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- [00:00]
A
How do you prevent kids? What birth control do you want? Don't have kids. Don't have kids. It's really a backwards approach to something that is such a big part of so many people's lives. Time will make a decision for you eventually. That doesn't mean age is the end all, be all, but it does mean that we deserve knowledge and data about our bodies earlier so that we can be the one in control of our reproductive future.
- [00:19]
B
All you hear are these doom and gloom stats like the older you get, the less likely that you're going to get pregnant.
- [00:25]
A
It does get harder as we get older, but by no means is it impossible. Let's focus on being healthy. Let's look at your cellular health, let's check mark for insulin resistance or chronic inflammation, and let's make sure that you're in the best position possible so that you can have an easier journey no matter what your fertility journey looks like.
- [00:41]
B
Welcome back to the Real Foodology Podcast. On this week's episode, I sit down with Dr. Natalie Crawford, a double board certified OBGYN and fertility doctor known for her work empowering women to understand reproductive health. In this conversation, we dig into why your metabolic and inflammatory health matter more for fertility than just your age and the doom and gloom narrative around getting pregnant in your 30s and beyond. Dr. Crawford breaks down how cycle tracking, hormone testing and lifestyle foundations like sleep, strength training and gut health can transform fertility outcomes for both women and also men. Whether you're trying to conceive now or simply want to protect your fertility for the future, this episode is all about giving women the data, tools and confidence to make informed decisions about their bodies. I loved this episode. There's also a really fun announcement, so you're going to want to stay tuned. If you are loving the podcast, take a moment to rate and review. It means so much. I know I ask every week, but seriously you guys, it helps the show show more than you will ever know. So please take a moment to rate and review. If you're loving this particular episode, please tag me. Please also tag Dr. Natalie Crawford. We will try to share them and get it out to people. Thank you so much for listening. We really appreciate the support and I hope you love the episode. If you're finally ready to fix your gut, make your hair healthier and stronger, and add a little extra glow to your skin. In 2026, you need to add colostrum to your daily routine. Today's sponsor, Cowboy Colostrum offers the highest quality bovine that's cow colostrum available in the US. It's 100% made in America from 100% American grass fed cows, which we love and it really matters when it comes to quality and sourcing. What sets Cowboy Colostrum apart is that it's true. First day whole colostrum rich in powerful bioactives like immunoglobulins and growth factors. And don't worry, they only collect the surplus colostrum after baby calves have had their fill. It's also not stripped down or over processed. Cowboy Colostrum is whole, full fat, high protein and incredibly nutrient dense, which is why it's considered the highest quality bovine colostrum you can buy. It's super easy to use too. You just add a scoop of their chocolate Madagascar Vanilla which is my favorite matcha or strawberry into your coffee or smoothie and it genuinely makes you feel good all day and beyond Gut support, these peptides and growth factors help your skin and hair look amazing. For a limited time, our listeners get up to 25% off their entire order. Just head to cowboycolostrum.com RealFoodology and use code RealFoodology at checkout. That's 25% off when you use code REAL FOODOLOGY@cowboycolostrum.com Real Foodology if bloating cravings or that post meal crash have started to feel normal, I want to challenge you to feel better because you don't have to live feeling uncomfortable after you eat. That's why I love the Just Thrive Gut Essentials bundle. It combines two clinically proven gut essentials, Just Thrive Probiotic and the Digestive Bitters. The probiotic is the only one clinically proven to arrive 100% alive in your gut so you actually feel a difference. Less bloat, better energy and feeling more balanced overall. It also is the only probiotic I've ever found that has a strain that you can take while you're on antibiotics because it can actually still help seed your gut even when the antibiotics are stripping your gut of all of its good bacteria. Then there are the digestive bitters. 12 science backed herbs in one tasteless capsule that help kickstart digestion and support GLP1 production so cravings don't run the show. Together they help you feel like your best self fast and there's even a 100% money back guarantee. Take the Just Thrive Feel Better challenge today and save 20% off your first gut essentials bundle. Visit justthrivehealth.com Real Foodology and save 20% off with promo code Real Foodology See the difference for yourself and get a full product refund, no questions asked. That's justthrivehealth.com real foodology. Be the best you with just thrive. Natalie, I'm so excited to have you on the podcast. Thank you so much for coming on.
- [04:44]
A
Thank you for having me. I'm so, so excited for this discussion.
- [04:47]
B
Yeah, we actually got connected through a friend, and I was blown away that you lived in Austin. I love being in Austin. There's so many amazing people here.
- [04:54]
A
It's such a great town. And, you know, I'm not from here originally. My husband is, but it was one of those things in our marriage. He's like, if we get a chance to move back to Austin, I want to go. And it's just such a unique and special city, and we're happy to have you now.
- [05:06]
B
Thank you. And there's so much health and wellness here. It's so cool. So please tell my audience who you are and what your mission is.
- [05:12]
A
Yes. So I am a fertility doctor, which means that I did training in OB GYN and then reproductive endocrinology. So that's seven years of training after medical school. I have been practicing now for over a decade. I have a practice here in town called Fora Fertility. But a large part of my mission is to try to educate women before they come in, meaning when do we learn about our bodies? When do we learn about our fertility? When do we learn how to track our cycles or how the world around us can impact our ability to get pregnant? We don't until it's too late. And so my biggest mission would be right now, the field of infertility is very reactive, meaning you have to fail first before you go see a fertility doctor, before you get fertility testing. And I'm sick of it. I think that this should be a more proactive approach where we start talking about our bodies, talking about our health, talking about testing, or what we should do to have a higher odds of getting pregnant when we're ready to start. And so that's my big mission, is to help women advocate so that we can change the trajectory of their journey.
- [06:12]
B
I love that. Well, one gripe I've always had, just as a woman that's gone through this, personally, I hate that we're not having these conversations with women in their 20s. And honestly, we're not really having it even that seriously with women in their early 30s either. Like, I wish doctors in my 20s were like, do you plan on having kids later? I know you're not now, but do you plan on having them later?
- [06:32]
A
Absolutely. The first chapter in my book, the fertility formula, I'm talking about, even in training, every question is about, how do you prevent kids? What birth control do you want? Don't have kids. Don't have kids. And there's never a discussion of, hey, would you like kids? And when would we approach any life goal, right? You and I both said, hey, we want to be moms one day. But when we were younger, when did anybody ever approach that as, okay, here's what you're going to do to achieve that goal, for our other goals, right? To become a doctor. I knew how to take the mcat, take these classes, do an internship, right? I had this plan laid out for me yet for parenthood. One of the biggest goals I had, it was just, well, don't get pregnant now and then suddenly stop birth control and have no idea what I should do, what was helpful, what was harmful. It's really backwards approach to something that is such a big part of so many people's lives.
- [07:19]
B
I totally agree. And again, like, I wish someone had asked me in my 20s so I could start thinking about it, to prep for it later because I've always known I wanted to be a mom. And what I hate so much is what I then what I found. I started hearing all these conversations about people saying, okay, you want to start prepping for your body for pregnancy, ideally, at least for a couple of years, you don't have to. But that's kind of what I've been hearing is like, detox, maybe get your gut order, your gut in order, do certain things just to start making your body prepared. So then I find myself, because I didn't find my partner until later in Life at like, 38. And then I'm like, oh, my gosh, I'm rushing. I'm like, shit. Like, I should have already been doing this years ago. And now I'm rushing to make sure that my gut is good, that my health is good. Maybe they don't have high glyphosate, like, just all these things that I never thought about, and I wish somebody had talked to me about that when I was younger.
- [08:05]
A
We just don't even have the discussion. So you're not even in a position of power to make educated choices or decisions. And the reality is, for women, our eggs are inside our body, our whole lives. That doesn't mean they're destined to be terrible as we get older, but it certainly means that genetics are one component we can't change. But the metabolic health of our Eggs we can influence by the choices we make every single day. And the sum of these decisions add up. And so the earlier we start having these discussions in the open, women can start making more informed decisions for their overall health, but also their fertility and hormonal health earlier.
- [08:38]
B
Yes, exactly. So what would you do? Maybe take a step by step. Let's say you had a woman that was maybe 25, that was just coming to, maybe she's getting her birth control or whatever it is, and you ask her, do you plan on having kids later in life? What would you kind of advocate for her to do throughout her life to prepare herself for it when she finally wanted to get pregnant?
- [08:58]
A
Absolutely. So, number one, the most important thing that our body is trying to give us is these hormonal clues. Is going to be your menstrual cycle, your period. Yet so often we are on hormonal contraceptive and we lose this vital sign. Your period actually shifts when you ovulate in reference to the follicular and luteal phase of your cycle. Gives you a lot of of data that we're not learning to leverage. And in fact, we're not even starting to pay attention to it until we're having trouble conceiving on the back end. That's so true. So learning your normal can be highly important for later on because shifts from normal always warrant an evaluation. If you're like me, and I was on hormonal birth control for well over 10 years, and trust me, I. I loved it. It was perfect for me at a moment in my life. But there were moments I wish I would have stopped it earlier. I would have said, what is my cycle doing? I would have learned to track my cycle leveraging. And I'll say to this, so many people say, oh, I'll check my cycle. I'll get this app and I'll just put in cycle day one. And they're just looking at when their period is coming. And that's helpful over nothing. But truly, we want to know when you're ovulating, because the first stage of ovulatory dysfunction can be a shift in the luteal phase, which is the second half of the cycle. So if you just say my periods are every 26 days, that's great that they're regular, but that's not telling us the full picture. And so in order to understand when you're actually ovulating, we want to be tracking our cycle either with our basal body temperature, with cervical mucus, or with urinary hormone monitoring. Doesn't have to be all of them, but something to start to understand what your normal pattern looks like so you can evaluate for some of those shifts that can occur later in life. So first cycle track at some point when you're younger. I've had a lot of young women who missed opportunities because they didn't know what their normal was and their body was giving them these warning signs, and I didn't see them until much later. The second is to know that, to put it really simply, inflammation hijacks your fertility. Inflammation is going to harm the metabolic health of your eggs. It's going to harm your body in so many different layers. And the way to combat inflammation is really by taking a more holistic approach to your health. That means looking at your gut health, your gut microbiome, the foods that you eat, but also other things that cause inflammation. Chemicals you're exposed to, your stress levels, how you sleep, how you move your body. And it's not that there's one thing that will cause or cure infertility, but really looking back and saying the sum of these decisions and the length of time that I'm exposed to certain levels of inflammation can be either helpful for me or harmful. And letting the person make the individualized choice for them at an earlier stage.
- [11:36]
B
Yeah, absolutely. Well, and, you know, I have a lot of girlfriends. I, by the grace of God, I got saved by the birth control because for some reason, when I was in high school, my mom didn't want me to go on it. By the time I hit college, I had tried to take it one time. And I think, yeah, I think because I didn't go on it on such a young age. I think a lot of my friends went on it when they were like, 13, 14, and they just didn't have the wherewithal to know that their body was maybe not doing what it was supposed to, or maybe they were having a great experience, too. And that's also a lot of people's stories. But for me, by the time I was like, 21 or 22 when I first tried it, I was like, whoa. Like, I don't feel normal. I don't feel like myself. I feel like I'm a monster. And so I just never took birth control. And so I learned at a really young age how to track my cycle, do all of that. So in that regard, and that was just by accident, and I'm really grateful, But I have a lot of girlfriends. What happened was they were on birth control from, like, 14, sometimes 10, 15 years, and then they're coming off of it. And they're going, oh, my God, I have all these issues that were masked. I never knew that I had all these issues. And many of them were coming off and then hoping that they could easily get pregnant and then realizing, oh, my God, I'm not ovulating, or, oh, my God, I.
- [12:41]
A
They're behind the game, right? Because they didn't get that opportunity to know what was happening in their body. I'll say this, we have a generation of women like myself who were put on the birth control pill and maybe for a valid reason, but it wasn't explained to them. I bet you there are doctors who thought, oh, this person probably has PCOS or endometriosis, but the birth control will fix the complaint. They have. At the moment, they didn't have formal testing done, or at a minimum, they weren't even explained. Hey, I think you might have this. We're gonna do the pill for now, but when you wanna get pregnant, you should consider coming off this earlier or getting more testing done or just some knowledge that really speaks to the paternalistic view we have in medicine or we had for so long that people don't need to fully understand what's happening in their bodies. They just need to be told what to do. And luckily, we're seeing, you know, a huge change. We're seeing women advocate for their own health. And I think that goes along with that. You know, to the earlier question, I think all women should have what's called their ovarian reserve checked at an earlier age. And to be clear, this goes against medical advice. The American College of Ob, gyn, ACOG says, don't check this if you're not trying to get pregnant or you don't have infertility, but there's a hormone called amh, which is made from the cells that surround all of the eggs that you have available in a given month. What's really interesting is I always use the analogy of imagining all the eggs in your body are stored inside a vault in your ovary. So when there's more eggs remaining, you actually have more eggs available every month. Because eggs come out of the vault, one of them is chosen to ovulate and the rest of them died. But as you start to have fewer eggs remaining, fewer eggs come out every month. Long story short is that AMH is made from these eggs. So the more you have, the higher it is, the fewer you have, the lower. And the reasoning, they say, well, if you are not going through infertility, don't check amh. Because they say, It'll cause undue stress and that it's not associated with infertility. Meaning having a low AMH doesn't mean you can't get pregnant. And that makes sense if we think about it right? If somebody has five eggs or 20 eggs, if you're ovulating one egg, both people, you should have the same age related chance of getting pregnant. My argument there is twofold. One, what caused AMH to be low? There's certainly, you know, chronic inflammatory disease, autoimmune disease, things like endometriosis or toxic exposures like smoking cigarettes that can cause a low AMH and can cause infertility. And the sooner you know about some of these, the sooner you can help your body. But also that takes that personal choice away from the woman because if you found out your AMH was low at an earlier age, you might be put in a position where you will do something different. And I've had women freeze eggs. I've had women who have found their life partner earlier and they've said, well, we were waiting to get pregnant because I was chasing XYZ dream, but if I have a limited time to grow my family because I will run out of eggs early, maybe I'll start sooner. And I've had people say, well if I don't have as many, quality matters so I'm going to really start to focus on decreasing inflammation. Or sometimes you say I'm not going to do anything about this, but, but I was the one who made that choice. Because for every single woman, time will make a decision for you eventually. That doesn't mean age is the end all, be all, but it does mean that we deserve knowledge and data about our bodies earlier so that we can be the one in control of our reproductive future instead of just letting the passage of time make that decision.
- [15:59]
B
I used to think that all extra virgin olive oil was basically the same until I learned that most grocery store oils are blended, they're bottled long after harvest and they're often stripped of their nutri. If it doesn't taste peppery or green, it's probably not doing much for your health. That's why Yaya's Evo extra virgin olive oil is now a staple in my kitchen. It's certified organic, single origin and cold pressed within hours of harvest from family owned groves and Greece. You can genuinely taste the difference. It's rich, it's vibrant and it's full of antioxidants and anti inflammatory compounds that support heart, brain and gut health. I use it everywhere on veggies, salads, eggs, even occasionally straight off the spoon, and it makes clean cooking feel elevated and intentional. Their subscription option makes it easy to always have fresh olive oil on hand. If you want to elevate your cooking and your wellness routine, go to Yaya's Evo that's y a y a s e v o dot com Real Foodology to get 15% off your order. And yes, it stacks on subscriptions. That's Yaya's evu dot com Real Foodology this time of year, it feels like everyone is trying to stay healthy through the winter months, and I'm always looking for simple, natural and honestly delicious things to add to my routine to just help my immune system stay on track. I've been reaching for Manukora honey a lot more in the winter, colder weather, more time indoors travel, and just wanting something supportive that actually feels nourishing. What I love most is how rich and creamy it is. This isn't regular honey honey. It has this depth and complexity that makes it feel almost indulgent, but it's still very intentional for your health. Manicora is ethically produced by master beekeepers in the remote forests of New Zealand, where bees collect nectar from the Manuka tea tree. That's what gives this honey three times more antioxidants and prebiotics than regular honey, which support your gut, and that's where most of your immune system lives. It also naturally contains contains mgo, a rare antibacterial compound that really sets Manuka honey apart. All you need is one heaped teaspoon in the morning. I love taking it straight off the spoon and letting it melt and coat my throat. But you can also add it to tea, yogurt or smoothies and even use it to replace other sweeteners throughout the day. I also love adding it to my morning coffee. Now it's easier than ever to try Manukora Honey. Head to manukora.com realfoodology to save up to 31% plus $25 worth of free gifts with the starter kit, which comes with an MGO 850 plus manuka honey jar, five honey travel sticks, a wooden spoon and a guidebook. That's Manukora M A N U K O R-A.com RealFoodology to save 31% plus $25 of free gifts. Yes, exactly. That's why I'm so glad we're having more conversations like this, because I think we keep saying this, but it's like so many people are so many women are going through this Blindly, but to no fault of their own. We're not having these conversations with them. I didn't even know to ask these questions until I started listening to all these podcasts and going, oh my gosh, wait one. I've never thought about this. I've never had a doctor talk to me about this. I've never checked any of this stuff before. Like, why didn't anybody raise a flag to me about this?
- [19:11]
A
And you were, you know, a science educator and you know, you're healthy. You are the perfect person who should know about this information at a minimum. And even you were not armed with, with this knowledge. Yeah, I tell all my friends who are OB GYNs out practicing, hey, in the same breath where you say, what birth control do you want? Say, do you want kids one day? Yeah, at least give somebody the opportunity to say, yes, but what should I do about it? And it doesn't mean we can prevent everything or control everything, but we've gotta have these discussions so that we can play a more central role in what's happening in our own lives.
- [19:43]
B
Exactly. So in the instance of the AMH that you were talking about and maybe some other markers, I don't think this is talked enough about in the fertility world. Are there things that women can do? We're not blaming women specifically, but are there things that women can do that can either help that number or harm it even further?
- [20:02]
A
It's important to understand that AMH is going to fluctuate some, Right? So it's not a perfect marker. It is a reference of how many eggs are outside the vault in a given moment. And we know that number can change by 20 to 30% month to month. We also know that number can be artificially lower if you are on hormonal contraception or if you are not ovul for a prolonged period of time. And that could even be in pregnancy or postpartum or breastfeeding. So there's some nuance to getting it checked.
- [20:27]
B
Yeah.
- [20:28]
A
But importantly, yes, there are definitely things that cause you to run out of eggs earlier. Some part of it is genetic. We're all born with a set number of eggs. We actually lose the most in our egg count from the time we're a five month old baby inside our mom until when we're born at five months of gestation. Inside our mom, we have six to seven million eggs, but by the time we're born, we only have 1 to 2 million in that wild. So you're constantly losing eggs, and we think this is a large reason why Maternal exposures can have a big influence on what younger women may see due to some of the epigenetic changes. Meaning what you choose to do when you're pregnant can turn genes on or off, can influence the egg health or the fertility of your unborn daughter, which is wild in a way, but speaks to the importance of taking care of yourself and the choices you make, both for you and for future generations. Yeah, but yeah, we can influence our amh. We know autoimmune disease, especially the higher you've had levels of chronic inflammation is going to be associated with a decrease of amh. And so anything that's contributing to that inflammatory burden is going to detriment, be detrimental in the long term to what your egg count is. Similarly, toxic behaviors that cause high levels of inflammation. So, you know, smoking when you're younger, marijuana use, heavy consumption of alcohol, but also endocrine disrupting chemicals and things that we talk about a lot that often I find patients can sometimes be dismissive of because it seems really overwhelming. Oh, all these toxins or, oh, the foods that I eat doesn't seem to the average person like it could be that harmful. But if we look at your fertility as a health marker, which we know, women who have infertility have a higher rate of cancer, cardiac issues, stroke, metabolic syndrome, earlier death, and it's not the infertility that causes any of those things. Right. There's an underlying common cause that is contributing to both the infertility and to this latter risk of disease. This is telling us our body's all connected and the cellular health matters so much. And so starting to look at how do we really decrease inflammation, how can we start to improve our long term health outcome is so important, especially when it comes to your fertility.
- [22:35]
B
Yeah, I totally agree. Well, one thing that I've been personally struggling with in the narrative of fertility is we hear all these doom and gloom stats. Right? So my, my audience is very well versed to the fact that I've been on this fertility journey for a little while. I just got married in June and I've been telling my audience I'm like, I hope I don't regret this. Like, I'm kind of giving you as a timeline and like, I'm holding myself accountable to like, I hope I can get pregnant around this window. And I've been listening to a lot of podcasts about fertility and all this stuff and all you hear are these doom and gloom stats. Like, you know, the older you get, the less likely that you're going to get pregnant. The More likely you're going to have miscarriages. After 35, we get called geriatric pregnancy. And I'm kind of on this mission to push back a little bit. I'm not saying that the stats are not saying that right now, but what I'm curious about is it's all about age. Why are we not having conversations about the actual health of the person and the health of the cells? Because I'm also here to share that I'm 41 years old, years old, and I got pregnant on the first try. Yay.
- [23:34]
A
We're so excited.
- [23:35]
B
I cannot believe it. And the only reason I share that, I just want to be very clear, the only reason I share that is not to boast, but to give other women hope. Because what I really found, what I needed the most was not all these doom and gloom stats. I get it. I know it's hard. I know it gets harder as you age because of, you know, your, your egg reserves and there's so many other factors involved. But I don't think there's enough of a conversation about the actual health of your body and the health of your cell. And I would love to hear the conversation more about how that affects your body and your fertility.
- [24:07]
A
You have hit the nail on the head here because even as a field, we have simplified the ability to get pregnant when it comes to, you know, how old you are. And we've simplified the age discussion to simply be genetics.
- [24:20]
B
Yeah.
- [24:20]
A
Right. And genetics are a huge piece. We're not gonna, we're not, we're not gonna say that they're not important.
- [24:24]
B
Yeah.
- [24:25]
A
And I'm not gonna sit here and say that age is not an important variable. But it doesn't mean that it's impossible to get pregnant as you get older. And it doesn't mean that we should have this, well, I'm old, so there's nothing I can do. Or this really doom and gloom mentality, the way I like to think about it is, well, also, thank you for sharing and for opening up and being vulnerable with your audience because we do need more real stories. When women do get older, they get scared. They hear these narratives that are very 3% chance if you're 40 and older. And that's fecundabilities, that's chance per month. And that does sound really scary. But on population based levels, because these are population studies, that is a lot of people. Right. And we have to compare that to, you know, when you're 30, it's 20% per month. It's not compared to 100, because we see 3%, we think 100 and we feel like that's zero. The reality is it does get harder as we get older, but by no means is it impossible. And to me, the empowering part of the narrative is that if it's not all genetics and metabolic health can be important too. Exactly what you're saying. Why are we not talking about our cellular health? Why are we not talking about what we can do to improve the odds of getting pregnant? Because I think the older you are, that just gives you more ownership of saying, well, I can't rewind the clock. Exactly. I can't have found a partner earlier or have been at a place where I could have gotten pregnant. So this is my moment. So instead of perseverating over doom and gloom statistics, we should say, okay, the empowering factor is that but half the discussion is my health, decreasing inflammation, understanding my body and tracking my cycle, maybe earlier fertility testing for some patients. Because if time is not maybe on your side, we want to take better ownership. I also have to say that when it comes to metabolic health, population based levels, women who are 38 and older tend to have poorer metabolic health. Right?
- [26:15]
B
That's exactly it.
- [26:16]
A
Right. We do see that, you know, they have more abnormally shaped mitochondria in their abs, there's an increased rate of having insulin resistance and chronic inflammatory and autoimmune disease. So there's a lot of overlap and nuance by what we might deem to be just genetic and also metabolic cellular health. But I will say this. In ivf, we take eggs out of people, we are fertilizing them in the lab, we're getting the genetic component of your embryos before we implant them very often. And there's a couple truths to be had. One is that that I can only work with the eggs and sperm somebody gives me. So the narrative that IVF can overcome everything is also false and harmful because I'll see some people say my lifestyle doesn't matter or I'll just do IVF and I'll get pregnant. Right. And that's upsetting too because I will see somebody sometimes have really poor egger sperm quality. We'll talk about inflammation and how to decrease their inflammatory burden, improve their cellular health, health, and they'll have a very different outcome in the next cycle. And I think that's also an empowering narrative. But to me, if I'm going to spend the money, time, effort to go through ivf, I want to have the highest odds of success possible. So it's even More important to look at all the factors outside the lab that you can control. We definitely do see a higher rate of genetic abnormalities as you get older. The eggs have been inside your body your whole life. I like to think about the chromosomes. So the chromosomes inside your eggs are, are held in perfect cell division. They're held apart by meiotic spindles, which are proteins. And proteins break down over time. Even in the healthiest of us. Right. We know that that's to be the truth. And I say it's like a line of kindergartners. The longer I ask them to stand in alphabetical order, like higher likelihood somebody's going to get out of line. So they don't split until you ovulate. So if you're 25 and you're ovulating, most your eggs will be genetically normal because they haven't been held there very long. Yeah, if you're 43, most your eggs are going to be genetically abnormal because they've been there for a longer time. They've absorbed more of the wear and tear just of life and tincture of time. But that's just one piece of the puzzle. From there, you know, the egg mitochondria passes on to the embryo. That egg allows fertilization. It has to grow and divide and have the competency to turn into an embryo that can function. So that's the piece of the puzzle that is to dismiss. Based on how early can you start to focus on this cellular health, especially as you get older, there's this, there's nothing I can do. It's hopeless. Instead of saying, hey, it's even more important, like, let's focus on being healthy. Let's look at your cellular health. Let's check markers for insulin resistance or chronic inflammation. And let's make sure that you're in the best position possible so that you can have an easier journey. No matter what your fertility journey looks like.
- [29:00]
B
January always feels like this pressure to completely reinvent yourself. And honestly, I'm so over that. This year I'm way more focused on taking care of the woman that I already am. My energy, my strength, and my future self. If you've been feeling tired, no matter how well you eat or how much you work out, here's something I learned. You can't out train low energy, and it starts at the cellular level. That's why I've added mitopure gummies to my daily routine. They're the first ever longevity gummies that support your cellular energy, basically helping recharge your body from the inside out. They're powered by Urolithin A, which helps renew your mitochondria, your cells, powerhouses, and yes, that is a huge deal for healthy aging and longevity. Healthy aging isn't about willpower. It's about giving your body what it needs to thrive. Don't let another year go by feeling less than your best. Grab 35 off your one month subscription of Mitopure Gummies at timeline.com Real Foodology 35 that's timeline.com RealFoodology 35 while the offer lasts did you know that all chips and fries used to be cooked in tallow up until the 90s when big corporations switched to cheap processed seed oils? Boo. I know. Cue the booze. Today's seed oils make up 20% of the average American's daily calories and recent studies have linked seed oils to metabolic health issues, issues and inflammation in the body. Masa decided to do something about it. They created a tasty and delicious tortilla chip with just three ingredients and no seed oils. Organic Nix demolicized corn, sea salt and 100 grass fed beef tallow. That's it. These chips not only avoid all the bad stuff, they taste incredible and they are so crunchy and sturdy. Unlike the other chips, these don't break in your guac, which is a total game changer. Snacking on Masa chips is nothing like eating regular chips. With Masa, you feel satisfied, you feel light, and you feel energetic with no crash, bloat or gross sluggish feeling afterwards. And an added bonus is that the beef tallow makes the chips much more satiating, so you will not find yourself uncontrollably binging and still feeling hungry afterwards. Personally, my favorite is the Cobanero. They taste like Doritos to me. I also really love the lime, so it's hard for me to pick favorites. If you're ready to give Masa a try, go to masachips.com real foodology and use code real foodology for 25% off your first order. That's masachips.com real foodiology and use code real foodology for25% off your order. If you don't feel like ordering online, you can also go to your local sprouts, stop by and pick up a bag before they're gone. Exactly. And I just, again, I think there's not enough of a discussion about your diet and your lifestyle. I was just thinking, you know, hearing you talk about all that and I was thinking, you know, it's so crazy. I, I'm, I think I'M healthier now being pregnant now at 41 than I would have been if I got pregnant at like 24. I believe it because I was binge drinking. I was basically eating slim fast bars and like Pinkberry frozen yogurt. You know, like we're not doing.
- [32:03]
A
It wasn't a good era for us.
- [32:04]
B
It wasn't a great era at all. Just not taking care of my body, not sleeping well, doing overnights all the time, you know, to study and just not. I mean, I just, I was unwell. I probably had some sort of undiagnosed like insulin dysregulation happening. I mean, just, you know, the list goes on. And so I think about now versus all the things that I prepped my body for in the last year, which I actually really think made a big, big difference. And I've just been on this health journey for the last, you know, 15 plus years making sure that I'm avoiding ultra processed foods. I check my CRP levels twice a year, make sure that those are at normal, healthy ranges. I check my A1C and make sure that I'm not headed towards diabetes or insulin resistance. There's all these things that can and will affect your body and ultimately your fertility if you don't have them in line.
- [32:46]
A
Absolutely. I think sometimes people will say inflammation's a buzzword. You and I both know it can be on a disease process. But actually inflammation is not supposed to be constantly present. Your body is not meant to constantly heal from inflammation. The inflammatory system is actually really important in getting pregnant. Right. And we think about acute inflammation. I get a cut, my body's gonna go he heal it. Well, acute inflammation is also really important in ovulation and implantation. So those are important steps in getting pregnant. So I'll have patients say, can I just take some anti inflammatory medications or you know, just, can we just treat the inflammation? And it's not as simple as that. We even know women who are taking anti inflammatory medications around ovulation won't have the follicle rupture. They'll go through all the hormonal changes of ovulation. But an egg won't be released. So we can't just treat it on the back end. We really gotta take a preventive approach. And things that cause inflammation can interfere with hormone secretion. Kind of interferes with the hypothalamus in the brain, which is the command center for hormone, has to interpret hormones and send out hormone signals. So if you have high inflammatory levels, you have a higher likelihood of having ovulatory dysfunction. So your brain's not going to appropriately respond. That's obviously going to be problematic. And then it's going to directly impact ovarian function. So then can the ovary respond? The ovary protect the eggs, can the eggs mature appropriately? And then, of course, egg quality and some of the metabolic health that we're talking about, dietary change, gut health are probably the biggest area for improvement for most people. Yet it can feel really overwhelming and daunting. It does.
- [34:23]
B
I've been there.
- [34:23]
A
Yeah, same. I used to. You and I were similar. My early 20s. I, you know, glamorized hustle culture. I don't need sleep. I can live on caffeine, eat all this junk food, drink alcohol. I can work hard, play hard. And I was the epitome of that. Was fine. Right. As long as I could, you know, get good grades or do well in other areas.
- [34:46]
B
If I looked like I was doing.
- [34:47]
A
Well, then if I looked like I would was healthy, I was healthy. Right. But that really wasn't true at all on a cellular level. And eventually that will catch up with you one way or another. For many women, infertility or difficulty getting pregnant is that first medical problem they ever have because we're relatively healthy, or ignore our health and then suddenly when we're struggling to get pregnant, it is that gut check moment of what's really happening inside my body. When you then go and you get dismissed by your doctor, it's even worse. Right. And I have patients who've seen other people, they've asked for labs that won't be done. They brought up problems and gotten dismissed. And that was me, too. I had multiple pregnancy losses. When I saw my. Thank you. When I saw my own doctor, though, I was told, oh, just relax, or it's just bad luck. Very dismissive and really eye opening for what it's like to be the patient on that side of the journey. But I think what's really important here is, you know, dietary change in gut health can make the biggest difference. But also, I always tell people, let's not start there, because that can feel overwhelming. Let's number one, start with the foundation of your day, and that's gonna be sleep more. So when your body heals from inflammation, work on lowering your stress levels, because stress contributes to chronic inflammation and insulin resistance. And work on building skeletal muscle, because skeletal muscle can help your body clear insulin resistance and then clear inflammation without having to kind of need the normal process. Right. So if I spend a minute because I use inflammation, I use insulin resistance. And I know your audience is really well educated, but my analogy for insulin resistance is to think about the fact that glucose, so breaking down from the foods that we eat, glucose is the fuel for supplements. Cells, when you eat a glucose is going to be released into your bloodstream and the pancreas is going to send out insulin. And insulin is the hormone that lets glucose into cells. And I like to think about insulin like a salesman knocking on the door, trying to let glucose in. And so if we eat foods that have a lower glycemic index, they don't cause as high of a glucose load, or we're eating up meals, instead of constantly snacking, we're going to have this really beautiful response where we eat. Glucose goes up, insulin goes up, glucose goes in cells, cells, glucose goes down, insulin goes down, process repeats itself. However, if you're eating high glycemic index foods, lots of artificial, you know, sweeteners, ultra processed foods, you're constantly snacking, you're gonna have this constant glucose in your bloodstream. Insulin is then going to be released. And then what's happening is it's like a salesman who comes to your door every day. What are you gonna do?
- [37:20]
B
You're like, go away, go away. I don't want to open the door.
- [37:23]
A
I am not gonna open the door. And that's exactly what happens in your cells. Your cells are like, no, I know who this is. No, thank you. This causes this terrible cycle because cellularly, your energy low. So then your body is going to actually start breaking down glucose from your liver, putting more glucose in your bloodstream. The cell is so sick of seeing insulin still. So the same process is happening, and it results in a process where you need really high insulin levels to even let glucose in. I think about like the salesman's got a pound at the door, so that glucose can even get in. Well, we've got to stop that process, right? And so part of it is changing how we eat, when we eat, what we eat, which we can talk about in a second because I know you and I are very like, have a love language over here.
- [38:06]
B
Yes.
- [38:06]
A
But also, part of this can be, number one, sleep is a great time for your body to kind of lower that glucose burden, to allow some of it into the cells and to become what we call more insulin sensitive, I always say, clearing inflammation. But you've got to sleep at least, least seven and a half hours to give your body time to do this process appropriately. So sleep more, sleep better. Two stress activates this process. And the way I like to Think about it is if we think about stress, let's imagine we live in the olden days and there's a bear and you need to run away from the bear. Your body suddenly needs extra glucose so that you can run away from the bear. It's got to fuel your body. So if we get a really bad email or we have a bad meeting, or we get bad news at the doctor, or we have a bad conversation, all the things that cause stress. Now what's going to happen is your body thinks it's a bear and suddenly glucose is going to be freed up. It's ready for you to go run and use it. But we don't do that. We're sedentary or worse, we stress eat or we stress drink, we add to the glucose burden and we start to worsen this process from having chronic stress. And this is especially hard when it comes to social stressors like PTSD, PTSD, or you know, social environments that never alleviate.
- [39:22]
B
Yeah.
- [39:23]
A
So learning to manage stress, it does work on preventing stress. Right. So building in protective mechanisms because the idea that we can avoid all stress is ridiculous. Instead saying, hey, the world is stressful, so I need some moments to have that cortisol drop. And I'm going to build those in in a way that works for me. And maybe that's journaling, meditation, mindfulness, a walk, feet in the grass, sitting outside, acupuncture, yoga, therapy, talking to friends, less.
- [39:49]
B
Time on social media. It always spikes my stress.
- [39:53]
A
But there's no one size fits all. Yeah, right. There's a lot of different things we can do there. But the other thing I say when it comes to stress is well know your body. So if your body thinks there's a bear, like get up and walk, use some of the glucose that's been released, like let your skeletal muscle use it. And the reason why is that your skeletal muscle has a transporter called GLUT4. And to put it simply, it allows glucose into the cell without needing insulin. So if we can say this insulin resistance problem is happening, but I can bypass this over here by building and using skeletal muscle. That's going to be a huge tool to try to help you get better hormonal health and fight back on this insulin resistance. But what tends to happen for most people because high insulin levels cause you to distribute visceral fat. Yeah, you start gaining weight because insulin's a growth hormone and instead you're like, oh no, I need to go, go do some high intensity workout. I'm gonna go try to lose this extra five Pounds I put on. So instead of building using skeletal muscle, we're using it, but we're kind of doing it in a more cardio focused way. Only instead of picking up weights or doing some resistance or strength training that often helps people get started, that feels a lot more attainable at first. Right. You start saying, okay, I can. Those changes I can start to work on. But the biggest room for improvement is, of course, gonna be improving your gut health.
- [41:11]
B
Health.
- [41:12]
A
Changing the foods that are going into your body and working on avoiding things that are extra toxic, Whether that's in our food or the environmental chemicals that are in our kitchen, our food itself, the processing, everything that's happening, because that is a huge source for inflammation directly. And when you damage your gut, you change the microbiome of your gut. Yeah, the microbiome is important in hormone metabolism, but also in your entire hormonal, mental health communication system. So we really have to start saying these choices that feel very passive or health neutral. A lot of people think the food they eat is very health neutral.
- [41:47]
B
I know, right? It's wild to me, actually.
- [41:50]
A
It's one of the best things you can do to control your health right now.
- [41:55]
B
Yes.
- [41:56]
A
In a month from now, in 10 years from now, is to pay attention to the choices you are making when it comes to the foods that you are eating. Eating it directly correlates with your overall body health and your cellular health.
- [42:08]
B
Yes, exactly. And this is what I. I like to remind people a lot is, yes, of course, there's always things we won't be able to control. I can't control my age. But there are so many things about your health that you can control. And I really like to focus on the controllables because that makes me feel empowered. I can't do anything about the fact that I couldn't find my partner until later, and then I'm 41 and having a baby. But what I can control is how much sleep I get, what exercise I'm doing, am I working on building muscle, what foods am I eating, am I making sure that I'm drinking filtered water? So I'm getting the least amount of exposure to chlorine and all the other stuff that's in the tap water. Right. There's a lot of decisions that we can make that I find incredibly empowering. And I want women and people in general just to know how much of a difference. Difference this can actually really make in your health. Sometimes this can be the difference between really struggling to get pregnant and not.
- [42:59]
A
Oh, absolutely. I mean, to put it simply, Again, like people who are pain and going through IVF will have extremely different outcomes when they are just living, quote, unquote, their normal life. And many people think that they're being healthy. Right. So we're not judging or blaming.
- [43:14]
B
Yeah.
- [43:14]
A
But we're really saying evaluate your life and let's start, look at how these little decisions start to add up. Because the sum of these choices really do matter. You know, my big why, like why you get on social media, why do you start talking about this is I really got sick of sitting across from women who are smart, educated, goal oriented. And they kept saying, if I'd known this information, I would have made different decisions. Right.
- [43:36]
B
Yeah.
- [43:37]
A
We can't always control the outcome. You couldn't necessarily control if you were going to get pregnant.
- [43:41]
B
Yeah.
- [43:42]
A
But you knew you were going to be in a position of power by saying, I'm, I'm doing everything I can to have the highest chance of success. I'm taking other variables, variables off the table. I know I'm decreasing my inflammation, having healthy foods. I have like a good foundation for this to be able to happen in addition to knowing your body and tracking your cycle. So coming to it from a place of knowledge and power and not just relying on luck or the luck narrative, I think is so empowering and really important.
- [44:08]
B
I totally agree. And I, the way I was just picturing this is just get all the obstacles out of the way that you can. You know, like you're, you're climbing a mountain, you're to going, going on a hike and it's, it's gonna be tough already, but like, let's get all the debris and stuff that's in your path out of the way to at least make it a little bit easier and give you a better chance of getting to the top of the mountain.
- [44:27]
A
Oh, absolutely. It's like running a marathon. You're gonna just show up one day and run it or you're gonna train, prepare, know the course, know what you're doing. Right, Exactly. We wanna come into this from a place of knowledge. We are goal oriented. We are smart enough to know that it doesn't make sense that the choices we make every day don't impact our fertility.
- [44:44]
B
Exactly. And I think this is what I've really, really been trying to get out in my message is that for so long we've been hearing in the medical system, oh, there's absolutely nothing you can do. It's just all genetics and it's all your age. This is just what happens. There's nothing you can do. There's a lot we can do.
- [45:00]
A
The data supports that too. It's important to say this isn't just you and I sitting here saying this is the way that we like to live and the way we think other people should. Data actually supports that inflammation is harmful to your fertility. There's a lot of population based studies showing greater adherence to anti inflammatory lifestyle practices improves the odds of getting pregnant naturally and with fertility treatments. So why do we not talk about this on a greater scale? I mean, you and I are both sitting here talking about it to help educate women, but that knowledge should help you feel empowered and say, okay, great. Hopefully that can be the nicest to change for a lot of people who do want to get pregnant women or even outside of pregnancy. Right in your 40s, you know, menopause is going to be coming for everybody. And so the longer your ovaries function, the better your hormones can communicate. The better hormonal health you have, the lower inflammation, you're going to do better throughout perimenopause and the menopausal transition than you are if you are already going into that change in a state of poorer health.
- [46:00]
B
Yeah, exactly. So something I want to talk about because I want to hear what you, what advice you give, your patience, but I also want to share what I did leading up to this. So about a year and a half ago is when I really like, I've been paying attention for the last couple years, but I really started to go, okay, I just want to make sure that I have all my ducks in a row. I want to make sure that I'm not dealing with any sort of underlying thing that like, I need, if I need to address it, I need to address it now. And so I found just some little stuff like that I needed to like clean out my gut a little bit. My gut was kind of like all over the place. I had some like dysbiosis and stuff. So I was doing, you know, cleanse and like getting my gut in order. I was testing for environmental toxins. I actually at one point found my. I've been testing my glyphosate last couple years. My glyphosate randomly shot up and so I was detoxing. Glyphosate. I'm trying to think of what else we did. I also got myself and my husband on a prenatal a year ago.
- [46:52]
A
Love it.
- [46:53]
B
There's this brand called Wenatal where they make one for the men too. And this is the other thing. As I sat down, my husband and.
- [46:58]
A
I Was like, we are not trying, but my husband takes that.
- [47:01]
B
Yes. It's just good for them in general. Right. It's good for their longevity and vitality. And. And so I sat him down and I was like, okay, there's some things that we need to, like, make sure that we're, you know, really cognizant of, like, please don't drink as much as you have been.
- [47:15]
A
You know, like, this is before you're even married. Or you're right. Approaching that. But you're being so proactive in your approach here.
- [47:22]
B
Exactly. We got my husband's gut tested. We got all of his markers tested. We just wanted to. To make sure that everything was in line. Because if there was anything really serious, like, let's say that I had. I was dealing with endometriosis and I didn't know it. I wanted to know now so that I had time to deal with it.
- [47:36]
A
Absolutely.
- [47:37]
B
So what are some other things that you suggest that women, if they know that they are eventually going to want to get pregnant, what are some areas that they should just start exploring now?
- [47:45]
A
Okay, so first, you already said it. Right. So being on a prenatal vitamin is going to be really important. So I'm going to say, number one, prenatal vitamin. I always say a man should be on a men's multivitamin as well. We know that many partners are not going to do what you're not going to tell them to do. So you need to be like, hey, honey, like, let's do this together.
- [48:01]
B
Fertility. I have to literally give it to my. I'm like, please take this same.
- [48:04]
A
I'm like, here's a little jar. This is for you. Fertility is a team sport. 50% of infertility is due to male factors, 50% to female factors. So this idea that the burden is all on the woman, that's all we've talked about so far, is really also not true. In addition to that, that sperm change every three months. The life cycle of a sperm is so different. They are generated in the testes. They are packaged and developed. That's so different than you and I, who have our eggs inside our body our whole life. That means that the lifestyle of a man can make even a bigger impact. Yet day to day, I see the opposite. I see women jumping through every hoop, doing every test, being as healthy as they can, and their partners making no change. Maybe they're smoking cannabis, they're not sleeping, they're doing whatever they want. And so, number one, I love what you said is the we, we wanted to do this. This was a goal for us. We sat down and said, what do we need to do to have a higher chance of this happening?
- [48:59]
B
Yeah.
- [49:00]
A
And so hopefully everybody listening is in a relationship where they can have that conversation too. So instead of just you do your thing, he does his thing. This is a team sport. What are we going to do? How are we going to change? And even in my own journey, when I started to do research in fellowship, I was having my pregnancy losses. I was told there was nothing I could do. And I started learning about environmental chemicals, endocrine disrupting factors. I did. I studied pfc, so perfluorinated chemicals and their impact on ovarian reserve and fertility. And I was like, oh my gosh. Like we have Teflon pans and we have plastics in our kitchen. And of course, this was 12 years ago, so it wasn't quite as common knowledge as now. But I remember coming home and getting rid of all of it and my husband being like, what are you doing? I was like, we are making changes, Right? Like, this stuff is not good. So take this team based approach. Right? So we need to say, number one, prenatal vitamin for both. Number two, if you have known health issues, do not pass go. Right? So go get those explored. If your partner has difficulty achieving or maintaining an erection, has low libido, gaining weight, has diabetes, pre diabetes, those things all need to be, you know, worked out. Now there can be a sign of something else. If you're a woman, your cycles are telling you a lot about your body. So as we said earlier, tracking them, your luteal phase should be at least 11 days in length. Your period should come regularly. Predictably, you should be able to take your finger, put on a calendar and with one to two days of accuracy, know when your period's coming. Many women have what I call irregularly regular or like, it's coming this month, but I don't really know when. Or it can hop around week to week. That is too much variability. Or they have a short luteal phase or spotting in the luteal phase, which is a sign of an ovulation problem. Could be thyroid, prolactin, hypothalamic, that warrants an evaluation earlier. Similarly, if you're bleeding through your clothes, it's not normal. And if your pain is so bad from your period that you're not going to dinner, you, you're working from home, you're canceling plans with friends, that is not normal. The problem with period symptoms and pains is that many women like you talked about earlier. Well, they were on contraception for a long time. They never learned what was normal. But also, we don't do a good job of sharing. So we assume that, okay, well, my periods are really painful, but nobody else is complaining about theirs. I must have a low pain tolerance and just not deal with it well. And that's the narrative that we even convince ourselves instead of saying, saying, oh, I shouldn't throw up for my period pain, or, oh, I shouldn't have to call in sick to work. That's abnormal. That's concerning for endometriosis or adenomyosis or uterine fibroids, and I should get that evaluated. So really thinking about your period and working up any of those period problems should happen from the get go. So we have, are you ovulating? Can you detect it? Do you have any kind of period abnormalities? And then there's preconception testing, which a lot of people don't talk about. This is evaluation of things before you get pregnant that can make a difference in your story. I'm a big fan of preconception genetic carrier screenings. This is seen if you and your partner carry the same genetic disease. Courtney, I'll tell you some of the saddest stories I've seen are people who did not have infertility but got pregnant with a baby with a genetic disease that died, and they had no idea they carried this. And so we've all heard of some of the more common ones that can be survivable, like cystic fibrosis or spinal muscular atrophy. And those can be serious and devastating. But some of the worst ones, things like Pearson syndrome or Barette Vidal, you don't even. These people have babies that die. It's. They don't even know about it, sometimes till postpartum. It's devastating. And they can do IVF with genetic testing if they want to take this really terrible disease out of their family line. Yeah, but just knowing you have that ahead of time can be helpful. And it doesn't mean you have to do ivf. But another good story is I have a couple sometimes that come back with congenital deafness. And I've seen this a lot. I've seen this more commonly. And people will make different decisions. So if you and your partner both carried a gene and you had a 25% chance your child could end up deaf, I've had some patients say, you know, that would be really hard for us. We want to do IVF and, you know, have a higher chance of having a hearing child, child I've also had patients say, you know, we're going to start to learn sign language. We're going to make sure that we get in with the community and that we know about earlier, you know, neonatal hearing screens and that we have the right resources so that if they did have a non hearing child, they were in a position of power. Instead of learning about this, could you imagine postpartum, really emotional. Right. So they said, okay, we're making this active choice. So again, it goes back to being the one to make the decision. And we can't make decisions on data we don't know. So genetic carrier screening is just a simple tube of blood checking to see if you're a silent carrier for a lot of different conditions. It's not really clinically relevant unless you and your partner carry the same one, which odds are you're probably not. But again, we don't know unless we check. Right?
- [53:53]
B
Yeah.
- [53:54]
A
And then there's some vitamin and hormone levels. So things like we talked about AMH already, you know, thyroid hormone, vitamin D, these are things that can be really helpful to check ahead of time because we know that diet deficiencies or problems can make it harder to get pregnant.
- [54:07]
B
Yeah, exactly. I'm curious to know, in your experience, have you ever seen differences in fertility outcomes with patients that have really bad diets and then patients that have really.
- [54:18]
A
Good diets, you know, bad and good. I don't love bad and good for diet. Right. You probably don't either. Right.
- [54:25]
B
Well let me rephrase that then. Maybe patients that are eating more ultra processed foods and fast foods versus just eating whole real foods.
- [54:31]
A
Absolutely. I, I think it's, you know, again, there's always n of 1. So when we talk about this, somebody's going to come in the comments and they're going to say, but my sister in law ate McDonald's every day and she got pregnant with five kids and it was no big deal.
- [54:46]
B
Like it's an anomaly or it still happens. Yeah.
- [54:48]
A
So of course there are going to be people whose bodies are different. Here's the thing that I say. Like all of our bodies are different, our gut microbiomes are different. But if you're in a place when you want to say I want to get pregnant fast as possible, I want to have an easier journey, I want to decrease the risk of having a complication, then paying attention to these things is going to matter. On the whole, people who are healthier tend to have better outcomes than people who make poorer choices. That of course is not all or nothing. Meaning Some people make really great healthy choices and they still have a difficult journey, of course. And some people do nothing that we recommend and they get pregnant just fine.
- [55:22]
B
Yeah.
- [55:23]
A
But when we look at the odds of it or saying, hey, I want to optimize my odds, I want to try to remember, run the marathon knowing what's coming, we are going to see improved outcomes when we are eating less ultra processed foods, when we're actively decreasing our insulin resistance. So avoiding artificial and added sugar, when we're increasing, you know, fruits, vegetables, fiber, feeding our gut microbiome and ultimately eating a healthier, more anti inflammatory dietary pattern is going to be extremely important in your long term journey to health. But especially for hormone health and fertility.
- [55:57]
B
Exactly. I want to know what's one health trend that you wish would die?
- [56:03]
A
Oh, the carnivore diet. Right. So it's not that all animal meat is terrible, but you know, in general. Right. Animal meat doesn't have fiber. And if we're going to roll back to the gut microbiome, fiber is the food for it. Fiber is really important to have a healthy gut microbiome and ideally getting that fiber from a diverse array, array of fruits and vegetables that have different micronutrients is going to be really important.
- [56:26]
B
Yeah.
- [56:26]
A
Well what we see is that people who are on the carnivore diet and they're not eating fruits and vegetables, they have a really limited dietary pattern, they are not feeding their gut microbiome with what they want and ultimately that's a very inflammatory dietary pattern.
- [56:39]
B
Yeah, I know. I will tell you, I'm, I'm on the fence with Carnivore and here's why. I completely agree with you and I think long term, I think it's terrible. I'm, I always say, for me, I don't believe in diets, I just believe in eating real food. And that to me means you eat a whole array of everything that was once alive. So plants, animals, you know, fruits, vegetables.
- [56:59]
A
Produce fiber, fats are not processed.
- [57:01]
B
Exactly, exactly. However, I have seen short term for very specific situations where somebody has like, I mean my husband is actually a perfect example of this. We went down this whole journey for two years trying to figure out his psoriasis and nothing, nothing, I mean it's driving us nuts, like nothing has helped. And he went on Carnivore for like four months and we basically got rid of like all of the psoriasis on his elbow except for on his scalp. But again, I see it as a very short term clinical thing where maybe for a couple Months. But I think it's more the fact that it's an elimination diet.
- [57:35]
A
I was gonna say it's so limited that it's almost hard to say which thing we're not consuming was the problem. And.
- [57:41]
B
Exactly.
- [57:42]
A
We're always, when we look at dietary studies, one of the hard thing about it is, well, what were we doing ahead of time? Are we going from standard American to carnivore, which is still probably going to be an improvement.
- [57:51]
B
It's going to be way better for you.
- [57:52]
A
Or are we going from Mediterranean to carnivore, which is probably going to be harmful for you? 100.
- [57:57]
B
I personally, like, I hear about people just, this is their whole lifestyle and they're like, I'm never going to eat anything else. I'm horrified by it because I'm just like, you need a variety of food, you need phytonutrients, you need the antenna antioxidants. There's so many other things you're missing out on. So I agree with you on that.
- [58:10]
A
You know, I always tell patients it's not really sexy, right? Like carnivore diet sounds sexy. Like what we're recommending isn't as sexy because you've heard about it a really long time, right? Avoid the easy processed foods, avoid added artificial sugars. You need to have, number one, fruits, vegetables, fiber, number two, healthy protein sources, right? If you're gonna have, you know, dairy products, we want them not to be processed. We want like, like that whole fat, that real dairy. And then when it comes to your carbohydrates, they're not all created equal. So really lean towards those, you know, whole grain, those complex carbohydrates. That doesn't sound very sexy to the average person. Right?
- [58:45]
B
And it's, let's be real, it's not click baity, it's not controversial, it's not, oh my God, all you're eating is meat.
- [58:50]
A
And we should say fats too, right? If I pass over that. But healthy fats are so important to your diet, especially when it comes to hormone health. Cholesterol is literally the backbone of your steroid hormone hormones. Meaning if you are not eating fat, you are not giving your body what it needs to make progesterone and other hormones. So we've got to really look at, especially, you know, those unsaturated fat options, the olive oils, the nuts, the avocados that can be so advantageous for your body. And making sure that we're not in this low fat craze which we've seen kind of a tend away from that. But I will say, right, as we see skinny culture coming back, I am seeing more patients who previously felt comfortable, you know, eating fat. And I say full fat dairy and having good, you know, fats in their diet now getting really nervous about what they're intaking again as we're seeing kind of public perception of body size, you know, switching back.
- [59:41]
B
It's the ozempic effect.
- [59:43]
A
It is the ozempic effect. And you know, I think GLP ones can be really incredible for a lot of patients, especially those with pcos.
- [59:48]
B
Yeah.
- [59:49]
A
Chronic inflammatory disease, we can see a lot of benefits. But I think societal, we are seeing a shift towards smaller body sizes and that can do some detriment towards eating patterns.
- [59:59]
B
Yeah.
- [60:00]
A
Especially to those of us who did grow up in the low fat craze at all. Right. It almost seems like patients maybe are not even aware that some of the bias they're having towards the foods that they're eating. For sure.
- [60:10]
B
I will tell you, you actually reminded me, this is another thing that I started doing. So I had Sally Fallon on the podcast last year who wrote Nourishing Traditions. And one of the things she told me because I told her I was on a fertility journey and I said, what do you recommend I eat? And she goes, eat full fat dairy and have it every day. And I was always one of those people that I had avoided it. I was diagnosed with lactose intolerance when I was younger. And so I just, I never really ate it, but I've been doing a 2 dairy and I've been doing full fat. And I swear to God, obviously I have no like stats or science or anything to back it up. It's just intuitively. But I feel like that might have made a difference because I just feel like my hormones came more online. I felt a little bit more vital. There's just something about having those full fat, the full fat that helps your body.
- [60:54]
A
What we know about dairy is for a lot of fertility markers, it seems quite neutral. However, full fat does better. Low fat skim options actually can be harmful and then there's certain nuance to it. Right. And so what I say is that, do you need to be to just purely eat cheese and yogurt and dairy?
- [61:11]
B
No, no, no, not what I'm saying.
- [61:13]
A
Can you incorporate it into your diet? Yes. And you should feel comfortable that it is a good, you know, fat protein source, that it can have good nutrients in it, but you should choose the full fat version. Yet we still see people getting skim milk or Low fat yogurt. And I always say, hey, there's processing involved in that. You're taking out some of the nutrients that are in there in this processing. And you and I are both trying to walk people back towards a simpler way of eating, eating where we're eating foods more in the forms that they're coming.
- [61:39]
B
Exactly. And let me be clear, I wasn't like, you know, I'm not gorging myself on dairy all day. Exactly. It's like, okay, I've been adding a little bit of cottage cheese, I've been adding a little bit of Greek yogurt, you know, and balancing all of that out with other things. But I just.
- [61:51]
A
A lot of people do get diagnosed with lactose intolerance or sensitivity to dairy. I think often this is happening because of other factors in our diet at that same time. And when you start to eat cleaner in other areas and you're having less processed foods, many people can incorporate full fat dairy back in and they actually are not sensitive to it they previously thought they were.
- [62:11]
B
Yeah, well, and I really think there's a lot to it. I mean, not even. I think there is data to back it up that if you get it from a two dairy cows, your body processes it in a different way because it's a different type of protein. So a lot of people that say that they have issues with dairy, I want to be very clear, not everyone, but there are a lot of people that say that when they have a 1 dairy, which is the majority of what you see on the shelves, if they get a 2, they don't have any sort of react reaction to it.
- [62:34]
A
I mean, we could have an entire podcast about factory farming and the food industry and what that has done to the food that we're eating, how that impacts, you know, our hormones and our cellular health. Yes, right. So I think what we have to do is start empowering people to make those educated choices. And there's times where you don't get to choose which type of date. Right. Maybe you are at a friend's house, you're at a restaurant. So we make the best decisions we can in the moments that we have to make the decision. But then that to me speaks to the importance of the moments that we are in control. Things in our house, the food that we purchase, making sure that we're making those really informed choices so that we can experience the world around us and not worry that this one time exposure is going to set us off on some terrible inflammatory cascade because we are all exposed to inflammation. Our Diets and everybody. We are going to have moments where we eat something and your body's meant to process that inflammatory burden and then heal from from it. But if you have a higher baseline inflammatory level, you're not going to be able to heal from these one time exposures. So that's what we're trying to change.
- [63:32]
B
Is there anything else just based on everything that we talked about today that you really feel like women need to hear?
- [63:38]
A
I think the biggest thing I'm going to say is that when it comes to your body, we've got to educate, right? So we're trying to increase, you know, the baseline fund of knowledge. 2 We have to advocate for our own health. We have to be the steward of our own journey. Unfortunately, the current medical system isn't made to be really friendly to patients right now. And there's many great physicians stuck in bad practices or bad systems. But that means that it's up to you to fight for your health in a certain way. Part of that means scheduling appointments that are made to evaluate your problems. So one good example to leave with is to say, I have so many patients who will say, oh yeah, my period's abnormal, but I'm going to bring that up to my ob, my annual. Well, that's not the point of an annual exam. An annual exam, your doctor has 15 minutes to get through a slew of preventive health questions. Instead, schedule a problem specific visit, say irregular cycles and go in. But also as a physician, I can only work with the data that you're giving me. So take the time to think through your story. How long has this problem been happening? How did things used to be? When did it change? What's associated with that? Because the first question you'll often hear is tell me what's going on. So be prepared for that question. Know your story and come to the table in a way that you can help your doctor out as well. But also you're not married to any physician and if you're getting dismissed gaslit, you're not getting what you want. There are a lot of good physicians out there in different health structures. Go see somebody new, your physician care team or your nurses or your PAs, whoever you're going to see, they have to be advocates for your health as well. And this is is a personal relationship. So do not hesitate. And especially Aster Star, Star, Star. If you're trying to get pregnant or have infertility, you need to trust that the person who you're trying to get to help you also understands your goals and is Aligned. Because you don't want to second guess everything. You don't want to be searching the Internet. You want to trust that y' all are in a partnership. So if that means sending your records, getting another opinion, please, please, please do that. And then number three, life is hard enough. There's inflammatory exposures everywhere. Control the factors. You can. Everything that we're talking about to say, hey, I want to make sure that I have the highest odds of success, that I'm my healthiest self. Those things do, in fact, matter. And I hope that information is empowering to people and that we kind of refuse the luck narrative and instead say, I have more control over this than I previously been told. And I'm going to leverage that to my benefit.
- [66:04]
B
Yeah. Yes. I'm so, so glad that you brought all of that up. It's so incredibly important. I don't feel like many people. I think the conversation's being had more, but I think so many people go into their doctor just thinking like, okay, I just have to take whatever they say, and if they don't respect me and I don't really feel respected by them, I just have to keep going back to them because they're my doctor. And no one's ever told you, well, you can change doctors. You don't.
- [66:28]
A
You don't have to go to who close teeth or who your friends saw. Yeah, send your records, go see somebody else. The end.
- [66:34]
B
Yes, it should be a symbiotic relationship. And I like to remind people of this because I'll get messages from people all the time. I'll say, well, my doctor's not listening to me. They won't even run any of these labs. And I go, sounds like a new doctor.
- [66:45]
A
Absolutely.
- [66:46]
B
Get a new doctor. And that's totally fine.
- [66:47]
A
I mean, I'll see it on a fertility end, too, where people are doing IVF cycle or transfer after transfer. They're not getting questions asked. They're doing the same protocol. No changes. Nobody's really personalizing anything. And that's not normal. But again, to one of our earlier points, if that's all you've ever experienced, you're going to think that's what everybody else goes through instead of saying that's not what the normal relationship should be. You deserve to have a healthcare patient relationship that you feel really good in, that you feel seen and heard, and somebody who, even if they can't get you all the answers, they're trying, they're giving you the data that you need to make the best choices you can in that Moment, moment. So if that means a new doctor, send out records, travel for care. I know that not everybody's privileged enough to be able to do that, but if you can, you deserve that.
- [67:33]
B
Yes. I love. I'm so glad that we ended on this. I feel like that's such a good reminder for everybody. Please let everybody know where they can find you.
- [67:41]
A
Oh, absolutely. So I am on instagram @natalie crawfordmd and I host the As a Woman podcast. My debut book, the fertility formula is in pre order right now. It'll be available in April. I'm so excited. It goes through everything we talked about, but in so much more. Right. So the first section's all educating what I want you to know about your fertility. Two is advocating when things are off, what should you do or what should you do when you want to get pregnant. And the third section is optimizing how are we going to leverage decreasing inflammation and the data between that and our fertility. And I practice at 4Fertility here in Austin. So thank you so much.
- [68:13]
B
I'm so excited about your book. I can't wait to get my hands on it.
- [68:16]
A
It I'm going to get to you as soon as I can.
- [68:17]
B
Yay. Thank you so much for coming on, Natalie. This was awesome.
- [68:19]
A
Thank you.
- [68:21]
B
Thank you so much for listening to the Real Foodology podcast. This is a Wellness Loud production produced by Drake Peterson. Theme song is by Georgie. You can watch the full video version of this podcast inside the Spotify app or on YouTube. As always, you can leave us a voicemail by clicking the link in our bio. And if you like this episode, please rate and review on your podcast app. For more shows by my team, go to wellnessloud.com see you next time. Thank you. The content of this show is for educational and informational purposes only. It is not a substitute for individual medical and mental health advice and doesn't constitute a provider patient relationship. I am a nutritionist, but I am not your nutritionist. As always, talk to your doctor or your health team first. Are you ready to rock middle age? I'm Dr. Tina Moore, Gen X truth teller and holistic physician. On the Dr. Tina show, one of the Apple Podcast top alternative health shows, I share what actually works for metabolic health, hormones and strength backed by decades of clinical results, not trends. From loving the gym and hitting your protein goals to peptides and microdosing GLP1s, it's all done the right way, not the hype way. Because menopause doesn't have to suck if you're fit. New episodes every Thursday Produced by Drake Peterson and Wellness Loud.