Episode 04: How The Microbiome Can Affect Women's Hormones

Hello, and welcome to the better biome podcast where we explore the universe within.

We're your hosts, Dr. Nicole Beurkens and Kiran Krishnan. And on today's show, we're talking with Dr. Jolene Brighten about the microbiome and women's hormones. Dr. Jolene Brighten is one of the leading experts in women's medicine and is a pioneer in her area of the far reaching impact of hormonal birth control and the little known side effects that impact health in a large way. In her bestselling book, 'Beyond The Pill', she shares her clinical protocols aimed at supporting women, struggling with symptoms of hormone imbalance, including post-birth control syndrome and birth control related side effects.

A trained nutritional biochemist and naturopathic physician, Dr. Brighten is the founder and clinic director at Rubus Health and integrative women's medicine clinic. She's a member of the mindbodygreen collective and has been featured in prominent media news outlets, such as Forbes, Cosmopolitan, ABC news, and the New York post.

It's such a pleasure to have you with us. Welcome to the show.

Yeah. Thanks so much for having me. I have to comment for as long as I've known you Kiran.

Yeah.

I don't think I've ever appreciated what a great radio voice you have. Wow. We've known each other for like five or six years now and this is the first time. I'm like, You bring out a fancy mic and I'm like, "Ooh, that's smooth".

Hello, people out there.

That's where whenever I'm on a mic set up like this and we're testing. I usually do my sexy Nebula voice. That's only for guardians of the galaxy.

*laughter*

I appreciate that! Um, well, I'd love to start out by having you talk to us about your career journey, how you came to be focused on women's health, particularly the issues related to birth control, those kinds of things.

Yeah. Well, you know, the funny thing is is here we are. We're going to talk about gut health. I actually struggled with significant gut issues as a child. And so I struggled for about a decade with severe heartburn. I was diagnosed with chronic gastritis. Nobody knew what was going on. Then the research on H pylori made its way into clinical practice and lo and behold, that's the infection that I had.

So I actually figured out from that, how do you leverage food as medicine and really how to change my diet, to heal my symptoms. I was like, I'm not going to take a PPI for the rest of my life. Now, here I am at 17. I'm not going to pop a pill every day. You're crazy. Oh, birth controls sign me up. Yeah, the irony of this story.

And so that's what propelled me into studying nutrition. I actually started in chemistry. So my first degree in chemistry, then when to study nutritional science and from there was actually getting my masters when I decided, well, I found naturopathic medicine. And having the science background, I really recognize I lacked the philosophy and the respect of the body's ability to heal. Like my arena was like, how can we manipulate the body to do what we want? And yet there was another side to that coin that I wanted to explore. So I actually thought it was going to get into gut health. I was like, I'm going to be a gut doc. Good thing I started there because it turns out everything women's health, everything women's hormones is actually rooted in the gut. Everything's rooted in the gut, right? But what really made me turn the corner and decide to do women's medicine is when I was sitting in class and. I just had this epiphany of how often women's medicine has done to them and not with them and how my experiences had been like. And I was working with mentors who had shown me another way, where instead of, "We're going to place the speculum scoot down". It was

"I have the speculum I'm going to place it. Is that okay?" Like, and we asked for consent and that was, I mean, that was way before, like all the consent talk has really ramped up as it has now. And just to really view it as like, this approach was about we're in a partnership and how we can help you heal.

Now, the other part of it is that hormones are really complicated. And I love organic chemistry. I'm a really big nerd. So when it came to steroid pathways, I was like, yes, yes. And give me some more. So whenever people say like, you know, hormones are really, really complicated and we'll often hear this from doctors they're too complicated. We don't even test them, just get on birth control, shut the whole system down it's too much. I'm like, you know, it's really not that complicated if you spend time and really walk through it.

But I think that's one of the things that I appreciate about you and how you practice it in, in your teaching is you - you, first of all, you are a nerd in that way. You love the chemistry of it. And you're able to. Drill down into that and explain that in a way that is beneficial and empowering for women, as opposed to just saying, "Oh, it's too complicated, don't worry about it". And so I think that's really a unique strength of yours and in a lot of the stuff that you've written and put out there is really helping women understand that.

I appreciate that. You know, we actually have had a lot of women write us after reading, Beyond The Pill, and what they were saying... And at first I was like, what? They were like, "It's like my older sister's talking to me and I was like, I'm your older sister?" Oh, we know I am older. Exactly. That's right.

And that's something there, there have been reviews though that people have said, "I appreciate like how, you know, how she breaks it down, but I don't appreciate, you know, how her personality comes through". And I'm like, "Okay, I'm not for you." But I kind of chuckled because I'm like, it's that whole idea of like, okay, if you're a doctor you're supposed to wear a white coat, Oh, we wear a stethoscope around our neck all the time, just FYI.

And that you only talk in a certain way and it's really sterile and really, I mean, how do we learn best and how do we remember when we're having fun? It's actually when we hook, when we anchor in what we're learning to an emotional experience that we retain that. And so, yeah. I think I'm funny if people don't think I'm funny, that's okay.

That personality is a big piece, I think, especially for, you know, us as women to be able to relate to that. But we're not all everybody's cup of tea and that's okay. Yeah. I want to circle back because I think you said something important in your journey with this about the gut being so critical. I mean really to health in general, but particularly we're talking about women and hormones and I think that's new information for a lot of women, right?

To say, wait. What you mean stuff that's going on in my gut is related to the things that are going on with my hormone issues, my periods, all of that? Talk about that a bit.

Totally. Yeah. So I have to say in the microbiome research has really, I mean, exploded and there's so much that we don't know, which is where, like anyone who's heard me talk knows I'm always calling for more humility and curiosity in medicine and science altogether. Because back when I was getting my nutrition degree, the microbiome was just a bunch of freeloaders that made a little bit of B12 and maybe vitamin K. But other than that, they just ate your food and did nothing. And now look at where we're at. So, you know, I think a lot of women- you know, because of the way that conventional medicine is really set up, every part is separate. That that's how they view the body as well.

And so if you've gut issues they think that has nothing to do with like your acne, for example. So this is something that I asked patients. And, you know, I'm currently traveling as well. "That acne when it came up. What were your bowel movements like before then?" And they're like, "Why, why are you asking about that?" Well, because if you get constipated, we can actually have shifts and changes in our hormones. So it's not just what's going on in the gut, but changes in our hormones. And so for people who don't understand how this goes, our liver. Awesome organ, and packages up all of our estrogen puts it into hopefully the most beneficial metabolites.

And then that sent out to be excreted. So this is the estrogen we no longer need. And that's really important because women will, some of them say, well, my estrogen is low, so should I try to get constipated? No. Right. Or should I try to stop my liver from doing its job? That's binge drinking. No, let's not do that.

That has other complications. So once your liver's packaged it all up, it puts it into the gut to be removed. Now you'll also remove it through your kidneys as well. Another organ of elimination, but the trouble is, is that if you've got the wrong kind of critters, they're not even, and I know you guys know this.... they're not pathogenic. I mean, this is where people are like, Oh, you have an infection. No, you just might have overgrowth of the wrong kind of guys in there. And they can make an enzyme called beta-glucuronidase. Now, all that work that the liver did that beta-glucuronidase enzyme will undo re-conjugate estrogen, put it back into circulation, except it's not bound by sex hormone, binding globulin.

So now I call estrogen. She's like Beyonce of the diva as hormones, because like, right. Who you going to put on stage next to Beyonce that anyone's going to pay attention to? Yeah. I don't know. Maybe like Aretha Franklin or some of the greats, but, you know, with that in mind, it's like, if you put estrogen on the stage, it's going to be all about estrogen.

And so this is same on the receptor. So estrogen isn't bound to the protein. It's free. It grabs all of the receptors. Now we've got issues with estrogen dominance and that can be acne irritability, heavy, painful periods. You know, often during the holidays, we're not sleeping as well. We're eating more sugar, maybe more alcohol. None of these things are bad things. None of these make you a bad person, but it's always like January, February, March, where my patients are like, "These are the worst periods of my life". It's because of what went down during the holidays.

Yeah. One of the things - I love the term you use the "fourth trimester", right?

I mean, you've written books about it and all that. So just looking globally at what women's bodies go through when they're younger, before they're ready to have children they are going through birth control. And a lot of times they switched to different types of birth control they're using because of side-effects or whatever. So they're going through different types of hormones, then all of a sudden they want to have a child. So they stop the birth control. They go through pregnancy, which is a whole other hormone game in the body. And then after that, then you're going through all the postpartum changes. So that, you know, how does that whole sequence of events impact women in general?

Like what, what are the things that you think those, that sequence of events is driving when in women's health?

Wow. There's so many places we can go with that. But, you know, one thing I want to comment on is that you just said like women switching birth control. You know, it's been estimated around 30% of women actually go through five different prescriptions because of the side effects. And those side effects are , you know, as much as we hear people dismissing mood related side effects, it's actually the number one reason that women leave these drug trials or stop birth control altogether. So, I think birth control is its own separate piece to definitely discuss. I mean we could easily go hours on that.

But, you know, one thing that I didn't know. I spent 10 years on birth control as a first-generation college student. My mom was a teen pregnancy. So as I'm critical of birth control, I also see the value of birth control. And so in that though, I have really, I mean, my jaw dropped when I started to come across the case reports from the 1960s, showing a correlation between hormonal birth control and inflammatory bowel disease.

This is actually a lot of what is in the package inserts now. Those were never there before, but also in the early iterations of birth control physicians actually testified on what they were seeing. And those were redacted. Actually, a lot of these things that women have been complaining about for generations now weren't actually disclosed.

One of those is that we know there's an increased risk of inflammatory bowel disease, most notably Crohn's disease. When it comes to ulcerative colitis in those studies in particular, the women were smoking, so we can't say for sure that this was birth control related, but with that, came the question, you know, paper after paper coming out, showing this correlation.

I mean, even so far as to say that, if you spend a year on birth control and you know you have Crohn's disease, you're more likely to have an additional surgery every year that you're on it. I mean, that's huge. So where is this coming from? Why is this the case? Well, hormonal birth control actually induces intestinal hyperpermeability. So it's one of the drugs that can lead to leaky gut. Yeah. It also alters the microbiome and we can see this just by yeast alone. So if you just go into dental research, you see that dentists have been documenting changes in the oral microbiome and yeast overgrowth, more candida strains. So for practitioners listening to this, this is something I always post to them is that if you keep treating yeast in the gut or in the vagina and you're not checking the mouth, you might be missing where it's actually coming from.

Right? We're swallowing all the time so we've got alterations in the oral. And this is something I think when I say it it's like, duh, but it does take me say it. It's the whole tube. So the mouth all the way through it, we can see alterations in the microbiome. We also see alterations in the vaginal microbiome as well.

Now, the impact of this. So we've got leaky gut and we've got the skewing of the microbiome that can certainly in itself trigger auto-immunity and we've also got nutrient depletion. So things like vitamin E or excuse me, vitamin A and zinc. These two are really important in terms of gut health, integrity, but also immune system regulation. And so the pill specifically,this is the thing, whenever people say. Well, it's low dose. Comparatively speaking to the first generation it is low dose, but it's still a high enough dose that you take it, your liver takes a crack at, it tries to metabolize it, break it down. It's still enough that it tells your brain to stop talking to your ovaries and you didn't even digest all that. You didn't metabolize all that because it makes its way into the large intestine as well. And we actually don't have great studies. That answer the question of, well, what the heck happens when we leave women on this for decades on end? Researchers have compared hormonal birth control to antibiotics in terms of what it does to the microbiome.

How many of us spend 20, 30, 40 years on antibiotics continuously, right? We just don't. So we have to start looking at this because, as you said, through the life cycle a woman might be having yeast infections, she might have now received the diagnosis of IBS. If you talk to pharmacists, it's actually really - it was really eye opening for me. How many pharmacists have said to me, "Oh yeah. Once we fill that control pill prescription, we know she'll be coming back for either a mood altering drug, a proton pump inhibitor, or H two blocker for digestive issues or a thyroid medication." Like pharmacists have been seeing this correlation there. And so this is important as we talk about through the life cycle, because if, and when you do decide to have a baby, your microbiome becomes baby's microbiome.

And that sets the stage for baby's health and immune health through their lifetime. And so this is something where I get having been a ten-year pill user that is very inconvenient, these things that I share. But the thing that I pose to people is, we're not talking about just a woman. Like we are talking about this woman and her community and the future of our entire species.

Like that's a lot of weight to take in, but what I advocate for is if you use hormonal birth control, replenish those nutrients stores. Get your microbiome in check before you have baby. This is why, in, Beyond The Pill, I actually recommend megaspore for as the probiotic. Because that is the probiotic that I found time and again, in my protocols that does have an impact and doesn't have some of the potential issues if like - so let's say a woman has small intestinal bacteria overgrowth. Because while on birth control, You know, there's also issues with gallbladder function, hydrochloric acid. Yeah. We're talking about all of the mechanisms that help sweep things through and kill off those critters because with SIBO, you know, for people listening, it's, it's my philosophy. It's not that we have problematic organisms. We've got good guys in the wrong place and why wouldn't they want to be there when they can have all that yummy food that you're eating?

It's a party in there for them.

Absolutely. But does that help answer your question, but that was really great question.

Totally, I think it's really great being able to tie that in and then talking about the impact of that.

And, you know, and this is a hard thing to talk about in many ways, because like you said, it also has its important factor in society, right? It prevents unwanted pregnancies and so on, and it's an easiest way to do that. Um, so then expanding on that...

Maybe that depends.

No, no, you're right. No, you're totally right. It's easy to show that for the guys. And you know, maybe we could say that that women tend to be more responsible anyway. So it's, it's probably better to try to put some of that weight on guys as well. So that's a whole other kind of conversation, right? But that's an important aspect because birth control can affect the microbiome the way you described. There are other estrogen-like compounds that we're exposed to through products that we use every day. Right? So Xenoestrogens. So those likely also have a similar kind of impact on the body, right?

And so this is what we have to look at when we're counseling and women's medicine, and really that individualized aspect. Is that with birth control, for example, if you bring up that the pill is associated with a mild increased risk of breast cancer, you almost immediately get someone saying, "But it brings down ovarian cancer so it just doesn't even matter". Yes. And then, and there's also an increased risk of brain cancer and liver cancer, but a decreased risk of endometrial cancer. Like we can talk about the good and the bad, and that's really what I'm all about is like, I want access, but I also want education for all women because they need to be informed on what to look out for in their body.

And so, when we talk about the breast cancer piece, people often say, "Oh, well, it's a mild, increased risk." Well maybe, but in the context of her health, maybe not. Does she already have a family history? Does she live in an area like the central Valley of California, where there's a high amount of pesticide exposure, and those are ending up in their water?

What are her personal care products that she's using? So while, birth control may seem like one drop in the bucket. It may be a bucket that's already full and overflowing. And Xenoestrogens. I talk about these a lot in my book. Because these, this is one of those things where it's like, I mean, there's a lot of ways in society where women just kind of get the short end and this is one of them where it's like, "Well, you know, this one lotion contains this one, Zino estrogen, but it's such a low amount. Doesn't matter. Let it in''. Okay. Accept that she's using 12 products with that same chemical in there, and she's going to use it for the next. 10 years, 20 years. I mean, we tend to be brand loyal. When we find that I have curly hair, I've been using the same product. I'm like this works. I mean, they keep it.

And so with that, that's the question we're not really answering. What about the compounded effect of everything that's coming in in our environment? And then that over a lifetime and it gets really scary. Like you can get on the environmentalworkinggroup.org, you can start reading all of this stuff and you can start having panic attacks because it's overwhelming. But the reality is isn't, there is a lot we can control and we have to accept what we can't control. You and I travel a lot, like on planes all the time. I can not control whether they sprayed insecticides on that plane. I can't control the jet fuel that's coming in. And you know, I do take time off in the year where I'm like, I'm not going to travel. I'm just going to work on my detox pathways. But, I can't control that. What I can control is actually I picked up this tip from Dr. Terry Walls now I am eating purple cabbage. Me and my kid munching cabbage on every flight. So I can control what I'm doing to support what my body does naturally. When it comes to personal care products, you absolutely can control that.

And as I share in my book, and as I shared this in my book, I just was like laughing at myself that I thought. In my twenty-something self, there's so many things that I'm just in trouble for in my twenty-somethings. I thought I was supposed to smell like vanilla or champagne and berries. Women are not supposed to spend like champagne and berries. And yet here I was bathing in all of these endocrine disruptors and wonder, and then taking the pill at the same time and wondering why I was having so many symptoms, so many issues. So these absolutely do have an impact, but, you know, as I wrote that in my book, I didn't really understand at the time I didn't grasp - like where did that come from? That really was a messaging that comes from society about the cleanliness of women's hormones or women to get all together.

And I'm just giggling, cause I would just in target with my kid, in the tampon aisle and what's right next to it, but like, yeah. All of these products. And I had to do a video I'm like vaginas, aren't supposed to smell. The cameras are not supposed to smell like a fresh summer breeze. What does a fresh summer breeze smell like? That is other part of personal care products that don't get talked about a lot, because like what you put in your vagina that can alter your microbiome.

And we understand now from the research that alterations in the microbiome in our vagina can actually impact fertility. It can impact fertility. And so this is where some women tune out. Cause they're like, "I never want a baby". That's fine. But when you're in your fertile years you still want to ovulate. And if it can impact fertility, it may be impacting your ovaries overall.

This is how we produce hormones, which, you know, the story in medicine and a lot of society goes, hormones are, you know, inherently awful. They make women crazy. You know, there's all of this negative connotation when in fact, they give us super powers. Like our hormones are something that we can leverage and they bring strengths throughout our cycle.

Right? And just to clear it up, hormones impact men's brains as well. And so men can be moody. Men can have rollercoaster emotions, they just do it over a 24 hour period where we do it over, you know, a 28 day ish period. Right.

But I think that that's a really interesting point because. You know, I've read recently that there have been some studies done on hormonal birth control for men.

Yeah. And that those studies often are stopped before they get very far because of the complaints that participants in those studies have about impact on their mood and their ability to think all of that. And yet for women, that's been the standard for years. And on the mental health side, I see the pieces of that women who then end up in the hamster wheel of psychiatry and mental health. Because of impact of these kinds of things on there, you know, emotional and behavioral regulation, those kinds of things, where really it all comes back to informed consent about what the potential benefits and problems can be with hormonal birth control.

Absolutely. And you know, what you're speaking to is well-documented medical, gender bias.

And this is sometimes when I talk about this, these people are like, you're just making stuff up. I'm like really? Because major medical institutes are actually shifting their curriculum because they're recognizing just by having an F on your chart for female, a lot of doctors make up their mind that it's already in your head, that you're just being hysterical.

They won't use that word. Right. But still the throw back to that and as much as like, I think we like to, you know, inconvenient history, we like to forget really quickly. I mean, I'm such a nerd. I will just keep outing myself for my honeymoon. My husband took me to a rare medical bookstore

Something else to love about you. I love that.

Like the stinkier the old book the better. But I have this endocrinology book and it's actually from 1956, not too old. Hysteria is a diagnosis in there. 1956. Yeah. So this is something that we haven't really, we haven't stepped away enough from that.

And while, we stopped using hysteria as a term it very much is in the undercurrent. And, you know, to your point, the male birth control trial when it was halted - when I found, I was going to say interesting, quite frankly, it was infuriating. Is that men had an uptick in libido. Yay. Yay. We lose our libido that is really how birth control works. You just don't want to have sex right. In that they had a low a very mild increase in depression compared to what women experience. But that same quarter that they halted that trial they came out with an IUD for women, way higher depression listed in there in terms of the percent of women who develop it and it was deemed perfectly fine for women.

Now, why is this? This is where as women we're like, "They just hate us. Like, what is wrong?" It's money. It's a business decision. And so it's not that they are like, "Oh, you know, women, the burden of pregnancy is just on you. You dealt with it." There's a bit of that. But if you are a drug company developing a pharmaceutical you have to have a return on investment. It's a lot of money to put together these trials to develop this. If you are ministering this to men who think condoms are negotiable and society has treated them differently and it's causing these side effects they're not going to buy it. They're not going to use it. Why continue? Because you're not going to be able to make your money back on that.

And that's just, that's the reality of a capitalistic market being in medicine. And so we have to recognize that. Whereas with birth control, we've really had that narrative be into us of like, you can get pregnant anytime of the month. I mean, I was taught you could get pregnant anytime you could get pregnant on your period.

Right. Very very rare. And what is the root of this issue? Well, then in the United States, only 17 States mandate medically accurate information when it comes to sex education. So, you know, we actually see, what's really interesting is that contraceptives were actually developed on the preliminary work that evolved into fertility awareness method.

And this is really more of that masculine kind of narrative in medicine of women have to take birth control and, it's the sperm and they're going to race and they're going to penetrate the egg and all this. And what's really going on is that the fertile cervical mucus, which there's a window for that is nourishing and you don't want the first sperm that meets it there. He's immature. You don't want him. That's like. You don't want to be dating that guy. But it's really that the cervical mucus nourishes, helps the sperm mature escorts the sperm. Yes, that's right. The egg has the say in this. And then the egg is like, okay, you you're in your cool, the egg is like a bouncer at the door.

But you know, in all of that to really recognize that it's only a 24 hour event, that that egg is viable to become pregnant. And yet, we've gotten this information and part of that, I think does come from a good place where people are like, I mean, an unintended pregnancy can completely hijack your life. That's no joke or, you know, you might have a medical condition that puts you at really high risk. And so, it is something that, you know, we can see that it's great that we have access to birth control, but we need to stop with the fear-based approach and really come at it of like, what, what do we know right now?

We don't know a whole lot for as long as birth control has been around. And you know with the age population that you're working with adolescents, they're the most vulnerable, especially to the mood side effects. I don't know if you saw the 2019 study that just came out, showing that every using birth control as an adolescence.

Forever increased risk of depression. Absolutely. I can put my hand up. I started at 17 and I'm like, yeah. Okay. So does that mean that I should be afraid or I shouldn't talk about it? By the way, the ostrich that sticks its head in the sand still gets eaten by the predator. So not a good move there. We know that tells me. Okay. So I got to keep my exercise up. I'm going to keep up my social. Network's is going to be important. Especially as I age, I need community. I need to make sure that I am nourishing myself, nourishing my brain. As you know, I went through a traumatic brain injury, so that's another piece of this. Okay. Having had that happen, I'm at even higher risk. And so if you have this knowledge, you can identify preventative measures that you can take personally, but also know when to see your doctor sooner and be more educated in advocating for yourself.

I think that's such an important piece is that information is empowering for people. Right? And then that's what I love about how you approach us. It's like birth control is not bad. Let's be aware of this. Let's be aware of the risk factors. Let's be aware of how that might be impacting us. Let's be aware of things that we can do to support our microbiome, while we're on birth control, if that's what we choose. Or if we decided to go off birth control to have a pregnancy, how can we best support ourselves? And I think that's, that's a really important perspective. You're not saying don't do these things because they might harm your microbiome or make you more prone to depression. It's like, just be aware of what you're doing.

Yeah.

Using your bucket analogy. I like that where you talked about, you know, where the birth control is just a drop in the bucket, but if your bucket's already full, you're going to have an issue. Right. So if you have to be on birth control for whatever, the reason is, then you could try to reduce what else is in that bucket that's impacting you, right?

So that it has less of an overwhelming impact on your system, which I think are things that you cover in your book. And of course in all the work that you do. The diet side, the cleaning up of personal care products and so on. Are there a few things you want to throw out? I know you did a little bit on the xenoestrogens. Just tips for people. If you have to be on birth control, here are the things that you should practice.

Yeah, I wrote a whole book on that.

What's the name of your book?

It's called, 'Beyond The Pill'. It's been interesting what you're saying how people are like, this doctor is so radical and like, and just the things people say. And I'm like, teaching women how to stay safe on a medication that shuts down their entire reproductive systems is radical? Teaching women how to be informed about their body and when to see a doctor is radical?

Like, where are we? What are we in the 1950s? Right. So, with that, we have to look at all the areas that hormonal birth control impact. Which here's the thing to understand. While it is designed to be reproductive system specific, those hormones impact every single system in your body. You have receptors all over your body for natural hormones and these synthetic ones can play with them too.

So while being on hormonal birth control, number one is if this drug is going to lead to nutrient deficiencies. Your diet needs to be on point, but you also need a prenatal or multivitamin. And for people who are like, "Oh, you know, like, it's really not that big of a deal."

Well, then ask yourself why a pharmaceutical company developed a pill with folic acid in it. Because you know what, it's only 91% effective with typical use, which means that women can and do become pregnant while using it. And really, if you are a sexually active female, you should be taking a prenatal or multivitamin because by the time that little stick says you're pregnant, your baby already needed folate.

So this is very important in protecting this future human. So multivitamin, prenatal. Making sure that we've got good dietary practices, which I am not a food is bad or food dogma. I'm a foodie. I'm like give me all the food. And so there are recipes all throughout, 'Beyond the Pill' to help support you with that. The other piece is supporting your liver and your gut health.

So your liver and your gut by design will detoxify these hormones and move them out of your body. But your liver requires certain nutrients to do that. Coincidentally, they're depleted by hormonal birth control. Your gut microbiome needs to be on point. Otherwise we're going to have issues. If you're constipated, if you're having gas and bloating, like that's pointing to there being an underlying issue there.

And, you know, for clinicians. So so many times with my patients, like how I really got started in all of this was just making the observation of what couldn't be healed while she was on hormonal birth control. I mean, the chronic elevation in cortisol, like throw all the adaptogenic herbs in the world at this woman and you can't bring it down.

Oh, then the studies started to come up showing that women's HPA access gets dysregulated while on hormonal birth control, they bathe in more cortisol. That's not good for the brain by the way. So we need to support the liver, eating our cruciferous vegetables, making sure we have the micronutrients and the macronutrients we need, and then having regular bowel movements.

If you're on hormonal birth control, you're going to need a probiotic. You need to make sure you're staying with the probiotic and you are getting a variety of fiber. So. These days people usually take the pill for every ill and then they're like, "Oh, supplements!", but it doesn't work that way. So you got, you want to repopulate, but you've got to feed them. And really, you know, as I talk about my book, it's all about the terrain. It's all about the absorption. It's not just about you are what you eat. It's what you absorb. It's not just like, Oh, you just take your probiotics. You have to nourish the terrain so they want to stick around. And then we have to look at the metabolic piece.

So if you're a woman with PCOS, polycystic ovarian syndrome, you need to be having regular cholesterol screening, insulin, HS CRP, because you're already predisposed. You have a metabolic disorder that leads to hormone imbalance symptoms. And now you're on birth control that actually can do that as well. So we have to monitor that. Interestingly, we've seen that now there are studies showing that just six months or more on the pill specifically in your lifetime puts you at over a 30% increased risk of diabetes when you enter menopause. So there is something happening to us metabolically. And so we want to be looking at that piece and the pill is inflammatory. So yes, you need to eat, right? Yes. You need to exercise. You want to drink your turmeric, eat your turmeric, bring your ginger in, you know, get your fish oil. Cause by the way, for the vegans and vegetarians who were like, I'm just going to get plant-based. I explained this to my book and I hate to break it to you, but you require your own natural estrogen to actually take the plant-based precursors into EPA and DHA.

Right? If you're on the pill, you're not making your own estrogen. So you actually need to be bringing in those fish oils. Always sustainable, always highest quality, always screened for support the people who are doing it right in the industry. So that's a few of the things to look at. There's really, I mean, there is, there's so much more. But if you are one of the, you know, approximately almost 60% of women using birth control for symptom management, then you also want to look at what is the root cause of your hormone imbalance. So that, you know, because we see sometimes, I mean, I can't even tell you how many patients were put on the pill for irregular periods or, you know, given an IUD for regular periods. And as it turns out, they actually had hypothyroidism. I was on the pill can't fix hypothyroidism. In fact, it can make it a whole lot worse. And now this woman has been left to struggle and she's gaining weight and her doctor's like just eat right and exercise like, Oh, and now, you know, she's feeling depressed.

Okay. Well obviously you have clinical depression. Let's get you on a medication, right. And in reality, what it really was is that her period being the fifth vital sign it is, was tipping you off that there was a problem there. So we really want to investigate why. If you want to use birth control for symptom management, sure100, go for it. And that's your right, your choice to do, but we really need to understand why. And through the research, we've come to understand that using birth control for symptom management actually delays the diagnosis for women. And so while there are people who advocate very much that like, Oh, we should have access to this.

And like, don't worry about it. It's not dangerous. It can be very dangerous. If you have a woman, let's say, you know, with PCOS or hypothyroidsim or what's going on is that she's having malabsorption issues because of something happening in her gut. Now you, you know, as I say, in my book, the pill is really gasoline to your auto-immune fire.

So if you are already, if your body's like, well, let's think about making some auto immunity like with lupus or multiple sclerosis or, you know, the conditions I talked about .The pill can really tip you over the edge because any major shifts in hormones can trigger auto immunity. So whether that's pregnancy, miscarriage, postpartum getting your period for the first time ,peri-menopause going through menopause,or getting on birth control or getting off. I mean, we take for granted what a big hormonal shift that is for women.

And so this is why so many women experience post-birth control syndrome when they come off, because you were bathing in all of these, like fake out hormones, so to speak. And then all of a sudden you're not right. And then your brain and ovaries are just supposed to pick up where they left off. And it's like, they haven't talked for 20 years and now you're like, get it together, guys, come on.

Well, and I'm glad you raised that because we've been talking about the birth control pill from the standpoint of pregnancy prevention. But actually a lot of what I see in clinical practice working with younger people and young adults is that they're not necessarily initially put on birth control for pregnancy prevention. They're put on it as young as 12, 13 years of age because their cycles are irregular. Oh, they're playing sports.

Like I call it it's a dance. Yeah, your brain and ovaries are learning a dance. Like if they're going to go ballroom dance, are they going to get it right?

Like every single step, no, they have to figure it out. And it's actually Dr. Jerilynn Prior's work is some of the best work on ovulation and showing that there's about a 10 year maturation cycle. So from when you start your period, it takes about a decade for that brain ovarian communication to really be reinforced.

Have we answered the question in science of what happens when you disrupt that in women? Right? We actually don't know. And this is why I think if that's true, if that's a necessary maturation cycle, then that may very well be why 40 something year old women come off of birth control and say, why do I feel like I'm a teenager again, I'm raging, I'm emotional. I have acne. All of this is going on. It's like, is that the dance that you were supposed to do that got hijacked and put on hiatus?

Yeah, but it's just so interesting because younger and younger women now are being put on this for all kinds of things. Oh, you're, you know, moody, you, you play sports, it's inconvenient for you to get a period every month. Which that's a whole other conversation, right? Oh, you don't need to get a period. It's okay. You can go years without getting a period just to go on birth control

We're all pregnant for like decades, right? I'm like, no.

But it's all those pieces that sometimes have nothing to do with pregnancy prevention. But I do wonder about how that sets young girls, young women up for microbiome disruption for gut problems for all of these things later on that most of the time are never connected back to early pill use.

Totally. And like what we're seeing with teenagers being at increased risk for suicide.

I mean, that's something that, um, I was lecturing somewhere and this doctor, he like shouted out and he was like, "So what are you saying? We just let our young girls get pregnant ". And like, I'm not saying that. But you know, as we're, as we're looking at all of these pieces, if we know this then we can cancel this. And instead of saying, here's your pill, like, this is what we do to women at college. Here's your pills study hard, don't get pregnant. And it's like, well, and then who follows up on her? What if you could just make a phone call six to eight weeks later, which is when the suicide risk peaks and say, Hey girl, Hey, how's it going?

Like your front desk person, you could have your mini mental health screening. You have your baseline, your front desk person calls goes through the checklist. Okay. Yeah. We actually have a whole flow. You need to make an appointment with the doctor. Let's get you in. Like we can actually do things differently so that we don't. I mean, you and I have talked about this. Our teenagers are already at higher risk of suicide. Now we're adding an optional medication that puts them at even higher risk. And then we're saying, but don't question it because you're a bad woman or feminist or whatever label you want to put on it.

Right. And really we could do a better job at supporting them and evaluating is this the best option for them. But, you know, we're actually seeing millennials and younger are rejecting hormonal birth control at the highest rate we've ever seen. And I get interviewed about this a lot and the biggest thing that I really pointed back to is that, I mean, yes, they're more body positive. Yes. They want to know their body. Yes. They want to work with their body. They also watched the generations that went before them. They saw what happened to their mother and their aunts. They understand like what they went through and they just are asking that there be another way. And so, this is a very, I mean, it's a twisty, turny conversation.

There's a lot that comes into play and that's why we have to be very individualized in this discussion. We can't just make blanket statements, such as, birth control works for every woman or, you know, No woman should ever take birth control. I mean, I see people online who are like, you should get off birth control it's the worst thing. And I'm like, she might have endometriosis and that may be the only thing making it so she can get out of bed. Like you don't know her, you don't know how to live her life better than her. And can you leave it to her and her doctor to be able to have this conversation. But we have to start educating more doctors.

That's why I'm here because there are doctors who truly believe that they fixed women's hormones are fixed women's periods when they give them birth control. And what I always pose is. Okay. So if you had someone with gut issues and you gave a medication that just stopped the tube from functioning. Tube doesn't function. Did you fix the gut?

No, that's ridiculous. So you shut down her entire reproductive system, and now you're saying you just fixed it. You fixed her ovaries? Nope. They're not functioning anymore. And you know, then the next place that we go in the conversation. Cause you know, there there's always, these are also the same people who are like, well, it's not really having those side effects and it only affects the ovaries and it's like, it actually affects the brain.

That's the level that birth control works on. And this is sometimes I just see these aha moments in doctors' faces. And this is where I'm like, I mean, this is what I'm so passionate about is educating and helping them understand your doctor's not bad. If they were taught that birth control fixes your hormones, fixes your periods.

That withdrawal bleed is just not a withdrawal bleed it's non-natural period. Periods only come through a cycle. You have to, you have to go through a cycle of hormones to have a real period. But really what your doctor, this is what they've learned, that they also just want to help you. And if they truly inherently believe this pill will fix all your problems. Why wouldn't they prescribe it to you? Of course, they're going to do that. But the problem is, is that what we've been taught, even what doctors are taught in medicine isn't actually accurate. And there are statements that have been made in medicine that are exclaimed that , the evidence for which there's no evidence, there's no evidence.

So when the, you know a great example is the newer generations of birth control are safer for breast cancer risk because they're lower dose. We never actually had any evidence to make that statement, but there it was over and over, that gets ingrained. It gets indoctrinated and now the research came out that said, Hmm, no, actually we weren't totally correct on it. And that's hard because that takes a lot of humility to say, oops, we were wrong. We're going to be wrong in medicine. Like we were wrong about the microbiome, we're going to be wrong. That's the way, you know, that's that's science. But if you're not okay being wrong, then you're in the wrong arena. Like we, we have, it's something that I explained to people like, part of my job is to prove myself wrong. Like that's part of my job is to say like, well, this is what I think. But could I possibly be wrong? Yeah.

As we get ready to wrap up here, I mean, we could talk for days about all of this.

For people who are listening, particularly women who are listening, you've drawn that strong connection between the gut microbiome, microbiome health, and hormone health, and just women's health in general. What do you feel like is a great starting point? For a woman who's listening who's like, I've never really thought about that before. I want to think about what I should be doing to support microbiome health. What, what would be a great starting point for people?

You know, it's really everything that you do every single day. So this is the thing that like, people they're looking for the magic bullet, like the super sexy stuff.

I mean, the stuff that I counsel a lot is like everything, your mama told you she was right. That's right. And it should really empower you because what people forget is over the evolution of medicine it's been like, it's been, frankly, doctor is God like bow down at the alter of medicine and they will save you. We have to flip that script because the reality is, is that what keeps you out of the doctor's office and where the true healing happens is what you do every day, what you put at the end of your fork, even how you talk to yourself. So studies showing that negative self-talk actually increases inflammation and these people also end up with depression and anxiety.

Well, where's all this inflammation coming from? From like, there's this gut check that happens. Right. Which is incidentally the name of my chapter is Gut Check. And there's a whole chapter on gut health in there, but you know what you put in at the end of the fork, how you talk to yourself, the relationships that you have in your life, the personal care products that you're using, the choice to take the stairs versus take the elevator.

All of these things. Well, you know, again, we want to compartmentalize and think like, Oh, that's just doing this. They actually all impact our microbiome and then not being so fear-based in your approach to food. Like there's going to be foods that don't work for you acknowledge that. But I think sometimes people get, especially in like the wellness arena, people like are like my badge.

This is who I am. I am. I am AIP. I am low-FODMAP. And I'm like, I eat, I like, you know, it's really, you know, Kiran and I talk about this a lot. About variety in your diet and making sure that you're getting variety, you're eating, you know, things that you wouldn't normally eat, trying stuff out. In the United States I can't eat gluten. It's wicked awful for my joints. Yeah. I can go to Europe. I can eat all the gluten and you better believe I do. I'm like, Oh, croissant, sign me up. Like I'm going to eat that. So just to recognize that, like, when we talk about gut health, it's not just about what you eat, it's really who you are and how you're moving through this world.

And I think. Very much. Oh, I hope it's in my lifetime guys that we call the gut the first brain, because I think calling it the second brain is such a disservice. And really from an evolutionary biology perspective, organisms don't develop a brain first. They develop a tube first. And so this tube it's sending messages out and it's bringing messages in. And just to understand that one of the best things you can do for your hormones is continually signal to your body that the environment is safe. Because when we signal the environment is safe by adequate sleep, keeping stress low, eating and yes, you can intermittent and fast and you can do you have all these things. But this signaling that it's safe tells the body we're in an environment where baby making is on the agenda.

And if baby makings on the agenda, we ovulate, we get progesterone, we get estrogen, right. Testosterone's right. We become more sexually engaged, which actually helps balance TH1 and TH2's immune system. So, you know, as much as it's like, I could tell you, like eat turmeric, Jerusalem artichoke so much more than that.

So every decision that we make that's healthy in any aspect of our life is actually supporting the health of our microbiome as well.

And it all adds up, right? That's the thing. Every little tiny thing adds up.

Right. It's funny because as you were talking about... so I used to work in dentistry. That's actually where I started. And I remember when we celebrated putting triclosan in toothpaste. Yeah.

Oh my God.

Now where were at when we talk about the environmental toxins, right? It messes with your hormones. It messes with your microbiome and ladies, if it messes with your gut, it messes with your hormones and vice versa. But that's just an example of something that was celebrated thought to be amazing. It was going to change everything. And then we were like, Oh, whoops. And like, listen, like, yeah, I I'm, I'm biased to love better living through chemistry. I have a degree in chemistry and yet at the same time, I'm like, mama nature never gets it wrong. But the humans we'll be messing it up left and right. Like every time it comes out of the lab, says the girl raised on margarine and the infant was afraid of butter.

I'm like, Oh man, we got it wrong again. But now, you know, and not, I say that because. You know, as you say, like every everything's a choice towards health or, you know, we're voting all the time. We also have to recognize we are doing the best we can with the information we have and that living a full and joyful life will do more for your health than eating the right prebiotic food. I just say that for my people who get a little bit neurotic about life and I've been there.

Yeah. Ironically, the food pyramid gate, I was orthorexic with, Oh, the FDA's food pyramid. I was like, I eat six servings of grains a day and never eat any fat. And I wonder why I'm in so much pain and I feel awful. So listen to your body. And enjoy your life. Like that is something that like, I don't think it's talked enough in health and wellness is that if you're not living and you're not having fun then what does it matter? I don't want to live to be a know a hundred if it's sucks. And so I was actually on Bulletproof radio. Dave's like, how old do you want to live to be? And I'm like, the number's arbitrary quality is what I'm here for. Like, if it's 180 or 200, whatever he's aiming for. That's awesome.

What if I have ride a bike and I'm not giggling? Yeah, I'm out.

It's such a great perspective. So many wonderful pieces of information that you shared and just great perspective, always a joy to be able to spend time talking with you. Thank you for being here with us.

Yeah. Thank you guys. It was a great conversation.