B (3:49)

Definitely. And again, this is conventional versus integrated versus functional. Right? So perimenopause is where the hormones start to shift. And that's probably the simplest and easiest way to explain it. So most, you know, we all get our period somewhere in our teens, and we're usually have a regular cycle. We usually get pregnant easily, all that other stuff. But somewhere in your mid-30s, things start to shift. And that age is different for different women. For some women, it might be earlier. For some women, it might be later. But that shift in hormones is very subtle. Most people don't notice it initially, but then it kind of crescendos. It gets louder and louder and louder until it's really impacting your life. It's impacting how you feel, and it's impacting how you see yourself. And so those are the early warning signs. But it does start very young. It starts around 35 is the technical definition. And think about it, like, so many women now are not even getting married till 35. They're not having children until 40, so they're already entering this perimenopausal hormone shifting time when there are a lot of other life stressors. So it just makes for a very challenging journey through being a female. And we've got to talk about it. There are solutions, there is hope, but we've got to dial into it and figure it out. We can't just be like, okay, well, yeah, that's your cycle. That's not acceptable.

C (5:04)

So you can be perimenopausal and fertile and carrying a child.

B (5:09)

Definitely. So perimenopausal is the decline in hormones that starts around 35. But it's not a steep decline downhill. It's just. It's very slow. It's gradual. There's these tiny little whisperings that happen. And the earlier we as women kind of latch onto that and start to understand that, the more we can do for our health. It's really interesting, in Chinese medicine, they don't see hormones as a start and stop point like we do in Western medicine. Right. They see it as this very fluid continuum that you have a lot of control over. You can control it by your diet, how you sleep, how you take care of yourself, how you manage stress. And so they would say, well, if you're starting to see that shift or 33, well, it's time to check in with your health. It's time to understand what's going on so that we can fix those factors, so that we delay this hormone shift that's happening. Not because the shift is bad, but because the hormone levels in your body are very much a vital sign. They're very much a sign of how you're functioning, how everything is flowing. They're tied to inflammation. They're tied to so many different aspects and pathways in our body. So that shift is what we all, as women, want to be aware of. And it's not like a big dramatic, like, aha, you're in perinatal menopause. It's more like very subtle changes in.

C (6:24)

How you feel and what are. What are you feeling? And does that. Does it always correlate with a drop in progesterone?

B (6:31)

I would say maybe even before the drop in progesterone is the cortisol dysregulation. So you notice that your stress tolerance just changes. Like, you could have handled a lot 50 projects at a time. Now the slightest thing is throwing you over the edge. So I think the first thing, even before progesterone, is that cortisol starts to get wonky. And think about it like you've lived through your 20s, you're in your 30s, and you've probably maybe lived hard, done a lot of stuff.

C (6:54)

The drugs, the sex.

B (6:56)

The drugs, the sex, or the work, whatever it is. But you push yourself and it starts to show. So I would say cortisol is the first thing that goes. As cortisol starts to get off, then progesterone drops and that drop in progesterone. And most of us know progesterone is that hormone that's secreted in the second half of our cycle. So when that progesterone starts to go down even a little bit, we start to lose sleep. So that's the 2 o' clock in the morning waking up. It makes the cortisol piece work. We start to get worse, we start to get a lot more anxious.

C (7:26)

Why are we waking up at 2 o' clock in the morning? What happens there?

B (7:30)

What's happening is that drop in progesterone, right? So progesterone is going down. Progesterone actually acts as something that balances cortisol. So if you've had a high cortisol level maybe all the way along, the progesterone that you were producing helped to manage that. So you could sleep through whatever stress, whatever you were dealing with. But when that progesterone drops, you know, it doesn't have that check and balance system anymore. So all of a sudden you're up at 2 o' clock in the morning and you can't go back to sleep and you're walking through your next day. You finally, this is what most women tell me. They fall asleep by 4 and then it's time to wake up at 5, 30 or 6. So you're walking through your day just completely foggy, not feeling good. So that's probably the first shift that really happens, that cortisol progesterone relationship. Some women catch it, some women don't catch it. They keep powering through their lives, they're not aware of it. And I think the next one is, is that your estrogen levels start to change and progesterone has gone down. Now estrogen starts to get stored and so you start to get really heavy periods or really irregular periods. Many women start to gain weight. They'll notice more weight in their hips or their thighs or their abdomen. The response is usually, I'm going to work out harder and I'm going to starve more in response to that. And that makes the whole hormone thing worse. So we're caught in this hamster wheel when really just very subtle, tiny things right at that perimenopause shift could stop, it could calm it down, get a good night's sleep, balance those hormones before you even progress any further. But most women don't catch it when it's happening.

C (8:58)

So those symptoms of really heavy period, et cetera, that's from low estrogen, or that's estrogen dominance, that is from low.

B (9:06)

Progesterone, primarily making estrogen very dominant and impairing how estrogen is broken down. So basically what we're left with is this very low progesterone, higher estrogen levels. That gives us this Very heavy period. Because that uterine lining, we need the progesterone to shed all that stuff away, to get rid of all that stuff. It never completely goes away. So every subsequent period is super heavy, super painful, A really big deal. Women talk about, like, bleeding through their underwear and all that other stuff.

C (9:37)

And then some go, that's what's happening to me in these past few months.

B (9:41)

Such a. Like, you know, women tell me they're afraid to go anywhere. You know, like, I don't know when I'm going to bleed through my stuff. And then finally, I was just on.

C (9:48)

An airplane and like, I won't go into details and gross everyone out, but, like, it was so crazy and so fast, regardless of what normal precautions I had taken, right? Like, I had to take a sweatshirt off my friend and tie it around my waist to get off the airplane. I was like, what am I, 16 and I don't know how to use a tampon? Like, what is happening here?

B (10:11)

It is that surge. I mean, that excess uterine stuff, basically, because you're not shedding completely every cycle. That's what's happening. And so it's so. So many women deal with that. And to me, those are the earliest signs, I think, of perimenopause. Is that sleep disturbance, you know, those periods starting to get wonky, the heavier periods, and then kind of everything else starts to follow suit, kind of in a very like domino effect sort of, you know, and you have the fatigue and the brain fog and all that other stuff starts to come next.

C (10:40)

So if we're having gut health issues as well, our gut issues impacting our ability to clean, clear out the hormones and regulate the hormones.

B (10:50)

Yes, and such a good point and such a good question. Because the gut is really ground zero. You know, I talked about it in the 21 day belly fix. It's really ground zero for your health. It's a detox organ. So people that are constipated, not eating foods that really are the right foods for them, having a lot of belly bloat, all of these things, they really care what's happening with your hormones. In addition to that, when we go to the Eastern systems of medicine, right, they think the liver is a part of the digestive system. They don't think of it separately. And remember, the liver, I've always said, is kind of the laundromat. It cleans everybody out. It breaks everything down. But your liver starting to get sluggish too, as you hit this perimenopause menopause timeframe. Why just from burden, toxic load, like the burden of toxins in your life that you've been exposed to up until this point. Diet makes a difference, like the quality of the food you've had. Drinking, if you've had maybe more than a drink or two every week or so, that might play a role. Medications that we go on, all of these things burn the liver. And here's something that is directly from Eastern systems of medicine. Our feelings, our feelings burden the liver. So if we have a lot of repressed anger.

C (11:59)

Anger, right.

B (12:00)

Yeah, they always said, or grief, any of these things. The liver holds all that stuff. And so one of the things that has been, like, haunting to me is the patients where they've gone through a divorce or they've gone through a loss of some kind. And I hate saying this when it's. But like, I can almost clock it. Like, they'll tell me their stories and surely eight, 18 months later, we're dealing with something and something with the breast, because the breast is on the liver meridian. So our emotional welfare, our emotional health is very much connected to this conversation around hormones. So that's why it's not just like one data point. It's like gut liver. Your emotions, your stress levels, your toxic load. How does it all impact how you're going to feel as you go through this hormone shift or through this perimenopause menopause timeframe, which does not need to be bad. It is not the end. I think that's the one message that we really need to get across, that this is not a stopping point, expired, and we're done. You know, instead, it's really a time for us to come into our power. But it does need a rebranding for sure, so that women understand that.

C (13:05)

Yeah. And especially like now, as I look forward to look forward to menopause, I'm going to be positive about it, which I'm sure you know, will come within the next, I don't know, however many years. So can you take the severity of the symptoms of perimenopause and apply that to menopause? Meaning like, you know, are you more predisposed to. To have a harder time or if you start to have a difficult time in perimenopause, are there certain things that one can do to start to mitigate the more severe symptoms that I imagine come with menopause? Not that I know quite yet.

B (13:45)

Yes. So, I mean, I think that's such a great question because I do think all of this is within our control. I think that's the Good news. That's the message there. And yes, there is a correlation. I think if you've had a really rough perimenopausal transition, right, late 30s, going into your 40s, you may. If you do nothing, that's assuming you're not going to do anything, you may have a really rough menopausal transition as well. I always say it's so fun to watch my patients because the ones that slide through menopause, right, no issues, no hot flashes, no night sweats, they're like in their power. They're running marathons. They're doing their thing. They know how to take care of themselves, really. That's what it comes down to. They have done the work of understanding the factors that are influencing their hormones. And that's where, for everybody listening, I would urge them to understand that if you're having any sort of hormonal roughness, any rough patch there, understanding all the factors that may be contributing to that. So what is your gut health doing? Where is your liver health? Are you super stressed to the point that is showing now in your hormone levels? What is your toxic load? Is that something you can start to manipulate or change and you don't have to make a ton of changes? Sometimes it gets really overwhelming when people hear this stuff and they're like, oh, my God, she wants me to change my whole life. No, it's usually just a couple of tweaks here and there really, really make a difference. For example, so many women are obsessed about their weight, right? They're so worried about their weight. But here's a simple fact. We know that if your BMI or your body fat drops below about 19% or 20%, you're going to have a really rough time in perimenopause and in menopause. Oh, really? Amount of body fat to weather these hormone shifts and these hormone fluctuations. So women that are highly overweight or very underweight both have issues with transitions because they don't have the buffer they need to help the overall hormone balance. Because hormones begin with cholesterol. That's the bottom. If you look at the pathways and geek out on that stuff, the bottom sort of molecule there is cholesterol. So women that don't have enough body fat suffer greatly compared to women that have kind of the right amount of body fat.

C (15:51)

Why? How come? What does body fat have to do with the hormonal pathways?

B (15:55)

So that allows a certain amount of cholesterol to be produced in the body, which then allows a certain amount of hormones to be produced on its Own. Regardless of the signaling that's happening from here to here, you know, so. So we need a little. We don't need to be overweight. That's another, you know, hormone dilemma there. But we do need to be balanced. So being too thin shouldn't be the goal. And this is, again, Ayurveda, Chinese medicine, they talk this stuff. They talk about being too thin, being too vada. The more vata you are, that more wind energy, air energy, then the faster they say you would dry up. That's the way they would describe it. Like, the hormones would dry up. It needed lubrication, it needed fat, it needed water. It needed these very basic things to function effectively. So that's why when we marry, the two kind of worlds of medicine together, you really have a powerful formula for understanding how to take care of yourself. I think if we just relied on Eastern medicine, we wouldn't get the whole picture. And if we just relied on Western medicine, you wouldn't get it. But when you put the two together, you have an aha moment. You're like, okay, I get it. Like, this is where I need to be. This is what my gut wants. This is kind of where my hormones need to be. This is how I can nourish myself. And then you're able to move forward.

C (17:06)

And are you taking the ayurvedic doshas into account, too? So, like, I'm vata, you know, I'm. I'm air and whatever.

B (17:13)

Yeah, definitely.

C (17:15)

So. So how do you use that in your diagnostic?

B (17:20)

So a part of my methodology is, yes, to use the ayurvedic diagnostics, to use the Chinese medicine diagnostics. Because it educates me. I mean, sometimes I'll use all this language, and I'm sure the patient in front of me is like, what are you saying? But it's really for me because it educates me. So knowing your vada, there are things about you that I know just like that. Like, I know you've got adrenal fatigue. I know you're low in progesterone. I know you have low cortisol levels and prone to thyroid dysfunction. So I know that just by knowing your vada. Right. I haven't seen a single one of your lab values yet. I don't know what they say, but I could.

C (17:52)

I just had them done. And you're right on every single one. Except my thyroid is apparently okay.

B (17:57)

All right, so that would be one I'd watch, right, because that's the next at risk, you know, kind of hormone. But the beauty of Marrying this stuff is that we know that vata is prone to certain hormone imbalances. Pittas are prone to certain hormone imbalances.

C (18:10)

What are Pittas? What do they tend to look like, and what are their imbalances?

B (18:13)

So I'm a Pitta dominant. I have a little bit of Vata, but definitely pit to dominance. So we, for example, have a lot of thyroid issues, and we have a lot of insulin regulation issues and cortisol issues because we're like, go, go, go, go, go. But that cortisol level gets out of control. It drains the thyroid. The thyroid is one of the first things to go. And then that in turn will affect insulin regulation and all this other good stuff. And they have insulin and estrogen dominance issues. That's what we see over and over again. They have issues with insulin resistance, and they have a lot of estrogen dominance, prone to fibroids, heavy periods. So again, and a lot of this, if we just even stuck to Ayurveda, but we married it to the patterns that we see in practice and the lab values we got. We get so educated about sort of what we need to watch out for on any particular person. And then you add Chinese medicine to the mix as well. You just get more information. I mean, it's really fascinating. It'll hone in on, well, the gut's the issue. No, no, no. The liver's the issue. Wait, no, it's stress. It's anxiety and depression that's really driving it. So just, again, makes it more and more precise rather than, okay, you're having hormone problems, take this pill. It should shut everything down. You'll be okay.

C (19:20)

So you'll look at the Ayurvedic dosha. You'll do Chinese medicine diagnostics. You feel pulses and look at tongue and stuff like that. And then you'll do kind of a blood. Blood labs.

B (19:30)

Correct. And we'll put all of that together to kind of come up with a formula.

C (19:35)

And so what do you. What is like kind of your general. You know, if somebody is. I mean, pick your dosha. But if someone is struggling with hormones, where do you normally start?

B (19:48)

I would say gut and diet is really always the starting point because there's so much that can be done there. Let's talk about. Let's talk about the pittas, for example. So I'm a pitta, as I said, and they have so many digestive issues. We talk about Pittas and Ayurveda as having a lot of digestive fire. Right. So they have all this. They hold everything in their gut. They feel everything in their gut. So you want, they need to be on a diet that, that's very simple, that's easy to digest, otherwise it's going to be more of a burden to the gut and the liver. Which is why the thyroid kind of takes a hit and the insulin takes a hit and all that other good stuff. And sometimes just the diet, before I even get into take this or take that, shifts everything. That was my story at 28, right? Just going gluten free shifted everything, all my hair came back, my thyroid corrected, and I hadn't yet delved into a million different supplements or medications.

C (20:37)

Were you celiac? Were you verging on, I think our.

B (20:41)

True celiac, but I think it runs in our family. I'm not celiac by the definition of celiac disease. That's used like if you do a biopsy on me, it's normal, you know, So I think a big portion of the population is getting missed or we need to change the definition of celiac disease for sure. Because there's just so many people that have my story. I'm certainly not the only one, but I am a testament, like so many others, as to how a simple diet shift changed everything. Now, it didn't change it instantly, right? It took time. It took a solid six months to a year to really see it. But it was so powerful, you know, so Pittas would benefit from, you know, gluten free, dairy free diet. They actually need food, they need digestive enzymes, they need probiotics, they need all these things that help the gut. Sometimes we can stop there and let the hormones shift on their own. But if someone's really suffering, right, they're having all these hormone symptoms, they're not doing well, then yes, we prescribe hormones for sure because we want to provide like a band aid almost to get them to feeling normal so that they can then do all the other work that needs to be done to get back into balance.

C (21:47)

And let's talk a little bit about hormones because there's fear around hormone replacement causing female cancer. And I think a lot of women white knuckle it through hormonal changes because of all the fear. So can you break down a little bit like from your perspective, when are hormones, okay, do you use bioidentical hormones? Are you doing sublingual? Are you doing creams or suppositories? Give me a hormone breakdown.

B (22:17)

Hormone breakdown. Okay, so here's my general thought on hormones and here's where the tide is sort of shifting. So yes, the world Health, Women's Health Initiative for four years, scared women, right? They had the study on women taking hormones found all these women were getting cancer or estrogen based diseases. They stopped it midway. And ever since then, and it's been like over 20, 30 years now, but ever since then, everyone's been afraid of hormones. What we are finding in research is that women really need hormones. We're finding that brain volume shrinks without hormones. We're finding all these other factors. Hair, skin, libido, cognitive function, joint health, bone health, all this other stuff is highly dependent on hormonal health. So women shouldn't be afraid of hormones. Here's where we get it wrong. Typically in the exam room. And so we have just blanket prescriptions, right? Like between you and me and maybe somebody else sitting here, we'd all get the exact same prescription for hormones that doesn't work. And the reason that that doesn't work is because all our genetics are different. We have different sort of markers for gut health and liver health and how we break things down. And so what I tell women when they're coming to me and asking me this hormone question, and sometimes they've had an estrogen based disease in their family, so they're scared for that reason too. It's not so much the hormone is bad, but it's what your body is going to do with the hormone. So if you have a really weak gut, or you have a toxic liver, or you have high stress levels and someone turns around and gives you this big prescription of estrogen and progesterone and testosterone, then yes, that stuff is going to get stored. And if it gets stored, it's going to activate genetics that probably need to be left alone. On the other hand, it's done very gently, like not taking over the body. Right. Again, a very sort of that subtlety, that softness, then you augment the body, you don't take over the whole hormone pathway. So I'll do a lot of bioidentical creams, troches which dissolve under the tongue, vaginal suppositories, we'll do even orals. We'll do what works for the patient, essentially, because some people don't like cream, some people don't want to stick anything in their vaginas, some people don't want to take a pill. So we'll customize it. But the commonality there is that it's very low dose, it is bioidentical. And then sometimes if the bioidenticals are not working, where we're not getting results, then we will go to some of the conventional stuff that's out there, like the patches, which are a little bit more gentler than the old study, which used Premarin, right. The horse's urine, and got the estrogen from there. So we use stuff like that. And it works beautifully as long as you are monitoring levels. So you have to understand where estrogen levels are, where estrone is, which is a storage form of estrogen, where progesterone is, and all the derivatives. And I think what happens. And, you know, to this day, we'll have patients come in and say, well, my doctor wouldn't check my levels, you know, or they said the levels don't matter because we don't know where you are in the cycle. And I would just push back on that. There's some absolutes that we know that women need to feel good. Like no woman feels good when their progesterone level is under 0.5. No woman feels good when their estrogen level is starting to go below 50. So, you know, you can start to look at these as absolutes and dose appropriately and gently and not take the body over. And people feel amazing. And again, not to talk about too many personal stories, but I went through this journey. I'm now. How old am I? I'm 49 years old. I'm about to be 50 next year, right? But 20 years ago, almost 21 years ago, I had to go on progesterone because I was in that phase where my body was so depleted, couldn't make it on its own, but had to go on it for a period of six months. And then once the diet stuff caught up, didn't need it anymore and still haven't needed anything until now, you know, so again, like.

C (26:03)

So you're not taking anything now?

B (26:05)

Not at the moment, you know, but.

C (26:07)

And do you attribute that to diet? You know, like, cleanliness of liver, all of those. All of your systems are functioning well.

B (26:14)

I think it's very much connected to diet and to kind of my regimen that I take and. And my supplements and acupuncture and all these other things that I do. I know the time will come where I will need it. And I did go through an incredibly stressful time a couple of years ago back in 2019. It was just like hit after hit after hit. And it's interesting, as much as I know when the heart's broken, the heart's broken, right? Like, you can't out think yourself out of anything. And it took a hit on my hormones and I started to have more irregular cycles. And those irregular cycles became super heavy, like what you were talking about, where I'd stand up and like I'd stay in the chain that I'm working on and all this other craziness. So it was again, you know, another wake up call to, hey, like, you know, we've got it, we've got to figure this out. I've got to start taking care of myself better. And kind of went into, okay, I can't. I started saying no a lot, right? I can't do this. I can do that. I need my massages, I need all this other stuff. So it took me, it took me a few months to get back on track. And so for that blip of time, I went back on progesterone and it helped me get back on track. So we go through these things in life because life is life, right? And we don't do know to what, what's going to get thrown our way. And sometimes we just need some support. But when we get back on track, then we're able to come off of this stuff. So now, so that happened, what, two or three years ago, and now I'm back off everything again. But, you know, I'm in a shifting age and I accept that. So something could change next year or next month, and I have to be prepared for it.

C (27:48)

When you have a patient on hormones, how often are you checking her levels?

B (27:54)

Such a good question. So I tell patients, when you're on hormones, I need to see you at least twice a year. I want to look at those numbers. Ideally, I know it's inconvenient, but ideally, quarterly is what's best because we can see what's happening. And the beauty of checking hormones. And for any of the younger women listening, the beauty of knowing your numbers all the way through is that we know when you're off, you know, because what's normal for you might not be normal for me. And we've got to know, like, this is where I felt really good. Like, I'll have patients with thyroid stuff tell me, you know, I feel great when my TSH is between 1 and 2. I try to replicate that on another patient. She feels horrible. She needs a TSH around 4. So I think the beauty of knowing your numbers and tracking them the whole way through your hormone journey is so important. And it continues to be important in menopause. Many menopausal women also, same thing like, oh, I don't need to know this, I'm in menopause. But you still need to know, like, you still need to know what your derivatives are, what all the different metabolites are. What is your body doing? Are you converting anything into estrogen? We need to know these things to be able to proactively take care of you. Because we all want to be vital as we go into the kind of this next phase of life and we don't want the surprises that kind of slow us down and stop us, us in our tracks.

C (29:09)

So good to start getting that baseline when in our 20s. When, when, yeah. So that we have, I would even.

B (29:15)

Say, I know you have a teenager and so do I and I have stories about that as well. But like, my daughter's 13. Like we checked her hormones, already diagnosed PCOS, already figured out.

C (29:26)

Really?

B (29:26)

Yes. And her brain, like once she got on the regimen that I, you know, we were having some issues with her and, you know, some of it I didn't know how much was like teen stuff and how much was hormones and how, you know, so took her and got test. She's replicating me and I'm seeing like the high androgens and all this stuff. So I put her on a regimen, totally natural regimen. She by the way, was begging for Accutane because she's got acne. And you know, mom, all my friends went on Accutane, please, please, please put me on. I go, I will. But let's look at everything first. Looked at it all, treated the androgens with saw palmetto and did a couple of other things to take down the PCOS component. Her brain woke up, she is like sailing academically and mood wise. When we were struggling quite honestly with trying to just be like, what is happening to this sweet girl? So again, I would say teenagers, check them in your teenagers. It doesn't have to be over and over again in the teenagers, but maybe once every couple of years. And then when you get into your 20s once a year and you get into your 30s once every six months.

C (30:27)

Oh, wow. So how do we go about like what is a really comprehensive liver detox? How do we do that?

B (30:37)

You can definitely start with the liver. And there's so many kind of organized detoxes out there. A lot of different companies make everywhere from a three day to a seven day to a ten day liver cleanse.

C (30:47)

And do you like those kinds of things?

B (30:49)

So here's what I've learned about us is that we like programs, right? We like a structure. We like to follow, like do this now, then do this. We don't want to think too much about things. So I like them for that reason because people can wrap their head around, okay, I'm doing this three day program, or I'm doing this seven day program and I'm at the end of seven days or 10 days or whatever it is, I'm done and then I can move forward. Whereas if I just send them out with like, these are the things to take, then it's kind of this like, okay, maybe I'll get to it, maybe I won't. So I think I like them because they're motivating and they force, force everyone to take action. And sometimes if you do them in a group setting, that's even better. But there's so many different ways to do them, you know. And I think that it can be as simple as doing green juices for three days in a row and taking out all proteins and being really plant based and then adding one or two supplements like milk thistle or dandelion root or one of these things into your, into your regimen. And it can be as complex as like truly trying to detox yourself from heavy metals, from mold, where you're taking binders and all that other stuff. So I think that, you know, I don't want to recommend one way of doing it because there are a lot of different ways to do it, but I would.

C (32:00)

Should people go to their doctor before they do a detox?

B (32:03)

So I think going to your doctor and understanding kind of what you're, which for you, that's probably the best one. Because some of the ones that are more complicated you can have reactions to, you know, we'll have patients that are weaker or a little bit sicker go and do a liver detox and the next thing you know, they're reacting to some of the products in that detox. I think that probably is the best.

C (32:24)

Advice or reacting to whatever they're detoxing.

B (32:28)

Right, that's getting released, but it's too strong, right? Like if your detox reaction, if you're not strong, then your detox reaction sometimes you can't handle. So they take you down and out. So you're having like light sensitivity or these weird rashes or numbness and tingling in your hands and all of that is just the detox reaction is too much for you. So you never want to put your body through that. I never feel like the win on that is worth all of that pain. So I think it is important to maybe check in with somebody. But sometimes just simple things, a three day juice cleanse, three day belly fix, you know, some of those very simple simple plans are liver detoxes and you don't have to overthink it.

C (33:07)

What is a three day belly plan?

B (33:09)

That's one of the ones that I have is from the belly fix book, but we're down to just three days. And it's a three day belly fix, but it's a way to just kind of clean out the gut and the liver if you don't want to sit there and do the whole 28 day, 21 day plan.

C (33:22)

So will you talk to me a little bit about. And I don't know if this plays into hormones or not specifically, but chronic fatigue, fibromyalgia, like what the heck is going on? Why are we so exhausted?

B (33:37)

Yeah, I think there are different reasons and I think the first place for women to go is hormones. If they are experiencing chronic fatigue, chronic pain, new onset autoimmune symptoms. You know, like if you've got a new diagnosis for rheumatoid or any of these autoimmune symptoms, get your hormones checked. Because what's happening often is that the hormone shift is triggering inflammation, it's triggering changes in digestive health. And all these different symptoms are starting to get managed by different medications or things like that. But the root is never addressed. Many people don't realize that progesterone is an anti inflammatory. It almost works as well as like a prednisone, which is a drug that we take for inflammation.

C (34:23)

I thought that was a steroid.

B (34:25)

Which is a steroid. Exactly. So you know, when, when most people have like chronic pain or they're having joint pain, many doctors will start with prednisone. Right. They'll start with the steroid to take the inflammation down. For women in particular, it's usually because they're losing progesterone. And that in turn creates the chronic pain fibromyalgia type symptoms. But then connected to that too is their thyroid, what their thyroid's doing, what insulin levels, we're doing, all of these play into that. Now, once you have, have solved or you've tried to solve the hormone piece of it, chronic inflammation is something that triggers all of those symptoms. Is there a virus that your body's not able to clear? Is there a toxin that you're not able to clear and that's what's causing it. But for every patient that has one of those syndromes, whether it's fibromyalgia, chronic pain, rheumatoid arthritis, any autoimmune disease, I will say it's three hits. And what you want to do I was thinking triangles. And what you want to do is really uncover the three corners of your triangles. One of it is hormones. Another may be stress. Another maybe. Maybe you had an infection or something else happened. But it takes three hits to develop one of those type of syndromes. So it's important to work with somebody to help figure that out and be able to put all of those pieces together. Why are we so tired? Is a number of things. I mean, if we look to Chinese medicine, they would laugh, right? They would laugh at us like, we're busting it. We're busting it at both ends. We are pushing ourselves to the max. Whether we are raising children or building businesses or working or whatever we're doing. We're the center of everything. And they would say we're so tired because our livers are sick of us. They're tired of us pushing us and having that cortisol level go higher and higher and higher until it sort of plummets completely. And that, in turn, is the reason why so many of us are tired. We don't know when to say no. It's a part of superwoman syndrome. It's a part of not knowing how to identify our boundaries, how to nurture ourselves, how to really dial back in, because it's not rewarded. Like, when were you rewarded last time for sleeping eight hours? Who said, good job. You slept eight hours. I'm so proud of you, you know, so it's not rewarded. And so women.

C (36:33)

Actually, my husband this morning. I somehow slept for eight and a half hours last night. And I came into the kitchen this morning, and I was like, what am I, like, a teenager? And he was like, congratulations, that's awesome. But I felt so.

B (36:49)

You're not sleeping enough. You're not sleeping enough. I felt guilty. Yep. See, there it is. It's classic. You feel guilty. I feel guilty. Now. I think a lot of us are built that way and wired that way, and we're tired because finally the body gives up, and we're in a chronic inflammatory state. Our immune systems are shot. We're vulnerable to everything that's out there, and we kind of live in the state of chronic fatigue. So I think that's what's happening there.

C (37:19)

What are the latent viruses that you find? Or, you know, as we were talking about before, can you tell me a little bit about the diagnostic tools for those things? Like, do you. Are you sort of like a detective?

B (37:31)

If you're.

C (37:31)

You start with the gut and somebody's not improving, and you. Hormones and then they're still not improving. Do you keep going layers down? And what are the tools that you use to find out?

B (37:40)

That's exactly what we do. So I would say we always start gut hormone diet, right? Maybe. Then the next layer up is nutrients and nutrient deficiencies. And then probably the next layer up, we get into this world of chronic viruses. We get into toxicity, we get sort of into that world. But I usually reserve that for a period because I know the body and I know the body can do so much on its own if I take care of these first bottom layers initially. Now, when it comes to the viruses that we see. So Epstein Barr is one that reactivates in women all the time, especially when they're again, just beaten up, have adrenal fatigue, have pushed it for too long. That, again, is mono, if any of you remember the mono virus that you might have gotten in high school or college, but it reactivates when the immune system's weak. Lyme is a bacteria, and there's been so much chronic Lyme that's been missed. And myths about Lyme. Lyme doesn't exist here. It doesn't exist there. It's really everywhere at this point. So it is something we need to be thinking about. But again, it becomes active because the immune system is just. Just tired. It's tanked. You know, it's done. And a lot of that is tied right back again to the gut. So those are two that we see over and over again. We're seeing more weird ones. Like, there are all kinds of mycoplasma infections that we're seeing. That's an opportunistic infection typically known for, like, a walking pneumonia. So, I mean, there's. There's so many. Those are probably the most common viruses and bacteria that we see. But after that, the toxicity part, like the mold is a big one. Especially, you know, I'm in the south, we see a ton of mold over here, and that's a big one that we pick up over and over again. That's really wearing the immune system down, triggering yeast overgrowth, which then is causing other issues, too. So we see all of this stuff. So how do we diagnose it? You know, we will look first. And in our practice, like, we are really respectful of trying to use what's there. So we'll use a lot of, like, conventional lab work, like LabCorp requests or things like that. We'll run titers, we'll run panels on that. And if we're still not getting the answers we need, we do some of the specialty Testing, but you can look at those titers and get a pretty clear picture of what's going on. So that's one way we do it. The other way we do is a little out there, but I love it. So we do a lot of frequency and vibrational sort of diagnostics that will sometimes pick things up that my labs won't pick up or my labs will pick up like six months later, whereas the vibrational stuff picked it up on the front end. So again, it's this.

C (40:04)

What is vibrational stuff?

B (40:06)

How does that. It's like you put your hand down. I don't know if you've heard of it, but it's like there's a scan called the Zytoscan or the biopulsar, and you put your hand down. And every point on our body can be mapped to a frequency, to a rhythm, and then that rhythm or frequency is in turn mapped to an emotion or to an organ and to a like substance even. So it does all this mapping. So you'll get a map of all the different frequencies going on with your body. So sometimes there it'll say line or mold or Epstein Barr. One of these things that I wasn't even thinking. So again, I do a lot of this stuff for me more than for anybody else, but I wasn't even thinking about this. And it shows up. And then I'm listening to the patient and you're getting the history that goes with it, and you're like, wait, maybe we should go there. And so then we start doing the lab work. And maybe initially the lab work doesn't show, but I'm convinced by the history and by this other stuff. So I start to treat, the patient gets better, and then six months later, it shows up on lab work. So the labs are sometimes. And this is true of hormones too. I feel like the labs are often behind the physiology that is happening. And that's why our intuition, our ability to really listen to what's happening to our body is so critical and so important. And that's where those eastern diagnostics become really important too, because I feel like they beat the western system when it comes to picking things up in a timely manner. All the Western stuff picks it up when it's like, ta da, it's like super obvious it's there, right? But the Eastern stuff is. It's quiet, it's subtle. So that change in the pulse, the change in the tongue, the change in your face color, the shifting of your hormones, all of this stuff is a way of the body talking to us and if we listen, then we'll catch it earlier than waiting for the labs to tell us kind of what to do.

C (41:49)

I find it so fascinating. I just wanted to ask you because you said you've been treating a lot of long haulers. So how are you addressing it?

B (41:58)

So, yeah, Covid's been so odd. It's been such an odd virus. It is disrupting the hormone pathway in women and we're seeing that over and over again. And I can't, I don't understand it, quite honestly. I don't understand how it's doing it or how it's able to do this. But what it's doing is it's kicking up the hormonal imbalances. I think it's disrupting kind of the pituitary function. And then for so many women and men, actually it's cognitive and it's respiratory and it's inflammatory. Like they're having joint pain and all these other symptoms that they were not having before. So our approach to dealing with it is again, not to sound like a broken record, but we have to literally rebuild somebody. It's like kind of building a house back up and it's laying the foundation. All right, we now have chronic inflammation in the body. We have to go on an anti inflammatory diet. This is not forever, but we've got to do it.

C (42:48)

And what does that tell us?

B (42:50)

Very low gluten, very low dairy. Really watching sugar, watching. Watching salt. Salt is a big one. Like keeping salt under 1500 milligrams a day or so and then getting in the plant based foods, the healthy fats, not eating too many raw foods because that's hard on the gut. That's again an eastern principle. But eating more steamed or slightly sauteed foods so that the gut can digest them well. So thinking about starting there, then working up to that next level to deal with all the nutrient deficiencies that have come about because of this, because the body's just been in overdrive. So many people need supplemental magnesium, they need supplemental methylated B vitamins, they'll need antioxidants. So they'll need that support. But where we really see like once we get that foundation built, where we really see like people go over that hump is by using, and I don't know if you're familiar with this, but using LDN or low dose naltrexone.

C (43:43)

No. What's this?

B (43:44)

It's an anti inflammatory, but it doesn't have like the side effect profile and sort of of all those other consequences of going on prednisone. So we'll put them on very low dose naltrexone and we'll put them on glutathione. Glutathione is an antioxidant but also has a lot of anti inflammatory properties. And we find that four to six weeks of like this gut regimen, getting the nutrients where they need to be, hormone balancing, doing ldn, doing glutathione, is helping our long haulers kind of within about four to six weeks or so really start to feel more like themselves and the shortness of breath starts to go away and the inflammation goes down. Because essentially what Covid is doing is sending the immune, immune system out of control and creating just very, very high inflammatory state. So that's why it's taking a long time for people to heal.

C (44:30)

Yeah.

B (44:30)

And their genetics involved and I don't think that's been studied yet. But like I'm finding the folks that have the hardest time with it have mthfr, have comt, like these are gene markers that you can test, but those are also people that with or without Covid already had detox issues or had a tendency towards chronic inflammation. So there's that piece of the puzzle too, which is why really struggle with it. Whereas other people can walk around and they don't have any symptoms whatsoever. So I think there's that differentiator too.

C (45:01)

And what about IVs like NAD or phosphatidylcholine or vitamin C or anything like that? Do you believe in any IVs?

B (45:09)

Yeah, we do a ton of IV therapy at the practice. But again I'm targeting. Right. It's like making it efficient, trying to target. It's hard for people to do a lot of stuff, you know, even if they, they have the time for it, it just gets weary. So I will use the vitamin C, but in the case of long haulers it's glutathione, ldn, gut work, hormone balancing diet that has seemed to work.

C (45:33)

Is LDN a prescription medication?

B (45:35)

Yeah, it is a prescription. So you do want to work with a provider that is able to do that and prescribe that.

C (45:41)

Also hair loss. So what can we do about that?

B (45:45)

So I would still look critically not only at thyroid, but look at progesterone, look at estrogen. Again I will look at your iron levels. That's a big one. So your first step might be just to over optimize your iron, whether it's iron shots or an iron infusion and that may arrest it pretty quickly. But thyroid is interesting. So that's one that has to be interpreted with care because sometimes it's taken a hit and we don't realize it. But that and progesterone, those could be the reasons you're losing hair. I always try to tell my patients to pay attention to their hair loss. If it's right here, kind of from the crown, it's typically thyroid. Right? It's usually the thyroid that's affected, affecting it, or it's nutritional. If it's like you have like thick strands of hair and now each individual strand is sort of thinning and becoming like paper and then just kind of coming out. Those are a different hormone pattern. That's the androgen. So that's like your testosterone and your DHEA and DHT and those type of hormones. If you're losing kind of like right here at the temples, that's more estrogen and progesterone shifts, imbalances.

C (46:54)

Okay, I told some of my friends I was interviewing you today, so I just have a couple more quick things. Night sweats. So I have a friend who's suffering really badly from night sweats. First it was just before her period and now it's happening more consistently through the month.

B (47:09)

So what is for her? How old is she?

C (47:14)

She's like 40. She's like my age, like 47.

B (47:17)

Okay, so I'm 48.

C (47:19)

I'm not trying to make myself sound younger. I'm 48.

B (47:22)

She's probably, she's having estrogen fluctuations. So that's what's going on. So night sweats and hot flashes are when estrogen, it's not high or low, it's just flip flopping constantly.

C (47:32)

Okay, so is that the body trying to regulate it?

B (47:35)

It is, yeah. It's the body trying to regulate, trying to balance it out. Is she taking anything? Like, I would put her on maca if she's not already doing that.

C (47:42)

Okay.

B (47:43)

That often helps with night sweats. I would put her on evening primrose oil and even CBD oil is helpful too. If it's unbearable, she probably should go on very low dose like estrogen and progesterone replacement. And there's nothing wrong with that. Like, I mean, I would just keep the doses low, like a milligram of estrogen and probably 25 milligrams of progesterone. And that probably would take care of it.

C (48:05)

Okay.

B (48:07)

And then diet, remember, always plays into. We didn't talk so much about diet and hot flashes and night sweats, but remember caffeine, sugar, alcohol, chocolate, spicy foods, all of those make night sweats and hot flashes much worse too. So just something to remember there.

C (48:21)

Okay, that's good to know. Okay, I have another friend.

B (48:25)

Yes. She need to meet these friends.

C (48:28)

I know.

B (48:29)

We should have brought them all in.

C (48:31)

I have three questions from three friends.

B (48:33)

Okay, got it.

C (48:34)

He is having real libido issues, and she always loved sack, and it was never an issue. And now she's like, I would literally rather watch Fox News than have sex with my husband.

B (48:51)

So libido issues are super common through the whole thing. Perimenopause. For some women, it sets in after childbirth. It sets in really, really early. But, you know, the most simplistic answer is that her testosterone levels are low and they've dropped. And would replacing that help? And with doing vaginal testosterone. Testosterone help. Some women don't want to jump to the hormone route. So for them, you know, we'll suggest, first of all, zinc, believe it or not, boost libido. So just simply going on some zinc or the amino acid arginine, boost libido as well. So those are some natural things she could do.

C (49:25)

Great.

B (49:25)

There's a new medication called Addy. It's a D, D, Y that helps with libido, but again, that's now going the pharmaceutical route, and it's supposed to help with sort of, you know, this whole low libido issue in women is supposed to be the female Viagra compared to the male Viagra that they've got.

C (49:43)

Do you prescribe it ever? Have you?

B (49:45)

I've prescribed it a few times. Usually I prescribe medications, but usually this approach works of, like, sort of balancing getting hormones right, getting nutrients right, the gut where it needs to be, that I don't have to prescribe it very often, but I have prescribed it, and women do seem to see a difference when they use it. But it's kind of like my last. Like, you know, I'll reach into all these buckets, and that's kind of the last bucket I'll go into, too.

C (50:06)

Yeah. But there's nothing wrong with medications. You know, it can be an absolute lifesaver.

B (50:11)

Yeah.

C (50:12)

Okay. And my last one, and this is a really important one, because it was really vulnerable that she asked, and I think a lot of people might be experiencing this as well. So she's also, well, a little bit older than I am, so, like, 51. And after, she's still menstruating. And after her period, her vagina is really dry, even though she doesn't have low libido.

B (50:36)

Mm. So she's low estrogen.

C (50:40)

That's low estrogen.

B (50:41)

That's low estrogen. So she is probably losing some vaginal lubrication and also the tissues down there as well. So she's still getting a period. So she's having enough to get a period, but the levels are probably going down. She. Again, it's simple if she's willing to do it. Going on vaginal estriol. Now, estriol is used more in urine than estradiol, which is used more here. Estriol is more protective. They actually think it's more. It's protective even against breast cancer. So to the compounding places, we'll send that in. But she wants to stay in the conventional world. She can do estrase, which is a vaginal estrogen. Again, use it twice a week. You don't have to use it every day. Just use it very sparingly. It builds the tissues back up and it puts the lubrication back in and it should take care of it for her.

C (51:27)

Okay. And have you heard, I have another friend who suggested laser in the vagina for tightening and lubrication. Have you heard of this?

B (51:37)

Yes. I'm not so convinced that it helps the lubrication issue because that's such a hormonal issue. But childbirth and all the other things our bodies do. Yes, it's supposed to tighten it up if there's been collapsing there or prolapsing there or all these different things that.

C (51:52)

Happen and you haven't seen, you know, patients have, like, a terrible side effect from it.

B (51:58)

I don't have that. At least in my patient population. I don't have that many that choose that, you know, but the ones that have done it have seemed to do it. See, these are important questions.

C (52:06)

Well, I think so, too, and I.

B (52:09)

Your relationships and your quality of life, and I think that's the biggest. When we go back to the why, right. When we're even having these conversations, it's not just about how we feel, but it's also how we influence, like, everyone around us. Right. So if we're walking into our relationships or into our companies or parenting, coming from this place of feeling less than, then it has devastating consequences for all that stuff. So I think for women, you know, there's no reason to be shy. There's no reason to see this as a failure or the end. I think this is an opportunity to rise into your power. I've always said 50 is where the shit hits the fan. Really? Because it's sort of that culmination of this is how I live this half of My life. What is the next half gonna look like? And how am I gonna take care of myself, you know, moving forward? So it's really. I see it as an opportunity. I do think we need to rebrand it, like, educate young girls, like our daughters. Like, here's your gift. If you do all these things, you're gonna get to your gift at 50 and really be in your full expression of your power.

C (53:10)

And do you observe women in their 50s having the best sex of their life ever and feeling incredible in their body?

B (53:19)

Yes. Confident, you know, like, all the silly stuff that bothered us before is gone. I'm sure you've noticed it. Like, you know, it's like they're confident, they're secure, they feel good about themselves, you know, and again, it's like, where have we. Where do you land at that age? And I think if you've landed somewhere that you're not happy with, there's all this stuff to help you get to who you are, your true soul, your essence, your purpose of being here, you know? And I think the women that arrive at that and own that and embrace that, like, they really live the next 30 or so years in their power. They're amazing. And, I mean, I have women that have started companies, written books like, you know, crossed the country, you know, and done all this stuff. I mean, they do really have done charitable work and, like, really made a difference in communities or, you know, underserved areas. So, I mean, there's so much potential that we all have, and to assume that we're done is something I'm not going to accept, you know, because I still have a lot to do. And we want to feel good the whole way through it, and we still want to be vital. Right. So I think we've got to get rid of the idea that we're expired and really embrace the idea that we're rising into our power and into the truest expression of ourselves.

C (54:31)

I love that. That is my inspiration for the rest of the. Thank you for listening to my conversation with Dr. Taz Bhatiat. As always, I love getting to pick her brain. For more, go to drtaz.com and be sure to listen to her podcast, Superwoman Wellness. Thanks for tuning in. This has been a presentation of Cadence 13 Studios. I hope you'll listen, follow rate and review all of our episodes, which are available for free on Apple Podcasts, Spotify, Odyssey, or wherever you get your podcasts.