Debatable Open 2022 - Round 3: Health (With Raffy Perez)

I want to invite you to something that I am crazy excited about. This October 3rd and 4th, I'll be joining an incredible group of speakers at Empower Your Life, a live event at the Alex Theatre in Glendale, California. We'll spend two days exploring health, personal growth, mindset, and practical tools to help you create meaningful change in your life. I'll be there alongside speakers like Susie Orman, Jim Quick, Jamie Kernleema, Brendan Bouchard, Nancy Levin, and many more. It's going to be an amazing weekend filled with learning, connection, and inspiration. I'd love to see you there. I'd also love to give you a big hug and you can grab your VIP or general admission ticket by visiting hayhouse.com/dokrimindy. Hey, Dr. Mindy here and welcome to the Live Like a Girl podcast where I bring you icons, his ruptures, educators, scientists, and doctors that show you what can be possible when you love and celebrate the female body you are blessed to live in. Let's dive in. When I launched Fast Like a Girl into the World, I braced myself for a lot of things. What I did not brace myself for was my inbox filling up with hundreds of thousands of messages from women in their 20s and 30s, all asking me some version of the same terrifying question. I don't have a period. What do I do? I remember sitting with that genuinely shocked, not because periods stopping as rare, because it had become so normal that these women didn't even know it was a red flag. They thought it was just what their body did now. Others what most of them didn't know, 15% of women in America live with a condition that hijacks their cycle, their skin, their hair, their mood, and their metabolism all at once. And in some Middle Eastern countries, that number climbs closer to 20%. And of all the women who have it, somewhere between 70 to 80% are never diagnosed at all. They spend years being told their labs are fine, their ultrasound looks normal, they just need to eat less and move more. Sound familiar? Meanwhile some of them end up in eating disorder clinics instead of an endocrinologist's office because nobody connected the dots. You know this condition by an old name, PCOS, polycystic ovary syndrome. The name that sent women running to Google, finding no cysts on their ovaries and walking away convinced they'd been misdiagnosed. This year, that name changed. It is now referred to as PMOS, polyendocrin metabolic ovarian syndrome. Finally, acknowledging that there is a metabolic piece to this hormonal condition. And I think it might be one of the most important shifts in women's health this year because a name isn't just a label. It's whether a woman gets taken seriously in an exam room. This is why I have brought you Dr. Tais Aliyabadi and Mary Alice Haney, founders of the podcast She MD. Dr. Tais Aliyabadi, known to her patients and millions online as Dr. A, is a Los Angeles OB-GYN with 30 years in women's health and one of the loudest voices behind the name change. Mary Alice Haney is an entrepreneur who spent years building brands rooted in femininity before turning her focus to women's health. Together they built OV, a platform giving women a free way to check their own risk. And they co-host the She MD podcast, built entirely around the idea that women deserve real answers about their bodies, not dismissal. In this conversation, we go deep into what's really happening at the cellular level when a woman can't lose weight, no matter what she does. We talk about why insulin resistance can hide inside a thin body just as easily as a heavier one. And we dive deep into how something as ordinary as the plastic your water sits in might be quietly disrupting your hormones. We also get into something bigger than any diagnosis. Both of these women told me without hesitation that if women ran this world, it would look completely different, safer, kinder, healthier. And I happen to agree 100% with them. So without further ado, PMOS, Dr. A. Mary Alice, take it away. Dr. A. Mary Alice, I am so excited to be back with you. So thank you for joining me again in a conversation about women's health that in my opinion ties very deeply to metabolic health. So thank you for being here. Oh my God. Thank you for having us. Yeah. So excited. You know, I'm definitely not an expert in metabolic health, but I'm very experienced, but I would consider myself extremely experienced in PMOS. And I would love to, you know, talk about it on your podcast because it's a condition that affects 15% of women in this country. And if you go to Middle Eastern country, that percentage goes all the way up to about 20, 23%. So it's a significant number of women around the world that are affected by this condition. Majority of these women are dismissed in the current healthcare system. They go through life never getting diagnosed. And I would say 75 to 80% of these women probably more are never diagnosed. And when they're diagnosed, they're not being treated correctly. But let's start, but just to fill everybody in, I think the biggest news of the year is that we change the name of PCOS. And what, you know, what do you feel about that? Why did we change it? It's a really important part of the conversation. I think it was the most important thing that could have happened because for years, I mean, I've been in women's health for 30 years. And for 30 years, you know, I had to fight to explain to physicians, to healthcare providers, to patients that polycystic ovary syndrome is not cysts in your ovaries. And commonly patients would say, you know, I went to my doctor and I didn't have any cysts on my ovaries. So I don't have PCOS. And it was an uphill battle. So by changing the name to polyendocrine metabolic ovarian syndrome, it basically explains the condition. So there's absolutely no confusion. This is a condition that affects hormones. It's directly related to our metabolic health. It affects the ovaries. It affects ovulation. It's a combination of these symptoms that makes this, you know, PMS diagnosis for patients. Because these patients present with different symptoms, it's always been very confusing to diagnose these patients. So I would love to take a minute to explain it to your audience. Yeah, explain the symptoms because there's a lot of confusion in the comments on my YouTube. I really see that exactly what you're talking about. So when we talk about PMS, like I said, it affects on average 15% of women. And when in order to diagnose it, women need to meet two out of the three criteria. The first one is ovulatory dysfunction or an ovulation, which means women who basically have irregular cycles, meaning they have their cycles are more than 35 days or they get eight cycles or less per year. And their cycles are very unpredictable. If you ask them, they never know when they're getting their periods. Number two is elevated. These are women with elevated testosterone symptoms. What are those symptoms? The most common, we call it hair satism, which means facial hair, body hair. These are women who usually laser their hair. They do electrolysis. It doesn't go away. It all comes back. They have acne. I always say if you're 25 and older and you're still struggling with acne, make sure you're not missing PMOS. So that's an important one. They have a hair thinning, which is mostly male pattern up front. So commonly these are the most common symptoms. They can have hyperpigmentation under their armpits or in their groin. Less common. But mostly is the facial hair and body hair and the acne and the hair thinning that they deal with. So that's the second criteria. And the third one is when the polycystic ovary comes in. And polycystic. the old name does not mean cyst on the ovary. These are frozen follicles inside the ovary and we can go into it why this happens. But these patients usually have more than 20 follicles per ovary. And if you look at the ovary it's a specific finding on ultrasound. We call it a string of pearl. They're these follicles in the periphery of the ovary and it's a classic presentation. You can't miss it when you do an ultrasound. Unfortunately you can have these patients get an ultrasound and I don't know a majority of the time the doctors will say oh you have so many eggs. You're fine and they miss diagnosing it correctly. So recently they added another another option for this third criteria which is elevated AMH. Antimilarion hormone is a hormone that gets released by the follicles and if you have a very high AMH that could meet this third criteria without needing an ultrasound. So patients need to meet two out of these three criteria. Irregular periods elevated testosterone symptoms and you don't have to have a high testosterone in the blood. It's the symptoms of high testosterone and the third one is PCOS ovaries on ultrasound or elevated AMH. It's important to understand that when it comes to teenagers we cannot use the AMH value in the third criteria because young women have a lot of eggs and that can be confusing. So I'm always hesitant to diagnose a teenager or label a teenager with PMOS but I watch them very carefully. They need to meet the other criteria which is irregular period and elevated testosterone symptoms. Okay so let's go to the ovulation symptom because one of the things that shocked me when I put fast like a girl out into the world because the whole premise of that book was to learn to fast according to your menstrual cycle is the hundreds of thousands of women that message young women 20 and 30 year olds that said I don't have a period what do I do. I was absolutely shocked now of course it could be you know they were on birth control some of them were incredibly thin but how would you know if your ovulatory dysfunction was because of something else or was because that's a very good question. So when it went in the first criteria when I said irregular periods first of all you have to make sure that you don't you're not dealing with any thyroid dysfunction that the patient's prolactin is normal yeah that you're not missing any other conditions like a adrenal p a p a p a p c o s which we call it you know it's a d a s levels that go up in the blood. So you want to get a basic hormone panel to make sure these patients don't have other reasons you have to make sure they don't have an eating disorder they're not anorexic they're not on birth control right so you have to rule all of that out when it comes to p a m o s 70 to 80 percent of p a m o s patients do not ovulate or have irregular ovulation of the ones 20 30 percent who report regular cycles even those patients are ovulating sometimes and 40 percent of the women who report having regular periods even when they ovulate the environment is not ready for implantation and that's why I think Marialis wanted me to talk about is besides the three criteria generally speaking p a m o s is the leading cause of infertility on the planet and we can talk why that happens 75 percent of these women gain weight and they have a very hard time losing it many of them have mood disorder they struggle with anxiety depression there's a high percentage of these women who end up having eating disorders or disordered eating they end up in eating disorder centers as a teenager but instead of someone diagnosing them with p a m o s they end up in a psychiatric office getting psychiatric care and no one you know diagnosis them correctly and you know without treating the underlying condition these patients are never treated and they stay in that you know system unfortunately so when we talk about p a m o s to generalize it these are patients who struggle majority of them struggle with weight they have anxiety and depression they have mood disorder they have acne hair loss facial hair body hair they have a hard time losing weight and they have irregular period but there's so many different varieties of these symptoms one and you know only 75 percent of these patients gain weight 25 percent of them are lean so imagine you combine all these different scenarios you have one who's lean and has acne and has irregular period you have another one who has facial hair body hair has an eating disorder and is gaining weight and can't lose it and there's just so many combinations of these symptoms that's why it's so complicated for doctors to diagnose and that's why the simple criteria if you follow what I told you of how to diagnose it there's not going to be any confusion if you need to out of the three criteria you have p a m o s you do not need to have a high testosterone in your blood you do not need to have an ultrasound if you have a high levels of amh in your blood and you're not a teenager follow the guidelines that I just mentioned right right and if you think you have p a m o s then I want to go into what these pillars of p a m o s are and how we treat okay so let me let me go one step before that in preparation for this interview I actually went into my youtube comments and what I found there was that a lot of the women who have been diagnosed with p c o s are as you know what we call a lean phenotype and they don't present as struggling to lose weight and they actually as a core group of people are very confused especially in the renaming of this because they don't present as somebody who has metabolic syndrome so what I'd love to talk about is just insulin resistance how it shows up in people the variety the all the different ways it shows up be and what we can start to do to help these women who might have a high hemoglobin a1c they maybe have some insulin resistance but when they look in the mirror that's not what's going on that's such a good question and I'm so glad you brought it up so as I mentioned 25% of p mo s patients are lean there's better than you sitting here but the only difference between p mo s regular the classic p mo s or an overweight p mo s and lean piece yours is just their weight nothing else everything else is the same now lean if you take a lean pick women lean girl let's say who doesn't have p mo s who's let's say 24 years old she's five nine she weighs 135 pounds let's say and you take the same girl same height and weight who has p mo s the girl with p mo s at tissue level has insulin resistance and that's why I want you guys to understand I've never been overweight in my life ever except when I was pregnant I've never ever struggled with weight but my hemoglobin a1c was 5.6 point one away from becoming prediabetic it's crazy it but and you know because you have a few like that because your environment makes a difference your habits every day habits make a difference you know there's so many factors as you know that effects are metabolic dysfunction but but there's a lot of us and I don't have I've never had p mo s but you know 50% of women are insulin resistance as we get older we become more insulin resistant and you know north of 90% of us at some point in our life will have some metabolic dysfunction but it's important for those lean p mo s patients to know that at tissue level they do have insulin resistance and that's why when they go to get pregnant right if we and they're not getting pregnant I actually put them on metformin and lean p mo s patients respond really well to metformin and ovulation stimulation when they're trying for pregnancy better than the overweight patients and and they can have p mo s or they cannot they could be pregnant a puzzle they could be in a puzzle so it's not just you know we created ov which is our other platform we created chmd to give women the best information you've been on our podcast we you know we have the greatest minds in medicine and the greatest women that come and talk about their health journeys and why they're there and give the best scientific and medical information but when I met her and she was telling me about p mo s at the time when we were starting the podcast she said this is my life mission 15% of all women have it 75% of don't get diagnosed so on ov we have the exact calculator you can actually go for free everyone listening and calculate the exact questions that she just talked about to see if you have the likelihood of having PMOS. But to your point, metabolic dysfunction comes across all women starting at from the teenage years until after they are in a puzzle, which is why we started OV and Dr. Aiken talked about the medicine about that, which she gives to her PMOS patient, she gives to her parent-manopausal patient, she gives her a midopausal patient, because at the core of all of this is metabolic dysfunction. And it's presenting in different ways. And you can have the same symptoms of PMOS as you do when you're paramedic apostles. Like she said, we both take OV and we're paramedic apostles. We don't have PMOS. Right. But. Well, I'm postmanopausal. Well, I'm. I'm pretty. You're supposed to say I'm a proudly postmanopausal. I am. I'm not always postmanopausal. Yeah, yeah. So let's stick with this insulin resistance for a moment, because I think PMOS is offering us a very interesting insight that insulin resistance doesn't always present as weight gain. And I think we might have to go. Like that's a really good understanding. So do you feel that hemoglobin A1C is still like a really good. No. Okay, talk. How would somebody know on labs? So you know what? I have patients who are PMOS patients who are very overweight. They're younger. And they still have a normal hemoglobin A1C. That doesn't mean they don't have insulin resistance. You still have to address it. So I don't chase labs. I always treat the condition. Sometimes. You have to look at the patient. Every patient is different. They present differently. You can't say, okay, so if your hemoglobin A1C is 5.7 or less, I'm not going to treat you. Because then you're probably overeating. You probably need to exercise more. You probably. Your diet is not good. And that's why these patients get so frustrated all the time and that needs to stop. So what I wanted. You know, when we talk about PMOS, added score is insulin resistance. And I'm sure your audience have heard it all, but I would love to explain it in the. Dr. A. In the Dr. A way, related to PMOS. Yeah, let's talk about that. So they can understand why this happens. So when we eat carbohydrates, our body in a simple way breaks it down into glucose. And glucose stimulates our pancreas to release a hormone called insulin. The job of insulin is it opens up the receptors on the surface of the cells, mostly on the muscle cells, to basically take that. Open up these channels to take the sugar from the blood and put it inside the cell where it turns into energy. This is what's supposed to happen. But like I said, 80, 70, 80% of PMOS patients have insulin resistance. So what happens to them is when they have carbohydrates and their body breaks it down into glucose and glucose stimulates their pancreas to release insulin, their cells are insulin resistant, right? So they don't respond to this insulin well. So these channels don't open up at an optimum level. So some of that sugar bounces in the blood and pushes this insulin to go up. And that's when we get these insulin spikes. As insulin goes up in the body, it does several things to a PMOS body. Number one, it tells their liver that the cells, the tissue, is not using this sugar as a source of energy. You need to clear this sugar, take this sugar and store it as fat. The fat that we store with this high insulin scenario is a visceral fat, is a fat that goes around our organs. And this visceral fat is highly inflammatory, is different than the fat under our skin. So it causes an inflammatory process in the body. Number one, and that inflammation in return makes the insulin resistant worse. So one of the first things that happened, these patients clear the sugar and store it as fat. So and then they start complaining of weight gain and they feel a complain of inflammation, they're tired, they have brain fog, they don't feel well. The high insulin also stimulates, it tells the liver to stop making the sex hormone binding globulin. Sex hormone binding globulin is a protein in the blood that grabs on to the free testosterone in the blood because as women we don't want to have too much testosterone. When the levels of the sex hormone binding globulin goes down, when because of that high insulin, then we get higher levels of free testosterone. And that's when the patients start having complaints of acne, hair loss, facial hair, body hair and other symptoms of high testosterone. The high insulin also stimulates, so PMOA patients are insulin resistant everywhere except their ovaries. Their ovaries are actually very insulin sensitive. And this spike in insulin stimulates the ovaries to release testosterone. And this testosterone causes several things. The acne, the facial hair, the body hair, the hair thinning, all of that. But as the testosterone goes up inside the ovary, testosterone is toxic. It creates an inflammatory process inside the ovary and inflammatory environment that's toxic to the little follicles. Every month a certain number of antropholeicles are recruited to come to the surface. One of them becomes dominant, ovulates, right? And whatever follicles are left behind, turn into a corpusudio, says to secret progesterone to get the pregnancy going, right? And I can go into the menstrual cycle and what happens. But what happens when you have testosterone secreted inside the ovary, the follicles freeze and one of them doesn't grow. And the follicles freeze, you get that polycystic looking ovary on ultrasound, right? When you don't ovulate, you don't get a period. So your periods become irregular. And the testosterone causes all these symptoms. So that's another cause for, that's another thing that the high insulin does. But the high insulin also crashes the blood sugar by clearing the sugar out of your blood, right? And you're ignoring it as fat. When your sugar crashes, then it causes release of cortisol because your body says, we, you know, we're in a fight or fight. We need to release cortisol. That cortisol makes patients irritable, causes more cravings, binge eating. You have already an inflammatory process that and the insulin resistance that affects your binge eating and cravings. So now you have a situation where the insulin is up, the inflammation is up, the testosterone is up, right? You're not ovulating so progesterones down and you have all these follicles in the ovary that are halfway mature and they're secreting a lot of estrogen irregularly. So now you have erratic levels of estrogen being secreted that can cause irregular bleeding. And all of this then affects their mental health because in our brain, we have a limbic system which is our emotional headquarter. And all of our emotions come out of the limbic system. And we have a prefrontal cortex that acts as a break to control these emotions in the limbic system. For the limbic system to become, it needs high progesterone ovulation. It needs normal levels of estrogen, it needs normal levels of testosterone and it needs low inflammation. What happens to a PMO S brain? Inflammation is up, testosterone is up, estrogen is erratic and progesterone as well. So then you have a limbic system on fire, anxiety, depression, irritability, anger, PMS, PMDD, binge eating, cravings, lack of motivation, all of it. And then you want a prefrontal cortex to act as a break and just control everything. Well, the prefrontal cortex needs low inflammation, normal levels of hormone, good sleep, PMO S patients are not good sleep. Sleeper, low stress, these people are very stressed out. And so then you have, so you have this limbic system on fire and you have a prefrontal cortex that the break is not working. So you have a car going under miles an hour down the street and the break doesn't work. That's why these patients struggle with anxiety, with depression, they're on antidepressant. They end up in eating disorder centers. I always say you want to find PMO S patients, go knock on the eating disorder centers. They're all sitting there in the facility clinic. Dr. A actually said that to me, when she, when I first went to, she goes, she said, I want to change the world for women's health and that's why we started the podcast. But then she said, if I could get every 17 year old into my office, I would shut down fertility clinics and I would shut down eating disorder clinics. And we had one of the best podcasts, one of our favorite podcasts is with Greg Rinfero. She started Beauty counter and her daughter Phoebe. And it was just, I mean, I get chills just even talking about it. She heard journey with PMO S and being in these eating disorder clinics and, you know, just and how she kind of came out the other side of it. And it's, it was life changing. And I think that validation, because they're just these women are told, these girls are told, you're crazy. It's in your head. Like nothing's wrong with you. When I hit my forties and my hormones started shifting, I thought I knew what to do. I've been teaching patients about health for years, but I quickly realized I didn't actually understand how the ebbs and flows of my hormones were affecting my mood, my energy, my sleep, cravings, literally everything. And that's when I went down a rabbit hole deep on the research and what I found changed everything for me. It all starts with your metabolic health and fasting is one of the most efficient ways to get yourself metabolically healthy. This is why I wrote the book Fast PsychoGirl. This book is a guide to understanding your hormonal cycle and using fasting to work with it not against it. There are six different lengths fasts in this book and I'll show you which ones to use and when based on where you are in your cycle. Whether you're a cycling woman, a paramanopausal woman or a postmanopausal woman, there's a path in fast like a girl for you. And something really exciting I love to share with people is that three years later, after this book has been out in the world for three years and sold over a million copies, it just hit the New York Times bestseller list. Something I'm incredibly proud of because it means women got results. So grab yourself a copy wherever you get your normal books or you can find it on Dr. Mindy Pels dot com slash books. And from the bottom of my heart, I hope it helps you like it's helped so many women and more importantly, let's make sure you don't give up on this miraculous body that you are so blessed to live in. Okay, so I want to go back to again, beautiful explanation. I agree. That was quite a journey you took us on. So thank you to both of you. But I want to go back to why a cell becomes insulin resistant because again in the research for this podcast, I found some interesting statistics showing that it's not just too much glucose. Not just eating too much sugar, but there's some research showing BPA plastics. And I really want to know you're opinion on that. I found a very interesting one on sunscreen, a chemical in sunscreen. This was a 2025 review on PMOS and the toxic, it's called ox, oxo cryline. Have you ever heard of that? No. It makes people in this, they were looking at, they were looking at PCOS when it was named that and they were finding that BPA plastic and the sunscreen toxin makes these women insulin resistant. You know what, by far no expert in, you know, this why someone becomes insulin resistance and but I will tell you 30 years in medicine, I feel like that's why I started by saying our environment makes a difference. Our genetics load the gun, but the environment calls the trigger. And I don't think it's just sunscreen. Everything we're exposed to. From the water we drink, from the food we put in our mouth, from everything we apply on our skin, whether it's a perfume, whether it's a sunscreen, whether it's a shampoo, it's a cream, it's your makeup, those get absorbed. So there's so many different ways that these toxins disrupt our hormones, make us insulin resistant, affect our cognitive health, increase our inflammation. If you think about it, when we talk about longevity, what is longevity? At the source of it, if you want to fix longevity, you have to lower insulin resistance, you have to optimize metabolic health, but you also lower inflammation. But everything we do every single day, so it could be yes, it's a sunscreen. I don't think it's just sunscreen. I think there were exposed to so many toxins every single day and it's overwhelming. You know, I was in Europe and it was so hard for me to find water in glass. Every restaurant we went to, everywhere you went to, there was water in plastic, right? And I was with a friend of mine, he said, well, I'm not going to drink for three weeks. I'm like, well, like I couldn't do that. Do you know why I'm saying like, oh, because of the plastic? Because of the plastic. It's also, it's not just PMOS. I mean, on the podcast, we've had so many experts, there's a rise in breast cancer and young women in all cancers. So we're not just, we're, when you're looking at women's health in general, metabolic health is a huge part of it. But it's also like you said, there has to be a correlation between the rising cancer of young women between the PCOS symptoms between all of them. Listen, visceral fat causes inflammation. Inflammation, these cytokines they get released, they can increase your insulin, make your insulin resistant worse. These are endrogens that are getting secreted from your ovaries, make your insulin resistant worse. Everything, everything is related. That's why 40% in, this is my opinion, 40, 50% of my PMOS patients struggle from leaking gut. And these are patients who say, you know what, when I eat, I get so bloated. You know, in 2014, I started prescribing GLP once to my patients with PMOS. That's 12 years ago. So none of these meds are really new. The first time they came to market, it was a trulicity back then. I don't even know if people know about trulicity now, but it was a diabetic medication. It was a GLP one, but I learned it from a cardiologist who told me don't send me these overweight patients, just give them trulicity and they lose their weight. So I started going this, down this rabbit hole and I started treating my patients and these patients would come back and say, my periods are back. My inflammation so much better. That happened with fast like a girl, you know how many people, once we got their insulin resistance under control, we got another hundreds of thousands of messages that people were able to get pregnant. There you have periods back. Like yes, this is why I'm obsessed on metabolic health because it's like the core of all hormonal problems and it's multifactorial. At the core of paraminopause issues, PMOS issues, it is this metabolic problem that causes all these sensations. And you know when, I don't know if you guys remember, I'm sure you do, but when OZM pick exploded few years ago, people were like, it's a miracle medication. I got pregnant. Why do you think? Anytime you go in the red. Metabolic dysfunction. Anytime you blunt that insulin spike that I just explained, when insulin goes down, when A, you don't make visceral fat, your inflammation goes down. But when insulin goes down, you don't stimulate this ovary to release testosterone. When testosterone goes down, the follicles start maturing as they should in a normal menstrual cycle, then ovulation happens. You don't have these follicles frozen in the ovary and that's how people get pregnant. But they thought this is a miracle drug, but it's not just ozemic. You can get someone pregnant giving them metformin. As she said, you can give them the OV supplement that we created. So anytime you address the metabolic, it can be diet and exercise. It can be fast thing like you were talking about anytime, in any way, when you address the underlying condition, which is insulin resistance and metabolic dysfunction, the puzzle gets solved. The brain fog gets better. It's great. The weight fluctuations go away. I have patients, we give them OV supplement. They come back and they're like, my PMS is getting better. I'm so confused. I just explained to you what happens in your brain when you have metabolic dysfunction, when you have testosterone, when you have inflammation. When you fix that, your brain health gets better. Your PMDD gets better. You're not suicidal anymore. So outside of drugs and supplements, what do you give your patients? Here's the basic guideline for metabolic health. Here's what you might think about eating and what -- and fasting. I'll just be really clear. We've seen so much change in our community with fasting and the research is conflicting. Some of it says fasting will help PCOS or PMOS. Some of it says that calorie deficit does the same thing. I'm a fan of fasting over calorie deficit. There is some interesting -- and I'm obviously a continued fasting fan. But what else, my audience has heard me talk a lot about it. What else can they be doing? Everything you talked about, I always tell them your body does not process sugar. Sometimes get two sisters. One is tiny. The other one has a BMI of 35. It's so hard for me, especially let's say they are a year and a half apart. It breaks my heart because the other sister says, "What's wrong with me?" And what do parents tell them, "Well, you're eating too much." You know, it's because -- and they're not eating. I have patients who come to my office. They're like, "I cannot possibly eat less than what I do. I cannot possibly exercise." more than what I do. And it's really hard for these teenagers, especially in our world right now in social media where everyone's of face tuning their bodies and their faces and everything. So it becomes more challenging. But what I always tell them, you know, the way I see it, and for me, especially when I get young PMO patients, I do everything in my power to make sure they don't go down the path of a needing disorder. I think because their self-esteem gets affected, they get it, they go down this path that's very lonely. They're hiding, they're, they're lying to their parents. So I do everything in my power. The first thing I do with my patients is education. I want them to understand why this is happening and how it's not their fault. I validate them. Because if you explain and what I just explained to your audience, I really take this time with every single PMO patient in my mind. But you know, because what do you know, I was listening to this, one of the most popular podcasts on the planet, they bring in OBGYN and they ask, the host asked her, so how do you treat PMO as? Back then, it was PCOS. What do you think she said? Birth control. Medication. Birth control. I found that in my research. That was the solution for everything. Everything. So you tell me, I'm not against birth control. Birth control can help, but does birth control address your metabolic dysfunction? Right. No. No. That's why these patients get frustrated. So if they don't understand it and you're handing them a birth control pill, they're going to go tried for three months. They're still gaining weight. They're still bloated. Maybe their symptoms of high testosterone gets better. That's their periods get regular. And their testosterone symptoms get better. But that's it, right? It doesn't affect their metabolic dysfunction. So education is very important. You need to know. And just like Mary Alice said, that's why I started GMD with her because we literally explain why, why these things happen and how you fix it, right? Sometimes you have no choice but getting prescription medication. Sometimes you can fix it with diet and exercise. Not all women are built the same, but no matter where you are in the PMO S journey, your diet, your exercise, your sleep, your stress level will make a difference. So you have to look at it holistically. You can't just throw birth control at someone. You can't just tell them diet and exercises your only solution. I've seen women, that's when they go down the path of an eating disorder exercising six, seven days a week, eating 800 calories and they can't drop one pound because their leaky gut is not addressed. Their metabolic dysfunction is not addressed or their insulin resistance is so severe that they really can't do it and they need help. So what I tell my patients is a watch what you're eating, limit processed meat, processed food, try to eat more of a plant-based plant-based you have to be careful because sometimes when you can't eat meat, patients start eating a lot of carbs. And that can backfire in PMO S patient. Carmicarian. Yes. Yes. Does your need protein? So you need protein. So I always say start with a healthy diet. I love when these women go to a nutritionist, have someone that follows them, teaches them what to eat, what not to eat. How do they make a training diet? Meditate and you know what even like chocolate ice cream, one of my pet peeves with PMO S is when they drink soda. I literally want to vomit and you'll be surprised how many people drink three, four cans of coke every day. You can't even even diet soda can make you insulin resistant. And it makes your cravings worse. Yeah exactly. So diet is not just for PMO S is for everyone on this planet. Limiting toxins that enter our body whether it's the air that you breathe, it's the water that you drink, it's the food that you eat or the product that you put on your skin. These are the four ways you're getting toxins in your body. And you know we can't get it to 100 percent but if you get yourself to about 70, 80 percent then you've done enough. That's amazing. You will help your health. Exercise. I think for me personally and that's just my opinion, some exercises are inflammatory to me and a lot. You do know what I'm saying. So you know I for a period of a year I used to do EMS you know electric muscle stimulation where you carry the vest and it would like literally zap you for 20 minutes. And I felt terrible afterwards. And it was just too much for me. I felt like my muscles were inflamed everything. It wasn't a calming like for me and that's why let patients decide for me walking, hiking, yoga, swimming are more calming. Maybe it's my age but I have such a stressful life that I need exercises that are mind and body that are not just wait, wait, I love wait bearing exercises. But I might not do well running on a treadmill or running up the hill. I would never be able to do that. Okay I have something I've got to say that I really think a lot of women need to hear. If you've ever followed a health program and it didn't work check this out. This is not your fault. I promise you. Let me explain. Most fitness programs, most fasting protocols, most dietary advice. It was researched on men. It was designed for men and then handed to women with a shrug and a here you go. Hope this works for you. But here's the thing. You operate on a 28 day hormonal cycle. The food you eat, the length of your fasts, even the intensity of your workouts. All of it needs to be timed to where you are in that cycle to actually get a result. This is the science I teach inside my reset academy. This is the science that I have researched for over a decade. And inside my account academy every month I walk you through it in a very practical and actionable and way. And it's actually built for your body for a feminine body. So it's going to work. I promise you I see it over and over again. So no more guessing, no more following advice that was never designed for you. This is a moment to get back into relationship with this beautiful body that you are so blessed to live in. So if you're ready to finally understand this incredible body of yours and work with it instead of constantly fighting against it, come find me over in the reset academy. It's reset academy dot drmindypells dot com. That's reset academy dot drmindypells dot com. I'll see you there. Where does fiber fit in because I've been doing a lot of research recently on how powerful fiber is for feeding the microbes that will make the GLP one hormone. And as you're talking, I'm like here we are again at a world that doesn't get enough fiber in every single day. And I think about the woman you said who's like I eat all the time. I eat really well. I'm doing everything right. And I feel like I've become the spokesperson for fiber. Like come on, we got to get more fiber in. I think our diet, you know, I was in Europe for three weeks. You can eat whatever you want. Yep. Yeah. I know. Pure food. I literally came back and I've lost maybe three, four pounds because I would get 15,000 steps a day. And I would eat stuff that I would never dare eat at home because I would just blow up. I just feel like our food, our bread, our gluten, our hormones, the meat. And even in this country, organic means nothing. You know, you go to Europe, the strawberries are tiny. You have to have five strawberries that would equal one strawberry in this country. I remember when I moved from Iran to this country, one of the things that shocked me was the size of the fruit. Right. The fruit that we eat. I'm like, how can a strawberry be this big? Do you know what I'm saying? Or how? Yeah. Like, no. Like, you don't see that anywhere else on the planet. So, and you know, when you, when you're in Europe, you really don't see morbidly obese patients. When I moved to this country, I was 17 years old. I had never seen a morbidly obese patient in my life ever. So, our food is a huge problem. I used to have clinics in downtown Los Angeles and I would deliver a lot of patients. And one day I was eating lunch outside of the hospital on a bench. And you know, I was at the entrance and these kids for the children's hospital, they were going in and out. And these eight-year-old boys had breast tissue. Yeah. Oh yeah. Which I had. Like, you cannot, that's the, yes. So, I think that's why I say the toxins, the four toxins, whether it's air, water, skin, and food, those four need to be addressed, whether you have PMOS or not, whether you're paramedicosal or not, it should be every single person needs to be educated about these toxins. But it's sometimes impossible when your food that you eat is McDonald's. Yeah, the toxic, the toxic, my clinic was a detox clinic for the last 10 years that I had it. We did heavy metal detox, we did a plastics, I mean everything you can think about. And I finally stopped, you know, as I moved into the world I'm in now, I don't talk about it as much, not because it's not relevant, it's the solution is not easy. And it's a very depressing topic. We live in the most toxic time in human history. And we, if you're going to get yourself hormonally balanced, you're going to have to start to learn the language of toxins. But you know what's interesting on the podcast and you're one of the experts that I'm going to talk about this too because you came on GMD. I don't care if it's a brain doctor, heart doctor, indecrindacter, every single medical expert has said that it's not a peptide, it's not vitamin. It literally is exercise, food, sleep, and stress. You have to fix those. And then the, you know, we talk a lot about PMOs because there's so much shame with these young girls that they come in and they're saying, you know, I, you know, I eat nothing, I exercise, I can't, you know, and so you have to give them OV and you have to give them metformin and you have to give them a G. And there's no shame in that. There are conditions that happen that, you know, once, if you really have done everything you can with diet, exercise, sleep, stress, like you need help, your body is not working properly. So there's no shame about that. But every major person who has ever come on the Shamedi podcast has, when you ask them, tell me the top things, it always are those four things. Yeah. Yeah. And when we put somebody, I want to go to the metformin thing because it's come up a couple of times. And I'm also curious about GLPs and what you think of this because what I'm concerned about, I'm not anti medication, but what I do get concerned about is if you put somebody on a medication that pharmaceutical balances out their insulin system, you got to make sure they're still motivated to keep their lifestyle in good order. And what has been your experience with that? I think we live in a world of shortcuts. Yeah. Everyone wants a shortcut. Yeah. You know, I had a patient yesterday who lost 22 pounds in three and a half months. And that's like massive, right? Is it healthy? That's massive. And is it healthy? Is it healthy as the question? And I mean, she's really overweight. So it's fine. I'm okay with that. But she was questioning whether it was fast enough. And I was like, you know what I always tell my patients is that your body is not a light switch. So I can just say on off, on off, even if I give you a supplement, give it four months. If you start exercising, give it a few months to notice a difference. There's nothing I can do that overnight, but right now people want overnight solutions. So when I say, what do we do diet, exercise, the supplement, and then you, you know, maybe I start you on metformin in three, four months. No, no, no, but can I start with GLP once first? And then, and I understand in a way because they've been dismissed for so many years. They just don't want to deal with it. They don't want it. They don't want it. They have so much trauma. These literally my endometriosis and my PMOS patients have PTSD and they need trauma work. Because of years, years of dismissal, years of dismissal yesterday. I had a mother and daughter from Florida. I had two sisters from Australia. I had a couple from San Francisco. I mean, this doesn't make sense. Yeah. Why do you have to travel for the most basic things? And I always say, that's why I started the GMD podcast because I literally army with the information. And if you listen to it, you're going to become your own health advocate. And you don't need to fly from Florida to come and see me. I literally wanted to, like I was so heartbroken, so heartbroken. Why is it? And you have to fly across the country for me to teach you about parry men, a pause, hormone replacement. And you know, these are, this patient, she was, the mom was 55. She's never had a coronary calcium scan. She doesn't know her apopie levels. She hasn't had a bone density, which I think is very important. But because the guideline says 60, nobody checks it. Her mammogram and ultrasound are way overdue. She had breast cancer since the diagnosis. No one ever did an MRI of the breast on her. And the list goes on and on and on and on. And she didn't have a genetic testing. I mean, it's just, it's so overwhelming for me. And I always say standard of care for women's health is in the sewer system. And that's standard of care. And when people come to me, they're like, well, is this standard of care? No, it's not. The care I'm giving you is a mile above the ground. Your standard of care is in the sewer system. The standard of care doesn't even teach these women about diet, about inflammation, about metabolic dysfunction. They know nothing. Right. Because they're not trained in lifestyle. That's a big thing that, that I think we need to admit is that they're not trained in lifestyle. Help, help my audience identify how to find a good doctor. Because I agree with you. And I used to say to people, fly wherever you can to get a good doctor, because the healthcare system that you're operating in is completely crumbling. So is there a way to find a doctor like you? I would say again, I met this woman on another podcast talking about GLP wines. And literally the next day went to her office, knocked on her door and said, you're, you're my next mountain. I'm going to get the kind of care that you give to every woman out there so that they can be, have the knowledge and tools to be there on health advocate. As a woman listening, listen to what you have available, because the kinds of doctors like doctor A are so far in few between that you need to walk into the doctor in your town. If you can find one saying, you need to give me this test, this test, this test, this test. And if you don't, I'm going to leave and go find someone that will. And that's what you have to do. I mean, in my opinion, as a patient and somebody that has, I couldn't agree with you more. And I know people get upset, but I can't wait for a day that I will be replaced by a robot because women, yeah, I will celebrate that. Say more. And I will happily, happily retire because a robot will not dismiss a woman who's complaining of painful periods. A robot will not dismiss a 42 year old who's complaining of brain fog. A robot will not forget to do genetic cancer testing on someone who has family history of cancer. A robot will calculate a woman's life to a risk of breast cancer every single time. A robot will never dismiss a woman. And it's my dream to train that robot. And I will do it. We're going to do it. We're working on it. I love where you're going with this. I mean, I think we're still obviously a ways away. But what you just said, I kind of go to two places because right now, they're showing that AI is getting health information wrong about 50% of the time. But then I also go to how sad is that? Because so many people become doctors because they care. You know, the word doctor actually means to teach. But somehow in the system, I don't know if it's the insurance. In the system, I don't know if it's the expectation of the patient. I don't know what it is. But I really hope people are hearing that you need to take control of your health. You need to go and do your own research. And don't put up with gas lighting and condescending behaviors from somebody who has a white coat. But why are there, why is there so much dysfunction there? I think I would blame insurance companies. Yeah. I agree. I don't pay us enough to see a patient. I stopped taking insurance because my office, I was seeing like 50 patients a day because they would literally come and sit emergency. Everybody wanted to come in and they would wait for hours to be seen. And one day I looked at my office manager, I'm like, I'm going to hurt someone. I'm going to miss something really major because I'm burnt out. And I can't do this. I want to spend time with my patients. I need to explain what's wrong with them. I need to tell them what, let me tell you, I want to talk about this because I know you have an audience of Perry Manipaz, Manipazel woman. And you know, a well woman exam right now. What is a well woman exam in the world of, in our world right now? A woman walks in once a year. The doctor does a pap smear, does a bimmanuel exam, that means nothing. Maybe they do a breast exam. you get an order from mammogram if you're 40 years or older. And maybe if you're younger, you get an STD test in a birth control and out you go. That's not a well-woman exam. No, no, not at all. But that's all they have time for because they have 15 minutes. Yeah. 10 minutes, right? With a patient. So that's why what Mary Alice was saying, if you arm yourself, if you know that if I'm telling you, let's talk about breast cancer. If you have five minutes, if I have five minutes, because I want your audience, yeah, please, please, don't do it. So, you know, I always say, if you know your first name, if you know your last name and your date of birth, the fourth thing you need to know as a woman is your lifetime risk of breast cancer. You cannot go through life not knowing your lifetime risk of breast cancer. You need to know what that number is at age 30. Okay, it's a simple formula, tire, QZIC. We have it on GMD. It's for free. You can go calculate your lifetime risk. And I tell you exactly what you need to do with the percentage that you get. All you need to know is the density of your breast in order to answer the question. If you don't know it, you can leave it blank. And the density of your breast, you get it from your breast imaging, usually from a mammogram. If you're young and you haven't had a mammogram, you skip it. The rest of it is your height, weight, family history, whether you've been on hormones, you just, whether you're Ashkenoff's or not, you just fill out the question and it will tell you your lifetime risk. If your lifetime risk of breast cancer is 20% or more, you fall into the higher risk category, which means you have a higher risk of developing breast cancer. For women with lifetime risk of 20% or more, they need to start breast imaging as early as 30, not 40. So this concept that you need to be 40 to get a mammogram is completely misleading. Your mammogram timing has to do with your personal lifetime risk. Okay, that's number one. If you have dense breast tissue, which 50% of women on the planet have dense breast tissue, in addition to the 3D mammogram, you don't want it to be, you want to ask for a 3D mammogram, you need to have a breast ultrasound. So we don't miss anything. For women who fall into the high risk category, which is 20% or more, in addition to mammogram and ultrasound, they need to ask their doctor for a breast MRI. A lot of times your doctor will say, you don't need it. It's not true. High risk patients need MRI. The most common breast cancers, which is ductal breast cancer, gets picked up on mammogram and ultrasound easily. But the second most common type of breast cancer is the type of breast cancer that I had, is lobular breast cancer. Those can go missed on breast imaging on mammogram and ultrasound and they get picked up on MRI. So if you're high lifetime risk, you need to ask your doctor for a breast MRI. If your doctor is not given it to you, switch or educate them. But you need to get that MRI. If you have family history of breast cancer or ovarian cancer or pancreatic cancer, ask your doctor for genetic testing. Well, this is just women's health. But if you have family history or colon cancer, if you have melanoma in your family history, if you have any kind of cancer, I want you to ask for genetic cancer testing. In my office, I do the my risk test or different genetic test. I like the my risk test by company, Mariat. But it basically checks for 63 cancer causing genes and you want to put a check in front of it. You don't want to miss that. It's a simple blood test. Do not miss it. If you have family history, ask your doctor for genetic testing. And the Mariat actually calculates your tire cusic for you. So if you don't want to go on GMD, you don't feel like doing it. Mariat will calculate your tire cusic risk and they will tell you whether you fall into the high risk category. The third thing they do, which I love in addition to calculating your tire cusic and checking for the major genetic mutations like the BRCA mutation, check to this. That PLB2. They look in your DNA for tiny little markers. These are markers that individually don't do anything, but some of us walk around with tons of these markers that can push your lifetime risk higher. I've had patients that by history, their tire cusic is 18%. But when I do the my risk test because they have tons of these markers, third lifetime risk goes north of 35, 38%. She saved a lot of lives. And you can save a lot of lives with that. Know your lifetime risk. Do your genetic testing. And if your lifetime risk goes above 35, 40%, there are ways that you can reduce that risk. One, we can take a medication called Tomoxifen every day for five years and reduce that risk by 50%. Or in my case, my lifefemrs was 37%, even though I had no family history, no genetic mutation. But I chose to do a double mastectomy. And when I did my double mastectomy in the tissue, they found breast cancer, even though my breast imaging was all negative. Why am I saying all this? If you're a woman, know your lifetime risk of breast cancer. And be your own health advocate and ask for the correct imaging. Okay, well, speaking of density, I think this was an info dance. We talked so fast. We tried to make sure that it like as much information is there. Thank you. It's funny too because I talk really fast too. And so I'm going to give the advice to the people listening. They go back and relus into this and take notes. I'm going to finish it with this. This this podcast is now called Live Like a Girl. Like a Girl is my brand. And I'm really diving deep into concepts that affect women because our bodies are so different. So what does living like a girl mean to each one of you? I love that. I first of all, I just love that. I think that 53 years old and I've always lived like a girl. Meaning I've created brands that are steeped in women. Whether it was a fashion brand or now this GMD brand. And I've done it in a very feminine way. I've never tried to be a male in a in a in a work environment. I've used, you know, being feminine, being Southern, being kind, being nice, being able to do things. And what I consider like a girl, I think that if more women and girls led this world, we would not be in a situation that we're in right now. So I think just really loving my femininity, loving the fact that I'm female and leading with that always and everything has really served me well. So that's what it means to me. For me, I would say, you know, obviously I love women. I think we're dominant. I think we're smart. I think we're the best breed possible. I have four daughters. I'm an OB-GYN. I've surrounded myself with women. And I've always wanted to be in a world where women ran the world. I think the situation of the world right now is not because this person's a Democrat, this person's you know, Republican. I think the problem is that men are running this world. That was in person. If I could have a mic, I would tell every young girl on this planet, not just this country, on this planet. I come from Iran, look at what's happening. We look at what the government is doing to the people of Iran. I think women need to start taking positions of power and to make our world a better place. It would be a world where there's no wars that, you know, women don't get attacked. They don't get raped. Children are protected. And don't dodge everyone's protected. As women, we bring life into this world. We never take it away. So for me, live like a girl is live your best life, but, you know, educate yourself, empower yourself. We are really special and we should be running the world. Yes. Oh, my drop. I was a percent agree. Your gals are amazing. Thank you so much. And I'm sure everybody will come find your podcast. Anywhere else we can point them in the. So it's the Shem D podcast. It's every week. Sometimes we have amazing bonus episodes. Anybody with metabolic health issues from PMOS to paramedicos and menopause, we have options for every woman. It's ove.vi.com. And our social media handles. It's Dr. Tais Ali Abadi. She's got amazing content and the Shem D podcast. So just, just find, find great information wherever you can. And I just want to thank you for also what you're doing. And we have you on our podcast. I think we might put them out at the same time, which will be fun. I love to do that. I actually love to do that so we could support each other. But women supporting women. So thank you so much for having us. I can't leave without saying this. You know, we created the ove platform for women with PMOS. If you listen to this podcast and you think you might have PMOS, go take the questionnaire like Mary Alder said. And if you have the likelihood of having PMOS, take the supplement. If your doctor is dismissing you, this supplement will help you. It will help with insulin sensitivity. It will help with inflammation. It will help with carbohydrate absorption. It'll help with all of it. And as you fix that metabolic dysfunction, the symptoms will start improving. Yeah, amazing, amazing. Well, thank you both and keep, keep screaming it from the rooftops. Yeah, take care. - Thank you both. - Okay. - Bye. - Bye. - Thank you so much for joining me in today's episode. I love bringing thoughtful discussions about all things health to you. If you enjoyed it, we'd love to know about it. So please leave us a review, share it with your friends, and let me know what your biggest takeaway is.