Reclaim Your Hormones: How to Treat PMS and PCOS Naturally

Struggling with PMS or PCOS? It’s time to get to the root of the problem. In this episode of “The Dr. Hyman Show,” I revisit powerful conversations with Dr. Elizabeth Boham and Dr. Heather Huddleston to uncover the hidden triggers of hormonal imbalance. From the risks of hormonal birth control to the critical role of diet, we explore how stress, toxins, and inflammation wreak havoc on your hormones—and what you can do to fix it. Tune in for a personalized approach to achieving hormonal balance and reclaiming your health. View Show Notes From This Episode Get Free Weekly Health Tips from Dr. Hyman Sign Up for Dr. Hyman’s Weekly Longevity Journal Full-length episodes of these interviews can be found here: The Hidden Cause of Your PMS and How to Fix It Fast The Underlying Causes and Solutions for Women’s Hormonal Balances with Dr. Elizabeth Boham The Root Causes And Treatment For PCOS This episode is brought to you by Rupa Health, Mitopure, and AG1. Streamline your lab orders with Rupa Health. Access more than 3,500 specialty lab tests and register for a FREE live demo at RupaHealth.com. Support essential mitochondrial health and save 10% on Mitopure. Visit TimelineNutrition.com/Drhyman and use code DRHYMAN10. AG1 is offering new subscribers a FREE $76 gift when you sign up. You’ll get a Welcome Kit, a bottle of D3K2, AND 5 free travel packs in your first box. Just go to DrinkAG1.com/hyman

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Dr. Mark Hyman?

  Coming up on this episode, many young women are becoming increasingly aware of the potential harms of birth control, not because their conventional gynecologist is explaining it to them, but through their own personal experience. They're on a journey to educate themselves and they want a more nuanced, personalized approach to hormonal health. Before we jump into today's episode, I'd like to note that while I wish I could help everyone via my personal practice, there's simply not enough time for me to do this at this scale. And that's why I've been busy building several passion projects to help you better understand, well, you. If you're looking for data about your biology, check out Function Health for real-time lab insights. If you're in need of deepening your knowledge around your health journey, check out my membership community, Hyman Hive. And if

• 0:45Dr. Mark Hyman?

  you're looking for curated and trusted supplements and health products for your routine, visit my website, Supplement Store, for a summary of my favorite and tested products.

• 0:55Dr. Mark Hyman?

  Hi, I'm Dr. Mark Hyman, a practicing physician and proponent of systems medicine, a framework to help you understand the why or the root cause of your symptoms. Welcome to The Doctor's Pharmacy. Every week, I bring on interesting guests to discuss the latest topics in the field of functional medicine and do a deep dive on how these topics pertain to your health. In today's episode, I have some interesting discussions with other experts in the field. So let's just jump right in. PMS is not a normal consequence of being female. If you're one of the many women who do suffer from PMS, you don't have to suffer from PMS every month, enduring mood swings, breast tenderness, fluid retention, migraines, bloating, or heavy painful periods. While medications may sometimes be helpful, they can have pretty significant side effects.

• 1:39Dr. Mark Hyman?

  And the good news is you can balance your hormones without them and without their potential side effects. Many young women are becoming increasingly aware of the potential harms of birth control, not because their conventional gynecologist is explaining it to them, but through their own personal experience. They're on a journey to educate themselves and they want a more nuanced, personalized approach to hormonal health. So today, we're going to discuss what you can do to support your menstrual cycle through your diet and a comprehensive functional medicine approach to get rid of PMS. For good and feel great all month long. The key to solving this type of problem is getting to the root cause of the symptoms. Now, I hear this story all too often, but the good news is that there are simple solutions that don't involve taking medication.

• 2:24Dr. Mark Hyman?

  We know what causes hormonal imbalances. Sugar, caffeine, alcohol, stress, a lack of exercise, and environmental toxins all contribute to hormonal imbalance and worsening of PMS. Even changes to your gut microbiome can affect your hormonal health. So what would conventional medicine docs do for PMS? Well, they give you NSAIDs or things like ibuprofen, birth control. They might give you serafem or Prozac, in other words. But they don't get to the root cause of symptoms and they inhibit your natural cycle, your infradian rhythm. And the birth control pill often has significant side effects with long-term use, including mood and gut issues, dysbiosis.

• 3:09Dr. Mark Hyman?

  Taking the pill depletes folate, vitamin B2, B6, B12, vitamin C and E, magnesium, zinc, selenium, all important, by the way, for fertility. There's also an association between hormonal birth control and depression. In fact, a nationwide perspective cohort study of over a million young women in Denmark reported an increased risk for antidepressant use in women prescribed hormonal contraceptives. And the results were published in JAMA Psychiatry. And their risk was highest in the adolescents who were aged 15 to 19 years old. So we don't want to be giving these teenagers antidepressants and the pill and just medicating the side effects of medication. It's crazy. So you have to look for what are the real underlying causes of PMS? Well, it's hormonal imbalance. And there are a lot of causes for hormonal imbalance.

• 3:53Dr. Mark Hyman?

  So it's important to understand what they are and how to deal with them. The main problem is something called estrogen dominance, which means that your estrogen levels are too high and your progesterone levels are too low. Now, this may be an absolute increase. In other words, a very high estrogen, low progesterone, or it may be a relative dominance of estrogen over progesterone. And unfortunately, this is not something well-recognized by traditional medicine. And you can measure this, right? The fluctuations in estrogen in relation to progesterone can cause all sorts of problems, including neurotransmitter signaling and lots more, because estrogen in part regulates serotonin levels in the brain, and that can contribute to PMS symptoms, things like mood swings,

• 4:33Dr. Mark Hyman?

  depression, irritability. And an absolute or relative excess of estrogen in relation to progesterone drives most of the symptoms of PMS, and menstrual problems like fluid retention, breast tenderness, migraines, mood swings, heavy bleeding, cramps, all that is really related to this excess estrogen and inadequate progesterone as women get through their later cycles in life. Poor diet is certainly a big factor, and when you clean up the diet, a lot of hormonal stuff just gets sorted out. And then there's a lot, unfortunately, hormones in conventional meat and dairy products. So I encourage you to eat regenerative, organic products, and particularly dairy might not be your best friend if you're having a lot of female hormone issues. I encourage people to just quit dairy

• 5:15Dr. Mark Hyman?

  as an experiment to see what happens. There are also environmental toxins that play a big role in hormonal health. And unfortunately, a lot of these petrochemical toxins are also endocrine disruptors. They act as hormonally active compounds in the body, even at low doses. And in fact, there's a word for them, they're called zenoestrogens. Foreign, but zeno means foreign, and obviously estrogen means estrogen. So foreign estrogens, and they come from pesticides, plastics, many personal care products, skincare products. I mean, these petrochemical products act as a toxic foreign estrogen-like molecule that drives hormonal imbalances and most female cancers, like breast, uterine, ovarian cancer. So toxins are a big factor, and you have to reduce your exposures. A lot of nutritional

• 5:58Dr. Mark Hyman?

  deficiencies also affect hormone function, particularly magnesium, vitamin D, and also iron. What else should we be doing for PMS or premenstrual syndrome? How do we get you back in balance and so you don't have to suffer and be really struggling your whole life? Because I just, I just don't think that is something that women should accept. It makes me actually quite angry that the conventional medicine system doesn't really take this seriously, or just tries to medicate it instead of dealing with it from the root cause. So the first thing is food. Food is medicine. It's information. It controls every function of your body. In mind, including your hormones, and it connects us to almost everything that matters in our lives. So you have to know that what you put in your fork is the most important thing you do every day for your health.

• 6:39Dr. Mark Hyman?

  So the first step to do with your diet is to cut down inflammation because inflammation will mess up your hormones. So first, get rid of the junk, right? Then get rid of the junk and then add in the good stuff. So take out the bad stuff, add in the good stuff. What's the bad stuff? Well, our current diet is really high in sugar and starch, and that drives insulin resistance. And that leads to belly or visceral fat. And here's something most people don't know. It's not just your ovaries that produce estrogen. Your belly fat is also an estrogen producing factory, right? So all of those belly fat cells in there aren't just holding up your pants. They're actually spewing out hormones.

• 7:20Dr. Mark Hyman?

  And there's something called aromatase also that increases estrogen production that's found in fat tissue. So, you know, having more estrogen is not necessarily a good thing, especially when it comes from your visceral fat. So what are the things you should eat and not eat to eliminate PMS symptoms, right? Eat real food, right? Real food, you know what that is, right? And my joke is if God made it, eat it. If man made it, leave it. Did God make an avocado? Yeah. Did God make Doritos or a Twinkie? No, right? Just don't eat that. So also you want to reduce fast absorbing carbohydrates, right? Any flour products, sugar, quickly absorbed sugars like flour, instant oats, white rice, potatoes or not, not all potatoes. Like the small fingering peas may be okay, but the big starchy potatoes we all eat are a problem.

• 8:03Dr. Mark Hyman?

  And they can spike insulin and that leads to insulin resistance and inflammation. And that can cause PMS, can cause PCOS. It can increase the risk for all chronic diseases. Also, you want to really limit caffeine or get rid of it entirely for a while to see how it affects your hormones. And for sure, alcohol, alcohol, it will screw up your estrogen and make you estrogen toxic ultimately. These really make hormone imbalances worse. Also, I would encourage you to do a full dairy elimination for eight weeks. It's often a huge factor in PMS and many menstrual and hormonal issues. Next, I want you to avoid ultra processed foods, right? Starch, empty carbs, grains, sugar.

• 8:45Dr. Mark Hyman?

  Sugar sweetened beverages, energy drinks, teas, coffee, you know, I mean, think about it. Any, any coffee or frozen blended drink from Starbucks, sunken donuts with flavor. It means tons of added sugar or glucose syrup. And lots of women drink these and they start their day with these drinks, not realizing it's a sugar bomb, like a vanilla latte, mocha frappuccino, even a matcha have tons of added sugar. I mean, a grande mocha frappuccino has almost 13 teaspoons of sugar. I mean, you'd never put 13 teaspoons of sugar in your coffee in the morning, but if you're going to Starbucks for your morning fix, you're literally killing yourself. Also avoid some of these quote healthy nut milks or oat milks. They're, they're often blended starch, sugar and water. So be careful. Oat milk really spikes your blood sugar.

• 9:29Dr. Mark Hyman?

  Sometimes there's also additional sugar from the flavoring too, like vanilla or chocolate, whatever hazelnut, just stay away from all that stuff. Drink black coffee and put a little almond milk in it. Ask for the unsweetened almond or coconut milk, although usually don't have that. Also, I want you to avoid processed food, packaged food, all kinds of food with quote health claims on the label, you know, plant-based, vegan, keto, gluten-free, whatever. It doesn't mean it's healthy. And my rule is that if it has a health claim on the label, I guarantee you it's bad for you. So just don't, don't, it's a way of, of getting food marketers to kind of get you engaged, but it's, it's often hiding something bad underneath. You want foods that really balance your blood sugar.

• 10:10Dr. Mark Hyman?

  You want to focus on fiber-rich, low glycemic, non-starchy veggies, low glycemic fruits. And fiber is really important because it helps balance out your hormones. It helps build a healthy microbiome. It helps prevent the reabsorption of estrogen that can cause estrogen toxicity. So you want to eat the rainbow, aim for about eight to 10 servings of colorful veggies daily for all their health benefits. Make sure you sort of eat every day, something from the cruciferous vegetable family, like that's the broccoli family, broccoli, cauliflower, kale, collage, cabbage, Brussels sprouts, arugula, bok choy. They're all important because they, they actually support estrogen detoxification. And they help balance the estrogen and progesterone because they contain amazing phytochemicals such as glucos

• 10:55Dr. Mark Hyman?

  Cinnolates or indole, three carbonol, diindole methane, all of these are, you know, big medical words, but they're essentially molecules that are in the broccoli family that help induce the expression of certain enzymes called CYP450 enzymes that enhance the metabolism of estrogen in the right way to produce beneficial estrogen metabolites, including, for example, they call two hydroxy estrogen, and they reduce the formation of a toxic estrogen metabolite called sixteen hydroxy estrogen. This is associated with heavy periods with breast tenderness, breast cancer and DNA damage. So, so there's different ways your estrogen can be metabolized in your

• 11:37Dr. Mark Hyman?

  body to the good or bad metabolites. And, and the bottom line is if you eat more broccoli, you'll be shifting towards the good metabolites. So that's the take home. Okay. And, but the science is there. It's quite fascinating. And I, and I do measure in my practice, the estrogen metabolites, and I can see what's happening with women's metabolites and whether they need more B vitamins or more support for the thione or more of these chemicals from food, these phytochemicals like indole, three carbonol or diindole methane. You also want to focus on, on slow absorbing and burning carbs, sweet potatoes, yams, lentils, some whole grains are fine, like quinoa, non-starchy veggies, protein to avoid the blood sugar spikes. Those are really important. Then you eat protein first as opposed to starch first. Eat about four

• 12:22Dr. Mark Hyman?

  to six ounces of protein per meal, roughly the size of your palm. Make sure you use high quality sources, grass fed meats, pasture raised eggs, poultry. I recommend force of nature. I love it. It's, I don't have any financial relationship, but they have great regenerative sources of chicken and meat and bison and venison, all so forth. You actually need protein, by the way, to make, to make hormones. So they're part of the building blocks. You need good fats to make hormones as well. Make sure your diet's really nutrient dense. You want a lot of bioavailable micronutrients like iron, magnesium, B vitamins and so forth. Nuts and seeds are great for hormones. I, I, I know a bunch of science on how they regulate hormonal health, but things like flax seeds are my favorite, almonds, chia seeds, hemp seeds, pumpkin seeds.

• 13:05Dr. Mark Hyman?

  Sesame seeds, sunflower seeds, all these are rich in fiber. They're full of good fats. They have micronutrients like calcium, magnesium, zinc, iron, B6, phosphorus, which are all important for a healthy menstrual cycle and hormone balance, right? Your body is just a big biochemical machine and you have to put in all the right ingredients to make the right things work. And what the problem is, is most of our diet is depleted. Most of us are nutritionally deficient at some level or other. Most of us have unhealthy microbiomes. Most of us are exposed to toxins. Most of us eat too much sugar. Most of us drink too much coffee. Most of us drink too much alcohol. Most of us don't exercise enough. No wonder we're having all these problems, right? So we really need to get our act together if we want to reset. And it doesn't take that long. One or two cycles of doing this for women really helps reset the whole system.

• 13:49Dr. Mark Hyman?

  One of the cool things you can do is use flaxseeds, ground flaxseeds, about two to four tablespoons. It's great for your hormones. It's great for beneficial compounds that that are helpful in regulating your hormones like lignans. And also it's great for bowel movements, right? So they're the they're really balance the hormones and they block the negative effects of some of the excess zenoestrogens. So if you're exposed to environmental toxic estrogens, you can actually reduce your exposure to them by having these flaxseeds. Also, you want to increase the anti-inflammatory fats in your diet, the omega threes, EPA, DHA. And my favorite sources obviously are sardines, herring,

• 14:25Dr. Mark Hyman?

  mackerel, anchovies, you can use small wild-caught salmon. Sometimes there's omega three rich eggs. There's plant-based sources like walnuts, chian hemp, but they're not really moving the body into the EPA, DHA. Only about 10% is converted. So you want to get the also the preformed EPA, DHA from from fish or from supplements. Now, if you're a vegetarian or vegan, it's really important to supplement with omega three fats. It really will help your hormonal health. Also, increase mono one saturated fats. These are avocados, olive oils, extra virgin olive oil, macadamia nuts, seeds, really important. Saturated fat may not be bad for most people. You have to watch your cholesterol and see what happens.

• 15:04Dr. Mark Hyman?

  But grass-fed butter, ghee, coconut oil, actually saturated fat is the building block for your hormones. Your hormones are made out of fat. To decrease the inflammatory fats, right? Trans fat, hydrogenated fat, margarine, even a lot of the vegan butters. They're actually not recognized as safe to eat anymore by the FDA, but they're still lurking on the grocery store shelves. So be religious about never eating them. Also, you want to reduce your intake of vegetable oils. These refined, highly processed oils. You know, if they're cold pressed, if they're organic, if they have high oleic levels, they may be okay. We need some, but the amount we're eating is just a pharmacologic dose. Sunflower, corn oil, canola oil, safflower oil, not so great.

• 15:48Dr. Mark Hyman?

  Also, stay away from processed meats. Stay away from like hot dogs, stay away from reprocessed cheeses. I mean, you should be in there anyway, but Kraft singles, I can't call it cheese because it's not more than 51% cheese. That's just a bunch of chemicals. Obviously, reduce your exposure to pesticides and hormones and antibiotics that are stored in some of these foods. And you can use the Clean 15 and Dirty Dozen Guide from the Environmental Working Group to guide you on which are the least contaminated or the most contaminated foods, fruits and vegetables. So it's not always possible, but try to eat grass fed and organic when possible. Fill up your water. I mean, also support your gut. Really important to support your gut. Probotic, which foods are key, things like sauerkraut, kimchi, miso, natto,

• 16:32Dr. Mark Hyman?

  which may taste weird, but it's actually really good for you. And prebotic foods also like asparagus, artichokes, hickama, and juice of artichokes, all great for your gut health. Don't eat within three hours of bedtime. Don't fast for too long. Actually, can be problematic for women. And start your day with a nutrient dense food, right? Protein, fat and fiber. Think protein, fat and fiber, not the typical breakfast. We have cereal, muffins, bagels, you know, sugared coffees. I mean, French toast, pancakes. I mean, the American breakfast is the worst and you do not want to start your day with that. You want protein and fat and fiber for breakfast. So you have eggs, spinach, peppers, olives, maybe some feta cheese from sheep, an omelet with avocado, protein shake.

• 17:16Dr. Mark Hyman?

  And you also need potentially some supplements. A number of supplements have been shown to really help ease PMS symptoms because they improve metabolic health, hormonal metabolism. And here's the superstars. Magnesium glycinate, 400 to 600 a day. Calcium, sometimes helpful, it's calcium citrate, about 600 a day. Vitamin B6, really important for estrogen metabolism, 50 to 100 milligrams a day. And folate, especially preformed.

• 17:42Dr. Mark Hyman?

  Form called methylfolate, about 800 micrograms a day. Vitamin B12 in the form of methylcobalamin, about 1,000 micrograms a day. And evening primrose oil, that works really well. Take 500 milligram capsules, one or two, twice a day. Take fish oil, omega threes, EPA, DHA, about 1,000 milligrams, one or two a day. Taurine, also really important for hormone metabolism. It's an amino acid, about 500 milligrams a day. Helps liver detox and a good multivitamin. All these things work together. And the good news is there's also a lot of herbs and phytochemicals that can really help, including chaste berry, also Vitex is known as Vitex. But chaste berry fruit extract is very good for regulating menstrual cycles and helping with PMS. Milk thistle, dandelion root also is great.

• 18:27Dr. Mark Hyman?

  Certain isoflavones from soy, red clover, chuzi root. Help improve estrogen detoxification because they boost some of the metabolism enzymes that you need to properly regulate estrogen. And they can be taken as supplements or in the diet.

• 18:45Speaker 01

  When I see a woman, so often we're dealing with hormone imbalances. They're so prevalent. You know, everything from, as you mentioned, PMS to, you know, to issues with menopause and perimenopause, to issues with estrogen dominance, right? Or over, over levels of estrogen, high levels of estrogen in the body, which can lead to breast tenderness or more PMS or cancers like uterine cancer and breast cancer.

• 19:12Dr. Mark Hyman?

  And fluid retention and heavy bleeding.

• 19:15Speaker 01

  That too.

• 19:15Dr. Mark Hyman?

  And all kinds of nasty symptoms.

• 19:17Speaker 01

  Yeah, so hormones are.

• 19:19Dr. Mark Hyman?

  Swings and mood issues.

• 19:21Speaker 01

  So we're really thinking about hormones and hormone balance when anybody comes into the office. So, I mean, that's something, I think that that's an area.

• 19:29Dr. Mark Hyman?

  And it's so common, right? 75% of women suffer from PMS.

• 19:34Dr. Mark Hyman?

  How is that normal?

• 19:35Speaker 01

  Right.

• 19:35Dr. Mark Hyman?

  It's not a normal state of biology.

• 19:37Speaker 01

  Right.

• 19:38Dr. Mark Hyman?

  It's an abnormal state.

• 19:39Speaker 01

  Right.

• 19:40Dr. Mark Hyman?

  Just because it's so common, doesn't mean it's actually optimal, right?

• 19:44Speaker 01

  Absolutely. So then we need to ask that question, why? Why are the hormones out of balance? And we look at everything from how is the body metabolizing the hormones? How is the microbiome and how is that influencing it? How is the person dealing with stress? And is that influencing the hormone balance?

• 20:02Dr. Mark Hyman?

  Yeah.

• 20:03Speaker 01

  So, you know, you want to look at, look at the whole body when you're trying to figure out what may be out of balance with somebody's hormones.

• 20:09Dr. Mark Hyman?

  Even fertility issues, I mean.

• 20:11Speaker 01

  Oh, that's, it's getting so common, right?

• 20:12Dr. Mark Hyman?

  It's so common, you know, affects so, one out of seven couples. That's big. And, and so when you go to a regular doctor and you have these, you know, symptoms of PMS or heavy bleeding or, you know, menopause, like what do they do?

• 20:26Speaker 01

  So often they'll say, okay, I'm going to put you on birth control pills.

• 20:29Dr. Mark Hyman?

  Oh, yeah.

• 20:29Speaker 01

  Right, right? Like if with, with PMS and or regular cycles or perimenopause, that is the common response. You know, let's just start some birth control pills.

• 20:38Dr. Mark Hyman?

  Is that safe?

• 20:39Speaker 01

  And that's going to even everything out.

• 20:40Dr. Mark Hyman?

  Is that safe?

• 20:41Speaker 01

  I don't know. I mean, it's a good question, right? I mean, there's, there are side effects to birth control pills. You know, we see, we see, we see stroke and blood clots with some women with birth control pills.

• 20:50Dr. Mark Hyman?

  Yeast infections, affects the microbiome.

• 20:52Speaker 01

  Absolutely. There's some, there's some women where we know that the longer you've been on birth control pills, or if you're on them more than 10 years, or if you're, you know, your risk for breast cancer goes up. So there is an association with long-term use of birth control pills.

• 21:07Dr. Mark Hyman?

  Or just breast cancer?

• 21:08Speaker 01

  Just breast cancer.

• 21:09Dr. Mark Hyman?

  Yeah.

• 21:09Speaker 01

  Yeah.

• 21:09Dr. Mark Hyman?

  That is interesting. So you take the pill for a long time and your risk of breast cancer goes up.

• 21:14Speaker 01

  Yeah, for women, when they're on the birth control pill, or if they've been on it a long time, they have a slightly higher risk. And, you know, so that's something we got to pay attention to. Not everybody handles the hormones in the birth control pills the same.

• 21:26Dr. Mark Hyman?

  So not, not everybody is being prescribed birth control for birth control. They're using it as a medical therapy for hormone imbalances when there's a very different way of treating it.

• 21:35Speaker 01

  Absolutely.

• 21:36Dr. Mark Hyman?

  That works better.

• 21:37Speaker 01

  Yeah.

• 21:37Dr. Mark Hyman?

  Where the women feel better and their hormones get imbalanced without nasty side effects of stroke and cancer.

• 21:44Speaker 01

  Right, right. I mean, you really want to ask-

• 21:45Dr. Mark Hyman?

  And migraines, and who knows what else.

• 21:47Speaker 01

  Right, migraines too, absolutely. So you want to ask, well, why is there that imbalance in the hormones? And, and what may be out of balance for that woman? You know, I think perimenopause is such an interesting time where we get a lot of women who come in to the office at that time because they're just feeling so crummy, right? Perimenopause is the timeframe between when your, between when your cycles are normal and you can easily get, you could get pregnant and menopause. So perimenopause are those years, you know, you know, it's can be, they can be like 10, 13 years of perimenopause. And it's can occur anytime, you can go into menopause anytime between 45 and 55, that's typical.

• 22:28Speaker 01

  And that perimenopause can be 10, six to 10 to 13 years beforehand-

• 22:33Dr. Mark Hyman?

  Yeah.

• 22:33Speaker 01

  Before you actually go into menopause is considered perimenopause.

• 22:36Dr. Mark Hyman?

  What is that? Do people feel bad, or?

• 22:38Speaker 01

  Yeah, I mean, there's, there's just the, the, this, the hormones are not as regular and consistent, right? So what happens a lot in perimenopause is during those years, women will have what are called anovulatory cycles. So, so they don't ovulate every time they have a monthly cycle.

• 22:58Dr. Mark Hyman?

  Right.

• 22:59Speaker 01

  And so those anovulatory cycles, meaning no ovulation that month, results in less progesterone being produced in the body.

• 23:07Dr. Mark Hyman?

  Because when you ovulate, that's when you make progesterone.

• 23:10Speaker 01

  Right.

• 23:10Dr. Mark Hyman?

  And if you're sort of weaning down your years of reproductive life, you don't necessarily make progesterone, you don't ovulate every time.

• 23:17Speaker 01

  You don't ovulate every cycle.

• 23:18Dr. Mark Hyman?

  And then you get these high levels of estrogen.

• 23:20Speaker 01

  Right.

• 23:20Dr. Mark Hyman?

  And that causes a lot of these symptoms of clots and heavy bleeding and bad PMS and mood issues and sleep issues and migraines and all this stuff that women suffer from, it is so unnecessary.

• 23:32Speaker 01

  Right. You think of it as, you know, when you're having regular cycles with ovulation, you have estrogen and progesterone and they sort of balance each other out. And then when you're in those perimenopausal years, you're going to have, so many women will have cycles where they don't have that progesterone spike.

• 23:49Dr. Mark Hyman?

  Yeah.

• 23:49Speaker 01

  So it feels like their body feels like it's higher in estrogen. Because they don't have that progesterone to balance it off. And so you feel like you have high estrogen and, and like you mentioned, you get more breast tenderness or more clotting or heavier bleeding and, and the low progesterone makes us often feel crummy.

• 24:10Dr. Mark Hyman?

  Yeah.

• 24:11Speaker 01

  So you can be more irritable. You can just, you know, cranky, harder time sleeping because progesterone really is a calming hormone and it helps us, helps women, helps people sleep better. So when it's low, many times you don't sleep as well. You'll have irregular sleep patterns where you've never had that before. And, um, and, and you just feel more irritable and cranky and, and, um, and it's no fun.

• 24:39Dr. Mark Hyman?

  Out of balance. Yeah.

• 24:40Speaker 01

  Yeah, out of balance.

• 24:41Dr. Mark Hyman?

  And, and you know, it's, um, it's important to sort of understand that we know a lot about what causes these imbalances and we know a lot about how to fix them, except your traditional doctor is just not doing it.

• 24:54Speaker 01

  Yeah, yeah.

• 24:54Dr. Mark Hyman?

  So what are the things that we know create hormone imbalance that make things worse for women? And, and by the way, you know, just to sort of a little aside, you know, it's not just sex hormones that get out of balance.

• 25:06Speaker 01

  Right.

• 25:06Dr. Mark Hyman?

  And when you, when you see this sort of period of life around perimenopause, there's like four different hormones that are all interacting that all kind of gets screwed up. One is insulin and blood sugar.

• 25:16Speaker 01

  Yep.

• 25:17Dr. Mark Hyman?

  Cause you're, you know, you're often in the sandwich generation. You're, you have kids and your parents are getting older and you're trying to have a career. And it's like, it's a lot going on at that time for women often.

• 25:25Speaker 01

  Yep.

• 25:26Dr. Mark Hyman?

  And then they have, uh, estrogen imbalances and progesterone. They have adrenal imbalances because their adrenal glands are their stress response and they're highly stressed in that time of life. So their adrenals interact with the sex hormones and screw that up. And then of course you've got thyroid thrown in there in a lot of cases. You've got thyroid, adrenal, sex hormones, insulin, and so it's like a big mishmash of hormone chaos.

• 25:50Speaker 01

  Yep.

• 25:50Dr. Mark Hyman?

  And actually you can fix it.

• 25:52Speaker 01

  Absolutely, and I'm so glad-

• 25:53Dr. Mark Hyman?

  These are like so easy to fix with functional medicine.

• 25:55Speaker 01

  Yeah, yeah, and I'm so glad you brought that up because all of our hormones are interrelated. They're all playing off each other. They're all influencing each other. And so that's important to really understand because, because that's how we can really help women feel better.

• 26:11Dr. Mark Hyman?

  Yeah.

• 26:11Speaker 01

  So when you really focus on the adrenal glands, for example, so you have, you have two adrenal glands typically. They sit up on top of your kidneys and those glands produce cortisol and they produce DHEA and they, a bunch of other things. Yeah, so cortisol is one of your stress hormones. So when you're under a lot of stress, if you're under chronic stress, for example, I mean, you know, your body's going to be producing a lot of cortisol all the time. And so what can happen, what can happen is then the body is spending all this time making cortisol to handle that, that chronic stress you're under. You're dealing with your, your kids and then your parents, as you talked about.

• 26:52Speaker 01

  You know, you're, you're working all the time, your job, you're not, you're not giving your body enough time to rest. You're not getting enough sleep. You might not be eating right. You know, you might be just running from one thing to the other. You may not be taking the time to do your meditation or your exercise, right? You're just not doing that self-care, which is so important for your adrenal glands. And when that's, when that's happening, then, then your body's spending all this time producing cortisol that it can't do as good a job at producing progesterone.

• 27:21Dr. Mark Hyman?

  Yeah.

• 27:22Speaker 01

  Right?

• 27:22Dr. Mark Hyman?

  Right.

• 27:22Speaker 01

  And so then you have-

• 27:23Dr. Mark Hyman?

  It's like a chicken wire thing. It's all connected. It's not like they're all separate.

• 27:27Speaker 01

  Right. And so then you have more of those signs of low progesterone, which we talked about before, which is irregular sleep, irritability, you know, more crankiness, more PMS, right? So, um, so it's really important that we step back and say, okay, how can we support your adrenal glands? And, and that's really a lot of, of self-care, you know, by saying, okay, I need to give my ti- myself time to rest. I need to give myself enough time to sleep.

• 27:54Dr. Mark Hyman?

  Meditate maybe.

• 27:55Speaker 01

  Exactly. I gotta get my meditation in, right? And, um, and I think that makes a big difference. It can really help.

• 28:04Speaker 01

  With balancing the hormones, we know, right, that even simple meditation, 15 minutes twice a day can cut back on, can significantly cut in half the amount of hot flashes a woman has during those perimenopause. We haven't even talked about hot flashes yet, right?

• 28:20Dr. Mark Hyman?

  Yeah, well, I mean, let's talk about the things that screw up your hormones, right?

• 28:23Speaker 01

  Yeah.

• 28:24Dr. Mark Hyman?

  So, sugar.

• 28:26Speaker 01

  Yes.

• 28:27Dr. Mark Hyman?

  That causes insulin resistance, that causes more estrogen to be made and all the imbalances, right?

• 28:31Speaker 01

  Right, right. We were talking about how when you, when you get more insulin resistance, you gain more weight around the belly, right? And we know that when we gain more weight around the belly, that we have more of that aromatase enzyme, which makes more estrogen and again, throws us out of balance.

• 28:47Dr. Mark Hyman?

  And what about alcohol?

• 28:48Speaker 01

  Yeah, alcohol, alcohol really is a concern because the, because the way alcohol, and there's multiple ways that alcohol can impact risk of, of breast cancer, for example, but it also seems to result in a higher level of free estrogen in the body.

• 29:04Dr. Mark Hyman?

  Yeah.

• 29:04Speaker 01

  And so, you know, and we know it disrupts sleep.

• 29:08Dr. Mark Hyman?

  It is a liver toxin.

• 29:09Speaker 01

  Yeah.

• 29:10Dr. Mark Hyman?

  And it, it literally impedes the body's ability to metabolize estrogen.

• 29:15Speaker 01

  Yep.

• 29:16Dr. Mark Hyman?

  And I've seen studies, it was shocking to me, where people were on hormone replacement and drinking, and their liver just can't handle it, and the estrogen levels spike, and their risk goes up. So, we have, you know, enormous link there. Even, I remember a study I read years ago, which was if a woman had a glass of wine a day, it increases their risk of breast cancer by 40%.

• 29:34Speaker 01

  Yeah, you know, unfortunately, there's a linear relationship between alcohol and breast cancer risk. So, for every drink a woman drinks per day, like every time she increases the amount of, she drinks per day, her risk of breast cancer goes up even further. So, you know, what's considered moderation for women is five or less drinks a week, with a drink being, you know, five ounces of wine, or, you know, an ounce of...

• 29:58Dr. Mark Hyman?

  One ounce of hard liquor, yeah. It's not very much.

• 30:01Speaker 01

  No, it's not very much. And that's all for a whole week. But what's interesting is you're right, there has been even studies showing that even, even one drink a day is linked with an increased risk of breast cancer. And, and maybe because it, it is... impairing, well, partly because it's impairing our liver and our ability to detoxify. And it's shifting estrogen levels and it also depletes the body of B vitamins. So there's so many, so many impacts that alcohol has there.

• 30:26Dr. Mark Hyman?

  Yeah, and even, even the microbiome plays a role in your hormone balance, right?

• 30:30Speaker 01

  Right, absolutely. Right. That's something we're always measuring, right? We're looking at how the body is metabolizing hormones and, and we're looking at the microbiome. And I think that that's important when we're dealing with a woman in perimenopause, like sometimes they're, they just don't even understand, why am I feeling this way? You know, why am I all of a sudden more irritable? Why am I having a harder time with my periods? You know, why are they heavier? Why can't I sleep? Why am I getting hot flashes now? Right? And so sometimes just educating them is a great first place to start. And a lot of times women just feel better when they start to understand, okay, this is, this is gonna, you know, my hormones are shifting. And then what can I do to support them?

• 31:12Dr. Mark Hyman?

  Yeah.

• 31:13Speaker 01

  And, and we were talking about how great meditation is, right?

• 31:16Dr. Mark Hyman?

  So powerful.

• 31:16Speaker 01

  Because it's, oh, yeah.

• 31:17Dr. Mark Hyman?

  Yeah. And the things, you know, we see typically the women who have the worst problems have the worst diet, the most stress, they drink too much. They don't exercise. They don't, they have, they have lots of stress. They don't meditate. It's not rocket science why hormones get screwed up.

• 31:31Speaker 01

  Right.

• 31:31Dr. Mark Hyman?

  And, and we know how to intervene using very specific diagnostic tests that we do at the El Truana Center to actually help map out what's happening with the hormones. We can go to estrogen metabolism. We can see how to really be sophisticated manipulating those hormones so that actually they, they're better. We can fix the gut and the microbiome. We can look for environmental toxins which act like estrogens in the body and get rid of those or heavy metals. And we can actually have an impact through using various foods to help, whether it's flaxseeds or other broccoli family, help estrogen metabolism, certain soy products. And that are, you know, whole food soy products are good. And, and then we can kind of get people's hormones to kind of work better. We may want to even use nutrients. And you were talking about sulforaphane, which is a powerful broccoli chemical that you can take.

• 32:16Dr. Mark Hyman?

  And there's a whole cocktail of things we use to help estrogen metabolism.

• 32:20Speaker 01

  We should probably talk about soy a little bit because honestly, this is probably The most common question I get because people are so confused about soy.

• 32:28Dr. Mark Hyman?

  Tell us, Dr. Bone.

• 32:29Speaker 01

  Oh, my goodness. Should we eat soy or not eat soy? So soy, right? Soy foods are in, they have these things called phytoestrogens in them. And this is what got everybody nervous, right? So they have these, they have these, these components, these phytonutrients, these components in them that can actually impact the estrogen receptor. And so for, you know, a bunch of years ago, oncologists used to say, oh, no, it can impact the estrogen receptor. I don't want you to eat soy. But what we know actually is that they, they bind to the estrogen receptor, preventing your own estrogen from binding to the estrogen receptor.

• 33:12Speaker 01

  And as a result, you have a lower estrogen-like impact in the body. And so multiple studies have shown that soy is actually associated with a lower rate of breast cancer.

• 33:23Dr. Mark Hyman?

  But it's traditional soy.

• 33:25Speaker 01

  It's a good point.

• 33:26Dr. Mark Hyman?

  Like tofu, tempeh.

• 33:28Speaker 01

  Yes.

• 33:28Dr. Mark Hyman?

  Natto, miso, soy sauce.

• 33:30Speaker 01

  Emame, right?

• 33:31Dr. Mark Hyman?

  Right. Those are whole soy products that are not industrial food. And most soy we're eating today is industrial soy.

• 33:39Speaker 01

  Yes.

• 33:39Dr. Mark Hyman?

  Turned in all kinds of weird ingredients like soy burgers and soy hot dogs and textured vegetable protein that gets inserted in all kinds of protein bars. And isolated soy protein, which very different than regular whole soy. And it may be linked to cancer in animal studies. So I think it's important for people to realize that, you know, it's, you know, food is a modulator and it usually helps the body do what it does rather than interfere with it. And so sometimes it's true, like you eat too much broccoli or whatever, raw broccoli, you're going to get saturated thylid. But the phytoestrogens in soy actually help to act more like a thermist. They keep things balanced, right? And, and I think, you know, recommending those whole soy foods is great.

• 34:24Dr. Mark Hyman?

  And I think that's a really easy thing to do. Flaxseeds also really help. Ground flaxseeds in the gut.

• 34:28Speaker 01

  Yep.

• 34:29Dr. Mark Hyman?

  The broccoli, family vegetables, simple dietary things and getting more fiber to help them. The antibiotics in the gut, getting rid of all the starch, the sugar, the processed food, all those ingredients, alcohol, there's really simple things you can do.

• 34:40Speaker 01

  Yeah, like balancing your blood sugar, balancing your blood sugar by making sure that every meal has a good source of healthy fat, has a good source of fiber, and has a good source of protein, right? So that prevents the spikes in blood sugar and the spikes in insulin, right? So you make sure your meals are balanced like that, then you won't get those ups and downs in your, in your energy. And so you just feel better and that helps with, that helps with all, you know, preventing those, that high insulin.

• 35:07Dr. Mark Hyman?

  And then you're going to be binging on carbs and sugar to get your energy up and all that.

• 35:10Speaker 01

  Right, right, right. So then that helps with the balance of all the hormones, as you were mentioning earlier. And, and so, you know, when a woman is going through perimenopause, you know, the first place we look at is, okay, what are these personalized lifestyle factors? What can we really focus on with them? I mean, there might be times where we at the Ultra Wellness Center may use some hormones to help with their-

• 35:32Dr. Mark Hyman?

  Pregesterone.

• 35:32Speaker 01

  Yeah, to help with their sleep if necessary. But many times just a woman understanding what's going on and then making some shifts in their lifestyle can make a huge impact and make them feel better.

• 35:45Dr. Mark Hyman?

  What are the causes of PCOS?

• 35:48Speaker 02

  Well, it's, I mean, I think it's a little bit of a million dollar question. There's a lot of research trying to answer that question. It's also a very heterogeneous disorder, so I don't know if there's one thing that causes it for everybody. But I think we do know that a major underlying factor is the hyperandrogenism that is, you know, that there's elevated androgens starting at puberty and that that may then sort of underlie a lot of the phenomena that comes across with women. So one of the things we know is that there's an increase in visceral adiposity or sort of-

• 36:21Dr. Mark Hyman?

  Belly fat.

• 36:22Speaker 02

  Belly fat that happens that we know is more common in general with men. But this is what happened when you have elevated androgens in a woman, especially starting at puberty, they lay down fat in that area. And that in women causes a lot of inflammation that then can really be a setup for insulin resistance. So there may be- Sort of a pathway where you see hyperandrogenism than in many people also leading to the insulin resistance. Then you start to get into a little bit of a vicious cycle because the insulin resistance in and of itself causes some weight gain, but it also can drive androgen production from the ovaries. So, starting at puberty, a lot of these people get into a little bit of a vicious cycle. It's very hard, if not impossible to get out of.

• 37:06Dr. Mark Hyman?

  What starts the high levels of androgens or the male hormones, testosterone and others?

• 37:11Speaker 02

  So it's a debated issue. I think that there's one component, maybe that there's just an, if you look at some of the enzymes in the ovary and in the adrenal gland, there's just sort of an overactivity of those enzymes in the ovary and in the adrenal gland. So there's some thought that it's just an intrinsic overproduction of androgens. There's also, at least in some patients, we think just a get from the get go, they have an increased LH secretion from the pituitary. This is a hormone that drives androgen production from the ovary. And so they may be set up by that, even sort of in utero to have increased LH secretion. So we don't really know, but we know that at puberty, immediately, these girls will often start to have much higher

• 37:53Speaker 02

  androgen levels than their peers. And then that sort of lays the groundwork for a sequence of events to happen.

• 38:00Dr. Mark Hyman?

  Yeah, you know, one of the things that's sort of read a lot about is the role of endocrine disruptors in our health. And endocrine disruptors are environmental chemicals. Years ago, I read a book called Our Stolen Future by Theo Colburn. It was sort of like the silent spring of its time, where she mapped out the ways in which environmental chemicals affect all kinds of reproductive functions. And whether it's sex, determining sex, or determining risk of cancers or infertility in animals and human models. How do you think environmental toxins play a role in the uptick of what seems like this increasing phenomena of endocrine disorders in women?

• 38:43Speaker 02

  I think it's hard to know how much they are causative in terms of PCOS. I think it's possible. I certainly think it's definitely possible that they may exacerbate certain elements of it by interfering with hormonal function. But PCOS has been around for a long time. As far as we can tell, it seems to be present at a pretty standard or set prevalence across many different countries and parts of the world, which somewhat argues against it being truly environmental. Now, I do think that certain environmental endocrine disruptors or just societal patterns,

• 39:28Speaker 02

  especially diet, can definitely exacerbate the way PCOS gets manifest. So if you look at PCOS patients in Europe, especially 10 or 20 years ago, or in China, they tended to be much more lean than patients in the United States and have much less inflammation and insulin resistance. And so there's certainly, if you have a PCOS phenotype and you put it in an environment where there is calorie excess or limited physical activity, you are going to see potentially, at least in some patients, an exacerbation of the symptoms. But I don't know that in my view and from what I understand about this syndrome, I don't think it's necessarily caused by our lifestyle.

• 40:15Dr. Mark Hyman?

  And the nutritional part, what role does that play? Because I've had many patients with infertility who, when we address the starch and sugar in their diet and treat the insulin resistance, they get better. And I had a very close relative who had obesity and pretty severe PCOS and hirsutism and acne. And we dramatically changed her diet and she was able to get pregnant and have a baby. So can you talk about the nutritional aspects of PCOS and how that plays a role and where it doesn't play a role?

• 40:47Speaker 02

  Yeah, I mean, I think for sure there's evidence that in some people with PCOS...

• 40:54Speaker 02

  Especially if there's evidence of insulin resistance, or if there's evidence of glucose intolerance, you know, that they're clearly have entered a phase where they're not processing glucose well, that if you act to correct that through diet and through exercise, and you reduce the degree of insulin resistance, you reduce the degree of adiposity, that in some of those patients, they will ovulate more regularly, they will have more successful, more healthy pregnancies. So that is certainly something that I think I always talk to my patients about when I see them, if I think that there's a window for that. There are patients, however, you know, especially when you look at some of the lean PCOS patients,

• 41:35Speaker 02

  or patients who from the point of adolescence have never had regular cycles. You know, I think it's a lot to say, oh, just change your diet and you're going to start ovulating. I don't think that's always the case. So I think every patient's a little different, and you need to really look at it. The what I usually look at, though, is I want to say, how are we going to get you as healthy as possible for pregnancy? And maybe that will help you get pregnant, maybe it won't, but I want to get you as healthy as you can for pregnancy, and get, you know, your insulin resistance as much as possible under control.

• 42:07Dr. Mark Hyman?

  Yeah. How about the microbiome? Because, you know, this is sort of the ear of the microbiome. And before, you know, nobody ever thought that the gut played a role in hormones, or endocrine health, or infertility. But now it's clear that it's sort of got its finger in everywhere. And, and, and, you know, we see studies, for example, on breast cancer, women who take antibiotics have high-risk breast cancer. We know that the microbiome plays a big role in hormone metabolism. So can you talk about what you're learning about that, and how that plays a role, and how you approach that?

• 42:34Speaker 02

  Well, I think that there's, there's definitely some really interesting research going on around microbiome in PCOS. And there's this idea that there may be a more sort of inflammatory microbiome that leads to more inflammation in the body. And we know that many patients with PCOS just have high rates of inflammation that is detectable, and if you look at sort of blood markers, or just even at the insulin resistance. So this is in many ways, an inflammatory disorder.

• 43:04Speaker 02

  So there is research going into like how much of that might be driven by the microbiome. And you know, that's a little outside my scope and maybe more your scope, exactly how that may be the case. But I think it's definitely a really interesting area for us to try to understand more. You know, how much that may be sort of setting people up to have PCOS sort of evolve adolescence and really to exacerbate the metabolic, you know, type.

• 43:31Dr. Mark Hyman?

  Yeah, we've said so super interesting about the inflammation because inflammation, independent of its source, seems to be a trigger for all kinds of things. Obviously, chronic disease in many ways, but for these hormonal disorders. So can you talk and maybe unpack about a little bit more about the link between inflammation and endocrine disorders and in particular PCOS?

• 43:53Speaker 02

  Well, I think for sure, we know the inflammation may have some direct effect on ovarian dysfunction. So there are some studies showing that if you treat inflammation, you can improve sort of ovulation to some degree in the ovary. So there may be a direct effect of inflammation on the ovary. There's also a path where inflammation does drive up insulin resistance. And that's through sort of TNF-alpha and other cytokines that are thought to interfere with insulin action. And we know that insulin resistance really drives androgen production from the ovary, at least in patients with PCOS. So there's definitely a metabolic sort of driver of the hyperandrogenism

• 44:35Speaker 02

  and hormonal dysfunction and anovulatory sort of status that we do see. And then we also know that that inflammation in and of itself has really important downstream consequences, not only in terms of cardiovascular disease, but there's more and more of a thought around depression and cognition that may be impacted by inflammation. So I do think it's really an important piece of this disorder that we want to try to get a handle on and try to treat.

• 45:05Dr. Mark Hyman?

  It's so important and it's so many causes of inflammation. It can be environmental toxins, it can be the microbiome, it can be inflammatory foods. I mean, there's so many factors that we know. That are driving inflammation or society are just getting worse and worse. And so it might be not one thing, it may be so many different things. So can you talk about the difference between the patients you see with PCOS, who would be the typical ones we've learned about in medical school are overweight. They have acne, hair loss on their head, facial hair, irregular periods and fertility versus the ones who are thin and, you know, exercise and don't seem to have any weight issues. Can you kind of, is there a different subtype? Are these the same kind of condition? How are they different?

• 45:44Speaker 02

  I mean, I, I think that they're, they're probably subtypes. So, I mean, I think this is a, PCOS is, I think, a very heterogeneous disorder. It's really just a syndrome, right? It's a collection of things that kind of go together and sort of have somewhat of a shared pathophysiology. But it's not like, you know, if you think about something like hypothyroidism, which is very much, you know, it's like your thyroid gland isn't functioning. You're going to have this, you fix this, it, you know, translates. PCOS is, is messier. And so, yeah, so the, the, the patient, there is a lean phenotype. We call it lean PCOS and it's often quite different than the obese PCOS.

• 46:23Speaker 02

  Some of the things that may be similar is the lack of ovulation, the need for help with fertility care. So that may be a constant. The other thing that may be a constant is trouble with elevated androgens. So hair growth on the face, acne, that can still manifest in lean PCOS. But, you know, lean PCOS patients are, are lucky and that they're often not quite as much struggling with some of the metabolic features. Although if in studies where they measure insulin resistance very closely and very carefully in research settings in even lean PCOS, they are more insulin resistant than lean non-PCOS.

• 47:05Speaker 02

  So there is still an insulin resistance piece there, but it's sort of either genetically not as sort of exacerbated or maybe that that person has just a very healthy lifestyle and they're able to keep a lot of it at bay.

• 47:20Dr. Mark Hyman?

  Hmm. And what, you know, one of the, one of the consequences for people if they have PCOS, what should they be aware of? What should they know about in terms of their own health and long-term risks?

• 47:29Speaker 02

  I mean, it's, I think, a very multifaceted disorder. There's generally sort of five or six things that I go through with patients with PCOS. So the first is menstrual cycle control. So it's important for people to have somewhat regular menstrual cycles or to have at least some sort of progesterone in their system to prevent overgrowth of the lining. There's the management of their skin or cutaneous findings with PCOS. So how can they manage their hair growth? There's fertility concerns. There's metabolic concerns, especially things like future diabetes, future cardiovascular disease. And then there's a lot of mental health disorders that we see in PCOS.

• 48:12Dr. Mark Hyman?

  Really?

• 48:12Speaker 02

  So there's a high rate of depression. Yep.

• 48:14Dr. Mark Hyman?

  And do you think it's a cause or a consequence of it?

• 48:18Speaker 02

  I mean, it's something I've been really interested in researching. One of the things we've shown in some of our work has been a very strong correlation between insulin resistance, actually, and depression. And even when you control for body weight, and even when you control for androgens, even when you control for hirsutism. So, you know, I do think, at least in some of these patients, that insulin resistance in and of itself may be contributing to depression. That's something we see in the diabetes literature as well.

• 48:49Dr. Mark Hyman?

  That's a frightening idea, because when you look at the metabolic health of America, I think the new, a new data came out from Tufts that 93.2% of Americans are metabolically unhealthy, meaning they have some degree of insulin resistance. And we also see this sort of epidemic of mental health disorders and depression. And I don't think people realize that, you know, sugar and starch and processed foods is driving not only weight issues, but also mental health issues.

• 49:15Speaker 02

  Yeah, I think it's, to me, one of the more profound connections and profound concerns. And I think it's unfortunate, because in some ways, that depression can often make it harder to address the diet and the exercise. You know, if you're feeling depressed, you're not in the most ideal state to sort of make those important lifestyle changes. So I think it's important that we take into consideration. What's happening in terms of a mental health milieu for patients with PCOS and take that into account when we kind of talk to them about treatment because that's an important component, I think, that needs to be addressed if we want them to make those important lifestyle changes.

• 49:53Dr. Mark Hyman?

  Yeah, for sure. So when you see someone with this problem, what's your general therapeutic approach? How do you treat these patients? What are the ways that we can help them have regular cycles through their acne, their hair growth, their hair loss? And I think you mentioned something really important, which is that you want them to have progesterone, which is sort of the antidote to this overbuildup of estrogens that happens in these patients, and they don't ovulate every cycle. So they don't make progesterone, which is what you do when you ovulate. So can you talk about what are the kind of therapeutic approaches and how do we potentially use progesterone or other therapies like that?

• 50:30Speaker 02

  I mean, so I think in terms of therapeutic approaches with PCOS, it's always hard because I think it to some degree depends on what is their goal? Like, what are they trying to achieve? You know, are they trying to get pregnant at this moment or not? But in terms of the menstrual, let's say it's someone who's like 22 and she's coming to me because she's only having three periods a year. And when she does, it's very heavy bleeding. I want to address that because we know that when people go many, many, many cycles without ovulating, it means they don't get progesterone. And that means that estrogen is going to cause over time buildup of the uterine lining, which can lead to very heavy menstrual cycles,

• 51:09Speaker 02

  but it also is a risk factor for endometrial cancer over time. So it is important that patients with PCOS get some sort of progesterone exposure. And that can be in the form of oral contraceptives, it can be in the form of bio-identical progesterone being taken cyclically, it can be in the form of an IUD that releases progesterone. I mean, so there's a lot of ways to do it. But if I have a patient who's having three cycles a year or something like that, that's an important conversation that I'm going to have is like, look, we need to figure out some way. For you to have progesterone because it's not healthy for your uterus to not have that progesterone over time.

• 51:49Dr. Mark Hyman?

  So that's helpful. And what else do you do to help with their, so besides bioidentical progesterone, what other kind of therapies support these patients?

• 51:57Speaker 02

  In terms of their other

• 51:59Dr. Mark Hyman?

  Symptoms or yeah, how do you deal with the hair loss or how do you have the acne or how do you deal with the the irregular cycles, what hormonal therapies are used?

• 52:08Speaker 02

  Yeah, so I think the irregular cycles would be addressed through some form of progesterone, but the hair loss or hair growth or acne, those skin findings are not our most, our best address, quite honestly, by being on something like a birth control pill because the, and you're going to suppress the sort of stimulation of the ovary that's driving up the androgens and you're also going to increase sex hormone binding globulin, which is a protein from the liver that really soaks up that extra androgen. So that's honestly the best way to get benefit in terms of the, especially hirsutism and acne. And then sometimes we'll even use medications

• 52:50Speaker 02

  that will block estrogen, block androgen action like spropanilactone. Now I do have patients who don't want to go on those medications and you know, feel like that's not fixing the underlying problem and it's just patching it or they don't want to be on the pill for any reason. So that tool is not always, you know, the ideal tool for our patients, but it is certainly one that I would discuss.

• 53:12Dr. Mark Hyman?

  And, and what role do you see as diet? Is it, is it a strong lever for changing these patients reproductive health and their cycles and their symptoms? I mean, if you basically put people on a low starch sugar sort of diet that treats the insulin resistance, do you see big changes in their clinical picture?

• 53:31Speaker 02

  I think in some for sure. And I think, um, you know, there haven't been great studies on this. There's been a few. Um, I do think that if patients are able to maintain a very low carb diet, sort of a ketogenic diet. They will be able to really manage their insulin resistance and that really takes away one of the sort of drivers or triggers or things that's really exacerbating their sort of phenotype or their symptoms. So if you are able to get the patient to sort of embrace that approach, I do think that you will see that often patients will see benefits. I think it's something that has to be monitored. I don't think all patients

• 54:14Speaker 02

  will suddenly start having regular cycles and their hair growth isn't going to suddenly go away. But some patients may have more cycles. Some patients may be able to conceive that way on their own without fertility treatment, but others will not. So I think it's something that I try to discuss as an option, but I think I shy away from saying like, here's a way to fix this, because I think in all honesty, it doesn't fix it for some patients. And that's really frustrating if they feel like they're sort of somehow failing.

• 54:47Dr. Mark Hyman?

  Well, that sort of speaks to how little we know, right? Because in some patients it works and some patients it doesn't. You don't really know which one's which, right? And it's really about personalizing care.

• 54:55Speaker 02

  Yeah. So I think it's a challenge. And I do think it's one, I mean, PCS is definitely a disorder that just takes a lot of personalization because it's such a diverse heterogeneous disorder. The concerns and the goals are often very diverse. So I think no patient and no treatment plan, quite honestly, is exactly the same.

• 55:15Dr. Mark Hyman?

  Thanks for listening today. If you love this podcast, please share it with your friends and family. Leave a comment on your own best practices on how you upgrade your health and subscribe wherever you get your podcasts and follow me on all social media channels at Dr. Mark Hyman and we'll see you next time on The Doctor's Pharmacy. I'm always getting questions about my favorite books, podcasts, gadgets, supplements, recipes, and lots more. And now you can have access to all of this information by signing up for my free Mark's Picks newsletter at drhyman.com/marks picks. I promise I'll only email you once a week on Fridays and I'll never share your email address or send you anything else besides my recommendations. These are the things that have helped me on my health journey and I hope they'll help you too. Again, that's drhyman.com/marks picks. Thank

• 55:59Dr. Mark Hyman?

  you again and we'll see you next time on The Doctor's Pharmacy.

• 56:04Dr. Mark Hyman?

  This podcast is separate from my clinical practice at the Ultra Wellness Center and my work at Cleveland Clinic and Function Health, where I'm the Chief Medical Officer. This podcast represents my opinions and my guests' opinions, and neither myself nor the podcast endorse the views or statements of my guests. This podcast is for educational purposes only. This podcast is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. If you're looking for your help in your journey, seek out a qualified medical practitioner. You can come see us at the Ultra Wellness Center in Lenox, Massachusetts. Just go to ultrawellnesscenter.com. If you're looking for a functional medicine practitioner near you, you can visit ifm.org and search "find a practitioner database."

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