How Ketosis Can Benefit Female Hormones & the Brain

Intro:

Welcome to Dr. Ruscio Radio, providing practical and science-based solutions to feeling your best. To stay up to date on the latest topics, as well as all of our prior episodes, make sure to subscribe in your podcast player. For weekly updates, visit DrRuscio.com. The following discussion is for educational purposes only and is not intended to diagnose or treat any disease. Please do not apply any of this information without first speaking with your doctor. Now let’s head to the show.

DrMichaelRuscio:

Hi everyone. Today I speak with Dr. Anna Cabeca. Her background is in gynecology and we’re going to definitely hit that in this podcast. However, we start off with her sharing some of her personal experience with having mold in her home, how she handled that, and also get into some discussion on EMDR (Eye Movement Desensitization and Reprocessing) and limbic retraining.

DrMR:

From there we go into quite an interesting conversation on estrogen and progesterone. In aging women, changes in these hormones may make women’s brains more resistant to glucose. Therefore, ketones may be a better source of energy for the brain. It’s so important for women to be doing things like intermittent fasting and ketogenic dieting. She’s a strong believer that this should be what she terms “keto-green” to make sure there’s enough vegetation in the diet to maintain an adequate pH. She also strongly believes in certain lifestyle interventions to ensure that someone has enough oxytocin being produced, which is a very strong influencer on pH.

DrMR:

There’s a lot there that was interesting to add to the conversation about ketosis and women. She has a little bit of a different perspective than Sara Gottfried, who was recently on the podcast. Also, what I’ve seen clinically, is that when women are too low-carb for too long, they may get into some trouble. Anna hasn’t found this when using this keto-green and alkalinity-focused application.

DrMR:

That was all interesting to discuss. We also went back and forth on hormones — meaning bioidentical hormone support for women — on what is the best approach, what to use, and when to use it. We also got into a discussion of pelvic floor health and how certain topical preparations that include DHEA – among other things – may help both men and women with pelvic floor weakness, hemorrhoids, anal irritation, or even ulcerative proctitis. Said more loosely, if you’ve had lots of diarrhea and loose bowels, this can irritate the anus and rectum. This can also cause some weakness in the pelvic floor. She’s finding – and I’m actually curious to experiment with this in the clinic – that this can be quite helpful for this grouping of individuals.

DrMR:

A few different topics, but it was really quite an enjoyable and insightful conversation. Just a reminder — if you need help with how to put together a plan for improving your own gut health and corresponding lifestyle, Healthy Gut, Healthy You is the resource I would point you to. In fact, it’s been number one in the category of gut health on Amazon, on and off for a few weeks, since its release. In addition to the paperback, the audio version is also now available if that’s something that’s easier for you to go through. Now we will go to the interview with Dr. Anna.

DrMR:

Hey everyone. Welcome back to Dr. Ruscio Radio. I am here again with Dr. Anna Cabeca who has been on the podcast in the past. She’s an expert on female hormones and that’s where we’re mainly going to go. However, we were having some pre-recording chatter and she was sharing her experience with living in Texas and having mold. So I said, “Oh, let me pause you there. Let’s record this so we can get this documented for people.”

DrMR:

I thought it was interesting that you said it was a gradual slide for you to notice your symptoms. Mine were more acute, so it was a little bit easier for me to pinpoint. Before we go into the female hormone piece, tell people briefly about your background in case they didn’t catch the last interview. Then let’s hear more about your experience with mold.

Background Information

DrAnnaCabeca:

Happy to. It’s so great to be here with you. Now I know you’re moving and are en route to Texas too. I’m super excited. We’re going to have to meet in person. I can’t wait.

DrMR:

Absolutely.

DrAC:

My background is in obstetrics and gynecology at Emory University in Atlanta, Georgia. I was National Health Service Corps, so I ended up at a small island off the coast of Georgia called St. Simons Island and had a clinic in Darien, Georgia – a small shrimping village. I really learned to take care of my patients in such an economical way, as well as understanding the underlying roots. Then, through my own personal journey, I added a bunch of tools to my toolbox. I dug into the research to help me balance hormones, help with post-traumatic stress disorder (PTSD), and address sexual health and female issues, especially around menopause. That’s been my specialty now for several years.

PTSD and Limbic Retraining

DrMR:

Awesome. PTSD is potentially a segue into mold because I think for some people it can feel like a post-traumatic stress event. In past podcasts, we’ve talked about how limbic retraining can be really helpful for some individuals. What did you notice with mold? What was your own experience?

DrAC:

What did you say? What type of training?

DrMR:

Limbic retraining.

DrAC:

Limbic retraining. I’m not familiar with that.

DrMR:

It’s also known amygdala retraining — DNRS (Dynamic Neural Retraining System) with Annie Hopper or The Gupta Program with Ashok Gupta. It’s essentially a very deliberate and intentional form of meditation. There’s quite a bit more that goes into it, but it looks on the surface like a mindfulness and meditation practice. It can help people who have had these kinds of emotional or physical traumas.

DrMR:

I believe Gupta has published two papers to date. I know they have at least one on Chronic fatigue syndrome which found fairly impressive results as compared to a placebo control set up. There was a sham intervention trial that was standard meditation. With that detail I’d have to cross-reference his study, but I know the results from the intervention were fairly impressive.

DrMR:

I think any clinician who has been using limbic retraining is probably nodding their head in agreement that it doesn’t necessarily work for everyone, but it works for over 50%. It is something that can help with food reactivity, supplement reactivity, environmental reactivity, and some of this immune system wind up which seems to partially be locked into the immune system.

DrMR:

I was feeling like I was being exposed to this thing that my body was reacting to. It can make you hyper-vigilant. I’d be out with friends having a drink and you hear the A/C go on. All of a sudden your subconscious is going, “Is there mold in the A/C? Am I going to start feeling weird in a few minutes?” It can really start to nocebo you. The limbic retraining can be helpful to start unwinding that.

DrAC:

That sounds fascinating. One of the things that I use and recommend is EMDR. Love it. I always give this PTSD example since my oldest daughter has seizures. If a patient has one seizure, she may not have another one. However, if she has two, we know she’s going to have a third. That’s how quick these patterns are set. That’s how powerful reliving the experience in mind or body is. It sets these pathways. Resetting – erasing the tracks – so we can be liberated from the pathway that’s been set in motion without our volition is really powerful.

DrMR:

Yes. 100% agree. We’ve done one podcast on EMDR. I haven’t referred for that as much, but it seems to be in that same camp. Full agreement – definitely something that’s really helpful for people. Was that something you had to use yourself?

DrAC:

Yes. I definitely used it in my own medical practice, but also personally.

DrMR:

If you don’t mind getting a little bit personal for me really quick – what were the symptoms? I wouldn’t say it’s brain fog, because I’ve experienced pretty severe brain fog back when I had a parasite and was having really bad and pronounced food reactivity. This was a much more mild manifestation where it just seemed like I had a hard time with deep and continual focus. I would find myself feeling a little scatterbrained. I’d be more prone to doing something else like going to check the temperature or going on Facebook. The thing that was the build hitting over time was that I was sleeping very lightly. I had this insomnia that really started to grind me down. That manifested pretty quickly, so it was easier for me to see, but you were alluding to having a slower manifestation. I’m curious to hear more about that.

DrAC:

My own experience was with PTSD for EMDR. There were just arms of triggers to be avoided, related or not – being in the restaurant and hearing the air conditioning go on, turning a corner for me was a trauma trigger. I still avoid certain places and I think that’s okay. I think I’ve come to just say, “Okay, I just don’t have to go there.” EMDR really helped me with flashbacks and some of the connective triggers that were spidered out and affected me.

Experiences with Mold

DrAC:

The experience with mold was really fascinating. At first, it was in my house in Souther Georgia – right on the coastline a mile from the beach.

DrMR:

Perhaps the house had a long history with mold.

DrAC:

It was quite an education. We learn so much because of our personal journeys, our family journeys, and from those we love and take care of. One of my daughters had repeated respiratory issues and one day I walked into her bedroom when she was 8 years old. I could hear her labored breathing and her face was as red as could be. I looked up and saw black around the vent. That started a big excavation and learning all the ways to test for mold. I just took out every piece of duct work and rebuilt walls. It was a crazy time period.

DrAC:

I came to Texas thinking, “Dallas, Texas. That’s got to be pretty dry.” That wasn’t why we came. We came for the rodeo and barrel racing because my youngest – who is now 13 years old – is in love with horses and barrel racing. For those that don’t know, barrel racing is a turn and burn sport. It’s part of the rodeo and it’s on a very fast horse. You do a cloverleaf pattern around barrels as fast as you can go to win a prize, to win points, to win a place, and to win money. I always joke with her that sometimes I drive hours to watch her for 16 or 17 seconds. It’s very fast and very competitive. Parents of young athletes get that.

DrAC:

That was what brought us to Dallas initially. We were renting this Airbnb on this cute old building built in the 1960s. There was a huge pool and we were a first level condo. It was a nice little furnished rental for us. I had been traveling. I had driven across from Georgia to Texas hauling horses and doing all these things. I was exhausted. There was also incense from the person who lived there before me. There was so much incense that I didn’t smell it. We just lived, were busy, and were going back and forth between the ranch.

DrAC:

However, I left for a couple of weeks and went back to Georgia. When I came back, I could smell the mold. It was so bad. I recognized the symptoms that I had been experiencing. I thought they were just from running around hauling horses and Texas heat, but nothing too out of the ordinary for my pedal to the metal lifestyle. I had fatigue, difficulty sleeping through the night, congestion, and a 15 pound weight gain. I’d wake up in the morning and my eyes were very tired and congested. My lids stuck together. It was so bizarre.

DrAC:

I always thought that I didn’t have any mold sensitivity whatsoever. In my house in Georgia, I never recognized it. I knew my daughter did, but I thought there was no issue for me. I’ve had patients with incredible mold sensitivity. They can go in a place and all of a sudden feel debilitating neurologic symptoms because of the mold and toxin exposure. I was really surprised to see that kind of insidious onset. I didn’t recognize it until I was gone and came back. We then moved to another really cute place on the 14th floor. I lived on an island for 21 years. One story, no hills, no anything, and now I’m on the 14th floor of this amazing condo building here in Dallas. No mold.

Mold Remediation

DrMR:

Wow. So you went through it firsthand. A lot of what you said is interesting and thought provoking. When the A/C would kick on at the second place that I lived in Austin, it would smell like an old lady. It would smell like my fourth grade teacher, Ms. Reedy – this very older woman perfume. It would drive me nuts, like, “Why does it smell like Ms. Reedy every time the A/C goes on?”

DrMR:

When the IEP (Indoor Environmental Professional) came out to do the investigation, he said, “Yeah, someone must have seen this mold or had been able to smell it, and they just doused the HVAC unit register with perfume to try to cover it up.” That thwarted my ability to smell it. I was thinking, “Well, is this mold?” It was very fragrant. If I do have mold growing, it must be a weird smell like perfume. That’s the one observation.

DrMR:

The other thing that runs through my head is having to replace the duct work and going through this laborious process. Having interviewed a few mold remediation specialists, I suspect a fair degree of those horror stories that you hear come from people that aren’t investing in a good IEP consultant on the front end. They’re just flailing their way through.

DrMR:

This happened to one of my colleagues who was so keen to clean the mold. He didn’t follow my recommendations because he had to wait a couple of weeks to speak with an IEP. He just found the first remediation specialist he could. They remediated and the retesting found the situation was even worse than before. My thinking is this is not as hard to sort out as it might be portrayed. For example, SIBO is oftentimes portrayed on the internet as this thing you can’t ever get rid of. However, if you work with a good clinician, it’s something that you can get through pretty quickly.

DrMR:

That’s been my tacit read on this. It’s harder if you don’t have good consultants to walk you through this. Then, if you do need to do something like EMDR or limbic retraining, it can make this whole process so much more emotionally charged. It can look more difficult than it has to be if you’re reading message boards or things like that. Perhaps you have a different perspective on how hard it is to remediate mold. What are your thoughts?

DrAC:

I think that’s a really great point. Just understanding the ins and outs. I’m not even up to date on the latest information or recommendations. In 2010, we got rid of the mold in our house. We completely gutted everything and put dehumidifiers in the HVAC systems. It was a roof leak that started everything, so we did a complete renovation and then retesting. We paid close attention to humidity levels and had a UV light in the HVAC system. At this point, I don’t even know the best way to address remediation.

DrMR:

All the more reason why I think you should refer to someone who is the doctor of the home — meaning the indoor environmental professional.

DrAC:

Absolutely. It makes a difference because we did the ERMI (Environmental Relative Moldiness Index) testing. It was interesting to compare those before and after results from doing the different types of air quality testing. For you, it was the perfume; for me, the incense at this new place. We need to trust our intuition and this little voice inside that says, “Huh, what is this?” Keep asking the questions. Keep thinking, “Okay, well, why did they need to put so much incense in the house?” Or, “Why did they have to spray the perfume?” Trust the energy that you feel in the environment you’re walking into – especially in a new home.

Menopause

DrAC:

Menopause is a natural process, but so many women will suffer through. In their head, they think, “Okay, I’m just supposed to live with this,” or, “The doctor says I’m normal, but I don’t feel normal. I know I’m struggling.” I would say menopause is natural and mandatory. Every woman will go through it. Suffering is optional. There’s so much we can do about it. Then again, just trusting that inner voice saying, “I know there’s a next right step for me.” If you feel that, take it.

DrAC:

Sometimes you’re stuck in the toxic environmental world, too. You can’t renovate your home or you can’t get out right away. There are those challenges. So working with EMDR or indefinitely retraining, you’ve got to think, “Okay, what’s my next right step to be free from that? What’s my next right step to stop the suffering? What’s my next right step to thrive? What are the things that I need to do?” Being told you look okay, that this is a natural process, or it’s in your head – that is not okay.

DrMR:

Even something that is in your head – maybe something like a limbic imbalance or something that requires EMDR – it’s not the colloquial way your head is used. The problem could be some neurological inflammation or the resetting of the tracks, as you said before. Not “It’s in your head, shut up and go away, or take an anti-depressant,” but an imbalance in the brain that could be supported. There’s always something to do – to your point of not suffering through symptoms. Some people might say, “Oh, well, I’m having hot flashes and I’m not sleeping well because of age, just like everybody else,” and kind of normalizing this.

DrAC:

Right. Back to in your head. One of my big ‘aha’ moments going through menopause the second time was driving home the point of in my head — the brain fog, the loss of focus, the inability to concentrate, the anxiety, the mood swings, the irritability. All of these things were in my head. You think, “Well, what is going on here?” That was coupled with weight gain and amenorrhea (loss of menses) in perimenopause. Add a couple of hot flashes in there and that’s not fun. That’s something women say – “Well, that’s just a natural transition.” But, it’s not.

DrAC:

What’s happening in your head is your brain is starving for fuel. Our brain will use glucose for fuel predominantly when it’s available. The second fuel source, which is even better, is ketone. So glucose is to gasoline as ketones are to jet fuel. In this time of perimenopause, the ability to use glucose for fuel is being strangulated. It is being suffocated because gluconeogenesis in the brain is a hormone dependent process. According to the research, we get that huge decline in progesterone between ages 35 to 55 along with our other sex hormones. Add in a little bit more stress and cortisol to rob that progesterone a little bit more, and your brain is starving for fuel.

DrAC:

Even with a healthy American diet that is relying on glucose, you have to shift to ketones. In menopause and perimenopause – age 35 to 55 and on – it is mandatory to go keto-green and keto-alkaline because the use of ketones for fuel in the brain is not hormone dependent. As I experienced, “Hey, I’m not doing anything different. I’m gaining weight. I have brain fog. I have irritability. What is happening? Okay, I get this hormonal change, but there’s nothing normal about this. There’s nothing healthy.”

DrAC:

We can breeze through menopause into the second spring of our lives. The way we need to do that is to shift the fuel for our brain. We need to shift into this keto-green type of lifestyle using ketones for fuel but, in a healthy way with good plant-based nutrients, alkalinizers, detoxifiers, or adaptogens. These are important ingredients that feed us in so many ways – especially as women. Men have 10 times as much testosterone. That’s an anabolic steroid. Men do keto easier – they’re not going to break down bone and muscle mass like women will.

DrAC:

This keto-green component is hugely beneficial. As women experience this shift, the hot flashes go away. We have research that shows that within 16 days, we can see an 80% reduction in all of these symptoms women suffer with for years — brain fog, memory loss, hot flashes. This is because we’re managing cortisol and insulin. It’s so much more important than micromanaging estrogen.

Keto-Green

DrMR:

There is so much there to unpack. This is fantastic because I truly have not heard of some of these things — namely this research that you’re discussing where the menopausal hormonal shift leads to a harder time with gluconeogenesis or blood sugar regulation. This is really interesting. Obviously, whatever we can do to get anyone’s brain function at optimal is a huge gift. As someone who’s suffered from brain fog, I just know how devastating that is. Run us through what the mechanism is and how this all plays out.

DrAC:

This isn’t in textbooks. I just saw a late 2015/2016 research paper after I’d been through my own journey getting keto-green. That was looking at the use of glucose in the brain and these neuroendocrine symptoms. I’m a gynecologist. Since my 20’s, I’ve taken care of patients with hormone imbalance symptoms. This has never been addressed or talked about in any of my medical education or specialized training. I experienced the brain fog, and then asked, “Well, why do women get twice as much Alzheimer’s as men?” I continued to dig through.

DrAC:

Patients throughout history of my clinical practice would come to me and say, “Dr. Anna, I think there’s a monster within me. I just don’t know why I’m reacting this way, and then I feel so guilty.”

DrMR:

I’ve met that monster.

DrAC:

Where does this come from? It’s so true. I get it – I experienced that firsthand. The predominant reason I created my keto-green plan was to drop the extra weight that I gained. However, the brain clarity – the memory re-gain – resulted in what I call a feeling of energized enlightenment. I was like, “Wow, I get ketones are a powerful brain fuel, but what’s going on here?”

DrAC:

It wasn’t just getting into ketosis. It was getting into ketosis with an alkaline urine pH. I write about this. I think urine pH testing is a vital sign as important as our pulse, our blood pressure, etc. It tells us so much. We want at least a urine pH of seven or higher – a more alkaline urine pH. It’s just a grounding physiology that you feel at home in your body when you’re living in this zone.

DrAC:

I challenge everyone on this call to check urine pH. Get into the state of being with an alkaline urine pH. Write to me. I want to hear it because it’s game changing. My audience and my community says it feels like Christmas. You just feel so supercharged and it’s really a nice thing. I experienced it. If I hadn’t experienced it, I wouldn’t know, but I needed to ask why.

DrAC:

This concept of “Why do women get twice as much Alzheimer’s as men?” “Why do you have more dementia in women than men?” This really has only recently been addressed by looking at some of these studies. That’s just so powerful. I found that the shift is in this time period – from when progesterone levels start to decline – as we shift into this more keto-green or keto-alkaline lifestyle.

DrAC:

It’s not just about what we eat. In my second book, Keto-Green 16, it’s 16 hours of intermittent fasting. No snacking. We’ve got to stop that. We have to eat earlier in the day. When we eat is important. Certainly what we eat, too – like a healthy amount of fats. I was in college and high school in the 80s, so the low-fat movement was full on. So women my age are now going through menopause or are through menopause and we were brainwashed against fats. We need fats. Hormones are made from fats. That’s a crucial piece.

DrAC:

Of course, there is quality protein. We need enough protein to maintain our muscle, our metabolism, and mitochondrial function; all the good nutrients that we get. The alkalinizers and dark green leafies with fiber maintain our microbiome and diversity of the microbiome. We know, based on so much research that you share about, that this is critical for gut health.

DrAC:

There’s a transition time. There’s a time when women are going through perimenopause and menopause. It’s a time of transition. Yhe sex hormones are falling. We have higher levels of cortisol as we age and higher levels of insulin. We are becoming more insulin resistant as we age. The concept I teach is that intermittent fasting and the carb restriction is creating this insulin sensitivity. We see physiologically the drop in hemoglobin A1C.

DrAC:

I’ve seen a client go from 6.0 to 5.4 in one month with hemoglobin A1C. That was pretty cool. You typically wait two months to test, but she was gung-ho and she’s a physician. So, she tested in one month because she was feeling amazing, and that was the best it had been in 10 years. That shift is increasing her longevity right there. It’s decreasing her risk of Alzheimer’s and dementia, as well as other cancers and metabolic syndrome.

DrAC:

That insulin sensitivity piece is key to the keto-green plan — teaching clients to eat earlier in the night, to intermittent fast longer, to not snack, doing things that are fun, and to embrace a more oxytocin laden life versus a more cortisol life. Having lived in the PTSD world and converting that to post-traumatic growth and resilience really requires making oxytocin the crowning hormone of your life.

DrMR:

Shelley Taylor wrote some interesting early work — When under stress or not feeling well, men seem to do better with fight or flight and women do better with what she terms “tend and befriend.” She feels oxytocin is much more important for women than it is for men. Not to say it’s not important for men at all, but there is this estrogen/progesterone/oxytocin tie in for women. It may be even more important for women to make sure that they’re doing these things where they’re having time with people and are not just go, go, go sympathetic all the time.

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DrMR:

It’s brilliantly said to be using the keto diet and fasting to establish better insulin sensitivity. We’ve talked on the podcast before about Type 3 diabetes, which is proposed to be one of the drivers of neurocognitive conditions like Alzheimer’s and dementia. Something like a keto diet and fasting – I should asterisk a healthy application of a keto diet because not all are created the same – seems very reasonable, practical, and definitely something that I would be expecting to really improve how a woman is feeling on multiple facets.

Length of Keto Dieting

DrAC:

There’s one follow-up on this I have because I’m in such strong agreement with all of this. There is this observation that prolonged ketosis may be a problem for women. This is something we recently discussed with Sara Gottfried and she recommends a pulsed keto approach. Is this something that you’re incorporating into your plan? Perhaps you don’t find it to be an issue for women? Is prolonged ketogenic dieting something that could lead to fatigue, insomnia, or other negative symptoms?

DrAC:

Are we testing or guessing? How well are we doing a ketogenic diet? Are we actually getting into ketosis? Are we checking urine pH? Are we checking to see that we live more alkaline? Do we wake up with a urine pH of seven or higher and go to sleep with a urine pH of seven or higher on most days? Let’s really work on that. A weekend trip camping and you’ll be alkaline. A party out with your friends and laughing and playing and you’ll have oxytocin – the most alkalinizing hormone in your body. How well is that in your life? The actual food is really just 25% of it. Who are we eating with? How are we eating? Are we stressed? Have we blessed our food? All of these things affect our physiology even more.

DrAC:

That’s one of the things that I recognized with urine pH testing. Oxytocin is so alkalinizing. As I went through my journey – when I would gratitude journal or walk on the beach – I was more alkaline in my urine pH all day, despite not doing anything different. That was the hot moment that made me realize cortisol is acidifying and oxytocin is alkalinizing. Who talks about hormones like that? No one does.

DrAC:

I’d go straight to the head academic nephrologist and to the research. Cortisol increases the hydrogen ion secretion across the renal tubules of the kidneys. It leads to excretion of a more acidic urinary pH, so you can see if you’re running. For those of us who have PTSD and those of us who just power through because we’re so capable of doing it, you forget how good you can feel until you start feeling good again. You don’t really realize how bad you’re feeling until you start feeling good again.

DrAC:

That’s a really important point of testing and not guessing. Check blood markers, check urine pH, and check ketones to really see where you’re going. I always say I have a 10/80/10 rule because there are seasons for a reason. There’s change and constant highs and lows in life. The longest lived cultures have tremendous celebrations. Food is to be celebrated, enjoyed, praised, and for us to be grateful for. You break bread with people you care about and enjoy. There’s much more to food than what we’re actually eating.

DrAC:

In this whole journey, I tried to create programs that I can live with as well. So 10% fasting, 80% keto-green, and 10% feasting. No guilt. I was interviewed on Khloe Kardashian’s keto plan. It was pancakes on Sunday, but she was in ketosis losing weight and feeling great. I’m like, good for her. If she has no other medical conditions, she’s having success, and she’s 80% following a healthy plan for her, I think that’s a step in the right direction. Restriction fatigue and feeling like you’re denying yourself is a real issue. I don’t care if you’re eating the best food. That feeling of denying yourself is destructive to your body. So celebrate and enjoy.

DrMR:

I definitely agree with you on that piece.

DrAC:

We have to break bread together now. Well, without the bread and gluten. We’ll break some cucumbers together.

DrMR:

I do okay with a little bit of bread. I’ll just put this on the table for whoever it may help who is on their food journey and struggling with that. I tend to be pretty dialed in with eating healthy most of the time. I think your point is an excellent one. I don’t feel the need to be restricted, but I notice that I perform better, look better, and sleep better when I eat a certain way. There’s no motivation for me to come home and have a bunch of bread or other stuff that I don’t feel is a healthy food. Again, it’s not for me feeling restrictive, but it is a fairly healthy dieted baseline.

DrMR:

However, let’s say tonight, if I were to go out with friends and go to dinner, then I’d probably have bread and maybe some dessert, and just enjoy that to your point of feasting. I think it is important for people to keep that in mind. I like the 10, because it’s enough where you’re not having three glasses of wine and some ice cream every night and saying, “Well, it’s my 10%.” Are you doing the math on that? It’s not tallying quite to 10.

DrAC:

I love that. That goes again to how we’re eating – enjoying that bread and dessert. When I grew up, my mom was a baker so we had a saying, “A meal has not been eaten until you’ve had dessert.” You’re not sitting by yourself eating a pint of ice cream, watching TV, and then feeling guilty about the ice cream you’re eating. Look, I’ve been there. I did that in the 80s, okay? I’m liberated from that. I also have a dairy sensitivity. I found out that sometimes what you go for the most is your food sensitivity. Choosing other ways or knowing the consequences of when you do eat something matters.

DrMR:

I’m waiting downstairs here in Dallas and there’s a French restaurant called Toulouse. I was eating here with our mutual friend Magdalena. She was visiting me here and they have soufflés. I was like, “A Grand Marnier soufflé? It is still my birthday week.” I think I will so enjoy that. Again, oxytocin over cortisol. Always choose oxytocin over cortisol.

DrMR:

This is the potential double-edged sword of all this information that people have at their disposal. FODMAPs can be a problem. Histamine can be a problem. Too much carbohydrate can be a problem. And if you go even deeper, oxalates and salicylates can be a problem. That can be helpful, but we have to be able to compartmentalize this information and run objective experiments on ourselves. We cannot just take everything we’ve learned that could be a problem with food and then end up in this ARFID (Avoidant Restrictive Food Intake Disorder) or orthorexic sort of territory.

DrMR:

Yes, I think it’s important for healthcare providers to be disclosing that they’re not personally doing low-carb, low FODMAP, low-salicylate, low-histamine, and/or low-oxalate diets. There’s a certain camp I feel best in and I generally follow that, but there’s some blurring of the margins. There are definitely times for which I’m going to have whatever I want, save for maybe one or two things. As Melissa Hartwig says, “Is it worth it or is it not worth it?” If you’re someone who has a really powerful intolerance to dairy and you’re going to be bloated for the rest of the night, maybe it’s not worth it. We all make these kinds of calculations.

DrMR:

I just want to step back for one quick second to make sure we don’t go too far from this. Your observation has been that when attending to and using whatever interventions are needed to keep one at an alkaline pH – whether it be more greens, sleep, nature, or time with friends – you’re not seeing what others are reporting as this deleterious effect from prolonged ketogenic dieting?

DrAC:

No – not in our keto-green community. We are tens of thousands strong at this point. I took it online in 2015. I have some clients that have been strictly keto-green. I think of this one client, Mary – she’s a lovely, amazing professor-type person. She’s in her 60’s and we talk about feasting. She goes, “Dr. Anna, I can’t.” For her, it does trigger an eating disorder. So, she has been pretty steady.

DrAC:

What I hope to curate in the community is that 10/80/10 rule – or whatever it may be for you at this time. “What’s the best you can do at this time? How do you feel?” That’s important. If you’re checking your pH, following your body, listening to it, and carbing up when you need to, that’s an important part of healthy metabolic flexibility. It’s about doing it without obsession.

DrMR:

Right. You’re leaving the door open for that with your 10% feasting. Ostensibly, people are not going to be feasting on cheese and steak all the time. There’s probably going to be a fair amount of carb dense food that’s getting into that 10% feasting.

Experimenting with Diet

DrAC:

In my next book coming out in April of 2022, it will be addressing some of these things I’ve seen in the community. It’s called Menu Pause. I just laugh every time I say it.

DrMR:

That’s great. You got me, too.

DrAC:

Yeah, it’s called Menu Pause. I created five six day plans. Just quick six day plans – two 72 hour cycles for the gut. I created different ones – auto-immune, carb-restricted/carnivore, plant-based, smoothie-focused, and fasting/gut-healing regimens. Check yourself on these days. How do you feel during and at the end of these six days? What are you struggling with? Where do you feel accomplished? Where do you feel charged? Where do you feel energized? Where do you feel the best?

DrAC:

How do you break through a plateau? We can get to this place in menopause and perimenopause where we get in that stalled out zone sometimes. I’ve seen that in my groups and in my own life. So switch and alternate – do some plant-based for a week, try a carb-up for a bit, do a complete carnivore(ish) restriction, and then do a keto-green extreme plan for a very low FODMAP diet. These are different things to just try to see how your body resonates. Break the pattern of your chicken and lettuce salad.

DrMR:

One can learn so much just by running experiments. This is definitely something many people (including myself) are just guilty of. We get into a certain pattern and don’t break it. I did this with exercise and I did this with diet. This is one of the reasons why I’ve tried to be such an advocate. Even though things like a paleo diet can be helpful, that kind of diet can be really high in histamine. There was probably a several month period where I was having brain fog due to just eating what I loosely call ‘the lazy man’s diet.’ I would wake up, have a can of tuna fish and avocado, and then sip on kombucha in between breakfast and lunch. At lunch, I’d have some jerky, some sauerkraut, and a little bit of lettuce. For dinner, it might be some salmon, but I cooked it yesterday.

DrMR:

It was just way too much histamine, at least for where I was in my gut-healing journey. I needed to get out of that rut, but as you’re alluding to, there was so little discussion to these different diet trials people can run to just to discover stuff. So I strongly echo what you’re saying. These experiments are really important to get us out of our ruts so we can get perspective and learn. Maybe I wasn’t spending enough time with people… maybe I was too stressed and I didn’t realize it. The stress wasn’t stressful, but it was just rapid task execution all the time. Until I had watched the sunset one night, I didn’t really realize that. I strongly agree that getting one’s self out of a rut is usually a pretty helpful exercise to learn more about what you need to feel your best.

DrAC:

I agree. It’s that self-experiment time and finding what’s resonating with you at this time of your life.

Bioidentical Progesterone

DrMR:

When it comes to female hormone support – whether it be bioidentical or using something that’s herbal in nature – I think there are two general camps. I’m not fully ensconced in the literature here, but there seems to be this empiric self-experimentation to find the lowest and most minimally effective dose vs. test, go on a target amount, re-test, and hit the target levels. Perhaps my framing is incorrect. Feel free to disagree with it. If the framing is correct, what are your thoughts on those different types of approaches for the women out there. They might be grappling with, “Well, my OB said I can do this. My natural-minded provider said I can do that.” What has your experience been?

DrAC:

I think it has to resonate truth with the individual. I’m glad you brought this up. Because of the way we live in our American society, I’m a big believer in women using bioidentical progesterone in perimenopause for the rest of our lives. I sometimes use it in men with insomnia, depression, and things like that. I will use small doses, but in women predominantly because of our reliance on ovarian function. With or without a uterus, progesterone is so important for the brain.

DrAC:

That drop in glucose utilization in the brain – or gluconeogenesis in the brain – is a function we know of estrogen. Estrogen is really derived downstream from progesterone. So we keep our top hormone levels healthy. I had to create things because there was nothing for me. My Mighty Maca Plus came from that – the 30 superfood combination. We see an increase in progesterone and DHEA in just two months of use. That’s a natural herbal combination that helps with that. Also add in that bioidentical progesterone – especially in menopause and beyond – and it should always only be bioidentical.

DrAC:

For me, I created my balance cream which has progesterone and pregnenolone. These are both important mother hormones that are needed, again, with or without a uterus. The reason I started using it in patients without a uterus was for the other benefits – the neurologic benefits – to help them with brain fog, mood swings, and difficulty sleeping. I’m like, “Well, let me give you progesterone.” Every single woman who came back who had a hysterectomy was told they’d only need estrogen and no progesterone.

DrAC:

Every single woman that came back said, “Dr. Anna, I feel like a cloud has lifted. I can think clearly. I’m back home in my body. I’m sleeping better. I feel rested.” Is it because of the progesterone or the better night’s sleep? It doesn’t matter. Progesterone is a neurohormone. It has incredible action in the brain. Yet, we deny it from women or give them a synthetic form that does more harm than good. That’s just pathologic; that’s malpractice in my opinion. Based on the research, with bioidentical progesterone there is no increased risk of breast cancer. With synthetic progestins, there is an increased risk. How much do we need to take? I think that’s really powerful. So, I’m big on progesterone.

DrMR:

I know there were some re-formulations of some of the synthetic progestins. Does that association still hold with the newer cropping of synthetic progesterone?

DrAC:

There are different derivatives of progestins like the norpregnane and pregnane derivatives. All of them have a higher risk of pathology than bioidentical progesterone.

DrMR:

That’s good to know. What I try to do is be naturally-minded. However, if there’s something in the more conventional camp that is innocuous, I try not to lump everything together. That’s really helpful for me to know that even the newer age re-formulations are still showing this increased risk.

DrAC:

We’ll see more results on that, but you can feel the difference in patient symptomatology. With progesterone, Prometrium is a bioidentical progesterone. It is in a peanut oil base, but any physician can prescribe it. Some physicians still adhere to “If you don’t have a uterus, you don’t need progesterone.” That’s just not true.

DrAC:

For vaginal health and using progesterone on the pelvic floor, there are progesterone receptors in our fascia. We become stiffer. Progesterone in pregnancy is a predominant hormone. It helps with laxity so that we can deliver this big baby. It helps keep us vaginally lubricated and flexible in so many ways. DHEA is also another hormone that men and women both start to lose in their 20’s – being able to add that back in a topical, safe way is really important.

DrAC:

Typically, if a patient is in their 60’s and they come to me, I recommend starting bioidentical progesterone transdermally. I always start transdermally with a dose that’s going to be effective. I’m not going to play around. I want the lowest effective dose, but I want an effective dose. I’m not going to give you a low dose of hormone just to resolve your hot flashes momentarily.

DrAC:

I want it to be healthy. As I told my patients, “I’m not just going to give you a pill, a prescription, or operate without you doing the fundamental groundwork and detoxification.” I had a med spa too, so detox before Botox — detoxification, adrenal support, a strong nutritional lifestyle, and an exercise program that suits you and that you have fun with. That’s more important than anything I can write on a prescription pad.

DrMR:

Amen to that. Are you seeing a subset of individuals who need some additional estrogen, even after a term or some adjustments with the progesterone?

DrAC:

I absolutely do. I typically will start with progesterone and again, adrenal support. I’ll do progesterone, Mighty Maca, and really work on a keto-green detox. I’ll start there and then add DHEA and then estrogen and/or testosterone. It depends on the individual. Sometimes I’m like, “Okay, there’s no sidestepping this. Here it is, all of it.”

Pelvic Floor Health

DrMR:

I’m glad you say that. There have been a handful of cases in the clinic where the individual clearly needed estrogen. It seemed that either the patient or the provider was scared to give it. It’s always good to corroborate if other people are seeing these things also.

DrAC:

If the provider is not prescribing estrogen for them, that’s where you can increase both progesterone and specifically DHEA to bypass that. I use it transdermally in my Julva cream. DHEA is one of the topical ingredients in Julva. Julva is my anti-aging cream for the vulva, but it is for the most important real estate in our body. It’s clitoris to anus – I call it clit cream, moisture maker, butt butter. DHEA with the stem cells from the Alpine rose is a miraculous combination.

DrAC:

DHEA intrinsically converts to estrogen and testosterone. We can supplement with a clean form of DHEA orally, but also transdermally. As women and men get older, taking care of the pelvic floor is more important than taking care of the wrinkles on our face.

DrMR:

With men or women, you’re finding some application to the perineum is helpful for the pelvic floor. We have one or two more guests coming up regarding the importance of the pelvic floor for people who have constipation, bowel urgency, or even a vague low abdominal pain. You’re finding that DHEA applied there topically is especially helpful.

DrAC:

Yes. DHEA for men and women. I’ve operated on patients with anal fissures and hemorrhoids. There is vulvar vaginal dryness and clitoral atrophy as we get older. Every one of us is going to experience wrinkles. You will. I am. The wrinkles that we’re experiencing in the pelvic floor are detrimental to the quality of life that we’re going to live. They cause incontinence, prolapse, hemorrhoids, and bowel issues.

DrAC:

When we’re working up a patient with constipation, we sometimes ask if they have to put their fingers in the vagina to reduce the bowel so they can have a bowel movement. This is because the pelvic floor – the walls between the posterior vaginal wall – becomes lax. Adding topical hormones back – DHEA, progesterone, and testosterone – can make a difference and have a benefit on the pelvic floor.

DrAC:

Estrogen only works on the mucosa and sadly, most women only get vaginal estrogen. Now that my product Julva has been out, a lot of men and partners have been using Julva, too for anal health, erectile function, and sensitivity. It’s pretty cool.

DrMR:

Interesting. I’m picturing a man who might have ulcerative colitis, ulcerative proctitis, or even IBS where they’re going to the bowels a lot. There are hemorrhoids and there is irritation. Is this an application where you think this cream could offer benefit?

DrAC:

It is game changing. I tell clients to buy a couple tubes at a time. Keep one at the bedside because it’s great for sexual health. Also, keep one in the bathroom, put a dime-size amount on a piece of toilet paper, and wipe with it. For women, wipe clitoris to anus. Let that soak in or massage it in. Guys can wipe with it, too.That’s just a very clean way to remember to use Julva every day to help. It does make a difference.

DrAC:

I had a 65 year old male client who was consulting with me on bleeding hemorrhoids. I wasn’t his physician, but I’m like, “Let’s start with Julva and talk to your doctor.” He said the symptoms went away. Up to today, he hasn’t had any other issues with hemorrhoids and that was over a year ago.

DrMR:

That’s great.

DrAC:

It makes sense because we’re using these pro-androgenic hormones to help build muscle and to help maintain tissue integrity. Because the pelvic floor is so vascular, it responds so well.

DrMR:

That’s great. These hormones are anabolic are involved in repair. So if there’s been chronic diarrhea, urgency, or inflammation, there will presumably be some tissue catabolism. That’s actually really good to know. I may keep that in the back of my head for certain patients in the office.

RuscioResources:

Hi everyone, this is Dr. Ruscio. In case you need help, I wanted to quickly make you aware of what resources are available to you. If you go to DrRuscio.com/resources, you will see a few links you can click through for more. Firstly, there is the clinic, which I’m immensely proud of the fact that we deliver, cost-effective, simple, but highly-efficacious functional medicine. There’s also my book, Healthy Gut, Healthy You, which has been proven to allow those who’ve been unable to improve their health, even after seeing numerous doctors, to be able to help them finally feel better. There’s also our store where there’s a number of products like our Elemental Heal line, our Probiotic line, and other gut-supportive and health-supportive supplements. Health coaching. We now offer health coaching. So if you’ve read the book or listened to a podcast like this one or are reading about a product and you need some help with how or when to use or how to integrate with diet, we now offer health coaching to help you along your way. And then finally, if you’re a clinician, there is our clinicians’ newsletter, the Future of Functional Medicine Review, which I’m very proud to say, we’ve now had doctors who’ve read that newsletter find challenging cases in their practices, apply what we teach in the newsletter and be able to help these patients who are otherwise considered challenging cases. Everything for these resources can be accessed through DrRuscio.com/resources. Alrighty, back to the show.

Episode Wrap-Up

DrMR:

Anna, it’s always great talking with you. Is there anything additional you want to make people aware of? Where can people track you down online?

DrAC:

Thank you. It’s always great talking with you. Who knew what we were going to talk about today?

DrMR:

I know.

DrAC:

I love that about you. That’s awesome. Thank you for having me and I thank your audience for listening. You can find me at my website: www.drannacabeca.com. I have a section where I have ‘The Girlfriend Doctor Show’ like your amazing podcast here. You can ask or tell me anything. I really feel that’s an important way to stay connected to what is real and important to our audience. I also have my essential reading books -The Hormone Fix and Keto-Green 16. I also love connecting with people on Instagram @thegirlfrienddoctor and in my Facebook keto-green community. A lot of great ways to interact.

DrMR:

Anna, thank you again. It’s always great and interesting speaking with you. I love how we just went all over the map here, but it was all useful. Even though there were many tangents, we were able to tie together what I’m hoping will be some insights and actionables for people. Let’s try to connect in person when I’m back in Texas.

DrAC:

I look forward to it. Thanks for having me.

DrMR:

Awesome. Thank you again.

Outro:

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