinicians who were applying it. So how. One of the things I've often heard is that the core, the original protocol is very difficult for most people to adhere to for the one to three months. So talk to us a little bit about the difference between the two.
- [54:05]
B
Yeah. So core AIP eliminates grains, dairy, eggs, nuts, seeds, nightshade family vegetables, and la legumes. So this is the, again, the original protocol. It's been around for a long time, but it is very, very hard. It's pretty extreme. It does get good results, but a lot of people can't do it because it's a lot of cooking. You're pretty much not able to eat out. It's really hard to travel, and the food is really expensive when essentially all you're eating is meat, seafood and vegetables and fruits. The modified protocol has been changed to include rif rice, but not other grains. Rice is actually of all the grains, is in medical research considered to be hypoallergenic. So it's actually extremely well tolerated. There is, of course, a blood sugar impact, but for a lot of people, it really expands things. Legumes, which are a great source of protein and fiber and really bring in some cultural foods that a lot of people were missing when doing the protocol protocol. And also they're very affordable. Historically, vegetarians have been left out of the autoimmune protocol because on core AIP there are not enough protein sources. But now with beans and rice, essentially we have a complete protein. It's not my favorite for people not to eat meat, but I like to meet people where they're at, if that's something that is for them. And then we also include ghee, but not other dairy. And that's because ghee is clarified butter. So there is no protein in. In that. Over the years, we found that There. There are still the people out there that react to ghee. I was one of them. So I know how you feel. But most people, even if they have a dairy sensitivity, ghee is pretty tolerable, and it gives them another nutrient dense cooking option. And then we also include seeds, which includes pseudo grains like quinoa and buckwheat. And this is because, compared to nuts, nuts actually have a high rate of being an allerg or sensitivity. Seeds are a little bit different, and they don't affect people as much. We do have a couple exclusions, so soy is an exclusion. So even though we're including legumes, we're not including soy, because it's one of the top foods people are sensitive to. And then in terms of legumes, also, we don't include peanuts because peanuts are also technically a legume. A lot of people think they're a nut, but they are highly allergenic. So modified has a lot of nuance to it. But if you're listening and going, hu. That does make it kind of a couple clicks easier. It makes it so that you can stretch your meals. If you're an athlete, a breastfeeding mom, underweight, you have a lot more options to get some carbs to really fuel your workouts. And. And people really report having near identical results with the modified protocol, because we think the other foods, so, you know, the gluten, the dairy, the eggs, the nightshades, and we can talk about those nightshades, Stephanie, the problem.
- [57:14]
A
Okay. And nuts, if you soak them, those are still not on the modified.
- [57:18]
B
They're still not on modified. But in reintroductions, if anybody has a history of not tolerating nuts very well, I always recommend soaking and sprouting if possible. Same things, even for people that do core. Like legumes are actually digestively hard for a lot of people. So soaking and tossing the soaking water and really making sure that you're cooking them low and slow, that can go a long way for people that have kind of borderline sensitivities to things.
- [57:45]
A
Let's talk about the nightshades, because I. I'm thinking about my aunt who always gets joint pain, and she's like, puffy the next day. What is happening with nightshades? Because I find that that is the cruelest. Maybe the dairy is cruel, but I find that the night shade. I mean, I am, you know, I'm all, I love eggplant. I love zucchini. I love all of those things. Tomatoes. I can't live without tomatoes.
- [58:05]
B
Yeah. So there is something about nightshades that we do not know what is going on. I will tell you. Nightshade family food. So I actually have to correct you, Stephanie. Zucchini is not a night is great. I know zucchini's not a nightshade, but zucchini is often cooked with nightshade. So nightshade family foods include tomatoes, bell peppers, potatoes. I think potatoes breaks a lot of heart.
- [58:32]
A
Oh, potatoes, that's hard. I mean, I'll take the zucchini win, but yeah, okay.
- [58:37]
B
Goji berries, even some fruits like ground cherries. So they actually are related to tomatoes. They have little papery shells on them. Not cherry cherries, but ground cherries, potatoes, but not sweet potatoes. So nightshades can be a little confusing. You guys can look up a list online. Ashwagandha is an herb that is a nightshade nightshade. The way that that is they are affecting people with autoimmune disease is elusive. There has been a little bit of research, and the research shows that when you ask autoimmune patients what foods are they reacting to, about 50% report nightshades are a problem. So it is a big burden for our community. I will also say that there is a spectrum of how people tolerate nightshades. And this is why in my book, I have different stages of foods that people can reintroduce. And the first nightshade that I recommend reintroducing is potatoes. Because potatoes tend to be one that if you're going to tolerate some nightshades, it's going to be that one. There's something about potatoes. They're just not very strong in whatever component that research has not borne out their lots of theories, but not a lot of hard data on what's actually happening. But you ask autoimmune patients, especially if you have a skin condition, a digestive condition or a joint condition. So this is gonna be, you know, my psoriasis people, my IBD people, rheumatoid arthritis, psoriatic arthritis especially, are reporting that when they eat nightshade family foods or specific ones, they get joint pain, their rash gets more severe, that type of thing. So what you're report, Stephanie, is very common. And what I will say is a lot of people get on the spectrum of nightshades, which is why we do it one at a time each nightshade family food and quantity. You see where that tolerance lies. And so buying nightshade intolerance is to tomatoes and bell peppers and eggplants, especially if they are raw and fresh. Which is so sad. I know. But I can do potential potatoes. I can do spicy peppers. Like the quantity used in like, you know, a sauce or something. Totally fine. So a lot of people are like me, where they find that there's kind of a limit where they can go. They can go down the spectrum of nightshade family foods and they stop at one point and go, okay, some, it's raw tomatoes. Some people react to tomato sauce if it's like really concentrated and cooked down. Some people react to any quantity. Some people are fine if there's like a tiny little spoonful of tomato sauce and a big pot of soup. For me, I'm fine. But I can't eat a tomato. And I wish I could tell you why. But at this point, it's just trial and error and, and figuring out what works for you and avoiding it. If that's something that helps you feel your best, you know, is there a difference between.
- [61:40]
A
In the bell pepper family? I remember watching a cooking show and absolutely being mind blown to learn that a green pepper is just an unripe red pepper. And I felt like, why didn't anyone ever teach me this? So there's a difference between a red pepper, which is the ripe version, versus a green or a yellow, which are under ripe.
- [61:59]
B
Yes. And green peppers are the most reported of the pepper family. It's always the green peppers. And my mom actually only reacts to them when they're green. So you. If you talk about nightshades to a group of autumn people, they will have stories of like this, where it's like, what? But it's always the green is the worst.
- [62:17]
A
Thank you, Nigella for that. That was. I was like, what did she just say? A green pepper is just an unripened red pepper. And I. My whole world turned upside down. Hey, Betty, quick one for you. Collagen loss starts late in your 20s and accelerates through perimenopause and menopause. Yay. Aging by 50, you've lost roughly 30% of your skin's structural collagen. However, you can support collagen synthesis at home. Red light therapy is one of the most evidence backed ways to do it. The right wavelengths signal your fibroblasts in your skin to produce more collagen and elastin. That's without needles. No downtime, no surgery, no nonsense. I use the Bon Charge face mask and the face wand. They are both clinical grade, genuinely portable, and priced like something you're actually going to use instead of something you're going to feel guilty about. I want you to head over to boncharge.com and have your best skin with me this year. Head over to boncharge.com better. That's forward/ B T T E R and use the discount code better at checkout. And that is going to give you 15% off your entire cart. Skin is infrastructure Betties. Treat it that way. Okay, let's talk about. Is oxalates a thing? This is another thing I hear in the fitness community that gives me a bit of a. An angry tick, truthfully. But in terms of an autoimmune sensitivity when we're thinking about, you know, dark green leafy vegetables, kale, spinach. Is oxalates an issue? Should we be thinking about?
- [63:50]
B
No. Oxalates and goitrogens are like my favorite thing to just tell people. Do not worry about it. If you are doing something extreme like juicing cabbage or you know, doing something wild like you could probably end up with a problem because these compounds are not meant to be taken in huge massive quantities in our body. Right. We have mechanisms to maintain balance. And when you do something extreme, you override that capacity. For normal people eating plant foods, I say eat as many plant foods as feel good to you. There is a small caveat of people that have kidney issues. Maybe they get smaller specific oxalate kidney stones. And you have been told this is the type of stone you get. You personally need to avoid oxalates or minimize them. You're not who this is for. Right. You're getting specific medical advice from your provider. But for everybody else, don't worry about those things because they're not a problem.
- [64:48]
A
Okay, great. Earlier you mentioned lifestyle. So in tandem with the dietary intervention with the elimination diet, you said sleep, stress, movement and connection with either other people eating in your community or other people with autoimmune diseases. So you can sort of have that. That kinship. I wanted to double click on movement because I have often, you know, just my line of work. I've had a lot of people where I counsel them on exercise and specifically it's my hashi ladies who will go in and do some weightlifting workout, let's say, and will be bedridden for four days afterwards. And I think that they just is either that internal GPS piece of them doesn't know when to quit or they overdo it. So what is an to ability appropriate movement? How can we think if you have an autoimmune disease or you think you might be on your way to developing one? What is the right way to think about movement for this population?
- [65:43]
B
Okay. So I have lots of thoughts. Movement is essential, but like you just described, there is a U shaped curve for the benefit of movement. So not moving is bad. Moving too much is bad. How do you find that sweet spot? And for every person at any, every place that they're at, they're going to start. You know, like I started when I was sick doing stretches in my bed because I could not get out of my bed. That was the, the perfect spot in the curve for me. Right. I wasn't going to force myself to get up and pass out and fall over because that's kind of where I was at in my health journey. So you really have to assess where you're at. If you have the ability to find a coach who is well versed in autoimmune disease or chronic illness, that can help help you figure out where you're at, give you something that is approachable and within your current capacity to do. Because right when, I mean, you know this, Stephanie, you are literally the expert in this. But you know, we're trying to load the body with a little more of something. And then in the beginning stages of working with someone, you're going to be asking them, how do you feel the day after, how do you feel two days after, how do you feel four days after? When do you feel ready to go again? People with autoimmune disease are going to need more time to recover and sometimes they can even experience. And this is very common with Hashimoto's. It is a documented symptom of the disease, which is exercise intolerance. So that's a kind of a separate issue, but I'll speak to it a little bit because it's something that I've really experienced myself. And we actually get peripheral vascular resistance with Hashimoto's, which means like bad blood flow to our extremities. It makes working out and exercising a lot harder on our system and need a lot more recovery. And we need a much slower on ramp to wherever we're going. So if you're looking at Instagram, like I'm looking at Instagram, I'm going through perimenopause. I'm learning all about like the jumping and the lifting and I'm like, I need to be that woman, right?
- [67:47]
A
Yeah, right.
- [67:47]
B
Like, I just, I know where this is going. Like, I gotta, I gotta do this. That might not be where you start. Right. And I think autoimmune people, especially if you're not exercising, I just can't stress this enough. And I, I'm speaking as somebody who didn't exercise for seven years in the depths of my illness, I got out of that hole by literally walking one block and then walking two blocks and then walking three blocks. To me, at that time, that was an exercise routine. So. So really can't say enough about scaling really, really slowly. And then that assessment, after your tolerance, when you're doing the workout, your brain is going to feel like, oh my gosh, we're doing the thing. I love this. Two or three days later, you might not be loving it. And so you just have to learn how to be consistent and temper that so that it's within your ability. And over time, if you do that right, you will be able to progress, but it just has to be nice and slow and tolerable, you know, which
- [68:47]
A
is everything that a Hashimoto's woman hates.
- [68:50]
B
Yeah, exactly. Which it's like we are, we are just like everything all the time, you know?
- [68:56]
A
Well, that's. I think the other comment I would make like I'll make is just having seen so many through my door. It's not, it's not all Hashimoto's patients, but a general pattern. I mean, any clinician worth their salt is like pattern recognizer. The pattern recognition with a Hashimoto's patient is she's so ambitious and she's so achievement oriented. And we talked about this maybe being a trauma response from, you know, earlier childhood experience experiences. But you, she sees, like you said, sees the woman on Instagram deadlifting two times her body weight doing these crazy barbell squats. And she's like, I can do that, right? And heads in there and completely destroys herself. And I think that there's, I think that's true not just of Hashimoto's. I think women in general, just more is more. More is more is more is more is more. When here really less is more. And to give yourself some effing grace and a long Runway, just a long, beautiful, easy Runway, you're going to get there. You're just gon take a meandering, scenic route, not just the direct highway.
- [69:56]
B
Yeah. And I, I also want to say something about pain. So like a lot of us with autoimmune disease experience chronic pain and live with chronic pain. And that is something that I have and I have worked through. And a really good trainer can help you figure out how to continue to move in a way that is less vulnerable and less flaring of your pain. And there are actually studies that I have had to really dive into for my own journey as I have a connective tissue autoimmune condition that affects my tendons specifically, but it can affect my joints. And I experience a lot of fear when I'm working out because I feel it in my tendons. And I feel like that is just gonna cause me a problem. And it's a mental thing. But having a trainer say, actually, I've assessed you, you know, we're talking about our recovery, we're working together to come up with a plan. Working within my ability actually has allowed me the ability to get stronger and improve over time, even though throughout I am having pain. And that is a very autoimmune experience. If you have rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, you have anything that's affecting your musculoskeletal system. I had to look at this research and see that even though people report that they're in pain and they start an exercise routine with a physical therapist or a provider who is delivering the top level care, right. They're not telling them to go do something that they're not able to do do. They're really scaling and assessing their pain levels improve despite doing activity, which, you know, we're so in our heads because activity causes us pain.
- [71:37]
A
Right.
- [71:38]
B
So I just want to acknowledge that for anybody listening who has chronic pain, who lives with chronic pain and goes, well, why would I exercise? Why would I work out? I was one of you for a long time and don't be like me, because actually I have osteopenia now because of those many years of my youth, youth that I spent just resting because I, I was so scared to exercise, you know?
- [72:00]
A
Yeah. Yeah.
- [72:01]
B
So it's only been in the last four or five years that I've started weightlifting. And it really took working with an autoimmune informed coach that could help me figure that out. But pain, pain is a part of it, and, and I still have chronic pain, you know, and that's okay, you know, But I just want to say that for, for anybody who might also be going through that, that is so
- [72:23]
A
fantastic because I think that the, the goal also shifts if you're somebody with ra, with so rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, which is a progressive, essentially fusion of the spine. Your goal is not necessarily to lift heavy, as you're seeing on social media. Your goal is to preserve your range of motion in your joint. And sometimes that means your own body weight is gonna be the sufficient state stimulus to, and you're just going to try and move through whatever range of motion is pain free for you. That is the number one goal. It's not to how many plates you have on the hip thrust, like, who cares? It's about maintaining preserve. Like it's about preserving your joints and preserving your range of motion. Because that's your, you know, that's your everything. That's your adl, right, Your activities of daily living. If you don't have range of motion, you can't bend over to put yourself socks on, you can't, you know, go for a walk, et cetera. So I think that that's really, really well said and sage, sage advice. Yeah. All right, finish this sentence. The worst thing a doctor ever said to me about my autoimmune disease was blank.
- [73:31]
B
You don't have one. I mean, 15 years ago when I went through my health crisis, so I didn't really tell my story, but I was bedridden at 26. I had lost my job, I had no health insurance. I'd previously just been a normal, active, healthy person. And I went from doctor to doctor to doctor trying to figure out what's going on. And I had honed in that I probably had an autoimmune disease from. At the time, Wikipedia was the source of, you know, online Google information. There was really no groups or, you know, what we have now. And I had six doctors in a row tell me that I was fine until I got a diagnosis. And I think that that experience of really being gaslit and told that you have a mental health disorder, that you're too young, that you look healthy, that you know your labs are normal, just everything without actually believing the person in front of them that they could be experiencing these debilitating symptoms and really trying to help them figure it out. It's awful. And it happens constantly.
- [74:32]
A
Six doctors in a row. I know you just hear it in passing. Wow, six doctors. But six doctors in a row. That's six appointments and six followers. Follow ups. And after you've done lab testing and all six of them are saying to you, no, nothing. Yeah, everything fine.
- [74:47]
B
Yeah, they're pulling my husband aside. Does she have a mental issue? Like, is she have like an eating disorder? Six doctors. I did not have insurance. I was saving up money. I was making $77.50 an hour working at a coffee shop. So minimum wage, saving up my money, going to these doctors and asking them for help because my body temperature was negative 93 degrees, half of my hair had fallen out. I was so cold and fatigued and exhausted that I could not work anymore. And yeah, six of them in a row dismissed me and told me there was nothing wrong and it was a mental health issue. It has to stop. Like.
- [75:26]
A
And I have to say that enrages me on a level I don't even know. It's like nonverbal. Like there's a non. Verbal, pre, verbal rage that I hear that, that makes me so angry because I think that this is, it's so common. There's going to be so many people listening. They're like, that was my story. And when you look at autoimmune disease affecting far more women than it does men, it's like when women tell you that something is wrong, can we just believe them? Can we just, sorry, that'll have to be bleaked out, but can we just believe them? It's so unbelievable that you can go to six doctors and they're like, shit, she's fine. And you probably are like, am I crazy? Like, is there some. Maybe I am mentally unstable. Maybe I am imagining it. Like, there's six cultural, like people of cultural authority. We look to the medical doctor, we delegate our health to them, and they're all telling me the same thing. So is it them or is it me? It's logical to say maybe it's actually me. Maybe there's something wrong with me.
- [76:32]
B
Oh my gosh, like a hundred percent. Like, it's, it's absolutely unacceptable. And also I was told that, you know, by Dr. Six I had identified, I probably have an autoimmune disease. It's probably Hashimoto's. I'd done all the work for them.
- [76:46]
A
Right, Just, just, just check my TPOs. Just check my TPOs. Yeah.
- [76:51]
B
This doesn't happen in women like you, women like me who are not overweight in their 20s. And I don't know, look, I looked too healthy. They, they kept saying that, like, you look too healthy. Like you, like, for sure, this is not what you have. Like, you know, you, you come in a different path package. And it's like, well, I'm not asking you to assess the package. I'm asking you to run the lab work. And of course that comes back positive. And then they're like, oh, but your hormone levels are normal. And you know, we're not going to treat because, you know, even though I was bedridden, even though, like I'd lost a bunch of hair, even though I was freezing, you know, but that, that's, you know, working through that was incredibly challenging. And now I've done discovered 15 years later, almost going blind, going through perimenopause. I have received the psoriatic arthritis diagnosis. I 100% know that back then. That's when I started experiencing that. But I went to rheumatology and they said, you don't have a rheumatological disease. This is not something, you know, that is your problem. Turns out it absolutely was what I have, you know. So the way that autoimmune patients get dismissed is so common. We are dismissed, we are gaslit. So much time goes on where, you know, my heart breaks for people who have permanent damage. Like I'm lucky that my psoriatic arthritis, it manifests as enthesitis, which is tendon inflammation. There are other types that are more involved with the joints and that damage is permanent. Like you know, the, the eye inflammation that I don't, I didn't know when I had a little red spot on my eye, went to the optometrist, they gave me some low steroid drops. I didn't know that that wrong treatment might have led to me having permanent vision damage. And these are things that you learn when you get a correct diagnosis. You know what's on the radar. Right. You know how to manage your health and have a heads up about stuff. But so many autoimmune patients are just really underserved by the conventional system because we're just not believed. You know.
- [78:59]
A
Yeah. What, what needs to change, do you think, with the, with the conventional? Because that, I mean that's the initial point of entry. You know, you're not necessarily, I mean you might go to a naturopath, you might go to a chiropractor, you might go to, you know, another pcp. But most people are going to go see a medical doctor who unfortunately, the way the system is, they got 10 minutes. You need to have an ICD code. You know, what, what, how, how does it change, how do we better change the system so that a, we have doctors believing women when they come in and tell their stories and, and get better care.
- [79:28]
B
So I think the first thing is really learning how to be a good patient. I wish that this wasn't my advice for everyone, but really learning how to be proactive, outsourcing all of your healthcare literacy and everything to your doctor and the people that you know, it does seem like you are hiring them to take charge of your health. But you can't do that because they are just way too slammed with again that 10 minute appointment time. Not really having having a lot of many years and follow up like we're all switching providers because insurance is changing and different networks are changing and providers move. And I mean, it's chaotic out there. Right? You don't have the ability to develop a relationship with a provider the way that I think historically that's how it was done. Right?
- [80:13]
A
Yeah. Yeah.
- [80:14]
B
So I think going in and really it's. It's on us as, as it always is. Right. I mean, should anybody be surprised that. That it's on us to be informed and show up knowing everything that we can know and asking the right questions and, you know, demanding the right lab work? And I use the word demanding because you do have to go in and ask for specifically what you want. And the way that you can get armed with that information is a lot of these patient groups, you know, if you suspect you have a certain condition, you can join different groups like the Hashimoto's group. This is where I learned about diet and lifestyle, was in a Facebook group of women who were like me, suffering with Hashimoto's, not getting answers, and knew all the questions to ask all the women that came before. And that's how I educated myself and, and that's how I demanded and got the treatment that I needed. But I think over time, if, if we're all talking about this and we are hopefully pushing the system to believe us and, you know, help us get through this. I mean, do you have any ideas, Stephanie? Like, I don't know.
- [81:25]
A
I mean, I know I think about this a lot. I think everything you're saying is correct. I think you do have to go in. You can't just go in and hope and pray that your doctor is going to advocate for you. I think every medical doctor does want to do right by you. I mean, that's. You have to assume that that's why they got into, you know, that's why they got into their career. But you do have to make their job easy for them because they are. You are one of fifty to a hundred people that they're seeing that day. So you have to shorten their learning curve. Shorten. If you can decrease their workload by saying, hey, the way that you did towards the end of it. Like, I think I have Hashimoto's. Please run the tpo, you know, please run these antibody labs for me so that we can confirm it. I think that. And that's. It's hard if you don't have the training, but it's just the necessary work because honestly and unfortunately, women are not like women perimenopause. And autoimmunity and where's the research? We, you know, we're calling out for clinicians on this show or researchers to, and scientists to, to get some fricking data on that cohort because it gets exponentially worse for them. So I think that the things you've said are great and I think you just have to, you know, some people have said, I, I think it's a little cheesy, but like the CEO of your health, you have to just be, you have to be the boss. You can't let someone else take that job over for you.
- [82:38]
B
Yep, absolutely. Yeah. And my hope, you know, I do a lot of advocacy work with the Autoimmune Association. I go to Capitol Hill, meet with lawmakers, really try trying to increase research funding. And what that means is that identifying people who are autoimmune before that 10 to 15 years before they develop an autoimmune disease. My hope that in the research in the future we have more tools such as antibody screenings that can be done when people are young and go, actually let's flag this. You have antibodies to your thyroid, you might not have a, a problem yet, but if that person can intervene, say five or 10 years earlier than you know, when their disease would manifest, I mean that, that is world changing right there. Right? Because a lot of people end up not getting diagnosed especially with like the rheumatological conditions until they are in a damage inducing state. You know, like the MIA 15 years ago being bedridden in pain wasn't enough for them to figure out. And, and that's no criticism of my doctors, it was just that, that there were not enough specific signs that pointed to psoriatic arthritis. But then the eye tipped off a wave of testing and signs and went okay for sure. This is what you have. That's just a research and a time gap. Right. So if we can close that up. And it really is my hope that this is where we're going in the future of autoimmune research is not just developing these drugs that kind of shut off the different parts of the immune system. Immune system that can be dangerous for other reasons. And you know, if anybody needs to be on these drugs, don't misinterpret that into like anti drug. I really think that a combination of the best of everything we have available, whether that is diet, lifestyle, natural therapies, conventional medical therapy, surgery, whatever a person needs, like this is what you need to manage your health and live your best life. Go for it, right?
- [84:33]
A
Yep, yep, yep.
- [84:35]
B
But I'M hoping that the research also encompasses identifying people early because I think that's our best chance at success of managing long term is when, you know, we know what we're dealing with and we know what to expect and we know, you know, the diet and lifestyle strategies that can help it.
- [84:51]
A
Fantastic. Mickey Trescott, tell us where we can find you your book and all the places online.
- [84:58]
B
Yeah, so I am@theautoimmuneprotocol.com I do have a new book out called the New Autoimmune Protocol that has all of the updates that we talked about. But I also don't gatekeep any of this information. I do what I do because I'm trying to make it easier for the next autoimmune patient. So if you head to my website, all the food lists and protocol instructions are located there and I have translations and everything. For anybody who has international friends or family, they want to spread the word. I'm on Instagram ickytrescott and I'd love it if you guys would come say, hey, send me a dm. Let me know that you came from the podcast. And thank you so much, Stephanie. I've been a longtime listener and I really appreciate all the work that you do for this community.
- [85:36]
A
Thank you so much. It's been a delight speaking to you today. Hello and welcome to the after party where I tell you my highlights, lowlights of the conversation that you just heard and couple things. Very, very impressive conversation. I think that there were a couple things I wanted to highlight that I really liked. First was six days, man. Okay, you can eat something and six days later is when you're going to start to see symptoms like that is wild to me because if you ask asked me what I ate two days ago, I couldn't tell you. So I think that that makes it extraordinarily difficult. I think the other part of the conversation that I really liked was how we can really delineate and differentiate between perimenopause and autoimmunity because they just sometimes look like the same damn thing. Fatigue recovery, mood, digestion changes, like hello, that is the life of a mid 40 year old or middle mid 50 year old woman. So I like what she said about being vulnerable, like seeing and looking at her symptom. Like for her it was being vulnerable in a cyclical fashion and symptoms being based on her hormonal status. So again, understanding your menstrual cycle, the how it's changing in perimenopause is going to be really important for you and Then tracking her the primary symptoms and the secondary symptoms that we had discussed in the show. I thought that that was phenom and I liked as well the leaky gut piece present in pretty much every single autoimmunity disease. So really putting your digestion front and center and making sure that that is a priority for you. That was fantastic. Alcohol as an amplifier, that was another highlight for me. And I think one of the things that actually the team was discussing just before I recorded this afterparty is I think sometimes with autoimmunity we think that it is our fault in some way. Like there's something defective with you, something that you did. And I think that there's a lot of shame around. I know we didn't discuss this in the show, but I'm just giving you my personal take on this. Sometimes there's so much shame and unlike other diseases where, you know, you break an arm and everyone sees that you have a cat past or you have something like cancer and you know, you lose your hair, you buy scarves, you ring the gong when you're chemotherapy, like people talk about like f cancer and there's all of these different, like run for breast cancer, etc. There's no 5k run for autoimmune disease. Like, I think that a lot of times people who have these diagnosis after they fight for the diagnosis are often like crap. What is it that I did? Why am I the one? What's wrong with me? And I think there's a lot of shame there. So I just want to to highlight that if you are somebody who is maybe suspecting autoimmunity or you have, you've received a diagnosis just in case. No one's ever told you before, there's nothing wrong with you, you haven't done anything wrong. So I really appreciated her vulnerability, how she talked about being in chronic pain and using diet as a really important tool, not the only tool, but a really important tool for healing. What did you think of this conversation? Is the next question on deck that I have for you. You. And is there anything that you are going to do differently after getting this deep into the conversation? Because if you're listening to this after party, you are a hardcore Betty. So what is the aha moment, if any and what are you going to do differently after listening to it? Because it's one thing to listen to the show, it's in another thing to take action. So I'm really interested in that. Leave it in a review on Spotify or Apple or wherever you are listening, listening and until next time, I bid you adieu. I hope you enjoyed today's episode. And now I must give you the obligatory legal and medical disclaimer. This podcast, Better with Dr. Stephanie, is for general information only. The advice and recommendations we discuss do not replace medical, chiropractic, or any other primary healthcare provider's advice, treatment or care in the consumption of this podcast. There is no doctor patient relationship and the use and implementation of the information discussed are at the sole discretion discretion of the listener. Please take this information to your primary healthcare provider to make the best choice for you. Remember, I am a doctor, but I am not your doctor, and these episodes are meant for educational purposes only.