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The Doctor's Farmacy

Addressing The Underlying Causes Of Infertility with Dr. Elizabeth Boham

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About 10% of women of reproductive age are struggling with infertility and that number is on the rise. Individuals struggling with infertility can often feel hopeless. And while there is no across the board explanation for what causes infertility, by looking at the underlying issues that may be factoring in, it can often be reversed.

In this mini-episode, Dr. Hyman is joined by Dr. Elizabeth Boham to discuss the Functional Medicine approach to treating infertility. They discuss specific patient cases and share why it is important to consider a wide range of factors including toxin exposure, nutritional deficiencies, stress management, and more.

Elizabeth Boham is a physician and nutritionist who practices functional medicine at The UltraWellness Center in Lenox, MA. Through her practice and lecturing she has helped thousands of people achieve their goals of optimum health and wellness. She witnesses the power of nutrition every day in her practice and is committed to training other physicians to utilize nutrition in healing. Dr. Boham has contributed to many articles and wrote the latest chapter on Obesity for the Rankel Textbook of Family Medicine. She is part of the faculty of the Institute for Functional Medicine and has been featured on the Dr. Oz show and in a variety of publications and media including Huffington Post, The Chalkboard Magazine, and Experience Life. Her DVD Breast Wellness: Tools to Prevent and Heal from Breast Cancer explores the functional medicine approach to keeping your breasts and whole body well.

In this episode, Dr. Hyman and Dr. Boham discuss:

  • Why infertility may be on the rise
  • The difference between the traditional and Functional Medicine approach to infertility
  • Reasons why people may struggle with infertility including diet, toxin exposure, nutritional deficiencies, stress management, exercise, sleep, and more
  • What your waist to hip ratio and body composition can tell you
  • How insulin and thyroid issues can affect fertility
  • Celiac disease and nutrient deficiencies
  • The importance of good prenatal vitamins with folate

For more information visit drhyman.com/uwc

I hope you enjoyed this conversation as much as I did. Wishing you health and happiness,
Mark Hyman, MD
Mark Hyman, MD

Guest

 
Mark Hyman, MD

Mark Hyman, MD is the Founder and Director of The UltraWellness Center, the Head of Strategy and Innovation of Cleveland Clinic's Center for Functional Medicine, and a 13-time New York Times Bestselling author.

If you are looking for personalized medical support, we highly recommend contacting Dr. Hyman’s UltraWellness Center in Lenox, Massachusetts today.

 
Dr. Elizabeth Boham

Dr. Boham is Board Certified in Family Medicine from Albany Medical School, and she is an Institute for Functional Medicine Certified Practitioner and the Medical Director of The UltraWellness Center. Dr. Boham lectures on a variety of topics, including Women’s Health and Breast Cancer Prevention, insulin resistance, heart health, weight control and allergies. She is on the faculty for the Institute for Functional Medicine.

Show Notes

  1. Is An Underactive Thyroid To Blame For Your Mysterious Symptoms? with Dr. Elizabeth Boham
  2. The Underlying Causes and Solutions for Women’s Hormonal Balances with Dr. Elizabeth Boham
  3. Clara’s Case Study: Overcoming Infertility
  4. A Functional Medicine Approach to Infertility
  5. Supporting the Thyroid: Food as Medicine
  6. Stop Drinking Your Calories
  7. 7 Strategies to Reverse Infertility
  8. Food, Fat, and Infertility

Transcript

Dr. Elizabeth Boham (00:00):
If you’re thinking about getting pregnant, you want to be on that prenatal with all of that folate before you get pregnant. You don’t want to wait to start it when you get pregnant. It’s really important.

Dr. Mark Hyman (00:13):
Welcome to The Doctor’s Pharmacy. I’m Dr. Mark Hyman and this is a special episode called House Call, where we dive deep into different issues that people suffer from that are very difficult to treat using traditional medicine. We use an approach called functional medicine here at The UltraWellness Center in Lenox, Massachusetts and we help so many people with so many different kinds of problems.

Dr. Mark Hyman (00:33):
And today I have my colleague, my friend, and my partner at The UltraWellness Center, the medical director, Dr. Elizabeth Boham, who you probably know well by now, who’s shared so much about so many cases that are tough to deal with with traditional approaches. Today we’re going to dive deep into infertility, which affects one in seven couples and is getting worse.

Dr. Mark Hyman (00:55):
What does infertility have to do with anything we do in functional medicine? What is the typical approach that we do in traditional medicine and how is that different from how we think about this with functional medicine?

Dr. Elizabeth Boham (01:08):
I think that one of the most important things we do in functional medicine is we ask that question why. That’s very important with infertility, as it is with everything we’re dealing with because for each, if we had multiple different people with infertility issues, there’d be multiple different reasons for why they’re having a problem.

Dr. Elizabeth Boham (01:30):
It’s really critical to get that very detailed history that we always get with functional medicine, get a really careful physical exam, do some evaluation to try to determine for that individual person and that individual couple, what’s going on with their fertility.

Dr. Mark Hyman (01:47):
So you’re saying there’s not such thing as infertility, they are infertilities?

Dr. Elizabeth Boham (01:50):
There’s infertilities, yes.

Dr. Mark Hyman (01:51):
Right. And everybody’s different and you have to dig in. And there are common patterns for sure but we do a method of evaluation that helps us really figure it out. Tell us, what is the definition of infertility? How many people have it and what’s the deal?

Dr. Elizabeth Boham (02:05):
Yeah. So infertility for a woman, you’re considered having problems with fertility if you’ve been trying, actively trying to get pregnant for over a year and have been unable to get pregnant.

Dr. Elizabeth Boham (02:17):
That’s considered infertility. And like you mentioned, a lot of… It’s very common. About 10% of women in the reproductive ages are struggling with infertility. And there’s multiple, multiple reasons but you’re right. We are seeing an increase. We’re seeing an increase maybe because of some of the toxins in the environment, our poor diet. We’re going to get into things that-

Dr. Mark Hyman (02:40):
Wait, wait. Did you just say that what you eat plays a role in infertility?

Dr. Elizabeth Boham (02:43):
Huge role.

Dr. Mark Hyman (02:44):
Wow. We’re going to get into that.

Dr. Elizabeth Boham (02:45):
Yeah. A huge role. There’s lots of different reasons for why that can be going on for that individual person, hormonal imbalances that we need to evaluate, toxin exposure, thyroid is not working optimally, things like PCOS that we’re going to be talking about. There’s so many reasons that people can have issues with fertility that we need to delve into. Nutritional deficiencies.

Dr. Elizabeth Boham (03:12):
I mean, I think that so often we’re thinking everybody in the United States, if we’re just in the United States, the people in developing countries, they’re just doing fine nutritionally. But when we actually start to look, we start to see nutritional deficiencies that can have a huge impact on somebody’s fertility.

Dr. Mark Hyman (03:28):
It’s really true. I look back, my 30 years of practicing and 25 years of practicing functional medicine and I can’t tell you the number of patients that have struggled with infertility that once we work with them in functional medicine, they get pregnant.

Dr. Mark Hyman (03:44):
And it’s like… I’m not an obstetrician or gynecologist, I’m a family doctor. I’m not a fertility expert, but just following the principles of functional medicine and optimizing people’s health allows them to kind of reset their hormones and their immune system and actually get pregnant.

Dr. Elizabeth Boham (04:00):
We always start with those lifestyle factors because for so many people, that makes a huge difference. We make sure that the person is sleeping enough, getting enough rest because if the body is under stress, it’s less likely to get pregnant. We make sure that you’re managing stress. We make sure that you’re doing some exercise daily because that helps in so many different ways.

Dr. Elizabeth Boham (04:23):
We make sure that somebody is eating the right diet because as I mentioned, if somebody is having some nutritional deficiencies or not eating enough calories, we often see that, people are under eating or not eating enough calories, or maybe they’re over exercising, we know that can impact.

Dr. Mark Hyman (04:40):
To low body fat if you’re-

Dr. Elizabeth Boham (04:41):
[crosstalk 00:04:41] Yeah. Yeah. And even if body fat is okay, but you’re putting too much stress on your body with excessive training or not eating enough calories, that can cause fertility issues.

Dr. Mark Hyman (04:52):
Think about it. historically if you had no access to calories and you were under stress, your body’s like, “I’m not getting pregnant right now. This is bad news for me to get pregnant. It’s a dangerous environment.” But our body doesn’t realize that we’re living in the 21st century and it’s a little bit different.

Dr. Mark Hyman (05:07):
I just want to kind of come back to a traditional approach because I think it’s really instructive. Most of the time when you go to a fertility doctor, they don’t find anything.

Dr. Elizabeth Boham (05:16):
That’s true. That’s true.

Dr. Mark Hyman (05:18):
Sometimes you have tubal problems, sometimes there’s low sperm count. Sometimes there’s some obvious structural issue or some hormonal thing going on that’s fixable. But most of the time, it’s unexplained infertility. And so what do they do? They pump you full of hormones, they extract your ovaries, I mean your eggs from your ovaries.

Dr. Mark Hyman (05:43):
They create a test tube baby. They put it back in. Hopefully it sticks. It’s enormously stressful, enormously expensive. I don’t know if it’s 15, $20,000 a pop each time you want to do it and it often doesn’t work.

Dr. Mark Hyman (06:02):
We’re batting a far better average here with functional medicine in terms of getting families started and helping women and couples get pregnant than with traditional fertility treatments. And why is that?

Dr. Elizabeth Boham (06:17):
I think that it’s because we’re asking that question why and when we ask that question why and get some clues as to why there’s an imbalance in somebody’s body, we’re so much more likely to be successful in our treatment approach. Because if we just treat everybody the same, it might work for some but it’s going to miss all these other reasons that people are having issues.

Dr. Elizabeth Boham (06:39):
So you have to ask that question why and like you said, a lot of times, many of these other approaches are less expensive, less toxic and easier to do than that hard hitting approach that of course works for some people. But we’ve got to really ask that question why.

Dr. Elizabeth Boham (06:58):
And I think that’s one of the things with this first woman who came to see me.

Dr. Mark Hyman (07:05):
Yeah, Clara.

Dr. Elizabeth Boham (07:05):
Yeah. She was 33 and she had had irregular periods. When she started to get her period in puberty, they were irregular and so she went on birth control pills.

Dr. Mark Hyman (07:21):
Now what is with that? Doctors are like, “Oh, your period is irregular. Take the pill.” I’m like, “Is that a thing?” Where’s the randomized controlled trial on that?

Dr. Elizabeth Boham (07:29):
Right, right, right. Right. So it regulates them, but it never asked the question why they were irregular in the first place.

Dr. Mark Hyman (07:36):
That’s right.

Dr. Elizabeth Boham (07:37):
So she went off of the pill when she was 32 over a year ago because she wanted to get pregnant. They were ready to get pregnant. She goes off the pill. Well, what happens?

Dr. Mark Hyman (07:46):
Nothing.

Dr. Elizabeth Boham (07:48):
Her periods become irregular again because she’s off the pill, they’re all irregular and she doesn’t get pregnant. So they tried actively for a year and then she came to see me because she was like, “I really want to get to this underlying root cause here.” I really want to try to figure out what’s going on and why we’re not getting pregnant.

Dr. Elizabeth Boham (08:10):
I had got one clue early on with my evaluation with her was… What happened when she first walked in the door, our nurses check a waist to hip ratio on all of our patients.

Dr. Mark Hyman (08:24):
So how big is your belly and how big is your hips.

Dr. Elizabeth Boham (08:26):
Exactly. And she was this patient, Clara, was just five pounds overweight, maybe 10. She wasn’t really overweight. She was not largely overweight but we did a waist to hip ratio and when we did that waist to hip ratio, we saw that she had too much weight around her midsection.

Dr. Mark Hyman (08:44):
So she wasn’t really overweight, but she was over fat in the wrong places?

Dr. Elizabeth Boham (08:47):
In the wrong places. Hers was about 0.86, I think, 0.86 about. For women, we want it to be less than 0.8. You don’t want as much weight around your belly as you do around your hips.

Dr. Elizabeth Boham (09:00):
And so to me, that was a sign. I was like… And with this history of irregular periods all her life, I said, “We need to look deeper at what’s going on with insulin resistance.” And it made me wonder, did she have this syndrome called polycystic ovarian syndrome.

Dr. Mark Hyman (09:17):
And that’s an easy test you can do at home using a tape measure, measure around your belly button, the widest part of your belly, and measure around your hip bones at the side and see what your hip range. And then you can just do the math. It’s waist divided by hip, and you get in a number. If it’s over 0.8, you might have a problem.

Dr. Elizabeth Boham (09:36):
For women-

Dr. Mark Hyman (09:37):
Or you can just do the mirror test, which is look in the mirror, jump up and down. If your stomach jiggles, you probably have it.

Dr. Elizabeth Boham (09:43):
So for women, we want it to be less than 0.8, for men less than 0.9. There’s some differences depending on your ethnicity where certain ethnicities, we want it even a little bit lower.

Dr. Mark Hyman (09:53):
Wait, wait, wait. So that’s important because what you’re saying is we think of traditionally people who have prediabetes or insulin resistance, they’re having a big belly. You’re saying certain cultures don’t. Which are those?

Dr. Elizabeth Boham (10:04):
Like the Asian cultures; India, China, Asia. That you can have signs of… You can have the symptoms and the repercussions of insulin resistance in prediabetes even at a lower weight and-

Dr. Mark Hyman (10:18):
You would be able to record a normal weight with a BMI of under 25, but you’re still having this metabolic issue.

Dr. Elizabeth Boham (10:23):
Yep. And your belly might not be as big as the Caucasian person, but you can have signs of insulin resistance prediabetes and a smaller increased belly.

Dr. Mark Hyman (10:32):
Yeah. That’s interesting.

Dr. Elizabeth Boham (10:33):
Am I saying that right? We are stricter with certain populations. We want their waist to hip ratio even lower because they’ve noted with research that if their waist to hip ratio is, for women, even at 0.8, that that’s too much, they have signs of all of the sequela of insulin resistance and prediabetes.

Dr. Mark Hyman (10:50):
It’s more about body composition and where the fat is, then your weight.

Dr. Elizabeth Boham (10:56):
Absolutely.

Dr. Mark Hyman (10:57):
Which is not something we really focus on in medicine.

Dr. Elizabeth Boham (10:59):
That’s so important. The weight tells you one thing, but really the most important thing is where that fat is. If it’s around the belly, that then is a sign that there’s signs of insulin resistance prediabetes. And we know that that causes of course heart disease and Type 2 diabetes and hypertension and dementia and cancer. But it’s also associated with infertility.

Dr. Elizabeth Boham (11:26):
And I think that’s one reason, one reason we’re seeing this rise in infertility, because we’ve got so much more insulin resistance prediabetes in our younger people in this country.

Dr. Mark Hyman (11:37):
I mean, think about it. 75% of Americans are overweight. 42% are obese. That’s 80 million people who are obese. Not just overweight. And even if you’re just a little overweight, like you said, you can still have insulin resistance.

Dr. Mark Hyman (11:51):
In fact, probably most of the 75% people who are overweight have insulin resistance. And if you look even deeper, there’s the skinny fat people.

Dr. Mark Hyman (11:58):
So of the 25% of people who are normal weight, probably a quarter of them have prediabetes. And there was a study that came out recently that only 12% of Americans are metabolically healthy, which means 88% are not. So we’re talking about 88% of the population that has this problem.

Dr. Elizabeth Boham (12:20):
Right. Because we’re just eating way too many refined and processed carbohydrates and simple sugars.

Dr. Mark Hyman (12:25):
Starch and sugars.

Dr. Elizabeth Boham (12:26):
Starch and sugar.

Dr. Mark Hyman (12:27):
Starch and sugar.

Dr. Elizabeth Boham (12:28):
Yep.

Dr. Mark Hyman (12:29):
Yep. Well, I’ve been talking about that for a while, back from the days of ultra metabolism 15 years ago.

Dr. Elizabeth Boham (12:34):
And I think what’s important for some people is like you said, they don’t necessarily look obese sometimes or they might not even have a huge belly, but when you really look in more detail and you do either the waist to hip ratio or look at percentage of body fat, which you can do, they may be thin on the outside, but fat on the inside.

Dr. Mark Hyman (12:56):
So Clara had other symptoms of insulin resistance. Even though she wasn’t overweight, she had-

Dr. Elizabeth Boham (13:03):
She had acne.

Dr. Mark Hyman (13:04):
Acne.

Dr. Elizabeth Boham (13:05):
Yep. And she had-

Dr. Mark Hyman (13:07):
Belly fat.

Dr. Elizabeth Boham (13:07):
A little bit of belly fat and she had these irregular periods. Right.

Dr. Mark Hyman (13:12):
And did she have any hair growth sometimes?

Dr. Elizabeth Boham (13:14):
A little bit around her abdomen, which is associated. So for women, if you get hair growth on your abdomen where you don’t want it or on your face where you don’t want it or you lose some hair on the top of your head, that can be a sign of insulin resistance.

Dr. Mark Hyman (13:28):
You lose it where you want it and you get it where you don’t want it. And that’s a problem. And the other thing you found was her insulin level was high. Most doctors don’t check insulin levels but it’s an test.

Dr. Elizabeth Boham (13:40):
It’s an easy test. We did a fasting insulin on her and her fasting insulin was nine. Now, officially the literature will say anything a fasting insulin greater than 12 is considered too high but we really like that fasting insulin more like five. So we know people around that seven, eight, nine, 10, they’re definitely-

Dr. Mark Hyman (14:01):
What’s yours, Liz?

Dr. Elizabeth Boham (14:03):
I haven’t had it checked in so long. I don’t know. I’m guessing four.

Dr. Mark Hyman (14:08):
Mine’s two.

Dr. Elizabeth Boham (14:10):
I bet yours is. I know yours is two. I have to be more careful.

Dr. Mark Hyman (14:13):
Now with the quarantine, I’m eating way more. We just cook a lot. It may be a little higher, I don’t know. Maybe a little more wine, I don’t know.

Dr. Elizabeth Boham (14:22):
We don’t have to compete.

Dr. Mark Hyman (14:24):
Hey everybody. It’s Dr. Hyman. Thanks for tuning into The Doctor’s Pharmacy. I hope you’re loving this podcast. It’s one of my favorite things to do and introduce to you all the experts that I know and I love, and that I’ve learned so much from.

Dr. Mark Hyman (14:35):
I want to tell you about something else I’m doing, which is called Mark’s Picks. It’s my weekly newsletter. And in it, I share my favorite stuff. From foods to supplements, to gadgets, to tools, to enhance your health, it’s all the cool stuff that I use and that my team uses to optimize and enhance our health. And I’d love you to sign up for the weekly newsletter. I will only send it to you once a week on Fridays. Nothing else, I promise.

Dr. Mark Hyman (14:59):
All you have to do is go to drhyman.com/picks to sign up. That’s drhyman.com/picks, P-I-C-K-S and sign up for the newsletter and I’ll share with you my favorite stuff that I use to enhance my health and get healthier and better and live younger longer. Now back to this week’s episode.

Dr. Elizabeth Boham (15:19):
But a fasting insulin is an easy test you can get done. We also often do a glucose tolerance test where you check fasting insulin one-hour and two-hour blood sugar and insulin. Because the insulin part is important because a lot of times people have normal blood sugar, but if their insulin is jumping up too high after you drink that sugary drink, you know that’s that sign of insulin resistance.

Dr. Mark Hyman (15:42):
Well, that’s one… Break that down for me because I just remember this one patient I had years ago at Canyon Ranch, who was very overweight. She had a giant belly. It wasn’t like just a little bit. And I said, “Well, let’s do a glucose tolerance test and see what your blood sugar is.” Sugar was perfect. And her average blood sugar was perfect.

Dr. Mark Hyman (15:59):
So she didn’t register as a prediabetic or diabetic according to traditional criteria. But I said, “Let’s do a glucose tolerance test.” Her blood sugar fasting was normal. One hour was normal, two hours were normal. And that wasn’t even normal. It was great. It was 110. It wasn’t even like when it went over-

Dr. Elizabeth Boham (16:14):
Borderline, right?

Dr. Mark Hyman (16:15):
No, no.

Dr. Elizabeth Boham (16:16):
It wasn’t.

Dr. Mark Hyman (16:16):
At was two hours, it was at 110. So she never even spiked. But her insulin level fasting was 30 and it went up to like 200. And so what was happening was her blood sugar was being controlled because her body was pumping out so much insulin. That insulin was making her gain weight and causing all these other consequences.

Dr. Elizabeth Boham (16:35):
Because insulin is a growth hormone, right?

Dr. Mark Hyman (16:36):
And so it’s important to do the right test and often you don’t get the right test. Check women at 28 weeks for pregnancy. If you think you have diabetes, they might check you, but it’s way too late by then and the early signs you can pick up with the glucose tolerance test that we do here at The UltraWellness Center. Right?

Dr. Elizabeth Boham (16:49):
Yeah. Because that high level of insulin causes us to gain weight and gain weight around the belly. And it makes it very hard. When people have high level of insulin, it’s very hard for them to lose weight.

Dr. Mark Hyman (17:00):
Or get pregnant.

Dr. Elizabeth Boham (17:02):
Or get pregnant.

Dr. Mark Hyman (17:02):
So back to fertility, what was interesting with this patient was not only did she have one problem, but she had many problems and another problem with hormones too. What else did she have going on?

Dr. Elizabeth Boham (17:13):
We did further testing and saw that she had these thyroid antibodies. So she had antibodies against her thyroid. Now her thyroid levels looked fine. Her TSH was okay. Her free T3, was okay. Her free T4 was okay, but she had these thyroid antibodies. And so-

Dr. Mark Hyman (17:31):
By the way, we did another podcast on thyroids. So if you want to go back and listen to the one that Dr. Boham and I did, you can learn more about the thyroid, but this is a really important point.

Dr. Mark Hyman (17:38):
You can have normal levels of thyroid. You go to your doctor, checks you, “Oh, they’re fine.” But if you check the antibodies, which they mostly don’t do, you’ll find that they’re often elevated and that still causes thyroid dysfunction.

Dr. Elizabeth Boham (17:50):
And very important to check when you’ve got somebody who’s trying to get pregnant and not being successful. So we saw these thyroid antibodies. So we said, “Okay, we’ve got to get you off of gluten.”

Dr. Mark Hyman (18:02):
Why?

Dr. Elizabeth Boham (18:02):
Because gluten is a cause of autoimmune disease for some people. So it doesn’t cause all autoimmune disease and it doesn’t cause all thyroid antibody issues, but for some people it does. So it makes sense. Okay, let’s try it. Let’s just pull it away.

Dr. Mark Hyman (18:16):
You can check gluten antibodies too.

Dr. Elizabeth Boham (18:18):
We did.

Dr. Mark Hyman (18:20):
I often find about 30%-35% of my thyroid patients with their antibodies, it’s gluten.

Dr. Elizabeth Boham (18:24):
Yes.

Dr. Mark Hyman (18:25):
They also have gluten antibodies.

Dr. Elizabeth Boham (18:26):
But for her, we wanted to take away the gluten anyway because it’s a common cause of… It’s a common food that’s in refined and processed foods. It’s a carbohydrate that’s in a lot of our refined and processed foods. So we said, “You know what? Let’s pull away gluten. But also, I don’t want you to substitute with gluten-free products.” Because a lot of times people pull away gluten, but then eat-

Dr. Mark Hyman (18:49):
Gluten-free cookies, gluten-free cake.

Dr. Elizabeth Boham (18:50):
Gluten-free cookies or gluten-free bread or gluten-free… But all of those foods spike the blood sugar too.

Dr. Mark Hyman (18:56):
Worse. Actually some of them are worse than actually-

Dr. Elizabeth Boham (18:59):
Absolutely, because they’re lower in fiber a lot of times.

Dr. Mark Hyman (19:00):
Yeah.

Dr. Elizabeth Boham (19:01):
So for her, that was not the answer. So we really worked to pull away the gluten as well as any gluten-free products, any refined starchy foods.

Dr. Mark Hyman (19:10):
I always say gluten-free cake cookies are still cake and cookies.

Dr. Elizabeth Boham (19:13):
They are. They are. People fall into that mistake all the time. They pull away gluten and then they replace it with some really not good healthy processed foods. And so for her, it was really important that we made that point.

Dr. Elizabeth Boham (19:28):
We pulled away that all of the flowers and grains and gluten containing as well as gluten-free really focused on balancing her blood sugar with high fiber foods, lots of vegetables, protein, good healthy fats at every meal to help with balancing her blood sugar. That really made a difference.

Dr. Mark Hyman (19:51):
And you gave her a thyroid too?

Dr. Elizabeth Boham (19:52):
We did give her thyroid.

Dr. Mark Hyman (19:54):
That’s the important point, even though her thyroid levels were normal, but because the antibodies were elevated, it’s sometimes important to replace the thyroid hormone. You can try to get off of gluten and that might fix it sometimes or give nutrients like selenium, iodine, sulfur and zinc, but often you’ll need to replace it.

Dr. Mark Hyman (20:08):
And I remember at a conference I was at years ago at Harvard where there’s an endocrinologist and he said, “Look, most people don’t measure antibodies, but if you measure antibodies and they’re elevated and their thyroid levels are normal and they’re symptomatic, you want to treat them.”

Dr. Elizabeth Boham (20:19):
Especially in this case because she really wanted to get pregnant soon.

Dr. Mark Hyman (20:23):
And low grade thyroid problems are often a reason why women don’t get pregnant.

Dr. Elizabeth Boham (20:27):
Huge reason.

Dr. Mark Hyman (20:27):
And their levels might be normal when they go to the doctor.

Dr. Elizabeth Boham (20:30):
Huge reason, huge reason. And often if your periods are irregular, so she had two reasons for why her periods were irregular. She had the polycystic ovarian syndrome going on, the insulin resistance. So as we talked about that, insulin is connecting to all your hormones and can throw off your female and result in these irregular periods.

Dr. Elizabeth Boham (20:49):
And she had her thyroid being out of whack. So she had two reasons going on for why her periods were irregular and so when we first… We first pulled away the gluten, cleaned up her diet. Her periods started to get more regular, but you’re right. It wasn’t until we added in some thyroid hormone that she actually got pregnant.

Dr. Mark Hyman (21:09):
So what happened? She lost a little belly fat and then what happened?

Dr. Elizabeth Boham (21:12):
She lost the belly fat and her periods started to regulate. But then when we added in, we added in some thyroid hormone and a few months later she got pregnant and had a healthy baby.

Dr. Mark Hyman (21:19):
Yeah. So we help a lot of women get pregnant here at The UltraWellness Center using functional medicine. It’s pretty amazing. I got a picture once of a baby from one of my patients, it says, “Dr. Hyman, thanks for helping me get pregnant.” And I’m like, “I don’t know if that sounds right exactly but I get what you mean.”

Dr. Mark Hyman (21:35):
I think that it’s so rewarding. I just had a patient who I’ve been treating who was like almost 40 but had been struggling to get pregnant for years back and forth with fertility doctors and just not getting pregnant. And then we did all this stuff, we optimized her health and she just got pregnant and had this beautiful baby. It’s so satisfying.

Dr. Elizabeth Boham (21:56):
Yeah. Yeah.

Dr. Mark Hyman (21:57):
So what was the second case?

Dr. Elizabeth Boham (22:00):
This is, I think is really interesting and something we do see also very often, but this was a 28-year-old woman who was also had been, trying to get pregnant, actively trying to get pregnant for over a year and not being successful.

Dr. Elizabeth Boham (22:13):
And so her vital signs were really different than the first woman. So when our nurse did her waist to hip ratio, it was absolutely fine but her weight was low. She was underweight. And what was interesting when I got a good history from her, she had had-

Dr. Mark Hyman (22:30):
What is that quote? You can’t be too rich or too thin. I think the answer is you actually can’t be too thin. Right?

Dr. Elizabeth Boham (22:35):
Definitely. Absolutely. And for so many reasons, but hormonally too, she had had digestive issues her whole life. So she was a good eater. So she wasn’t somebody who was restricting her calories. She was a good eater. You ask her all those questions. You want to make sure somebody is not, as I said before, undereating or over-exercising, but she was not. She was a good eater. She was doing moderate exercise-

Dr. Mark Hyman (23:03):
What did she have? A tapeworm or something?

Dr. Elizabeth Boham (23:03):
I know. Right. You want to think about that. we did a workup on her. We looked at a lot of nutritional markers and we saw that she was low in B12. She was low in zinc. She was low in iron. She was low in some of her protein markers, some of her amino acids, which make you go, “Why would somebody be-”

Dr. Mark Hyman (23:25):
What could cause that?

Dr. Elizabeth Boham (23:26):
Right.

Dr. Mark Hyman (23:26):
Because she’s eating.

Dr. Elizabeth Boham (23:27):
She’s eating.

Dr. Mark Hyman (23:27):
So why is she low in these? She’s not absorbing them.

Dr. Elizabeth Boham (23:30):
That’s exactly right. So we did some further tests and found out that she had Coeliac disease. And Coeliac disease is an autoimmune disease where the body because of wheat gluten starts to fight off the villi in your intestines. So-

Dr. Mark Hyman (23:44):
So this isn’t just like, “I have a little gluten sensitivity.”

Dr. Elizabeth Boham (23:47):
Right.

Dr. Mark Hyman (23:48):
It’s actually a real serious problem where she’s got real damage-

Dr. Elizabeth Boham (23:52):
She had full blown Coeliac which is kind of interesting because it had never been found before, which is not uncommon.

Dr. Mark Hyman (23:57):
By the way, she didn’t have a lot of terrible symptoms you’d often see along with it. She had some digestive symptoms, but it was like irritable bowel, right?

Dr. Elizabeth Boham (24:04):
Yes. It wasn’t crazy bad.

Dr. Mark Hyman (24:06):
She didn’t have any diarrhea, miserable symptoms.

Dr. Elizabeth Boham (24:08):
No.

Dr. Mark Hyman (24:09):
Right.

Dr. Elizabeth Boham (24:11):
Because what’s interesting about Coeliac disease I think is when it develops in somebody’s life. So sometimes when kids develop Coeliac disease… Some people have a genetic risk for developing Coeliac disease and then-

Dr. Mark Hyman (24:24):
About 35% of us do.

Dr. Elizabeth Boham (24:26):
Yeah. And then at some point, those genes get turned on or for some reason, the body starts to develop these antibodies against the… And damage the villi in the intestine. So that can happen when you’re young or it can happen when you’re older.

Dr. Mark Hyman (24:45):
And it created a leaky gut. And then you get inflammation throughout the body and inflammation, you can’t get pregnant. And it’s like a whole downward spiral.

Dr. Elizabeth Boham (24:53):
I mean, those villi and intestines are so important. We have… They always say if you take your intestines and stretched them out, we stretched out those villi, they would be the size of a doubles tennis court. And so those villi, it’s kind of think of it as an accordion. It squishes together and it gives us so much surface area.

Dr. Elizabeth Boham (25:10):
So we have this large, large surface area in our intestines. Those that doubles tennis court is smushed together in these villi in our intestines, allowing us to absorb all of the nutrients that we’re eating.

Dr. Elizabeth Boham (25:23):
So if those villi get damaged as they do, when somebody has Coeliac disease, the villi get attacked and they get flattened. So that surface area goes away. So you don’t have all of that surface area to absorb all your nutrients.

Dr. Elizabeth Boham (25:37):
So with people with Coeliac disease, they get a lot of nutritional deficiencies. But if it happens later in life, like not as a child, we often don’t see the growth deficiencies that we see with children. So when children-

Dr. Mark Hyman (25:53):
Stunting and-

Dr. Elizabeth Boham (25:54):
Yeah, when children get Coeliac, you see that, oh, they stopped growing and they have belly pain. You go, “I should check them for Coeliac.” But sometimes when it happens… Maybe for her, maybe it happened in her late teens or early twenties, so her growth didn’t shift.

Dr. Mark Hyman (26:07):
Well, that’s an important thing that people realize. You can get a lifetime of being okay and maybe when you’re 50, something happens, it’s like a stress or a trigger-

Dr. Elizabeth Boham (26:16):
Or an infection.

Dr. Mark Hyman (26:17):
An infection, or you get traveler’s diarrhea and boom, you get Coeliac disease and you don’t know it. And the average time from the onset of symptoms to diagnosis with Coeliac is 11 years. So there are so many people running around with this who have no idea and that’s just full blown Coeliac. That’s not even gluten sensitivity, which is a whole another subject.

Dr. Mark Hyman (26:37):
But I think that the identification of these nutritional deficiencies like B12 deficiency, iron deficiency, zinc deficiency, these are really important nutrients that regulate fertility and protein. It’s a protein malnutrition which is critical. I mean, your body doesn’t want to get pregnant if you’re starving. And essentially it’s like-

Dr. Elizabeth Boham (26:55):
It’s like the whole body is under stress.

Dr. Mark Hyman (26:55):
Right.

Dr. Elizabeth Boham (26:56):
Yeah. And so it was not getting pregnant. And so what was interesting is when we pulled away the gluten, we said, “Okay, you can’t have gluten anymore.” And we put her on a good, healthy diet. It’s going to take some time for those villi to regrow, but they do. The villi in your intestines will regrow if somebody has full blown Coeliac, but they do come back.

Dr. Elizabeth Boham (27:15):
And we put her on some really good nutritional repletion because she was deficient and making sure there was a good prenatal, so there was enough folate in it, which is really important to be on. If you’re thinking about getting pregnant, you want to be on that prenatal with all that folate before you get pregnant. You don’t want to wait to start it when you get pregnant. It’s really important in that early, early first trimester time.

Dr. Mark Hyman (27:39):
Take the right nutrients.

Dr. Elizabeth Boham (27:39):
Yeah. So we got her on a really good multi and she started to absorb your nutrients well. It took just about a year or so before she got pregnant, but she got pregnant and had a beautiful baby.

Dr. Mark Hyman (27:53):
Yeah. So I have another patient who reminded me of that. She came in and she was fat and she had Coeliac. She knew she had Coeliac, but she was on a gluten-free diet but she was still not better. And this is a phenomenon I see very often. Doctors say, “Oh, you have Coeliac. Just stop gluten and everything’s going to go back to normal.” It’s not true.

Dr. Mark Hyman (28:08):
You have to rebuild and repair the gut, which traditional medicine doesn’t really know how to do and then functional medicine at The UltraWellness Center, that’s exactly what we do. So we not only get them off gluten, but we help them rebuild and repair the gut with the right prebiotics, probiotics, the right nutrients and so forth. So we actually help them restore gut health, restore their immune system function and get out of the cycle.

Dr. Mark Hyman (28:28):
And this woman, she was very thin, she was trying to get pregnant, she couldn’t get pregnant and I fixed her gut and did all this sort of tweaking of everything and she got pregnant and that was a few years ago. Now she has a beautiful five-year-old baby boy and was like… It was actually such a great story.

Dr. Mark Hyman (28:44):
I just see how often people suffer needlessly. And I think that’s what’s so stressful for me knowing that we have these solutions for patients and we have… It’s not that hard if you know what to do, but unfortunately the lens that we look at these problems through with traditional medicine only looks at a few things.

Dr. Mark Hyman (29:06):
In functional medicine, we have a much wider net we cast to look at things and we have a much different set of filters through which we analyze the data. And then we can come up with a personalized approach that helps people. Most of the time, not every time, not with everybody, but most of the time we see such incredible results from patients using this approach of functional medicine.

Dr. Mark Hyman (29:27):
And it’s just so satisfying, especially with these patients who are struggling with infertility, who are stressed about it, who are spending so much money on infertility doctors and there’s a role for that. And yes, they provide a service and I don’t want to diss them but I do think you’ve got to start with this first and if you fail, then okay, then you can get an in vitro or whatever.

Dr. Mark Hyman (29:48):
But I think most of the time you don’t need that. And it’s just literally dozens and dozens and dozens of women I can think of over the last 30 years who’ve successfully got pregnant when they’ve suffered from infertility. So if you’re out there and you’re listening, if you’ve struggled as a couple, I mean, yes, the man needs to get checked and there’s a lot of interesting research on male infertility.

Dr. Mark Hyman (30:07):
And the nutritional levels that we have that are deficient and taking even a multivitamin or fish oil can help men getting rid of toxins. We know that there’s an increase in infertility men because of environmental toxins like pesticides. You can work on those things as well, but I think for women, it’s so satisfying to do this as a doctor because we see we can identify these issues, we can do the right kinds of tests, we can customize her lifestyle and dietary plan, the right supplements, fix their gut if needed, balance their hormones.

Dr. Mark Hyman (30:35):
And it seems like it’s a miracle, but it’s really not. It’s just good science. It’s just good systems, functional medicine.

Dr. Elizabeth Boham (30:40):
Yep, absolutely.

Dr. Mark Hyman (30:42):
So I think if you’re listening and if you’ve struggled with infertility as a couple, as a family, there is a way out. At the UltraWellness Center, we focus on that.

Dr. Mark Hyman (30:52):
And what’s great now is with COVID-19, we’ve transitioned to be able to do everything virtually so we can do virtual consults. It doesn’t matter where you are in the world, we can figure out how to get you the tests and we can actually customize this approach, and we have a great team approach here. We have doctors, nutritionists, physician’s assistant, health coaches, nurses. It’s just a really great team.

Dr. Mark Hyman (31:11):
And often, one of the problems I have with this practice is that often we’ll see people and then we’ll treat them and then we never hear from them again. And I’m like, “Well, what happened to you?” It’s like, “Well, I got better. I didn’t come back.” I’m like, “Oh, okay.” Often we lose people because they’re… And that’s good. We don’t want to be in the annuity business.

Dr. Mark Hyman (31:35):
We want to treat people, find out what’s going on, teach them how to take care of their bodies and then graduate them. And they can come back once in a while and say hi if they have the issue. So it’s very, very satisfying. So I encourage people to check out a different way of thinking about this.

Dr. Mark Hyman (31:49):
Read some of the articles we’ve written. There’s a lot in the show notes, some references and articles of how you can think differently about this. You can go to ultrawellnesscenter.com and learn how to become a patient. Go to get started tab. We do all things virtually now.

Dr. Mark Hyman (32:01):
If you love this podcast, please share with your friends and family on social media. Leave a comment. I’d love to hear from you and subscribe wherever you get your podcasts. And we’ll see you next time on The Doctor’s Pharmacy.

Dr. Elizabeth Boham (32:11):
Thank you, Mark.

If you are looking for personalized medical support, we highly recommend contacting Dr. Hyman’s UltraWellness Center in Lenox, Massachusetts today.

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