 According to a recent study, nearly half of American women struggle with hormone imbalance. And in my practice, this number is much higher because most physicians don't take the time to really delve into proper hormonal testing. So what gifts? Why do so many women struggle with hormone issues? And why do these issues so often go undetected by medical professionals? My guest today says you not only can help balance your hormones, but use them as your secret superpower. And as a result, enjoy better relationships, better bodies, better sex life, and better minds. She's Dr. Stephanie Estima, a chiropractor with a special interest in functional neurology, metabolism, and body composition. She's also the creator of the Estima Diet, host of the Better Podcast, and author of The Betty Body. We're about to cover a lot of important topics as Dr. Estima shares her approach to healing, modern science mixed with ancient wisdom to help you, or the woman in your life, find health. So welcome to the Dr. Gundry Podcast, Dr. Estima. It's great to have you on. I am thrilled to be here. Thank you for having me. So let's start with your book, The Betty Body, that came out earlier this year. Okay, I gotta know. What is a Betty Body? Yeah, this is a point of confusion, and maybe this is a fallacy in my marketing. But we started a podcast at the end of 2019. The name of the podcast is Better, with Dr. Stephanie. And the fans of our show, we started just lovingly calling them our beddies. And it was very, very sticky. They started, you know, calling themselves beddies, and I want to be a Betty, and I want to learn how to be better, and I'm a Betty. And we looked up the definition of a Betty in the Urban Dictionary, and turns out there's a definition for it. And I put this in the book, but the, and I'm paraphrasing a little bit here, a Betty is a modern day queen. She's a fully embodied woman. She's quirky. She's loving. She's intelligent. She's excited about becoming, you know, the best version of herself in every way. And when I saw that definition, I said, Oh my gosh, like that's, I'm that person, you know, I'm quirky and I'm loving and I'm aspiring to be the best version of myself. So we named the book, the book is called The Betty Body after our fans and after the pursuit of just trying to love and accept and optimize the body that you live in. So it's not, you know, it's size agnostic. I'm not trying to tell you that you need to look like a size two or a size, you know, whatever size. It's really about loving the skin that you're in and optimizing, you know, what we'll talk about today, your hormones and, you know, your metabolism and working on your body composition. So it's really about being the best version of yourself in the body and, you know, in the meat sack that we all live in. All right. Yeah, I was trying to figure out if you were referring to, there was a cartoon character in the 30s. The Flintstones. Well, Betty Boop, actually. Long before Betty Rubble. Yes, that's right. That's right. So and she was, she was kind of an epitome of the perfect proportioned woman, I guess. So it would be whatever. All right. So in the book, you share a lot of your personal story about health and emotional struggles. Can you explain what you mean when you were at war with your body? Yeah, this was part of the, you know, the birth process of, you know, the book and my own story in that, you know, for years, I really looked at my own menstrual cycle as this really pesky, you know, punishment for being a woman that came every month. It was really annoying. I often medicated, you know, taking lots and lots of mitol and lots and lots of medications to really silence the symptoms that my body was trying to tell me. And partly because in schooling, even though I was in, you know, I was, my undergrad is in neuroscience and psychology. My professional degree, as you mentioned, doctor of chiropractic, you know, we're not really taught about fertility. I mean, we have the basic like this is a female menstrual cycle. But we're not really taught about our fertility. And I think in society so often we're really taught to fear our fertility as well. So I would, you know, every month, and I talk about this in the book, you know, when I would be going into see patients, when I knew it was that time of the month where I would be in my, you know, week one or my bleed week, needed to take multiple pairs of pants, needed to schedule lots of breaks in between patients because of the discomfort that I was in. And it really wasn't until I had a couple of, you know, major life events sort of happen at the same time, was going through a, you know, divorce with very young children. And my clinic actually burnt down. I don't know if I put that in the book, but my clinic burnt down and I had to rebuild it from the ground up and you do that in, you know, at the same time as going through a divorce. I mean, I'm great friends with the father of my children now, but I don't care what ways life is divorce. Yeah, at that time it was really stressful, not sleeping very well, et cetera, but it wasn't really until I went on this trip with my family to Italy where I really experienced what it meant to have proper menstruation and how quickly I could actually turn that around. And I know we'll talk a little bit about that, but for me for years it was just, you know, my period and my menstrual cycle was just a punishment for being a woman. It was sort of how I looked at it without really understanding that these were my body's way of saying like, hey girl, you know, like something's wrong here. I just need you to pay a little bit more attention to me. So, yeah. So yeah, you mentioned that this kind of wake-up call happened in Italy, which is one of my favorite places in the world and I just returned from there two weeks ago, hiking in the hills above Portofino. So what happened in Italy that, you know, that turned things around? Did you eat better or sleep better or all of the above? All of the above and more. I mean, when, you know, and someone who loves Italy as I do, I always feel like whenever I go there, like everything's better, like the coffee's better. Even the little like mom, posh shops, selling sandwiches, like everything is just better there. And what I did was I got a lot of natural sunlight, right? So we were, we went in the summertime, so we'd spend lots and lots of time at the beach. I would sleep. I would sleep in. I would go to sleep when it was dark. I would wake up when it was light. Lots of natural low-level movement. So we would, you know, wasn't necessarily following a very, you know, estima diet. We'll talk about what the estima diet is. Not a very estima diet friendly diet in Italy. I was enjoying the pastas and the gelatos and the, you know, the pizzas and stuff. But a lot of post-prandi, a lot of post-meal walking. So we would walk to the place that we were going to have our supper and then we'd walk, you know, along the beach. We'd walk in the town. We'd go to the little, you know, square where all the action was. So a lot of low-level movement. And these were two main, you know, coupled with, you know, being able to sleep and lowering my stress and not having to, you know, not moving so much during, you know, in my practice days, all of these together in aggregate over the course of just once, like towards the end of that trip in Italy, we were there for about three weeks. Last week of the trip, I got my period. And normally this would be the worst thing that could ever happen. Like I would be holed up in the hotel room, you know, mask on, lights off, you know, drugged up. But it was beautiful. It was easy. It was graceful. I didn't have, you know, no excess heavy bleeding. All of that, that was really plaguing me for, you know, really decades before. And I really was curious about if I could, I mean, like I said, everything's better in Italy. But if you could take some of those basic fundamentals around health, low-level movement, like generalized movement through the day, sunlight, getting outside in fresh air, sleeping, you know, in accordance with the, when the sun is down, you're inside, the lights are low, and then you wake up with the sunrise. And I brought all of those things back to North America where I live. I live in Toronto. So major Canadian city. And I really wanted to experiment both with myself and my female patients. So I was already at that time running a nutrition program. It was ketogenic in its flavor and already noticing a difference in outcomes and prognoses from my male cohort versus my female cohort. Like men were like, this is like the best thing ever. Just dropping 20 pounds, like just blinking like it's gone. And so I started experimenting both with myself, like N of one, and then extending that experiment to the female patients that would let me. So we started playing around with their macronutrients and like some of the basics that we talked about, like circadian fasting and circadian, like getting movement in the morning, making sure you're being exposed to sunlight first thing in the morning, sleeping, making sure the lights are dark in the evening, all of those things. And that's part of the origin story of the book. That's why the methodology exists and I wanted to put it into a book for people to consume. All right. So that's interesting that your male patients were going, wow, this ketogenic guy is great. 20 pounds fell off in a day and a half and I'm joking about that. And your female patients are going, hey, wait a minute, that's not what I'm experiencing. And I hate my husband. He does this and it works. And I've certainly seen that as well in my practice that men seem to respond to this just as a general rule much better than most of my female patients and we can go into that. But hormone imbalances both in men and women seem to be rampant today. And any thoughts on why that is? I mean, any part of your wake-up call will motivate you to figure out, okay, why is everybody so screwed up right now in their hormones? It's an interesting question. I think for our males, our beautiful male population, what we're seeing is we're seeing more of this estrogenization of them. So we see this lowering year over year. The data is very clear that our testosterone levels in our men are falling a lot more irregularities in their sperm, more so than would be considered normal, not only in sperm count, but in the quality of the sperm. And then with women, of course, we're seeing kind of a whole gamut of things. We're seeing things like estrogen dominance in our women who are in their perimenopausal years. And even before that, I have seen a lot of women in their 30s, myself included. I would put myself before I really discovered this way of living, having just terrible periods, terrible menstrual cycles. And then we also see more of a testosteroneization of women as well. We're seeing this androgen dominance through categories like PCOS, which is polycystic ovary syndrome for your listeners who are not familiar with that, where a woman has a heart, she either has too much free testosterone circulating in her system, or she's having trouble moving the testosterone into estrogen, which is just the natural way of things. We make testosterone, and then testosterone gets converted into estrogen. And that's true for men and women. And I think there's a lot of different verticals that we can explore. I think that there is a huge amount of stress in this modern-day life. And stress can be, I talk about this in the book, you can really divide stress into like you stress and distress, like good stress and bad stress. And we're a very sedentary populace. So we sit and talk to our computers all day long. And you add in the pandemic where everyone's sheltering in place and sheltering at home, not getting a lot of that low-level general movement that I was talking about that I was experiencing a lot of in Italy. You get sort of this reversal of light. So we tend to, we're all told, put on your sunglasses when you go outside. Like make sure you get your sunglasses on. Protect yourself from this evil thing called the sun. So we all have our sunglasses on. We have this sort of toxic sunscreen, which is maybe another conversation. And then in the evening, we are exposing ourselves to this really bright blue light via the television or our phones or our devices. So there's almost this reversal in light exposure that I think is affecting a vast multitude of sins. But one of the most important ones is sleep. Like I think most of my women that I work with complain of some type of dysregulated sleep on a regular basis. So what that means is that they may be able to have like one, two, maybe three good nights in a week, but there are multiple bouts of insomnia or they have a hard time initiating sleep or maintaining sleep. So they'll say like my mind is, like I feel tired, but my mind is racing like this tired and wired presentation. So I think that there's, and then there's the whole conversation around, you know, endocrine disrupting chemicals that are being put in. You know, we are exposed to plastics and in our food and the soil is nutrient devoid now. And we have, you know, I think, I believe it was Dr. Mark Hyman who said we have, you know, 60 more harvest, something like that before the soil is, you know, completely dead and is just sand. So I think that there's a lot of different, a lot of different ways why we are stressed. And I know stress is such a sort of umbrella term where it's like, well, what does that even mean? But it can be physical stress, chemical stress, emotional stress that is really weighing in on our physiology and on our biology as well. Yeah, I agree with all those. And certainly I've written about almost every one of those subjects in my books. And so I agree with you. And one of the things that you notice when you are in Italy, and it's certainly true in many of the European countries that I visit, is this idea of walking, walking particularly after meals. And I mean, you see it in Barcelona on the Ramblas. You see it in Italy. People, you know, after a meal, they don't, you know, just go sit on the couch and watch TV there. And we do that. We walk to dinner. We actually choose a fairly far away place and walk there and then walk back, even though we'd rather not in a way. But it's very typical. And if you look at the blue zones that Dan Butler has described, and I spent most of my career in the only blue zone in North America, La Melinda, California, they're all in actually hilly cities. Every one of these blue zones is in hills. And one of the things they do, and certainly I've visited a number of these cities, is they walk. They walk up the hills. They walk down the hills. And just walking is so useful, particularly after meals or before meals. And in fact, there's a very famous study I wrote about in my first book long ago. They had people walk 10 minutes before they ate dinner versus walking 10 minutes after they ate dinner and literally compared weight loss. And it turns out the people who walked before dinner had no change in their weight. And the people who walked after dinner actually lost weight. And I postulated that it was almost like you had gone on a hunt and you hunted and you ate. And they said, okay, you captured the food you ate. We're going to store whatever you ate. But if you eat and then walk, your genes say, oh, what the heck, you know, we're at it again. We shouldn't store this stuff. We're going to use it up. And I think these cultures have figured out some of these secrets that when you think about it seem fairly obvious. And what you're saying is, I mean, it's 100% true and it's such a powerful. When we think about these blue areas, these blue zones, we're talking about powerful ways to modulate glucose regulation. That is one of the best ways. If you are someone who struggles, if you are on the spectrum, maybe you have metabolic syndrome or even if you have type 2 diabetes, one of the best things that you can do is go for a walk after your meal as you very well know and you just beautifully describe the study. Because what's happening is you have these big muscles, your leg muscles, your back muscles are keeping you erect. You have that contralateral arm and leg movement. And so the food that you've just eaten is being broken down into these constituents, which now can be thrown into the muscles, right? Into these legs and back and everything. And of course, we know that once glucose gets into the muscle, it can't get out again. So it stays there to be able to be used as a substrate for energy for the musculoskeletal system. I just love it. It's one of the things I think we get wrong in North America. We are very much movement specialists, right? We get the, not throwing, not blowing shade at Peloton or whatever, but we get on our Peloton bikes and we get on our, you know, we do this one class for an hour and it's this super high end to maybe it's CrossFit once they open up again or whatever. We do this very high intensity work for one hour or maybe an hour and a half. And then we sit for the rest of the day, right? Whereas these European cultures or these blue zones as you're describing have a lot of lower level general movement through the day, like the gardening and the tending to the tomatoes and the walking to the plaza and the walking to the butcher. We don't really get that. I mean, at least there are some pedestrian cities, I think in North America, you know, I would say that San Francisco might be one of them, New York might be another. But for the most part we're driving cities, right? We drive to the grocery store, we drive to pick up our kids, we drive, you know, we're driving all the time, which is another form of being sedentary. Yeah. Yeah, it is interesting. People who live in large cities, that is in Toronto, certainly a large city, tend to have as a general rule lower weights than people who live in the suburbs because, like New York, for example, when we're in New York, we will, whether we want to or not, walk five to 10 miles a day. We don't take subway, we don't take cabs, we just walk, man. And even if you do take subways, you end up walking usually a considerable distance to your office or whatever. So yeah, there's something cities should have been better designed for walking. Now the problem with Toronto is too cold. You know, I mean, come on, get over it, would you? You need to move. It does get cold in the winter. I'll give you that, yep. All right, so let me, I'm going to throw out a patient from this week and she's actually a physician and she's been seeing a hormone specialist. She's 46, and that's all I'll tell you about her. This is the first time I met her and she was seeing a hormone specialist because, let's just say, she lacked libido. And so I looked at her hormone panel and she has, her FSH, and for those people who are wondering, that's follicle stimulating hormone, and it's a good way of telling, is perimenopause approaching? Are you in menopause? But, so she's on hormone replacement and she's got an estrogen of 395. I remember this distinctly, because it was two days ago. She has a testosterone of 996 with a free testosterone of over 20. Wow. And I went, how long has this been going on? And she said, well, it's been about a year now. So I won't tell you any more about the conversation. What do you think about that for hormone replacement? For libido in a woman? So she's complaining of low libido. Yeah, this is how she got started on hormone replacement. And this is not a test? Yeah, no. I appreciate the, I love talking clinical cases. I think that when, and she's currently on, just so I'm clear, she's currently on hormone replacement therapy. She's on estrogen, progesterone, testosterone. Okay. So I think when it comes to a woman and HRT or even bioidenticals, before that is a conversation that is even breached with the patient, I think that there's value in making sure that there's some foundational basics that are in place. So one is going to be that she has proper, that she, irrespective of her genetics and the way that she's processing her estrogen, we want to make sure that we can amplify her liver detoxification, which is one of the main stays in terms of how estrogen is metabolized. And there's a couple of different, without getting into the weeds of like, you know, two hydroxy estrogen and four hydro, we want to be promoting, there's three main metabolites of estrogen metabolism. We want to be promoting the antagonist, which is the two OH pathway, which is the metabolite that does not retain the ability to continue to activate the estrogen receptor. The other thing you want to think about is lean body mass, right? How much muscle does this woman have? 46. So she's sort of right in this, like smack in the middle of perimenopause. And even though she's still cycling, we want to make sure that we can increase her lean muscle mass such that she is going to, A, you know, kind of back to what we were saying with those blue zones, be a sufficient and, or efficient glucose disposal agent via more muscle mass. So we want to be thinking about resistance training. There's going to be maybe some cardiovascular component in there, but the mainstay there is like lifting weights. And I think that we also want to get things like stress and sleep under control and light viewing behavior. I mean, we can talk about the brain, you know, what happens in the brain when you get like early morning light in terms of the retinal ganglionics. We won't go down that like nerd pathway, but I think that some of these foundations have to be in place before we consider hormonal replacement therapy because what can happen, like it seems is happening in this patient we're getting a lot of testosterone that is not necessarily being aromatized into estrogen and her estrogen at 395 that's, you know, that's high, you know, we want to be thinking about, and I'm assuming this is like picograms per milliliter, that's, you know, it's, you know, an estrogen in a woman, same with testosterone is going to be cycle dependent, but now we have this accumulation of excess hormones in this woman's body and her body, it doesn't sound like nose or efficiently knows what to do with it. So I'm a big fan of HR, like I'm a big, I think that the woman's health initiative got it completely asked backwards. I'm a big fan of it if it can help augment a woman's perimenopausal and menopausal symptoms. But I think before we bridge that subject with her, we want to be thinking about how we can directionally already optimize some of these pathways, these hormonal pathways that I was just describing, like the estrogen metabolism, how can we get her going down that protective pathway? How can we be increasing her lean muscle mass so that we can improve her glucose disposal agent and also maintain natural levels of testosterone? You know, if she's a poor aromatizer, which it sounds like, you know, maybe with the T at 996 and the estrogen at 395, maybe we have a problem with aromatization, right? Like maybe we want to be thinking about how we can, there's ways that we can help amplify that through the diet, taking in lots of green leafy vegetables that have compounds like indoles and diandylmethane and then the sulforaphanes, which are going to help with that conjugation piece in estrogen metabolism. So, yeah, I mean, I don't know her. There's a lot of context that I would like to have in terms of her lifestyle, but that would be my initial thoughts on that woman. Well, I like what you said and maybe I think that's the point we ought to emphasize. I think, and I agree with the same premise, before we go down the hormone replacement pathway, we need to find out, you know, exactly how that person is number one producing the hormones they're producing and number two, how they're metabolizing them. And I agree with you that so many times, particularly in my male patients and my PCOS patients, I see a lot of men with low T and they're usually highly estrogen dominant. And they're carbohydrate eaters to beat the band. They're insulin resistant. They may not have been diagnosed as pre-diabetic because unfortunately in the United States, almost nobody measures a fasting insulin. And so anyhow, those guys, I can always get their testosterone and their free testosterone normalized just by changing their food, doing resistance training. Same way with my females who have PCOS, a ketogenic diet and strength training just does miraculous jobs for this in general. So I love what you're saying. Let's work with the person first and then if we need to, then we can titrate in, you know, what we can't accomplish with food and lifestyle. Is that paraphrasing you correctly? That would be spot on, absolutely. I think that these foundational basics of nutrition and resistance training, appropriate rest and recovery, these are all things that we need to be considering. Before we, I would say that any type of exogenous medication, whether it's a hormone or it's a steroid, whatever it is, these are all unnatural to the body and we want to be able to optimize the way that we process, the way that we naturally process, have our own pathways processing and then when we take these exogenous substances, we want to be able to optimize again the processing of the desired effect of those medications. All right, I want to backtrack for a second because I think this is going to be very interesting to take into account that it's going to be very interesting to my listeners. I know most of my female patients don't feel like this, but I think it's interesting that you mentioned in your book that a woman's menstrual period when understood properly is a superpower. You also talk about that menopause can be turned into a superpower. I think that's fascinating and give our listeners the pitch on why menstruation and menopause could be superpowers that you should embrace. Yeah, thank you for bringing this point up. I think that I've been talking a little bit about with our conversation how I used to really hate my own cycle. I thought it was really punitive and I just thought it was this big thing every month and it was only after Italy and then coming back to Toronto, working with my patients where I actually started to really look forward to, it was almost like a report card. I was like, what is my hormonal report card going to be like this month? And I think that when you understand the ebbs and flows of your ever-changing hormonal milieu, because as women in our reproductive years, this includes my perimenopausal ladies, we have a different hormonal composition every single day of the month. So that is going to have profound effects on what we should be eating, how we should be moving, what our mood is going to look like, our energy levels are going to look like, our receptivity, our libido, so our receptivity to sex and whether or not we are interested in it at all and all of these things are really important to consider for a woman's health. There's also I go into a lot of detail in the book around estrogen receptor. There's basically estrogen receptors almost everywhere. There's areas in the brain that are very sensitive, particularly these areas around verbal acuity and being able to pull and be able to floss your vernacular if you will. So there's certain times of the month where you are much more, you are much better suited to be on a podcast like this or give a presentation or ask for a raise. There's different times of the month where we have that slight edge because of that hormonal composition that we are currently experiencing. So I think once you get to understand your ebbs and flows, like when you are more introverted and it's time to sink into your body, when you're more extroverted and it's time to network and chat and ask for that raise, once you understand that, this is what I'm talking about in terms of a superpower. I try to schedule most of my talking when I need to be giving a presentation or speaking as I am with you now. I try to schedule it around week two of my cycle and into week three because I know that we have estrogen bathing my brain in these articulation centers. I know that I'm a little bit more extroverted. I tend to kind of skew introverted normally, but week two I'm super happy. I love everybody. People are good. These little nuances in understanding where you are emotionally and physiologically I think can have profound effects on your enjoyment in your life. And the same is true also in menopause. First I just want to say, I think that we tend to forget about menopausal women. We've been talking about menstrual cycles and I'm happy to go into as much detail as you'd like. Menopausal women are often forgotten about. We see this in Hollywood. We're devoid of sexuality. As soon as we turn 50, we all wear cardigan sweaters and whatever. I have no beef with cardigan sweaters. There's just no zest for life. You and I, it sounds like you have a love for European culture as I do. The Greeks say there's a certain like zoe, like a certain sex for life that I think is portrayed as lost once we move into menopause. And I completely reject that. I think that all of the energy that we put in every month as women in our menstrual years towards the development of this endometrial lining, you can now take that energy because it's no longer happening in your reproductive cycle. And you can use that to call into your life the things that are most important to you. And it's really important to you. You know, when you're 55 or your menopausal woman, whatever age that happens for you that you've been spending likely decades taking care of other people, your children, your career, your husband or your partner. And so this is a time of almost reclamation where you can say, okay, I'm going to do what's really good for my soul. I'm going to make sure that I do what's good for me. And so you can take this reproductive cycle and then move that into energy that you want to create. And even though you don't have ovaries, you don't have a womb that can be reproductive, you can still be very productive. You can use that. In the book, I talk about your womb space being this all chemical prowess. You can use your womb space to create and call in the things that you love. So that's me kind of getting into my feminine a little bit, but I really feel strongly about that. Speaking of getting into feminine, I know you've seen and I've certainly seen in my practice that there are a certain percentage of women and we can maybe argue what their percentage is that their brain is so dependent on a little touch of estrogen that when their estrogen finally gives up the boat and most women will stop making estrogen unless they're making it out of their fat stores and we could get into that. But I find that a small amount of topical estradiol, tiny amounts, just enough to even measure in picagrams, all of a sudden they'll come back six weeks later and go that was it. I mean, that's it. My brain works again. What the heck? Do you see that in your practice? I do. I think and this is kind of what we were talking about before. I'm a big I love bioidenticals. I think that they can be an incredibly powerful augment to a woman and estrogen is as I was saying, we have estrogen receptors on our lungs. We have estrogen receptors everywhere. And I talk about this in the book as well even our libido, right? A lot of women in their late 40s and early and beyond we have this perception that their sexuality and their sensuality like that life is over. But part of that is because of a change in the hormonal composition. We have lowering T, we have lowering E. These are lowering estrogen or estradiol as you were saying. And these are really important for maintenance of the vaginal wall, for lubrication, for orgasm. So a lot of women will say, gosh, my libido is just not what it, my interest in sex, my receptivity to sex is really different. And even penetrative sex is very painful. And this is where I think the topical cream is great. You can also do vaginal cream as well to help specifically with that. But I'm a big fan of bioidenticals, especially from, you know, you can, and a lot of times you can get them. I mean, I don't recommend you do this, but you can get them from online retailers. I always recommend that you try to work with a functional medicine provider and to help them like titrate the levels for you. But this is something that I think should be available to every woman if she needs it. All right, let's switch gears again. You mentioned that you were really eating different in Italy and that lifestyle there seemed to play a big part in your transition. So you created your own diet. And can you summarize it for us? Absolutely, yeah. So there's two main, it's called the esthema diet and there's two main phases of it. There's a phase one, which is a therapeutic intervention of a ketogenic diet. And I would say that the way that I formulate my ketogenic diet is much more female focused. I mean, men can do it as well. But I've made sure that we have an abundance of some of the brassica genus. We have lots of green leafy vegetables in there. It's not bacon, butter, burgers and repeat. It's not tubs and tubs of sour cream. But there's a therapeutic intervention of ketosis that can be modified based on the person. I've had my ladies with hashimotos. I've had multiple sclerosis like patients with MS. We've extended this phase. So usually in the book I talk about it being a 28 day cycle. So one cycle. And then moving on to phase two. But some populations like my autoimmune women I tend to keep them in phase one a little bit longer. So that's phase one. It's a 70-20-10. So it's 70% fat 20% protein and 10% carbohydrates. With the carbohydrates being from mainly green leafy vegetables. Proteins I love meat. You certainly can give vegetarian options in there as well. But I love meat for a variety of reasons for women. Iron and full spectrum of B vitamins. You don't have to think about protein combining and all of that. However, you can also do it as a vegetarian. So that's phase one. Phase two and phase three. So this is where we start to pair we start to change the macronutrients if you are in your reproductive years and we do that in accordance with your menstrual cycle. So there are times in the month where you are much more resilient to carbohydrate restrict. So in the book I talk about your bleed week or week one of your cycle is a great time to play with the ketogenic diet. I also talk about fasting protocols in the week as well. In week two of your cycle we see a different hormonal composition in the woman so we see testosterone rising, estrogen rising these are anabolic hormones. So I like to help promote that by increasing the protein in the carbohydrates that week. So we will change from a 70, 20, 10 to a 40, 40, 20 or 50, 40, 10 depending on the person but for ease we'll call it 40% fat 40% protein 20% carbohydrates and the reason for that is I'm trying to activate these growth pathways. So mammalian target of rapamycin is the main one that I'm after with that more protein and carbohydrate intake which is involved in you know when you're having more protein you're going to initiate something called muscle protein synthesis which is kind of what it sounds like it's making new muscle proteins very important for my ladies I'm talking about resistance training as a proxy for helping with keeping testosterone levels at a healthy level at least directionally you can also support that you can also supplement when you're having more protein in the kitchen you can make testosterone and muscles in the kitchen by increasing your protein intake but I also don't want that the reason why we go in and out is I almost want to hold and tour that growth pathway I want to kind of bring it down like weeks like a spring and then I want to let it loose for a week in week 2 and then in week 4 I talk about returning to that higher protein, higher carb in week 4 so we sort of are cycling in and out of growth but it's a strategic type of growth because I like to pair the nutrition with a certain amount of activity like certain types of activities like resistance training and how you do that so yeah so we do keto in week 1 and 3 and then protein, high protein, high carb in week 2 and well I'd say 20% carbs is we'll call that moderate you know moderate carb, higher protein in week 2 and 4 and you say you're not going to eat a quart of sour cream and wash it down with a stick of butter but so where is your 70% fat coming from? it's really I am a big fan of mono unsaturated fatty acids and polyunsaturated fatty acids so moofas and pufas as they're abbreviated and then saturated, you'll get saturated fat from the you know if you're a meat eater you're going to not only be consuming protein and all the vitamins and stuff but you get fat from that as well so avocados olive oil it's a Mediterranean-esque type of fat where we're getting most of our fat from and I talk about in the book some people don't do well a typical traditional ketogenic diet is very high in the saturated fat realm and I don't have a problem with saturated fat there are some people who have a really hard time metabolizing SF so what we do is I tend to err on the side of caution and I give you more of these moofas and pufas so more olive oil and more avocados and avocado oils and things like that but you will get some saturated fat from the animal protein if you're a meat eater you'll also get it from coconut oil if you're consuming coconut oil as well but we try to minimize the saturated fat you mentioned fasting now there's there's a lot of online fear mongering about fasting in women so what say you doctor I'm a fan of fasting for women I just think that it needs to be done intelligently there's been a lot of there's been a lot of bizarre conclusions made about fasting that somehow it's an eating disorder or you know somehow you know not eating and I actually would argue the opposite is true I think that eating when you're when you're not hungry is the eating disorder you know we're just at that point you're just soothing right you're just soothing yourself we're trying to placate yourself I think that fasting strategically for a woman can absolutely help with her growth hormone with her testosterone levels with her sleep with if she's interested in weight loss or you know body recomposition body recomping I think it can be a very useful tool and again you know as you are a woman in your perimenopausal and well actually we haven't really spoken about this but a woman in as we age we naturally become more insulin resistant right so we want to really be thinking about ways that we can increase our insulin sensitivity and one of the ways that you can do that is through carbohydrate restriction through keto but you can also do that by restricting all macros you know you can just fast so I think that that's a really powerful way that we can sensitize ourselves to insulin and then of course if you are cycling you know if you are someone who is following that phase 2 of my program when you do consume more carbohydrates your body is going to be able to make use of that rather than your pancreas having to throw out a boatload of insulin like your cells and be like oh I haven't seen you in a week yes I would love to have some you know I would love to have more vegetables yes and let me bring that into the cell so I think that we want to be thinking about fasting as a tool as we age as something that is appropriate to help with insulin sensitization and you know in the book I outline I tend to look at fasting like three you can sort of manipulate fasting variables in three different ways you can change the type of fast you can change the length of your fast and the frequency of your fast so this is not to say that you should only just be doing a 24 hour fast all the time I think that women like we want to always be sensitive because in the culture that we live in at least I can speak to my experience as being a woman it's very much like you must always look 25 no matter what you know like you always have to look in a certain way you have to be a certain size so I think that we want to be we want to be sensitive to women who are using fasting potentially in a and one of the contraindications that I outline in the book is you know a history of eating disorders is using fasting as a tool but fasting can be really really powerful for helping help reset the gut you know we know that the endothelial lining of the cells in the gut they can over every three to four days you can completely help with the we'll call it GI distress you know that can happen as we age right the distinction the bloating you know maybe belching or what have you so fasting can really help with that and I outline you know water fasts I also talk about bone broth fasting as a way to help with the lumen of the gut as well because there's a lot of really powerful components in a bone broth in bone broth in general that can really help with you know closing up the hyperpermeability of the gut these payers patches that sort of these junctions that open up if you if you have any of those you know GI symptoms that I talked about and again you compare it with your cycle so there's going to be weeks that you are much more resilient and do you can do much more aggressive fast like just a water only fast or a longer fast or more frequently like more frequently fasting in that first week and then there's times like in your luteal phase of your cycle the last two weeks of your cycle where fasting aggressively is just going to be a miserable experience so you know and we're actually not designed especially in that fourth week I talk about this in the book that I really want gentle intermittent fasting that week so it can be a daily time restricted eating protocol where maybe you're doing a 1212 or a 1014 or maybe even a 168 but really just being a little gentler with yourself your body is actually throwing in a lot of substrate into the endometrial lining it's throwing in glucose amino acids free fatty acids glutathione vitamin D selenium zinc all the things are going into your endometrial lining so we were also hungrier so honor that don't try to white knuckle it and just eat the same calories that you were last week like give yourself a little bit like have a little bit more celery have a little bit more kale have a little bit more foods that are going to are more protein or more fat foods that are going to make you feel nourished and full without any I like to say like cutting the energetic chords without any guilt or shame around it you mentioned that maybe eating continuously is an eating disorder and certainly for the last year and a half with COVID-19 I've seen a number of patients that have put on what I call the COVID-19 right I'm sure you've seen that as well because there I think there is a lot of stress eating for obvious reasons where does stress fall in and managing stress fall into your program I think that that was chapter two in the book it was right after my intro it's that important to me I think that we often dismiss stress like it has to someone stressed if they're screaming at the top of their lungs and they're red in the face and stress doesn't look like that if you have chronic low grade stress or like we think about in the pandemic with people being at home and isolated from each other it's a very scary world rules are changing every single day that can be an incredibly laborious amount of stress on the body we try and process so that's the absolute first thing that we talk about in the book is really trying to get your stress levels right and there's a lot of different ways that you can do that I mention meditation who I was introduced to this through Emily Fletcher who I know we better on our podcast yeah she's wonderful her programs Eva has been a game changer for me I meditate every day because of Emily I've noticed I'm a different person I just get that extra space when I want to react and versus when I do react like that meditation just allows for that frontal lobe flex hold on don't yell at your kid just wait just calm just a minute I homeschooled my kids last year I didn't want them going to school with masks and I have certain feelings about that and I said well I'm just going to hire a tutor and I'm going to do it myself so I had that and I had I was very stressed as well so meditation saved me last year so yeah there's a lot of different strategies that we talk about I talk about the 2x breath that Emily taught us which is more of a vagus nerve activation where you inhale or you exhale rather twice as long as you inhale and there's a lot of other ways that you can mitigate stress in our society we are very scared of our feelings we run away from them we dive into our work we dive into other things in order to avoid the way that we're feeling so I go through in some of the chapters evening and morning routines that you can do to help buffer your stress response and to help bring down your cortisol levels in the evening when that's important and when you need to when you need cortisol up is you need it so I talk about different strategies around you know gratitude practices and journaling and I one of the things I talk about which has been a game changer for me I've done this over the past several years is just making the inside of my home look like nature so you know I live in Toronto as I mentioned we get all four seasons here in winter it's dark you know it's like it's dark at like five o'clock and that means that all the lights in my house are off at five o'clock we have dinner by candlelight you know so things like that that really helped to you know get back to that circadian rhythm of light and its impact on the brain and reducing you know that physiological stress response so yeah I could talk a lot about stress I think that it's super important and it has everything to do with your hormones it'll affect your menstrual cycle it'll affect your sleep it'll affect your reactivity it'll affect your partner if you have a you know a romantic partner relationship as a parent your you know with your parents and your children if you have them so really becoming awake to your triggers and how you become activated I think is really really really profoundly important so I want I want to kind of finish up with another pet peeve of mine and that is women I have two daughters and I have a wife so I guess I've been trained properly but women get short when they have complaints or when they have issues that they want their healthcare provider to look into and quite frankly I see that every day a lot of times healthcare providers toss this off as depression or you're a mother with two kids and you're you know 40 years old what do you expect and they don't want to do the blood work they don't want to listen how how do you how do we get the word out to empower our female listeners that this is not the way it should be yeah I mean I think data is always key so one of the best things that you can begin to do is to track your own if you are still in your reproductive years tracking your cycle so that when you do go to these appointments with your you know medical doctor or your primary whoever it is you can say look look at this data like you know for the last eight months I've had a length of cycle like this and now it's changing and now I have you know so you can go in with some concrete data I'll borrow from Dr. Aviva Ram who was on my podcast she's a midwife and a medical doctor and she was talking a lot about this dismissal in for women's medicine in general this is like a historical problem we've just sort of always been looked at even the word hysterical you know when you say oh she's hysterical even that word I'm a bit of a word nerd if you look at the root of hysterectomy hysterical we're talking about the uterus the womb exactly so one of the things Dr. Ram advised which I thought was profound is if you have a you never want to go into a medical you know you never want to go into whoever your PCP is you never want to go into your appointment and be like listen Dr. Gundry said that I should be doing this and if you don't like you never want to go in with this sort of combative you know because all that's going to do is going to put that practitioner like they're human that's just going to put them on the defense right so you want to you want to go in and say hey you know what I was just thinking like just as a total complete package maybe we could explore what my hormones might look like and this is why you know maybe bring a deeper or two another thing that would be really useful is maybe bringing in an advocate with you so a female advocate is preferred sometimes you know maybe bring your partner if your partner's male and if the doctor's male there can be this kind of like weird like male bonding thing that can happen and then it can you know the woman is just essentially getting bullied so I would say bring in a female advocate if that's possible for you and the other piece again boring from Dr. Rahm is don't get undressed until it's time for the exam you know sometimes when you're waiting in the room they'll say the nurse or someone will come in and say here's the gown right saying something like thank you so much for the gown I'm just going to wait until I have a conversation with the doctor before I get into the gown because if the doctor comes in you're like your rear is exposed you know you're already in this gown there's already this power differential much less likely to say hey this is what I came in for and the last piece I'll say is just bring something to write on bring your questions that you already had pre-prepared so that you don't forget like your doctor and we have to love our doctors they're seeing hundreds of patients a day they only have 10, 15 minutes with you another thing that I've often told my females when I'm trying to work with their medical doctor is call an ambulance in advance and say hey I would like a longer appointment with the doctor because I have a couple of extra things that I would like to be able to discuss with her or him and that's going to help so that the doctor is not like looking at their watch saying oh my god I have 20 other people and I'm an hour behind right so if you give the office a bit of a runway and say hey can we book a longer appointment is there other times in the week that they take longer appointments at their clinic and you're not coming in all guns of blazing my grandmother used to say a bull in a china shop you want to come in delicately respect the person in front of you they are human after all and try to get what you want with love it's like the old saying you get more with honey you attract more bees with honey than you do with vinegar alright so where can people find out more about you you can probably get your book wherever you can find books yeah so any online retailer you can find the book is called The Betty Body a geeky goddess's guide to intuitive eating balance hormones and transformative sex so amazon and wal-mart and barnes and noble all the places you can find I have a podcast that I'm really excited to be hosting you on very soon you're going to be coming on the better with Dr. Stephanie's show so we have you know a weekly podcast you can check me in my work out and you can find me on the gram you can find me on instagram I'm fairly active on instagram as well so that's at Dr. Stephanie Esteema great ok I warned you that we have an audience question and I'm going to let you have first dibs on this one because it's right up your alley and mine on instagram at southard I think I got there right ask if you want to lose weight but like ice cream which is more effective non-dairy sugar free with 240 calories or regular ice cream with 120 calories ok here's our female expert on weight loss and ice cream alright so share I think share so I would I have a couple of questions that are not answered but assuming that the portion size is the same maybe she's not having this every single night as a tool for numbing but maybe this is like a treat on the weekend and she's going for that walk after maybe she's going for a walk after her ice cream I'm much more I like fat in my food whenever I have like a fat free yogurt like I mean my face is in the fridge 20 minutes later so I would definitely go for the ice cream that has the higher fat content preferably higher fat with lower sugar so just from her description it sounds like the 240 calorie one non-dairy sugar free with 240 calories would probably be the one that I would choose I'd have it last in your you know if you're having you know your dinner I'd have that last it's pure sugar right so go for a walk afterwards and then I would just watch portion size as well I think that when we're trying to eat healthy it's not that you need to hit the mark 100% of the time I'm really a bit more flexible and there's a little bit more ease like as long as you're doing well 80% of the time of course you can enjoy a glass of wine here and there you know a bowl of ice cream as she's describing but there's some ways that you can help to reduce the impact that it's going to have on your physiology the walking would be one of them of course you can always you know you can always jump into a resistance workout if you can afterwards or the next day or you can you know you can have a fast the next day as well like we often you know we feast right so the ice cream would be like a feast it's like really easy you know calories coming in and you can always just jump into a fast the next day as well so so that would be my answer I think that calories do matter we do want to make sure that seems like the regular ice cream with 120 calories is about half of that so again you want to make sure that the portion control there is like the portions are equivalent so calories do matter but I think it's okay to have a bit of a refeed every now and then as well if you're doing all the other things we've been talking about for the past hour well I'm going to answer that question by taking you back to Italy where you where we started this and you and I so in Italy and France in Spain the gelato's or the gelets are in very very very tiny cups and they are concentrated flavor they are luscious fat laden things and particularly in Italy and France they're made with a two milk rather than one milk which is another favorite subject so I think we can learn and they actually are walking most of the time while they're eating their gelato and interestingly enough a number of my patients who think they're lactose intolerant come back from Italy and say guess what there's no lactose in Italian gelato and I said well yes there is but I can eat it and I feel fine because it's a different breed of cow but yes we should learn that these things in concentrated pleasure is kind of what we're wanting not the I'm going to take home a quart and finish it off and it only has 100 calories we're not going to get the pleasure out of that we really aren't and it's these little things that we can take away and take a walk with that are far better off for you so so we just came around back to Italy alright so take me there that little piece of dolce that little dolce in the evening so lovely as long as we walk as long as we walk well it's great having you on the podcast and hope to see you on your podcast soon and see you soon thank you it's just been a pleasure you have so much energy it's just been a joy talking to you today so thank you thank you so much for having me pleasure and good luck with the book and we'll see you soon bye alright it's time for our review of the week from iTunes Reverend Mr. Lane has a review and question combo he says I really appreciate tuning into your broadcast every week I have adjusted my eating schedule to closer to a six hour window and I'm very happy with that so far I'm also reading the energy paradox and I'm very excited about that I have a question for you sous vide cooking what do you think about it is there a way to reduce or eliminate certain lectins using a sous vide I'm curious as to whether there has been much research into this yet I'll keep tuning in and I hope you get to my question well Reverend Mr. Lane we got to your question and thank you very much for your review as many of you know I'm friends with a number of James Beard award winning chefs and Michelin starred chefs and I like to hang out with them and learn their techniques and certainly a number of them really enjoy and benefit from the meat tenderizing aspects of sous vide and for those of you who don't know you basically seal whatever you're going to cook whether it's a cut of beef or a duck breast in essentially a sealed plastic bag and you put it in a very low temperature controlled boiling water for lack of a better word and you cook it for a very extended period of time at very low temperatures and then you finish it by quick cooking and what it does is it makes your mouth tenderize thing that you can imagine now I'm glad you asked this question because as a general rule long slow cooking does not have the temperature or the pressure to destroy lectins I have quite frankly never seen a paper talking about the effect of sous vide on breaking down lectins but long prolonged cooking like the equivalent is braising in a way certainly breaks proteins down so I doubt if it will work but I wouldn't count against it and after your question I'll tell you what I'm going to look like I said I'm not aware of a paper but I'm going to look again and thank you for tuning in and as you know please please please put your questions and your reviews on iTunes and maybe like the good Reverend Mr. Lane I'll be talking to you soon and I appreciate your questions because I'm Dr. Gundry and I'm always looking out for you Before you go I just wanted to remind you that you can find the show on iTunes Google Play, Stitcher or wherever you get your podcasts because I'm Dr. Gundry and I'm always looking out for you