EP#28- Taking Control of Hormonal Health with Dr. Tolentino, Senior Physician at Parsley Health

(gentle music) - In order to really understand your body, hormones is right up there in the list of things to learn about. - Welcome back to Everyday Endorphins. You just heard from Dr. Jacqueline Tolentino. Dr. Tolentino is a senior physician at Parsley Health, which is one of the leading telehealth companies in the United States, offering personalized care and focusing on holistic wellness with their patients. Dr. Tolentino has already been a guest on the podcast. Back in January, we had a conversation about holistic wellness and gut health, and I'm so excited to bring you back on to the podcast again. This time, we talked about hormone optimization and hormonal health. There are a lot of misconceptions out there regarding hormones and hormonal health that we debunk, and we also talk about how different lifestyle factors can play a really important role in shaping our hormonal health. We also talk a little bit about PCOS, which is a condition involving the hormones, what to do if you have PCOS, what to be on the lookout for. We cover a lot of interesting topics in this episode, so I'm really excited for you guys to have a listen. Before we get into the interview, I have a brief message for my sponsor, Anchor. - Hi, Dr. Tolentino. It's so great to have you back on the show. - Hey, Stella. - Before we get into our conversation today around hormone optimization and hormone health, I wanted to congratulate you on your partnership with Headspace. - Thanks so much. I really loved the videos that I did, and they worked with them on that a few months ago, but it was just so fun to be able to bring what my knowledge is and what my experiences into the Headspace and the world of meditation and breath work, really from a doctor's point of view, on a couple key concepts there. - Yeah, absolutely. And you did a few videos around digestion and movement and mindful eating. Can you talk a little bit more about what you were discussing in those videos? - Yeah, so the videos I did, they live on the Headspace app under mindful eating and under there under the expert advice. And I did two videos with Headspace so far. So one is called How to Eat for Better Sleep. And then the other was how movement aids in digestion. And those were such important topics. And I'm excited that we were able to bring this into Headspace into that vertical that really is discussing one concept that's universal to all of us. It's how we eat and how we live. So it was awesome, it was so much fun. - I think that really just shows how the concept of mindfulness extends beyond breath work or just thinking about meditating. There's really ways to put it into action, like mindful eating or mindful walking. So there's so many different ways that mindfulness really manifests in our day to day. And it's so cool to have a doctor who's very, you know, specialized in holistic medicine to come to the platform and share these topics with the Headspace community. - Thanks, Stella, I appreciate that. - Today we're here to talk about hormone health and hormone optimization. So I'd love to start off with this umbrella question. Why are hormones important in understanding holistic health and how do hormones really play a role in our entire wellbeing? - Yes, it's such a buzz word, but it's such an important one for every reason. And I feel like every person needs to understand or at least learn the basics on hormonal health. And it's underestimated. So I feel like when it comes to hormones, hormones really impact so many different processes physiologically in our bodies. Hormones are the chemical messengers, right? They initiate different types of communication with different parts of our bodies. And I consider educating my patients on hormonal health to be really crucial because I want patients and I want you to understand exactly how your body works. And to learn to recognize when it might be trying to tell you something, that's a little off. Or sometimes when it comes to hormonal health, there's certain types of key symptoms that some women and men experience that are absolutely tied to hormonal health in one way or another. And there are so many different types of hormones, but I feel like in order to really understand your body, hormones is right up there in the list of things to learn about. My understanding is that a lot of common knowledge around hormonal health is how it relates to the menstrual cycle for women. But I feel like it extends so far beyond that. There's so many other factors that really impact your hormonal health. There's other factors that can change or cause an influx in different types of hormones that are being secreted in your body. So I'd love for you to talk more about what that looks like and what can actually cause those changes in your hormonal levels. Right. So when we think about women and menstrual cycles, just as a starting point, that wasn't something that they had gone into like full details to really get us to understand intuitively, what types of symptoms that we might have when our hormones change. And I don't know about you, but I rarely, I like I very vaguely remember it being discussed in high school. But it didn't get into the depths of like helping people understand what types of symptoms are going to go along with some of these things and educating us more in the different types of options when it came for younger women with birth control and things like that. And when it comes to hormones in general, the way that it stems far beyond that is we often focus on just the sex hormones whenever they're thinking about hormonal health, whether that's a men or women. So oftentimes we're thinking of progesterone and estrogen and testosterone, but there's so many other hormones out there. I want to say there's anywhere from 50 to 100 known. And some of the more common ones are not just those three. So oftentimes we're also in our practice at Parsley Health, we're often talking to our members about cortisol hormone, which is the stress hormone. We're also talking about thyroid hormone, which is really important for so many things metabolically, including digestive health. There is a role that thyroid plays there. Thyroid also plays a role in fertility health. So it's not just the sex hormones. We're also talking about other hormones. Another one that is often under looked is the insulin hormone that is secreted in response to glucose or sugar in our bodies. So I wish that these concepts were just not foreign or unheard of, but that most people have at least the basic understanding that it's not just the sex hormones whenever we're thinking of hormones. That there's several other ones that also go along with a picture. That's a really great point, because I do think a lot of people associate sex hormones with just the conversation around hormones. And in conversation with the menstrual cycle, if a woman is on her period and she may be feeling a bit more hormonal that day, it's often in relation to changing levels of maybe estrogen and progesterone and testosterone, but we're not really thinking about all those other hormones that factor into our entire well-being. Like you mentioned, like cortisol, which is huge, because it's the stress hormone and the thyroid hormone and insulin, especially. - Absolutely. And the reason why we emphasize hormonal health and functional and holistic medicine is because it really is. hormonal health is really whole body health. And when you asked about what types of other things are in relation to hormonal health, think about the way that we sleep, think about our appetite or how much we're eating or what types of foods that we're eating, also how your energy levels are from day to day. This is the kind of stuff that we're looking at to help determine like what kind of recommendations that we need to make, even from a lifestyle perspective. - So let's start with sleep. So getting adequate rest, I think we all can agree is really important. It's important to sleep so we can have, you know, an optimal level of functioning the next day and have mental clarity. But what does adequate sleep really mean in terms of having better hormonal health? How does that affect the way our hormones operate in our body? - Right. So sleep is important because a lot of our physiology is restoring, especially during the sleep cycle. And that means that even our hormones in our body are restoring, whether it's the sex hormones or cortisol or your thyroid hormone or even insulin, all of these hormones are restoring themselves in your body while you're sleeping. And so oftentimes when we're doing lab work, we'll recommend that patients have their labs drawn in the morning if we're trying to assess hormone levels because of the way that these hormones fluctuate throughout the day. And because it's so restorative in order to get these hormones working, this is why sleep is always one of the first things that's emphasized when it comes to lifestyle changes. Because oftentimes people that aren't sleeping great, they're also not feeling great hormonally the next day. If I don't have a good night's rest the next morning, I feel really groggy or tired or sometimes I'll wake up kind of anxious. And maybe that means that my cortisol levels are higher in the morning because I didn't have a restful night of sleep. - Right. And that might be like your body also trying to overcompensate because it did get that restorative process while you were sleeping. And we also know that the effects of poor sleep are cumulative. So it's not like it's just that next day. It can also kind of tap into the following days after that. So one night of poor sleep can also start to trickle down affect them to the other days as well. Which is why we really try to recognize when somebody is having those types of issues and really focus on like creating a nice sleep sanctuary and focusing on sleep hygiene and really dialing it back to what created those types of issues to begin with. - Do you have any advice for how to really create a nice sleep sanctuary or get into a better habit at night so that you can have a good sleep. have a more restful sleep and wake up feeling rejuvenated the next morning. Yeah, we have we have so many tips that we give all of our members at Pursley Health. We have this great sleep guide that's on our website under Pursley Health dot com slash guides. And what I love about this guide in particular is that it goes into a lot of the details of sleep and explain sleep education, like the sleep cycle, the hormones that are also at play here, the neurotransmitters that are at play, and also just giving our patients just a general guide. And this is totally free cell. So anyone's able to go to our website and go to the guide section, download and take a look at it. I will definitely take a look at that as well. It's super interesting to think about how something that we all do every day, every night, we sleep, that's a decision that we make, but also it's something that our body needs to do so that we can go through those restorative processes. When we make that decision to go to bed at a certain time, obviously, the gut reaction is that we just want to feel good the next day, or we're tired, so it's time to go to bed. But it's really interesting to have this deeper perspective and understand that this simple decision that you make every single day really has this profound effect on your entire well-being. And so now there's I feel like there's a lot of emerging research specifically on sleep and all the other factors that come into play that really affect hormonal health in particular. Yeah, especially when it comes to melatonin production and how the sleep hormone melatonin also helps to support our body's immune system, which is another interesting concept, because if we're feeling under the weather, cough or cold or whatever the case may be, we also know that our body is more inclined to want to rest. And oftentimes, you know, if you're talking to a friend, they'll be like, yeah, I think you should get some more rest when we're feeling under the weather, because the melatonin that also is produced when our body is resting and when we're sleeping, it does support immune function. And that's one thing that we forget. We forget that some of these neurotransmitters and hormones do also affect our immune system. And that's why that restorative sleep is so important. One of the things I've noticed for myself is I can't be doing anything that is too stimulating at night. My husband says something funny. If I am reaching to wash a dish like super late at night, or I'd like decided, I'm going to wash the dishes. And it's like 830. And he's like, what are you doing? You know, because all the lights are on in the kitchen, you're like washing everything, you're creating a lot of noise, you're like stimulating yourself as you're actually like doing a full load of wash. So I have a tendency now to not do that so late at night. So that really read it around at least one hour to two hours before bedtime. Things are a lot more calm. That also includes the lights that are on in the house. That includes whether or not I'm going to be like on phone or TV or anything. I try to make sure that anything stimulating is shut down and focus more on something that's relaxing either breathwork, using a one of my apps, reading, or even just us talking. I'm definitely a culprit to this behavior, but it's really hard to not be on my phone right before I go to bed to not be scrolling on TikTok, which is definitely a session of mine. Or I mean just checking my emails or whatever I'm doing on my phone. It's like that's what I consider to be the time when I'm winding down. But that's just it's actually it's not really calming me because it's more stimuli. It's the brighter light. It's not telling my body that it's time to rest when in fact, it should be the time that I'm resting. So I think that's great advice you to create a calmer environment where you're eliminating that stimuli. So you really can get in that calmer state. And it's not like we can control what's on some of the apps, right? So sometimes like say it's on TikTok, there could be something that's super stimulating like somebody created this awesome dance video. And then all of a sudden you're like not in this sleep state. You're like getting ready and you want to get up and start moving. Exactly. And so that's that's why sometimes late and night after scrolling, I'm like, okay, I actually do want to make a TikTok dance. And then our passes and I'm I've exhausted myself. So I think that's a habit I need to change. I'd love to talk more about eating as well. And what type of foods that are beneficial for optimizing our hormone levels and our hormone functioning. So when it comes to food, it really you have to start to exactly where each person is because not everybody has major changes that they need to make and what they're eating or how they're eating. And some people have a lot more that needs to be changed, right? So sometimes, you know, if you ask somebody intuitively to pay attention to what type of food they're eating and how it makes them feel, that's really the starting point. Seeing whether or not food brings them joy, does it create guilt? Is there anger associated with it? Is it mainly, you know, is there is there no motivation to eat? You know, does somebody have issues with specific types of foods that can be triggering or what kind of emotional states that we've associated with certain foods? So we at Parsley, we usually use this approach where our health coaches and our doctors are really tuning in to how somebody is eating not just now, but how that's evolved over time. For some people at different stages of their life, they may have been eating differently. And as they started to learn more about health and wellness, they've started to create some of those changes for themselves. And by the time they come to see us at Parsley, we really have to assess exactly where that is for each person to decide what kinds of changes we're going to make. Anti-inflammatory foods, trying to eat less processed foods, organic when we can, environmental working group just came out with, I think they just came out with their fresh new dirty dozen and clean 15, which is always nice to go off of for foods that we really want to focus on organic because of high amounts of pesticides and things like that. And then healthy fats, you know, omega-3s are always excellent and also any antioxidants or plant-based antioxidant foods are also really helpful for hormonal health as well. But say you're somebody who's really struggling with eating a ton of fast food or a lot of things that are in boxes, not eating a lot of fresh fruits and vegetables, you know, there's some like, you know, subtle baselines where we need to start. So it sounds like there are some rules of thumb really just trying to stick organic when you can eliminate or at least avoid processed foods or have that in moderation and having, you know, whole grain instead of, like, refined sugar. And that kind of seems in alignment with a certain type of like dietary practice like the Mediterranean diet. Are there specific types of diets that are in alignment or that reflect these rules of thumb that are beneficial towards our hormone health? Because I feel like there's all these different diet trends and there's these buzzwords with paleo, keto, Mediterranean, low carb, whatever there, you know, there's so many. So, right? First, like, you know, how can people choose which one is the right one for them? And secondly, is it healthy to engage with that kind of behavior? If you're, you know, you have the best intentions, you want to really fuel yourself with the proper nutrients, but you don't want to restrict or eliminate anything as well. Right. Well, our health coaches really dig deep into that. So the needs or what somebody should be on or should be doing, I don't think that there's one, there's like a one-size-fits-all solution here. So it's not like I can say that there's one perfect diet that is going to be perfect for every single person because each person is unique from a physiology standpoint. Say, for example, somebody is having a difficult time with processing and breaking down fats. Well, then a ketogenic diet might not be the best thing for that person because they may have some difficulty with breaking that down. So really, it also stems from, do you have the right physiology to kind of support the type of dietary strategy? And always ask yourself, what are you trying to accomplish? So whenever people consider certain diets, they really work one on one with their health coaches on that. So they can decide together, like, here's what we're trying to accomplish by implementing this specific strategy. And some of these things are lifestyle changes based off of general nutrition. That'll be helpful over the course of their life. And then sometimes it's a specific dietary strategy for a shorter period of time as they're trying to make a few changes and see how their body responds whenever they try to make some of these dietary changes, whether it is through a Mediterranean diet or through keto or a paleo diet or something else. Yeah, so really just kind of taking stock of how certain foods are affecting you and seeing maybe how it affects, like, you know, across different dimensions or energy level, your mood, your, just just looking to see how these different foods really affect your overall well-being. And I like that point. One size doesn't fit all. One size does not fit all. Exactly. And I think that testing, testing is also great too. Like to learn about what your body is deficient in and what it actually needs versus what you want is two different things, right? Sometimes they're one and the same, but sometimes we'll take a look and we'll do blood work and we'll do some of this advanced testing and realize before we even take a step into a dietary strategy, we really need to focus on their baseline foundational physiology. Maybe they're deficient in B vitamins, so we need to boost up more food specifically that are high in these B vitamins. Maybe they're deficient in vitamin D or magnesium or maybe they look like they are having some blood sugar issues. So oftentimes, like, the concept of testing and this holistic approach and also utilizing the support, the support of our health coaches is really what makes parsley shine. Because our members feel like they're really part of a team here. It's not like it's one person telling you what to do. It's that we're working together to really create the best solution for you. Yeah, I really love that because then not only do you feel really taken care of, especially, you know, food is also, it can be very a very touchy subject, a very personal matter. So I really love that there's so many different types of support that's offered on the parsley side and within the parsley team. And it seems also like inflammation is probably one of the worst things that can be a side effect of certain foods that you consume and how it affects your body. And inflammation might be different. There might be different types of foods that create an inflammatory response for different people. So being mindful of that as well. Exactly. And I think an important question that some people are surprised at that we ask within our parsley symptom index when they're filling out the questionnaires to establish with us is what is your relationship with food like? Just asking somebody that oftentimes even just asking it, they don't know how to answer because they're not really sure and they haven't really thought about it. But when you ask about specific things and you dig into it and you ask more about, okay, well, how do you feel when you eat this or how or what does your body seem to crave? Or when you're hungry, what's the first thing that you reach for like right away just instinctively? So just asking somebody what's the relationship like with food? It's not often discussed within the world of medicine. But at parsley, we think it's absolutely important to really understand this concept because this is vital to how somebody lives. And I think this ties in really well with the whole concept of mindful eating and the videos that you've created for head space as well. So bringing in that question, you know, really investigating how you view certain foods and what your relationship is like with them. That can be better answered through the practice of mindful eating, you know, moving into also exercise. That's another factor that can really influence our hormonal levels. Is there any specific type of exercise that can help balance hormonal levels or help support optimal hormonal health? Again, I don't think there's a one size fits all. And it depends on where that starting point is, you know, for women or men that are having, having even having difficulty just with starting with basic cardiovascular health, whether that's taking walks or getting their blood moving and getting their heart racing. And, you know, increasing those types of things, we might not be like stepping right into a high intensity interval training program or something like that. If we really just need to focus on the basics. So some people have an aversion to exercise and we also have to understand why that is so that we can flush out what the what's blocking or what's creating that shift. And our health coaches they oftentimes do talk with our members about stress and sleep support, but oftentimes movement and what types of movement is great on our parsley blog. We've got a great article that talks about how you can exercise for women at different times of your menstrual cycle as well. Because there are certain times of your cycle where you want to rest and restore and we want to take it easy. And that might not be the right thing for a woman who's like just about their start their period and feeling like horrible and having like a ton of symptoms. So yes, we should be paying attention to those types of cues. And that's where our health coaches really like help our patients decide how they should be exercising to support their body uniquely. Getting your heart up to a certain heart rate can be important, but also can that rest and restorative meditation yoga breathwork stretching. So there is a delicate balance between cardiovascular exercise and also this strength building and toning and then also the breathwork and meditation and stretching and all are equally important. And for some people, maybe they're really heavily focused on doing extensive workouts that are hardcore and we have to discuss the opposite of really dialing that back for an individual. Because that actually may be creating more cortisol and more stress and inflammation than they need and we need to help balance out with things that are more restorative. So each person's unique also not really a one size fits all, but just a couple examples. I think that's a really important point that you've brought up because about all of these different types of exercises being equally important because I was a rower in high school. And so that was very high intensity every day at the boat house and a blend of anaerobic and aerobic exercise. And I always thought, you know, as an athlete, well, if I'm not pushing myself to the limit or if my heart isn't racing so fast all the time that I'm not really getting in a workout. And I think I started to kind of shame, even though I've always loved yoga and I would I would practice yoga pretty regularly growing up. I think I started to shame lower impact exercises because or less cardiovascular focused exercises because I didn't think it was actually generating the benefits or the results that exercise should be. But I think it's interesting how my understanding has shifted and especially after what you just discussed because now as I am not a rower anymore and I've transitioned out of the athletic regimen that I was in. I started to realize that I feel really good when I do a toning workout or a strength workout and I don't need to do something so cardio focused every single day of the week and you're right, maybe that was causing me more stress higher cortisol levels, which isn't actually what you really want. Right, right. And you know, that's what we learn along the way, right. So you reflect back on what your experience has been. And I think that's what I think I think I know it was serving you at that time in your life and then you're looking forward and being like, okay, well, I want to create more balance for my body and the years to come. So I love that you kind of like tie this into your own life as well. Yeah, and I think, you know, especially for my listeners who may have been athletes in the past and now aren't practicing any sports that transition is kind of challenging to navigate. And then you stop and you have to reevaluate your relationship with exercise and how to engage with different types of exercises in a way that's going to support your entire well being. So I think, you know, this is it really ties into what you're just talking about. And it also ties into specific types of exercises that are beneficial for those who are dealing with PCOS. And I'd love for you to talk a little bit about what PCOS is, what it stands for and how to be on the lookout maybe for any types of symptoms or signs around the diagnosis. Yeah, so we just put out a great article in our blog about PCOS. And I would encourage all of your readers to take a look at it. And then we'll talk about the basics for what the myriad of the types of symptoms that a woman can experience if she's ever diagnosed with or a doctor discusses PCOS polycystic ovarian syndrome, which is so strange because I think that's what makes it so difficult for for people to understand not every woman that has been diagnosed or a doctor has discussed PCOS actually has these cystic ovaries. And frankly, we don't understand fully why this happens to women. We know that genetics can play a role in PCOS. We also know that the elevated and origin levels also play a role. We know that insulin resistance plays a role. And oftentimes you'll see that insulin resistance and blood sugar issues can aggressively turn on the testosterone that is starting to elevate and women that have been diagnosed with PCOS. And then of course elevated testosterone can then cause some of the other symptoms like irregularities in your menstrual cycle. But there isn't like an exact this is the exact cause because I think it's a combination of different possibilities and different women. And I think this is what also makes it so difficult is that to get diagnosed there's different types of PCOS and not all women experience the same types of symptoms at the same time. Not all have the excessive and origin levels or high levels of testosterone. Not all women have the cysts on the ovaries. Not all women have our overweight or underweight even. So there's no there's no like right exact you know one plus one equals to when it comes to PCOS. And that's what makes it such a complex disorder with different aspects that are really involved in helping to manage a woman who's experiencing it. Especially because there's so many different ways that it can be diagnosed and it may manifest itself differently in different women that you know obviously presents a challenge to navigating that diagnosis and lifestyle changes I think are the best or one of in addition to going on birth control. Lifestyle changes I think are one of the best ways to help potentially reverse those hormonal patterns or at least keep the androgen and testosterone and estrogen levels in balance. And so lifestyle changes I mean you know diet and exercise and taking care of your stress and your stress manifests itself in those cortisol levels as well. Yeah and for some women you know you can support a woman who's experiencing PCOS and helps abort it holistically but like you said you really have to hone in and what are what are the lifestyle factors that have contributed to it. And we're trying to develop a plan that addresses the symptoms so that you can actually put this into practice in a way that works for you and is truly sustainable. And oftentimes too the lifestyle factors are the bigger part once we see the physiology and I'm able to explain what we're seeing and what is the theme and does it seem like a woman has having PCOS really implementing the lifestyle changes to go along with it are a big part of how we support women. And I think the other difficulty is sometimes people just don't feel seen or heard maybe they'll go to one doctor and they'll talk about their symptoms but they don't feel like they've asked about the pattern of how these symptoms came to be and they might not give them the time to really understanding let let the patient explain themselves. And so getting diagnosed. PCOS is just such a difficult one because a lot of times patients have come to CS because they've seen so many other doctors, but they just didn't really feel like there was an understanding of why this was occurring. It was just a band-aid solution of maybe it was here to take this birth control, that's going to make it go away. But you really want to understand like maybe my body is insulin resistant, maybe this is part of what's creating the higher levels of the endrogens and we really need to investigate that part of it. Absolutely and it goes back to that whole human approach as well. And through having personalized care and integrative medicine like this is exactly what parsley health doctors do. This is how they solve these ambiguous problems or these ambiguous diagnoses. And I think it's similar with potentially gastrointestinal issues or digestive issues or endometriosis. These are also I think diagnoses that can be very hard to pinpoint because they may manifest themselves differently in different women or different people. Yes, and it might take some process of elimination to help us understand that. But since we have a lot more time with our members and they also have access to our health coach and we're really like working as a team, there's just so many pieces of the puzzle there where patients really feel like they get the time and the energy to spend with a healthcare team who's going to take a look at all of these factors together and see what the patterns are. So when it comes to PCOS, it's important to really have a healthcare team that you trust so that you can really work with close with them to help manage some of these symptoms while you're working through where this is what's feeding what where is it coming from. Exactly. And PCOS is very much related to what we've been talking about today with hormonal health and how our hormones interplay in our bodies and how that will affect our lifestyle and how our lifestyle also in reverse effects are hormonal levels. As we're wrapping up with the episode, you know, the one question that I ask every guest that comes on, it's been a while since we've spoken, but what's something that's bringing you endorphins now and currently? Right now, every day I am so lucky and grateful that I get to spend it with the people I love. Being around, a Cali being around, my husband Charles, I'm working from home. I see members virtually all throughout California, all throughout Florida and being able to spend and cherish this time together. I'm really soaking that in right now. Every single time I'm talking to my brothers on the phone, they I've got one brother in Puerto Rico, another brother that lives in Florida. And then of course, these frequent Zoom visits that I have with my parents, you know, I'm really just trying to cherish all of these moments and that's what really is bringing me endorphins right now. That's amazing. Yeah, I mean, it's it's hard to have that human connection right now, because we've you know, it's been a year since I've had everything has started with COVID and we've we've I think we're itching now to get to get back to those in-person connections, but it's really beautiful that you are still making the most of this time and still surrounding yourself with people that are uplifting you and bringing you endorphins every day. We have to. That's what keeps us going. Exactly. Well, thank you so much, Dr. Tolantino. It's wonderful to have you on to every day endorphins. You're welcome. Thanks for having me Stella. Thank you for listening. If you liked what you heard, please follow rate review every day endorphins on whichever listening platform that you use to stream my episodes. Thanks again and I'll see you next time. (upbeat music)