Podcast Episode #302: Self-Love & Adrenals, Stress & Alcohol, Hormones & Birth Control with Dr. Jolene Brighten

Topics

1. Perimenopause and menopause [2:12]
2. Gratefulness mindset [8:37]
3. Alcohol and estrogen [14:11]
4. Healing and alcohol [21:46]
5. Working out while under stress [29:16]
6. Testosterone levels in women [38:06]
7. What happens when you're on the pill [43:43]

Subscribe to Real Food Liz! 

Subscribe to DianeSanfilippo.com

The episodes are also available in iTunes, Spotify & Stitcher.

 Show sponsors:

 

 

 

 

You’re listening to the Balanced Bites podcast episode 302.

Diane Sanfilippo: Welcome to the Balanced Bites podcast. I’m Diane; a certified nutrition consultant, and the New York Times bestselling author of Practical Paleo and The 21-Day Sugar Detox. I live in San Francisco with my husband and fur kids.

I’m the co-creator of the Balanced Bites Master Class, along with my partner in crime, Liz Wolfe, and together we’ve been bringing you this award winning podcast for 5 years and counting. We’re here to share our take on modern paleo living, answer your questions, and chat with leading health and wellness experts. Enjoy this week’s episode, and submit your questions at http://blog.balancedbites.com or on our Instagram page. Remember our disclaimer: The materials and content within this podcast are intended as general information only, and are not to be considered a substitute for professional medical advice, diagnosis, or treatment.

Before we get started, let’s hear from one of our sponsors.

Diane Sanfilippo: Today’s podcast is sponsored by Vital Choice seafood and organics. Purveyor of premium sustainably sourced seafood and a certified B corporation. Vital choice offers a wide range of fish, shellfish, humanely raised meat, protein rich bone broths, and paleo friendly snacks like organic dark chocolate, super antioxidant trail mix, and bison jerky. As the days get longer and the grilling season heats up, www.vitalchoice.com is your source for real food.

Diane Sanfilippo: Alright guys, this is part 2 of my conversation with Dr. Jolene Brighton, all about female hormones. Now, if you didn’t hear part one, it was episode 299, just a few weeks ago. So go back and listen to it. I give her full bio, and we talk about all of the foundations that you’ll need in order to understand what we get into with some of these deeper dive questions, more specific. So please, if you haven't listened to that episode, go back and listen to it. It really is a foundational episode to this one. But if you already heard that one, you're going to love this one. We’re getting into a lot more nitty gritty topics. A lot of the questions that you guys asked. I absolutely loved this conversation, so here we go.

1. Perimenopause and menopause [2:12]

Diane Sanfilippo: So more questions about perimenopause and menopause. Can you touch on some suggestions for women? It sounds like it's really a lot of the same stuff going on. It’s lifestyle stressors, it's the sleep. It’s supporting the liver. But is there anything more specific about the perimenopausal and menopause time. I mean, I would probably consider myself roughly perimenopause. I mean, I’m 39.

Jolene Brighton: No! {laughs} No, don’t say that!

Diane Sanfilippo: I don’t know!

Jolene Brighton: No, no, no. So I hear that a lot where women are like.

Diane Sanfilippo: Well, pre-menopause. Sorry, I guess I should say pre-menopause.

Jolene Brighton: Yes! So perimenopause is more like, I try to get my ladies to 48. So, you know. I’m like; let’s not start experiencing symptoms until 46, 48. Because the average woman is going to be in menopause about 51. And that’s when you haven’t had a period for a year. So, this is where women will get really frustrated, because they’ll go like 10 months, and then they’ll have a period. And they’re like; “I have to start over!” {laughs} And the deal, why women get so frustrated, is because you could get pregnant at any time. That’s like the sneakiest time for pregnancies to happened.

Let me give you the secret. The secret to perimenopause and menopause. You’ve got to take care of your adrenals. So, why? Because your ovaries are meant to give out. And once they give out, they're not going to make estrogen and progesterone. All those yummy hormones. Not going to make them anymore. So what are you going to do? You're going to lean on your adrenal glands for that. And they make DHEA. And DHEA is going to give you your estrogen and testosterone. Which, estrogen and testosterone get a lot of bad wrap, because in excess they’re horrible. But they’re absolutely essentially. I mean, we see in perimenopause. So postpartum, perimenopause, and menopause with the estrogen fluctuations and the low estrogen is when autoimmune diseases can really flare.

But to all of that. Women are always like; “Oh, perimenopause is just going to be hard.” And then everybody gets really focused on estrogen and progesterone. Now, I do use bioidenticals in my practice. But we always start with the adrenal glands. Because if they’re taken care of, it’s a lot easier. Now, let me give you how to gauge whether your hot flashes are coming from estrogen or they’re coming from your adrenal glands. Most women don't even realize that hot flashes can be an adrenal response, and not have anything to do with estrogen. So if your hot flashes seem to come out of nowhere, and they especially are coming on at night. That’s usually the peaks and troughs of estrogen. It’s like, your brain is yelling at your ovaries, and your ovaries are like, “Ok, we want to try!” And then they’re like, we can’t try anymore. {laughs} So, that’s the peaks and the troughs of the estrogen. And that’s when you’ll get a hot flash.

But if you get a hot flash when you're driving on the freeway, or you're going to give a talk, or you're going into a board meeting. Or if it’s the end of the day and you're a mom, you’ll know what I’m talking about. If it’s around 5 p.m. to 8 pm, what I call mom hours, which is trying to get dinner on the table, trying to get the kids to bed. It’s super stressful time of day. If that’s when you're throwing hot flashes, that’s adrenal. And that’s actually you're spiking epinephrine and norepinephrine, usually. And that’s big trouble. Because if you're spiking epinephrine and norepinephrine, that means; one, that means that every time you get stressed, your brain is being told to freak out. That’s what those do. But in addition, that means that your adrenals, they’re starting to falter. And it doesn’t mean, oh your adrenals are going to give out. It means that your adrenals are going to stop responding to your brain, or your brain is going to stop screaming at your adrenals. Somebody's just going to call it quits here. And at that point, you’re not only going to be frazzled, stressed out, gaining weight. All that whole perimenopause/menopause picture, but you're going to be flatlined fatigued as well. And then you might throw yourself into having thyroid issues.

So if you're a woman. I'm really, any time you're looking at preventing something, think about going decades ahead. So if you're a woman in your thirties, you need to be concerned about perimenopause now. What can you do? Diet, lifestyle, all that stuff. Sure. But you need to get a handle on your stress and on your adrenals.

So that comes back into the things like, doing a 5-minute reset of meditation or yoga in your day. Setting an alarm to get deep breathing in. These things that are always like; they’re not sexy, we’ve heard them a million times before, everybody rolls their eyes. Yeah, decrease stress. But if your stress is not in check, your hormones will never be in check. And you will always, always struggle. So you’ve got to work on the stuff. But usually, if women are at that point, that’s usually when we’re bringing in herbs like maca. Maca can be overstimulating, so caution with that. But maca can be a great one, because it raises estrogen and testosterone by supporting the adrenal glands. That’s really the mechanism it goes through.

But I just want to say, if you're not taking care of the diet and lifestyle stuff, forget the maca. This is always when women are like, “I tried it, and it didn’t work.”

Diane Sanfilippo: Yeah.

Jolene Brighton: So two things is; If you're not taking care of diet and lifestyle, it’s never going to overcome that. And the second thing is, women we have cycles that are at least 28-30 days. You have to give these therapies a few months to see if they’re really going to work.

Diane Sanfilippo: And I think one of the points you made about supporting the adrenals. So we have many episodes on adrenal fatigue, or adrenal dysregulation, HPA axis dysregulation. You guys can check out the podcast archives by topic. I also talked about this in one of the new meal plans in Practical Paleo second edition. But I just want to remind our listeners that supporting the adrenals; and I know this is what you mean. So I want to remind them; it's not a, “I take this supplement, and it helps my adrenals do better.” The adrenals are working in response to signals from your brain. They don’t have a thought process on their own. There's no decision-making of the gland. The gland is told what to do by our brain, by this HPA axis, which you were referring to. And I just want to clarify that again, because I think some of it is the lifestyle, the 5 minutes, the saying no to more things. And I think a lot of it is stuff that we; Liz and I have talked about this a lot more in the recent episodes, and recent years. Mindset, and the way that we look at the way we're eating. Or just literally, do you wake up happy? I think that there is something so; I can’t understand how someone honestly isn't just happy to wake up every day. I mean I feel like…

Jolene Brighton: I feel you on that. {laughs}

2. Gratefulness mindset [8:37]

Diane Sanfilippo: Why are we not grateful to just open our eyes in the morning, when there are people who are struggling with so many things. Whether or not we wake up in perfect health, it’s just we woke up. I have so much gratitude for that every day, that I think that that really does help. Whatever else is going on in my body I think would be so much worse if I didn’t have a grateful attitude for whatever it is, you know.

Jolene Brighton: Yeah.

Diane Sanfilippo: Grateful for the bills I have. It means I live in a certain place. Things like that. So I know it sounds crazy and woo-woo, but that's the reality. How you think about your life and the story you tell yourself every day about your stress or your life or your family or your job or your partner, that is all real. And your thoughts create physical responses in the body. I just think that we are so dismissive of that as a culture. And that's an epidemic. Of dismissing how we think about our lives.

Jolene Brighton: Mm-hmm.

Diane Sanfilippo: I just got on a soapbox there for a second.

Jolene Brighton: Yeah, yeah. No. I’m going to back you up with some research, though. Because there is so much research in these areas. But nobody’s really talking about this. So, for instance, there is a research study that shows that self-kindness and self-compassion beats out meditation in lowering inflammation. The way you talk to yourself will raise inflammatory cytokines if its negative. If you’re like, in the mirror. “My thighs are fat.” “I’m so stupid, why did I do this?” researchers have measured blood, and have seen inflammatory cytokines go up. The easiest way to bring it down is to be in love with yourself. To be gentle with yourself. To be compassionate. And the researchers said if you actually treated yourself like you would treat a child, you'll keep your inflammation down.

And so that; to think about it from that perspective. You are that powerful. Ladies; our brains are way more susceptible to inflammation than men. We have one alcoholic drink, it’s upregulated. Estrogen is going up. It's insane what inflammation can do to the brain overall. To think about the story we’ve been told about, with these serotonin deficiencies and we actually recognize now; well documented research. No, we have inflammation on the brain disrupting all the neurotransmitters.

And part of healing that is just reframing how you talk to yourself every day. And so, it’s not woo-woo, and it’s not out there. And this is something; not to be a conspiracy theory person; this is how I look at things. It’s like, you know, what interest does Merck have in you practicing self-care and self-compassion? What interest do these companies have in you actually taking care of yourself? When we see drug companies are also in cahoots with the food companies, like Monsanto, that we know are hurting people. Which, PS; where’s your evidence based medicine now? You're telling us we can’t use an herb because there’s no evidence based medicine? But you’ve yet to give evidence based anything on genetically modified foods. We don’t even allow the research.

But this is something I tell people; look. When you go online, and you start researching things. The majority of what's on the internet is actually, a corporation has put this up to manipulate you into buying something. We see this a lot, it’s very well documented; you'll find an ad on Facebook. And then you’ll click on that. And then next thing you know, everybody in your feed is talking about this thing. It’s what’s called astroturfing. And it's the way that we’ve actually been manipulated to think that these lifestyle therapies are ineffective. And that we as individuals don't have any power. This is what I fully reject, as a doctor. This concept of doctor as gatekeeper of health. The only way you can ever be healthy is if you see your primary care doctor, and you get your pharmaceuticals, and you get your surgery and all these things. Hey, once upon a time when we had a sniffle, we asked our mom what to do about it. And that’s what I think we should be doing more of. Is looking at how can we support people every single day to take care of themselves.

The medicine I practice is root cause medicine. I don’t heal people, though. I teach them how to heal themselves. In my mind, when a patient gets to the end of their journey with me and they’ve healed, it's not me who did the work. I was like, here is the road map. But that person took that step every single day. How do you stay out of the doctor's office? How do you keep from having to see someone like me? I mean, that’s the ultimate goal I have, is that you don’t need me. It’s all this lifestyle stuff. And something as simple as; I mean, you'll even see people bagging on; “oh, what are you going to drink, water?” Um, yeah. Because if you're dehydrating, your adrenals get stressed. Because they actually govern your blood pressure. And being dehydrated can actually crash the adrenals in itself. But you don’t see a whole lot of talk about that. There are so many things about that. But instead, what do you get marketed to?

It’s like, “oh, what are you going to drink, water? Well there’s Gatorade. You could be drinking that. Isn’t that so much better?” And then your adrenals glands and everything in your body is just angry. It’s like; that’s not what I wanted at all that. Now that was my soapbox. {laughs}

Diane Sanfilippo: I know. These are my favorite episodes, though. I mean, we have a lot of good questions. But I really think it's important for every woman who is listening to understand that while there can be nuanced answers, or certain nutrients that are supportive of different functions in the body, the root cause issue of so many of these things are similar or the same. And it's just a matter of different tweak and little things.

3. Alcohol and estrogen [14:11]

Diane Sanfilippo: I want to ask you about alcohol and drinking and wine. Because it’s a hot topic.

Jolene Brighton: Yeah.

Diane Sanfilippo: You know, every night having a glass of wine, or feeling like you either need that to unwind. And this isn’t a judgment. I’m just expressing something I’ve seen in parents, and moms specifically.

Jolene Brighton: Oh, totally.

Diane Sanfilippo: But I’ve seen the expression around. And I'm not a mom; so total disclaimer here. I don't claim to know what that's like and how that feels. And that’s actually why I'm not a mom, because I've seen, and I’m like; “I don't know about that, you guys.” But how bad is it, you know, to have a glass or two glasses of wine either every night or several times a week in a situation where the woman is not otherwise in a place she feels healthy. Because when someone is like, “I feel great, I’m healthy, I’m sleeping well, I’m happy.” Blah, blah, blah. I don't have any questions about any of that. Do your thing. But what's the bottom line from you on the place of alcohol and that glass of wine when someone's asking questions like they are here on this podcast feed that they’re asking on.

Jolene Brighton: Yeah. So, I’ll share. About five months ago I had a traumatic brain injury that I’m still rehabbing my brain from. I couldn’t walk for a while. It was serious stuff. Not a lot of people know about this. Everyone is like; how come I didn’t know? I’m like, when you have a head injury, you're not on Facebook posting. It just doesn’t happen. So, I'm currently not drinking wine or any alcohol. Just because I tried, actually, a few sips a bit ago and it made my head all fat and brain fogged. And I was like, not time for that.

So, why I share this story is because I was hanging out with a mom friend of mine, and she was like, “Oh my god. How in the hell are you doing motherhood without wine or alcohol? How are you doing this?” And I’m like, “Some days it's really hard.” Because it’s legit that modern motherhood in this evolutionary mismatch; we, a lot of moms come to lean on alcohol. And when does it happen? It’s when everybody gets hope at the end of the day. You have to make dinner. You have to get people to bed. Maybe your kid is a sleeper; most kids are totally a pain when it comes to bedtime routine. Like, bad. {laughs} And that’s just something that’s universal. They’ll have their moments when they’re good, and then they’re like, “I don't want to sleep.” Especially in the summer, the lights out longer, so I feel moms on this.

But I’m with you. No judgement around this. Sometimes you're like; “I just had a day, and I just want to have a glass of wine and I want to chill out.” We always want to be careful to monitor how many days are we leaning on that. And if that's something where it’s like, whoa, that’s most days a week, we’ve got a problem there. Now, I’m not about to call anyone an alcoholic. Because I don’t even think the way we classify these things is really appropriate. And I don't think if you have a bottle of wine a night because you’re feeling stressed, that makes you an alcohol.

So, why I say that. And some people are going to be like; “Whoa, that’s a lot of wine.” But my thing is, when a patient comes to me. I never tell anybody stop drinking or stop smoking. I figure you're using it for a reason and I need to know what that reason is. And what that reason is, and that root cause, that’s where we have to work. Same thing with coffee. Just because you have an adrenal issue, my first thing to do is not take away coffee. I’m like, we’ve got to start working on this other stuff so coffee isn’t needed anymore. The other thing we have to recognize is that rituals are really, really important. And many of us are going to cigarettes or wine or coffee as rituals. We need rituals. So, as doctors, practitioners, we can’t just take people's rituals away. This is something this is just a part of what we’ve always done.

So with all of that being said, we’ve got to look at why you're using that wine. And if it’s stress, we’re going to work on all of those pieces. And we’re going to work on that. But in terms of what it can do to your health. Now, even though I’m not going to be shaking my finger at you, being like, you have to quit this. I’m not going to do that. But I am going to share with you. And this is my caveat of coming into my practice. This usually comes with vegans, usually, who ask me this question is, “Are you going to tell me to stop being a vegan?” And my take is as your doctor, there needs to be a space held for me to have whatever conversation I need to have with you. If your diet is not working for you, I need to be able to say that. If you're alcohol intake isn’t working for you, I need to be able to say that. If you don’t want to listen to me, you want to do whatever you want to do, that is totally your call. That I respect your right to choose for you. But I have to be able to do my job in an honest way. Otherwise I don’t sleep at night. And I’m worried about you. So that’s part of my deal.

So when it comes to alcohol, we know one alcoholic drink will raise your estrogen by over 10%. It’s anywhere from 11-15%. That’s one alcoholic drink. So if you're a woman with estrogen dominance, you probably don’t want to drink alcohol. Because now you're going to raise your estrogen, and you make your liver work double time. If you're somebody who has a drink, and you're feeling drunk for a while, or you're feeling hung over the next day, you are terrible at detoxifying. Just leave it alone. {laughs} Is that you? {laughs}

Diane Sanfilippo: I’m gray drinker, but it's definite. I knew, and I know. I don’t really like the taste of alcohol anyway, for the most part. Which is the thing. But anyway.

Jolene Brighton: Yeah.

Diane Sanfilippo: But this is good. So 10%, one drink.

Jolene Brighton: 10%, one drink, yeah. So the other thing too, is I say. If you're struggling with any kind of mood symptoms, you actually want to avoid alcohol. It’s transiently disrupts the microbe. So if you do; it’s considered binge drinking if you hit 4. You just wrecked your microbiome for a minute. You can do some stuff to work on that. It's not like; I just want to say. We think about, “oh, if I do one thing to hurt my microbiome, my life is over.” You can do that drinking once in a while and come back from it. It’s repeat, it’s often. Your gut is just going to be angry at you, and it’s going to be like, we’re doing the best we can here.

So there’s the raising estrogen, but then there’s the mood piece. It can create inflammation in your gut if you aggravate that vagus nerve. If you're creating more estrogen and inflammation in the brain, then you should be more depressed or you should be more anxiety. Or like your OCD tendencies get worse. That’s normally. I can't tell you; and this is a little extreme. But it’s happened enough times where I’ve had patients. So I just had a woman recently, she got diagnosed as bipolar. I’m like, “tell me how you got that diagnosis.” “Oh, it was my bachelorette party. I was binge drinking for three days, not sleeping at all.” She tells me this whole story, and then she was like, “And then I just went crazy and I thought I was hearing voices, and all this stuff. And my doctors want me on this medication because they were like, you were having a manic episode, and they were like, you’re bipolar, maybe you’re schizophrenic.” She’s freaked out, and I’m like, um no that’s how any human would respond. You can’t not sleep for 3 days. You can’t; she wasn’t eating. She was just drinking alcohol! She had a great bachelorette party, but I’m like, when you're pounding these sugary cocktails, your body is like, “We’ve got sugar! We have sugar going on!” But I’m like, take all of that with the fact of what your diet was before, and you were already nutrient depleted. I'm surprised you didn’t go crazier. Like, everybody should have that kind of response. So I just wanted to say that as an aside. Because doctors will be quick to be like, that's a pathology. And it’s like, no that’s a human response. It’s very normal. You can’t stress the system like that. That’s going to happen.

And now she hasn’t done anything like that, her mood is totally fine. {laughs} So nothing has happened. And we’re monitoring her.

4. Healing and alcohol [21:46]

Diane Sanfilippo: Yeah. Do you think even the 1 to 2, I’m just going to say 1 to 2 glasses of wine a night. Do you think that can have sort of a feed forward effect, where the next day it makes it even harder to deal with those stressors?

Jolene Brighton: Oh yeah.

Diane Sanfilippo: Even at that level? Because I think when you say a bottle of wine, I’m guessing most of our listeners are like, “Well I don’t have that much. Or anywhere near that much.” But could that 1 to 2 make it that much harder. And again, not a judgement. Just, is this physiologically happening, possibly?

Jolene Brighton: Yeah. So the thing is, this is how I like to frame it. If you're in a healing phase; so if things don’t feel right, you're in a healing phase. We’re going to have to dial in the diet. We’re going to have to get strict about your diet. We’re going to have to get strict about alcohol intake. And we’re probably going to have to hit you with supplements. That’s what a healing phase looks like.

My perspective in my practice is that you should be able to get a wide variety of foods, have lots of experiences. You should be able to go out all night dancing with your girlfriends, and recover from that. Because you're not doing it all the time. But if you're having 1 to 2 glasses of wine, the reality is that we know that those bumps in estrogen, and especially the toll it can take on your liver for the estrogen metabolites. You can be putting yourself at serious risk for estrogen and positive cancer. So the ones that respond; like breast cancer.

I actually just had this happen with a patient of mine that I’ve been working with for the last four years. And the biggest thing; I finally in the last year, she was my exception. I was like, the wine has got to go. We can’t get your Hashimoto’s completely under control. We’re doing pretty good, but the wine has got to go. She’s a single mom. She's actually an executive assistant for a huge tech company in the Bay area. Which you can imagine how much stress that is. And I’m like; look, we’ve been doing all this work, but things are not getting better. And then it was just in February that she calls me, and she’s like, “I feel a lump in my breast.” And I’m like, “You have got to get to a doctor ASAP. Get it checked out.” She has invasive ductile carcinoma, estrogen positive. This is something I was tracking on her Dutch panel that I consistently saw her estrogens were high; I consistently saw that the types of estrogen she had was dangerous. I was trying to give her magnesium, give her the mineral; well, I was. She was taking the minerals, and taking the B vitamins, and doing liver cleanses. She was doing everything right to combat that, but we could never get it to change. And she sat in my office. I was not about to say I told you so. That is not even where I’m going to.

And my thing is, none of us actually do any good putting our energy in the past and doing “I told you so” or should, or any of that. I’m like, “Ok. This is the situation we find ourselves in today. What can we do right now?” And so much of her treatment plan; I don’t manage cancer, so she has to be working with oncologists. She has a naturopathic oncology specialist. My job is to make sure her Hashimoto's doesn’t get out of control as they do all of this. So much of what we did is mind-body stuff. Getting her walking. And jacking her up on broccoli sprouts. Because nothing beats. Broccoli sprouts themselves, they’re like the rocket fuel of broccoli. And so if you are in that stage of, “I’m having 2 glasses of wine a night.” Then I want you eating like a fourth a cup of broccoli sprouts every day. And knowing that ain’t enough! You're going to have to kick that.

But the reason why I tell that story is because it's something in my gut that I knew was coming down the pipeline. And I'm not responsible for the choices that that she makes in her life. But it’s still really hard as a doctor to be like; “Ah! We could have prevented this if we had done XYZ.” Now, I say that, but who knows. She could be getting exposed to something at her work all the time that’s contributing to this. It could be other things. Which is why it does us no good to sit there and be like, “Oh, look what you did. Shame on you.” Nope. It doesn’t do us any good.

But, it’s just something that there have been so many patients that I’ve tracked. And we’ve tracked their hormones with the drinking. And I’ll tell you, I’ve seen women kick alcohol. And kicking alcohol is just like kicking birth control pills. I can get you 80% better; but once you kick those things, it’s like you're 120% better. And I’m like, “Whoa! We far exceeded what we wanted to see.”

So to your point, we know the research is definitive. Ladies, we are very, very sensitive to alcohol. If you're hitting one a night, you're already at an increased risk for breast cancer. You're already inflaming your brain. You're pushing your estrogen too high. I know it sucks, and I know it’s not fair. I love whiskey. But I can’t be drinking whiskey all the time! Because I know this research.

Liz Wolfe: The Balanced Bites podcast is sponsored in part by the Nutritional Therapy Association. The NTA trains and certifies nutritional therapy practitioners and consultants (including me; I’m an NTP), emphasizing bio-individuality and the range of dietary strategies that support wellness. The NTA emphasizes local, whole, properly prepared nutrient dense foods as the key to restoring balance and enhancing the body’s ability to heal. Nutritional therapy practitioners and consultants learn a wide range of tools and techniques to assess and correct nutritional imbalances. To learn lots more about the nutritional therapy program, go to http://www.NutritionalTherapy.com. There are workshop venues in the US, Canada, and Australia, so chances are you’ll be able to find a venue that works for you.

Diane Sanfilippo: I think there's probably a percentage of our listeners who kind of hate me because I'm kind of always talking about this. Because it's not necessarily the, in a healthy population, or in healthy people.

Jolene Brighten: Mm-hmm.

Diane Sanfilippo: It’s like, we already know we’re at a disadvantage. I live in northern California, and it is that habit and it is that ritual. And I don't like to be the bad guy or take that stuff away from people, either. I just, I don’t know.

Jolene Brighten: Just having real talk.

Diane Sanfilippo: I want to help them find other ways, based on what you've just said. And I think you’ve laid out plenty of information about that. So, thank you for that. I think that was, hopefully our listeners have taken it to heart.

Jolene Brighten: Well, and I’ll say to the percentage of people, if you're hating this right now and you’re feeling this really visceral response of, “I hate you guys for even bringing this up.” Oh, your body just gave you a big signal. You’ve got to pay attention to. {laughs}

Diane Sanfilippo: Yep.

Jolene Brighten: So if you are feeling like angry or heated about this, maybe it’s not time for you to change. But that type of emotion coming up means it’s worth examining, and something to look at. Plus you and I, if we’re doing our job right, there should be a percentage of people that hate us.

Diane Sanfilippo: Right.

Jolene Brighten: Because we’re speaking truth, and we’re disrupting things. And whenever you start to challenge the central dogma of society, and we’re marketed heavily to. The only way to have a good time is to drink alcohol. You’ll also notice; so now I'm not drinking. I just get soda water and lime. And it looks like I have a cocktail around people. But you’d be surprised how many people get really uncomfortable when you're not drinking.

Diane Sanfilippo: Oh yeah.

Jolene Brighten: Like you're judging them for not drinking!

Diane Sanfilippo: There are so many things built into that. It is part of my personality to mostly not care what other people think, just inherently innately. I am wired that way. So not succumbing to peer pressure or giving two poops about literally what anybody in that room thinks. So, you know, I understand I’m more hardwired to be able to handle all of that. But, anyway. Just wanted to throw it out there.

5. Working out while under stress [29:16]

Diane Sanfilippo: We definitely have a question about training while under stress. And knowing that; so this question was, “If you're stressed, what’s the best way to work out, especially if you potentially have thyroid dysfunction.” And I’m going to throw hormonal imbalance, obviously if you have a thyroid dysfunction, you have other hormonal imbalances. They all work together. There's no isolation of this stuff.

Jolene Brighten: That’d be easy!

Diane Sanfilippo: But what suggestions would you have for this? Knowing also that a lot of our listeners are crossfitters. And they're doing high intensity exercise. And how do we have that conversation?

Jolene Brighten: Yeah. So I don’t have anything against CrossFit. But the way you have to frame it is you really have to look at it as, how stressful is your life? Because exercise is a form of stress. And if your life is mega stressful, and you're not sleeping well and then you're going to something like CrossFit, well then you're exercise is stressful, and now you have nothing but stress in your life. Now does that mean you can never do CrossFit? I mean, doing CrossFit and doing those kinds of exercise routines and understanding is that too much for you? That’s a good conversation for one on one. And we talk about, like, how do you feel? So if you do CrossFit, and it takes you like; there’s the DOMS, so delayed onset muscle soreness. If you're doing it right, you should get that, and so that's ok. But if three days or a week later, you still can’t walk. You're still really sore. Or, you do CrossFit and you have to take a two-hour nap, that’s too much for you. You just got that signal. Is it too much for you forever? Probably not. You should be able to go back to that. But it’s just a signal we have to respect.

Crossfitters always hate it when I’m like, you’ve got to do yoga and Pilates {laughs}. Because they’re like, I want to lift heavy things. Right? Because you're probably running your stress hormones like crazy all day, you crave. So when we’re stressed, what does our body want to do? It wants to move big muscles. So this is something that if people can handle it. And I’m like, you're getting anxious and stressed at work, I want you to step out and do 10 jump squats. I want you to move those big muscles, because that’s ultimately what your body wants when you’ve got that stress response. It’s like, we should be running. We should be doing something.

So it's not like, these exercises can be really good. Now, the thing is is that if you suspect you have any kind of hormonal disorder, and you're pushing yourself so hard that you're breathless, so you're going anaerobic. Or you're feeling like you're going to throw up in your workout. I was a fitness instructor for a decade, so I definitely know I have induced vomiting in a lot people. But that’s a little bit too much, in some cases. Unless your body is ready for it.

So, it’s kind of the same thing as, I’ll say crossfitters will bag on marathon people. Marathon people bag on crossfitters. It’s kind of all silly when we look at all the micro feuds that happen. It just cracks me up. Both of those can be depleting. Both of those can mess with your adrenal glands. So, the biggest thing I’d say is that sometimes we have to dial back the exercise. We have to do different forms. Maybe you're only doing CrossFit; like you're doing a 10 to 12-minute kind of quick burst, and then calling it a day. But the biggest thing I’ll say is that I always have to warn people. And this is my warning in clinic. Is that we’re going to work on all of this stuff, and then once you start feeling better, you’re going to go all out again, and then you're going to be completely depleted. It’s going to take you a couple of weeks for you to recover. And this is how we’re going to help you recover with that.

And people always thing I’m crazy. They’re like, why are you just telling me I’m going to do this? Why don’t you tell me not to do this? Because everyone does it. I do it too. The second you start feeling good, you're like, let me go all out! It feels so good. Then you burn it out again, and you have to do a reset. So that’s the other thing, too. Is that if you dial back from the CrossFit, and then you're like, I’m ready to go all in. I actually recommend 10 minute intervals of bringing yourself back and seeing how you feel. You may feel incredibly frustrated in doing that. I can certainly understand. Because exercise can get really addictive. You feel so, so good.

But you know, the thing is, if you step in at 10-minute intervals, and be like, “I’m going to try 10 minutes.” And a few weeks later, I'm going to try 20 minutes. You actually give your body the chance to adapt. And you're going to be more successful. And the biggest, biggest thing I want to say is when you're doing an activity like CrossFit, is if you're depleting yourself, and you're getting exhausted, and your wrecking your hormones. One is; you're going to get injured. You're going to get injured. You're not going to be paying attention. Your body is not going to be set up for it. So we want to be careful about that. And then other thing is that you're actually not going to have the muscle gain. So if you're running stress hormones, you’re breaking down your muscle mass. You actually can do CrossFit, and you can do these stressful exercises, and make yourself gain more body fat than muscle mass, just depending on where your hormones are at.

So, this again is why it comes down to the individualized level. We’ve got to see what's going on with you, and then what your response is.

Diane Sanfilippo: I love it. And I will say this, too, for any of my CrossFit peeps who maybe aren't as inclined to switch to yoga and Pilates. I honestly find bodybuilding-style lifting to be; I don’t know. It’s just been such a great crutch for me over the last couple of years, to be able to feel that's. Not really fatigue, but almost that fatigue in my muscles, and not get the adrenaline push. So being able to squat moderately heavy, but a couple of times. Not 10 reps super heavy, where you push that adrenaline response like you were talking about. And this is a lesson than I had to learn when I wrote Practical Paleo, the first time. Because my old coach still talks about how I just came into the gym one day, and I just broke down crying. I don’t even know what was happening. I don’t know if I just couldn't do the work or I didn’t even start it. Because I was so depleted mentally and emotionally. And it was like, I obviously cannot be doing metabolic condition. Or with any sort of weights. So I ended up taking several months where I literally would just lift in the corner while the class was going on, because I still wanted that community thing.

Jolene Brighten: Yeah, yeah.

Diane Sanfilippo: Not every coach; they didn’t really understand it at the time, either. But I remember talking to Robb Wolf, you were talking about Robb before. I was like, you need to remind me, or just kind of crack the whip about how I need to train right now. I knew what was right. But he was like, don't get that scrunched up face. You shouldn't be grunting. Or getting lightheaded. Or any of that stuff. And I really do find kind of going back to that body building style of lifting, where I feel it in my muscles. Because I’m not a yoga person. I mean, you see my body, and you're like, yeah she obviously doesn’t want to do yoga. It’s just not for me.

But, anyway. I do think that the CrossFit mindset, we get away from. We think curls are bad. I’m like; listen, they have their place, people. They have their place. Anyway.

Jolene Brighten: Well, and it’s also like; what is all of this really? It’s ego that it comes down do. I caution my patients like crazy around burpees, because I’m like, if you're core is not strong, and you're not ready to roll, and you jump back like that, you're going to get whiplash. It’s not good for your cervical spine. And that’s so much of people, they want to be at that level. And I also appreciate that you said, “Oh, I went to Robb Wolf and I asked him.” That is so important for people to understand. Even though I might be an expert in the hormone/autoimmune arena, I have a doctor keeping an eye on me. Because you’ve got to have that outside perspective. Because that ego is tricky, and it comes in. And also you never want to believe that you can do less. And then if you’re A-type personalities, like us, you're just like, no I’m making excuses for myself, and I have to go. So having someone else that’s from the outside looking in that’s going to be able to give you an objective perspective about what's going on is tremendous.

Diane Sanfilippo: Yeah, for me it was somebody who understand the physical manifestation of the emotional and physical stress of going through the process of writing a book. Which was just; I mean, I’ve never had more stress in my life in the year or even the last three months before that book came out. So it was really intense. Anyway, long story short, yeah, definitely. What's funny is for as much confidence as I have, I think that the ego thing in CrossFit, I literally never had it. I walked in there thinking, if I try to push myself too hard, I’ll probably get hurt. Because I had so much influence ahead of time about how dangerous it was. I just literally; I actually probably sandbagged most of the time. Meaning I didn’t try as hard as I could have the vast majority of the time, because I was like, I'm not really winning any awards her. I want to come back and do this again tomorrow. That was always my thing. I don’t really need to get hurt. I’ve been hurt.

6. Testosterone levels in women [38:06]

Diane Sanfilippo: But anyway, that’s not about me. I want to talk, last couple of topics here that we can wrap together, I think. What about testosterone levels, whether they’re high or low. And with or without PCOS; because that’s such a big topic. And then my little secondary question there is people are asking about facial hair. Which I kind of have this assumption, right or wrong, that it’s tied into some testosterone levels.

Jolene Brighten: Yeah.

Diane Sanfilippo: But what can you say about lowering it if it’s high, or raising it if it’s low. Obviously we’ve talked enough about stress, but what additionally do you have to say on that?

Jolene Brighten: Yeah. Well the big thing I want women to understand about testosterone is that you do need it. And this is something that, I don’t know why this happens in conventional medicine, where they give so much attention to estrogen and progesterone, but they leave out the fact that if we as women don't have enough testosterone, we’re really tired; all day tired. So that's what that looks like. You do not wake up in the morning motivated or loving life at all, because you're just like; “This again? I’ve got to get up?” Your bone, your brain, your heart. All of it. You can get osteoporosis from having too little testosterone stimulation. So testosterone is a really important hormone.

And of course, there’s libido. That’s something that everyone thinks about for testosterone. So the issue with high testosterone; you don’t have to have PCOS. PCOS is a metabolic condition. This is about blood sugar regulation, how the adrenals, the liver, pancreas, everybody is interacting in that way. So if it’s PCOS, you’ve really got to go down to that metabolic issue. And you’ve got to work there to get the testosterone down. But, I’ve seen women without PCOS. I think the term PCOS kind of needs to go away. I think there’s probably about 5 different conditions we can probably parse out of that and reclassify. Because I do see high testosterone in women, and they don’t have PCOS. They have no signs of PCOS. But they’ll be losing their hair. Or they’ll have oily skin. Or they have a dark mustache coming in. Nobody likes that business. That dark hair; chin, chest, abdomen, that is too much testosterone. That’s very classical PCOS. It also can be what culture you are descended from. I’m a mutt, basically, but my grandmother is from Mexico. So I have a propensity to get a little more sideburn action going. So keep that in mind, ladies. It’s not always all abnormal.

But, definitely if you're growing hair in places that men grown hair and it’s getting dark, you’ve got to get your testosterone checked. So if that’s happening, and especially if you're losing hair on your head, you likely have what's called DHT, which is a form of testosterone. Testosterone gets converted into this. This is what causes prostate cancer in men. It can cause acne and hair loss in women who basically go bald and we look like teenagers on our face. Not cool at all. Don’t like it at all.

So, with that being said, we can use things typically we see these things being used in men. But Saw Palmetto. Eating pumpkin seeds every day. They have to be raw pumpkin seeds, but get 2 to 4 tablespoons going in every day. Getting flaxseed going. We often think about flaxseed about estrogen. So flax oil can raise estrogen. Flax oil is bad; don’t eat that stuff. Ever. And don’t even bother reading studies about it. It’s never going to come out better. Every study is like, it’s worse that it was before. And we know flax oil will make prostate cancer worse. All of these cancers worse. We don’t want any flax oil.

Flaxseeds, on the other hand, have lignins in them. Lignins will actually bind your hormones, get them out of your body, and it will raise sex hormone binding globulin. Now, sex hormone binding globulin is basically what it sounds like. It binds onto excess protein. So if you’ve got too much testosterone, we want to raise your sex hormone binding globulin. So we can get that going. You’ve got to take care of your microbiome. You’ve got to take care of your liver. But we can get that going with just simply flaxseeds every day. Can start raising that. So we want to start binding up that testosterone. So what we should see is we want to look in the blood at a total testosterone, a free testosterone. Ladies, if you're doctors are not checking a free testosterone, they don't know what they’re doing here. So you have to get a free testosterone. And that sex hormone binding globulin. To see that maybe you’re still making more, but we’ve got to work on getting that testosterone down by binding it.

And so what you do with your sugar; 21-Day Sugar Detox is great. Because if you’ve got blood sugar dysregulation, forget it with your hormones. Just forget it. They’re all going to be off. So you have to be working on that. And this is something I see as the stress and the high sugar intake will push the testosterone in women without PCOS.

Now, on the flipside, what if you have too little testosterone? Which is a really common problem. It’s probably going to be the next hot topic everyone's talking about, is how do we get testosterone up in women. So, one of the biggest reason I see for testosterone to be low is actually birth control use. So, what we know from the research is that women who are on the pill, two things happen. It tells your brain to shut up; to stop talking to your ovaries altogether. And now you're not making testosterone. But any testosterone you might make actually gets bound by all the sex hormone binding globulin. So that mechanism we tried to induce with the flaxseeds; you’re going to get so much of that. When you give that birth control pill to your body, and all that estrogen hits your body, protects you like crazy by raising all your sex hormone binding globulin. This is actually how cortisol gets low. Thyroid hormone. Testosterone. We stop using pretty much all of our hormones when we’re on the pill. That’s why a lot of women feel kind of crazy on them. Because yeah, it’s doing all these bad things.

7. What happens when you're on the pill [43:43]

So what happens when you're on the pill? The pill stimulates your liver to make four times the amount of sex hormone binding globulin. So you're four times higher. Now, our research studies that we have post-pill, they’re short. We need more long-term studies. But what we know is in post birth control syndrome, which typically comes on in the first three to four months. It’s an absolute horrible rush of all kinds of hormonal symptoms after you stop the pill. There’s research that’s been done in that period of time that show that 4 months following the pill and your sex hormone binding globulin has not returned to the same level of a never user of the pill, or where you were before you ever started the pill. So what the research is actually, what they’ve looked at is the pill actually altars your liver at the genetic level, to forever make more sex hormone binding globulin. Which means that forever you may not have enough testosterone. That means your bones, your bones are being compromised. Your mood is being compromised. Your energy is being compromise. I mean, it has a big effect.

And we know that when sex hormone binding globulin goes up, cortisol binding globulin comes up. So does thyroid binding globulin. So now all these other hormones that you would be making, you're actually binding them up. And then, if all of that's happening, your cells are actually changing and becoming more rigidly with the inflammation, now they’re not picking up insulin. Now they don't care. Now, we’ve induced a metabolic issue. It’s like this huge thing that drives me insane that nobody is talking about. Yet we’ve got decades of research about all of this.

Diane Sanfilippo: I mean, I kind of, you just hit me with a two by four when you said that it's affecting our liver perhaps process that stuff for forever, the way that sex hormone binding globulin is working, because I was on birth control for 10 years and I was joking with you before we started recording that probably for at least the first half of those I didn't need to be taking it. But I was taking it because I had these really horrible cramps in the very beginning of my cycle that were debilitating. I would go home from school in high school, whatever that first day was, it was hours of so much pain. Like unbearable pain, back when I was a teenager. So I think that is that's just like all huge lightbulb, I’m blown away kind of moment, that it may have all started for a lot of us right there. And I know a lot of women in my nutrition program, you were saying we need to look more than a year out. I had women sitting right next to me who hadn't been taking the pill for a year who still didn’t have a period back. I mean the effects. It’s not just you stop taking it, and ok, right away you can try and have a baby because, it’s probably not going to happen that way. Maybe it will. And there are some people for whom…

Jolene Brighten: But you shouldn’t, because the birth control pill depletes all of the crucial nutrients. I mean, for like everything. But when you think about the birth control pill is rapidly depleting folate and B12, and when do you need folate? It’s before you even know you're pregnant. Before a positive pregnancy test can come up. And what most women don’t know is that the birth control pill, when you look at how it’s intended to be used. Oh, it has really high efficacy rates. It actually has really low efficacy rates with how it is typically used. So typical user is not going to take the pill every single night. And some days, she’s going to skip it because it’s making her feel really bad. Or she took a round of antibiotics and was taking the pill. Or, name any scenario.

Diane Sanfilippo: Just plain forgot!

Jolene Brighten: yeah, right! I mean, I did the pill for over 10 years, too. And there were definitely times where I was like, oh I have to take two today because I forgot.

Diane Sanfilippo: I think we’re going to have to do a whole separate episode on this. Because you're getting really heated.

Jolene Brighten: {laughs}

Diane Sanfilippo: I feel like there are a lot of questions that we’re all going to have about this because, this is a big one.

Jolene Brighten: And just to your point about women who never have their periods. I challenge all the time; how many doctors before they reach for that pill pad. Before they reach to write that prescription, how many of them actually tell you what’s the most common reason women are getting prescribed the pill? It’s for irregular periods. We know that 60% of women who are on the pill are not on it to prevent pregnancy. Which, oh my god, that makes me so angry! Because for you and I, it was heavy periods. “Oh, just put her on the pill.”

But women with irregular periods, they’re being put on the pill and being told, “Now you're having a normal period.” No you're not. You're having withdrawal bleed. But nobody tells those women that 40% of you will never have your period come back. By taking this pill and masking these symptoms for however long you do it. Actually, the research shows it does not matter. You start that pill; you do it once, you may never, ever have your period come back. So it’s 37% will be infertile after coming off of the pill. How many doctors are talking about this before they write that?

Diane Sanfilippo: Goosebumps. Goosebumps.

Jolene Brighten: It’s crazy to me.

Diane Sanfilippo: That is crazy. It’s actually chilling. And I was not prescribed it for heavy period, it was just heavy cramping.

Diane Sanfilippo: Oh, ok.

Diane Sanfilippo: TMI warning, I’ve actually never had it to be very heavy. Now I’m finding my iron is kind of high. And literally my worst nightmare is needles, and I probably need to go donate blood. And I’m like, is this the thing? Is this the thing that is my biggest fear and now I have to face it! {laughs}

Jolene Brighten: So I have a friend with hemochromatosis.

Diane Sanfilippo: I think I might have a form of it.

Jolene Brighten: Well, check your liver then.

Diane Sanfilippo: Well my liver is not working as well as we’d like it to, so all of this is like, lightbulbs. Yeah.

Jolene Brighten: But he does leeches. He’s terrified of needles. So he went with leeches instead.

Diane Sanfilippo: A needle! {laughs}

Jolene Brighten: I came to his house, and he’s got this big jar of leeches!

Diane Sanfilippo: No. Nope.

Jolene Brighten: He moves them around, and you see the blood. I’m like, oh!

Diane Sanfilippo: Nope. Nu-huh.

Jolene Brighten: So that’s the thing. So I went through medical school. You get stuck every day for 2 years, it’s ridiculous. I hate needles, and I still hate needles, and I still don’t want my blood drawn. But as soon as I’m like, “Well your option is leeches.” I’m like, “No, no, no. Needles it is. Needles it is.” {laughs} I don’t like parasites of any kind.

Diane Sanfilippo: Oh god. That was. Alright.

Jolene Brighten: Have you ever seen Stand by Me?

Diane Sanfilippo: Come on.

Jolene Brighten: {laughs} Oh my god! That’s what I think of very time.

Diane Sanfilippo: I was born in 1978, of course I’ve seen it!

Jolene Brighten: {laughing} But that’s what I think of! And I’m like, I’m going to pass out just thinking about that.

Diane Sanfilippo: Oh, that’s actually what I pictured, and then the blueberry pie throwing up. So, anyway. Oh my gosh. This has been amazing. I’m so appreciative of all the time that you’ve shared with our listeners today, because this is just. I mean I think they’re going to be kind of blown away by all of this. We’re definitely going to have to be selfish and invite you back one day. But where can our listeners get more from you? I know www.drbrighten.com. We’ll link to it right from our show notes. But where else can we find you on the internet. And what are you up to?

Jolene Brighten: Yeah. You can also find me on Facebook and Instagram. So I live on both of those places. That’s the best place I would say. And then as I got into talk about the pill and everything, if you're like, “Oh my god, I did the pill, or I’m on the pill.” Grab my post birth control syndrome quick start detox guide. Whether you're on the pill or coming off the pill. And I’ll say if you’ve ever been on the pill, and you haven’t done work for leaky gut and working on all of this stuff. It doesn’t matter if it was 10 years ago. You have to start working on this. Because of the genetic changes that we know it can cause. So you can grab that. It’s www.drbrighten.com/pbcsdiet {laughs}. So post birth control syndrome diet. You can grab that.

Diane Sanfilippo: We’ll link to it.

Jolene Brighten: My biggest mission right now is that I’ve got to get the work out. I’ve been working on this stuff in the clinic forever, and it was finally somebody who said to me. It was another clinician that we know that reached out to me, and was like, will you teach this stuff? I don’t know anyone else who has protocols around this. And I was like, ah-ha! Like, I should be talking more about this. And so many of my patients are like, I need more information on this. So that’s a big thing I'm working on right now, is just getting more information out to women. I’m not anti-birth control pill, by any means. I’m just pro informed consent. And for a woman to have all of the information to make the best decision for her body.

Diane Sanfilippo: Thank you so much.

Jolene Brighten: Yeah, thank you for having me.

Diane Sanfilippo: I recently sat down with Balanced Bites podcast sponsor, Bethany, of Primally Pure Skincare to ask her more about her company and the products that they make.

Hey Bethany; I would love to hear, what’s your story in a nutshell?

Bethany: I started formulating products in my kitchen in 2013, and gave them out to family, friends, and people at my CrossFit gym. In 2015, I began selling on my family farms website, Primal Pastures. Soon after that, Primally Pure really took off, and grew into a business of its own. Today, Primally Pure is no longer in my kitchen, but in a mixed office/warehouse space in southern California, and we have a team of 6.

Diane Sanfilippo: So tell me. What inspired you to create Primally Pure?

Bethany: I suffered from acne, rosacea, and weird skin sensitivities throughout my teenage years and early 20s. I tried all kinds of creams and prescription medications, but nothing provided me with lasting results. Finally, I found some relief when I adopted a paleo diet and started using all natural ingredients on my skin. Which inspired me to share the natural solutions I had found with others.

Diane Sanfilippo: Don’t forget Diane’s favorite Primally Pure product is the dry shampoo, and Liz’s favorite is the Everything Spray with magnesium. As a special bonus for you, Primally Pure is offering a free lip balm with your first purchase of one item or more. Simply add a lip balm to your cart along with any one item, and use the code “balancedbites”, one word no caps, during checkout to receive one of their lip balms for free with your order. Head to www.primallypure.com and check out their range of safe and effective all natural skincare products.

Diane Sanfilippo: Alright, that’s it for this week. You can fine me, Diane, at http://dianesanfilippo.com. And Dr. Jolene at www.drbrighten.com. Don’t forget to join my email list for free goodies and updates you don’t find anywhere else on my websites or even on the podcast. While you’re on the internet, please leave us a review in iTunes. We’ll see you next week.