Recently, I interviewed Dr. Anna Cabeca, and we talked about a unique approach to optimizing sex hormones during menopause. If you would prefer to listen to the interview you can access it by Clicking Here.
Dr. Eric Osansky:
I am super excited to chat with Dr. Anna Cabeca, as we are going to be discussing a unique approach to optimizing sex hormones during menopause, talking about alkalinizing the body as well as maca root. It’s going to be a lot of fun.
I am going to dive into her bio here, which is very impressive. She is the bestselling author of The Hormone Fix, Keto Green 16, and MenuPause. Dr. Anna is triple Board-certified and a fellow of gynecology and obstetrics, integrative medicine, and anti-aging and regenerative medicine. She holds special certifications in functional medicine, sexual health, and bioidentical replacement therapy. She lectures frequently on these topics throughout the world to large audiences and is known nationally as The Girlfriend Doctor. She is the host of The Girlfriend Doctor Show.
She has personally developed natural products to help women balance hormones and thrive through menopause, including the highly acclaimed Julva cream for the vulva and Mighty Maca Plus, which is a powerful superfood blend. She now lives in Dallas with her daughters, horses, and dogs. Thank you so much for joining us, Dr. Anna.
Dr. Anna Cabeca:
Great to be here with you. Thank you for having me.
Again, the pleasure is all mine. Let’s start out with a little bit of background. How did you get into more of an integrative approach in your practice?
I went to an osteopathic medical school. Then I went to residency at Emory University, so a very allopathic institution. During that time, my mom, who had been part of getting the best health care through our U.S. military and some of the best doctors that we had in northeast Pennsylvania, she passed away undergoing a second heart surgery. I was in residency at this time. I thought to myself, God, this should have never happened. This was a surgery that was supposed to give her another 15 years.
It really made me look at our roots. How was it that my mom and two of her brothers, out of nine siblings, who all came to the U.S. were now deceased prior to other older relatives in the Middle East in war torn areas? It made me think, what is the underlying root cause?
That led me to a very integrative approach. Leaning on my osteopathic background, digging into functional medicine and root cause medicine. It took me on a journey. Then I had my own personal health crisis with early menopause, prediabetes, nearing prediabetes, obesity. Well over 240 pounds. Working 80-100 hours a week. Then diagnosed with early menopause at 39 years old. I was told I would never be able to have another child. That literally took me on a journey around the world, looking for answers.
With the grace of God, I reversed early menopause and then naturally conceived and had my youngest daughter at age 41. Spontaneously, no intervention. A blessing. I’m now 57 with a 15-year-old, and God help me. That’s where I’m at right now.
That’s a wonderful story. You mentioned you’re 57 now. How do you feel? I imagine you’re feeling pretty good.
I’m amazing. I came out of retirement. I definitely recognize when things are off. I see this in my patients, too. They have known things are off. Yet they have had the symptom treatment approach versus the root cause approach. That’s really important.
I moved from Georgia during the pandemic to Dallas, Texas because there was a rodeo school nearby that my daughter was training at. My youngest, who is just loving horses. I have lived on an island for 22 years, St. Thomas Island, Georgia, just south of where you are, Eric. When I first moved here, I thought they had the best restaurants, no lines, no traffic. I love this city. It was July 2020. Traffic is another story right now. Takes me an hour to get 20 miles. We’re here because we have the horses, and she is still in the rodeo.
I just started back in clinical practice here. It tells you that energy and vitality. To pursue your dreams at any age. For everyone listening, not to give up.
I’m sure you’ve had a lot of people tell you that you don’t look 57. You look a lot younger.
I bring that up, the question of how you feel, because a lot of women in general don’t feel good, but the focus here is menopause. It’s not normal to feel lousy. It’s common but not normal, correct?
That’s right. I always like to say menopause is natural and mandatory; suffering is optional. It takes more than hormones to fix your hormones. My first book is The Hormone Fix. This just came out in paperback yesterday, so I am carrying it around with me. Hardcovers, I love them, but they are so heavy.
It’s my magnus opus. I go into details about the many things we can do to resuscitate our glandular function, like we do with our adrenal glands. How we can use lifestyle and what we do with our thyroid, to resuscitate our thyroid gland, to reconnect our mind and body together. The whole HPA, gonadal, thyroid axis connected, communicating heart and mind together. That’s the practice of good medicine.
I reflect upon the hundreds of thousands of dollars I spent on my education and how many years. It’s all come in handy. Now I tell people to get a good night’s sleep. You have to eat better. For me, it’s the key to a great lifestyle. You have to think positive. You have to move more. You have to laugh more. You have to play more.
What I can actually do with my prescription pad and surgical knife, very little is necessary. Not none, but very little. Still have to claim some.
Excellent book. I listened to it on Audible. A big reason why I call this episode “a unique approach to optimizing hormones” is because in your book, not that you don’t talk about hormones, but you don’t focus on them primarily. What are the main three hormones that you focus on?
As a gynecologist and obstetrician, I studied all the reproductive hormones, the pathways, the enzymes that take them down a certain pathway, etc. Starting with cholesterol to progesterone to DHEA to testosterone and estrogen.
Going through my own health journey, my own health crisis, and a second menopause, let’s say, ages 47-48, I recognized that even though my hormones were dialed in, things were still off. The hot flashes, mood swings, difficulty sleeping, anxiety. I was a hormone specialist. I lecture on this stuff.
If we look at our hormones, and this is the best way I have found to explain it, if we consider our hormones the students at a university, every student at a university has its own purpose, its own mission, its own goals. That’s awesome.
The professors of the university, these are the two more powerful hormones. They are leading a student body. If they’re not doing well, they’re chaotic, they come in drunk or high or whatever, there is chaos in the classroom. For me, those professors are our hormones, insulin and cortisol.
When we’re insulin resistant, insulin is screaming essentially at the students to get in order. There is chaos in the body, and it leads to inflammation. Cortisol dysregulation leads to acidifying physiology and when our body is in a breakdown mode. It’s really dangerous for women in perimenopause and menopause at any age of course, but definitely during this time period, because we are more susceptible to help those reproductive hormones and testosterone compared to men of course. Cortisol is very acidifying to the body.
I like to consider the dean of the university. Someone is governing the professors. If they are left on their own or mismanaged or being yelled at, or whatever the situation, if it’s a bad academic environment, the head of the university isn’t doing a good job. Then the professors won’t do well. Then the students won’t do well.
For me, the dean of the university is oxytocin. Oxytocin is the most powerful hormone of our body. When it is on, it is prioritized in our life through many things. Our body makes oxytocin naturally by loving, playing, orgasm, massage, doing things we love, getting out in nature, having fun. All of these things create the hormone of oxytocin. It’s a very benevolent hormone, a very godly hormone. It’s the hormone of positivity, joy, goodness, generosity, kindness, the gifts of the spirits as it says in the Bible. That’s oxytocin as the head of the university.
I look at those three. If I was a physician and wanted to do things efficiently as a woman, mom, single mom, and all the many hats we have, we can go through treating- Let’s treat the hot flashes this way. Let’s treat the anxiety this way. Let’s treat insomnia with this thing. But when it comes down to the most powerful changes I can make, it’s by empowering oxytocin, then managing cortisol and insulin, and then the other reproductive hormones. That is the hormonal hierarchy.
Most people have chronic stress these days. That is a big problem when it comes to healthy oxytocin production. You talk about this in your book. If you have chronically elevated cortisol, it will be very difficult, if not impossible, to have healthy oxytocin levels.
Yeah. If you are in this high stress state, like if you are a soldier on the front lines and are charging forward toward the enemy, it’s not a time to love your enemy. They don’t exist in unison very well.
The big thing with cortisol to remember is we are 100% capable of managing our stress, our thoughts around stress. Our internal environment is not dependent on our external environment. I have been to the pits of hell. I have been to the depths of grief and sadness and despair. I say that with complete compassion for those of you listening who are struggling. Our internal environment is independent of our external environment.
I remember a urologist in med school, and he said to me one day, “Anna, you’re the only one who can upset yourself.” “No, my boyfriend can really piss me off.” He said, “No, you choose how to react. You choose how to respond in that situation. You choose what you put your energy into.” I will never forget that statement. He was totally correct. Just reframed it in my mind. All that stress went away.
It is the blessing of the present moment. It is the gift of being present. Present presence. Combine those two. You want a gift. Get a present. That is where we really do have some control. A lot of control.
I definitely agree with you. There are certain tools that can help. I don’t know if you still use this. In your book, you mentioned the Muse headset. Do you use that?
Yeah, I have it on my desk upstairs. I am downstairs in my home office right now. I have the Muse headset. I have to get back on that for focused meditation, especially when your thoughts are so distracted, to bring you very clearly into this present, to be able to focus attention. That Muse is really good. Biofeedback is amazing for this reality check.
I never used that. You also mentioned the Inner Balance from HeartMath, like heart rate variability. I have been using that for a number of years. There are a lot of great tools out there to help with stress management.
With insulin resistance, is that where a Keto Green diet and trying to get people into ketosis comes in?
The Keto Green program, the beauty of it is it’s not just a diet; it’s a lifestyle. The keto part is the part that when we are managing our blood sugars, when we are becoming more insulin-sensitive, when we stop snacking, cut out sugars and high carbs, and intermittently fast, we become more insulin-sensitive. That is key to managing progesterone, testosterone, estrogen, and where they are going.
This whole concept of insulin resistance is so crucial because women in perimenopause become more insulin resistant. Those who are suffering from hot flashes, you think the answer is estrogen. The answer is about becoming more insulin sensitive. Insulin resistance is a cause of underlining hot flashes.
I didn’t know this when I started with my Keto Green program. Patients were saying, “I don’t have hot flashes. I was having them every 20 minutes, and they’re gone.” Within two weeks of following the Keto Green diet and lifestyle. You’re becoming more insulin-sensitive, and your body is like, “Oh man, I can chill out now. I can rest.”
Same with cortisol. The alkalinizing factors in foods that we eat, the mineral content, nutrient content, fiber to feed the gut. All of those good things are critically important for our body’s gut microbiome and metabolism. When we are fasting for extended periods, when we are in ketosis for extended periods, we can shift into a more acidotic state.
Blood pH isn’t going to change much, but urine pH is a really good bio marker. The alkalinizing foods. That is also the cortisol piece. Cortisol is acidifying. Oxytocin is alkalinizing. You can be eating the perfect green diet and still be in a very inflamed, acidic, imbalanced state because of cortisol.
By empowering the most powerful hormone in our body, oxytocin, with gratitude practice, journaling, positivity, mindset, focus, presence, working in the here and now, that can make a huge difference on your physiology. That was so eye-opening for me. As I went through my own journey and figured out what was going on and looked at what is the research day about this? It’s been fascinating. So much more needs to be done in women’s health.
Most people aren’t doing it. Even the practice of expressing gratitude every day, it’s something that is not going to take an hour or two for people to do. Most people won’t block out the time just to take a few minutes to do that.
I have a helpful tip I can share with your audience. The practice that I have that really has kept me alive is before I open my eyes in the morning, it’s a reflection on the day before. Where did I see love yesterday? Where was I loving? Where did I see love? Where was I loved? What am I grateful for? Where could I have laughed? Where did I laugh? Where could I have laughed more? What was amusing? Those three questions, before I open my eyes, that’s a practice I do every day.
Wonderful. As far as being alkaline, you said you test the urine pH. That’s first thing in the morning or throughout the day or both?
Every time you pee, initially, when you start out, check your urine pH regularly. What gets measured gets managed. It’s eye-opening. After a workout, you will be acidic. I want you to wake up alkaline. I want you to go to bed alkaline. Your body needs to rest and repair itself while you’re sleeping. You’ll see the nights you’re more alkaline, the deeper sleep you get. You’ll also recognize that you wake up more alkaline. When you’re not sleeping through the night, you wake up more acidic. It’s a good marker. You understand what’s happening to your physiology. It gives you one measure to say, “What can I do to improve this outcome?”
Maca root. I haven’t had an expert on maca. I have been taking your Mighty Maca. I have been adding it to my smoothies. Why do you like maca root? What are some of the benefits of it? If you could talk a little bit about what differentiates your product. I know it’s not just maca; it has other things in there.
When I was 39 and diagnosed with infertility and early menopause, again, I was devastated. I went on a healing journey. Our girls were seven and nine at the time. I had one in college. We went on this healing journey.
One of the first places we went was to Peru. One of the nurses that worked with me in my private practice was a nurse midwife in Peru before she came to the U.S. She still has been working with me since 2000. She has had different roles throughout the years. 23 years, she has worked with me. I loved her family.
We went to see her family in Peru. Everywhere we went, they would say, “If you’re infertile, drink maca. If you’re tired, drink maca.” They would elbow my husband, give him a wink, and say, “It’s the Peruvian Viagra.” Y’all know we were drinking some maca, right?
But I couldn’t stand the taste. I’m from a family of cooks, chefs, bakers, and gourmands. This is such a powerful superfood, and the history of maca is fascinating. That was the first thing. What is this? As this skeptical doctor/scientist that I am. What is it about maca that makes it so amazing?
The research shows that maca has specific proteins that are unique to it, maceins. It also is rich in arginine, which increases nitric oxide, which increases blood flow, which lo and behold is how Viagra works. Huh? Fascinating.
It’s adaptogenic. It really helps you in times of high stress, low stress, as a preventative. It does so much good in and of itself, Peruvian maca.
I started using maca, but I started mixing it. What other superfoods are out there? I couldn’t stand the taste. I’m of the belief that if you have an aversion to something that is supposed to be good for you, that partially defeats the purpose. I started mixing it with other superfoods: cat’s claw herb in Peru, acerola cherry, mangosteen, and green tea extract. I found superfoods as we traveled around the world. Part of this miraculous healing journey that we had. I blended these things together. Lo and behold, my periods returned. Within a year or so, during sometime in that journey, 2006/2007/2008, I became pregnant with my daughter, Ava Marie.
When I come back to Georgia, I have to keep taking these superfoods. I have to keep taking it. I worked with a manufacturer to reproduce what I was making, using organic Peruvian maca, these highest quality ingredients, and blending them together. Just a small amount for me, my family, and some of my patients. My first batch was 500 bottles. That was the smallest batch they would let us make. Within months, that was gone. Word of mouth had started spreading. Now we are all around the world with Mighty Maca.
What we have seen clinically is the most important. We have Mighty Maca babies. We have seen a reduction in hot flashes. We have seen an improvement in day 21 progesterone. We see an improvement in DHEAS. We see an improvement by 70-200% in two months of adrenal function. Just taking Mighty Maca Plus for two months, we have seen a 70-200% improvement in adrenal function.
The reason I combine some of the ingredients—the fibers, the enzymes, the liver support, the detoxification support—is because part of that is to support our body’s natural hormone production, so we can use more of what resuscitates the glands, like I mentioned earlier. Our body is using more of the hormones that we’re designed to use.
Like I said, I have been adding it to my smoothie.
And it tastes great.
It does. I have been adding it to my wife’s smoothie, and she is very particular. She is very picky about taste. I can vouch for the taste. I haven’t added it outside of my smoothie. I think if anything, it does make the smoothie better. There are other powders I’ve added where you can notice it makes it almost unbearable. Definitely does not do that. It’s good tasting.
I asked someone else on the podcast a while back, over a year ago, and she didn’t have knowledge about maca. I was excited to chat with you about maca.
You also have another product, Julva.
Yes. That’s another product I created from my own health journey. Also, as a gynecologist, seeing women suffer unnecessarily with vaginal dryness. Initially through my work with patients who had a history of breast cancer and working on optimizing their sexual function, I found out we can use androgens and pro-androgens like DHEA to help improve the vaginal tissue very safely—it’s not contraindicated—in women who have had breast cancer or any other cancer. Healthy levels of DHEA are a marker for a decreased risk of cancer.
I started compounding formulas for sexual health and vaginal formulas, topical formulas. For compliance, and my own self and patients, I created my product Julva to help with the whole vulvar area, the perineum, for sexual health, but also for incontinence, bladder health, and vaginal support. It has been a blessing in so many ways.
I combined it with plant stem cells from the Alpine rose, which are known to decrease- They are part of really high-end cosmetics because it is anti-aging. It helps with collagen formation, decreases fine lines and wrinkles. I will enjoy my laugh lines and smile lines here. The effects they have down there are we don’t want them: incontinence issues, lack of pleasure, discomfort, pain.
I had a patient in my clinic yesterday, and she has been married for 28 years. She is in her late 50s now. She said that it’s like a ring of fire when she has sex. She has been struggling with this. She has been to her primary care, her gynecologist. They gave her some vaginal estradiol tablets, and she is not noticing any improvement. We have known this for two decades: DHEA is so much better for vaginal and vulva tissue.
Let’s not forget the other important parts of our anatomy. The way I created Julva was to combine it with plant stem cell technology and with emollients to help it absorb deeply into the tissue. We know that DHEA works at the cellular level and helps with turning back the hands of time, so the natural moisture production, so you’re not reliant on a lubricant. With pelvic floor exercises, it decreases incontinence symptoms. We have over 5,000 five-star testimonials on my website. The stories are just beautiful. Just a shoutout for everyone who has left a testimonial because it’s so important to hear your voice.
Thank you for creating these products and the Keto Green. I know you have to run, but one thing I quickly wanted to say is when it comes to DHEA, I know you test for DHEAS. One thing I liked that you said in your book is you don’t start out with massive amounts of DHEA. If someone has a DHEA deficiency, you start out with 5mg. If necessary, gradually decrease. I am glad you do that because I’m like that, too. If I recommend DHEA, which I don’t for everybody, but I recommend starting at a lower dose, not jumping into 50mg right off the bat.
What we do when we do that is suppress the body’s natural production. I do hormone replenishment, not replacement. I never want to suppress or take your body’s ability to heal away and rely on something external. We use it as a complement to our lifestyle and mindset and all of these things. We use these in companionship because it’s never just a pill, a program, a peptide, or anything else. It’s a lifestyle that we have to create. It’s a mindset. That is what I want everyone to know. It’s within their power to be healthy. Healthier tomorrow than you are today.
Well said, Dr. Anna. Where can people find out more about you? Where can people get those products if they want to get them?
Come to my website, DrAnna.com. You will see my storefront there. There is information on trials that you can get. I’m @TheGirlfriendDoctor on social media, like Facebook and Instagram, YouTube. Lots of great free content for you guys to enjoy.
Dr. Eric, thank you so much for having me on today.
It was a pleasure. Thank you. Appreciate you sharing your thoughts on optimizing hormones and talking about maca and your other products. Thank you so much, Dr. Anna.