214 - Your Women’s Health Questions Answered by an OBGYN

Welcome to the Just Ingredients podcast. I'm Cara Lynn, and here we dive deep into the journey of healing and wellness. If you're ready to learn, feel empowered, and take charge of your health, you're in the right place. Welcome back to the show today. I am super excited because we have one of my absolute favorite doctors here on the show with us. is Dr. Mallory Craycroft. And she's been on the podcast before. And I actually asked you guys on Instagram the other day what you would want to hear from an OBGYN who now also does functional medicine, which is not a common combination. And so many questions about, oh my gosh, perimenopause, menopause, postpartum, taking care of the baby, annual screenings. So we'll try to get through as many of these questions as we can today. But thank you so much for being here. Oh, my pleasure. I'm excited. Well, I'm excited to ask you all these questions because we've got a lot of women out there just wanting answers. I'm ready. So I'm going to start with perimenopause and menopause just because that was a big question people kept asking. So let's start with perimenopause. I will tell you in my twenties and thirties, I never even really heard that word. And then I feel like it's very trendy right now. Everybody's talking about perimenopause. So what is perimenopause and how does someone know if they're actually in perimenopause? Yeah, it's a great question. Perimenopause is just a transition state. So think about puberty, right? You're changing from no periods and the hormones are quiet because you're a child into adolescence where now your cycles are starting. That goes on and you have babies or you don't have babies. And then you go through another transition where the ovaries quiet down again. So it's just that downslope of the hormonal lifespan. And the tricky part is just like puberty, right? If you think about puberty, if you have a daughter, you might notice they get little arbor hairs or get little, you know, changes in body odor, or maybe a little bit of skin changes before their period ever starts. It's the same thing. Like when is the start of puberty? There's not like a day and there's not really a test that you would do. You start noticing things in your child and you start seeing like, okay, I think we're moving along. It's exactly the same thing with perimenopause. We like things to play by the rules and perimenopause doesn't play by rules. It's just a transition state. Now, I like to think of perimenopause in four phases, and these are all loosey-goosey, so you can't put a timer on these. But for most women around their mid to late 30s, you'll enter the first phase of this transition called perimenopause, where the ovaries start maybe running out of steam a little bit, starting to transition to menopause, which would be when your periods go away altogether. So in that first phase of perimenopause, the progesterone starts to go down. This is a direct marker of how good we are at ovulating. And this is why fertility goes down around the same time. The other thing you'll see as this starts happening is maybe your sleep isn't quite as good, especially in the second half of your cycle. Maybe your periods are getting a little heavier or a little bit weirder. Maybe you're just feeling a little more irritable. The second phase of perimenopause is that transition in the forties, maybe early forties. And that's when then the estrogen actually goes up and we don't talk about this enough, but as the estrogen starts to climb, now you've taken that progesterone estrogen dance that they're doing all through life. And you're going in the opposite extremes, right? Progesterone is supposed to be nice and robust when we're having babies. And then it starts to fall. Estrogen is supposed to be there the whole time and not be too high and it's going up. So you're going to the opposite extreme. And that's really where people start to feel pretty crappy. So you'll get really heavy periods, really heavy cramping. Sometimes the periods are closer together and annoying, or sometimes they start to space way out. Maybe you get breast tenderness, maybe you get really emotional or depressed or moody. It's just kind of this chaos stage. So in the third stage of perimenopause, that's when the estrogen starts to fall. And that's where you get the symptoms that we think of more classically and that we're hearing a lot about. Hot flashes, night sweats, brain fog, vaginal dryness, low sex drag, depressed mood, all of these things, you know, and we're hearing about like can't build muscle and you get frozen shoulder and ringing in the ears and heart palpitations. Those are all symptoms most of the time of estrogen deficiency. So probably you've been in perimenopause for a while before you start feeling that way. And then there's one magical day in time, which is called the menopause, the pause of menstruation, where you hit 12 months with no bleeding. That is menopause that one day. And then after that, it's post-menopause. So perimenopause is this whole transition state that can last 10 years, 15 years. And that's why it makes sense now, as I say, there's no test for this. How would I test? What would I even be testing for? Now, when someone comes in, they'll come in at age 47 and say, I don't know, maybe I'm in perimenopause. Yeah, yeah, you are. You are in perimenopause somewhere along the road. So 35, I don't know. I get patients coming in too in early 30s saying, I've heard this on the internet. I think I'm in perimenopause. Are you in perimenopause or do your ovaries need some support? Like, does your body need a tuna? So I don't care if someone's truly in perimenopause by some magical test. what I know is that in the late 30s I know how to support you in the early 40s I know how to support you late 40s early 50s and so on I as a hormone expert should know how to support you differently through those different phases so this idea of like I'm perimenopausal and therefore I should get all the hormone replacement I can have it's been blown out of proportion I'm all for HRT and I know you have a million questions for me about it and it's a good thing but it's not as straightforward as just like, oh, you're feeling like your hormones are off. Let's add testosterone and estrogen and progesterone, and then you'll feel all better. It's much more nuanced than that. Yeah. Because as you're talking about these different phases, that second phase, when the estrogen is high, then you don't want to be on HRT. Exactly. And that's what I see people coming in, especially estrogen HRT. So adding estrogen to someone who is already high estrogen creates a little bit of chaos and I've done it. I've done it. And sometimes I can't tell, right? Because to go back to your question of how do we test for it? I can test hormones. I can do a blood test anytime you want. And I know there are patients who get weird reactions from doctors like, Oh no, no, no, no, no. We never test hormones. Test your hormones. It's cheap. Oh, an estrogen test is less than $6. Like I will test it anytime you want to test it. will it be helpful is the question interesting sometimes sometimes not because our hormones are going in a cycle right so the first two weeks of the cycle look different hormonally from the second two weeks of site of the cycle when you get into perimenopause that's even more erratic maybe your cycle isn't playing by the rules where you get those nice normal curves maybe some days they're a little chaotic and erratic so if we do blood tests sometimes it can be helpful and the way that I utilize that is to first take a history, understand their symptoms. By the time I've talked to someone for 20 minutes, I have a pretty good idea of where they're at. If I add blood work to that, it either confirms it or it's unhelpful. It could prove me wrong. Interesting. Okay. So this goes back to when I was introducing you saying that you were an OBGYN, but now doing functional medicine health. So a lot of people are going to OBGYNs for perimenopause, menopausal health. They don't have 20 minutes to sit there with them to get their whole back history. Yeah. And so do you suggest people find a functional medicine doctor for this help or where do they go for this help? This is such a tricky question. What I will say is there's no set black and white answer here. There are some really wonderful OBGYNs. I will also say that the vast majority of OBGYNs really mean well, we were not trained in this. This is not something I received training in. In my residency, we had one rotation in menopause care, which was more than most people. And it was because one of my attendings was passionate about this because she was in her fifties and going through it. So she had a menopause clinic and we got to rotate with her for, I think, six weeks. And that was really helpful to me. And that's way more than the vast majority of OBGYNs get. So there are some OBGYNs out there who know a little more and who want to spend the time. There are also OBGYNs who have zero training in this or very minimal training or very old training. And so it's all over the map. What I will say is I never think it's a bad idea. If you have insurance, you've met your deductible, it's kind of a free visit for you. You want to go try it out. Great. Do that. Go knowing kind of what you're feeling. I would go organized. I would make yourself a list and I would try to make it as easy for them as possible. And this isn't how it should be. This isn't how I operate now, but in that system, you know, that that OBGYN has three patients in labor. They've got, you know, a patient who's having pregnancy complications that they need to slow down and really be there for. They're going to want to rush through your visit because you're the easy patient of the AI. Now I'm not saying you should do that. I run a cash-based clinic where I have 45 minute visits for this reason, but let's just stay with this. Can my conventional OBGYN help me go organized, know your stuff, have a pretty clear idea of what you're wanting to try and try to deliver that as quickly and cleanly and calmly as you can. And an OBGYN who understands this, you're going to be her favorite patient. And she's going to say, sure, let's start with progesterone. Sure. Let's start with estrogen. Let's start with progesterone come back in two months and then we'll talk progesterone or estrogen let's come back in two months and then let's talk testosterone you're going to make it so easy for them now if you go to that visit and you start hearing things that should raise red flags like women don't ever need bioidentical progesterone or bioidentical hormones or a marketing term or oh i never prescribe testosterone for women you can say thank you so much for your time and then you can Yeah. So there are some OBGYNs you'll be fine with. Okay. So let's help these women be informed when they go to their doctor then. And so being 50 years old, I'll just tell everybody I'm still in perimenopause, but I have definitely felt the times of high estrogen and definitely felt the time of low estrogen. So maybe let's distinguish like, what's the difference? How can someone tell if they're high estrogen or low estrogen? So first thing, high estrogen can feel like low progesterone. And we don't really need to distinguish that too much, but that's all in the same camp. So that's that earlier phase of perimenopause. And what that feels like is everything gets more. So more breast tenderness, more bleeding, more pain, more acne, more emotional. Yes, exactly. More reactivity. like I'm super irritable, but also I'm super sad when you said that, right? I just feel a little bit like a crazy person. More fat around the stomach. Maybe sometimes that's more with loss of estrogen because the loss of estrogen causes fat deposition to change. And I will also say estrogen is our feminine hormone. So when it's in balance, we get little curves. We maybe get breast enlargement. We maybe feel feminine. You know, maybe your sex drive is going pretty well. maybe you feel a little weepy at a really lovely movie right turn that volume up and you'll get high estrogen it's like now i'm crying at every commercial out there and i i don't think sex drive necessarily goes raging in this state but like we just feel a little bit much okay the downward effect of that as the estrogen falls off is more hollowed out i i think of it especially with testosterone which we'll come back to but this like black and white living where it's like i used to be like fun. I used to be colorful and vibrant and like a good partner to my husband. And now I'm done. I am, I'm faded away. I'm washed up. So that's when everything goes less, less bleeding. So maybe periods are spacing out or, or that doesn't always play by the rules. Maybe breasts are starting to sag or get smaller, low sex drive, vaginal dryness. It's a little harder to, to get to orgasm when we're having sex, everything at our mood tanks, a lower mood, trouble sleeping. It's where everything kind of feels all about. Which is crazy that women have to go through all all. Yes, yes, that is true. Yeah. Okay. So a couple more questions about this. So on Instagram or social media, I see a lot of people that will be like, oh, I'm dealing with depression. So it must be perimenopause. And I'm thinking, or maybe you need some B vitamins or maybe your gut's a mess. Or I see this one a lot of like, oh my gosh, my joints are just aching all the time. So I must be in perimenopause. And I'm like, or you're dealing with so much inflammation and need to change your diet and deal with inflammation. Or it could be perimenopause. Like I feel like perimenopause is being the excuse for everything. Yeah. I love this question so much. And it's something I'm so passionate about. And one of the things our clinic does differently that we get a lot of pushback from patients on is it's never just about hormones. It's always about, yes, we do a lot of HRT, fine. But I don't want you leaving my office only having talked about what's your testosterone level, here's your prescription. Because that's not enough. And here's why. When we're going through life, our hormones are going through this nice rhythm, everything's working well in a perfect situation. Those hormones are a buffer for many, many things. Our mental health, our physical health, our energy, our skeletal muscle system. The hormones are an amazing buffer. They really let us get away with so much. This is why women in their 20s when they go to college they can take terrible care of themselves and they get away with so much right When we go through perimenopause and those hormones start getting erratic, and especially as they start falling, the progesterone starts to fall, testosterone, estrogen, we don't get away with much anymore. And that's why there often feels like this tipping point of what on earth is happening to my body. It is absolutely falling the part because the estrogen was keeping you intact. It was allowing you to get away with things. And as the estrogen goes away, you're not getting away with it. But does that mean the estrogen is the problem? No. I think of it like dominoes. If you line up a road dominoes and you have something tip over the dominoes, you can stop tipping over the dominoes, but then you have to go sit them back up. Does that make sense? So estrogen could be the final trigger. The drop in estrogen could be the thing that tips over the dominoes, but adding estrogen doesn't tip up the dominoes. So think of this with weight gain. We see this a lot as estrogen goes down. People will say this all day, every day to me, I'm doing exactly the same thing that I've always done. And I'm gaining weight. What's this about? Well, so is that due to estrogen? Yeah. Yeah. That's a big part of it. Estrogen causes your fat to be deposited in feminine areas like your hips and breasts. And when that estrogen goes down, if you have fat, then it's going to be in your midsection instead. But guess what? If you add estrogen, it often does plateau the weight gain. People will say, oh, finally, I was a runaway train and it stopped. But that's not the end of the story. It doesn't cause weight loss. It doesn't make you magically lose the effect of what was happening. So it's never adequate just to add HRT. We always have to go back and build up the whole system. If you want to feel great, some people get really lucky and they add HRT, they feel like a million bucks. not usually not usually if you really want to feel amazing we should take care of your body and hormones are one tiny part of that they're a very important part of that but they're one tiny part and i'll add one more part of this because this does not get talked about enough hormones and the idea of cancer right hormones and the idea of could hormones cause bad problems for me this is a real messy answer and i think it's getting oversimplified in the media right now of hormones are good for you, they'll never cause you any problems. The more, the better. If you are not good at taking care of your hormones, if your body's not good at processing hormones and you're now menopausal and I'm giving you HRT, how are you processing better all of a sudden? Like now that you're in your fifties and I'm giving you exogenous hormones, you're going to process them better. No. If you had a liver problem before, if you had a gut problem before, if you had a brain problem and nutrient deficiency before, that's not getting better because we just gave you hormones. And that I think is where we do see some complications with HRT is if you take HRT and put it into an imperfect system, is that okay? Who knows? We haven't done those studies. We don't know that. So you're saying to stack those dominoes back up, you're talking things like diet, sleep, exercise, like all the things that I try to teach about and you try to teach about? Is that what you're referring to? 100%. And one of the things I see is patients come in and they say like, I want to feel so good. And we say, great, we need to talk about food and movement and all these things and HRT and they get HRT and they go. Very often they end up coming back saying that the hormones were working for a while. I felt so good. What happened? Can I get more? And that's not, it's not how I do things. I don't think that's how we should be doing things just to get more and more and more and more and more. At some point, it's not your hormones. Just to your point, like I have depression. Might hormones help? Yeah, they might. But B vitamins might help as well. It depends. Yeah. Are you B vitamin deficient? Is your gut absorbing B vitamins? Are you eating B vitamins? What is your B vitamin level? There's so much more we can do to support the body in addition to HRT. Okay. So to me, it sounds like you're very supportive of HRT as a tool in the toolbox and to feel healthy. We all have this toolbox of good food. And like I said, the controlling our stress, diet, exercise, sleep. You got it. And if we're doing all those things right and still feeling off, then HRT can be a supportive tool to our health. Absolutely. Yeah, absolutely. We always say that in menopause, you can't really be in menopause. I have to say in post-menopause. And you don't say in the post-menopausal, You could say I'm in the post-menopausal phase or I am post-menopausal. No one says that. We always just say in menopause. No one will fight you on it. Like it's fun. It's just how we learn to say it, even though menopause is only one day. It's a medical definition. Okay. Post-menopause. And women are like, no, I don't want to take HRT. Like I feel okay. I don't want to take HRT. But then the other side will say, but actually being really low on estrogen is harmful, even for like the heart or the muscles or all sorts of things. And actually I heard two ladies the other day arguing over this. Yeah. So do all people in post-menopause need estrogen or not necessarily? This is such an important question because we don't know. We don't know this. We do have good studies supporting the use of estrogen. And here's the way that I tell my patients is there's good studies showing, for example, with the addition of estrogen, a decrease in all cause mortality. That's good. I want to die of everything less. I should add estrogen. The timeframe matters. So adding it earlier seems to have a better benefit than adding it late. And that's in terms of bone health, cardiovascular health, probably breast cancer, dementia. There's both sides. Dementia is a really unclear space right now. So maybe, and if estrogen is helpful, then earlier is probably better. So here's where my hippie self has a little bit of a mixed opinion. So I love the idea of supporting our bodies naturally with what we do, right? Get enough sleep and eat the right nourishing foods and manage your stress. I believe in that deeply. So how does that relate then to, we now believe that all women should come to me and get between two and four prescriptions that are, that have a cost to them. They're not paid for by insurance frequently. They're a little expensive for some people. And now they're supposed to stay on four prescriptions throughout their whole life. There's something that rubs me the wrong way about that. And I do it and the data does support it. And I'm happy about it that we have that as a tool. but I just think we have an incomplete story. I do have a belief that the better we're taking care of our bodies, the better the aging transition goes. That makes sense, right? I mean, name one part of your body that if you don't take care of it, that it does great. You know, we have to take care of our bodies. So I just like to acknowledge that there is a little bit of a disconnect. We have the holistic now and medical communities saying adding exogenous hormones are the way to go. And that is what the data is showing. And it is what I do. But I also think there's so much to be said for supporting our body's natural aging processes, the best ways we know how many. So maybe those two ladies I was talking about were both right in their own way. Exactly. Because the one who didn't want estrogen, she has lived the most healthy lifestyle for the 40 years I've known her. Right. And so, and the other one, yeah, she's saying something, right, that women need estrogen, but there's truth to both sides. Yes. So, for example, bone health. bone health we know benefits from estrogen but what else benefits bone health adequate dietary calcium intake adequate vitamin d weight-bearing load-bearing exercises on our bones so when we do studies in western medicine we can't do a good study with multiple variables it's science right like if you have three variables you can't study that very well so western medicine likes to have one variable so they take the whole population and they say what if we give you estrogen and we don't give you estrogen. And that's the data that we come up with. And it's no one's fault. It's just the difficulty of science, right? But what if we took a study and we studied the hippiest people we could find, like they've been living the healthiest lifestyles their whole lives. They live out in the woods and they grow their own food and they don't watch the news. So they're not stressed. What about those guys? Do they need estrogen? We don't know. We don't have that study. We'll never have that study. And that's why I don't, as a practitioner, I don't like to be super dogmatic. I think we should try to take care of ourselves the best ways we can for the state we're in. For some people, taking the best care of our bodies is not accessible to them. Maybe they have to fix stuff first, but we should take the best care of our bodies we can. And then I'm really glad we have extra supports and tools, supplements, medications to help us get through life and feel the best we can. So if someone feels amazing, am I going to shove estrogen at them? No, I'm going to tell them the data we have with the limitations and let them decide for themselves. And if someone feels like trash, then I'm going to tell them the data that we have, tell them their options and let them decide for themselves, acknowledging that there are things we don't know about HRT and we're all just doing the best we can. Love that. Okay. So one other question about HRT is you hear different things out there. Some are like, you can't take estrogen without progesterone or you You have to take testosterone with this. I mean, all these different combinations. So do we have to take certain things with other hormones? Or can they be done individually? There's one given. You cannot have estrogen without progesterone. Because estrogen is our proliferative hormone. It's our growing hormone. It's get ready to have a baby. It makes hormones upregulate and grow bigger and bigger. Progesterone is its counterpart that says, we're good now. Settle on now. Go ahead and release, shed the lining, right? Have a period. And if you only have estrogen, there should be no argument here. If you only have estrogen, proliferation goes and goes and goes until you get couples. Cancers. That's a given. You shouldn't argue with that one. Everything else. Could you have progesterone without estrogen? Probably. Yeah. Could you have testosterone alone? Absolutely. Could you do any combination otherwise? Yeah. Okay. Talking testosterone, that's another trendy one. For women, I'm hearing a lot of women are claiming it as their cure-all to all of their problems. Okay. What do you think of that? Yeah, I mean, we know that testosterone goes down as we age. And testosterone is actually one that we can test pretty well through a blood test. It's cheap and easy. So I like to see a testosterone on most of my patients. Because if a testosterone is super low in someone who's like 28 and I see that, that's not perimenopause. That's a sign of wear and tear in your body. That's a sign of stress and strain that your body is saying, I'm not going to contribute to hormones and testosterone. I got to survive. So that's one of the cues that I see when I have an unreasonably low testosterone that someone is struggling, whether that's inflammation or toxicity or stress. It's something that I can point at and say, you should not have a testosterone level this low. Can I give them testosterone? Maybe. In younger folks, we don't have very much data or any real significant data on giving testosterone. So I am always going to want to support the body naturally before we do that. But we do know that it goes down through stress and strain and age. So if I have a 57 year old who says, you know what, I'm exhausted. I have no sex drive. I I've been trying to go to the gym and build muscle and I just, I'm not getting anywhere. And we test their testosterone and it's undetectable. They're probably going to do really well with testosterone. But I will say in my practice, I would say about 70% of women that I feel pretty strongly that testosterone is going to help them. I would say about 70% of them do feel way better. 30 to even up to 50%, I would say don't. So it's not the cure all for everyone. And that can leave frustrated patients that are like, wait, my girlfriends all said this was going to make me feel like a million bucks. I've taken it. I don't feel anything. Yeah. Sometimes it doesn't. Well, then those other dominoes maybe need to go back up. Yep. Okay. Are you talking testosterone cream, pellets? Yeah, I don't do a lot of pellets. I don't do pellets for the main reason that pellets overdose to start with. You get a big whopping dose and then it slowly degrades in your skin, right? You actually embed little pellets of medicine into your head and they just slowly degrade over time. I don't love the overdosing because people can have negative side effects. And once they're in there, they're in there. So I take care of a lot of people who have complications after pellets. I will do just about anything else though, a cream, a gel, a shot. sometimes we do vaginal inserts or vaginal cream so there's lots of different ways we do it and it's it's nuanced it depends on what we're trying to do and what you feel and how you feel with them so testosterone decreases as we age so most people post menopause well i should say most people but i will say there's a lot of wiggle room there so i test testosterone levels on most of my patients and i get women in their late 20s and early 30s with undetectable levels and i get some 60 year olds who have great testosterone levels. And so I really do think testosterone can be a really good marker of stress and strain. It also does go down as you're aging. So I don't know what percentage of 80 year old women have awesome testosterone levels. It does go down as you age. Okay. So good to know. Let's take a quick break to hear from our show sponsor. I've been talking about ingredients for a long time now. What's in our food, what's in our homes and what we're feeding our families. One thing I get asked about often is on-the-go snacks. That's why I've recommended Scout Organic for years. Scout makes the kind of snacks I'm always looking for. Simple, organic, real ingredients I actually recognize. No weird stuff. No long ingredient lists. Just food that makes sense. My kids love them and I trust them. Their bars are soft and easy for younger kids. And the cookies are a great better for you choice when your kids want something that feels like a treat. but you still want to feel good about the ingredients. 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So let's use mammogram as an example, because that comes up a lot, right? Mammograms are imperfect. I don't, I don't know anyone who would truthfully argue that mammograms find stuff that isn't anything that cause a lot of worry. It's radiation exposure a little bit, but it's still radiation exposure. And we're now saying kind of willy nilly, like make sure you get these every single year. Now, those guidelines have changed a little bit. They now say 40 to 45. They say every year or every other year, depending on your family history and your risk. But anyone who's making a decision about this needs to understand that if you're not doing mammograms, you're taking on some risk based on the data that we have. If you are doing mammograms, still a little bit of risk. And that's the hard part of science that we're in is there is no perfect way to go about it. There are other breastfeeding modalities. There's breast thermography. It has some great sides about it. It doesn't have radiation. It's very easy. It's not as painful, but it doesn't do as good of a job at catching early cancers is what the data shows. So when people come to me and they say, I'm only doing breast thermography, I will give them the data that we have, and then I will respect their decision. But you just have to recognize that you may be taking a little bit of risk based on what we know. But I also think from the dogma of the medical community, there's a little bit of risk there with mammograms too. Just, you know, mammograms are not perfect. They're missing stuff frequently. We just don't have a perfect solution. There's also QT imaging. That's the acoustic imaging. There's only a few centers around the United States that have this, where you lay on a table with a hole in it and your breast goes into water. The sound waves travel through the breast tissue to map out any lesions. And that's the one I'm the most excited about. But right now it's pretty expensive and really limited, but it's comfortable and very safe, no radiation. So not a perfect choice out there. Everybody has to figure out their own risk. And hopefully science will provide something better over the years. And we can't take away the ideas of what you're talking about is, and let's do everything we can to minimize our breast cancer risk. Right. Like that's alcohol and that's maintaining healthy body weight, maintaining healthy blood sugars. Like there are things that we can be doing. It's not just about I made a decision to screen and I'm, you know, I'm not going to do mammograms because those have radiation. Are you only doing that or are you also taking really good care of your body to decrease your risk that way? It's very different. So I would say that when we're talking about annual screening, it's a little bit of an imperfect science. We're all doing the best we can. And if you follow the set guidelines, I think they're okay. I think they're pretty good. Namorgram, I would say, is probably one of the more controversial because of radiation exposure, but a lot of the other annual screening goes well. Now, in my clinic, we do this in a way that I'm really proud of. And in a different way, we do an annual exam that includes a physical exam, but it also includes a comprehensive lab evaluation that are kind of the bread and butter for me. So I want to see blood sugar markers every year, extensive blood sugar markers. So insurance will only pay for a hemoglobin A1C. That's a lab test that is a diabetes marker. But I want to know your fasting insulin. I want to know your triglycerides. I want to know your ratio of triglycerides to HDL, which is your good cholesterol. I want to know your fasting blood sugar. I want to know your uric acid. These are all things that help me understand how well you're fueling, how steadily you're fueling, how well your body is taking up energy. I care about that so much because that's what prevents a cancer. So instead of only screening for the cancer, there's a set amount of lab work that I want to see on you every year. So that's part one is we do a comprehensive lab test. We also do a full conversation of what I call six pillars and the habits that go along with those six pillars. You could name these six pillars, right? Nourishment, movement, sleep, stress recovery and stress management, gut health, detox. So I want to go through that every year with you and say, let's really talk about your food. Where is there an area that we can improve? Now, if we combine lab testing with those habits, then I can tell you, yes, you're doing pretty well. But we could do a little better and you'll get more benefit. You might feel well. I won't say I think patients like the idea of this type of annual exam. Let me do a physical. They like the idea of it, but it's effort. It's commitment. You have to decide that this matters to you. You have to decide that you're willing to spend the time and the money to come talk about your habits and then be open to changing them. And people sometimes think that's what they want, but they don't go through like that whole commitment process internally. And then they'll be like, no, that's too hard. And I get it, but it makes me a little sad because there's so much opportunity there. When we're talking about an annual wellness visit, like you want to go to the doctor every year so you can live your healthiest life possible. is about so much more than did you get your colonoscopy every 10 years. That takes me three seconds. Go get your colonoscopy or here's the other options. But I want to talk to you so much more about how we can help you live your healthiest life. I love that. And a lot of doctors don't do that, but that's such a great option to think about. Like, it's just not the mammogram or the thermography. It's also the lab work of seeing your blood sugar, your blood sugar levels. And you know, if you're going to help D and your inflammatory markers. And, you know, there's so many key pro or, um, there's so many key lab markers that are so valuable. That lab panel costs about a hundred dollars. I'm not talking about a thousand dollars worth of labs here, but if you go to a lot of conventionally trained doctors, insurance will pay for them. So they say, Oh no, no, no, you don't need that. Insurance said we don't need that. Since when do we want insurance brokers to decide what we don't need. Like forget about insurance. If I can give it to you at a reasonable price, then we should be doing that. Like just because insurance doesn't pay for it is not the right logic we should be using for anything. Right. Okay. So really quick pap smear sense, same philosophy. Pap smear guidelines have changed. If you're low risk, you've never had an abnormal pap smear. You're in a monogamous relationship. No new exposures. Every five years is reasonable. I think having someone do an exam, a physical exam more often than that is a good idea. Any symptoms at all, any new sexual partner, you should have a more updated pap smears. Do you know pap smears are getting a bad rap out there on social media though? I do. And I kind of think, I mean, this goes to my philosophy overall and I'm proud of my philosophy because I was trained in conventional medicine and now I'm trained in holistic, functional, integrative medicine. And so I'm really proud of the patient base that I attract, which is a lot of everyday normal people trying to get by, trying to do the best they can while holding down a job and raising kids and doing all these things and not becoming full on scientists and experts in every chemical and every little thing. Right. So my job is to manage fear in large part. And I think that we live in a toxic world and we could all make ourselves absolutely insane by trying to find every tiny thing that is bad for us. But you know what I think we should do? I think we should eat more broccoli. You know, I think we should sweat. I think we should drink a lot of water. And I'm not making light of it because we do want to take good care of our bodies. But I think if we spend so much time on the friction of like, don't do that, that's dangerous. Don't do that, that's bad for you. Don't do that. Do you know, a pap smear is a plastic swab. It is a piece of plastic that I touch against your cervix. that is it there's no formaldehyde on it it is a blank it's not even sterile it's just a piece of plastic interesting because people out there are claiming differently no that i mean i've done i know you've done hundreds of thousands of pap smears it is a piece of plastic i pull out of the drawer now i will walk you through the whole thing i ask very gently there's trauma involved right i have to i go very slowly i'll say you'll feel my touch on your thigh before i touch anything and then I touch the labia and I put a little bit of KY jelly or medical grade full of grossness gel. I put that on a plastic or a metal speculum. The metals then sterilize the plastic are clean. That goes in the vagina. And then I take a piece of plastic and I swab it around. That is the entire pap smear. So the only part of that I think you can really argue about is microplastics. You know, we get way more microplastics. Especially if you're doing it once every five years you're going to handle plastic touching your skin you know once every five years you could argue the gel and you know what you could do if you're worried about the gel you can bring your tube of coconut with you there you go and say do you mind using this instead but there is no toxic chemical that is applied from that piece of plastic good I get I get excited I get passionate well no I'm glad I asked you take that one off of our worry list okay that That is good because, you know, Instagram people, TikTok people, they love to just blow things up out of proportion. They do because that's what gets them viewership. That's true. Scare and fear tactics work. It's true. And do you know what that does is it massively dysregulates your nervous system, which is the number one worst thing you can do for your health. So instead of worrying too much, we should do what we can. We should learn. And this is, I will compliment you. This is one of the things I love about following your account and using your products is I don't have to be afraid. I just know like I used to have to read the label because I know you did. And that's one of the ways that I can help regulate my nervous system and say, like, I cannot panic about everything that I put in my body. I can go for a walk. I can do some breath work. I can turn off social media. And I do think our health would be better than agonizing over every tiny decision along the way. I don't think that's helping us. I agree. And I think you nailed it on the spot by saying it gets engagement of people's posts and it makes people fear over unnecessary things. Yep. Okay. So moving on to a new topic, because I had a lot of people asking about pregnancy and postpartum. Obviously I've got all ranges of women listening to this podcast. So let's talk about before getting pregnant. Are there specific tests or labs that people should do before trying to conceive? Yes. And this is another thing I'm really excited about that we do in our clinic is a preconception visit. Have you ever heard of a preconception visit? No, no. Why don't we do this? Why don't we? I don't know. Data says that there's nothing really to do. So when I was in school, we learned about preconception counseling and it was about genetic testing for cystic fibrosis. I didn't get trained in anything about how to prep the body for pregnancy. And it's one of the most important things we can do. And here's why. People don't think about this enough. Like, of course, it makes sense that if you are a healthy body before you conceive, you're going to be a healthier pregnant body. Right. Right. Could you argue that at all? The other part of that that we think about is if you are a healthier body before you conceive and you're healthier through pregnancy, you're going to be healthier postpartum. That's a really big deal because you know what? Now you have a kid who's relying on you. And what I see so often, I get really excited. So I'm sorry if I'm bringing, you know, I heard energy here, but I get so passionate about it because I see so many patients who come in after their third baby or their fourth baby or their fifth baby. And they say, I was fine until I had X number baby. And I've never been the same since. And for some people, it's 10, 20 years later that they say, I've never been the same since. So just think about what's happening. You take a body that may not be in its very best state of health. You get pregnant. pregnant takes away from our health. It does. That's just, it's wear and tear on the maternal body. And then maybe we recover some, but not all the way. And then you have another baby, which drops you further. And then you recover a little bit, but you have another baby that drops you further. And now you've got three kids. So how are you supposed to eat well? And how are you supposed to exercise? And how on earth are we supposed to keep our stress intact? I say this as a mom of four kids, it's rough going as a mom. And the sleep is hard. And the sleep is hard. So we should be doing everything we can to prepare our bodies for pregnancy. We shouldn't be waiting until we have infertility. We shouldn't be waiting until we have multiple discarriages. We shouldn't be waiting until we have a pregnancy complication or a postpartum complication. Let's do it first. And the reason I feel so excited about this is it's not that hard. It's a matter of telling people how much protein are you eating? How many colorful fruits and vegetables are you eating? How many nuts and seeds? How many, did they say vegetables? How much sleep? And then we do a lab panel that's very similar to what we do for the annual wellness. Although we do like a testosterone level and a couple other wellness ones. And we're saying these ones help moms be healthier and feel better. Who doesn't want that? I wish someone would have done this for me. Now, funny story about that. I just had my fourth baby. I'm 44. It was not planned, which yes, as an OB, I should know better. But we've had infertility my entire childbearing years. So what have I done the last few years? I've taken really good care of myself. I worked really hard to learn how to take care of myself And I did this preconception lab panel that I did not know was a preconception lab panel I was just taking good care of myself and I fixed those things and ended up pregnant at 44 Wow But it was it was a wonderful healthy pregnancy And I it was a hardest pregnancy. Don't get me wrong. Like it was harder at 44 than it was at 35. Sure. But I bounced back so quickly. I've now four months postpartum. I feel like a million bucks. Like, I'm not just saying that I'm shocked by that. I feel so good. I can. And it took me time and I had to take steps and figure out how to get back to this point. So it wasn't day one that I was like running and exercising. Right. But I knew what to do to get back. And that's what that's what we should be doing. That's what's possible. We should not be in these giant slumps postpartum. And that starts with preconception. That is so interesting because a lot of people do deal with postpartum. Yes. And congrats, by the way, on your baby. And I can't believe the baby's only four months and you're back to podcasting and back to your clinic. Well, there's a, there's an argument against that. Like I should regulate my nervous system and be home more, but we're working well, a balance. Yes. Trying to balance. That's right. All right. So a lot of people don't do, do deal with postpartum. So what are your tips and suggestions, especially those that didn't take care of their health beforehand or didn't even do these preconception labs? Yeah. What advice do you give them? There's a lot we don't understand about postpartum, but postpartum depression is what we're talking about. But one thing we do understand is that the postpartum transition is a state of depletion. You've just given up everything. You've just spent nine months, 10 months giving everything to your baby. So one of the first things I do if I'm taking a patient who's just newly postpartum, I like to do it before then, but if I'm taking someone who's coming to me with postpartum depression, I want to know all their levels. Are you iron deficient? Are you vitamin D deficient? Are you B vitamin deficient? What are your blood sugars doing? we have to make sure we prop you up at the very least. I also want to know about hormones. Hormones are tricky in postpartum because they do tank and they should because they can't stay at pregnancy levels forever. And some people are just sensitive to that transition. Sometimes we can nudge it up with hormone therapy. So taking hormones, there are some medications that sometimes we do get in a bind. And the most important thing is we get you feeling better. So as much as we want to do that without medications, we just have to get you to a safe place and get you feeling better because postpartum is not the best time to be like well are you exercising five days a week you know like we can't do that so sometimes we do have to use medications just to i call it duct taping and we gotta duct tape you together for now and i'll get you off of them i will help you get off of them but we have to keep you safe and we have to get you feeling better and then there's some lifestyle things that are really important leave your home people get in this cave mode and they don't leave their house because it's so difficult, but can you go out onto your porch? Can you just see natural daylight once a day, three times a day? Can you move your body a little bit? Even if you're not doing a routine, open up your body, get your arms swinging around. That blood flow gets so stagnant when you breastfeed a baby and I have my legs crossed, my arms crossed, and I'm breastfeeding a baby, and my whole body turns into this melty schlump, and it feels so bad and so achy, and everything starts to compound. So as we just move our bodies, we start to get these good endorphins going again. So we have to take all of these little steps without asking too much of our minds. We have to take these little steps to support the body. And if there's anything that we as people who are not postpartum can do to support, it's bring them vegetables, colors, protein, fats. Can we bring them really great foods so they can just get their body working? We have to recognize that the body is a machine that needs stuff. You can't expect your car to run without gas. You can't expect your body to run without fuel. So I know you're craving French fries and you should eat those French fries if that's going to make you happy, but also eat the peas and the green beans and the broccoli. I love that. Okay. This is another trendy thing out there that I want to ask you really quick. Have you been seeing the things out there about folic acid in the prenatal versus the folate and that it's the folic acid maybe causing postpartum issues to those that have the MTHFR gene? I've seen both sides and I honestly don't know what the answer is except preconception testing a homocysteine level it won't tell you whether your MTHFR gene mutation is present but it will tell you how you're methylating so if you have MTHFR gene mutation and you need more methylated B vitamins your homocysteine and your B mostly homocysteine will tell you that So if you are on a prenatal and you get a homocysteine level and it's low, you should probably be on a methylated B vitamin. Like you should do that. Other than that, we don't know because you can make the same argument that the studies show that folic acid is what prevents neural tube defects, not folate. That doesn't make very much sense to me, but that's what the data shows. So I think at fair minimum, test your homocysteine before pregnancy. understand that you're methylating you've got the right b vitamins before it's the best we can do right now i'm gonna ask you one other thing that a lot of people ask about and that is newborn care so these moms are so worried about newborn care meaning in the hospital like the delayed court clamping the vitamin k the first bath all these things to the point that i'm like oh my gosh i'm glad i'm done with having six kids yeah they're confused out there so what do you say to that I would say the very best newborn care that you can give your baby is to love that baby and to be a safe place for your baby. That's going to make me cry. It's your job to be the safe place for your baby, number one. And so it depends on where you're at. If you're trying to make these decisions is causing you to panic and shut down and have depression and anxiety, you got to do something different. So rely on someone else to make the decisions or just let some of those go because you need to be the safe energy. This is, again, my hippie side coming out. Our babies feel us. I know it. They feel our energy. They feel our vibration. They feel our vibe. And you get to snuggle that baby. It's the very best thing you can do. So if you can't decide whether to get vitamin K or not to get vitamin K, snuggle that baby, right? Like you can do that. So my perfect game plan and what I have done with my children is number one, can you get that skin to skin right away? The more you can get that baby onto you, the better. Delayed cord clamping? Absolutely. If your baby's not doing well, then you got to make an exception and the baby needs the support they get. But the more that you can be calm and slow your breathing and be a state of safety during labor, the less you're going to be in a state of fight or flight. And I do think it has outcomes on how your baby comes out. So the more you can be in a state of safety, the more you can get that baby skin to skin, delayed cord clamping, sure, but don't lose sleep over it if that's not in the cards for you. Most doctors are pretty good about that now. and then keep that baby on you as much as you can manage. Don't panic if they need to take the baby for safety, but as much as you can, keep that baby on you. Dad can hold the baby later. That baby needs mom. Getting the baby in a position where they can look at you, keep your breast exposed to them. Don't worry about getting it in their mouth. Just keep their mouth right next to your breast. Just you looking at them, talking them, rubbing them, snuggling them. It is the very most important thing you can do. More than the vitamin K, more than the corticlandin. You just snuggle them, look at them, touch them, let them be near your breast. And then you get them to the breast when you can. And then from there, I think it gets a little more complicated. I don't like to bathe them right away. And most hospitals don't do that anymore and don't need to do that. So if you have a say in it and you can voice that, like, don't bathe the baby. They don't need to be bathe. And it's good for them. So I like delayed cord planting. Now, I'm a doctor. I see complications. I like the vitamin K. I know I'll get pushback from the holistic community. But if you've ever seen a cranial bleed on a baby, you want that vitamin K on board and you don't know until you don't until it's a problem. So I say vitamin K erythromycin ointment is for chlamydia and gonorrhea, eye infection that can cause blindness. So people will say, like, I know a thousand percent that I do not have chlamydia. I don't know. Make your make your decision. I did not have chlamydia. And I said, I don't even want to think about it. Just just do it. I'll wipe it off later. and I don't think it's that big of a deal that we need to be worrying about it really one way or the other is blindness and that's as doctors we say let's not do blindness right so we're always going to say let's be on the safe side and just do the ointment but if you really feel passionate and you know a thousand percent sure then I don't think it's the biggest deal to skip well and I've heard you say something before which I like you were saying like don't sweat the small stuff with low toxins, like worry about the bigger decisions, right? Exactly. And that's where, when you get your baby home, don't slather them with a bunch of weird lotions. Don't have plugins in your house. You know, don't put a bunch of stuff on the baby. Watch your laundry detergent. I think those are far bigger decisions for the baby than the one time tiny little thing. You know, now a one time big thing is a different conversation, but a one time tiny thing, you got to protect your nervous system. You got to just embrace that baby and be there for your baby. It's so much fun. Well, thank you so much for being here. My listeners are going to be like, wait, you didn't ask my question because there's still so many questions, but thank you for answering all the questions that you did. Sure. You are amazing doctor. I wish so many more were like you that looked at the functional medicine side of things. More and more people are asking questions, wanting to know the root cause of their issues. And so it is coming. We always end the podcast by asking five fire rapid questions. Okay. And so here's the first one. What emerging health topic excites you the most? Oh, MCAS probably, MCAS, but so many, but that's probably the big one. Tell me really quick what that is. Mass cell activation syndrome is an immune system overaction that causes the body to freak out about every little thing. So you get patients who are tired and they get rashes and they have period problems and they have gut problems and they have brain problems. And they're like, why am I so unlucky that I get all of these problems. You don't have all those problems. You have one problem. You have one thing. And especially in the gynecology world, it's really starting to tie some pieces together like chronic vaginal pain and painful periods and ovulation issues and mental health issues around the cycle. So many of them are all tangled up in histamine and massive cells. We have help. Once we identify that, we can help, but it's starting to get a little more data. Interesting. Okay, number two, What is a piece of advice you'd give to your younger self? Oh, I so wish I would have had someone to tell me what I know now when I was younger, because I spent years not feeling well. I was exhausted my entire life. I'm 45 now and I feel so good. And I think like, what could I have done if I felt this good always? Right. So I would give that to my younger self and I would give that now. And people don't wait. Feel good. Love that. Hey, number three, what's the one health practice you'll never compromise on no matter how busy life gets? I'll be honest. Life has gotten busy and I've compromised on all of them at some point. So I'll be honest. And I think that's important to say they're all going to be in flows. You got to have your toolkit and what works for you. So what I do know is when I struggle, I know exactly what tools I'm pulling out. And that's nervous system regulation, either prayer or grounding or nature. that's sleep, that's movement, that's vegetables and protein. Love that. Okay. What's your favorite just ingredients product and why? I am a big just ingredients fan and have been for years. So I could go through the list, but the newest one is the bone broth protein. All right. Last one. What is the best ingredient you've found to life? Oh, I will say right now release. Like I am in such a personal state of growth and such an exciting state for me of self-discovery and recognizing what I don't need anymore. And it is so exciting to say, I don't need to hold on to that coping strategy that was keeping me safe from, you know, 15 years ago, but now it's just doing me hard. Like the more I can shed that and just step into like abundance and love and warmth and light is, I am just like on a high of stepping into that version of life instead of this constricted, constrained, you know, version. I just want to release it all. Whatever's not serving me, it can go away. I don't need it anymore. You know, I have done over 200 episodes and no one has ever said release. I love that thought, though. Yeah. I am really going to just ponder on that today. I really like that. I love it. Well, tell everybody where they can find you because people are going to want to learn from you. And your podcast is amazing. Women, if you need a podcast or want a podcast to learn more from, hers is amazing. So tell them where they can find you. Well, our company is Uplift for Her. And the podcast is the same name. The clinic is the same name. The clinic is local in Salt Lake. And we have a few practitioners. We have a health coach. We have a dietician. We have a therapist. And we have lots of people that can help in a lot of different ways. So right now that in-person is our healthcare practitioners, but our health coach and dietitian are not just in-person. They can be virtual. Awesome. Thank you again for being here. You just are incredible. Thank you so much. It's been such a pleasure. Thank you for being here and being part of this community. Don't forget to subscribe to the Just Ingredients podcast. We've got so much more to share with you. And if you're not already, come join us daily on all social media platforms at just.ingredients. Until next time, keep choosing what nourishes you.