Hormone Intelligence with Aviva Romm

By March 9, 2024

Power of Electrolytes

In today’s episode of the Keto Diet Podcast, we’re chatting about hormones and how to understand them better. We’re talking about the hormone landscape and your cycle and pms and the foods that can support us and the movements that can support us and sleep and circadian rhythm and everything in between.

Aviva Ram, MD. is a world renowned midwife and herbalist who also happens to be a Yale trained MD and board certified family physician with specialties in integrative gynecology, obstetrics and pediatrics.

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Aviva Romm [00:00:00]:

One of the most important things that women can do for our own health, which is keep our blood sugar steady. And so it’s not just what we’re eating, but making sure that we are really getting an adequate distribution and a good distribution of what are called macronutrients. So protein, fats and carbs and our culture tends to lean into either overeating protein. A 32 ounce porter steak is not a healthy dose of protein any more than like only eating carbs is right. And our diet tends to lean either inappropriately heavy, really pro inflammatory protein, or really heavy carbs, or typically a combination of both rather than kind of a steady state of getting enough protein, getting good quality protein, getting good quality fat, and if you’re going to eat some carbs, paying attention to how they feel for you and when you’re eating them.

Leanne Vogel [00:00:52]:

Hello and welcome to another episode. Today we are chatting about hormones and how to understand them better. We’re talking about the hormone landscape and your cycle and pms and the foods that can support us and the movements that can support us and sleep and circadian rhythm and everything in between. Today’s conversation is going to be really great for any woman. Any woman, really, truly any woman on planet Earth. Our guest today is Aviva Ram, MD. She’s a world renowned midwife and herbalist who also happens to be a Yale trained MD and board certified family physician with specialties in integrative gynecology, obstetrics and pediatrics. A longtime home birth pioneer and birth activist, Dr. Ram is keenly committed to patient empowerment and addressing health inequality. You can find out more from her by going to her website, avivarom.com on instagram. She’s Dr. Avivaram and she also has a book called Hormone Intelligence. I will include all the links in the show notes today so you can check her out. Okay, let’s get to today’s interview. Hey, my name is Leanne Vogel. I’m fascinated with helping women navigate how to eat, move and care for their bodies using a low carb diet.

Leanne Vogel [00:02:11]:

I’m a small town holistic nutritionist turned three time international bestselling author turned functional medicine practitioner, offering telemedicine services around the globe to women looking to better their health and stop second guessing themselves. I’m here to teach you how to wade through the wellness noise to get to the good stuff that’ll help you achieve your goals. We’re supporting your low carb life beyond the if it fits your macros conversation, hormones, emotions, relationship to your body, workouts, letdowns, motivation, blood work, detoxing, metabolism. I’m providing the tools to put your motivation into action. Think of it like quality time with your bestie mixed with a little med school so you’re empowered at your next doctor visit. Get ready to be challenged and encouraged while you learn about your body and.

Aviva Romm [00:02:58]:

How to care for it better.

Leanne Vogel [00:02:59]:

This is the Keto diet podcast. Hi, Aviva. How’s it going?

Aviva Romm [00:03:12]:

Hi. It’s going really well. I’m excited to be here talking with you and to support your community.

Leanne Vogel [00:03:20]:

Oh, I love the work that you’re putting out there. And today it’s no surprise we’re going to be talking about hormones. And I would love for you to just tell us a little bit about how you got involved in this, why it lights you up, and why you just feel really called to educate women on this.

Aviva Romm [00:03:35]:

Well, let’s go back 40 plus years. When I started this entire journey I’m on in women’s health and integrative medicine. My first exposure to all the things was actually about food, and it was about the intersection of food and food politics and food scarcity and environmental exposures that we get in our food and the chemical agricultural industry. And so as idealistic radical teenager, I was like, oh, I can make a difference in my life and planetary health by changing my diet. So at that time, I actually went vegetarian, plant based, and primarily vegan. You really couldn’t get good organic meat, good organic dairy back then, unless you happen to know a local farmer. And that led to understanding more about women’s health politics, the history of women’s health, and all these interconnected factors. And so between 15 and 16 years old, I actually had started college, left college, apprenticed myself to a midwife and an herbalist, and there began the whole journey that’s led me to here, including four kids and practicing as a home birth midwife and an herbalist, and becoming a Yale trained MD and a family doctor.

Aviva Romm [00:05:03]:

And I think what really keeps me inspired now is, sadly, how much things haven’t changed in sort of this medical patriarchy and cultural patriarchy, and how much the food industry, the agrochemical industry, the pharmaceutical industry, not to sound all conspiratorial, because I’m not, but like, literally, factually, how many of these things are still impacting women’s health? And not just still, but actually impacting women’s health more than ever. We have more autoimmune diseases, more hormone conditions, more problems that women are struggling with. And still the answers from the medical community are like, we don’t know or drugs or surgery. And so I would say about that keeps me inspired, is the stories I hear from women day after day of their struggles, but also the women who write me. I got an email last night from a woman in a little town in Italy. She’s 24, and she said, I haven’t had my period in two years. I got your book, Hormone Intelligence. Not a plug for the book, just telling you the facts.

Aviva Romm [00:06:10]:

And I started taking one of the herbs that you talked about in the book and making changes in my lifestyle, and my period started again. Or the story of the woman from Turkey who. She and her sister in law had both been struggling with fertility problems for several years, changed their lifestyle, changed their diet, started some basic supplementation, and both are pregnant. So it’s that. That just really blows my hair back, if you will, and keeps me up at night on how to make changes in all of this.

Leanne Vogel [00:06:40]:

Yes, completely. As somebody who had hypothalamic amenariah for eight years and went to multiple doctors who said that I would never menstruate, I would never ovulate, I would never be able to do any of these things. And really taking matters into my own hands. Now I’m six years ovulating, having a perfect menstruation, not dealing with pms and those lifestyle factors and just simple things that we can shift, really do make a difference. And the hopelessness we can have when we meet with a doctor. I mean, I must have seen seven different specialists who all said the exact same thing. And at some point, you’re like, you throw in the towel. And so that’s why I love having this conversation, because there has to be at least one woman who was as frustrated as I was, just feeling like there’s this glimmer of hope.

Leanne Vogel [00:07:24]:

Like, is this actually my reality?

Aviva Romm [00:07:26]:

Totally. And it’s like, through all of these different arcs of our life cycles, right? Like, whether it’s puberty or pregnancy or postpartum or menopause. Menopause should just start with a p, then it. Well, perimenopause, then it would all fit together, right? Like, we can alliterate women’s life cycles. There are so many women struggling, and still. A survey was done looking at endometriosis. 70% of doctors interviewed said they didn’t know enough about it to diagnose it. And even if they knew, they wouldn’t know how to treat it.

Aviva Romm [00:07:55]:

We look at the overlooking of thyroid problems, the dismissal of women with PCos, and the list goes on and on and on and on. And there’s so much that we can do when we just take our health in our own hands. And I’m not saying that I don’t ever recommend surgical procedures or pharmaceuticals, but it’s really. That is the exception compared to the rule. And I just see so many things as possible and so many changes when we really do make simple lifestyle changes. Unfortunately for women, it’s not always just like, it’s easier said than done, right? Like, you’ve got little kids, you’ve got parents, you’re taken care of, and now we’re talking about how do I prepare meals for myself? And there’s economics involved and all the things. So I do like to make it simple, but I don’t want to just make it sound like it’s always so simple.

Leanne Vogel [00:08:43]:

Completely. And so is that where the whole ecosystem healing kind of concept comes from, of seeing the body, not just as when you go to your doctor and they say, this part is broken and we’re going to fix this part while not looking at the whole picture. Is that kind of what you’re getting at when it comes to the whole ecosystem?

Aviva Romm [00:09:02]:

Yeah, totally. There are these kind of two intersecting ecosystems that aren’t really separate, but it’s helpful to think of them as like a ven diagram. So there’s one circle, another circle, they overlap. Right. And the ecosystems are all the things that are happening in our physical selves and our emotional beings. So whether it’s the health of our gut microbiome or the stress point of our stress response, based on maybe like trauma, we’ve had our living situation, all these things that shape our personal world and then our diet, all the things how well we assimilate our nutrients. And then there’s the external world, which is like the environmental chemicals. We’re exposed to the food marketing and advertising, we’re exposed to the food, we’re exposed to the stress, we’re exposed to racism, sexism, all the things that affect people, depending on ageism, genderism, like depending on what your sort of wheelhouse is.

Aviva Romm [00:10:02]:

And then those things intersect into the ecosystem that sort of shapes you and that you’re living in.

Leanne Vogel [00:10:09]:

So when you’re saying taking our health into our own hands, I would assume that that whole ecosystem healing has to contain the addressing of the diet, stress, trauma, other things you mentioned, like living situation, like everything combined into one big holistic piece that we’re addressing.

Aviva Romm [00:10:29]:

Totally. And also there’s another element which is, and I know it’s sort of an overused word, empowerment, but when we talk about taking our health in our own hands, there’s actually data that shows that women who actually become more empowered about their health actually have better outcomes. One, they’re more likely to advocate for themselves at the doctor’s office, but also that difference between being in a fighting spirit for your health versus this sort of hopeless, helpless victimization, which the medical model reinforces us to be hopeless and helpless. And yes, we can feel hopeless and helpless because feeling unwell can feel so overwhelming, and our choices can feel overwhelming to pick from, or we might not even have access to all the choices we might want. But there was a study done in Australia looking at women with endometriosis who felt victimized by having endometriosis. Like, what’s wrong with me? What am I doing wrong? I’m broken. I’m never going to get answers, versus women who are a little bit like, okay, I’ve got this issue, and I am going to do everything I can to get to the bottom of it and find the right doctor. And interestingly, those women were more likely to, not surprisingly, find the resources they needed to feel better.

Aviva Romm [00:11:48]:

But just getting activated like that, in a way, made them feel better, too.

Leanne Vogel [00:11:54]:

So when we’re thinking about chatting about hormones, I’d love to kind of define who would need to listen to this episode. And I think a really good way maybe to do this, and you might have other ideas, is to kind of go through the common symptoms that are hormonal, symptoms that we just assume are totally normal, to kind of give us an idea of whether or not a conversation about hormones is where we need to spend our time today.

Aviva Romm [00:12:20]:

Yeah, totally. So I think every woman should listen to this episode one, because you’re obviously a good interviewer. Thanks. But I think you’re welcome. We’re so under educated about our bodies. Like, most women can’t identify most of their intimate body parts. Most women can’t define their hormones. Most women go into perimenopause and menopause having no idea what that is.

Aviva Romm [00:12:41]:

So I think it’s important for all of us, my sort of bottom line with our hormone symptoms and knowing what. So I separate what I call signs and symptoms. So, for example, let’s say you are three days premenstrual and your boobs feel a little bigger or maybe tiny, know, fuller. And maybe you’re kind of feeling like, yeah, I just assume not go to that office party on Friday because I’m just going to be bleeding or it’s, like, tomorrow, and I just really want to be home watching my favorite Netflix show. And you’re wanting a little chocolate, right? Those are signs. There’s nothing wrong with any of that, right? It’s like they’re just signs that you’re going through some hormonal shifting, and maybe you feel a little more internal, have a little bit of a craving because your hormones are dropping, your blood sugars may be a little different, and you’re just sort of like, yeah, not feeling the same perky thing I might feel when I’m ovulating. But there’s nothing wrong with that. There’s nothing wrong.

Aviva Romm [00:13:45]:

Now let’s put that on steroids. Okay. I can’t get out of bed to go to work today, let alone that party tomorrow night, because I feel like hell. I feel so depressed. I feel so anxious. I am so filled with rage. And it’s like you’re not just having a craving for chocolate, but you feel like you’re completely empty and you just want to eat the whole bag of chips, then the whole container of Ben and Jerry’s, then eat the chocolate, and then maybe go for some fries or the pizza. And your boobs aren’t just aching a little bit, but they’re like, you can’t put your normal bra on or your shirt.

Aviva Romm [00:14:24]:

And you’re thinking, I’ve got to take some ibuprofen. Right? So we’ve got kind of like normal little body signals or signs that you’re getting to your cycle versus discomfort and a level of incapacitation and inability to do your normal social or career things. And there’s a spectrum in there, right? But I would say that signs that our body or signals that our body is going through some changes, that’s normal. But when any symptoms you have are making, you have to take a medication regularly or miss work or miss school or bail out on social events, not because you just don’t feel like going, but because you just really can’t get it together to go, and you don’t really want to be around other humans or they’re causing you physical or emotional or psychological or cognitive discomfort, that’s very different. And that’s where I would say help is needed, support is needed. And then kind of like, you have to decide where on the spectrum you are now to your question about what we’ve been taught to expect is just normal. Heavy bleeding, skipping periods, irregular cycles, painful periods, pms. That does make us feel like crap, even if it’s not completely incapacitating premenstrual headaches, feeling like you do need to eat to the bottom of the bag of chips and then the fries and then the ice cream.

Aviva Romm [00:15:49]:

We’ve just been taught to expect all of this is just how it’s meant to be. Any pain? No, we’re not supposed to be in pain. I mean, maybe when you’re in labor. Labor is pretty intense, but for the most part, there’s no other time that you should normally be in pain. Painful sex. I would say low libido is more complicated because low libido can be a sign that your hormones are off or something is going on. But low libido could also just be like, different people have different levels of sexual desire that can be related to your partner relationship. Other more complicated, having little kids and you just feel touched out.

Aviva Romm [00:16:25]:

But yeah, anything that’s sort of taking you out or getting more attention than it should because you’re uncomfortable, none of it is normal.

Leanne Vogel [00:16:34]:

I love that definition. It almost sounds like soft experiences of little nudges versus being pushed off a cliff. Pretty epic.

Aviva Romm [00:16:43]:

Yeah. I had some hot flashes when I went into menopause, and I didn’t think, oh, this is abnormal, I have to take hormone replacement therapy. But if hot flashes were making me embarrassed to show up on podcasts because I’m sweating or keeping me up, like 3468 times a night and now I’m getting sleep deprivation, that would be the difference to me.

Leanne Vogel [00:17:10]:

We know that we lose muscle as we age and that this loss massively affects our ability to function. Like I’m talking basic tasks here, muscle is important for protecting our joints and also keeping our metabolism revving. Basically, you want muscle, and unfortunately, a lot of us just don’t prioritize muscle maintenance or see it as an importance. And you may also be cringing at the idea of going to the gym and being able to maintain that muscle consistently. Yes, active moving is super good, and.

Aviva Romm [00:17:44]:

There’S really nothing like it when it.

Leanne Vogel [00:17:46]:

Comes to the mood boost of pumping iron. So when I share about Eurolithan a, I am not saying just to do this. And you can maintain your muscle without movement. Well, I am saying that because urolithin a does do that. But I think pairing eurolithen a with exercise is likely the best path forward. So I started taking a product called mitopure to boost my performance and improve muscular strength. And mitopure has 500 milligrams per serving of eurolithan, a postbiotic shown to have major benefits to significantly increasing muscle strength and endurance with no other change in lifestyle. Yes, you heard that right.

Leanne Vogel [00:18:34]:

I just said that it has major benefits to significantly increase muscle strength and endurance. With no other change to lifestyle, it gives your body the energy it needs to optimize its cellular power grid through boosted mitochondrial health without changes to lifestyle or diet. Now imagine what it could do with your low carb diet and a walking goal or a lifting goal a couple of times per week. It took me a long time, like a couple of months, to introduce mitopure to my day because it’s so strong. Every time I took it, I almost had too much energy, so I really had to titrate up. Mitopure is the first product to offer a precise dose of eurolithan a to upgrade mitochondrial function, increase cellular energy, and improve muscle strength and endurance. They’ve created three ways to get your daily dose of 500 milligrams of eurolithan a in their product, mitopure. They’ve got a delicious vanilla protein powder that combines muscle building protein with the cellular energy of mitopure.

Leanne Vogel [00:19:41]:

Now, this product does contain whey protein, and then they have a berry powder that easily mixes into smoothies or just about any drink. This is dairy free. And finally, the soft gels, which is what I prefer because it’s just easier. This is also dairy free. I love the starter pack idea, though, if you can handle the dairy, the three forms of mitopure to play around with, which one is your favorite? Top notch. So, timeline, the creators of mitopure is putting together a sweet little offer for you. 10% off your first order. So if you go to timelinenutrition.com kDp and use the code KDp, you’ll get 10% off your order.

Leanne Vogel [00:20:23]:

Again, that’s timelinenutrition.com kdp. I recommend trying their starter pack with all three formats and picking out your best format. Again, that’s timelinenutrition.com kdp. Okay, so when we’re talking about these individual pieces, I know since we’re talking about this, there are going to be many women that if I don’t ask this question, they’re going to be upset with me. So can we go into some other. I know there’s that woman being like, come on, Leanne, ask the question. Can we go into some reasons why these. You mentioned a couple things, like irregular cycles and wanting to eat all the things.

Leanne Vogel [00:21:03]:

Hot flashes. What are some of the root causes under these common issues that are a lot more symptomatic than they are the signs?

Aviva Romm [00:21:12]:

So at the surface level, there are the cycles that we go through with our estrogen, our progesterone, testosterone, throughout the month and throughout different phases of our life. And along with those changes, we think of, as you mentioned in silos, right? Like, there’s the cardiologist and the neurologist and the obstetrician, but in reality, your hormones and your neurotransmitters. So that dopamine, serotonin, the things that make us feel good, those are all interconnected. So when, for example, estrogen and progesterone normally drop before your period, so does serotonin. It goes down with estrogen. So some of these cyclic changes are what give us these normal little nudges, as you said. But when things are falling off the cliff, usually there are some underlying or root causes, and that can be a whole kind of panoply of things that interact, like these multifactorial causes, as I say, or it can be an individual thing. So, for example, you could have low calcium and low magnesium, and that causes you to have more spasy muscles, and that causes more menstrual pain and lower mood.

Aviva Romm [00:22:26]:

You could have low vitamin D and low magnesium. That could cause lower mood. So it could be simply like a nutritional factor. But let’s say you have irregular periods. You skip a period for three months, then you get one, then you skip it for six months, then you get two. That could be, let’s say, pcos or polycystic ovary syndrome. That could be due to insulin resistance. That can happen as a result of not even just a standard american diet, but just a diet that is not heavy enough in protein and not getting enough exercise, and that causes insulin resistance.

Aviva Romm [00:23:03]:

But inflammation can cause that. And inflammation can come from diet. It can come from stress. It can come from endocrine disrupting chemicals in the environment that we don’t even know we’re being exposed to. It could come from four rounds of antibiotics you had because you had utis in pregnancy or you got utis at another. There’s a whole wide range of things. We look at something like endometriosis, which can cause debilitating menstrual pain, pain with sex, urinary problems, bowel problems, depression, anxiety. And that can be a result of chronic exposure to endocrine disruptors before we were even born that have changed our immune system and caused inflammation.

Aviva Romm [00:23:49]:

And even these endocrine disruptors that I’m talking about, those can mimic estrogen, progesterone, thyroid hormone, and block our own body’s hormones or mimic us having extra hormones. And that can set off a whole wide range of these impacts. So it’s really quite complex on one level because there are multiple different factors. But what’s kind of interesting is the solutions, in one way are relatively contained. I’m not going to say simple or easy, because making changes is complicated. And then there’s a level at which we have no control. Like, we have no control over what chemicals are in certain foods or our water or our soil or our air. But we do have control over what cosmetics we use, what shampoo and soap we use, what household cleaners we use, so that we can reduce our endocrine disruptors.

Aviva Romm [00:24:45]:

That way we have control over what we’re eating. And while certain things like going 100% organic may be cost prohibitive for most people, there’s a lot we can do to reduce those environmental exposures. We can support our gut health by eating a wide variety of foods in our diet and getting some fermented foods. We can do our best to get better sleep and reduce our stress and all those things. So there’s like a set sort of container of changes that we can make that actually impact pretty much all of those imbalances and disruptions and symptoms and conditions pretty straightforwardly.

Leanne Vogel [00:25:27]:

Yeah. So earlier, when you spoke about hot flashes, you mentioned it sort of being a sign as an experience through menopause. But if you were sitting on this interview and you were sweating like crazy, then it becomes more of a symptom. So what are your thoughts when a woman goes to her maybe functional doctor or doctor, and they instantly say hormone replacement therapy, what are your thoughts on that ecosystem situation?

Aviva Romm [00:25:52]:

It’s actually driving me a little bit crazy and feeling a little bit throwbacky to the forever young kind of thing. And it’s interesting because a lot of the sort of wellness people, some of whom are doctors, some of whom aren’t, who are really promoting hormone therapy right now, are some of the same people that would be critical of the overuse of birth control in teenagers. And yet I feel like the pendulum swung from, oh, we shouldn’t use hormones. With the Women’s Health Initiative study in the early now you’ve got all these wellness influencers who are menopausal age, who are like hormones for everything. And the data is a little bit more gray area than that. First of all, I think there are a lot of ways that we can support our perimenopausal and menopausal health without using hormones. I also think that nobody should suffer and be miserable. So if you’re already at the point of misery and you have symptoms for which hormone therapy is appropriate, and that’s a big, important statement right there, then absolutely, you can use hormone therapy if it’s not contraindicated or unsafe for you, but you want to make sure that you’re using it for an indication that is appropriate.

Aviva Romm [00:27:14]:

So, for example, we do know that hormone replacement therapy, or now called menopausal replacement therapy, can be very effective for hot flashes, it can be very effective for vaginal dryness, and it may even help with sleep. There are a lot of people touting how important hormone therapy is for preventing dementia, and basically, women should all just go on it for a few years to prevent dementia. But that evidence is not definitive, and there are lots of other ways to prevent dementia than going on hormone therapy, and most women are not going to get dementia. So putting every woman on hormone therapy to prevent something that hasn’t been proven for it to prevent, which there are other ways to prevent that don’t involve things that can have risky side effects and which may never happen to you, seems like overkill to me. So I’m more conservative. I do prescribe hormone replacement therapy for menopausal women in my practice who just really are struggling and symptoms are debilitating. And either for whatever reason, they didn’t get quick enough or effective enough results from more natural therapies like herbs or supplements, or they’re just freaking over it and they’re like, I am not getting any sleep. I can’t wait four weeks for these other things to kick in.

Aviva Romm [00:28:27]:

Please help me now. And we might do hormone therapy as a stopgap while we’re onboarding some of these other things, or it may just be like, exactly the best thing for them, in which case, I’m going to use the lowest possible dose for the shortest amount of time and be really mindful of safety guidelines. So, yeah, I feel like an outlier. Not an unusual thing for me, but to feel like an outlier in the wellness world when it comes to women, there are a lot of women doctors, and there are a lot of companies sprouting up for menopause. It’s a cash cow. It’s like a multibillion dollar industry. So I’m a little bit leery. It sounds like you are, too.

Aviva Romm [00:29:08]:

I got a little sense of like, yeah.

Leanne Vogel [00:29:12]:

The amount of ladies that I onboard in my one on one coaching that are on a significant amount of hormone replacement therapy while also having massive infections like Lyme, living in mold, heavy metal toxicity, and I’m like, you can throw hormones at this all day long. It’s going to do nothing. It is a drop in the bucket if you’re dealing with these issues and it costs a lot of money. Like, those testosterone pellets are not cheap. And the programs and the subscriptions.

Aviva Romm [00:29:41]:

Yeah, and the data on testosterone pellets is not convincing, in my opinion. I’m not saying testosterone never has value, but I’d never use testosterone palates. The other thing that’s really important for listeners to know is that bioidentical hormones, even if they’re from natural sources, aren’t necessarily safer than other forms. And a lot of people are like, oh, it’s bioidentical, so it’s natural and it’s safe. But we have to treat all the hormone therapies with the same level of respect as any conventional. And I have had patients who started seeing me after they were put on bioidenticals by an integrative or functional MD or nurse practitioner or what have you, who have had endometrial hyperplasia as a result of overgrowth of their uterine lining from too much estrogen, including two women who were getting biopsies and being told they might need a hysterectomy for cancer, who, when I took them off of their hormone therapy, their symptoms resolved. And sadly, one woman who did not become my patient, but I met her through a friend. I was meeting the friend for tea, and she’s like, can I bring a friend who would love to meet you? And it turned out to be, like, a curbside consult.

Aviva Romm [00:30:52]:

But she was actually put on hormone therapy about a year and a half prior and did develop endometrial cancer and was having a hysterectomy. By the time I met her, it was, like, so far gone, she had to have the hysterectomy. But, yeah. So I think we’re going to see another swing back in another five or ten years, maybe sooner.

Leanne Vogel [00:31:12]:

I’m totally taking the curbside consult. That is a fabulous. Yeah, I’m always ready for the curbside consult.

Aviva Romm [00:31:21]:

I used to do them, but now it’s like we’re having tea, and this is not the best way to give you information. Yeah, I feel you.

Leanne Vogel [00:31:30]:

Okay. So kind of moving into other hormone replacement type therapies, can we touch a little bit on the pill with PMS? Because oftentimes a woman would go into her doctor’s office and say, I’m dealing with all these symptoms, and they go, how about the pill? Does what you were talking about with hormone replacement therapy kind of merge into that?

Aviva Romm [00:31:51]:

Yeah, it’s kind of the same thing. It can be really effective to go on the pill. For some women, it can be a great mood stabilizer through stabilizing hormones. I mean, I’ve worked with women with polycystic ovary syndrome and horrible cystic acne, and they go on a low progestin dose that doesn’t convert to testosterone, and they get such relief, and it’s like they get their life back because women with cystic acne don’t show up for job interviews or graduate school interviews or that date or that social event because it’s so stigmatizing to have acne in our culture. So it can be like night and day. But I would say a few things. One, there are so many other things that we could try. First, it’s a band aid.

Aviva Romm [00:32:33]:

It’s not a solution to the root causes. So if somebody has polycystic ovary syndrome and we treat their acne and their cyclic irregularity with a pill, but we don’t address the underlying factor of insulin resistance, they can still develop diabetes later. And I’ve worked with so many women who come to me at 32, 34, 36 who have been on the pill since they were 15, 1617 for hormonal problems, who come off of it and their symptoms have been suppressed all this time. And now they’re like, I want to get pregnant. And they go off it and wham, they’re right back to the symptoms. And now they’re 36, 36, 37 facing that fertility deadline that is so often imposed on women. And then the other thing is much like hormone replacement therapy for menopause, women are just not given adequate informed consent. We’re not told about the actual real risks.

Aviva Romm [00:33:33]:

Most doctors don’t even screen for things like migraine with aura, immediate family history of cancers. We don’t tell women that you have a 26% increase in likelihood of needing an antidepressant, even if you’ve never felt depression before, or teens, like 80% increase in depression. And so women go on these things and they’re just kind of left on. It’s like, take two aspirin and call me in the morning. It’s like, take your birth control pill and call me. Never call me when you’re 35 and having a baby or call me when you’re 55 and in menopause. So, yes, these therapies can have tremendous palliative effects on symptoms. And we still aren’t addressing the underlying issues that come back to bite us in the butt or still are acting as underlying factors.

Aviva Romm [00:34:19]:

Like if you’re having cycle trouble because you have excess estrogen, that doesn’t go away if you go on progesterone it’s now just all those risks are still there and accumulating. So we’re just not doing a good job at looking at root causes, and we’re not doing a good job about educating about the alternatives, the risks, the pros and cons, and we’re not doing a good job. And when I say we, I’m talking about physicians, medical providers of follow up. Right. Should she come off the pill that she went on at 13, at 18, at 22, see if she still got the symptoms? Does she still need it? Or do we just sort of, like, say, stay on it indefinitely because you want birth control anyway? Yes.

Leanne Vogel [00:35:01]:

I feel like we’re so aligned in how we view things. I agree with you 100%. I think, too, because you’ve mentioned root causes quite a few times. I know it can be frustrating for the woman who’s listening, being like, one, I don’t know my root cause, and two, my PMS is just so bad, my period is terrible. Like, what do I do right now? Do you have any advice for that individual?

Aviva Romm [00:35:22]:

Yeah, definitely. So, first of all, I want to just emphasize that the term root cause, there are people out there who are really anti integrative medicine who will say, oh, if somebody says root cause, run. Well, first of all, that’s scientifically unsound. There is an entire body of medicine called exposome medicine. There is a department of exposome medicine at Columbia University Medical School. And this is exactly what we were talking about earlier, looking at the various factors that contribute to why we’re having this increased rate of so many of these problems in women’s health. And so at a core level, even if you’re still going to go on the pill, or even if you’re going to take doxycycline for your acne, or you’re going to take a medication for your endometriosis or metformin for your pcos, even if you do those things, all the things that address healthier diet, better sleep, stress reduction, reducing environmental exposures, improving gut health, those are sort of core foundational things, no matter what. And it’s like, no matter what kind of car you’re going to drive, whether you’re going to get on a plane, just put your seatbelt on.

Aviva Romm [00:36:32]:

Think of those things as putting your seatbelt on. Essentially, those are the core healthy lifestyle things. Getting good exercise, being around people that make us laugh and make us feel connected. If you’re really just not functioning and miserable right now, that could be a time to say, all right, I am going to go on the pill. I am going to take an antidepressant because I’ve been unable to get my life going for three weeks, three months, three years, and I’m just so down, like I need to do that. Or similarly, if PMS is taking you out of your life three, five, seven days a month, migraines are taking you out. There is no good or bad in this, right? You have to do what helps you live your best life. And sometimes, if you’re so exhausted, so depressed, so uncomfortable, it’s impossible.

Aviva Romm [00:37:21]:

Like, if you’re fatigued and depressed and in pain, what are the chances you’re going to batch cook yourself four chicken breasts on Friday or Sunday and make a big salad and make a big pot of great squash soup? It’s like zero, right? Because you’re going to want to watch Netflix and sleep and not do any of those things. So sometimes those things can be a catalyst to give yourself permission to use. But you have to know your risks. It doesn’t exclude doing all the other things we talked about. And then, ideally, you’re finding someone you can work with, an integrative nurse practitioner, an integrative nutritionist, an integrative MD, or functional, who knows how to support you using supplements, botanicals, targeted nutritional and dietary therapies that are right for you while you’re on those pharmaceuticals, and maybe how to bridge off of them. So then it becomes kind of working with the right person, people or team, or having the right resources. If you don’t have access to those, for whatever reason, your location, your finances, that’s where podcasts like yours, or a book like hormone intelligence, which is meant to be a comprehensive program that you can use, that I would give to my patient. But you’re living in Wisconsin and don’t have access to someone who can provide that for you directly.

Aviva Romm [00:38:42]:

So I would say, yeah. And then figuring know, going deeper. There are so many subtle things that could be leaky gut, it could be Sibo, it could be histamine intolerance. It can be a whole host of more granular, subtle things that then you’ve tried the more general things. You’ve gotten a book like mine, or you’ve done a program that should be trustworthy, and you’ve done all the things, and maybe you’ve had some improvement, or maybe not, and there’s still things going on, and that’s where the one on one can really be so important.

Leanne Vogel [00:39:19]:

So what I’m hearing you say is, step one, get yourself to a place that you can at least make the chicken breast walk. And if you’re so very uncomfortable, you may need to use some form of medication for a time while you work on the root causes that are causing that uncomfort kind of get yourself to a comfy place, then start working under the hood so you can build yourself up so that ideally, you can get off those things and be in a.

Aviva Romm [00:39:43]:

Better place than when you started. Absolutely. And look, some people might be like, yeah, my symptoms are uncomfortable, but I can still make the chicken breast. I don’t need the medication. But then certain conditions, like hypothyroid, if it’s significant enough, you will need the medication, and you may just need to also stay on it. And I think that brings us to another piece of this whole conversation. And I think if there’s any takeaway that I would want women to have from what I’m saying, is that you’re not broken and none of what’s happening is your fault or your doing. There are 80,000 environmental chemicals that are circulating in our environment.

Aviva Romm [00:40:20]:

Maybe 200 of them have been tested and not even necessarily found safe for women’s reproductive and hormonal health. We’re being exposed to all of those. Not only that, we don’t know how those interact in our bodies. Our mothers may have taken antibiotics when they were pregnant with us, or we may have had. The average American has 18 rounds of antibiotics by the time she’s 20 years old. Think about what that does to your gut health. So none of this is your fault. And some of it is unpacking what we can heal and improve and resolve, and some of it is doing the best we can.

Aviva Romm [00:41:00]:

So I might have a patient who comes into me, and I say, on a scale of one to ten, how significant is your pain? And she’s 38. She’s had endometriosis symptoms since she was 14. She has adhesions in her bowel and her abdomen that are causing urinary problems and bowel problems. And I’m not going to say to her, look, we can get rid of all those. Those can all go away. Maybe with a really good surgeon and really good anti inflammatory diet and all these things, we can improve dramatically. And she’ll say, I’m an eight on a scale of one to ten with discomfort. And I’ll say, okay, if we could get you to a four, she’ll be like, amazing.

Aviva Romm [00:41:39]:

And then maybe we can get her to a two. But I’m going to be honest and say the chances of getting to a zero could happen. I’m not going to kibosh that. But let’s also set realistic goals, because this happened long before you even knew it was happening or had a chance to do anything about it. And so I think that’s really important that we not blame ourselves. We’re the canary in the coal mine, and we have to really give ourselves grace. And I think that’s also important, too, because I see women go crazy, like, trying every dietary approach, every supplement, and exhausting themselves and exhausting their bank accounts and so finding guidance, knowing what does and doesn’t work, being careful, like we were talking about with hormone therapy, like just jumping on things because they’re Dou or like, the trend is really important. And always getting back to the basics, like low inflammatory diet, good sleep, stress reduction, healthy gut, avoiding pharmaceuticals that we can avoid whenever possible.

Aviva Romm [00:42:44]:

And those are all such getting out in nature, connecting with people that make you happier, because just connecting with other women increases progesterone, it improves oxytocin. These are all things that are really important. So, so much we can do, but we, again, just have to give ourselves grace and compassion.

Leanne Vogel [00:43:02]:

Yes, completely. Today’s podcast is sponsored by nutrasense. What your blood sugar is doing can significantly impact how your body feels and functions moment to moment. Nutrasense lets you analyze in real time how your glucose levels respond to food, exercise, stress, sleep. So let me tell you a little bit about how it works. If you’re not familiar with the continuous glucose monitor technology, basically, it’s a small device that you wear on the back of your arm. I swear it doesn’t hurt to insert it. I promise you it does not hurt.

Leanne Vogel [00:43:39]:

And it allows you to track your glucose level in real time. Application is super easy. I promise it’s painless, and each device lasts 14 days. Then you use the Nutrasense app to help you interpret the data. So if you wear a CGM alone, all you’re going to get is a number, but it’s going to be hard to interpret that number based on food and adjustments and movement. And the nutrisense app does all of this for you. So if you’re unsure what the app is showing you, though, it is super straightforward. Each subscription plan comes complete with one month of free nutritionist support.

Leanne Vogel [00:44:15]:

So your nutritionist will actually help you to interpret the data and provide suggestions based on your goals. Now, seeing this data in real time makes it super easy to identify what you’re doing and where you need room for improvement. So if you’re feeling a little bit off, where’s your glucose level at? If it’s super tanked or really high, you can adjust your activities in the moment based on what you’re seeing. If you wake up in the middle of the night, was your glucose to blame? If you totally had the best workout of your life, where was your glucose at? Perhaps you feeled really, really well for this workout, and you need to repeat it. By tracking and learning from and then acting on the data from your nutrasense app, you can expect to lose weight, provide stable energy throughout the day, better sleep, understanding which foods are good for you, control cravings, and my personal favorite, make lasting change. I’ve been using continuous glucose monitors now for about three years. I’m in love. I use them every couple of months to just help me kind of mitigate some adjustments I’ve made with my diet and movement and really tone things in a little bit.

Leanne Vogel [00:45:25]:

And then I’m off to the races again. So you can visit nutrasense IO KDP and use my code KDP for $30 off, plus one month of free nutritionist support. Be sure to let them know that you’re a listener of the Keto diet podcast when they ask you how you heard about nutrisense again, that’s nutrasense IO slash KDP. With the code KDP, you talked a little bit about the improving of diet. Can we focus on that just a little bit and kind of what that means? Because you also touched on doing a lot of different diets and getting really busy with that. And how do we know kind of the restriction versus not restriction and all the diet stuff.

Aviva Romm [00:46:08]:

Yeah. So, for me, a healthy diet at the most basic level is whole foods, as close to natural, as few ingredients as possible. So, like, if I were to walk you through my kitchen right now, and you went into my pantry, you’d see bottles of grains, bottles of beans, bottles of nuts, bottles of seeds. Those are single ingredients. If you went into my refrigerator, you’d see kale, collards, chicken breast, tofu, salmon eggs, single ingredient things that are as much as possible organic and 100% unprocessed. I mean, tofu is processed, but when I say unprocessed, I’m talking about, like, zero ultra processed foods, minimal processed foods at all. That’s sort of the foundation and a wide variety of vegetables and staple type of foods like that, and then the next level, that’s sort of for everyone, right? But it may be that you are. I have a patient right now.

Aviva Romm [00:47:09]:

She just started in my practice the other day, and she’s having hives all over her body, and she’s in her early 30s, has no idea why this is happening. And as I’m looking through her medical history, I see that her two sisters and her mother all have autoimmune thyroid disease. One has graves, two have Hashimoto’s. Her sisters and her mother have either joint pain or joint problems and rheumatoid arthritis. So I started talking with her about diet. Now, I am 100% zero restriction. I don’t believe in restricting anything. I think we either choose not to eat certain things because they’re not healthful foods.

Aviva Romm [00:47:49]:

I mean, not drinking Coca Cola is not restricting. It’s not drinking something that’s not a food. I mean, like, sure, if you have one, it’s a hot summer day, and you decide to have that rum and coke at the beach, and it’s a one off, sure, that’s one thing. But, like, Coca Cola is part of your diet. That’s not a food. So to me, not having it is not restricting it if you are celiac, as it turns out, this patient’s mother is. So the patient’s mother is celiac. Two sisters with autoimmune disease and joint problems, and now this woman starting to have this weird immune reaction.

Aviva Romm [00:48:24]:

Nobody’s ever explored whether these three women daughters have celiac. So to me, having her take gluten out of her diet, that’s not restricting, right. If something is toxic to you and actually making you sick, it may feel sad to not be able to eat it because you might really enjoy bread, but it’s not technically restricting, that’s making a therapeutic lifestyle choice. So, past that sort of big picture of the whole healthy foods, I want to look at things like, are there specific foods that are triggers for you? I also glossed over or skipped over something that’s, to me, probably one of the most important things that women can do for our own health, which is keep our blood sugar steady. And so it’s not just what we’re eating, but making sure that we are really getting an adequate distribution and a good distribution of what are called macronutrients. So protein, fats, and carbs, and our culture tends to lean into either overeating protein. A 32 ounce porter steak is not a healthy dose of protein any more than, like, only eating carbs is. Right.

Aviva Romm [00:49:32]:

And our diet tends to lean either inappropriately heavy, really pro inflammatory protein, or really heavy carbs, or typically a combination of both, rather than kind of a steady state of getting enough protein, getting good quality protein, getting good quality fat, and if you’re going to eat some carbs, paying attention to how they feel for you and when you’re eating them. So I’m generally like, I encourage my patients not to have carbs at breakfast, but to stick with really a good quality protein, good quality fat and some veggies, ideally. I mean, I’m not opposed to the occasional soaked overnight oats, but it’s got to have some almond butter or nut butter or nuts and seeds or some nut milk in it to make a steady blood sugar food, but typically more like savory breakfast. And then if you’re going to have a carb, there’s some evidence that having a small amount of carb at dinner, for example, may actually help with serotonin mood and sleep. So thinking about it, then. So those are some of the big picture things. But then again, if somebody has specific symptoms, then I’m going to start looking at are there specific dietary modifications that we might need to make? So somebody comes in with a really high cholesterol and they’re eating a paleo diet with like four eggs a day, or they are a vegan or vegetarian, and they’re tired all the time and they’re not getting protein, or they come from a family with someone with celiac and autoimmune disease and they’re getting hives. I’ll look at those very specific dietary approaches and create something that feels nourishing and delicious and abundant and proactively healthful, rather than thinking of that as restrictive.

Leanne Vogel [00:51:14]:

Yeah. So when it comes to, I guess, the next kind of pillar that people will think about is exercise and movement. You talked about being outside and what are some pieces that we can think about to support our hormone health versus things that we can do with our movement that doesn’t support it.

Aviva Romm [00:51:31]:

Yeah. So being sedentary doesn’t support it. And that’s just the bottom line. The whole 10,000 steps or 8000 steps a day has been disproven. I mean, yes, it’s healthful, but getting a minimum of 4000 steps a day is good. Now, that’s hard if you’re sitting in front of a computer all day. So how can we do that? Standing desk, making sure that we’re getting a good walk in before work or after work, like 2 miles is going to be about 4000 steps ish. Whatever it is that you love to do, I think is the most important, though, quite honestly, I love walking and hiking.

Aviva Romm [00:52:09]:

I am not a person who’s like, oh, let me exercise. My oldest daughter, she lives for exercise. She’s like one of those people who it totally transforms her stress to exercise for me, and she’s religious about it. For me. I love movement. I love fun movement. I love dance. I love walking.

Aviva Romm [00:52:28]:

I love hiking. I love my hula hoop and my jump rope. But I have to get myself to get on a stationary bike or do things that are specifically exercise. So I love how I feel when I do it. So if you’re one of the people who loves exercise, then the main thing is just to be careful not to over exercise, because that can have an impact on our inflammation, on our hormones. And as you mentioned earlier, hypothalamic amenarrhea. One of the causes of not getting our period is over exercising and or undereating. But find what you love if it’s putting on music in the morning and just dancing it out.

Aviva Romm [00:53:08]:

I have a hula hoop, a weighted hula hoop. It’s a two pound weighted hula hoop. I love that if it’s swimming, yoga, whatever it is, and then find a variety of things so that you’re using different muscle groups and have some aspect of it be a little bit promoting cardio metabolic health. So, like, getting your heart rate up a few times a week is really important. And then for women, and particularly as we get into perimenopause and menopause, bone strengthening is really important. So weight bearing exercise, walking, jumping, rope. Jumping. You can jump rope five minutes a day and get benefits from that, from weight bearing and then actually lifting some, using some free weights can be really good.

Aviva Romm [00:53:49]:

Anything that builds your strength, anything that builds your core and anything that builds your balance, particularly as we get into forty s and fifty s and beyond. And ideally, you’re doing it in your thirty s and early forty s, not waiting to catch up later. It’s always harder to catch up. But you can do it.

Leanne Vogel [00:54:06]:

Yes, completely. And so I guess the other piece that you touched on a little bit that I just wanted to clarify was sleep and its effect on hormones. Because we’re go, go. We have the to do lists, and the thing that gets cut often is either food prep or sleep time. So can we talk a little bit about the impacts of that?

Aviva Romm [00:54:24]:

Definitely. Well, and the thing with sleep, it’s like in Italy, they say, if mama ain’t happy, ain’t nobody happy. I actually had somebody, a young man in his 30s, say that about his mother when I was in Italy one time in Rivello. And I always think, if sleep ain’t happy, ain’t nothing happy, right. If you’re not sleeping well, that automatically increases your cortisol that increases weight around our waist, which is inflammatory, but it also makes us tired, which makes us want the coffee and the sugar and the carbs, right? That’s our quick go to energy. It increases inflammation and inflammation, as I mentioned, even with the belly weight. But it can be more systemic inflammation that can affect our moods, our physical comfort, and disrupt our hormones. When cortisol is jacked up, it affects our thyroid hormone, our estrogen, and our progesterone.

Aviva Romm [00:55:14]:

So we can have irregular cycles, all kinds of things. It affects our mood, so it affects our motivation. And if our motivation goes offline, there goes exercise, there goes the food prep. So to me, getting good sleep and good sleep is seven to 9 hours a night. I need 7 hours. Some people really do need the 9 hours. Sleeping under that or sleeping over that can both actually be disruptive of hormones. They can also be symptoms of hormone disruption.

Aviva Romm [00:55:41]:


Aviva Romm [00:56:36]:

So cooler temperatures, ideally like 65 to 67 degrees, would be great. And then covers as you need them or layers as you need them, making sure it’s dark and soundproof as possible, keeping your phone notifications off and your phone not near your bed. All the things that you can do to promote sleep, not having caffeine. And honestly, probably the number one thing, particularly for perimenopausal and menopausal women, is stay away from alcohol. Like, alcohol is just a circadian rhythm. Disruptor, mood disruptor, sleep disruptor, hormone disruptor. So 86 alcohol completely?

Leanne Vogel [00:57:15]:

Yes. I feel like we could go through pcos and endometriosis more and menopause more, but we got to cut it off. So thank you so much.

Aviva Romm [00:57:25]:

Well, and all those root causes or the root health things, there’s the root cause, but there’s the root health things. Those all support you in healing all those things as the baseline plan anyway. And then you add on the things that you need to support that, whether it’s herbs or supplements or specific dietary tweaks or a pharmaceutical if needed. So it’s still the core. It’s the foundation, yes.

Leanne Vogel [00:57:49]:

Where can people find more from you? Where can they grab your books, connect with you? How do we get in touch?

Aviva Romm [00:57:55]:

My website is avivaram.com. There’s tons of free articles over there. Instagram. Dr. Aviva is great because I actually am the one in there doing posts and checking comments. And yeah, you can find out about my practice, my books, all the things on my website. And then of course, there’s the old Amazon for hormone intelligence, which is for all things hormones, and adrenal thyroid revolution, which is specifically for adrenals, thyroid, autoimmune, general state of overwhelm. Those are great books for those.

Leanne Vogel [00:58:30]:

Well, thanks again for coming on the show, and I’ll include all of those links in the show notes if people.

Aviva Romm [00:58:35]:

Are looking for them.

Leanne Vogel [00:58:36]:

Thank you.

Aviva Romm [00:58:37]:

Thank you for having me.

Leanne Vogel [00:58:39]:

I hope you enjoyed our time with Dr. Aviva. You can find out more from her by going to Instagram. Doctor that’s Dr. Avivarom Avivaromm and her website, avivarom.com and her book, Hormone Intelligence. I hope to see you here next week for another episode. Have a good one. Bye.

Leanne Vogel [00:59:06]:

Thanks for listening. Join us next Tuesday for another episode of the Keto Diet podcast. Looking for more resources? Go to healthfulpersuit.com for keto meal plans, weight loss programs, low carb recipes, and oodles of free resources to get you going. The Keto diet podcast, including show notes and links, provides information in respect to healthy living recipes, nutrition and diet and is intended for informational purposes only. The information provided is not a substitute for medical advice, diagnosis, or treatment, nor is it to be construed as such. We cannot guarantee that the information provided on the Keto Diet podcast reflects the most up to date medical research. Information is provided without any representation or warranties of any kind. Please consult a qualified health provider with any questions you may have regarding your health and nutrition program.

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Hi! I’m Leanne (RHN FBCS)

a Keto Nutritionist, host of The Keto Diet Podcast, and best-selling author of The Keto Diet & Keto for Women. I want to live in a world where every woman has access to knowledge to better her health.

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