Birth Control for Perimenopause? Why Bioidentical Hormone Therapy Fits Better

All right, everyone who's live, welcome. Uh we're going to be going live twice, once or twice a week now with the providers here at MedMatrix, talking about different uh topics, everything health and functional medicine related that uh we get from patients every single day. So today we're going to be talking about a couple things. We're going to start talking about female hormone replacement therapy and menopause um and some of the biioidentical hormone replacement treatments that we have available at Menatrix. And uh disclosure, everything anything we talk about today is not medical advice. Um but with that said, we are joined by the lovely Dr. Rose. Dr. Rose, thank you so much for joining. Thanks for having a long day of work. Yeah. How many patients you see today? I saw 13. Nice. That's a busy day. Normally it's like seven, right? Or eight. Depends. Yeah, it was. It felt definitely felt full. Yeah. Was it a lot of more follow-ups? More follow-ups. Only a couple new. That's awesome. Cool. How did that go? When do you before we get right into stuff, when do you normally start seeing improvements in patients? Is how often are patients seeing improvements in uh three months versus, you know, taking six months to a year to like really notice different changes in their health or is it just really that different for everyone? Are we talking specifically people who start on bio identical HRT or No, no, we're just broad. broader than that. Um, oh, it doesn't usually take usually within three months we can start to see if we're going in the right direction. Um, yeah. I mean, the way that I usually talk to people is like in general this is a slower medicine because we're supporting the body's own healing, own metabolic pathways. We're not really like suppressing anything. But um I can usually tell by 3 months if we're going, you know, if we're if we're headed in the right direction, if we're on the right track. Okay, cool. Well, we'll probably do another episode on the timeline and expectations of functional medicine, but we got to stay on track and my squirrel brain will get us totally off track. So, let's go back to hormone replacement therapy. So, uh yeah, give can you give a little context just on your expertise with uh hormone replacement therapy specifically for females and biioidentical hormone replacement therapy? Yeah. Um, I mean it's probably I would say 80 75 or 80% of what I do every day involves um like evaluating kind of a woman's baseline hormonal status and that is that includes um lab results which I'm sure we'll talk about more um and her current symptoms just her history and discussing whether some form of bioididentical HRT makes sense for her. So it's um yeah and I've done a fair amount of continuing education over the years. I try to stay current um as our viewers may know. I mean things are things are changing I think for the better in the kind of main terms of mainstream awareness. Um, so just kind of keeping up with that and um, both in terms of safety, efficacy, what you know, what forms of hormone replacement make the most sense, meaning like topical versus oral. Um, yeah. Gotcha. Okay, cool. So, let's start with got a bunch of questions here that are pretty common. So, what So, is because people go to their primary care provider, conventional doctor, and very often they'll ask for, you know, things like their sex hormones tested. We hear this all the time from patients and um either they're just told flat out no or sometimes I'm sure they say yes. But also a lot of times say blood hormone testing with through blood doesn't actually matter. How much of that is true? How much of that is um not true? Um so we like to get baseline blood work um on women for a couple reasons. Every individual is different. So, um, uh, whether or not we're going to start kind of treating somebody with hormone replacement therapy, it's always just good to get kind of a bene to get benefit. Um, sorry, to get a baseline and um then we can decide, you know, is there something really kind of abnormal that we need to investigate further? Are things appropriate given um her age? Does it do what what we see on blood work does that match what she's telling us in terms of her menstrual cycle um when she's permenopausal menopausal like what is what are we can we match her clinical presentation to what we're seeing on blood work and so um I find it as a clinician extremely beneficial to um just kind of have that data and then have a very kind of informed discussion with her of what are her options? Is it safe for her? If so, what makes sense? Um rather than um just relying on what she's told me. So, I really value having the lab results. Okay. Gotcha. So, when Okay, so like in 30 seconds or less, like when is blood hormone testing good for sex hormones and when is blood hormone testing bad and misleading for sex hormones? Um, I don't think it's ever bad for Okay. Yeah, I don't think it's ever bad. I think it's always valuable. Um, I think there are some instances when it's not absolutely necessary, but it's never bad. Okay. So, when is it necessary to do something like a Dutch test that's like, you know, I know saliva testing or, you know, over a period of time. When when do you need more in-depth sex hormone testing more than just blood? So, so just to let people know, a Dutch test is usually urine and sometimes saliva. Um, and it what it does is it tests um what are called sex hormone metabolites. So rather than just getting kind of a blood level or a serum level of a hormone, we actually see kind of the metabolites which are breakdown products and it is kind of the gold standard in terms of um especially managing hormone replacement therapy. So ideally somebody comes in, we have baseline blood work and then say 6 weeks at least 6 weeks into treatment is when we would do a Dutch panel and that would kind of show us um how well she's responding and it what it shows us is what's happening at the level of the tissue or where the receptors are, the estrogen receptors, the progesterone, the testosterone receptors. And so that's like just more specific, more a little bit a little bit more accurate than the serum or blood levels. Um it's not always necessary. It's not always convenient. Um but it's great for certain people at certain times during that um treatment. [clears throat] Okay. Gotcha. That was a great explanation. Thank you. So all right, switching topics a little bit with testosterone in female health because I know like we get this all the time. females asking, "Hey, do we offer, you know, do we look into testosterone for female health?" Yes, we do. Why, like, why is testosterone so important in females health? Because you hear it all the time in like men's health, testosterone, very rarely around female health. And I know that's something that, you know, sometimes gets brushed over. So, yeah, why is testosterone so important in female health? Yeah, it's um again, I'm kind of excited because I think there's now a conversation around this and up until I think quite recently, it's kind of been a it's [clears throat] been taboo. It's been a no no in terms of giving women testosterone. And I think there's more research and more um conversation around the benefits of women having adequate levels of testosterone. What does it do? Yes, libido. Yes, like sex drive. overall overall drive, overall interest um and like motivation um mental mental clarity. So women also talk a lot about brain fog in those permenopausal and menopausal years. We see benefit yes from progesterone supplementation but also testosterone as well with that kind of mental clarity. Um and then on the physical end of things like muscular strength, muscle tone, um just that lean muscle mass that um you definitely get a benefit from taking testosterone. Gotcha. Pretty important. Yeah. Yeah. And I think that you know it's when dosed appropriately, like at the right concentration, at the right dose, it is extremely safe. And I think that's kind of where the misconception has been. So are like, so what about to all the ladies out there who are like afraid they're gonna like grow a mustache or like I have never seen that happen with all the women that we prescribe to whom we prescribe testosterone. Um you know maybe if you took way too much but um you know I don't know dosed appropriately I'm not seeing it. And you have to look at it in the big picture. You have to make sure that estrogen levels are adequate too. you could the estrogen and testosterone are sort of competing and so you don't want somebody to be so what we call androgenic like the testosterone level is so high that that like overpowers estrogen and in a post-menopausal woman her estrogen is low. So you most of the time you're wanting to boost that estrogen as well so that you don't get that um you don't get unwanted body hair. So, if you're post-menopause, like 99.9% of the time your testosterone is low. Um, yeah. So, there's there's I mean, I don't know if you want to get into it, but there's the there's the normal versus optimal, right? And so, there's like the labs have the reference ranges of what's considered normal. Um, and that a woman could fall a woman's testosterone levels could fall within normal. Um, but our definition is different, right? Like we might see we would see that we we have like an optimal level that's safe yet higher than what some other conventional medical providers might consider to be normal. And I'm always bringing in her lived experience, her clinical presentation to match that. We're not just we're not just treating her serum levels of testosterone. Sure. Yeah. Fair enough. All right. So let's talk a little bit about the difference between bioididentical hormone replacement therapy and synthetic hormone replacement therapy. So yeah um synthetic is um similar to our own um endogenous hormones. So like the chemical makeup of our own hormones. synthetic is similar whereas bioididentical is actually identical. Um bioididentical hormones are usually sourced from wild yam sometimes from soy and the um because the chemical makeup is identical the safety profile is better than synthetic. That's the short answer. Okay. So why does like is there ever a time that like synthetic makes more sense than bio identical or is it just like like why would conventional medicine even use synthetic hormones? Um maybe cheaper maybe approved by insurance companies. Um just kind of there's no clinical answer though. There's no clinical reason. No. Have you ever used synthetic hormones or are you always using bioidentical hormones with patients? I have never used synthetic. Okay, gotcha. I have women coming. I have had women come who are prescribed by somebody else and we have that conversation and maybe we switch to bio identical, but I don't think I've ever been the prescriber. Okay. How how often are patients coming in who are already on hormone replacement therapy who are coming from like a conventional medicine doctor um on synthetic hormones versus Yeah. Um it's not that often. Not that often. Um yeah, I think um well I mean I have women coming who are on um oral birth control and that's synthetic. that's synthetic hormone replacement um or an IUD uh a hormonal IUD that is synthetic. So if I include that then yes. But in terms of kind of what we think of as hormone replacement therapy you know usually for women who are you know 40 and over um these days most people have not they've maybe tried they've asked primary care they've asked gynecology and for whatever reason have been told no. So they're usually not on anything. I I can't hear you. Sorry for those who are listening. I was accidentally muted. Um okay. So for women who come to Med Matrix who like um you know have night sweats like they're having all the menopause symptoms [clears throat] um they're tired, they're putting on weight, they're not sleeping, they're anxious, they have no sex drive. Like we hear this all the time where doctors are putting them on birth control. Like what do you think of that as like a solution? Like is birth control a good solution for menopause symptoms? I would say no. Um, so one, it's synthetic and we just, you know, I just finished saying how the safety profile of bioididentical is better than synthetic. Um, we cannot adjust. The other thing is that um part of that is also the the route of transmission. Um, in terms Yeah. So, in general, especially when we're talking about estrogen, specifically estrogen, you want to do transermal or topical, not oral. Um, so there and that's just a safety safety thing in terms of reducing your risk of blood clots. So, um, so the other thing with um, oral birth control is that we cannot tweak the dose, right? Like once a woman's on that dose, we can't adjust it. Um, and with versus with bio identical hormone replacement, we can get super specific in how much oral progesterone and how much topical or transdermal estrogen. There's several different types of estrogen. So, I can adjust estriol versus estradiol. One's stronger than the other. can get very specific in the dosing um and really match that woman's individual needs and we just can't do that with oral birth control. Um and and so if a woman really the reason to do oral birth control is if a woman needs it for contraceptive purposes otherwise I don't see why I don't know why one would I right now I can't think of a reason why I would pick that over bioididentical HRT. Gotcha. Um all right so see I got a list of questions here. Um, at what age do would you recommend a lady or I guess either at what age or what things should someone be experiencing to, you know, consider coming to a place like Med Matrix for help with their hormones? I mean, yeah, I mean, it can if a woman has polycystic ovarian syndrome or PCOS, I mean, it could be she could be in her 20s or 30s and we would, you know, start working with her on the appropriate um HRT. Um, in terms of kind of the the permenopausal transition, like that can start as early as 35. um we really see women experiencing some of these symptoms 10 to 15 years before their menes actually stop and they're considered menopausal. Um I would like to point one thing out which is that we're not necessarily going to see dramatic changes in the blood work at that time. Like people, women can be are often usually symptomatic for that 10 to 15 years before we look at the blood work and we're like, "Oh yeah, you're menopausal." So what am I looking for blood work-wise with a when a woman's permenopausal? It's any real red flags, anything that looks super off. Um, but mostly again, it's just that baseline. And really what I'm prescribing on is is she fatigued, has she gained weight, is she having trouble sleeping, is she irritable, has she lost her libido, and is she having hot flashes, night sweats? And again, based on that, deciding what combination of um bioididentical HRT makes sense for her. So I don't know if I think that answered your question. I mean, it could start depending on the on what the woman is coming in for. Or maybe it's regulating cycles, you know. Um, that could be a woman in her 20s. Okay, gotcha. That's Thanks for sharing. All right. Um, why is menopause and weight gain linked? Like how? Because we hear it all the time where you know men but specifically for this talk women you know they get older weight becomes harder to lose. What what role do hormones play in that? It's usually that drop in estrogen. Um and so we see um Oh really? So the estrogen is the one that's linked to the weight loss weight. Yeah. Um it's usually and it's like really that kind of midsection men belly as they call it. um is often it's often where that's the most common part of of a woman's body where she's going to notice the weight gain. But overall um yeah, it's super I mean I can't tell you how many I'm sure you've heard it when people call. I hear it every day. It's like I haven't changed anything. I I eat really well. I haven't changed how I eat. I work out however many days a week. I haven't changed anything. And yet I just can't lose the weight. And um you know I look at her age and it's kind of you know I mean there's I I don't want to simplify it. Things like excessive stress, things like not sleeping which may be hormonal um also are going to exas it's going to make it harder to lose weight. Um but it's usually the way that it's described is like you kind of know it's got that hormonal flavor. Okay. Sure. So, for like realistic patient expectations, um how often do women come in with weight and um you know, you fix their estrogen and then all of a sudden things start working like they used to? Yeah. So, and it might it might be estrogen and again building putting in a little bit of testosterone can also help um depending on the woman. But um um I would say that it like overall body composition can definitely improve. We can start to see a little bit more of that kind of lean muscle, a little bit of fat metabolism, a little bit of less weight. Um, if a woman comes in and she needs to lose 25 pounds or more, I'm not going to promise her that that's going to just come off in a couple months with without adding anything else in. Um, I mean, I think it's really about again the body composition kind of like feeling better in your clothes, losing I'm going to say, you know, somewhere in that like 5 to 15 pound range can can maybe be realistic. She still has to do the work. She has to move her body regularly. She has to eat well. That's a whole conversation. Um, but um, yeah, I I think it's that kind of weight. It's not somebody that comes in and has to lose 100 pounds. If your sex hormones are super screwed up, is it like impossible to lose weight without without balancing your hormones? Yeah. Um, if your sex hormones are super messed up, is it impossible to lose weight? Is that the question? I guess let me ask a better question to preface that. Um how like because obviously there's varying degrees right of everything. So with menopause like um like could you give like a distribution of like what percent of women like you know their hormones are like really messed up and like they really because I you know I've used to talk to a lot of patients who would come in the door and some of them it's like menopause like you know it's all right. Some of them are like this changed my whole life like this ruined my life like what's what's that distribution look like? Generally, we're talking about women who are menopausal or postmenopausal. Is that right? Okay. Um I would say that um the majority I'm going to say 70% of women it well let's see it's just such a it's such a gradient, right? I mean, there's women who um became depressed, gained a lot of weight, you know, can't sleep more than three hours at a time, like everything like everything's just off, right? Like really, really severe, intense hot flashes, night sweats, like you name it. That's going to be the minority when it's that bad. Um and then there's the handful who are like it just stopped and I didn't notice anything and nothing changed and you know um and that's also a very small so small percentage right so um the majority are there somewhere in the middle where it's like I can't sleep anymore and I'm tired and I have brain fog. um those are the biggest and then I would say a smaller percentage they have all of that and they're dealing with night sweats and hot flashes. Um so I think that answers your question. I mean, it's such a range and it and it's like everyone's affected differently and and and it's multiffactorial. Like there's there's other hormones are a a big piece of the puzzle, but there's other pieces in terms of lifestyle, diet, stress level, all of the above. Other other coexisting conditions. Gotcha. Yeah. So, I know in the past you've talked about the link between your adrenals, your thyroid, and your sex hormones. Can you talk about how cuz when you go through menopause your sex hormones change but that also affects your thyroid affects your adrenals which affects other things. Can you talk can you talk about like the cascading effect of menopause? Yeah. I think of it as a triangle. So I think of it as the thyroid gland, the adrenal glands and the ovaries when we're talking about a woman. It does apply to men also um with testes but we're talking about women in this in this podcast. So it's a triangular relationship which means it's not linear. So um and these are all hormones right this is all within the endocrine system. I think we are in conventional medicine there's this idea that you know somehow the thyroid is off on an island the adrenal glands are off by themselves and then you've got the ovaries and somehow they're separate. All of these hormones are in the blood together. Um and these glands in particular, these organs have kind of a relatively complex relationship or with each other influence each other. So if there's been chronic stress, if there's been um trauma in this person's life, either early childhood trauma, continue, you know, later in life trauma, years of chronic stress, you name it, super common. um that is going to not only impact cortisol levels um but also thyroid and sex hormones. Um likewise, if a woman has um you know kind of estrogen dominance or some kind of more sex hormone imbalance that's probably going to show up in the thyroid. Like it's just all together. And that's I think kind of where we specialize or where we shine is like kind of having the tools and the skills and the testing to figure that out and kind of get to the root of it. Um it's not like there's going to be it's not like the the the the goal is to say, "Oh, it's actually your adrenals." Like it's probably a little bit of both, but let's figure out where are the imbalances, where do we what needs the support, where do we start? And um that's a little bit of that like stepping back and looking at the whole person and not not just throwing even if it's a natural supplement, not just throwing a natural supplement at somebody, but like really figuring out where this specific woman's um overall hormonal imbalances and and how do we Yeah, sure. support her. Yeah, totally. I mean, that's uh [cough and clears throat] I think that's what patients are looking for is a more holistic approach. So, what um what are your thoughts on like I know there's services out there like where you can get women can actually get hormone replacement bio identical hormones online things like one main one I've heard of is called Winona. Um what do you think of that where women are just ordering like hormones online getting it shipped. It's obviously some cookie cutter dose. Um there's no testing involved. What do you think that's a good solution? Um no. uh [laughter] not if not if there's the option of something like what we do. Um you know I fully understand because women have are trying they're trying to go through again primary care sometimes gyne you know their gynecologist and if they're just keep they they really kind of feel and they know that um something is off hormonally and they're just not getting the answers that they need. They're not nobody's really stepping up to the plate. I fully appreciate going online and or, you know, and ordering, but whoever, you know, if there's a provider on the other end of that, that person is really just kind of checking off a box. Like, there's no, it's not individualized. They don't know this woman's individual chemistry, metabolism, hormonal makeup. There's probably no testing. Um, I don't know if they're looking at medications and supplements that she's already on. like we spend an hour with somebody um and that's after having the blood work done just going through and you know again it's a customized medicine. It's so individualized and that's what every woman deserves. Um and yeah I just wish more women knew that that was that were here that and there's places you know there's places like this. So, no, I don't think I don't think that that a male order thing is ideal. Um, if a woman's lucky, taking whatever that whatever is given to her will make her feel good, but um and feel better, but you know, there's there's more than that. Yeah. How often So, how often do these things need ongoing care and adjustment? Like, how often are you like I'm sure you don't get it right the first time every time. I know a lot of this is based off of symptoms and the way they feel, right? Everyone feels different at different levels. It's very personalized. This is why we do what we do. Um, but how often is it like, okay, a year goes by, all right, then we tweak it and another another year goes by, tweak more. Is it like once you get it, you got it? No, I like seeing after that after a woman starts on um bio identical HRT. We like to do labs 10 weeks later um if she's doing, you know, whether that's blood work or a Dutch panel. Um and then I like to see her um basically two weeks after that. So, so I see her and then 12 weeks later I see her again. Um, yes, I'm reviewing lab results and I'm I'm asking how is your sleep? Um, how is your mood? How is your libido? All the above. Um, you know, have things changed physically? All of that. Uh, we, you know, it's a really I think that timing works really well. It gives the medicine long enough to kind of do its job and for us to really get a sense of if we need to tweak it in what way. So, um, unless there's something kind of unusual, she needs um that touch point a little more frequently, it's on kind of an a quarterly or every 3 month uh basis. Okay. Very interesting. Um, how often do you see peptides play a like or as far as peptides or any other tools um play a pretty, you know, big role in uh moving the needle with women's hormonal health? Yeah. So, um, again, I'm not sure if viewers know what peptides are. I'll I'll give my little quick explanation. Um, peptides are basically, um, short proteins. So, it's a a peptide is a sequence of amino acids and depending on the sequence, we can target different parts of the body, different tissues. So um I would say in terms of a woman again in those parmenopausal menopausal years kind of dealing with hormonal uh fluctuations there are some spec we have a lot of peptides safe peptides to choose from. Um if a woman is here's an example dealing with kind of joint pain. You know we're probably going to want to make sure the thyroid is in balance. We're going to want to make sure that her estrogen levels are adequate and that that's, you know, make sure that those are once those are balanced. Has the joint pain improved? Um, yes, there's other things like weight and other things like that. But if we then can want to tweak it further, she's like, I'm better, but I'm not as good as I want to be. We have peptides that target connective tissue. They target the joints and they're anti-inflammatory and it's completely safe um to take along with bio identical HRT. Here's another example. Um a woman has been dealing with um poor sleep and anxiety. We're working on figuring out the right bio identical HRT combination for her. We're working on the progesterone, etc. Same thing. Better could, you know, could be even better. um we were adjusting the doses the doses there's a peptide that um has a neurotransmitter modulating effect right so it basically helps put put somebody a woman into that relaxation mode into that what we call parasympathetic mode that um that can help lower anxiety help with sleep again completely safe it's not an SSRI there's no dependency there's no weight gain uh completely safe to do along with really any other medications including hormone replacement. Okay, gotcha. Um what are some of like the symptoms of something like menopause that um because obviously there's the classic ones, right? Like the weight gain, anxiety, lower energy. Are there any others that um are less common or less known? Um, well, I would say in some ways maybe like the joint pain one, you know, how So, how is menopause linked to joint pain? I think it's the low estrogen. I think it's the low estrogen and, you know, and maybe a little bit of the low testosterone as well. I think that um Well, you know, we know that estrogen kind of has like a lubricating effect. And so just like we see dry skin, dry hair, dry nails, like vaginal dryness with a drop in estrogen, that's going to affect the joints, too. Um, and so I think sometimes that is overlooked. That's, you know, it's that Yeah, I don't think that's like the most common symptom um that's people would when they're listing out menopausal symptoms. Gotcha. Okay, cool. All right. So, that is it for the um menopause, female sex hormones, and biioidentical hormone replacement therapy. Now, we're going to transition into the second uh talk, which is going to be about anxiety, depression, and functional medicine, talking about that mindbody connection. Um so, if you're just joining us, my name is Cole Cy from one of the co-founders, MedMatrix, director of marketing, too. Joined with Dr. Rose. Uh nothing on here is medical advice. We're just simply for educational purposes only. Um so yeah, Dr. Rose, why don't you start us off like um I guess we'll start with a hot question like how often is something like a SSRI actually in your opinion medically necessary versus there's a better root cause um reason for you know the way someone might be feeling psychologically. Yeah, I mean, we've seen we've seen, I would say, an uptick in SSRI prescriptions over the last 20 years, probably 10 to 20 years. Um, it's pretty common for me to see people come in, new patients come in, and they have been on an SSRI for 20 years. um and kind of they they've moved from primary care doctor to primary care doctor and this just kind of they just keep filling it. Um there are definitely situations when they are absolutely like the best tool, right? Um again depending on the person there's like debilitating depression, maybe debilitating anxiety. um the person like you know really isn't functioning is having suicidal ideiation. Yeah. like if that medication is prevent is managing that absolutely that's you know when that's not the case um I think it's kind of a band-aid solution um that sometimes works not always so great has some side effects um it really takes effort I think it takes some effort it takes effort on the in terms of the um part of the patient and on the provider to dig deeper to root cause, right? So, is it a hormonal imbalance? Is it a nutrient deficiency? Um, is it a is it a actual situation where the person actually needs to get out of a pretty bad marriage? Um, that that's not easy, right? Like that's not just take a pill and you're fine. That's like, you know, um is it is some kind of therapy or counseling really does that, you know, the right kind of counseling, the right person for that for that specific patient? Like is that going to be beneficial? Um again, it's just more effort, more time, um and sometimes just more education than just taking a pill. So, um does that answer your question? Yeah, it does. So, well, you mentioned the long-term side effects. Like, what are the worst of the long-term side effects with um Yeah, I mean, we see weight gain, we see low libido, um we see um uh kind of a a numbing effect. Um you know, I don't know if people would call that a side effect. I think of it as a negative side effect where um they're just like that you're just not the person is just kind of not in touch with what they're feeling. They're not feeling much of anything. Um and to go through life like that for years or decades I think is unfortunate. Um and you know I don't have any studies right at the ready but um you know there has been some evidence of kind of this some of the some of them actually c like worsening depression. Um, and I just think that that there are there's other work to be done. There's other tools out there to help with mental health. Um, and it's important that people dealing with anxiety and or depression or other mental health concerns um know about those other tools. H gotcha. So let's so let's talk solutions. What are the top three root causes of depression and anxiety that you see? That's a big question. Okay. [laughter] Um I mean we can talk about again we can talk about childhood trauma. That's a whole conversation, right? Um we can talk about Okay. So life life circumstances life life. Um, we can talk about um like I would put gut health deficiency as one. Um, and um I don't know this is a big question. I was going to say hormonal like hormonal imbalance. Um, depends on the age, right? Depends on the age and the sex of the person. Um, what do you real quick? What do you mean by that? are like women more prone to well or men more prone to based on um I think you I think statistically we see that women are more prone to depression um I also think that sometimes women this is a bold statement but maybe are a little bit more in touch with their feelings um and kind of recognize what depression might feel like um but Um, I also think that there's been a shift generation-wise. I think there's just, you know, mental health used to have much more of a stigma. And I even see it among my patients. I have patients who are in their 70s and are a little bit more hesitant to talk about anxiety or depression. It's just there's kind of been this, you know, it's a little bit been of a bit of a taboo maybe, especially among older men. And then I have, you know, men and women coming in who are in their 20s and they're like, "Yeah, I have a diagnosis of anxiety. I have a diagnosis of OCD." And that's just how it is. And you know, and it's I I just think that's great. I think that just culturally that that shift is allows us to have a better conversation. Yeah, definitely. And then um when so when a patient comes to you with you know they're whether they're diagnosed with something like OCD, ADHD, depression, anxiety, um or they're you know talking about it and say hey I have anxiety but they might not be you know diagnosed. What is your framework for like uncovering the root cause as far as like what functional medicine can do? Yeah. So part of it is um I think kind of figuring out that life piece of it like you know is there are there significant layers of trauma that a referral to a therapist in in conjunction with what we're going to offer that that really makes sense. um is um is there a nut, you know, are there nutrient deficiencies? And so some of that's going to show up on our initial panel and then if I want to do kind of a much more advanced test to find out about nutrient deficiencies, nutrient imbalances, I can easily order that. Um there's a fairly, you know, pretty significant conversation around gut health and diet. So, what what is this person eating? Um, you know, caffeine intake, sugar intake, alcohol, and then including like nicotine and cannabis use, all of those. So, stimulants, depressants, um, and then gut health in regards to mental health. I mean, that's a whole another conversation, that gut mind connection. But, um, you know, how well is this person actually absorbing nutrients? Maybe they're eating this amazing diet that, you know, they're what they're eating is great on paper, but their gut health is so messed up that it's like it's not really doing the right, it's not doing enough. Um, and so I'm looking at that and then um yes, looking at depending on the age, depending on the sex of the patient, what's happening hormonally? Is it a pmenopausal person who really didn't have anxiety or depression? um until she hit 42 and then nothing else changed in her life, nothing else changed in how she's eating, but all of a sudden she's dealing with really significant depression and brain fog or anxiety and brain fog, then we definitely have to think about the hormonal piece. Um yeah, gotcha. Let's dive into the gut one a little bit because um that's a term that's thrown a lot around a lot is the gut brain connection. Gut health affects everything. How does your gut actually affect things like depression, anxiety, OCD, ADHD, etc. Yeah. So, we have um neurotransmitter receptors everywhere, but like the greatest concentration of those receptors is actually in the gut, not the brain. The gut, correct? And and we have more neurotransmitters in our gut than we do our brain receptors. So, the receptors Yeah. So, um, it's called the anteric brain. E N T E R I C. It's like the that's like the part of the nervous system that's in the gut. And um, so we have these receptors for serotonin and dopamine and norepinephrine and all of that in the gut. And um you know if if the gut is messed up, the microbiome is messed up, all you know, again, we can get into the weeds here, then um you're just not your body's not going to respond optimally to those neurotransmitters. There's also, you know, a lot of evidence of research coming out now around the importance of the microbiome. So those beneficial microbes and you know an imbalance in that ecosystem like literally being a huge piece of anxiety andor depression um and other kind of um you know the autism spectrum maybe OCD um the whole gamut. So that's just we're just kind of at the tip of the iceberg with that research, but um I think there's something to it. Gotcha. All right. So what are um what are things you do in your clinical practice um at MedMatrix to help patients who have, you know, psychological things like anxiety, depression that are linked to the gut. How do you help them fix that and get better, feel their best again? So, um there's a there is a um comprehensive stool test that I run quite frequently that gives me a good picture of the microbiome. It shows me um just kind of how well somebody's absorbing their nutrients, what the level of inflammation is at the gut level. Um it rules out various um infections um parasitic uh bacterial viral all that. So gives me a good baseline of kind of the gut gut health. Um and I'm doing that. I'm talking to them about what they're eating, um how much they're eating, what if they have any digestive symptoms, if they have any mental or emotional symptoms. kind of link that together, right? And then we I usually like to treat in parallel. And what I mean by that is um I don't I like to both start to support the gut. Um and we can also start to kind of balance those or modulate those neurotransmitters like um do mood, you know, help with mood regulation, help with that um mental health essentially. I think I I can we can do those at the same time. We don't have to like just start with the gut, wait a year, and then decide that we can start it, you know, because there's such an interplay. They're so interrelated that supporting both systems, nervous system, um, gut, digestive system at the same time can be very effective. Um, are you looking for specific tools that I use? Yes, I love specific. So why don't you explain some of like the specific things that you use to um improve the gut brain connection and in turn anxiety, depression, things like that. Yeah. So um there um there are some peptides that we use. There are some peptides that we use. Um one is BPC157 and that one actually mimics our own like a part of our own stomach acid. I talked about um peptides maybe in the last podcast, but basically a sequence of amino acids and so the sequence of amino acids that makes up BPC 157 kind of mimics again our own stomach acid. It has a very strong anti-inflammatory effect. So yes, it does reduce inflammation in the joints, but it also reduces inflammation in the gut. Um, and that reducing that inflammation is going to kind of um help you absorb your nutrients better. If you can absorb your nutrients better, like your vitamin D, like your B12, like your magnesium for example, um like your iron, you are going to um have a better kind of neurotransmitter balance. You're going to have better ba better brain chemistry, I guess, is one way to put it. um and kind of make those receptors just kind of more um available, more sensitive to the circulating neurotransmitters that need to be balanced for um for optimal mental health. The other piece to this with gut health is um kind of the detoxification pathways and so making sure that you know if somebody is having regular bowel movements is not constipated. Um because then you're just get if you if you're not really fully eliminating then your hormonal balances are going to be, you know, out of whack and um even the neurotransmitters are going to, you know, things aren't really circulating the way they should and we Wow. We need that to be optimal. It's amazing how everything's connected. Yeah. Right. Your pooping to your sex hormones, your neurotransmitters. [laughter] Who would think that who would thinking who would ever think that uh pooping regularly would improve your mood? But I think we all think we all know that it kind of does. Yeah. [laughter] All right. So, man, I mean that would be really scary if someone like was taking a anxiety or depression medication when it was actually a gut issue or a sex hormone imbalance issue. Obviously, there's other contributing factors, but um how often are patients coming into, you know, your practice and they're on I guess let's start with this. How many patients what what percent of patients do you see are coming into already on something like an SSRI? Um 25 or 30%. Really that many? I didn't I didn't That might be a little high. Um Okay. It's le Yeah, something. Yeah, that might be a little high, but um it's not Let me put it this way. It's not uncommon. Sure. Yeah. All right. Um how often are you How often are patients getting off of these meds after fun help with functional medicine? Yeah. I mean, that that one takes a while. That's not a um you know after one month they're off of it. I mean that you know those you do need to kind of wean off of um and obviously if they're working with a psychiatrist were kind of doing it with their blessing with their support. Um and um but yes it definitely happens and it can h it can happen in a in a healthy in a healthy way. You know, one thing that I do like to tell patients is, you know, if there if it's depression that we're dealing with, if there's a SAD or a seasonal affected disorder component, um, this time of year is not usually the best time to play with going with, you know, stopping your anti-depressant. Um, Sure. But that said, you know, we make sure that their vitamin D levels are are are optimal. We make we give them all these other supports. if they're really committed to going off of it, like we have the tools, right? We've got some other peptides. We've got um some great kind of neutrutical supplements that can um support uh for example serotonin, melatonin, dopamine or all of those um as if they are choosing to cut back or go off of their SSRI. Okay. Yeah. Do you have any um good patient stories of someone who came in and like kind of some of their you know one of their main goals was like maybe getting off a depression med or they were struggling with depression and mood and with the help of functional medicine and what what you did you essentially turn things around. Do you have any Yeah. case studies that come to mind? Yeah, I mean I think the um one case I'll just bring up because it's pretty common is a woman who um I think she's early 50s and she's one of those ones that had been on you know wellutrin for 20 years. Hadn't really well she was just on it right again like it hadn't really questioned it. um and was having was you know maybe wouldn't she wasn't wouldn't say that she was still depressed but again that kind of a little bit of you know a little flat a little disinterested in life brain fog weight gain um what I will call kind of classic or common pmenopausal symptoms and we um put her on some lowdose bio identical HRT And um I worked with her on both kind of sugar and caffeine dependence. And when I I didn't I didn't have her I didn't ask her to completely quit. It was more about amount. Um you know we looked at micronutrient levels. Um kind of adjusted those a little bit. And I in my recollection I didn't know that she it wasn't necessarily like the spelled out plan that she was going to go off of her medication. Um it kind of happened organically. And so when I saw her 3 months later she was feeling better. She like overall better energy, less brain fog, just like better mood. And then when I saw her 3 months after that, so 6 months after initiating kind of some of these lifestyle changes, the HRT, um, she had basically gone off of it and was feeling totally fine, maybe better. Um, awesome. And yeah, so it's it's kind of simple, not super complicated, but you know, again, she was the one that kind of initiated it. It kind of felt organic on her end. Great. Oh, that's really exciting. Yeah, thanks for sharing. How are sugars and nutrients related to things like anxiety, depression, ADHD? Yeah, I mean, [sighs] you know, like with with ADHD, it's like kind of um it's a little counterintuitive. It's usually kind of like low dopamine, low norepinephrine, and taking stimulants kind of relaxes the person. Um, and I think we see that's what sugar is, right? That's what caffeine is. Those are stimulants. And so I think there's like kind of this um if you have that kind of brain chemistry, this is just ADHD. It's a way to kind of self-medicate. Um, and so I think it depends again on the neurotransmitter baseline, right? And we do have tests that we can easily test to see if somebody where somebody's dopamine is their neurop you know all of the neur there's so many neurotransmitters and we can easily do a panel on that. Um we're trying to like really diagnose it but um there sugar is addictive. Um caffeine can be addictive and they can be used to um it's like false energy. You know what I mean? It's kind of um you know it's props you up people it's it's easier than again getting to the root why why am I not sleeping well you know why am I tired um it's just kind of like a a an easy a very available way to self-medicate and um it's not really sustainable if you want long-term health if you want kind of that longevity if you want like to live well. Um, you know, does that I don't if that answers anything. Sure, that makes sense. Um, let's see here. Go over my notes. And I just want to clarify, I'm not saying that caffeine is bad. I'm not saying that sugar is bad. It's about like the amount and the frequency and in relation to like what else you're eating. Gotcha. Okay. Yeah. Um, how often I'm going to ask a probably controversial question. How often is like some like these um the diagnosis of like a psychological you know disease like I don't know if that's the right vernacular but you know something like depression, anxiety, OCD, ADHD. um a cover up for, you know, something that's deeper seated versus legit. Um I don't know if there if it's like necessarily a cover up. Um like for with anxiety for example, there's such a range, right? You can have you can suffer from panic attacks um or you can have generalized anxiety disorder. Um, I so I think that you can have those things, but I maybe what you're getting at and I would agree with this is that there's there's more underneath that, right? So, is there um an imbalance in the autonomic nervous system? Is the autonomic nervous system in sympathetic overdrive? Right? this person's operating in fight orflight response because of a metabolic imbalance, because of um like a neurotransmitter imbalance that isn't really anxiety, but it's showing up as anxiety. It's showing up as like a racing heart, you know, palpitation. So, if you've heard of POTS, which is postural orthostatic tacicardia syndrome, that's like a type of dysotenomia and anxiety is like a hu often like a big part of that. And if that's missed, if that if that diagnosis is missed, that person is just going to be labeled as being anxious. Um so I think it's um often maybe more complicated there. Again, there's a hormonal imbalance, a metabolic imbalance, a neurotransmitter imbalance that is not being addressed slashrecognized. And in a in a primary care visit, which is five minutes, it's the only it's not the only option, but what happens is is that anti-depressant, that anti-anxiety medication is handed out is handed out, you know, maybe a referral for counseling, but um it's just not it's just it's just not that that's all that's that's all that's done. And it's not looking at the it's not looking for underlying issues, testing, etc. All the stuff that we do and kind of like really digging deep to find out where the where the imbalance is, what's going on maybe in addition to the anxiety or depression or what's like, you know, what really is at the root for this person because we're all different and maybe it is trauma for one person and maybe it's per menopause for somebody else. Yeah, thank you for explaining that and uh articulating my question because that's that's what I was getting at as far as like um from my understanding of this conversation, anxiety, it's not just anxiety, it could be an issue in the gut, could be neurotransmitters, could be sex hormone, could be a sugar issue. Thank you for explaining. Um cool. So that's it. Uh we're at an hour for both of those talks. Uh Dr. Rose, thank you so much. uh for sharing [snorts] that was awesome. I learned so much. Um if you are not a patient and interested in becoming a patient med matrix, just go to the website and you can um submit a new patient application. Um and you can talk to a patient coordinator and we would love to see if we can help you out. Um Dr. Rose, do you have anything you want to take us home with? No, this was great. I just feel like the more that this information can be disseminated, like the better, the more empowered I hope people feel and know that um they don't have to be limited by kind of the standard mainstream conventional medical tools that there's just so much more out there and yeah, the more the marrier. Yeah. Yeah. I know it's scary and I know you probably want to get home. It's later on a Friday night. But um I I want to share one little story cuz I experienced this firsthand where I had a brain injury and I went to a you know my primary and they pretty much just said I had um ADHD and to take Adderall. Um and that was it. And when I ended up going the functional route, it turned out I had a um you know some inflammation in my body and my brain from this brain injury and I needed to uh do some things to work on that. put up I had a underlying autoimmune called Hashimoto's and my testosterone was really low because my pituitary gland was hurt from this brain injury and when I fixed those things my and my energy came back my motivation came back um so yeah I mean it's just scary to think like patients out there who you know might be taking something right a anti-depressant what whatever it is and there is a deeper reason why this is going on right and obviously there's most likely a psychological component But um digging deeper, you know, making sure it's not there. If there is something in the gut, your body is at least working with you and not against you, right? Absolutely. Yeah. Cool. Awesome. All right, Dr. Rose, thank you so much. Have a wonderful evening. Thank you everyone for uh listening. Bye. Take care.