WEBVTT - WORLD’S TOP OBGYN Dr. Aliabadi: The #1 Hormone Problem Affecting Millions of Women (And The 4 Changes That Can Reverse It) 0:00:00.240 --> 0:00:03.320 I want to scream in this mic and say, let 0:00:03.320 --> 0:00:07.520 me tell women what they deserve to know. If you 0:00:07.560 --> 0:00:11.920 take PCOS, seventy five percent of these women are not diagnosed. 0:00:12.240 --> 0:00:15.520 If you take endometriosis, over ninety percent of these women 0:00:15.760 --> 0:00:21.840 are not diagnosed. Wow, endometriosis with PCOS, they're the leading 0:00:22.160 --> 0:00:24.600 cause of infertility on this planet. 0:00:27.440 --> 0:00:29.840 Hey, everyone, welcome back to on Purpose, the place you 0:00:29.920 --> 0:00:33.640 come to become happier, healthier, and more healed. Today's guest 0:00:33.760 --> 0:00:36.960 is someone that I'm extremely excited to talk to because 0:00:37.159 --> 0:00:40.080 it's a subject matter that so many of you have 0:00:40.159 --> 0:00:43.400 been asking me about. If you have questions about PCOS, 0:00:43.640 --> 0:00:46.560 this episode is for you. If you have any questions 0:00:46.560 --> 0:00:50.720 about endometriosis, this episode is for you. And if you're 0:00:50.800 --> 0:00:53.199 someone out there who has friends or family that are 0:00:53.240 --> 0:00:57.680 struggling with fertility, this episode is for you. I'm speaking 0:00:57.720 --> 0:01:00.240 to the one and only Dr A, who is an 0:01:00.240 --> 0:01:02.880 authority in the space, someone who has helped so many 0:01:02.960 --> 0:01:06.759 people go through their fertility journey. Please, welcome to on Purpose, 0:01:07.000 --> 0:01:09.160 Doctor A. Doctor. It's great to have you here. 0:01:09.560 --> 0:01:12.720 Jay. I'm so excited. I'm so excited for you to 0:01:12.760 --> 0:01:15.119 give me this mic and I'll tell you why I'm 0:01:15.160 --> 0:01:19.120 so excited to be here. You know, I've always listened 0:01:19.120 --> 0:01:23.600 to you, and you speak so amazingly to these women, 0:01:23.720 --> 0:01:27.840 to your listeners, basically talking to them about calmness and 0:01:27.920 --> 0:01:31.520 how to get to that calm, about mental health, about meditation, 0:01:32.480 --> 0:01:34.920 And one thing I want the world to know is 0:01:34.959 --> 0:01:38.800 that there are millions of women out there that cannot 0:01:39.000 --> 0:01:42.600 get to this calm space. Not because they're not trying 0:01:42.600 --> 0:01:46.399 hard enough, not because they're spiritually weak. They can't get 0:01:46.440 --> 0:01:50.360 there because they have an underlying condition like PCOS and 0:01:50.480 --> 0:01:56.400 endometriosis that affects their hormones, their inflammatory pathway, and their 0:01:56.600 --> 0:02:00.000 nervous system. And that's why they can't find that calm. 0:02:00.520 --> 0:02:03.320 I sit with women all day long. These are women 0:02:03.680 --> 0:02:09.959 who've struggled for years with endemytriosis and PCOS, debilitating pain 0:02:10.520 --> 0:02:13.799 that they can't even you know, stand up straight, and 0:02:14.200 --> 0:02:17.520 just because no one ever believed them, no one, and 0:02:17.560 --> 0:02:20.920 they dismiss their symptoms. You know, you have these thirteen 0:02:21.000 --> 0:02:24.080 year olds who are literally on the bathroom floor with 0:02:24.200 --> 0:02:28.080 every period, thinking this is normal life and that's life 0:02:28.080 --> 0:02:30.959 for them and they can't really complain about it. Or 0:02:31.040 --> 0:02:35.040 they have women who are ashamed of their body, and 0:02:35.160 --> 0:02:37.360 they go to the doctor and all they hear is 0:02:37.400 --> 0:02:41.160 will just eat less, exercise more, but no one really 0:02:41.240 --> 0:02:45.720 addresses the underlying condition. And I've done this for decades, 0:02:45.880 --> 0:02:48.840 and I reached a point in my life that I 0:02:48.919 --> 0:02:54.760 said enough, enough is enough enough dismissing women enough, normalizing 0:02:54.800 --> 0:02:58.600 their pain, normalizing their symptoms, and telling them it's they're 0:02:58.680 --> 0:03:02.720 in their head, they're crazy, they're anxious. It's none of that, really, 0:03:03.320 --> 0:03:06.280 and it's time to really start listening to these women 0:03:06.400 --> 0:03:10.040 and dealing with these underlying conditions. And that's why. You know, 0:03:10.960 --> 0:03:14.200 millions of women are affected by PCOSN and the metriosis, 0:03:14.200 --> 0:03:17.320 and majority of them are never diagnosed. So that's why 0:03:17.320 --> 0:03:19.720 I'm so excited to be here to take at least 0:03:19.720 --> 0:03:23.120 this hour to bring some awareness to these two conditions. 0:03:23.400 --> 0:03:24.800 So thank you for having me. 0:03:25.080 --> 0:03:27.440 Let's dive in, because, like I said, my audience really 0:03:27.440 --> 0:03:29.840 wants the answer to these questions. I really want to 0:03:29.880 --> 0:03:32.000 shed light on this topic. I really want people to 0:03:32.040 --> 0:03:35.560 feel seen, heard and understood as they're navigating this. But 0:03:35.640 --> 0:03:38.040 you've actually said that we're in the middle of a 0:03:38.040 --> 0:03:40.560 fertility crisis. What does that mean? 0:03:40.960 --> 0:03:43.880 So when you know, let's say you take one hundred 0:03:43.880 --> 0:03:46.280 couples and you have them go try to get pregnant. 0:03:46.280 --> 0:03:48.920 You tell them have sex three to four times a week, 0:03:49.240 --> 0:03:51.960 and then come back in a year. Fifty percent of 0:03:52.000 --> 0:03:54.480 them on average get pregnant in the first six months, 0:03:54.640 --> 0:03:56.880 ninety percent of them are pregnant within a year, and 0:03:56.920 --> 0:04:00.520 ten percent don't get pregnant. Well, in that ten percent category, 0:04:00.560 --> 0:04:04.240 if you take male fertility out, majority of those patients 0:04:04.560 --> 0:04:09.240 have PCOS and endometriosis. The problem is if you take PCOS, 0:04:09.760 --> 0:04:12.560 seventy five percent of these women are not diagnosed. If 0:04:12.560 --> 0:04:15.640 you take endometriosis, I think over ninety percent of these 0:04:15.680 --> 0:04:19.760 women are not diagnosed, so they fall under this unexplained 0:04:19.839 --> 0:04:24.720 infertility because doctors are not diagnosing these underlying conditions. 0:04:25.040 --> 0:04:27.720 What is PCOS? Define it for us. 0:04:27.680 --> 0:04:34.960 So PCOS is a chronic hormonal, metabolic, inflammatory, and neurological 0:04:35.000 --> 0:04:38.680 condition that affects fifteen percent of women in this country. 0:04:38.960 --> 0:04:41.440 If you go to countries like India, that number can 0:04:41.480 --> 0:04:45.280 go north of twenty percent. The problem with it is 0:04:45.320 --> 0:04:48.840 that seventy five percent of these women are never diagnosed 0:04:48.839 --> 0:04:52.240 and they go through life not getting a diagnosis. In 0:04:52.360 --> 0:04:55.919 order to diagnose PCOS, it's very simple. You neque to 0:04:55.960 --> 0:04:59.560 meet two out of the three. Criteria. Number one is 0:04:59.640 --> 0:05:04.760 basically ovarian or ovulation dysfunction. These are women who have 0:05:04.839 --> 0:05:08.800 irregular periods. They get their periods not every twenty eight days, 0:05:08.920 --> 0:05:11.600 they get it like every thirty five days, thirty seven days, 0:05:11.720 --> 0:05:15.240 or they get less than eight periods per year. So 0:05:15.279 --> 0:05:19.320 that's criteria number one. Criteria number two is PCOS looking 0:05:19.360 --> 0:05:24.200 over is on ultrasound, So PCOS is not Polycystic ovary 0:05:24.279 --> 0:05:27.080 syndrome is not cyst To this day, doctors say, oh, 0:05:27.120 --> 0:05:28.680 you don't have assist on your ovary, so you don't 0:05:28.680 --> 0:05:33.120 have PCOS. Polycystic ovary syndrome is a group of follericles. 0:05:33.160 --> 0:05:36.400 It's a specific finding on ultrasound. These are ovaries that 0:05:36.440 --> 0:05:40.760 are enlarged with at least twenty Foller coles and it's 0:05:40.800 --> 0:05:44.440 a specific finding on ultrasound. Again, a lot of doctors 0:05:44.560 --> 0:05:47.599 don't know what to look for. So that's the second criteria. 0:05:48.080 --> 0:05:52.520 And recently for this criteria they added high account or 0:05:52.640 --> 0:05:56.080 high AMH to this criteria. Be for women who can 0:05:56.240 --> 0:05:59.240 have access to ultrasound or they don't you know, or 0:05:59.240 --> 0:06:04.080 their doctor's this ovarian morphology on ultrasound, so elevated account 0:06:04.200 --> 0:06:08.080 also counts as this second criteria, and the third criteria 0:06:08.279 --> 0:06:13.040 is elevated testosterone or androgen symptoms. What are these symptoms? 0:06:13.320 --> 0:06:18.919 Facial hair, body hair, facial acne, body acne, oily skin, 0:06:19.400 --> 0:06:22.680 male pattern, hair thinning, or hair loss. You don't have 0:06:22.720 --> 0:06:25.000 to have all of these symptoms, you have to have one. 0:06:25.520 --> 0:06:27.839 So this is the third criteria, and you need to 0:06:27.920 --> 0:06:31.839 meet two out of these three criteria. PCOS patients, for 0:06:32.480 --> 0:06:36.160 reasons I'm going to go into details, struggle with anxiety 0:06:36.200 --> 0:06:39.480 and depression. They have mood disorder, they're moody people. They 0:06:39.480 --> 0:06:42.840 have really bad PMS. They usually have someone in their 0:06:42.839 --> 0:06:48.159 family who's PCOS diabetic, overweight, insulin resistant. A lot of 0:06:48.200 --> 0:06:51.120 them have an eating disorder or disordered eating, and they 0:06:51.240 --> 0:06:55.240 end up in these eating disorder centers because their PCOS 0:06:55.320 --> 0:06:59.479 is not being diagnosed. It's the leading cause, with endometriosis, 0:06:59.600 --> 0:07:04.520 leading cause of infertility on this planet. Seventy five percent 0:07:04.560 --> 0:07:07.480 of these patients gain weight even though they're eating exactly 0:07:07.480 --> 0:07:10.840 what you and I are eating, exercising exactly the same, 0:07:11.080 --> 0:07:14.680 but they cannot lose a pound. Twenty five percent of 0:07:14.720 --> 0:07:19.240 them are lean, lean PCOS patients. Even these lean PCOS 0:07:19.320 --> 0:07:23.360 patients have eating disorders. So imagine, take this young girl 0:07:23.640 --> 0:07:28.160 who's gaining weight, is in high school, let's say, gaining weight, acne, 0:07:28.400 --> 0:07:32.520 facial hair, can't lose her weight, She's moody, she's anxious, 0:07:32.520 --> 0:07:35.520 she has really bad PMS, and she goes to the 0:07:35.560 --> 0:07:38.000 doctor and the doctor says, there's nothing wrong with you. 0:07:38.000 --> 0:07:39.320 You're probably eating too much. 0:07:39.400 --> 0:07:41.320 So wait, you would know as early as then. 0:07:41.680 --> 0:07:45.240 Oh my god, yes, teenagers, that's you know what I 0:07:45.280 --> 0:07:48.040 always say. If you want, if you go knock on 0:07:48.160 --> 0:07:51.400 the doors of these eating disorder centers, your PCOS patients 0:07:51.440 --> 0:07:52.800 are sitting behind those doors. 0:07:52.880 --> 0:07:55.120 So why is it not getting correctly diagnosed? If it's 0:07:55.120 --> 0:07:57.880 such a big issue, it's affecting so many people, and 0:07:57.920 --> 0:08:00.560 there's so many symptoms through which you can measure it, 0:08:00.760 --> 0:08:02.040 why is it not diagnosed? 0:08:02.200 --> 0:08:05.440 So I think it's multiple reasons. Number one, doctors don't 0:08:05.520 --> 0:08:08.760 consider you know, they don't know enough about PCOS and 0:08:08.880 --> 0:08:12.360 PCOS presents in different morphologies. Once we talk about it, 0:08:12.400 --> 0:08:16.440 you understand why you don't have to have irregular period 0:08:16.440 --> 0:08:20.119 to have PCOS. Some there's a morphology of PCOS patients 0:08:20.160 --> 0:08:23.160 who don't have any elevated testosterone symptoms. They just have 0:08:23.240 --> 0:08:26.440 the irregular period and the PCOS. So remember I said 0:08:26.480 --> 0:08:29.440 two out of the three criteria. You have different combination 0:08:29.600 --> 0:08:34.240 of these symptoms and different presentations of these patients. Some 0:08:34.320 --> 0:08:37.080 are leans, some are overweight, some have irregular periods, some 0:08:37.160 --> 0:08:39.400 have acnes, some have hair loss, some have facial hair 0:08:39.440 --> 0:08:43.160 and body hair. They present differently, so it's very confusing 0:08:43.200 --> 0:08:45.520 to doctors. That's why I'm here to tell you you 0:08:45.640 --> 0:08:48.000 only need to meet two out of the three criteria. 0:08:48.400 --> 0:08:51.160 And if you meet those criteria, then you look for 0:08:51.200 --> 0:08:53.679 the anxiety and the depression and the eating disorder, and 0:08:53.720 --> 0:08:57.439 the weight issues and the insulin resistance and the fertility issues, 0:08:57.440 --> 0:09:00.360 and you put this picture together and you can your 0:09:00.360 --> 0:09:03.280 PCOS patients. I always say, you don't need a doctor 0:09:03.320 --> 0:09:05.840 to really diagnose you. If you listen to this podcast 0:09:06.240 --> 0:09:09.040 from home, you can self diagnose. I'm giving you the 0:09:09.080 --> 0:09:14.560 tools to diagnose yourself. But because PCOS has these underlying 0:09:14.800 --> 0:09:19.920 pillars that affect their entire, their whole body. So it's 0:09:19.960 --> 0:09:24.120 not just a fertility issue, it's not just the period issue. 0:09:24.360 --> 0:09:27.120 Is a total body issue. It affects your mental health, 0:09:27.360 --> 0:09:30.920 it affects your reproductive health. It affects you metabolically, it 0:09:30.960 --> 0:09:36.280 affects your hormones. And until you address every single underlying 0:09:36.880 --> 0:09:40.679 pillar of the driver of these symptoms, you can make 0:09:40.720 --> 0:09:41.960 these patients feel better. 0:09:42.280 --> 0:09:45.160 So if a woman is listening to this right now 0:09:45.480 --> 0:09:48.199 and feel she has PCOS, what's the next thing she 0:09:48.240 --> 0:09:48.640 should do? 0:09:49.040 --> 0:09:53.120 Very good question. So the domino, imagine, the first domino 0:09:53.320 --> 0:09:57.559 of this PCOS storm is insulin resistance. You have to 0:09:57.679 --> 0:10:01.080 understand insulin resistance. What is it? Sulin resistance. When we 0:10:01.120 --> 0:10:05.280 eat carbohydrates, bread, pati, pizza, chocolate, ice cream, our body 0:10:05.280 --> 0:10:08.840 breaks it down into glucose. Glucose stimulates our pancreas to 0:10:08.880 --> 0:10:12.120 release a hormone called insulin. The job of insulin is 0:10:12.240 --> 0:10:15.400 it goes at a cellular level, opens up the receptors 0:10:15.400 --> 0:10:18.960 on our cells. The receptors grab the sugar and put 0:10:19.000 --> 0:10:22.000 it inside the cell where it turns into energy. This 0:10:22.080 --> 0:10:25.520 is what's supposed to happen. But PCOS patients genetically have 0:10:25.600 --> 0:10:29.200 insulin resistance, So when they eat carbohydrates and their body 0:10:29.240 --> 0:10:33.960 releases insulin, their cells are insulin resistant. So these channels 0:10:34.000 --> 0:10:36.040 don't open for the sugar to go into the cell 0:10:36.080 --> 0:10:38.880 and turn into energy. So the sugar bounces in the 0:10:38.920 --> 0:10:42.800 blood and pushes the insulin to go up. Insulin is 0:10:42.840 --> 0:10:46.600 a fat storage hormone. It's an inflammatory hormone. You don't 0:10:46.600 --> 0:10:49.079 want your insulin to go up. So what happens when 0:10:49.120 --> 0:10:53.280 this insulin goes up? Few things happen. Number One, insulin 0:10:53.320 --> 0:10:55.959 tells your liver the cells are not taking up this 0:10:56.040 --> 0:10:59.160 sugar to turn it into energy. Take this sugar and 0:10:59.200 --> 0:11:02.720 store it as fat. The problem is the fat that 0:11:02.800 --> 0:11:06.640 gets stored with insulin resistance is not the good old 0:11:06.720 --> 0:11:10.800 fat under our skin. It's the visceral fat around our 0:11:10.920 --> 0:11:16.920 organs liver and our inner abdominal organs. That's highly, highly inflammatory, 0:11:17.160 --> 0:11:20.240 and we'll get into it later. So one, the high 0:11:20.320 --> 0:11:22.880 insulin tells your body, take this sugar and store it 0:11:22.880 --> 0:11:28.600 into this inflammatory fat. One two, high insulin stimulates their 0:11:28.679 --> 0:11:35.600 ovaries to secrete androgens. So, and this is the first domino. 0:11:36.200 --> 0:11:41.000 Why because when the ovary starts secreting androgens, our menstrual 0:11:41.120 --> 0:11:44.240 cycle completely goes out of whack. I want to take 0:11:44.280 --> 0:11:47.640 a minute to tell you what a normal menstrual cycle 0:11:47.720 --> 0:11:50.600 look like and what it looks like for these poor 0:11:50.640 --> 0:11:55.880 PCOS patients. So, in a normal menstrual cycle, our brain, 0:11:56.120 --> 0:12:00.520 our hypothalamus releases GnRH, which is a hormone that affects 0:12:00.559 --> 0:12:03.720 the pituitary gland, an other gland in our brain that 0:12:03.920 --> 0:12:08.320 releases two hormones FSH and LH. When this GnRH is 0:12:08.360 --> 0:12:15.040 being released slowly, the pituitary gland releases a hormone called FSH. 0:12:15.320 --> 0:12:19.959 FSH effect stimulates our ovaries, the follicles in the ovaries 0:12:20.120 --> 0:12:23.319 to start growing for that cycle, and these follicles, as 0:12:23.320 --> 0:12:26.840 they grow, they start releasing estrogen. The estrogen they release, 0:12:27.200 --> 0:12:30.040 it gets the lining of the uterus ready for pregnancy, 0:12:30.080 --> 0:12:32.920 because that's the job of the ovaries helping us get 0:12:32.960 --> 0:12:37.599 pregnant every month. So these ovaries basically release these follicles 0:12:37.640 --> 0:12:40.720 release these estrogens, and the estrogen stimulates the lining of 0:12:40.760 --> 0:12:44.199 the uterus. While these estrogen is being released, it has 0:12:44.200 --> 0:12:47.439 a negative feedback on our brain. When the estrogen levels 0:12:47.679 --> 0:12:52.040 hit a very high level, it actually stimulates this GnRH 0:12:52.120 --> 0:12:55.880 secretions from the hypothalamus to go faster. And when the 0:12:55.920 --> 0:13:00.840 GnRH starts firing faster, the FSH slows down and the 0:13:01.200 --> 0:13:05.320 LH surge comes. And LH is a hormone that is 0:13:05.360 --> 0:13:09.080 a lutinizing hormone and it causes the ovulation, so it 0:13:09.240 --> 0:13:13.000 pushes one follicle out, and that's when the egg gets released. 0:13:13.000 --> 0:13:15.760 And if we're trying for pregnancy, the sperm comes up, 0:13:15.920 --> 0:13:18.840 the embryo forms, and now the lining of the uterus 0:13:18.920 --> 0:13:21.280 is nice and juicy, and the embryo implants and the 0:13:21.320 --> 0:13:28.079 pregnancy happens. What happens with PCOS patients, remember the insulin resistance. 0:13:28.120 --> 0:13:32.360 That first domino starts stimulating the THIKA cells in the 0:13:32.400 --> 0:13:36.160 ovary to release androgens. When you start having androgens in 0:13:36.200 --> 0:13:39.600 the ovary, it freezes these follicles and doesn't let them 0:13:39.600 --> 0:13:44.480 grow normally, so then the estrogen starts becoming erratic and 0:13:44.600 --> 0:13:48.000 you have and when your androgen levels go up, the 0:13:48.200 --> 0:13:53.199 androgens stimulate the GnRH to go faster, and then the 0:13:53.360 --> 0:13:58.880 LH starts going faster, and the LH constantly stimulates these 0:13:58.920 --> 0:14:03.240 ovarian tissues, the THEKA cells to release more androgens. So 0:14:03.360 --> 0:14:06.959 you start in PCOS patients, you start getting this environment 0:14:07.080 --> 0:14:13.320 of high androgens and these irregular estrogen secretions that not 0:14:13.440 --> 0:14:21.200 only block ovulation, block implantation, affects our causes irregular periods, 0:14:21.560 --> 0:14:26.560 but it starts affecting our brain because the androgens affect 0:14:26.640 --> 0:14:29.840 our mental health, and we can go over that later. 0:14:30.640 --> 0:14:34.480 But this is what happens, and this is why seventy 0:14:34.520 --> 0:14:39.480 to eighty percent of PCOS patients don't ovulate. Of the 0:14:39.600 --> 0:14:43.720 twenty thirty percent of them who ovulate, they ovulate sometimes 0:14:44.160 --> 0:14:48.120 even the ones who have regular periods. They're regular periods. 0:14:48.160 --> 0:14:51.840 It's not because necessarily they're ovulating. It's because they're getting 0:14:51.840 --> 0:14:55.480 withdrawals from this estrogen. It gets very complicated. But the 0:14:55.560 --> 0:14:59.200 human the women's hormonal system is so beautiful when you 0:14:59.240 --> 0:15:03.000 really understand and it. It becomes very complicated with these 0:15:03.000 --> 0:15:09.160 PCOS patients, and that is why it becomes a vicious cycle. Right, So, 0:15:09.200 --> 0:15:13.560 the insulin resistance starts reproducing androgens in the ovary. The 0:15:13.600 --> 0:15:17.200 androgens affect the brain to release more LH. The LAH 0:15:17.240 --> 0:15:20.760 affects the ovaries to secrete more androgens out and this 0:15:20.960 --> 0:15:25.920 becomes a vicious cycle that doesn't stop. And so the 0:15:26.040 --> 0:15:30.520 first underlying condition is this insulin resistance. The second underlying 0:15:30.680 --> 0:15:33.400 pillar is this androgen being it. 0:15:33.960 --> 0:15:36.800 Is there anything women can do about that insulin resistance? 0:15:37.200 --> 0:15:38.040 Absolutely? 0:15:38.200 --> 0:15:39.720 What do they do. Let's focus on that one and 0:15:39.760 --> 0:15:40.800 then we'll move to the others. 0:15:40.840 --> 0:15:44.880 Absolutely, So for this pillar of insulin resistance, you want 0:15:44.920 --> 0:15:49.760 to make patients insulin sensitive, right, So there are many 0:15:49.880 --> 0:15:54.520 supplements that can make patients insulin sensitive. And that's why 0:15:54.520 --> 0:15:55.960 I don't know if you know I have an OV 0:15:56.160 --> 0:15:59.360 platform and I have a supplement. PCOS is actually one 0:15:59.360 --> 0:16:03.200 of those conditions that supplements actually play a huge role 0:16:03.280 --> 0:16:07.880 in it. Why because by making a you want to 0:16:08.000 --> 0:16:11.960 reduce for this insulin resistance pillar A, you want to 0:16:12.040 --> 0:16:16.280 reduce the glucose in the blood. Right, So you tell 0:16:16.280 --> 0:16:20.760 the patients decrease your carbohydrates. If you're eating carbohydrates, go 0:16:20.880 --> 0:16:24.120 for a walk ten minutes twenty minutes after each meal. 0:16:24.360 --> 0:16:28.000 When we walk, we actually wake up these insulin receptors 0:16:28.280 --> 0:16:30.800 and they start grabbing sugar out of the blood. So 0:16:30.840 --> 0:16:33.360 we lower the sugar so low carbsize. 0:16:33.000 --> 0:16:35.080 By having a ten minute walk after each after. 0:16:34.960 --> 0:16:39.120 Each meal, so eat less carbohydrate, walk ten twenty minutes 0:16:39.160 --> 0:16:43.600 after each meal. Exercise makes a huge difference, obviously, in 0:16:43.640 --> 0:16:46.640 addition to the walking after each meal. Then we go 0:16:46.720 --> 0:16:50.920 to supplements. There are supplements like my OV supplement. These 0:16:50.960 --> 0:16:55.200 supplements work at a cellular level to open up these 0:16:55.280 --> 0:16:59.160 channels and pull the sugar in my ov supplement also 0:16:59.200 --> 0:17:02.400 has one wild mulberry leaf in it, and what that 0:17:02.480 --> 0:17:05.000 does if you take it before your heaviest meal, If 0:17:05.040 --> 0:17:08.160 you take the supplement before your heaviest meal, it actually 0:17:08.200 --> 0:17:12.120 blocks the absorption of carbohydrate in that meal by forty percent. 0:17:12.640 --> 0:17:16.480 So now you're decreasing the load of sugar you're also 0:17:16.520 --> 0:17:20.200 and whatever gets absorbed, you're pushing it. You're opening these 0:17:20.280 --> 0:17:23.480 channels and pushing it into this cell, so you're clearing 0:17:23.520 --> 0:17:26.680 that sugar out of the blood. By doing that. What happens, 0:17:26.720 --> 0:17:30.080 your insulin goes down. When insulin goes down, your fat 0:17:30.119 --> 0:17:35.440 storage goes down, your weight management becomes easier. When insulin 0:17:35.520 --> 0:17:39.000 goes down, your ovaries are not secreting as much androgens. 0:17:39.160 --> 0:17:43.400 Your androgens go down, androgens go down. What happens your 0:17:43.520 --> 0:17:48.040 ovulation becomes more regular, the inflammation goes down. So that's 0:17:48.080 --> 0:17:50.600 how the supplements work. And the ov has a lot 0:17:50.600 --> 0:17:55.159 of anti inflammatory supplements. But there's prescription medication met forman. 0:17:55.600 --> 0:18:00.679 What does metforman do. Metforman makes us insulin sensitive. Anything 0:18:00.720 --> 0:18:04.280 that makes you insulin sensitive again lowers that insulin. 0:18:04.359 --> 0:18:05.800 Are there any side effects to either of this? 0:18:06.040 --> 0:18:09.240 So the supplements don't have any side effects. Met Foreman 0:18:09.320 --> 0:18:11.760 does have side effects, but patients get used to it. 0:18:12.320 --> 0:18:15.080 The most common side effect with met Foreman is nausea 0:18:15.560 --> 0:18:20.639 or diarrhea, but most patients do really, really well. The 0:18:20.680 --> 0:18:23.640 next thing patients can do are glp ones. I'm sure 0:18:23.640 --> 0:18:27.200 you've heard of the ozempics and the wagovis and the urzeppetites. 0:18:27.600 --> 0:18:31.520 So in twenty fourteen I started treating my PCOS patients 0:18:31.520 --> 0:18:35.080 with GLP one, so almost twelve years ago, so none 0:18:35.119 --> 0:18:37.760 of these medications are new. But back then I had 0:18:37.800 --> 0:18:42.520 trulicity glp ones. Why do PCOS patients love GLP ones? 0:18:42.560 --> 0:18:45.080 I started treating them, and one thing I realize is 0:18:45.440 --> 0:18:48.240 not only they're losing a lot of weight, but glp 0:18:48.359 --> 0:18:53.520 ones regulates their insulin and makes them insulin sensitive. By 0:18:53.560 --> 0:18:56.840 doing that, they that's why patients say, oh when I 0:18:56.880 --> 0:19:00.000 take I don't know met foreman, or when I take oh, 0:19:00.440 --> 0:19:04.479 or when I take. When I use these glp ones, 0:19:04.640 --> 0:19:07.600 I get brain clarity, I get pregnant. My periods are 0:19:07.600 --> 0:19:11.320 becoming more regular because at its core, you're fixing this 0:19:11.480 --> 0:19:16.800 insulin resistance. So for this pillar, this underlying condition, I 0:19:16.920 --> 0:19:21.560 say low carbohydrate diet, walk ten to fifteen minutes after 0:19:21.640 --> 0:19:25.480 each meal, exercise cardio at least four times a week. 0:19:26.560 --> 0:19:30.320 I recommend the OV supplement. It works amazingly well. Take 0:19:30.560 --> 0:19:33.280 ask your doctor for a met form in prescription. The 0:19:33.440 --> 0:19:37.560 minimum dose of met forman to affect insulin resistance is 0:19:37.600 --> 0:19:40.480 fifteen hundred, so you want to start with seven hundred 0:19:40.520 --> 0:19:43.359 and fifty at night. If you have no nausea or 0:19:43.359 --> 0:19:45.680 no diarrhea, you want to increase it to twice a day. 0:19:46.240 --> 0:19:49.119 Then if you have weight issues, if you have a 0:19:49.119 --> 0:19:52.159 hard time losing weight, if your BMI is in the 0:19:52.200 --> 0:19:56.240 obese category, or if you're overweight with high blood pressure 0:19:56.280 --> 0:20:00.600 or high cholesterol, then I recommend the GLP ones. You 0:20:00.640 --> 0:20:04.400 can do the ozempeg, wagov. They all work really really well. 0:20:21.040 --> 0:20:24.080 Talk to me about the nutritional impact of being on 0:20:24.160 --> 0:20:26.679 gop one because the friends that I know that have 0:20:26.720 --> 0:20:29.480 been taking it, they're not getting nutrients because they're not 0:20:29.480 --> 0:20:32.399 eating as much anymore. And that obviously sounds like it 0:20:32.440 --> 0:20:35.000 has terrible effects on the body. I not be able 0:20:35.040 --> 0:20:35.840 to actually. 0:20:35.520 --> 0:20:36.520 Eat, you know, and I. 0:20:36.480 --> 0:20:38.600 Can use weight, but you're not eating. 0:20:38.960 --> 0:20:42.600 Yes, But remember we're talking. I'm talking right now about 0:20:42.600 --> 0:20:46.439 my PCOS patients. I'm not talking about that, you know, 0:20:46.480 --> 0:20:50.360 perimenopausal woman or someone out there who wants to lose 0:20:50.400 --> 0:20:54.240 ten pounds five pounds. Patients who are already underweight and 0:20:54.320 --> 0:20:57.239 they want to lose ten more pounds and you know 0:20:57.320 --> 0:21:00.280 they're not eating. This is four PCs, this is this 0:21:00.480 --> 0:21:03.920 is for pcos. I mean twenty fourteen I started using 0:21:03.920 --> 0:21:08.360 these medications. It's a game long someone to conceive, So 0:21:08.440 --> 0:21:11.720 it depends, it depends. So for someone who wants to 0:21:11.720 --> 0:21:14.920 lose one hundred pounds, you know, they might have to 0:21:14.960 --> 0:21:16.840 stay on it for two two and a half years. 0:21:17.240 --> 0:21:21.960 And the reality of it is, you know, insulin resistance 0:21:22.040 --> 0:21:26.040 metabolic health is not a one size fits all. Someone 0:21:26.080 --> 0:21:29.640 who loses one hundred hundred and fifty pounds with glp 0:21:29.800 --> 0:21:32.760 ones is probably never going to get off of these mets, 0:21:32.840 --> 0:21:37.120 you know. But their patients, my PCOS patients who want 0:21:37.200 --> 0:21:40.200 who I don't know. They lose thirty pounds, forty pounds, 0:21:40.400 --> 0:21:44.399 fifty pounds on these glp ones. But what I do. 0:21:44.640 --> 0:21:48.880 I keep them on ov and met foreman after they 0:21:48.920 --> 0:21:52.359 lose their weight. So if someone has insulin resistance, you 0:21:52.359 --> 0:21:55.199 give them glp ones and you stop it. What's going 0:21:55.280 --> 0:21:58.480 to happen? They shoot back up. Right, take a pcos patience. 0:21:58.800 --> 0:22:01.479 Her insulin resistance is not going away. You give her 0:22:01.520 --> 0:22:07.200 GLP one, You address her insulin sensitivity, you regulate her insulin. 0:22:07.440 --> 0:22:10.040 She loses fifty pounds. You stop it. The patient comes 0:22:10.080 --> 0:22:12.160 back three months later, she's like, doctor, I gain all 0:22:12.160 --> 0:22:15.440 of my weight back. Why because you did not address 0:22:15.440 --> 0:22:18.800 the underlying condition. So what I do with my patients 0:22:18.800 --> 0:22:22.760 if you're starting on glp ones in about three four months, 0:22:22.800 --> 0:22:25.080 when they get used to the GFP one, that's when 0:22:25.119 --> 0:22:28.960 I introduce the MET format. And right when I start 0:22:29.000 --> 0:22:31.960 them on the GLP ones, I have them take the 0:22:32.000 --> 0:22:36.280 OV supplement. So when I'm ready to stop the golp ones, 0:22:36.480 --> 0:22:39.520 they're already on the OV supplement, They're already on the 0:22:39.560 --> 0:22:44.159 MET format. I'm addressing their inflammation, I'm addressing their insulin resistance. 0:22:44.520 --> 0:22:48.320 I'm decreasing the load of carbohydrate that's being absorbed in 0:22:48.400 --> 0:22:51.520 their diet. And then I wean them off of the 0:22:51.600 --> 0:22:56.360 GLP one. You have to address the underlying disorder. If 0:22:56.440 --> 0:22:57.080 that makes sense. 0:22:57.160 --> 0:22:58.640 Yeah, So what's the second pillar? 0:22:59.080 --> 0:23:02.119 So the second pill is the hormone pillar that I 0:23:02.200 --> 0:23:06.119 was explaining. When the when the insulin resistant stimulates your 0:23:06.160 --> 0:23:12.040 ovaries to secrete androgen. The androgen actually affects your GnRH secretion. 0:23:12.200 --> 0:23:15.359 It makes it very rapid. And this rapid secretion of 0:23:15.480 --> 0:23:20.080 GnRH causes a shift in the LH FSH, So the 0:23:20.119 --> 0:23:23.960 FSH kind of stays down and the LH chronically stays up. 0:23:24.160 --> 0:23:27.280 So instead of only going up mid cycle causing ovulation 0:23:27.880 --> 0:23:31.560 all month, this LAH is firing. What does LH do 0:23:31.880 --> 0:23:35.520 It stimulates your ovaries to release androgens. So then it 0:23:35.600 --> 0:23:38.920 becomes a vicious cycle. You have these androgens that block ovulation, 0:23:39.320 --> 0:23:41.800 and you have these androgens that are free floating in 0:23:41.880 --> 0:23:46.440 the system causing facial hair, body hair, irregular period acne 0:23:46.440 --> 0:23:50.119 oily skin. And on top of that, these androgens are 0:23:50.119 --> 0:23:53.080 affecting your brain, which we'll talk later. So this is 0:23:53.119 --> 0:23:56.960 the second pillar. And for this pillar, not only you 0:23:57.000 --> 0:24:00.560 want to deal with the insulin resistance. This is when 0:24:00.600 --> 0:24:03.480 we give patients birth control pills, right, and birth control 0:24:03.840 --> 0:24:10.560 pills help help regulate this vicious cycle. The third pillar, 0:24:10.680 --> 0:24:15.399 which is extremely important and nobody talks about, is chronic inflammation. 0:24:15.920 --> 0:24:20.600 These poor PCOS patients have chronic inflammation in their body. 0:24:20.720 --> 0:24:24.960 This chronic inflammation, remember I told you with the insulin resistance. 0:24:25.200 --> 0:24:28.199 The liver takes this sugar and turn it turns it 0:24:28.240 --> 0:24:33.680 into a visceral fat. Visceral fat is highly inflammatory. Insulin 0:24:33.720 --> 0:24:38.640 resistant increases this inflammation. PCOS patients are stressed out, they 0:24:38.640 --> 0:24:43.359 have high cortisol. Cortisol increases inflammation. These follicles that I 0:24:43.440 --> 0:24:47.000 tell you freezing the ovaries and they're not ovulating, are 0:24:47.119 --> 0:24:52.560 highly inflammatory. These PCOS patients have sleep disturbances. Sleep disturbance 0:24:52.800 --> 0:24:58.040