Female Hormone Solutions with Dr. Anna Cabeca

When women enter perimenopause and menopause, estrogen declines and other female hormonal cycles shift. Even younger women can experience female hormone imbalances. Managing gut health differently can be one foundational piece to restoring balance. Gluconeogenesis (using glucose for fuel) is an estrogen-dependent process, so a diet that uses ketones can be beneficial in the midst of hormonal changes. Expert Dr. Anna Cabeca’s patients have seen success with a combination of a ketogenic-alkaline diet, lifestyle, and, in some cases, supplements. Other factors may skew balance and are worth looking into, like stress, lack of vitamin D, inflammation, and food or toxin sensitivities.

Episode Intro

Dr. Michael Ruscio, DC: Hey everyone, welcome to Dr. Ruscio Radio. This is Dr. Ruscio. Today I’m here with Dr. Anna Cabeca, who is a second-time guest on the podcast. She is going to be enlightening us about female hormones, which is such an important topic. I don’t think we speak about it enough on the podcast. Certainly in the clinic it’s something I talk quite a bit about, so I’m glad that she is back. She also has a new book, which we’ll talk about for more resources. Anna, welcome back to the show. Thanks for being here.

Dr. Anna Cabeca: It is great to be here. Thanks for having me.

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DrMR: Absolutely. You’ve been on before, but really briefly, tell people about your background in case they haven’t heard your name before.

DrAC: Yeah, thank you. I’m an Emory-University-trained gynecologist and obstetrician, and I came to practice in Saint Simons Island, Georgia. I felt like I did not have enough in my tool bag, hence I board-certified in anti-aging, regenerative medicine, and integrative medicine. As triple-board-certified, one thing I recognize now from speaking with hundreds of thousands of women is we are generally confused about our hormones and about our bodies, not to mention how to fix them. I always tell people, I was an Emory-trained gynecologist, and I was confused with what happened to me.

Michael, as I told you before, I was 38 years old. I was diagnosed with premature menopause and early ovarian failure, told that there was no way I’d have another child, and I was just going to have to deal with it. I was at my wit’s end. That started me on this long journey to find natural solutions to empower our bodies to heal themselves, to regain mental health—I always say, get your slim, sane, and sexy back—because it’s really important. Lo and behold, I did have another child at 41. I’m 52 now. It’s been a journey, a good one. So I’m sharing my strategies that anyone can do to regain their health and quality of life, in a really easy way in a short time.

DrMR: Awesome. Again, it’s something that I see in the clinic and a very important complement to the work that I do. I have this conversation at least a few times a week, with a woman who is co-presenting with both digestive symptoms and female hormone imbalance symptoms. I often explain that in my experience, those tend to either be dysfunctional together, or function together. So if you start turning the tide toward functioning—take steps to improve your diet, improve your lifestyle, improve your gut health, and if needed, give some support for the female hormones—everything tends to respond nicely.

You see less PMS, less cycle irregularities, improved fertility, all these things. In my experience, this has been an important aspect of the total health picture.

DrAC: I love that, because that is absolutely right. It takes more than hormones to fix our hormones. If that wasn’t the case, everyone on thyroid hormone would be thin. It is the case, and getting to the digestive issues is critical. That’s the first step to go, honestly. In functional medicine, we always say, “Okay, we’ve got to look at your stool samples, we’ve got to know what’s going on. What comes in, what’s going out.” Right?

DrMR: Right. As we wade into this picture, are there a few important foundations that we want to paint for people? I’m sure women have a sense of what symptoms are indicators of female hormone imbalance, but get us up to speed on what you feel to be some of the most relevant contexts here.

DrAC: I think that there are three key areas to address. One is the differentiation of how our hormones function, and what are our major hormones versus our minor hormones. The second is taking what I call the Keto-Green approach: as we enter the perimenopause and menopause, our hormones have shifted dramatically. Now we need to support the rewiring of our body, essentially, and optimize our functions. The Keto-Green approach really works to do that. The third is looking at what the “heck yeses” and the “heck nos” in our life are, so we have discernment.

What’s working for us? We know we’re individual, and individualized treatment is key. So it’s about teaching the individual to figure out, “Yes, this is working for me,” or “No, this isn’t, or I need to fine-tune it this way in order for it to work” (or to get the best results). Those are the three areas I think that are key to cover, and I cover them in my book. I’d like to hit on these three with you today.

Major Symptoms of Female Hormone Imbalance

DrMR: Yeah, let’s expand on those. This might be a little rudimentary to start, but what would you say are some of the main flagging symptoms that could let a woman know that her female hormones are askew?

DrAC: That’s a great question. We think of the common symptoms, like hot flashes and weight gain or weight loss resistance, and night sweats, covers on, covers off. One leg on the covers, one leg under the covers, twisting, tossing, turning all night. Yes, I’ve been there. I’ve experienced every one of these symptoms, but the sleep, brain fog, and memory loss is hormone-related too at this time. I’ll talk about why. Also, there may be symptoms we don’t typically think about, like heart palpitations or restless leg syndrome. So many times a woman in her fifties goes to the emergency room because of these heart palpitations. Then that person is given a beta blocker.

I saw it so many times in decades of practice. The beta blocker creates insulin resistance, one of the major hormones that I advocate getting under control as quickly as possible. It creates more insulin resistance, hence more weight loss resistance, more hormone dysfunction, and more imbalance symptoms overall. It’s that slippery slope. Whereas maybe we just needed to add some bioidentical progesterone and some minerals, magnesium, etc.

Maybe we need less of something in our life and not more. So we look at all those components.

DrMR: In my clinic, I’m seeing female hormone imbalances. And there’s a difference between perimenopausal, menopausal, and other female hormone imbalances, but I’m seeing these in women as young as late teens. I’m assuming that this is becoming more prevalent as the generations are creeping on here. Are you seeing these imbalances become more prevalent at a younger age?

DrAC: I’ve been in practice for nearly 30 years and I definitely see hormone imbalance symptoms at a younger age. I have four daughters I’m raising, and I see their friends. Now my children are age 10 to 30, since I had Ava Marie at nearly 42. I’ve seen these symptoms in their friends, and certainly in my clients and my patients. We learn from Speroff endocrinology—really the Bible for reproductive endocrinology—that it’s probably a two- to five-year perimenopause time swing, five to 15 years. I rarely see anyone say, “One day my period just stopped.” When I hear that, Michael, I consider it a red flag for estrogen dominance. And that person is at risk for endometrial cancer unless I do an ultrasound and rule it out.

DrMR: Right. A moral here for women is this applies to many ages, not just those who are getting close to menopause. These are lessons we can take to heart at almost any age.

DrAC: A generational effect, too. So anything we can do that affects us, affects our children, affects our parents, is an improvement. These principles work all the way around.

DrMR: That’s of course near and dear to my heart with the gut microbiota. I see that as a tide that’s turning in a bad direction and we really need to intervene, especially early in life, so that we set the next generation up with healthier guts. And hopefully the generation after them with even healthier guts still. We have a lot of work cut out for us as a society to try to turn the tide here. But hopefully with your plan, we’ll give people good things to do to effectuate that.

Let’s go into some of the details of your plan. You have the three components. How do you want to launch into expanding on these?

Intro to the Keto-Green Approach

DrAC: First, as a gynecologist, I always want to talk about the female hormones: estrogen, progesterone, even DHA and testosterone. I went through menopause at 38, reversed it, then went through it again at 48. And I figured out what worked for me—and what works for menopausal women around the world now through my online programs—is addressing the major hormones. Those are insulin, cortisol, and oxytocin. In my program I work through nutrition, lifestyle, and basic disciplines and principles to empower those three hormones. That’s critical. That’s where the Keto-Green approach came in.

Michael, the story on my Keto-Green or keto-alkaline approach is kind of funny. At 48, I was struggling again. I was experiencing what so many of my patients told me (and I know they tell you the same thing). They would say, “Dr. Anna, I’m gaining five, 10, 15, 20 pounds and I’m not doing anything different.” Do you hear that?

DrMR: Oh yeah.

DrAC: All the time. And for a while, especially in my young clinical years, I was so green. I would say, “Oh yeah, sure you’re not.” Thinking to myself, “Yeah, you’re just more sedentary, probably not outside as much.” I thought that, and then it happened to me. I’d been over 240 pounds and lost that weight and kept it off for nearly a decade.

Then when menopause hit again—that’s why I’m a menopause expert, I’ve experienced it a few times—I had the realization, “Oh my gosh, I’m not doing anything different and there are five, 10, 15, 20 pounds of weight coming on. When will it ever stop?”

That fear came into play. I’d been practicing functional medicine for over a decade at that point. I said, “Okay, what do I need to do?” I understood the ketogenic diet, that that was important for brain health and could be used for weight loss. So I would try that with myself and my patients. I would get what I’d call keto crazy—irritable, moody—and that is not how you want to be when you’re raising children, that’s for sure. I wanted to figure out why, so I started rechecking my urinary pH. I was always on the alkaline diet. I wasn’t doing anything different, but something wasn’t working.

With the hormone shifts, etc. in a ketogenic diet, my urinary pH was typically five. Always below six, but typically in the five range. Our body’s got to work to maintain our blood pH, so we’re going to rob our minerals from somewhere in our body to keep that blood pH balance. The urinary pH is just a sign of what’s going on in our body. So using that as a piece of detective work, I went to the research.

I was looking for combining alkalinity with ketosis. Had anyone done that? A hundred years ago, a Cambridge scientist, Dr. Wigglesworth, researched that very thing to evaluate the improvement of ketogenic diet in seizures and noted an improvement and increase in ketones in the urine. I decided to really work to get alkaline: adding the greens, adding the minerals, adding the low-carb, cruciferous vegetables. We know all those things are hormone-beneficial, as well as meat, intermittent fasting, no snacking, and testing—not guessing—to get your body into an alkaline state and a state of ketosis so that you use ketones for fuel.

What I noticed right away was improved mental clarity, improved peace. I lost 18 of the 20 pounds in six weeks. And it was, I call it, energized enlightenment. I felt like, “Oh my gosh, this is the piece that surpasses all understanding.” I enjoyed my kids more. They enjoyed me more. That was really critical, because my middle two were teenagers at that point. Then I took it to my most difficult clients that were weight-loss resistant, all menopausal, and I said, “You’ve got to try this program. Here’s urine test strips.” And I had them check their urine pH and urine ketones.

I created combined test strips to make things easy, because I like things to be easy and simple (and that’s what people reading my book will find out). I had them do two to three meals a day, and really work on alkalinity and getting into ketosis. They experienced the same thing. Then I went into the research to understand how our hormones are shifting. Another a-ha moment was the realization that as estrogen declines (it declines naturally as we’re going through perimenopause and menopause), it leaves women open to cardiovascular disease and increasing risk of dementia.

Lo and behold, gluconeogenesis—using glucose for fuel in the brain—is an estrogen-dependent process. A-ha, we can use ketones for fuel even though estrogen stays. That becomes better for brain health, better for memory, and all the other good aspects that come with that. Clarity of thought. That was really a big a-ha moment. I put that together and took it online to thousands of women who did my online Magic Menopause program and then my Breeze Through Menopause program. That was the story on becoming Keto-Green, and why it’s so important. Those principles improve insulin sensitivity and also cortisol balance.

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Alkalinity and Keto for Female Hormones

DrMR: That’s great. I’m curious if you think it’s the alkalinity that solves this problem. I think you were saying a moment ago that people go keto and crazy. Some women just do not seem to do well on a low-carb approach. Does it seem to be that the alkalinity is the missing ingredient in getting rid of that crazy component, the feeling-tired-and-irritable part? You just don’t have enough fuel in the tank when you are keto?

DrAC: In my experience, it’s 100% of the issue. When I have work online with clients who I haven’t seen face-to-face, I can’t tweak things: I can’t prescribe them hormones, I’m not giving them supplements. I have them test their urine. If they’re going into ketosis and they’re acidic with their urinary pH, I really work with them to step back, work on higher levels of alkalinizing carbs, and see if we can’t improve that alkalinity. When the alkalinity improves, then we add the ketosis.

That’s crucial. It makes all the difference in the world. I let them stay for at least a week, waking up with a urinary pH of seven or greater. I’m not looking for eight, 8.5, just seven or greater. Also, I want them to recognize that if they’re doing everything right and it’s not working, something could be interfering. There are other reasons besides what we eat that we have a low pH. Stress, not getting outside, low vitamin D, high inflammation, high blood sugar. Also toxins and food sensitivities. All of those interfere with alkalinity.

Our body is not at peace, so why should we feel at peace? Behavior is a physiological phenomenon. We have to improve our physiology, and then we see an improvement in our behavior. This one patient, Katherine, is an ICU and kidney nurse. She worked in a dialysis center as well. She would come home after work and just sit on the couch. Probably some listeners can relate to that: giving everything at work, running the unit, and then exhausted at home and on the couch. Here she had a beautiful yard, a beautiful family. And she just checked out when she got home.

 

She took the plunge and did my Magic Menopause program. Within a few weeks, as she got alkaline (she hadn’t even really gotten into ketosis yet at that point), she said, “I feel I have much more energy. I feel so much better, and you know what? I think my family likes me more. But what’s more important, I like them more.” I’m smiling as I’m thinking about her telling me this.

DrMR: That’s great.

DrAC: Yeah, it was good. Then she was out riding her championship horses she hadn’t ridden in two years, that she was going to sell. Now, I’m a horse person. I’m in southeast Georgia, I’ve had two horses. My girls all do barrel racing. So I know selling your horse is like selling your kid. To have her out there riding and doing things that she hadn’t done in years, that makes a difference. It takes away that irritability. It’s important that we like ourselves and like those around us.

DrMR: Yeah, that definitely makes life more pleasurable for yourself and all in your proximity. How much of a role do you feel the minerals are playing? And are these alkalizing minerals specifically that you’re using? How does that interface?

DrAC: Typically from food sources. And we’ll use my Maca Plus too. That’s my greens formula that has super food. Often I’ll have clients do one to two scoops of that a day, just to add that alkalinizing support. I also encourage Bragg’s Apple Cider Vinegar, or unfiltered apple cider vinegar with mother, on an empty stomach first thing in the morning.

One other principle to know is that at night, our bodies should be restoring and not digesting. Once we’re going to break fast at some point in the morning, preferably by 10 a.m., we really want to improve our digestion.

Even though apple cider vinegar is acidic, it works to have an alkalizing effect on our urinary pH. That’s good. It improves our digestion, which is going to improve the absorption of the minerals. Plus, if there’s anything else in there, it’ll help that digestive process. I think that’s really critical.

DrMR: Do you then transition to a moderate carb approach after that, or are you recommending staying in ketosis and feeling it out?

DrAC: I really recommend—especially in the program—to try to maintain keto-alkaline state. Don’t be too religious about it though. I don’t want to villainize any food group. We’re without grains. We’re following a very strict Keto-Green diet during this time period because I want to restore what’s been wrong. We do a symptom quiz and I give that in my office. It’s a medical symptom questionnaire that we use in functional medicine. I’ve had clients go from scores in the hundreds to in the low twenties within that eight-week time period. That’s critical. We’re reversing. We want them to see this change as quickly as possible.

In the program, I do this for six to eight weeks. You start with the 10 days and really stay with it. But understand, I believe in celebration. I love to party; feasting is right up my alley. There’s feasting and fasting in moderation. I have a 10/80/10 rule, so 10% of the time, have a feast. Enjoy, celebrate, with foods that your body’s not sensitive to, or won’t raise a red flag to. Then Keto-Green, continuous, 80% of the time. And then a fasting day, because fasting is so important for resetting.

Orthodox and Catholic cultures have fasting days every Sunday, Wednesday, no meat on Fridays. We’ve built this fasting into our cultures for reasons more than religiosity. There are, for sure, cultural reasons that these fasting principles have been put into place.

It does help with spirituality as well. I believe my clients in my Magic Menopause program are all seekers. They want wisdom, they want to give back to the community, they want to shed light, and they want to live out each day with quality of life and a higher connection, a higher purpose. This approach helps that.

The Importance of Connection to Health: Oxytocin

DrMR: I’m assuming this is the part where the oxytocin connection comes in? Community relationships, tribal associations… is that something that you’re speaking to to facilitate oxytocin? By the way, I speak about this in Healthy Gut, Healthy You, and some of Shelly Taylor’s work on how oxytocin and estrogen make bonding and people and connection arguably more important for women than for men. It seems that if anyone is being dis-served by our society— which is breaking us into these small, independent factions and pulling us away from tribal associations where we always had people and connectivity—it’s really more women than it is men.

DrAC: Yeah. 100%, and we need that connection. I do speak about that: accountability, connection, having sisterhood, and bringing it back into our families too. I have a mantra. It’s probably on everything that I own, but it’s: “Pause, breathe, smile, and connect.” We know deep breathing lowers cortisol and that will help with oxytocin. High cortisol impedes oxytocin, so I talk about that in my book with my experience with PTSD, and chronic and everyday stress, and how that creates disconnect and dissociation burnout.

None of us should experience that. And if someone’s listening and has experienced that, please read my book. You’ll find some answers. There’s no self-blame in here. Just know that physiology affects our behavior. If we’re not loving the things we used to love, we’re probably off-balance hormonally, physically. And we need to improve that.

DrMR: It’s a foundational piece of well-being. Before we run to a hormone cream, we want to make sure we have the foundational pillars in place. Community and friendship is clearly one of those.

DrAC: Yeah.

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DrMR: What about any kind of supplemental recommendations? You mentioned maca. Are there certain herbal formulas or nutritional formulas that you’re recommending for some women as part of this protocol, to help facilitate balance with their hormones?

DrAC: Yeah, I do. I was thinking supplemental when we were talking about oxytocin. I thought, sex. Sex is very good for you. Have lots of it, enjoy. Patients would always tell me, “Dr. Anna, I’m not interested in having sex, but I’m okay once we get started.” That’s normal. That’s a secondary sexual response, and it’s our actual physical response. We need to understand that just being receptive is fine. We can say, “Okay, we’ll start petting, playing, and I know I’m going to be in. And that’s so good for me,” because oxytocin is the best anti-aging hormone out there and we can get it from lovemaking, kissing, hugging, playing with a pet, having fun, laughing with girlfriends, and giving, gratitude. Enjoying each other in communities.

That’s the first supplement that I really highly encourage. Nothing beats that. As clients figure it out too, they’ll say, “Oh my gosh, I was off-program and we were having wine and a great dinner, and yet I woke up alkaline.” That’s oxytocin, and that is good.

Supplemental Support for Female Hormones

For other supplements, I’d definitely say Mighty Maca Plus. Mighty Maca has maca, resveratrol, turmeric, quercetin, grape seed extract, and the list goes on. It has a combination of enzymes and fiber. That’s one of the formulas that I created from my healing journey around the world when I was struggling with that early menopause, and I believe those ingredients certainly helped me.

That’s why I’ve created it for my patients. Now it’s available and recommended by physicians worldwide. Really excited about the adaptogenic formula. The second thing I often do for women is add in bioidentical progesterone, with or without some pregnenolone. I use my Pure Balance cream. That has a little bit of progesterone, a little bit of pregnenolone, and some essential oils. The combination is really beautiful. If you’re menstruating, we just do it after ovulation, until day 28 or menses. If we’re postmenopausal, just Monday through Friday or Monday through Saturday, and take one to two days off a week if you’re not having your periods.

And women, just use it at night when you sleep. It’s also an anti-aging cream formula. My new formula has peptides in it, so I’m always looking to improve. If I’m using a cream, it’s got to have multiple benefits! So this does. It can also help with getting a deeper night’s sleep, because we know progesterone is important for our neurotransmitter GABA. GABA’s our relaxation hormone. We need more of that as progesterone declines. So supplementing with progesterone is an option, too. Then I often recommend a protein formula.

There are many that I love from different brands. I have one that’s my Keto-Green shakes. Zero grams of sugar, monk fruit sweetened, and with healthy amount of protein and fat in it. We’re looking for a good, high-quality protein shake, just for those quick and easy meals that you sometimes need if you don’t have time for a real meal. The third supplement I would recommend—if a woman is having trouble with their hormones in general, in addition to progesterone—is Vitex, or chasteberry. It’s one of my favorites.

For PMS, for perimenopausal issue or regular bleeding, often I recommend Vitex (chasteberry) with some evening primrose oil, black currant oil, or GLA. Those are a couple options too.

DrMR: You outline all of these in the book, I’m assuming?

DrAC: Yes.

DrMR: Awesome. Is there anything else about the book that you want to touch on as we move to a close?

Episode Wrap-Up

DrAC: I’m just really thrilled to have it out there. This is a book that I wish I had written decades ago. I wish I knew the knowledge when my mom was struggling with heart disease when she was 52. And she only lived to 67. She didn’t get to experience her grandkids. But I think what’s worse is they didn’t get to know her, because she was amazing. I want every person out there to live high quality days. With a life of quality and joy that they deserve. Sadly, our medical system is lacking. My mom was on 11 medications when she passed away. I see that cycle repeated in postpartum depression, diabetes, heart disease, surgery, antidepressants, medication, this, that, and the other thing.

It’s still happening today. So I just want to encourage everyone who’s listening that there is hope and a future, and wherever condition you’re in right now, you can be better tomorrow. I hope that my book serves you well in this, and your families, and your families to come, too.

DrMR: Love it. Tell people the book name again and where they can get it. If you also have a free on-ramp to the book, please tell people about that.

DrAC: Yeah, thank you. The name of the book is The Hormone Fix, and it’s subtitled, Burn Fat, Boost Energy, Stop Hot Flashes, and Sleep Better the Keto-Green Way. That’s available February 26th. We have a book bonus page on my website, which is dranna.com. We also have a free bonus for a 10-day masterclass called Breeze Through Menopause with some supplemental material to accompany the book. It’s 5-10 minute videos of me each day for 10 days, and it’s a free 10-day masterclass that I know that you will love. I’m excited about being able to give that to your audience.

DrMR: Thank you for writing the book and taking the time. Like I said at the open of the podcast, the female hormone aspect is very important not to overlook. I don’t believe we touched on this, but I think there are a fair number of women who are thinking their thyroid is the problem when it’s actually their female hormones. Not to say that thyroid is never an issue, or is not an issue. But definitely if you’ve been at this for a little while, you’re looking for some answers, and you haven’t gotten them yet, give your hormones a look. I am continually surprised at how many women have a female hormone issue rather than a thyroid issue. It’s something that needs more attention brought to it.

DrAC: Yeah, I agree completely. I think we start with, if there’s a thyroid issue, always ask why. That’s the question, why is TSH elevated? Or, if it’s not the thyroid at all, let’s look at other things and start with the major hormones first. Then, of course, I love progesterone.

DrMR: Thank you again, Anna, and until next time, keep doing the good work that you’re doing.

What do you think? I would like to hear your thoughts or experience with this.

• Get help using this information to become healthier.
• Get your personalized plan for optimizing your gut health with my new book.
• Healthcare providers looking to sharpen their clinical skills, check out the Future of Functional Medicine Review Clinical Newsletter.

Dr. Ruscio is your leading functional and integrative doctor specializing in gut related disorders such as SIBO, leaky gut, Celiac, IBS and in thyroid disorders such as hypothyroid and hyperthyroid. For more information on how to become a patient, please contact our office. Serving the San Francisco bay area and distance patients via phone and Skype.