The Gut‑Hormone‑Immune Connection: How Gut Dysbiosis Impacts Estrogen Dominance, PCOS, & Infertility | Gut Check Podcast Ep30 with Dr. Christine Maren

Unpacking Dr. Maren's Personal Health Journey and Expertise Birth control pills do increase your risk of blood clot. We've been prescribing birth control for the listeners. It's it's shutting your hormones off and gut microbiomes with the crux of inflammation and autoimmune disease and nutrient absorption. The primary thing here is fiber, fiber, fiber, fiber. Eat some more of it. This is why I preach a higher complex carbohydrate diet for a lot of women. For women who are constipated and not eliminating, they suck back more estrogen. Sometimes have these big chaotic high estrogen spikes relative to estrogen, which universally is declining. Women end up with estrogen dominance. Speaker 2 Polycystic ovarian syndrome, which is now the leading cause of infertility in the US. Speaker 1 Literally every system in your body has estrogen receptors in it. The female's gut microbiome has a lot more diversity until age 40 when it starts to plateau post menopause. Her gut microbiome looks like a male gut microbiome. HRT might actually support a better gut microbiome. This is really emerging research and we need more of it. Speaker 2 Hey everybody, welcome back to the Gut Check podcast. Today I have Doctor Christine Marin on the show. She is someone who I followed along with her work for a while. She's an expert in really the gut hormone immune connection. She's a board certified physician that now spends her time focusing on functional health for women. And so she has a just a wealth of knowledge with things like perimenopause, what is it and how does our body change during perimenopause, menopause and specifically, how does our gut microbiome change during these hormone shifts, which is really interesting and under discussed. I think you're going to love this episode. Let us know what you think and enjoy. Hey everybody, welcome back to the Gut Check podcast. I am very excited to be joined today by Doctor Christine Marin, someone whose work I've followed personally for a while now and it's great to have her on the show. So, Doctor Marin, thanks for being with with us today. Speaker 1 Thanks so much for having me. Speaker 2 Let's just jump into your background and your personal journey as well. But what led you to doing the work that you are today? Speaker 1 Oh gosh, it's a really long story, but to keep it brief, I am so much like all of my patients. I, you know, was a high achieving woman who struggled with health issues, particularly around big hormonal transitions. And for me, that was trying to conceive postpartum and perimenopause. And, you know, I've been through a lot between Hashimoto's and hypothyroidism and IBS and migraines and even mobile toxicity. So I've really, in the last decade, learned how to take care of myself in a way that has influenced how I take care of women so deeply. Speaker 2 It's very profound way to put it. And I think with women, you know, one of the things that we've talked about a lot recently is just the stress that women carry, right and throw through all, all of these different hormone shifts in these seasons and times of our lives. Understanding Thyroid Basics: Normal vs. Optimal Lab Ranges Let's dive in first because this is something that you're, you know, a real expert in and have spoken, I think very clearly and well about to thyroid health. And this is a, you know, still very misunderstood. I mean, women, I think the statistics are something around the, the range of like 5 plus times more likely to have thyroid issues than men's. This is something that impacts women a lot when we walk through that. I mean, you know, there's, there's a lot of, I think misunderstanding of even what is, you know, hypothyroidism or hypothyroidism. Can you walk through that and maybe talk about your own journey as well and what that led you to? Speaker 1 Yeah. So I'll just frame it from a conventional standpoint. So if you go to your regular physician and you're complaining or worried about things like fatigue or excessive weight gain or Constipation, hopefully they'll check ATSH. And TSH is thyroid stimulating hormone. But really that's a brain hormone and it's your brain's way of telling your thyroid that it needs more hormone. And so if your TSH comes back and it's over the upper limit of normal, which is somewhere usually depending on the lab, 4.5 to 5 and higher, then you have some degree of hypothyroidism. If it's not over overtly high, we call that subclinical hypothyroidism. And in the conventional paradigm, women with subclinical hypothyroidism aren't treated. There's an exception to that, which is when you're trying to conceive, your TSH should always be less than 2.5. But warning, not all doctors know that. I was never trained that in like my family medicine residency. Nobody taught me that. But so be aware if you're listening, you know, when you're trying to conceive, we have these different thresholds, but the lab doesn't. So the lab's not going to, you know, the lab doesn't know you're trying to conceive. So anyways, for most women, unless their TSH is greater than 10, which is pretty darn high, they don't get treated with thyroid medication. It's sort of like a watch and wait. Speaker 2 Sort of thing. Speaker 1 So the other side of the coin is like a more integrative or functional medicine approach. And to be totally truthful, like sometimes women are overtreated. Actually, I've seen women get treated too early or too much thyroid medication because it does help with energy. It can help with brain fog. Maybe it'll help with some weight loss, but it's certainly not a treatment for, you know, weight loss. So, you know, there's really two sides of the coin. I feel like often women are undertreated in the conventional paradigm and sometimes women are overtreated in the integrative world. And so I am somewhere in the middle for women who have a TSH over 2.5 will consider treatment or at least follow a little bit more closely. And there's other aspects that I look at. And so free T4 is a really critical marker in my opinion. It's sometimes checked by regular doctors, but not always. A lot of times what they check is a TSH, and they only check a free T4 if your TSH is outside of normal. So I always check a free T4 and that's what your thyroid is making, that's the thyroxine hormone. And then T4 gets converted to T3. So I like to check a free T3 also. That's really your active hormone that interacts with the receptor. And so generally free T3 is almost never checked in the conventional model. And to be totally truthful, like I'm not sure why it's no less accurate than T4, it's just as useful, but you have to understand how to how to use it. And again, if you look at the, you know, if you look at your lab parameters, there's this really wide, you know, range of normal. And if you're at the bottom of that range of normal, usually you know, if your doctor's willing to check a free T3, usually they'll say, well, it looks fine because it's in a normal range, but there's a difference between normal ranges and optimal ranges. Speaker 2 That's right there's also a big difference between what now is common when when what is normal right absolutely exactly was talking to you know another guest about even kind of the window of what is normal moving with things like obesity and these other issues. So it's really, it's very confusing to say the at least, right? So for anyone listening, like we're, we're not the experts sitting on some podiums. Do you know, preaching at everyone, we're all in this together. It's very confusing. And I think that this is the power of more functional medicine versus conventional is spending more time with every patient. I mean, this is the whole point because No2 cases are exactly identical, even though they may present similarly, which is a very, you know, hard thing to do when you're trying to see 15 to 30 patients a day, right? So it's almost impossible. From Conventional to Functional: Birth Control's Role in Women's Health Was there a moment for you within your journey early on that you realized conventional medicine wasn't where you wanted to spend your time? You wanted to spend more time in this kind of functional medicine? What was that moment? Speaker 1 Yeah, I love this question actually goes way back to like 17 year old Christine. So 17 year old Christine went to college and stopped getting her period and she went to the doctor and they gave her birth control pills. And as a 17 year old, I was like, this doesn't make any sense. Like, why would I take a birth control pill? Like, I don't get it. That's not the problem, though. And so at that point, I actually started seeing an acupuncturist, which helped me actually. Yeah. It was like we made progress. Speaker 2 Yeah. Speaker 1 I started seeing a more integrative nurse practitioner at that time and so that really propelled me into like more integrative Wellness and caring for my body in a different way. It ran into my sister having health challenges as well. She had Graves' disease. My other sister had Hashimoto's. So thyroid stuff has been swirling around in my world for a very long time because of my sisters and, and later because of my own story. But yeah, it really did propel me into this different level of interest and like looking at the body holistically. And at the same time I was in Boulder, you know, which Boulder, Co is like a really. Yeah, open minded, kind of. It's a place where I fit it's. Speaker 2 To be for functional medicine. Speaker 1 It's a good place to be. So being around people who thought that way. And it wasn't hard for me to find an integrated physician who would look at my case and say, like, yeah, OK, birth control doesn't make sense. Speaker 2 Yeah. Why do you think that is? I mean, we're, we're going to talk to you about birth control and perimenopause, which I am just like really pleased about. But why? Because I was similarly put on birth control when I was even younger than you were teenagers by a pediatrician for acne, you know, like normal hormonal acne. Thankfully, I just hated it. I just hated it and stopped taking it and was like, this is not good And that, you know, obviously in hindsight, glad that I did and listen to my body in that way. But it was just so you know, and my my parents are more natural minded as well. But it was just so like, oh, this is what we'll do for for acne. And then here you are. Don't have a period at 17 and birth control. Why, why did why did we see that? Why are we seeing that? I mean, everyone has their own theory, but I'd love to hear yours. Speaker 1 Yeah, I think it's because doctors are really accustomed to prescribing it. It's such a, we're so comfortable with it. And as we talk through perimenopause, doctors aren't comfortable prescribing HRT in so many instances, but we've been prescribing birth control pills for like since our training, you know, so it just, I think is a comfort level. I think there's also some misunderstanding around it. I don't think doctors really understand like what's happening when you go. I mean, I'm not speaking to every doctor. There's certainly a ton of like really brilliant doctors out there. But I think in general the thoughts around it are, you know, it's no big deal. It's just going to, I don't know, dial down your hormones or something. I mean, for for the listeners, it's, it's shutting your hormones off. And so it's replacing your natural rhythm and your natural bioidentical estradiol and your progesterone with a synthetic estrogen and a synthetic progestin, which have a lot of side effects. And of course, I'm a huge fan of women's reproductive freedom. I mean, great, there are benefits to it, but I do think there are better forms of contraceptives for most women. Speaker 2 Well, even, I don't know if you had this experience as well, but postpartum, it's like the first thing that they, you know, recommend and, and are asking you about is birth control. And I just denied all of it postpartum. But but it's, it's a very interesting thing. I think it is the comfort level right of, of this is what we do and, and the incentive structure as well. So, so a woman comes in to, to you to see you, to your practice, someone seeing you for the first time. Dr. Maren's Framework for Uncovering Hormone Disruption Root Causes How do you look at identifying root causes? I think, you know, saying that plural, I don't think there's one root cause, but totally causes. But how do you go about approaching the identification of root causes of hormone disruption and hormone issues that a woman might be facing? Speaker 1 Yeah, well, first of all, it's not simple. And as you mentioned earlier, there's just like there's not one-size-fits-all. It's just not. And my brain thinks in puzzles, that's how I came out. I don't know. So I've developed a framework that helps me and my team really think through things. So, you know, the first pillar is like underlying root cause. Is there a gut issue? Like we listened to the patient, right? We talked to her for an hour. We hear her hold history. We hear her timeline. Sometimes I hear things like, you know, she had a significant infection and took IV antibiotics. And, you know, down the road, then she had this big gut issue. And so we'll put that together like, Oh well, you know, you're on a ton of antibiotics for this infection of like that makes sense. And often she has some aha moments as do we. But looking at it from a timeline approach can be helpful. And then just really considering, is this an underlying gut issue? Is this a nutrient deficiency? Is this some chronic infection? Is this mold toxicity? Is this all the above? Because as you mentioned, it's like multiple often root causes. And so I look at it from that framework and then do testing to analyze, like what's behind the scenes here. And then at the same time, we're really looking at like hormone optimization, what's going on with your periods? What's your flow like? How often are you getting them? Are they painful? Are they heavy? Sure, that's common, but it's not normal. And so really just, you know, talking through those pieces and understanding what all of her symptoms look like and putting this puzzle together. And, you know, then we get laps, we get data. And from that data and from her experience, we figure it out together. Speaker 2 I'm glad you mentioned even looking at the physical environment because again, good, good on all of the, you know, different experts that are speaking up more about this. I've interviewed a couple around mold, right exposure. How Environmental Toxins and Stress Impact Women's Hormones But these toxins that we're just so comfortable with now in our in our lives are endocrine structures. I mean, they are playing a huge role maybe kind of on a, on a very high level, you know, high level answer here, how do these toxins disrupt our hormones and their natural rhythms and cycles? Speaker 1 Yeah, I mean, like you said, EDC's endocrine disrupting chemicals. And so they're just, they're everywhere. They're all over, right? And so how I think of it is that is another thing that fills our bucket. And so I always talk to my patients about their bucket, like what? What's filling your bucket? When your bucket's full, it starts to overflow and we have symptoms or chronic disease or chronic pain or whatever it might be. And so we just have to start bailing water. And So what does that look like? So toxins are one of those things that bills that fills our bucket and you know, it's progress over perfection. We're always going to be exposed to our chemicals in our environment. And I've been on the other side of that fence. As somebody who lived in an environment where there's mold, I was like really hyper vigilant. And that hyper vigilance creates its own monster called more stress, right? And we high achievers are really good at getting things done and really good at being hyper vigilant. So that was a a major that was just big work for me. But yeah, I mean, I think what's important is that we are making good decisions in the things that we do everyday. So, you know, drinking out of glass, not plastic, filtering our water, filtering our air when we can. But when we travel, maybe being a little less like hyper vigilant about it. I don't. I always think women like I want to go out to dinner with my friends. I don't want to have 17 things I can't eat and not be willing to drink the tap water. I mean sure, I'd rather have bottled, but like, if that's all I have, that's OK for today. Speaker 2 Well, and I think this is a great point. I mean, one of the, the issues that is no matter who you talk to now in the health and Wellness world, they're going to talk to you about stress. And in there is a just an inclination that women, especially cheating women have towards perfection and therefore stress. And so many of you know, these issues that we have at the end of the day cannot be solved. We cannot heal if we're too stressed. You know, if if you had a way of putting it, and this is nuanced question, a big question, but how does stress impact women differently than men? Speaker 1 Well, let's just say this way. Stress deprioritizes some vital systems, which include digestion, reproduction or hormones and immune system, gut health, hormones, immune system. That's called the microgenderome. We can talk about that in a minute, but we're prioritizing survival when we're in this stress and survival mode. Yeah, and we de prioritize these other systems and they impact women's hormones and Women's Health significantly. I mean, I think they also stress also really impacts males. You know, I think it's just they have their own thing and I don't see them as often as I see women. And I'm not a male, I'm not living that experience, but I am living the similar experience that my patients have and got like every day of my professional life. When I talk to a woman, I'm like, we have such a similar lesson in life and so many similar patterns with a different life curriculum. Speaker 2 Yeah, yeah. And it's it's something that, you know, it's so easy to say it just stress less, relax, all of these things. But it is a huge aspect of, you know, all of these lifestyle changes. And I love to talk about the lifestyle changes. I love to talk about the diet, but not from a standpoint of let's get someone stressed out and let's create a huge To Do List. To your point, you hit on it, it's really progress over perfection. It's just, hey, I'm not feeling great. I've got all these symptoms. Maybe I have a pretty serious, you know, root cause issue that I'm dealing with. I need to make some changes. What can I do? And I think that's kind of the, the tone and the voice that we like to use to equip people with different tools and resources, but also to to just address the fact that the stress, it has to be, it has to be identified, right? And you have to say, OK, whoa. Because the other thing that women are great at is if we know that we have an issue, we want to solve it, right? And so if we know, whoa, I'm just way too, I've got to change some things in my life, you know, and that's causing these issues. So it's important to dig into and we will get back to how it impacts the gut and immune system in just a moment. Debunking HRT Myths: The WHI Study and Real Benefits But kind of changing, changing topics and other kind of hot topic has been, you know, and you had mentioned this earlier, just think the difference between conventional and functional medicine. Still a lot of confusion. And I think there will be for a while, for what it's worth, around HRT and bioidentical hormone therapy. So I know this is a huge topic. Why do you think that bioidentical hormone therapy gets some pushback or there's some controversy of that in the medical world today? Speaker 1 Yeah. I mean, the WHI, you know, there's this big study, the Women's Health Initiative study in the early 2000s, and the press got their hands on it. And yeah, it's on the front page of magazines telling women, telling doctors also that hormone replacement therapy causes cancer. And that trickled into our medical education. Nobody taught me in residency a thing about HRTI didn't learn anything about hormone replacement therapy. So I think it's just a lack of education. It's a lack of doctors being up to date on what that research really shows. But it's also this just the aspect of like, what happens when the press, you know, puts it on all the magazine stands and everybody starts to think that HRT causes cancer. I mean, that was, you know, back in the 2000s before social media, too. Like, we didn't have a way to negate that information or for the doctors who knew, you know, better, they didn't have a way to do that. And so I think that what we're currently dealing with is, is how do we reverse that huge message that got out there? And it's it's slowly but surely happening. But in the meantime, you have a whole bunch of doctors who haven't been trained or educated on how to prescribe HRT and might also think HRT causes breast cancer or has a lot more risks than benefits. And some of these doctors are functional, like there's a lot of functional medicine doctors who don't know anything about HRT. There's a lot of conventional doctors who don't know anything about HRT. So in my work, I'm really marrying like menopause medicine and functional medicine and lifestyle medicine and mind body medicine and how all of these things have merits and they all can go together. But I think what's important is just because you see a functional Doctor Who often, you know? Won't won't get HRT though. Functional medicine doctors are generally earlier adopters. You know, I'm an early adopter. Like I'm comfortable learning something new and applying it to my practice and many physicians and it depends on the specialty. If of course, it depends on the individual as well, but many physicians are just less likely to be early adopters. Speaker 2 Why is that? Why do we see such a lag? Speaker 1 Honestly, I think doctors are oppressed and they're in a really hard system where they don't even have time to take care of themselves yet alone like time to really go educate and learn something about HRT. And there's no CME like we do these continuing medical education. I have to do CME to maintain my board certification. There's, I don't think they're, I mean, I don't know, I haven't gone and looked at that hard, but there's not a lot of CME around medical medicine and how to prescribe HRT. Maybe that'll come. But that's on the boards, right? That's on like the American Board of Family Medicine or the American College of Obstetrics and Gynecology. Like I think part of their job should be educating and keeping these physicians up to date. But ultimately it's business and I don't I don't know when that message will come through. Speaker 2 Yeah, just to backtrack, so the WHI, the Women's Health Initiative was I I think on, on record here at the largest clinical trial to date ever in history and taxpayer funded, of course, and very, very mixed results at best. But you know, what Doctor Martin say in here is it's Marin say in here is that it's, it was, you know, the conclusion that hit the headlines was that hormone replacement therapy caused breast cancer. Since then, there's obviously been a ton of research that's been done. And also, I mean, Marty Mccarry, Dr. Marty Mccarry's book Blind Spots, he wrote a chapter on this that I think was a really good, really good summary of it. And I always point people to that chapter of his book because he, he hits on this. Well, there was just a lot of lying kind of deception, etcetera on how those results were shared. And even before it hit the press, during that time when we didn't have social media, there weren't other people to say, Hey, I don't think this is right. So the press was a big deal at that time. Like if it hit, you know, hit, hit the headlines, that was that. And he, he really walks through in this chapter of how there were multiple physicians, etcetera, who came up and said this. I, these results don't make sense. This is inconclusive, etcetera. So, so, so, but, but again, kind of backing up here. So let's, let's dive in for a moment because there's also a subset of women that would prefer to not have HRT or go through menopause naturally. So when you're talking to a woman, if you're kind of deciding between do I go through hormone replacement therapy or do I go through hormone naturally? What are some of those considerations that you would walk through with someone and how do you make that decision? Speaker 1 I think, you know, autonomy, like women are always have a right to make whatever decision is best for them. And I always encourage women to like tap in what feels aligned for you, what feels out of alignment, and don't make decisions based on bad data. So let's talk about what that data really looks like and talk about the actual risks and the actual benefits. Because every clinical decision I make is what's the risk and what's the benefit. It's not what's natural and what's not natural because sometimes the prescription stuff works better than natural herbal stuff, like when we're treating gut, for instance. So safety, right? We're looking at risks versus benefits. And if we're talking through benefits, I think it's important that a woman understands like what are the real benefits of HRT? Those include things like brain health, cognition, mood, probably dementia risk. I mean, for sure, dementia risk is just not indicated necessarily at this point for lowering your risk of Alzheimer's. It includes heart health, especially when you start it early. We get more flexible vessels. That includes bone health, less risk of osteoporosis, less risk of fractures. When you get old and listen, this is a huge deal. My mom had fractured her hip. Worst thing ever. I mean, really significant. And when you're old and you fracture your hip, that increases your morbidity and mortality by like 50% in the first year. It's a really big deal, Yeah. It includes better muscle, muscle tone, better metabolism, the WHI The things that it did show are decreased risk of colon cancer, decreased risk of type 2 diabetes. I mean, it did show benefits. They just didn't talk about them. You know, that wasn't what the press grabbed. It wasn't like that wasn't the headline. I had gut health. I mean, HRT might actually support a better gut microbiome. This is really emerging research and we need more of it. But I totally believe it and it's what I see clinically. So we can talk more about that. What other benefits? I like it. Literally every system in your body has estrogen receptors in it. And so your hormones really do matter. So I think it's important to just understand what are the benefits look like. And then let's talk about the risks for women who have a history of aggressive breast cancer. Hey, listen, the risks might outweigh the benefits. And that's not because estrogen causes breast cancer, but estrogen is like the garden, like it makes things grow and proliferate. And so if you have some underlying issue, it can make that a issue proliferate. So I always ask my patients to get a mammogram or some sort of breast screening before we start HRT for that reason, because we don't want to pour estrogen on that. Progesterone is like the gardener. She keeps things in order. She, you know, puts the trellis, ruins the plants, makes it grow in a organized fashion. So we need both, and they're both important. And the balance is really critical. But I think just understand, like, what are those risks really look like? Understanding the Critical Difference: Bioidentical vs. Synthetic Hormones Yeah. And then how do we mitigate them and where do we start? Speaker 2 And I realized that in beautiful, beautiful response there, I realized that we, we've been talking about this and just kind of jumped into bioidentical hormone therapy. OK, so and an HRT hormone replacement therapy, but we should take a step back because I still think that there's clarity needed between bioidentical versus what, right. Synthetic. Yeah. So let's talk about the difference there. And my understanding with the WHI, which is the Women's Health Initiative, this large study we're talking about was done around hormone replacement therapy, was that they did use synthetic hormones, if I'm, if I'm not mistaken. Speaker 1 So. Speaker 2 Yeah, let's let's decipher a little bit more between bioidentical and synthetic, why that's really important as well. Speaker 1 Totally. So bioidentical, that term is really body identical. And listen, sometimes it's synthetic actually, like they are technically synthetic hormones, but they're body identical. And that's what's important when we talk about progesterone, that's the really critical one a lot of times. And in the Women's Health Initiative, what they used is a synthetic progestin, medroxy, progesterone acetate. What's that sounds like? Sounds like progesterone, right? What's a synthetic progestin? But even some doctors don't know that. It's just not something we're taught. And the research makes it really complicated because we're lumping together all the progestigins and that includes body identical micronized progesterone and medroxyprogesterone acetate or other synthetic progestins. So when we're talking about synthetic progestins, those convey more risk. And it doesn't just include medroxyprogesterone acetate, it also includes birth control pills. That's when we use a synthetic progestin and a birth control pill. You might be on a progesterone only pill that's a synthetic progestin. So the other side of the coin is the body identical progesterones like micronized progesterone or prometrium, and I'm a huge fan of those. They're great. They mimic what our body makes. Our body knows what to do with them and how to use them. So then estrogen or estradiol is that other conversation. So body identical estradiol you can get from a regular pharmacy as a patch or a cream or a gel or a ring, but it's body identical and that's what's important. Some women might go through a compounding pharmacy and compound biased, So biased is just estradiol plus estriol. In my opinion, there's really no reason for that. Like I don't need estriol. Estriol is great for skin. So it's great for cosmetic reasons. It's great for the genital urinary tract, but it really isn't replacement for estradiol. It's very weak potency estrogen. Just using estradiol for systemic estrogen is sufficient. If we're talking about genito urinary syndrome of menopause, estriol is a good candidate. So body identical, So bioidentical usually kind of implies that maybe you've gone through a compounding pharmacy, but that's really not necessary anymore. It's not a terrible option if that's what you want to do, but I don't think it's necessary. You could go through regular pharmacy and get estradiol. The other side of that coin is synthetic estrogens. So synthetic estrogens are what you're going to get in a, a birth control pill. And actually in the Women's Health Initiative, they studied conjugated equine estrogen. So it's not as technically synthetic. It was from a pregnant horse's urine. Technically that one would be body. It's not even body identical to a horse because it's what the horse peed off, but close enough. Like it would be closer to, to a horse's, you know, chemical structure, not what we need. That said, it's not the worst choice in the world like. Speaker 2 Yeah, I think could work on it on like face value there. When you tell women, OK, you know, this is a study. It's literally the largest clinical study in history. I think it was a couple billion dollars if I'm not mistaken. I mean, this was a huge study and what they were looking at was a pregnant year, horses year. I mean, I don't know. Yeah. Speaker 1 We're looking at whole. Speaker 2 Thing is very disappointing I guess at best is the is the is the point and this goes to the the back to the you know the topic that a lot of people have discussed just there's just not a lot of research on women. I think there's various reasons for that, but there's, there's more. I mean, we're investing in some, a lot of people are investing into it. So it's great. But that, that is a really important distinction, right, Because the synthetic hormones versus bio, I like the way that you're saying is body identical. It's easier to understand even. And and then you, you were mentioning birth control. So birth control would be synthetic hormones. Speaker 1 Yes, synthetic estrogen, synthetic progestin. So if you check your blood work and you check like a urine test for hormones and you're on birth control pill, they're like 0, they're gone. You've suppressed all your hormones, you're replacing them with this synthetic thing that we can't test for because we don't have a test for that type of estrogen. Speaker 2 What's the problem with that long term? Speaker 1 I mean, a ton of problems, right? Like bone health for one, metabolic health. I mean, when we talk about birth control pills, there's a lot of known risks associated with them. And it's everything from lowering your libido, lesser known, but changing your gut microbiome in a negative way, it affects your mood, and then bigger time risks like stroke and blood clot. So birth control pills do increase your risk of blood clot HRT, transdermal HRT. So through the skin, a patch of estradel does not increase increase your blood clot risk. Yet they're held at these standards that are so different because women will go through menopause or perimenopause. And, you know, for whatever reason, what's offered is like, oh, well, you can take a birth control pill. But then if they want to take a, you know, some sort of HRT, they're often told, no, you're not a candidate because maybe you have factor 5 Liden or, but that was never a problem for birth control. I just it's it's just backwards, but it doesn't make any sense. The Hidden Impact of Birth Control on Your Gut Microbiome One of the things that, you know, we've clearly looked at this a lot more just because of the nature of our work in the gut microbiome and, and how we're approaching, you know, Women's Health through the gut is this connection between how birth control impacts the gut and you said the immune system. Obviously, we know the gut and immune are intricately connected. What was your take on that? How does birth control connect to the gut and how does it impact the gut microbiome? Speaker 1 Yeah. I mean, it changes the gut microbiome, and the gut microbiome is at the crux of inflammation and autoimmune disease and nutrient absorption. And I don't know, you name it, right? It affects your mood. It affects everything else. And so if we have something that's changing our gut microbiome, like we know that's what happened with antibiotics or pesticides or stress, all of those things change our gut microbiome and we want to tend to that garden. You know, it's sort of like putting some chemical on your garden every day instead of really tending to the garden and tending to the soil. Speaker 2 Yeah. And the other thing that's just kind of misunderstood. So birth control absolutely impacts the gut microbiome, which impacts your immune system. But it's more important than just birth control itself to just call that out. It's your your hormones, right? Your hormones, your natural hormone cycle all throughout your life impact your gut microbiome. They're living together. There's a bi directional conversation connection going on all throughout our lives. So let's talk about that because this is, you know, really the focus of a lot of our work right now. And we're really looking at a lot of things like how the gut microbiome impacts things like polycystic ovarian syndrome, which is now one of the leading causes of infertility, if not the leading cause of infertility in the US here, and endometriosis, estrogen dominance, all of these things. So we're really focused on on that area. But backing way up, this is actually how I found doctor, Doctor Marin's work and, and something that she's really great at it at explaining. So the gut microbiome is obviously this, this subset or this this this universe of bacteria. There's also a subset of this bacteria called the astrobulum. So I want you just to describe to the listeners here how our gut and hormones are connected over the course of our lives, and then also what the astrobulum is. The Estrobolome: How Gut Bacteria Metabolize and Regulate Estrogen Yeah. OK. So let's talk first about how gut health impacts hormones. And by the way, this is super cool because it also impacts your risk for things like cancer. It plays a role in that. And so 2011 we are introduced to this concept called the astrobolome. That's when that research came out, and it was in a paper called Microbiome and Malignancy. And so they were looking directly at cancer risk. And so the astrobolome is the subset of gut bacteria that's responsible for metabolizing estrogens, and so it can unpackage them with the an enzyme called beta glucronidase. So it sucks it back up into circulation. And for a long time we thought, well, that's a bad thing because estrogen dominance and estrogen's not good. Well, it's a good thing in some situations. What if we're menopausal? We want to suck it back up into circulation. If we're in a low estrogen state, that really plays a role in protecting us. On the flip side of stuff, the estrobulum can also determine how much estrogen we get rid of. And so this is really called phase 3 of estrogen detoxification. Your liver also plays a role here, and so do certain nutrients with which help with something called methylation. So like magnesium and some D vitamins. That's kind of phase two. Phase 3 is when we poop it out or we suck it back up into circulation, depending on what's going on with your estrobulome. So it's this really fascinating switch and that switch doesn't work as well if we have dysbiosis or gut microbiome perturbations or some kind of imbalance there. So was more recently like 20/17/2018 when we started to figure out that, oh, hormones also impact the gut microbiome. Well, that's interesting. And what's really interesting is how they impact the gut microbiome as we go through big hormonal transitions like perimenopause and menopause. And So what we see is this concept called sexual dimorphism. And what that means is that a male and a female have very different gut microbiomes. A female's gut microbiome has a lot more diversity until age 40 when it starts to plateau. Post menopause, her gut microbiome looks like a male gut microbiome. Less diversity, less a strobe alone potential, higher inflammation and higher cardio metabolic risk, which just directly conveys this risk for like weight gain, diabetes, heart disease, which is the number one killer of women. And so this gut microbiome is really changing through the course of our life. And menopause I believe is probably the biggest transition. You know, puberty probably plays a really big role too, if I think about it. But I don't have any research to look at that I might be out there. I haven't even looked. But you know, that transition when we go from, you know, 40 to 55, like on the other end, if we're not using HRT especially, we end up with a completely different gut microbiome. Speaker 2 And so, OK, so you you have a obviously. Speaker 1 Lost your sound? Speaker 2 So the you you'd mentioned that HRT can help with what it seems like from your from your last response, HRT can help with the gut microbiome through these transitions of perimenopause, menopause. Let's talk through that. So this you've seen? Speaker 1 This is really cool, but the research is not looking at transdermal estrogen, it's looking at estrogen. So we can sort of extrapolate it. But I, I just say clinically, I mean, I've, I have a lot of patients who struggle with IBS or inflammatory bowel disease. IBS is irritable bowel syndrome and we see that they have a lot of improvement with HRT. Now it's multifactorial because the other really cool thing is that estradel influences your tight junctions. And when I found that research, I was like mind blowing, you know, estradiol influences leaky gut. Like what? That is so cool. And if you take birth control pills, you don't have estradiol. So what's happening with your gut? Like leaky guts, a really big deal. Like intestinal hyperpermeability is a huge deal for overall health. So anyhow, I digress. But there's two papers that I'm aware of looking at HRT and how it impacts the female gut microbiome. In one study, they were looking at women who had premature ovarian insufficiency, so younger women, and they were looking at certain metabolites in the blood and then and looking at certain bacteria in their stool. And they found that after one year of treatment with HRT that those reversed. The other study was, I believe, looking at upper esophageal samples. Mark Pimentel was one of the researchers on this one. And it was, you know, similar outcome. Like, it wasn't the study population was not premature ovarian insufficiency, but it was in women who used HRT. And the finding was that they had a lot of improvements in their gut microbiome. You know, interestingly, for whatever reason, they used oral estradiol, which isn't the end. Like, I'm fine with oral estradiol. It's not generally what I use. I use transdermal. But oral estrogen does increase the risk of blood clot a little bit, but much less than a birth control pill. So, you know, if I had to choose birth control over oral estradiol, hands down oral estradiol, though, obviously, I hope this is obvious. It doesn't. It doesn't provide contraception. So yeah. Speaker 2 Yeah, the, the, the overall kind of theme here that I really try and communicate to women as much as I can is that the gut microbiome and for men too, but different specifically for women, the gut microbiome plays a critical role all throughout our lives, right. So, you know, childhood and then all throughout our lives. And there is this, this relationship with actually, you know, our levels of estrogen and our levels of flaca bacilli, right? That kind of are, are in tune throughout our lives. And then, and then it, I don't know if you, if you want to speak to kind of how the gut microbiome shifts during menopause. I mean, you were talking about this, but becoming more male like let's, let's dive into that a little bit more. I think that's really interesting for people to understand. Post-Menopause Gut Shifts and Foundational Lifestyle Habits for Health How does it become more male? Like is it less diversity? And what can we do right when we are in our 40s and 50s? Speaker 1 Yeah, yeah. So less diversity is what we see and also less mucus layer. So we have like less all our barrier functions really disturbed. So diversity like we can look at a ton of different species. As you know, when you look at the research like there's a lot of different bacterial species in our gut, Acromancia lactobacillae, bifidobacteria, like whatever it is, but of all of the family of bacteria, we have less of them and that impacts. All of these systems and especially at least from the research cardio metabolic race and that's from a 2023 paper HRT potentially, right? If you're a candidate, that's definitely something I would consider. Also, I'd like to frame it like when I, when I give this lecture, I show a pyramid and I say, you know, estradiol's queen, she's at the bottom. That is really the biggest impact to our gut microbiome. Progesterone also impacts our gut microbiome and our intestinal permeability. So does testosterone, so does thyroid, so does cortisol. So if we're under a ton of stress, that does impact your gut microbiome. Because remember, under stress and survival mode, we prioritize survival and deprioritize digestion and hormones and immune system. So all of those hormones matter when we talk about it. So yes, like, I don't know, stress management makes me stressed out. I like to think of this as like, how do I have more fun and show up for myself? Like how do we encourage women to self advocate and really get in tune with their needs and align with their needs and all of that? So, so hormones are like 1-1 discussion. The other piece of it is just like your, your foundational lifestyle habits. So diet is a huge one. Diet goes a really far away and shaping your gut microbiome. We see when people change their diet, the gut microbiome changes in a matter of days. And so the primary thing here is fiber, fiber, fiber, fiber. Eat some more of it. This is why I preach higher, not higher. But yeah, a higher complex carbohydrate diet for a lot of women. So many women in my practice have come to me concerned about high blood sugar, which I believe is really because they're under great stress, because they're high achievers. So their blood sugar is a little bit higher than expected. They're not in diabetes range. Certainly there's another population who has true insulin resistance and type 2 diabetes, but these women are super stressed. They're at a high level, they're performing at a high level and their blood sugar is responding to cortisol really. And so they're scared and they're, women go all in because we're awesome. And they start eating low carb because they think that's the best thing for them to do. But in doing so, they eat a lot more fat and a lot less complex carbohydrates and a lot less fiber. And so fibers, the really critical thing. So, you know, whole fruit, whole oats, chia seeds, potatoes with the skin on, all of these things are good source of fiber. Beans, lentils, hummus, you know, all of these things, of course fresh vegetables. But like eating a salad has a lot less fiber than you'd think. I think the easiest tack to get more fiber is really more full whole fruit. And so I say whole fruit, not fruit juice, whole oats, not oat milk. Those things don't have fiber. We're really going for the higher fiber foods to feed our gut microbiome. So, you know, diet is one of them. And then we can also just speak to like the things that really rob our gut microbiome, like alcohol really messes with the gut microbiome. Heavily processed foods can really mess with the gut microbiome. Pesticides can really gut mess with the gut microbiome. So limiting or eliminating some of those, you know, toxins in our food and really going for like a whole food, high fiber and high protein diet because I also am an advocate of building more muscle. That said, exercise is really great for a gut microbiome. Again, same thing. So many women in my practice are told they shouldn't exercise because it's too too much more stress. And while that's true if you're running a marathon or training for like an Iron Man, that's really not true for most women, right? Like most women aren't training for those really high endurance kind of sports. They're not riding in the Tour de France. We're talking about normal women who should be moving their body and are under sedentary states for a lot of different reasons, work and time and family and priorities and all that kind of stuff. So exercise is one of the best things you can do for a gut microbiome. So move, move your body. Low tox living is the third, you know, kind of thing I talk about on this pillar of building resilience that I have. But low tox living, like we talked about at the beginning, disrupts your endocrine system, but it also disrupts your gut microbiome. And so progress over perfection. But just trying to be mindful about the toxins you get exposed to, especially those that you get exposed to on an everyday basis. And just thinking through like, what are the biggest things to move the needle? Filter water, get an air filter in your bedroom. It doesn't have to be like, you know, insanity sleep, sleep is actually a really big one. And your sleep impacts the gut microbiome. If you're not sleeping, you'll see negative effects to the gut microbiome. And then vice versa. Gut microbiome impacts your sleep. It's all bi directional, right? Because we're really complicated, intricate humans. Like we don't, our health doesn't operate in silos like our medical system does. And then the other one is, is that like stress and mindset pillar? So when I work with women, my encouragement for them is to really like show up for yourself, speak to yourself kindly. When your body perceives that you're under a lot of stress, whether it's real or not, if your body is perceiving it, your body diverts those resources to stress and survival mode and it diverts them away from building. And actually, this is something I learned from Quran. He was talking about what he kind of put it together. He gave a lecture talking about anabolic versus catabolic state. And so we really want to get into this. We want to build, right? We want to be in an anabolic state. We don't want to break down, we want to be anabolic. And So what do we have to do for that? Gut health is really important. Inflammation is really important. Getting enough food and eating enough food is really important. All of these two are signals on the stress system that like, hey, I'm safe, you can build. We're in safety mode. We want to give our body more safety signals. Speaker 2 Yeah. And I'm, I'm so glad there's a lot on back there from a sleep, yeah, etcetera. But that was again really wonderful and comprehensive response. I think something that's really understandable and digestible. The Crucial Role of Fiber in Estrogen Metabolism and Gut Regularity I want to go back to fiber because this is a huge breakdown right now culturally. I think there's many reasons for this. The most important reason is that we're not eating high quality food and we're not cooking. I mean, we're just speaking as a blanket statement. Obviously a lot of people are cooking, but generally speaking, not enough. And women on average are getting somewhere around all this data. Take it, you know, take it with a grain of salt. Somewhere around 15 grams of fiber a day. We need at least 30, probably more, right? And so how? How does fiber and eating fiber impact all hormones directly? Speaker 1 So fiber, there's a lot of different like little webs here, but fiber impacts our gut microbiome, which impacts our hormones. Fiber also regulates blood sugar. It plays a big role in how you know, how we, you know, whether or not we have these big glucose spikes. So that would be the difference between eating an apple and drinking apple juice. Apple juice is going to spike your blood sugar because it doesn't have the fiber, whereas eating an apple for most people is better tolerated. What am I missing? Speaker 2 Well, let's talk through the connection between the ostrobulome, right, the ostrobulome and estrogen. And I think, you know, right now a lot of what we're seeing with unfortunate, and I'm talking before menopause, estrogen dominance issues is really lifestyle and diet. Speaker 1 Related. Yeah, totally. And OK, it also gets back to regularity. So for women who are constipated and not eliminating, yeah, they suck back more estrogen. Like we've estrogen. I say it's like a river, right? We come in, we need to come out like estrogen metabolism. It's like a river. Like we got to bring it in, bring it out. Everything in our body does better with flow. Gallbladder, if you don't have flow, you get a Cholecystitis or, you know, gallstones. Same thing with your urinary bladder. If you're not like bring it in, taking it out, if you don't have the flow, you get a UTI. Well, estrogen's in the same boat. Like if you don't get estrogen, if it's not coming in and going back out, there's no flow, It gets stuck. And when it gets stuck, we've got problems with too much estrogen in relationship to progesterone. So this brings up that other really big concept, which is this estrogen, progesterone balance. It's very yen Yang. And so you need back to the estrogen as your garden and progesterone as your gardener. You need estrogen to proliferate, but you need progesterone to direct that proliferation in an organized way. And so that balance is really important. And when your guts out of whack, that balance is often out of whack, which is you know goes into then how HRT could. It's different for everybody. I don't have every single person on 100 milligrams of progesterone and .05 of estradiol. Like some women need more estrogen, someone who need less, some women need a lot more progesterone. It really depends. But women who are not, the estrogen doesn't flow as much. We got it off. We got to balance that out with, you know, more fiber, you know, more elimination work on the gut health, yes, but also more. Speaker 2 Progesterone yeah. And I think this is something that, you know, I, you know, really from from kind of my perch right now, I'm 31, so kind of in the in the middle of, you know, my peer group trying to have kids, a lot of people unable to have kids, a lot of people having kids, etcetera. But that kind of mixed group right now, one of the things that you you cannot go to, you know, I always use the analogy at dinner party, but you can't be around friends, right? You can't be in a conversation of your peers without someone talking about endometriosis or PCOS or estrogen dominance. I mean, it's, it's really, it's very prolific right now. And it's totally right. And part of it, yes, is the testing, the awareness. But a lot of it's that we're unhealthy, you know, and it's not just that the testing has gotten better, it's that these are some serious issues, right? And. Speaker 1 Our environment's a mess. Like there's a lot of issues. Speaker 2 And stress. And stress. Women are asked to do like, so much a lot. That's not natural and frankly not healthy. I mean, just period. It's too much. And then you add that to the stress we put on ourselves and it's just, it's not good. I do want to tap on something as well. So before a woman reaches menopause age, we'll get to perimenopause in just a minute. But before they reach their 40s, let's say early 40s, what are some of the most important health indicators that they can be looking at? And what are some of the most important things that they can be doing from a hormone health perspective to set them up well for their 40s and 50s? Defining Perimenopause: Hormonal Shifts and the Unmasking Effect Yeah, I mean, I'm going to go back to those. Yeah, say it like while they're still cycling. Yeah, I'm going to go back to those five. Foundational health. It's like diet, movement, low tox living, Have fun and mitigate stress and make sure your sleeps on point. Because all of those are really critical foundational pieces and they will often set you up for success later in life. But if you have underlying issues, address them sooner versus later. It's easier to get better when you address this stuff on the earlier side of things. You know, if you have autoimmune disease that's been raging on for 30 years, like there is damage and you can't always undo all that damage. So really being an advocate for your health and addressing things early on, I think goes a long way. What else do I want to say here? I mean, I think the lifestyle piece, you know, what happens in perimenopause and menopause is that a lot of women tend to have a really profound transition in the way they experience life and the way they show up for others. And women start to show up for themselves more, not all, but some. And I love to see women who go through this transition and we call it mother to queen and this transition and she reclaims like, hey, what is it like to speak for my needs? What is that experience? Like? How's that feel? And you know, what if we did that sooner? What if we sort of acknowledge the cultural conditioning that asks us to over function and show up for everybody else before we show up for ourselves. And we know that at age 30 or 31 or whatever it is before we have children is all the better because it really is a significant, you know, you have children. And the, the pattern I see and almost every woman I know is she was over functioning, but like she could get by because she didn't have 3 little humans asking her for things and three little humans to like manage calendars and all this other stuff, right. And then as she, I'm speaking from, I have 3 little humans. So let let me be clear. I'm just talking about myself here. So she goes into this phase of motherhood and women are encouraged to give everything to their families. And that's not a bad thing all the time, right? But like, you have to get, you cannot pour from a dry. Well, Yeah. And we are not taught that our social structure functions on women self sacrificing and over giving. And the best women, the women who are the best at that, are the high achievers. They're really good at that because we are capable and we know how to do that so. Speaker 2 Yeah, it's learning to say no more. Yeah, that's really what it is. It's like what's in what's actually a necessity, you know, and, and figuring that out and it's hard and everyone has to figure it out for obviously themselves and every, every season of the parenting journey and the professional journey, right. I mean, yeah, you know, I think, you know, you, you can say you can do it all, but you can do a lot in your lifetime. You could do it all, but you can't do it all at once. And I think that's another way to think about it is like there's times and seasons when we're going to be really good at doing certain things. But you know, when you've got 3 toddlers or three little kids or, you know, it's might not be the time to also have a massive career. It's hard, it's hard to do both right. And that's, and that's the, you know, that's the ebb and the flow of things. But I, I do want to also kind of just pick your brain a bit here about perimenopause because this is a term that's still relatively new. I was looking at it yesterday kind of in curiosity ahead of this conversation of like the Google trends of search volumes and how kind of awareness and the word perimenopause specifically just over the last five years or so has kind of grown exponentially. And it's always been there. There's been research since 90s and before that even. But I would love to hear what is your definition of perimenopause and at what age are we really entering this perimenopause state? Speaker 1 Yeah, so for most women it's late 30s to early 40s. On average, menopause starts around age 51 for women in the United States. That could be earlier for women who have autoimmune disease, who have hypothyroidism, who've had a hysterectomy, even if they still have their ovaries, there's there's a lot of different reasons that that could be accelerated. And so that could be called early menopause or premature ovarian insufficiency. So, you know, these hormonal changes can definitely start earlier. But on average, you know, most women, if they experience menopause, let's just say age 50, you start to experience perimenopause about a decade before that. And so let's say age 40, but you know, it might be as early as 35. And so perimenopause is really a transition. It's just like postpartum, right? We have this big hormonal transition. It's like puberty, really. Speaker 2 Puberty. Speaker 1 We see this like increase in our hormones, perimenopause, we see this decrease in our hormones. So perimenopause itself is getting a lot more attention, which is awesome. And I think it's a bit of a double edged sword as always, because the misunderstanding here for some people is that like, oh, I'm in perimenopause, so my life's going to suck now. It's going to be really complicated or that's the reason I have XYZ. And I reframe that around, you know, perimenopause is a hormonal transition. It's a time when our estrogen levels start to decline, but are often really chaotic. And so we sometimes have these big chaotic high estrogen spikes and relative to estrogen, which universally is declining signing in these years, women end up with estrogen dominance. But some women in perimenopause have low estrogen to begin with. They don't have these big spikes. They just have low estradiol overall. So that woman is less kind of talked about. But you know, there's there's two types of perimenopause. There's the woman with the high chaotic estrogen spikes who experiences kinds of estrogen dominance, and then there's this woman who is just really flat and she has low estrogen and low progesterone overall. Testosterone also plays a role, but it's also coming from our adrenal glands. So it doesn't correspond to always with the decline in estrogen and progesterone. So, you know, all of those hormonal changes during this phase of life is what we call perimenopause. And women start to experience more symptoms because of what I term the unmasking effect. So hormones help us bail water from that bucket. When we have hormonal fluctuations, we lose resilience or when we don't have hormones on board or they're very low and we lose that resilience. And so a lot of underlying stuff comes to the surface. So that might be an underlying issue with your gut microphone. Maybe that's an underlying issue with your thyroid function. Maybe it's an underlying issue with like metabolism, but women experience these changes and have higher rates of things like autoimmune disease, higher rates of hypothyroidism, higher rates of IBS or irritable bowel syndrome. I mean, really across the map, you know, migraines, headaches, histamine issues, allergies. Women start to experience a lot more health symptoms at this, you know, in this phase of life. Speaker 2 It's very interesting and and why from from your perspective, why over the last couple of years has this idea and this, you know identification of perimenopause sort of taken off as far as education is concerned? Speaker 1 I mean, all credit the women in, you know, my sort of my colleagues who have brought attention to it. And now we have social media and we have famous people who are talking about menopause, right? We have this generation of women who are going through menopause right now, and they're saying, oh, no, yeah, no, I'm not going to do it that way. I don't want to. I don't want to suffer. Yeah. And so women have started talking about it more. Speaker 2 Yeah, it's very interesting. In closing here, I want to go back to a concept that you you talked about at the beginning and just get your, you know, your read on this because you are, you know, functionally an expert in this and have talked about it a lot. The Gut-Immune Connection: Hashimoto's and Intestinal Permeability This connection between a thyroid got an immune system, So if you don't mind, walk us through that and just what you've seen in your work. Speaker 1 Yeah, for sure. The missing piece of that conversation we had earlier was Hashimoto's. And so Hashimoto's is a really common autoimmune condition that over time causes hypothyroidism. So they're two separate conditions. And if you are a woman with hypothyroidism, make sure you know if it's caused by Hashimoto's or by something else. Because I think addressing that is understanding the root causes of your hypothyroidism is really important. If it's if it's caused by Hashimoto's, which is likely the answer if you're a woman in the United States, then there are things that you can do about your underlying autoimmune issue so that you don't continue to have ongoing thyroid over the course of your life. And you may need thyroid medication for all of your life if you're already in a hypothyroid state. But you can prevent needing higher doses by addressing the underlying autoimmune condition. And so many women who have hypothyroidism have no idea they have Hashimoto's because nobody has tested them, right? It's a relatively easy test to get. It's a blood work panel. It's called TPO or thyroid peroxidase antibodies. There's also thyroglobulin or TG antibodies. A thyroid ultrasound sometimes will pick this up. There are some women who have Hashimoto's with normal antibodies, less common on the whole. You know, the most common one would be the thyroid peroxidase antibodies. And so if those antibodies are high, that indicates this underlying destruction of the of the thyroid gland. It comes with a lot of different symptoms that can be non specific and confusing actually overlap perimenopause a lot. Things like brain fog, weight gain, anxiety, depression, trouble sleeping, irritability, like it's all over the map and really nonspecific. So that's where I really like to get some data on some lab testing so we know exactly what we're, you know, what we're working with here, so. Speaker 2 If you. Speaker 1 Have an an autoimmune disease. The conventional paradigm is like, OK, you have an autoimmune disease, end of story. I don't have anything to give you unless it's really bad. And then we might give you steroids or drugs that suppress the immune system like methotrexate. Of course, these come with a ton of side effects and a lot of risks. There's a time and place for them in certain situations, but obviously it's something you want to keep for like last line, and it's not really something we use for Hashimoto's in the functional medicine paradigm. This is where we do a really. Speaker 2 Great. Speaker 1 Job of addressing autoimmune disease and the primary target here is intestinal permeability. So people with leaky gut or intestinal hyperpermeability, like imagine what your immune system might be doing if it sees this hose with a bunch of holes all over, right? It's trying to protect you. It's mounting a. Speaker 2 Response. Speaker 1 But that is at the crux of autoimmune disease. Sure, genetics play a little role, not a not a lot of role, but they play a little role. And environmental toxins or environmental shifts, and specifically hormonal shifts like perimenopause and postpartum and pregnancy, those play a really big role too. So those are the environmental triggers that can bring on an autoimmune disease. But the first thing I do with any woman who has Hashimoto's is address her gut health. That's awesome and thank. Speaker 2 You for thank you for explaining that connection because I don't think that is well understood at all. So again, as you mentioned, we and this is the the power of functional medicine too is treating the body as a whole because all of these things are related. Every single thing that we've talked about and you know the hour that we've been talking here, everything is is interconnected and in specifically there's just this powerful role that they got plays that's, you know, still all of the stuff is still I think misunderstood, right. That's the point is that we're going to continue to learn and research and discover new things. But we do know a lot and there's a lot that we do know that's fundamental. The lifestyle and just day-to-day dietary sleep, all of these things that you talked about, I think are at the absolute, you know, fundamentals that are connecting the dots between all of this. So thank you for thank you for sharing all of that in in closing here, I'd love to hear from you, from your practice and the work that you're doing, what you're optimistic about right now as we look in the future, Women's Health, all of these different topics that we've been talking about. What makes you, you know, not only from your practice perspective, but as a mother? And I know, you know, now I have, I have a daughter and another one on the way. And it's it does make you think very differently about the future and not just being pessimistic all the time, right, because that's easy to do. But what are some of the things right now that we're optimistic about when it comes to work that you're doing? Future of Women's Health: Education, Self-Advocacy, and Optimism Yeah, I mean, I'm optimistic that women. Speaker 1 Are advocating for themselves and we're talking to each other. We're talking about apparently menopause is a conversation that people didn't have 10/15/20 years ago I don't know like it was kind of under the table like people were apparently uncomfortable with it. I talk about a lot of menopause in my life, so I don't understand that discomfort, but but I'm glad that women are having these conversations. Speaker 2 With their friends. Speaker 1 On Oprah, you know, with you, like women are listening and women are smart and I'm optimistic because I really believe in women. Like I believe that women, the women I see everyday. Like I said, I'm her, she's me. Like, these women are smart, and I think that they aren't getting comprehensive answers in the system they're in. And so they're going, you know, outside of that system, and they're seeing me or listening to podcasts or whatever. But I think that the fact that women are showing up for themselves and educating themselves is a really great thing. Yeah. The education alone is what makes. Speaker 2 Me so optimistic, I mean, you know, you can't get until, you know, you're mid to late 20s to understand what hormones are. We got to bring that way down to the teenage years and all of these things are, I think, happening in real time. So it's very, it's very encouraging. Thank you for the work that you do. Like I said, I've followed along for a long time and just the clarity and how you describe things and explain things is so important because that's I think what we've lost a lot of from conventional medicine, bringing that down to functional medicine into really helping people feel better. So I know this conversation is going to help a lot of women, which is always the point. And a lot of people, a lot of listeners, not just women, we've got a lot of men that listen as well. So thank you for your time and thank you for your work. If people are just curious about where to find you and your practice, how they can engage with you, how they can reach out to you, where do you spend time? Where can they find you? Yeah, go check me out my websites. Doctor Christine Marin dot. Speaker 1 Com and I'm on Instagram and Facebook the same handle Doctor Christine marin.com Awesome well thank you Doctor Christine. This has been a wonderful. Speaker 2 Conversation, I can't wait to have you back at some point. We'll continue and pick up where we left off. But friends, good. Thank you very much. Thank you. Hey everyone, thank you so much for tuning in to the Gut Check Podcast. If you enjoyed this episode, leave us a comment below. 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