Recently, I interviewed Dr. Jennifer Roelands, and we talked about the perimenopause and its connection to thyroid health. If you would prefer to listen to the interview you can access it by Clicking Here [1].
Dr. Eric Osansky:
I am very excited to chat with Dr. Jennifer Roelands. We are going to be talking about hormones with a focus on perimenopause.
[Some audio issues during this bio reading] Let me go ahead and dive into Dr. Roelands’ impressive bio: Dr. Jennifer is a double Board-certified OB-GYN and integrative medicine doctor. She is a consultant, an educator in the women’s health space, and did her integrative medicine fellowship at Andrew Weill Integrative Medicine Center.
As a fellow sister and sufferer of hypothyroidism, she is passionate about helping women heal their PCOS and advocating for themselves in the health care system, using a whole-body approach to women’s health. She believes the key to healing is a personalized approach for each person because we are all unique. She serves her patients holistically by integrating each patient’s individual complexities and similarities *audio cut* from multiple vantage points of functional, holistic, and integrative medicine.
When she is not working with patients, she is an avid hiker, foodie, and the go-to math guru for her four energetic kids. Thank you so much for joining us, Dr. Jennifer.
Dr. Jennifer Roelands:
Thank you so much for having me. I’m excited to be here.
Dr. Eric:
Excited to chat with you. Just curious, how old are your kids?
Dr. Jennifer:
I have a 16-year-old, a 14-year-old, and two 12s. Two twins.
Dr. Eric:
You are the math guru, so I was trying to see what type of math. Is it some type of calculus in there, too, or not yet?
Dr. Jennifer:
There is. He is starting to outgrow my math skills because I have to go look things up again. What was that thing again? It’s been a while. We are getting to a point where he might have to go to the Khan Academy.
Dr. Eric:
Or hire a tutor.
Thanks for being here. If you could talk a little bit about your background. You are an OB-GYN. I assume you weren’t integrative right from the start? How did you make that transition into being a functional medicine practitioner?
Dr. Jennifer:
Like most of us in this space, I had my own health struggles, my own health journey. I was a traditional OB-GYN for several years. I already had a child, and I was working on trying to have a second child. I suffered from infertility. I couldn’t get pregnant. I was not able to get pregnant. I had done a basic workup on myself with my OB, realizing that nothing really came to an answer as to what was going on.
Ultimately, I ended up having to see an infertility doctor. On that journey, we discovered I had Hashimoto’s that was hindering my ability to get pregnant, which is an interesting story as it is. The screening test, the TSH, did not pick up my Hashimoto’s. It was my thyroid antibodies that they realized were very high. Anybody who possibly has Hashimoto’s, and you’re looking to get pregnant, being on Synthroid or levothyroxine is important is aiding in the fertility journey.
Once I was able to conceive that son, I started having all the typical thyroid symptoms. I was exhausted all the time. My hair was falling out. I just felt awful. No matter what I did, even with Synthroid, I was still suffering from all these symptoms: weight gain, constipation, all the ones you hear related to hypothyroidism.
It forced me to say there has to be something I don’t know. There has to be some piece of the puzzle that’s missing here. I told my patients all the time, “Just take this medication. Things are going to be great.” Here I am on the other side, going, “Things are not great. I am drinking 4-5 cups of coffee a day. I know I have a newborn, but this is excessive.”
That led me down taking a lot of integrative nutrition courses and realizing nutrition actually matters. In medical school, we are not taught that. We literally have a month of nutrition. I started connecting the dots and realizing that it was bad medicine not to talk about what we are eating and how food helps your conditions. How can food be medicine?
My own personal struggles with Hashimoto’s, and after that, when I was diagnosed with PCOS, made me think of medicine as it has to incorporate these diet/lifestyle/other things into what we do for treatment. I did the fellowship in integrative medicine, so I could offer more tools to my patients to make sure they are treating or preventing their illness.
Dr. Eric:
You mentioned how it’s important for people to take thyroid hormone, which is true. If someone needs it, it’s important for them to take it. Now the difference is you are doing more than that. A lot of medical doctors just give the Synthroid, the levothyroxine, or whatever they are giving, and say, “That’s it. That’s the treatment.” Being integrative, of course, you look at other areas. That’s great that you made that transition to help others.
Let’s get into the hormones. A lot of people have hormone imbalances. Perimenopause is a little bit tricky just because it is that transition between pre-menopause and post-menopause. What are some of the common symptoms? What are normal symptoms compared to maybe not normal but something that women typically experience, like hot flashes, for example? I know we chatted a little bit before this, and you’re in perimenopause. Maybe you could talk about some of the symptoms you might be experiencing, or maybe the symptoms you’re not experiencing but many of your patients experience.
Dr. Jennifer:
Sure. The key part of perimenopause is these symptoms can happen 10 years before you hit menopause. We define menopause by one year without periods. It’s this day that just happens on one year and one day, and all the balloons start falling, and the rainbows come out. You have made it to menopause. It’s an interesting definition.
Up to that, 10 years before, people can be experiencing perimenopause. Perimenopause can be broken down typically into three stages. For context, if you are going to go through menopause in your late 40s, you could be experiencing these symptoms in your late 30s. Oftentimes, many women don’t recognize these things are starting to happen.
The first stage of perimenopause is when progesterone is really starting to drop. You are not ovulating consistently. You don’t have cycles where you are getting as much progesterone produced. During that time, that 10-year transition, progesterone starts to decline, decline, decline until it’s low enough to where you do not generate a cycle, which would be in menopause.
Symptoms that are associated with that drop in progesterone are difficulty getting to sleep and difficulty staying asleep. Progesterone works at the GABA receptors in your brain to calm your brain down to get you to sleep and stay asleep. Women will often say, “I have been waking up at 4am. I go to bed, but I wake up ready to go as if it’s time to start a workday, and I can’t get back to sleep.”
Progesterone also works at the GABA receptors in the heart, so some women experience fluttery situations, as if they had two cups of coffee, but they didn’t. Even sitting at rest, you feel this tachycardia feeling, this racy heart. It goes away.
It can often make anxiety worse, so that you feel very anxious, or edgy, like their personality. Women will often describe it to me as, “I typically don’t yell at my kids this much, but I am yelling at my kids really easy. Or I saw a sock on the ground and am like, ‘Who put that sock on the ground? Why would someone do that?’ I am overreacting to things that most people would feel is just a sock.” But feeling that edginess or that anxiety.
Women who are already sensitive to progesterone issues, who may have a history of PMDD or PMS, may have low moods. They feel the effects of feeling down, like real pronounced PMS-type symptoms.
Progesterone can also sometimes be responsible for joint pain, feeling achy in the morning or getting injured more commonly than what you’re used to.
As we transition to the second stage of perimenopause, unfortunately, estrogen doesn’t just decline, but it rollercoasters up and down, up and down, on its way down, ultimately to where it’s low enough in menopause where you don’t have cycles.
Those are how women describe most of what they feel: “This week, my breasts are tender and killing me. Next week, they’re not.” “This week, I’m an emotional mess, crying at the Bank of America commercials. Next week, I’m not.” “This week, I’m waking up with night sweats and hot flashes. Sometimes, I’m not.” “Sometimes, I am in a super good mood. Sometimes, I can’t get myself going and am in a funk.” “Sometimes, I have brain fog and memory issues, like what’s my neighbor’s name? What’s going on? I missed deadlines. I missed the kids’ parade I am supposed to go to.”
Those are the sorts of up and down effects that happen as estrogen slowly goes down. The brain is telling the ovaries, “Can you please make estrogen?” The ovaries are saying, “We are working as hard as we are going to work.” Sometimes, there is a peak of it, as more is able to be made, and sometimes there’s not. That’s the way it works.
Eventually, they get low enough where they are both too low to produce a period. Then you hit that menopause definition, where the ovarian hormone production is so low that you can’t cycle.
Women can have all of these symptoms, leading up to menopause. There is more than 80 symptoms associated with perimenopause. They can be those usual ones I mentioned, but they can also be unusual ones like skin changes. People notice rashes or eczema flares or things that can change. Their skin becomes more wrinkly and saggy and not as luxurious as it used to be.
Healing can change, where they are not healing injuries as fast, or joint pain. Even some unusual ones like itchy ears or itchy skin can happen. Dental changes.
If you realize that every cell in our body likes estrogen, you can imagine that every system can also be affected in perimenopause by the lack of estrogen. There can be all kinds of different symptoms associated with this.
I always tell women if you feel off, if you feel like nothing has really changed. “I have the same diet/lifestyle situation, but I just don’t feel right,” it’s time to go talk to someone, especially if you are over 35, about maybe some of these hormone changes are starting to affect your life.
Dr. Eric:
When it comes to testing, it sounds like it might be challenging, especially during that estrogen rollercoaster, because your estrogen might be low one time and then higher another time. Do you bother testing at all? How do you get around that?
Dr. Jennifer:
I don’t routinely test every perimenopause woman because of exactly what you said. The other thing is the range of normal for premenopausal women is 20-200 for estrogen. You could imagine that a lot of women are told, “Your labs are normal.” It could be that last week, my estrogen was 200, and today, it’s 20. Yes, it’s “normal,” in the normal range, but that doesn’t mean it’s normal for what I feel like.
I try to discuss with women the pros and cons of testing. I will do testing if someone is on HRT, and we are trying to figure out if we are optimized. If you’re still having symptoms, one may be lower than the other. We may need to use it for a data perspective. But I don’t test everyone in perimenopause because the data can often be confusing.
Dr. Eric:
How do the adrenals affect sex hormones in general, including during perimenopause?
Dr. Jennifer:
The precursor to all sex hormones is cholesterol. It starts at the top. Then we have prednisolone. Then we can make these divisions between the androgens and progesterone. When you are losing sex hormones, the body says, “Where can I get them? I’m asking the ovaries to do it, and the workers are saying, ‘No, thank you. We only work from 8-12. That’s all you’re getting from us.’”
The other ways the body can do that is something called cortisol steal, which is making more cortisol to flush it this direction. We know that in the peripheral tissues, you can get testosterone to be converted to estrogen with aromatase. Because of that, it’s trying to think, “Where can I get these sex hormones from? I can’t get them from the ovaries because the factory is only open from 8-12. Potentially in other tissues, like with fat cells, I can potentially get testosterone to convert to estrogen, so I need to increase my testosterone. I need to do it from another location to do that.”
Unfortunately, some people’s cortisol does go up. The cortisol can cause all kinds of symptoms. We know this mid-abdomen weight gain happens in perimenopause. Anxiety for sure can get much worse. People have worsening sleep issues related to cortisol. Often, you feel like you’re eating a little better, you’re exercising, and something isn’t working. It can be this adrenal piece that is derailing the rest of the crew in the hormone balance.
Dr. Eric:
Do you test the adrenals, either in the blood or saliva or dried urine testing?
Dr. Jennifer:
Yeah. Conventional medicine, there is not very good tests for this. If you went to Lab Corps or Quest, and I am not picking on them, but a traditional office typically uses those labs. You can do a 24-hour urine cortisol or an 8am cortisol, but it’s not helpful. What is more helpful is having these points in time, like you are describing, with saliva or urine testing.
If I do do cortisol testing, I typically like the Dutch test, only because- I don’t know if you’ve ever done the saliva test, but it’s a lot of work to sit there and spit in the tube four times. I have done it before, and I think I’m good. I will just pee on this piece of paper; it’s much faster. I typically do the Dutch test.
I like the way the Dutch also gives me sex hormones and cortisol. You not only see the production, but what happens in the body as the metabolism of those hormones. If I order it, I typically order the Dutch test because I find it to be the most useful test for that.
Dr. Eric:
Personally, I have done both. Years ago, when I was dealing with Graves’, I did saliva testing because I don’t think the Dutch was available then. When I became aware of the Dutch around 2016/2017, I did it. It’s a pretty easy test. I don’t personally remember struggling with saliva, but I know people do struggle to generate enough saliva. It’s a good point.
Cortisol responds to stress, so if someone is doing a saliva test, and they are stressing out trying to generate enough saliva, that could be a potential cause for an elevated cortisol if you do that first thing in the morning. If I see a big spike, I will ask someone, “Were you stressed out about something?” I’m glad you mentioned that.
Dr. Jennifer:
Maybe more women have those issues, I don’t know. I know I sometimes get emails that are like, “This is a lot of work. I don’t think I can do this test.” Rather than having to reorder a new test- If you had to choose between one or the other for just straight cortisol testing, saliva is in my mind the better test. I almost always look at the bigger picture with both. Usually for me, the Dutch is the better test.
Dr. Eric:
I don’t know if you do Dutch testing in perimenopause. The hormones can be inconsistent, especially during that second stage. How about the estrogen metabolites? Are those worth looking at during menopause?
Dr. Jennifer:
The reasons I do them during perimenopause is someone could be on HRT and still struggling with the issues. You don’t want to miss the cortisol piece. Upping the hormones may not be the answer, as it may be a cortisol problem. You have to address that.
Especially with someone who says, “I can’t get going. Afternoon is terrible.” In my mind, it’s this radar going, “We need to have a cortisol picture.” In perimenopause or post-menopause, I will put that cortisol piece in there.
For the perspective of the metabolites, I have a wide range of patients. Some patients are interested in things like HRT or bioidentical hormones, and some women want to do it completely with food, lifestyle changes, and supplements, with no hormones. For those patients, the metabolism is completely important for me. If we are going to optimize nutrition and supplements, we need to know what happens to the estrogen they make. Where is it going? Which pathway? The detox pathways in phase one or phase two of the liver, what’s going on there? How can I then help them optimize what’s going on?
Certainly, genetics can be important, too. Nutrigenomics, to understand what pathways may be a problem. If you’re going to try to do it from food and lifestyle changes, then that really helps you understand someone’s biology of what’s going on.
Dr. Eric:
Do you do any nutrigenomic testing in your practice?
Dr. Jennifer:
I do. I order the 3X4 test for people who want it. I have been starting to look at some other smaller panels specifically as opposed to a bigger picture because that can be an overwhelming report. You have to be focused. You don’t want to hand someone a 70-page report and say, “Here you go.” I tend to try to focus on what we are trying to solve from that perspective.
For someone who wants to avoid hormones at all costs and wants to optimize it from nutrition, it’s very useful. Or like a breast cancer patient who wants to know, “What can I take for these hormone symptoms if I’m not allowed to take HRT in any way? What are my options from a more natural perspective?” That can be useful to understand the metabolism of what hormones are there.
Dr. Eric:
Speaking of giving hormones, in the case of someone who is open to receiving HRT, let’s say the Dutch test shows low estrogen but high 4-hydroxy estrogen metabolites. In that case, is it safe to give bioidentical estrogen? Would you want to address the estrogen metabolism problem first? Can you give bioidentical estrogen while addressing the estrogen metabolism problem?
Dr. Jennifer:
I often will talk to them about both pieces of the puzzle and assess what is the best thing for them. For example, I had a patient, very similar scenario to what you’re describing. Her quality of life was so incredibly affected by the low estrogen. She was not getting out of bed. She was not working. She was struggling with day-to-day life.
In my mind, in order for people to make those changes long-term, it’s hard to do that if you can’t get out of bed. From that perspective, I took the bigger picture and said, “This lady needs to start feeling better. Let’s give her some estrogen back. Let’s start incorporating these changes that need to be made from a long-term sustainability perspective. I gotta get her feeling good.” I can’t tell someone to go outside in the morning light and eat cruciferous vegetables if they’re not even getting out of bed because they are so low in mood.
Some of that has to do with the situation going on with the patient and where they are in their journey to make changes. Sometimes, it’s a matter of getting someone to feel better with HRT. Then let’s understand you and how we can make these changes.
To be honest, being an integrative doctor. I never give HRT and not talk about the other stuff. With any other thing in the world, if I gave someone Synthroid or MP thyroid, I don’t do it without saying, “By the way, how’s your gut? How’s your sleep?” To me, it’s just a Band-Aid of the issue. You’re restoring the hormones, but there are still these other factors that can derail them at any moment. I try to address all those pieces as well.
Dr. Eric:
That makes perfect sense. Let’s say you recommend bioidentical progesterone and estrogen to someone. At the same time, you are improving their adrenals and gut health. Do you sometimes see where a person may not need as high of a dose because you are addressing other bodily systems?
Dr. Jennifer:
Yes. We always start low anyway to see how someone feels to begin with. That is where I use bloodwork sometimes. I’ve had patients who I have put on the patch, and they are at the mid-dose patch and feel nothing. Hormone testing is very effective there. What is their estradiol on this patch? Maybe the patch is not the right option for them. Maybe they require more. That is what I sometimes use lab testing for.
Certainly, the healthier you are in general, if you’re taking an oral pill, and your gut is better, then the absorption will be better, so the effects will be better. It is important to put the bigger pictures together as well.
If someone has a high stress/high cortisol problem, you can’t out-estrogen them. You can’t pour enough estrogen, and it will all work out. They all work together. These hormones are like a symphony. I can make the bass player play way louder, but no one will hear the violins. They all have to work together.
Dr. Eric:
It’s true. If you give bioidentical hormones but are not showing them what they can do to better manage their stress and make sure they are getting sufficient sleep and eating a healthy diet, they might get some symptomatic relief from the hormones. Like you said, there is a time and place, but you also want to incorporate the other diet and lifestyle factors. I agree with that.
Let’s get back to the thyroid. You have a history of Hashimoto’s. I’m sure you see a good number of people, mostly women, who have Hashimoto’s. If you don’t mind me asking, how old were you when you developed Hashimoto’s?
Dr. Jennifer:
I’m 46, and my son is 14. So 33/34.
Dr. Eric:
I work with people with Graves’ and Hashimoto’s. I see people in different ages. I see people in their 20s struggling with thyroid autoimmunity. Sometimes, I see children and teenagers. We see those in perimenopause, menopause. Some wonder, can those hormone fluctuations serve as a trigger? Is it just a coincidence when someone develops Hashimoto’s or Graves’ during perimenopause or menopause? Is there a relationship in many cases?
Dr. Jennifer:
It’s not a medical term, but there is a term that has been established by a lot of people who take care of thyroid people, something called “thyropause.” This same part of the brain, the FSH that tells the ovaries what to do, is secreted from the TSH. We know it’s the same area. The beta subunits of both of these molecules look very similar.
When the changes happen, the pulsivity of the FSH is getting messed up because of perimenopause. The brain is constantly trying to tell the ovaries, “Could you please make more and do what we’re asking you to do?” The ovaries are saying, “We’re doing our best. This is not happening.” The feedback comes back, and oftentimes, that disrupts the TSH connection. The TSH tells the thyroid, “You should make more T4.” T4 gets converted to T3.
When I start noticing people having abnormalities in their thyroid labs and are in perimenopause, I am doing thyroid antibodies to see if it’s truly Hashimoto’s, or hypothyroidism of maybe some other reason. You can imagine if someone is having perimenopausal changes and cortisol disruption and blood sugar imbalances and gut health issues, potentially, change in the thyroid can happen, and it’s not truly Hashimoto’s. It’s not an autoimmune issue. Those are two different things. Most hypothyroidism is Hashimoto’s, but not all of it. Not every single person has Hashimoto’s.
The autoimmune people tend to be a little bit different than the people who have hypothyroidism that are not autoimmune. I often will want to know if their sex hormones were fixed, and we redid their thyroid panel, what is the result? Is it the sex hormones throwing them off, or are they truly actually developing a thyroid problem in their 40s? That’s the typical perimenopausal age.
Dr. Eric:
That makes sense. When it comes to diet and thyroid autoimmunity, I was listening to one of your podcasts. I heard you talk about autoimmune paleo (AIP), which I was impressed. I commonly recommend AIP. You had some good things to say about it. I think that was a few years ago, so I don’t know if you still feel the same way.
If you do, or even if you don’t, can you talk about diet? Most people I chat with would agree there is not one diet that fits everybody perfectly. I am not saying AIP is a perfect fit for everyone with Hashimoto’s or Graves’ or autoimmune conditions. I think it makes a good elimination diet as a good starting point for many people. Would love to hear your thoughts on that.
Dr. Jennifer:
For people who are struggling with thyroid issues, particularly if they have gut health issues, that can be defined by testing, but it can also be defined by someone who is telling you they are having IBS-type symptoms or constipation issues or bloating. They have pizza, and things go off the rails.
I am not being more integrative or functionally driven. I don’t test everybody for everything all the time. If a patient tells me they don’t poop in seven days, I don’t need to test them for gut health problems. I know they have a gut problem.
Oftentimes, I’ll talk to them about AIP to figure out what is triggering the inflammation in the gut? What is causing the leaky gut, the inflammation that is occurring in the gut, to try to distinguish what nutrition plan works for them? You could be somebody who is a functional medicine doctor who tests these and does food sensitivity and a GI Map and all these functional tests. Or you can use an AIP diet to let the patient figure out what are the things that are triggering their inflammation? Taking out the common allergens or antigens that cause inflammation. Then introducing them back.
It is a slow process. It is a learning process. You have to be patient with yourself. You can get constipation if you didn’t have it. Things can happen with your bowels. What you are ultimately doing is calming down your gut by removing those things that are causing the issue. Then figuring out things by reintroducing these food groups back slowly. Which one is causing you the most grief?
It doesn’t always have to just be GI stuff. Some people do AIP because they get bad eczema flares or other autoimmune symptoms, and they want to figure out what is the food that is causing them those problems?
For patients who find that AIP is just too hard or strict or too much for them to follow, then I often talk to them about just a paleo diet. It’s an anti-inflammatory diet. Following more of a paleo protocol to get rid of those things that are causing them issues. You could even put them on an elimination diet. There are a lot of ways to do this.
Most of the time, when I am deciding how to work with a patient, I ask them, “What are the obstacles to changing what you do? If I tell you that you can’t have gluten, dairy, nightshades, alcohol, can you do this?” I don’t want to set you up for failure. I want you to succeed. If you can’t, let’s talk about what if we just got rid of gluten for three weeks? Sometimes, we make a modified protocol. I’m sure you do this with your patients as well. It depends on what they are capable of doing.
Dr. Eric:
Exactly. There are some people who are already following an AIP diet before they become a patient, just because they have heard me or others talk about it. You’re exactly right. There are some people where giving up gluten or their morning coffee are big struggles, so let’s do baby steps with them. Can you start with gluten, and we will worry about everything else, the dairy, the nightshades later?
I also take a similar approach. If someone is willing to follow a standard paleo diet, where they could eat eggs, nuts, seeds, but avoid everything else that is part of AIP, that’s great, too. There are some people where we just start off with gluten-free, see how they do. I think we do take a similar approach when it comes to diet.
Dr. Jennifer:
Izabella Wentz is a big person in this field with thyroid. I understand her ideas of yes, most people with thyroid problems will need to be off of gluten and dairy. We know that because of the types of cells, where they’re located in the gut, tend to cause problems with people who have thyroiditis.
And this could be for women with PCOS or anything. You can’t just pan across the board and say everyone with thyroid has to do this, that it works for everybody. There is so much more complexity to people’s medical problems. I tend to like AIP or paleo to weed out the things that are causing problems as opposed to just putting everybody on the same protocol.
Dr. Eric:
Quick question with AIP. Do you consider ghee to be acceptable? Clarified butter as part of AIP.
Dr. Jennifer:
I do, yeah. I have a lot of patients who do that.
Dr. Eric:
That is considered dairy, so it’s controversial. There are some AIP advocates who allow it, and others who don’t. I wanted to get your opinion on that.
Dr. Jennifer:
I think working with women for 15 years, maybe part of it is also I am not a big diet person. I don’t like that word. If you tell me you will put me on a diet, I want whatever you tell me I can’t have. Same thing with weight loss. It’s about finding the foods that love you back. Let’s find the foods that are actually going to be the ones that work for your biology and create that as an eating pattern as opposed to a diet, per se.
I do know that sometimes, women (and men, too, because I do see men as well) get stuck in this- I have had patients who are on an elimination diet for two years and came to see me. This is not what you’re supposed to do. You’re supposed to be eliminating and reintroducing. You don’t want to narrow your scope too much, so you end up with a nutrient deficiency. Make sure you find foods that are working for you and not eliminating everything. Do you know what I mean?
Dr. Eric:
Yep. I definitely do.
This ties into hormones, too. Not necessarily talking about food. Do you also talk to patients about avoiding plastic water bottles because of xenoestrogens as hormone disruptors? Overall trying to reduce their toxic load?
Dr. Jennifer:
I do. I talk a lot about lifestyle factors. What do you put on your skin, your beauty products? What do you use to clean your house? Plastic water bottles, toxins in general. Where are you eating out?
I also talk about things like getting the morning sun, Circadian rhythm syncing. I also talk about intermittent fasting. I also talk about mind/body and how important it is to have some sort of way to activate the parasympathetic response. It can be things like tapping or meditation or journaling. All of that gets put into my treatment plans.
It doesn’t matter what we are talking about. Could be perimenopause or PMS. Let’s talk about what are you doing for these other aspects of your life, too? Nobody is a one size fits all. There are different approaches for different patients depending on what they feel resonates with them. I do bring into those other aspects as well, the lifestyle changes.
Atomic Habits is one of my favorite books. I am not sure if you’ve read it or not. I am always talking about these small changes. Small changes that lead to habits that ultimately become part of your life.
Dr. Eric:
I did read that book a few years ago. Good book. I can’t remember if I read it or listened to it because I listen to a lot of audiobooks.
Circling back to gut health. You mentioned that sometimes, you do testing, and sometimes you don’t, which describes myself, too. I can’t say I recommend a comprehensive stool test on all my patients. Let’s put it this way. If someone is following AIP and has gut symptoms, and then they resolve, maybe you don’t do a GI Map or other stool test because their gut is feeling better just with diet. In what situations do you recommend testing, such as a GI Map?
Dr. Jennifer:
I probably order more food sensitivities than GI Maps. Oftentimes, a patient may or may not want to do that long protocol to figure it out. They’d rather start with some baseline of what’s going on. Or they are doing it, and it’s not working, and they are still having problems. Therefore, they are trying to narrow down what is it that is causing them to react? I definitely do more food sensitivities.
GI Maps, I sometimes see some outside the box things like Lyme and mold and unusual things that happen. I will be more apt to order GI Maps for those patients. Treatment has to come from a lot of different angles to figure out what order works to treat first.
For a standard thyroid patient, I will order that if they are already doing an elimination diet or AIP or paleo, and it’s not working. What is the missing piece here?
Dr. Eric:
Makes sense. With food sensitivity testing, just so I’m clear, you do that if someone finds AIP too restrictive, and they don’t want to follow that diet. You will do a food sensitivity test instead of an elimination diet to see what they are reacting to?
Dr. Jennifer:
For those patients, or someone with a lot of skin issues. They want to know what they have to start eliminating from their diet, and they don’t want to do the slower, figuring it out technique. I will get that testing. If it lights up all these dairy proteins, we are going to eliminate dairy.
Whenever you do a food sensitivity, you have to keep in mind that some of these things are mildly positive. It depends if you are doing IgA, IgG, IgE. There are different types of testing. You should never just order it on your own and go off whatever it says. You have to make sure someone is helping you guide through what type of test you got.
They now have these direct-to-consumer tests. Patients can order their own tests. They have to interpret them themselves. I do find it sometimes gets confusing with the test they ordered. It can sometimes give you some basic ideas of where to start with getting rid of certain foods.
If it’s hard for someone to think about taking something out of their diet, sometimes giving them data on themselves helps to say, “Hey, looks like you have a lot of dairy issues. Why don’t we get rid of dairy and see how this goes?” For some patients, they like to see their own data to make changes.
Dr. Eric:
I agree. Sometimes, seeing is believing.
Dr. Jennifer:
Like CGMs. I use a lot of continuous glucose monitors on perimenopause women. They see their data, and they go, “Okay, this is the type of food that loves me back. This is the food that does not love me back. Let’s make some changes.” I tend to like that personal data to figure out how can I, for lack of a better word, hack my own biology or understand my own biology?
Dr. Eric:
Which food sensitivity testing do you use? Do you do all three you mentioned?
Dr. Jennifer:
It depends on what it’s for. I use different ones. I’ve used Vibrant Wellness before. I’ve used Genovva. I use them the most because I find their company is a little easier to work with.
The type of testing depends on what we are looking for. Most people with IgE issues already know they have an allergy to something because that is an immediate reaction versus IgG or IgA, which are more of what we are talking about, the gut issues that someone might not necessarily connect the dots that eating pizza causes a gluten problem. Therefore, they should not eat pizza. Some people can’t connect those because when you are eating pizza, you are also having cheese and sometimes wine or beer. They may not always connect the dots as to what is the actual thing causing problems. The IgG and IgA testing is typically what I will do in those scenarios to understand the group that may be the issue.
Dr. Eric:
When someone does an IgG test, and they have a few dozen positive findings, and a lot of those are healthier foods. There is the thought that that could be because of an increase in intestinal permeability, leaky gut. Do you still have them avoid those foods, or just have them avoid the foods on the higher side of positive?
Dr. Jennifer:
I start with the higher side of positive and talk about the fact that this is not forever. Because it says you can’t have it right now, that doesn’t mean you are forever not allowed to eat it. That’s an IgE type reaction. I first talk about this is this moment in time, what’s going on with you. Some of these things that are more milder may very well be something you can tolerate in a couple months. We have to get your gut healthier and not have this leaky gut, so you can tolerate these types of foods.
You see these people who have non-Celiac gluten sensitivities sometimes heal their gut and tolerate things later on. It’s just that at the moment, there is so many things causing reactions in their gut that they can’t tolerate those things in general.
Dr. Eric:
You covered a lot here. Anything else that is worth mentioning, or you’re burning to get out as far as helping women with hormones and perimenopause?
Dr. Jennifer:
I think the most important part is your symptoms are real. If you feel like something is off or wrong, or you just don’t feel like yourself, it’s very common that women are told, “Ugh, it’s part of getting older. Suck it up, buttercup.” Even by physicians, they are told, “Suck it up, buttercup. You’re not in menopause. There is nothing I can do.”
That is incorrect. HRT doesn’t happen when you hit menopause. It can be used for anybody. You can use it on a 20-year-old who has PMDD. It’s not magic that happens, and certainly nutrition and lifestyle changes can be at any age.
Often, I hear women who are dismissed. They are saying, “My mom said I went through it, so you can go through it. My doctor said it’s not a thing until you hit menopause. My friends say HRT is for the weak.” I try to tell women the most important message is: If you feel like something is wrong, and you want help, then find the person who is going to listen to you. Find a provider who is going to hear what you have to say.
It very well may be a hormone thing and not you. I have had patients who say, “It might just be me. I might be mean right now.” No, it’s probably your hormones. It’s okay to reach out. Let’s talk about these things and figure out if it’s perimenopause.
Dr. Eric:
Well said. Thank you for sharing. Where can people find out more about you, Dr. Roelands?
Dr. Jennifer:
I’m on Instagram, @DrJen.MD. I also have a virtual practice. I see patients in 10 states. I am licensed in 10 states. My website is WellWomanMD.com. You can go there or on Instagram and find me.
Dr. Eric:
Thank you so much. Appreciate your time. I’m sure the listeners learned a lot about hormones, especially related to perimenopause. A lot of what you cover, regardless of age, they can benefit from.
Dr. Jennifer:
Thank you for having me.