Why Reproductive Health May Be the Most Important Biomarker for Women's Longevity with Dr. Natalie Crawford

Mark Hyman, MD

Full Transcript

Automatically generated. Please forgive any typos or errors in the following transcript. It was generated by a third party and has not been subsequently reviewed by our team.

Natalie Crawford
So if we take infertility not just as a disease or a problem and we treat it also as a symptom Yeah. That it's a representation of your underlying health, that really allows people the opportunity to change their life.

Dr. Mark Hyman
What you're saying really is important. Fertility and the the your reproductive health, those are not just relevant for people who are looking to have a baby.

Natalie Crawford
Correct.

Dr. Mark Hyman
They are relevant for everybody because they they speak to this early warning sign. It's like an early flashing warning sign in your body that something's off.

Natalie Crawford
For young women, it is that first glimpse into your cellular health. If we can get women to start paying attention to this younger in their twenties and thirties, we're gonna have a new generation of women.

Dr. Mark Hyman
If you've been dealing with anxiety, low energy, or trouble focusing and still feel like you're missing something, you're not alone. And that's why I created the Brain Shaping Academy, a new program that looks in places most people never think to check, like nutrient deficiencies, the health of your gut, metabolism, your immune system, and lots more. Welcome, Natalie. It's so good to have you on the podcast.

Natalie Crawford
Thank you, Mark. I'm thrilled to be here.

Dr. Mark Hyman
What's interesting about your work in the fertility space is that you kind of reframe fertility and fertility issues in both men and women as sort of a biomarker of overall health.

Natalie Crawford
Right.

Dr. Mark Hyman
And, like, you talk about it as a vital sign, the reproductive cycle as a vital sign, but you could also say sperm health is a vital sign.

Natalie Crawford
Correct.

Dr. Mark Hyman
I think that that most people don't think of it that way.

Natalie Crawford
It is important that we zoom out on fertility, not just being the ability to get pregnant. Because for many couples, especially younger couples, they don't have any medical problems. They've never had, you know, chronic illness care that they know about.

Dr. Mark Hyman
Yeah.

Natalie Crawford
And when they first try to get pregnant, this is one of the first time they're challenging their body to do something else, and we get insight for underlying cellular and metabolic dysfunction. So if we take infertility not just as a disease or a problem and we treat it also as a symptom Yeah. That it's a representation of your underlying health, that really allows people the opportunity to change their life and get earlier testing, think about how they advocate for themselves Yeah. And optimize things. And that could change their chronic disease risk as well.

Dr. Mark Hyman
And I I love your reframe of, like, the fertility space and reproductive endocrinology from a disease based, like, infertility as a pathology

Natalie Crawford
Mhmm.

Dr. Mark Hyman
To saying, oh, maybe we reframe this and say, how do we create healthy reproduction cycles and healthy sperm as a way of creating fertility as opposed to medicalizing fertility?

Natalie Crawford
Right. Right now, the space is very reactive. In fact, just the definition of infertility. Let's try for a year. And then when you fail only when you fail will we bring you in.

And now we'll test your sperm and test ovarian reserve and find out if you have uterine birth defects. It doesn't make sense to me in today's day and age when infertility rates are rising that we're making people fail first before they even get data about their body. And as a clinician, I know you and I feel similarly. I shouldn't be the gatekeeper for you to get data about your body. You should be able to access that information because we can't make decisions on data we don't know.

Dr. Mark Hyman
It's true. I remember I I'm older than you, but I remember it it was so patronizing when I was trained. You know, basically, you do the test on the patient. You don't give them results. You say your labs are fine.

If they ask specific questions, you might go into all your blood sugar is okay, your cholesterol is okay, but not like any real detail. You certainly don't give them the paper that it's printed on.

Natalie Crawford
No. In early training, I would send patients, you know, notifications, and it was in the EMR at this time, but it would really just be your labs are all good. No not even attaching the results. No explanation about what good means or optimal means.

Dr. Mark Hyman
All changed because I cofounded Function Health, and people are flocking to find out what's going on in their body, and they should have the ability to own their health and to check their health.

Natalie Crawford
100%. I couldn't agree more.

Dr. Mark Hyman
Your work really came out of we're gonna dive into not exactly how to get pregnant and fertility exactly, but more in reproductive health as a biomarker of your overall health. And what it tells you about what's going on in your body, it often is pre disease, but it is really meaningful. Exactly. If you catch things early, you're actually gonna have a better trajectory of your overall health for your life.

Natalie Crawford
Right. So that's

Dr. Mark Hyman
kind of what I love about your work. Okay. So let's let's kind of get more specific

Natalie Crawford
Good.

Dr. Mark Hyman
And granular about this. Because, you know, you know, a lot of women just feel like something's off, and they go to the doctor, and they're they're reproductive age, they get the pill. Or if they're perimenopausal, they get hormone replacement therapy. And it's kind of like a like a binary option. Mhmm.

And nobody starts to look underneath the hood and see what's going on. So you talk about about women feeling off and and the the menstrual cycle being like a vital sign. What does that actually mean?

Natalie Crawford
The menstrual cycle is your body's way to tell you how your hormones are communicating. I wanna set the stage that your hormones come from different organs, and we'll talk about the reproductive system, we'll say brain and ovaries. Your brain doesn't know what's happening in the ovary. Can't see the ovary. It's relying on the signals that the ovary makes to tell it what to do.

Estrogen, progesterone, testosterone. So if we think about these as, you know, friends on a walkie talkie. You know, the ovary is gonna walkie talkie the brain. The brain's gonna hear it. One important factor is people say, well, how does inflammation impact this?

One way is static interference on the radio. So if the brain can't hear the signals that are coming in because they're static on that radio, it's not going to respond appropriately. Same things happens at the ovary level. And then inflammation doubles down on this because it actually impacts your egg quality, the genetic normalcy, the mitochondrial function, and the ability of the ovary to respond to the brain signals. To put it really loosely, though, because I don't think a lot of women always understand their menstrual cycle, I'd love to give you my one minute analogy overview.

So women are born with all the eggs they're ever going to have. We like to think about them as kept in a vault inside the ovary. That's my favorite analogy. Every month, a group of these eggs comes out of that vault. From that group, one will be chosen to ovulate.

So the brain sends out FSH, follicle stimulating hormone, well named and one of the one times in medicine where things are named after women because each egg grows inside a follicle.

Dr. Mark Hyman
It also works for men too.

Natalie Crawford
Yeah. Does. But it's named for women this time.

Dr. Mark Hyman
That's true.

Natalie Crawford
So follicle stimulating hormone stimulates that follicle to grow. The egg matures and makes estrogen, and this is the first phase of the cycle called the follicular phase. This is by nature an estrogen dominant phase. Mhmm. And then when estrogen levels are high enough, and it's really specific, two hundred picograms for fifty hours, now the brain gets a strong enough signal to say, oh, I have a mature egg and sends out a signal of LH or luteinizing hormone.

LH allows that follicle to rupture, the egg to be released, and then the follicle to reform. That's ovulation. And then after ovulation, that follicle that just reformed is now a corpus luteum. Same structure. So the foundation was built from the follicle, but now it makes progesterone.

So LH pulses from the brain stimulate progesterone pulses from the corpus luteum. Corpus luteum can only live about two weeks unless you get pregnant. If you get pregnant, HCG keeps it living. HCG and LH are similar in structure. Pregnancy Exactly.

And so if you don't get pregnant, which is often what happens most months, that corpus luteum will die. Progesterone levels will drop. A woman will get a menstrual period, and this process will start over inside the ovaries. The reason why this is really important is that well, you alluded to some of the reasons. Women are given hormonal contraceptives, so they're not ovulating or they're losing their cycle as a vital sign.

But even if they are not and they're trying to track their cycle, many women are using apps where they simply put in cycle day one. And these apps, if they don't leverage other markers of ovulation, are using an old fashioned method called the calendar method. Assuming that for every single person, the video phase is set at fourteen days and giving you this day of ovulation, and it's only accurately predicting ovulation twenty percent of the time. Twenty percent.

Dr. Mark Hyman
It's not good.

Natalie Crawford
So when somebody eighty twenty in the wrong direction. The wrong direction. So if somebody sits across from you, it's a doctor, and they say, are your cycles regular? And you say, yes. And they move on to the next question.

We're actually missing those little tire warning signs, the little red flags about what's going on. Ovulation is not a light switch. Yes, no. That's how many physicians treat it, and that's how many patients think about it. Either I ovulate or I don't ovulate.

If we step back and we think about this beautiful communication system and how intact everything has to be, there are stages of ovulatory dysfunction that can allow us to intervene earlier, get earlier testing, or make changes well before we're in the I'm not ovulating at all. So one of the first actual signs is what we call a short luteal phase. So if the luteal phase, again, the second half of the cycle, if it's less than eleven days in length, that means the brain hasn't been able to send out enough signals to keep this corpus luteum growing, or the follicle, the foundation that became the corpus luteum wasn't strong enough. You know, build a house on a bad foundation. It's not gonna last as

Dr. Mark Hyman
long as going right, it'll be fine. But if if things are going wrong, it kinda gets wacky.

Natalie Crawford
It gets wacky.

Dr. Mark Hyman
So what are the symptoms of wackiness, and what are the reasons it gets wacky?

Natalie Crawford
So for a short luteal phase, some of the top symptoms can be thyroid dysfunction. We can have hyperlactin, which is a pituitary gland hormone, or we can have inflammation impacting what we call hypothalamic dysfunction. So that static interference on the radio, The brain can't interpret those signals quite well, so it's missing.

Dr. Mark Hyman
Stuff like your thyroid's off or your pituitary tumor.

Natalie Crawford
It's benign pituitary tumor.

Dr. Mark Hyman
Or you have this inflammation.

Natalie Crawford
Chronic inflammation, insulin resistance because of how they impact the brain. The brain's lost that tight connection with the ovary. And so when we start to say, oh, well, if I'm not just relying on my app, if I'm actually tracking ovulation and this can be with cervical mucus, body temperature, or urinary hormone measurements, which we can go over. But then I can pinpoint when I'm ovulating, and I can count how long is my luteal phase. Mhmm.

And I can start to see, oh, this is a problem. It might make it harder for me to get pregnant, but regardless if I wanna get pregnant or not, this is my body's red flag that something in my hormonal system is not connecting appropriately.

Dr. Mark Hyman
So you mentioned two things. I think the thyroid is understandable. People have thyroid issues, and one in five women have these thyroid problems, and most of them are undiagnosed.

Natalie Crawford
A hundred percent.

Dr. Mark Hyman
Two is is pituitary tumors, which pretty rare, although we're finding that a lot on functional labs with high prolactin levels.

Natalie Crawford
But also, prolactin, we should say, can come from other things, not just pituitary tumors. A lot of medications, especially psychiatric medications. So we see ADHD medications or medications for, you know, bipolar disease or depression. They actually can cause the pituitary gland to make more prolactin, and they can throw off your cycle.

Dr. Mark Hyman
So drugs.

Natalie Crawford
Right.

Dr. Mark Hyman
Then there's inflammation, and then you mentioned insulin resistance.

Natalie Crawford
I did.

Dr. Mark Hyman
So insulin resistance really primarily comes from diet, sugar, processed foods, and I've talked a lot about that on podcasts. People I think understand that, but it's affecting like ninety two percent of people at some level in this country with metabolic dysfunction. Oh, yeah. So it's huge. And and the inflammation can be caused by the insulin resistance, but there are other causes.

And for you, it was it was gluten. But it can be environmental toxins. Uh-huh. It can be the microbiome. It can

Natalie Crawford
be A 100%, Mark. Here's how I like to think about this and how I explain to patients. I say, first of all, your inflammatory response system is needed and good. Right? Like, acute inflammation, the ability for your body to activate your immune system and heal is needed.

And even for reproduction, you need to have it. Because many patients will say, can I just take a pill and get rid of inflammation?

Dr. Mark Hyman
Take aspirin or take Advil or whatever.

Natalie Crawford
The problem is, right, inflammation's needed for ovulation. If you take anti inflammatory medications at the time of ovulation, you actually won't release the egg. The follicle will not burst and let the egg out. You'll go through hormonal changes of ovulation, but you will not release an egg. So important for people to know, we don't recommend NSAIDs, Motrin, Tylenol, Aleve, ibuprofen, any of those around ovulation because they do prevent egg release.

So inflammation is important. So we like to think about I say the inflammatory burden. So let's imagine how much inflammation you're exposed to on a day to day, and let's imagine it is a lever that can be moved up or down. For some of us, you might have factors causing you to have more inflammation that you don't have that much control over. Think about some patients with endometriosis or certain autoimmune disease.

Dr. Mark Hyman
So they But we know what the those causes are of those

Natalie Crawford
diseases too. Causing it, but sometimes you can't get rid of it all. Right? So everybody has a different, we'll say, baseline starting value. But every single decision that we make, whether we want to accept it or we know it, can increase that total burden we have that day, or they can decrease it.

So things like if I got enough sleep or if I got too little sleep. Too little sleep, now I'm knocking it up. The foods that I eat can increase that burden, the toxins I'm exposed to, how I manage stress that day. And so I'm not sitting here trying to tell patients that you have to be perfect every single day or you're screwed. What we're saying is I want your body to have the resilience within it so that you can respond appropriately to the inflammatory things you obviously will be exposed to in your world.

So we're looking at the things we can control. When you can't control everything, we wanna make sure that in these five buckets that we go through that you mentioned earlier, food, toxins, stress, sleep, and exercise Yeah. We are making active decisions in line with our priorities that are going to actively decrease inflammation as much as we can because that's going to set us up on a better track, yes, to get pregnant, but also to have better cycles, better hormonal health, and long term health and longevity as well.

Dr. Mark Hyman
Yeah. So it's so important. And and the things that you mentioned, environmental toxins are harder, but those are things that we have agency over.

Natalie Crawford
We do. And so many of those decisions we make without thinking about it. Right? I call sleep, stress, and exercise the foundation of your day. You've made a decision, you know, what time to go to get up, what time you go to bed, how you're gonna cope with stress.

We can't avoid all stress, but how you're gonna cope with it, if you're gonna build in ways for your day, if you're gonna move, what type of movement you're going to do. And we should be lever leveraging those choices in a way that's going to be beneficial for us.

Dr. Mark Hyman
Yeah. And people often don't even know. Like, I just talked to a friend who's just who was at a friend's house, and she poked a bunch of holes in a plastic bag

Natalie Crawford
Oh, sorry.

Dr. Mark Hyman
Full of broccoli and stuck

Natalie Crawford
in a microwave.

Dr. Mark Hyman
I was like, wow. Microplastics in the ovaries are a red thing, and they do

Natalie Crawford
And and the placenta. Yeah. Yeah. Microplastics are a huge problem, so are endocrine disruptors. And just because something is prevalent and difficult doesn't mean we don't need to start paying attention to it.

And when it comes to toxins, thinking about in your world, what you're exposed to the most, the things in your home, how you cook, in your bathroom, those are easy places for us to make good decisions that are going to change how you live most of the time so that you're able to adjust. You know, when we're in a hotel room right now, we don't have as much control over this environment. We control the things that we can.

Dr. Mark Hyman
And what what you're saying really is important because you're a fertility doctor, but you're saying that fertility and the the your reproductive health for both men and women's sperm quality and women's reproductive cycles and their their auditory capacity, fecundity, you call it, those are not just relevant for people who are looking to have a baby. Correct. They are relevant for everybody because they they speak to this early warning signs, like an early flashing warning sign in your body that something's off.

Natalie Crawford
Right. And specifically, let's say for women, women been dismissed in the health care system very often. I mean, I was dismissed as a patient. And when you do get dismissed, you start to dismiss yourself. So these little early warning signs, we really have to give that agency back to women to say, these are not normal.

You deserve answers, and here's how we go about trying to get them and paying attention to these things that are off like our cycle, like our ability to get pregnant because that's going to give us insight for our whole health. Right? We wanna live a long, healthy life. We don't wanna just live long. We wanna be healthy longer.

And it really does for women start by paying attention to the ovary much earlier in life.

Dr. Mark Hyman
Nelly, you you were you were a doctor. You're working. I mean, what were the early warning signs that you ignored?

Natalie Crawford
For me, you know, fatigue, especially in the afternoon on days when I shouldn't be. I dismissed a lot because I was in medical training. Oh, I'm just a resident. I'm tired. But understanding that not everybody feels that afternoon fatigue, especially if you have gotten sleep at night.

Mhmm. You know, I had really poor coping mechanisms. So thinking about, you know, I was definitely making choices that were more inflammatory, you know, drinking alcohol after a shift or stress eating or eating a lot of junk food while I'm on shift. So then a lot of the bloating Wait.

Dr. Mark Hyman
Mean hospitals are just the

Natalie Crawford
Oh, peanut butter crackers. Right?

Dr. Mark Hyman
You only get help in hospital. Right?

Natalie Crawford
Mark. We eat a McDonald's inside the hospital.

Dr. Mark Hyman
Tell me about it. I mean Right. Where I did where I did training, right, actually, where I was working as an ER doctor, the cafeteria is open eight to nine, twelve to one, and six to seven. And the rest of time, McDonald's was open from 6AM to 2AM. It was only close from 2AM to 6AM, and that was the only place you could eat in the hospital.

Natalie Crawford
Overnight?

Dr. Mark Hyman
And I would be on the ER shift. I'd to go I'm like, I'd have to go to get McDonald's, and I was, like, try to get the chicken and not eat the bun.

Natalie Crawford
I visited that McDonald's, like, too many times at the counter. I even delivered a baby in there. But it's wild to think that this is how your hospital is structured with a McDonald's. So, yes, those were not great decisions I was making, but I also then excused and dismissed some of these early signs of bloating, fatigue, headache, brain fog.

Dr. Mark Hyman
Yeah.

Natalie Crawford
I'll tell you that fast forward later in life, I got my celiac diagnosis because I started having peripheral neuropathy. So I started having numbness of my fingers, my toes. Of course, I'm a physician. I said, well, this is not good. I I need to be able to use my hands to function.

Ended up getting an MRI. They were afraid I could have multiple sclerosis or some neurologic problem. And I had a, luckily, a good radiologist because it's not standard on MRI, but they said her bones look too thin for her age. K. I sent that back to my primary doctor who then got a DEXA, and I had osteopenia at age 41.

Dr. Mark Hyman
Yeah. Osteoporosis is a is a feature of celiac.

Natalie Crawford
Yeah. Because you're not absorbing.

Dr. Mark Hyman
Right.

Natalie Crawford
And I was I would have told you I was healthy. Right? I ate really plant forward. I was a big runner. I was of normal weight.

So from the outside and if I were to sit across from a doctor and say, oh, I'm really healthy. But then we got this Dexa, and I had osteopenia. And luckily, my doctor didn't just say, oh, well. She said something's going on and dug deep. So something's absorbing, and she's the one who ended up getting me the celiac diagnosis as an as an adult.

And it was not classic as we have already talked about, but also, you know, the fatigue, the headaches, the brain fog, some of those symptoms that were mild in my younger years became so much stronger right around this time of diagnosis. And then taking gluten out of my diet, I mean, it's changed my life. Right? I mean, I don't have any of these symptoms anymore. And, yes, for me, it's one thing, and not everybody has celiac.

But it speaks to the impact I was able to make earlier by just listening to some of these inflammatory signs. Right? Even if you can't get the answer yet or you're searching for it. Yeah. Like you said, being that, you know, individualized experience and believing your own body's warning signs Yeah.

You can make a meaningful difference in your own health.

Dr. Mark Hyman
It's true. Everybody's gotta be the CEO of their own health.

Natalie Crawford
I mean,

Dr. Mark Hyman
they can't abdicate that to the health care system or to their doctor. Even if they can work with their doctor, they can be allies. But you're not being proactive about your health. You you're you're you're likely gonna have issues.

Natalie Crawford
Nobody's going to care about your health like you will, so you need to. Unfortunately, we put our own health last until it's really bad.

Dr. Mark Hyman
Especially doctors. Especially

Natalie Crawford
physicians. Yeah. But speaking of that, female physicians have double the rate of infertility. Mhmm. Right?

That's not a coincidence. It's how we're structuring our life, the things we're exposed to, all of the increased inflammation we have because of lack of sleep, poor diet, poor stress, exposure to toxins, all the things we're talking about in training, especially in your reproductive years, we're at higher risk.

Dr. Mark Hyman
But you came to this honestly. You were an OBGYN resident. You were working like crazy. You were in the l and d labor delivery room, and you were struggling. You were having miscarriage after miscarriage.

You said your your current kids are your fifth and sixth attempt at having a kid. Yeah. You had also underlying issues that were immune issues that were affecting your fertility that often go undiagnosed for a decade or more, celiac disease. So I'd love you to sort of share your entry into this. Because often when people like you and I get into this kind of work and off the grid a little bit, it's usually because we had some story behind it.

Natalie Crawford
Yeah. Our arc is definitely personal in origin very often, mine is. I was already on the trajectory to be a fertility doctor because I loved the science and I loved the hormones, but I did start having recurrent pregnancy loss when my husband and I started trying in my last year of residency. And I remember being so clinical about it at first. My first pregnancy loss, I sat across from him, and I said, you know, Jason, one out of four pregnancies ended loss.

It's okay. It's good that it didn't get further along. Those statements that I'd said to patients.

Dr. Mark Hyman
And that you learned in medical school.

Natalie Crawford
That I learned in medical school. And then when I lost my second pregnancy, I was further along, and I was working L and D actively and started bleeding while I was working. And it wasn't that time in medicine. I don't know how it is now, although I can hope it's better. But I was not gonna leave work.

I was a resident. So I had

Dr. Mark Hyman
to Go to bathroom, have your miscarriage,

Natalie Crawford
my miscarriage, and go to work. Go do a C section. Yeah. Right? Deliver other people's babies while I was losing my own.

Dr. Mark Hyman
God. That's hard.

Natalie Crawford
And I remember pulling over the car on the way home and throwing up because the contractions from the miscarriage, the pain was so severe and feeling so emotionally and physically distraught, but also understanding that I took care of patients who'd been going through this, and this was so much worse than I could have ever imagined. And I went to my doctor after that and said, I think something's wrong. And here's this litany of vague symptoms, and here's these two pregnancy losses. And they sat across from me and said, well, you have to lose a third pregnancy before we'll do testing.

Dr. Mark Hyman
Aye. Aye. Aye.

Natalie Crawford
And that even though I I, quote, knew that. Right? At that time, recurrent pregnancy loss is three pregnancy losses. Zero blood work. Zero testing was done.

Dr. Mark Hyman
Knew that meaning that's how you

Natalie Crawford
were trained in Washington Medical School. That's how I was taught. So, I mean, I was a resident. Right? So at the time, I knew that was the party line.

Then when you are training, I do think it's important for people to know, right, there is a lot you don't control, and you learn what's taught to you because you have to to take your boards, to pass the test. Right. So I knew that's what would be told to me, but to hear it was extremely disempowering. It was one of the worst things I could I could hear. So I was told it was bad luck and keep trying, and I kept trying.

And I lost pregnancy three, when I lost pregnancy four. And along the way, was told that everything was normal. I did get tested, and I had unexplained recurrent pregnancy loss. And I was given the option to do IVF so that would help what was going on. And I wasn't opposed to that.

By this time, I was in fertility fellowship. And IVF is an incredible technology. We we have to lay where it is. Seventeen million babies have been born because of IVF. Incredible.

Dr. Mark Hyman
Miracle of modern medicine. Absolutely.

Natalie Crawford
Right. But I was the IVF fellow, so I was learning to do IVF. So I couldn't be the IVF patient at that time. I had to wait about six months until I could be the one to go through the process, another pleasantry of medical training. But I said, okay.

What should I do to prepare myself? If I'm gonna do IVF, how are there things I can do that will make it better or worse, the outcome? I don't wanna have the highest chance of success. I'm a goal oriented person here. And I was told none of it matters.

Just do IVF. And that really didn't make sense to me. Right? At the same time,

Dr. Mark Hyman
we were starting matter what you eat.

Natalie Crawford
Right. I said, what about foods I eat? Am I running too much? What about sleep? You know, I was a resident, and I'm a fellow.

None of that matters. IVF will take care of it. And we do a year and a half of research, and fellowship is three years. So a year and a half clinical, a year and a half of research, and you start your projects early. And most people do IVF projects, more controlled environment.

You can, you know, change one little thing and see what's happening. But I wanted to study fecundability. Like, why do some people get pregnant and others do not? That that's my passion. These are my wishes.

Dr. Mark Hyman
For people. That dependability means are you able to get pregnant?

Natalie Crawford
Pregnancy. Yeah. Pregnancy naturally without intervention. What's your pregnancy rate? I was permitted to do that luckily, and I got a master's in clinical research and started to look at vitamin levels, endocrine disrupting chemicals, luteal phase abnormalities, and cohorts of people who were trying to get pregnant.

And this is when I started to see that inflammation was in all the literature. But we weren't talking about it in medicine yet unless it's the disease state. Right? This disease causes inflammation. But in all of these different aspects, they were saying, well, this causes inflammation or had higher inflammatory markers, and that same group of people had a harder time getting pregnant or more pregnancy losses.

And I said, well, even though they told me there's nothing I can do, let's try to decrease inflammation. What does that mean? Let's try to decrease that. And so I remember my husband came home, and I was cleaning out our kitchen, getting rid of the plastic and the Teflon, and this was, like, twelve years ago, trying to get rid of everything, looking at how we ate, looking at sleep and exercise. And we ended up getting pregnant before we needed IVF and stayed pregnant with pregnancy number five, my daughter.

And one of the things we cut out during that time, I cut out gluten. I would have never told you that I had celiac disease. I got diagnosed with celiac or an allergy to gluten more than a decade later. I would never have known I had that. I didn't have classic GI symptoms.

Dr. Mark Hyman
Which most people don't.

Natalie Crawford
Right. But I felt, you know, just a little more fatigued, bloated. And when I was really trying to listen to what is inflammation and how does it show up, when I cut it out, I felt better. So I kept it out of my diet for both my daughter and then got pregnant with my son pretty quickly postpartum, not eating gluten. So And when I got

Dr. Mark Hyman
hadn't done your celiac antibodies or anything?

Natalie Crawford
I mean, I was told all the testing was done that could have been done, but there was no celiac testing at that time.

Dr. Mark Hyman
There was. They just didn't do it.

Natalie Crawford
Correct. There was no celiac testing done on me.

Dr. Mark Hyman
Right? I wanna just double click on that because you you you kinda threw it out a little earlier. And and they said, you know, they they did all the testing, everything was normal.

Natalie Crawford
Right.

Dr. Mark Hyman
And so that's often what you'll hear from doctors. Oh, we did all the tests, and everything's normal. What it means is they did the test that they knew to do Correct. Not all the tests that need to be done. And and doctors, you know, when they say that, they should be a little more humble because there's only one or two answers to the question of what's going on.

Either you're crazy and you're making stuff up about your health, or two, the doctor's missing something. And it's not necessarily their fault, but they're missing something because they weren't trained in it. I certainly wasn't. Celiac disease happened to little kids. They got bloated.

They got emaciated. They got malnutrition. They got diarrhea.

Natalie Crawford
You're not gonna get diagnosed at 41.

Dr. Mark Hyman
No. No. Of course not.

Natalie Crawford
There's a lot that we leave on the table, patients should understand that. Right? For something for a doctor to order a test doesn't mean that there aren't other tests. And I often tell people unexplained anything. So unexplained pregnancy loss, unexplained infertility means we just haven't found the answer yet.

Dr. Mark Hyman
Idiopathic, which means we have no idea what's causing it. But we we doesn't mean that the

Natalie Crawford
cause there's nothing there. And that is a big mistake sometimes in, you know, traditional medicine is we say, oh, well, all these things are normal. Just keep trying, or, oh, you can do this instead of what I say is, you know, none of the things that are easy to test have we been able to find. That doesn't mean something's not there, but sometimes it's difficult, or we have to really hunt for it. Right.

We have to either spend more money, do more invasive diagnostics. And sometimes we just make decisions based on that idea of Yeah. That we have an underlying chronic inflammatory disorder, and that's how I treat unexplained. But to piggyback off your question or just to double down on the importance of this even more, I have two sisters, and one is eight years younger than me. And so she I got diagnosed at 41, and she had more miscarriages than I did.

She's had six miscarriages, and she now has three children. But when I got diagnosed you know, who's the first person I called? I called her. And I said, hey. We need to I'm gonna get you tested.

I'm ordering testing right now. You need to go in. And, of course, she has celiac as well.

Dr. Mark Hyman
Partly genetic.

Natalie Crawford
And right. And so she cut out gluten as well after she got her diagnosis. And then her her last two children are close in age, and she didn't have pregnancy loss between them because the difference of having these six losses on that earlier journey and then taking gluten out, and now she has her completed family.

Dr. Mark Hyman
That's amazing.

Natalie Crawford
So it really just goes to speak that patients have to be advocates for their own health. The medical system right now is not patient centric. It's not

Dr. Mark Hyman
disease centric.

Natalie Crawford
It's disease centric. You can get really sick.

Dr. Mark Hyman
Definitely not health centric.

Natalie Crawford
You can get really sick, and we'll take good care of you.

Dr. Mark Hyman
Yeah.

Natalie Crawford
Right? But if we think about things that are much earlier in spectrum, thinking about especially your hormonal health, trying to get pregnant, trying to have a normal menstrual cycle and what these things mean. Many doctors are not trained to evaluate these problems. It's not their fault. It's the system.

But that means you're gonna have to come to the table with a level of knowledge and literacy in a way to be able to adequately advocate for yourself in the system.

Dr. Mark Hyman
Yeah. It's so important. And I think what your work is doing is highlighting something really important. And I I think your story is just an, you know, a personal example of what happens so often in medicine, which is that, you know, you're a highly educated doctor. You're like a specialist in the very topic.

You are a significant I

Natalie Crawford
didn't answer.

Dr. Mark Hyman
I mean, it's just gotta be irony. It's kinda, like, kinda bad. And and and and and it's it's led you to this path of really looking at what what is it to create healthy biological reproductive system for men and for women? And what are those factors that play a role? Diet, exercise, stress, sleep, toxins, things like habits like alcohol, pot.

All these things play a role, and we don't really know in medicine how to tell people what to do about these things. But they are the most important things, and they result in metabolic dysfunction, in in mitochondrial dysfunction, which is related to toxins and nutrition. It's related to inflammatory triggers, or that for you is gluten. So all these things are things we can actually start to double down on, and look at hormonal dysregulation, thyroid things. And and these are these are these are things that actually like, and you you read about this is there are, like, very early warning signs.

You know, like like, if if your tire pressure starts going down by, like, one millimeter

Natalie Crawford
Yeah. You you get the little flag. The

Dr. Mark Hyman
little alert. It might not look like it was a problem yet. It might not be in the, like, fill up your tires, but it's like it's starting to go down. And you can track that often years and years before we even pay attention, even if it's in the, normal range.

Natalie Crawford
A 100%.

Dr. Mark Hyman
May because not be normal for you. And I think we're learning more about biomarkers, and we see this in function that, you know, you have to be your own control. You you know, if your liver function tests are, like, let's say, 25, one of the common ones, ASC, but the next year it's 40. Like, that's abnormal.

Natalie Crawford
But that's abnormal for me.

Dr. Mark Hyman
It's abnormal for you.

Natalie Crawford
We have to allow ourselves to be our own in of one experiment in a way and really learn that we we're gonna give generalized advice based on the data that we have out there, but we have to apply it to our own body and health. And I agree. We'd rather just put more air in the tire and fix the problem than have a blowout while we're on the road, which is the pathway so many people are on.

Dr. Mark Hyman
What in in terms of the inflammatory lifestyle that we're talking about, what are you what are you advising people to do to kind of reduce inflammation? Because it seems like inflammation is connected to insulin resistance, to toxins, to mitochondrial health, like all that. So how do you how do you kind of advise people when you're like, someone's coming to your office, say, I'm having problems with my my fertility or my reproductive cycle. Mhmm. Men and women.

Natalie Crawford
First of all, let's double down because you said it a couple times. Mitochondrial health is extremely important in how the egg is going to function, and we know that the follicular fluid so if we think about a follicle has an egg and fluid inside of it, The follicular fluid can carry inflammatory markers in it. And women who have more inflammatory markers in their follicular fluids, so a higher inflammatory burden, have more abnormally shaped mitochondria. So inflammation is directly harming the mitochondria of your eggs. Mitochondria of the eggs impact egg function, response to hormones, but they get exclusively passed on to your child.

So very important for us to connect the dots for people that inflammation is not just this buzzword, but that it's significantly impacting your life, and you can make a difference.

Dr. Mark Hyman
So Well, you just said something really important. Wanna gloss over it. The mitochondria in the egg Mhmm. Are influenced by inflammation. Yeah.

And the mitochondria from the mother is what's passed on to the child. They don't get the mitochondrial DNA from the father. They get it from the mother, which is unusual when when you look at genetics. Everything else is half half. So are you saying that that the quality of the egg and the mitochondria of the egg is passed on to the child might influence their mitochondrial health?

Natalie Crawford
It does. It influences their mitochondrial health. It influences their genetic expression. And I know everybody wants to be making decisions that are going to be beneficial for, hopefully, their future baby, their child's health. But we've got to really bring this conversation publicly and talk about how do we influence our mitochondrial health because many people are still told the party line of it doesn't matter what you do.

It's just luck. Right?

Dr. Mark Hyman
Oh, it doesn't matter what you eat. Yeah.

Natalie Crawford
I guess. No. It's just Fertility is all luck. None of this matters. Yeah.

But luck by definition is something you have no control over. Even if we don't control everything, you are directly controlling most of the inflammation you're exposed to, and it's worth it if you care about your health to start to break it down. So I'd love to dive into these type five and what I recommend.

Dr. Mark Hyman
Please. Go for it.

Natalie Crawford
So the first thing that I recommend to patients and the number one thing people are not doing in my practice is sleeping enough. So sleep is gonna be number one on the list. I have so many I live in we we live in Austin. So we have so many patients who are healthy from the outside, kind of like I was. And they look fine.

They They

Dr. Mark Hyman
go to yoga class.

Natalie Crawford
Yeah. They declare themselves as healthy. And we go down and I talk about sleep. They'll say, oh, I only need five and a half hours of sleep per night. That's all I need.

And so we'd have to say, like, hey. That might be what you think you need. That's not what your cells need. That's not enough to function optimally. So we're not just trying to get up and get through the day.

We really are trying to reprogram our body. When it comes to a fertility or reproductive lens, for every hour less of sleep that a woman gets, she's gonna get fewer eggs in an IVF cycle. For every hour less sleep a man gets, he'll have a lower testosterone level and have less sperm.

Dr. Mark Hyman
Wow.

Natalie Crawford
And then if either person gets poor sleep, it takes us longer to get pregnant and lower success with IVF. So this isn't just a good thing we should do. It really is foundational in how our body is set to deal with the inflammatory burden of the day. So when you sleep, inflammation levels can drop. You can obviously become more insulin sensitive in your cells because you're not eating during that time frame.

But, for reproduction, FSH and LH are released from the brain in the early morning hours. If you are not sleeping long enough, your body's not getting to the stage where your brain is able to interpret and respond appropriately. So it's really important. Ideally, we get at minimum seven hours. Seven and a half is probably better for women, especially in the luteal phase.

Progesterone is a really energetically expensive process for women to make progesterone. So we wanna make sure that we're prioritizing sleep and setting a good sleep environment, both men and women, dark room, cool room, think sleep mask, sound machine. But, also, if we have a partner, we've gotta be on the same sleep schedule. So many couples have somebody they share a bed with, and this whole one person goes to bed early, the other person goes to bed late, but that's really disrupting our sleep pattern when somebody's not coming to bed at the same time and getting up at the same time. And in the perfect world, this is similar.

And then your circadian rhythm matters as well. Right? So when it's dark outside, you're sleeping. So

Dr. Mark Hyman
sleep. What

Natalie Crawford
are those? Number one. Number two is going to be stress. And so we already talked about stress a little bit. There was a study called the life study, which is looking at a preconception cohort.

So people who want to get pregnant, who don't have infertility, and people who had higher salivary amylase levels, a stress marker that took them longer to get pregnant. And this was whether the man had it or the woman

Dr. Mark Hyman
had it. Calibrate cortisol or amylase? Amylase. Amylase. That's a digestive enzyme.

Natalie Crawford
It is, but it's also increased in stress. Interesting.

Dr. Mark Hyman
That's new for me, but that's good to know.

Natalie Crawford
It's interesting.

Dr. Mark Hyman
I like doing podcasts. I talk to smart people like, how did know that?

Natalie Crawford
So we wanna think about how your body was made to function, which is obviously not in this world. Stress response had a very specific purpose. When your adrenal glands would make cortisol right? Cortisol is inflammatory, but we'll use the old example of running from a bear. You know, your body wanted you to run from a bear.

So it didn't need your survival from the bear to depend on when you ate your last meal because glucose coming from our food is the fuel for cells. So what happens when cortisol is released and you have stress, as you know, glucose gets broken down from the liver and goes into your bloodstream so that you can hopefully run from your bear, use up all that glucose, and get back to normal. But bears are not what causes most of us to be stressed. It's bad meetings, encounters with people, the Internet, you know, bad medical news. And what we do is we internalize that stress.

We don't leverage our physiology, and in fact, we do the worst thing. Right? So leveraging your physiology would say, hey. I know that glucose has been released, so maybe I should do 10 squats right here. Go for a very quick walk.

I need to use up some of that glucose to get back to baseline. But what most people do is not that. And if we have extra glucose, our body will secrete more insulin from our pancreas. So insulin resistance is directly associated with chronic stress. If you have more chronic stress, it can cause insulin resistance.

So not just from our food, but from our lifestyle or environment as well. And when we think about it this way, the fact that insulin levels being higher longer is so inflammatory, more visceral fat deposition impacts the hypothalamus or the brain's response, but high insulin levels change the ovarian response specifically. So the ovaries are gonna make more androgens, more male hormones Yeah. And less estrogen in the setting of higher insulin. And insulin's going to change mitochondrial function and shape when it's at high levels in the ovary.

So it's not a benign hormone. It's an important one. So if we say

Dr. Mark Hyman
right amount, not too much.

Natalie Crawford
Exactly. So we need to say, okay. If I'm stressed, I need to be in a place where, hopefully, I can manage that stress better. Right? Go go do something, activate your muscles so that you can use up that glucose and not be on a path.

Dr. Mark Hyman
Tiger on a treadmill. Seriously.

Natalie Crawford
I mean, a small walk, a few squats, a few push ups, do something.

Dr. Mark Hyman
And Jump up and down, scream.

Natalie Crawford
But what do most Americans

Dr. Mark Hyman
feel? Right?

Natalie Crawford
Right. If you have a stressful day, what do most people come home and do?

Dr. Mark Hyman
It's to be eat food.

Natalie Crawford
Eat eat food, drink alcohol. We actually do things that are going to worsen our insulin resistance instead of improving it. And then to the last tenet here, especially for women, we we need to build muscle. Right? Muscle is really one of the keys for hormonal health because it can utilize glucose without needing insulin.

It is one of the best ways to combat insulin resistance, which many, quote, healthy people are still insulin resistant. And you and I probably struggle with the fact that a lot of the lab tests to check for this have reference ranges that you and I also would not like most people to be in when it comes to are they optimal versus, quote, normal because of population based norms.

Dr. Mark Hyman
Right.

Natalie Crawford
So we see people who are more insulin resistant. And if they function and work on building more muscle, one, they'll be able to use up more of that glucose in a better way, and that's gonna be more formal.

Dr. Mark Hyman
It is such a prevalent problem, like this insulin problem.

Natalie Crawford
It's it's huge.

Dr. Mark Hyman
I mean, I I we at Functional Health, we've tested half a million people. Yes. And we've done 80,000,000 lab tests.

Natalie Crawford
It's a

Dr. Mark Hyman
lot. And we test insulin

Natalie Crawford
Yeah. Which I test fasting insulin in my No

Dr. Mark Hyman
doctors do except maybe you and me and a few others. I asked Quest, you know, how many tests that they receive are for insulin. They said less than one percent. Sixty five percent of our members who we we think would be health forward have high insulin levels at the Quest reference range, which is 18.

Natalie Crawford
And so I want mine

Dr. Mark Hyman
less than seven. Right. Should be think less should be less than five. So we're about the same ballpark.

Natalie Crawford
Yeah. But they're like Far from 18.

Dr. Mark Hyman
So sixty five percent are over 18

Natalie Crawford
That's wild.

Dr. Mark Hyman
In fasting insulin at function, which is insane to me. That's severe insulin resistance in my book. And, you know, I I saw somebody recently with a woman. She had she had, like know, her insulin was, like, 70 or something. You know?

Like, I think she had PCOS, obviously. So these are these are things that we can modify a 100%.

Natalie Crawford
It's so important because when I talk to patients and I bring up insulin resistance, the first response I always get is, well, nobody in my family has diabetes. Like, like, this doesn't apply to me. Or I'm really healthy. I go to yoga. I do these other things like that.

This is not me. They have this idea that that's not gonna be them. Or they had a hemoglobin a one c that fell into its reference range, so they think that they are fine. Yeah. But I'm like you.

I check a fasting insulin in in all my patients Yeah. And say, like, look. Here's tangible proof that your body's not functioning as optimal as it could Right. And we can move the needle. And it's not just one thing that's going to do it.

It's all of these things. And Yeah. You know, sleep, stress, and building muscle are really keys. And for young women specifically, a lot of them are not picking up weights and building muscle. We still see a lot of, you know, aerobic activity, which is not bad, but it shouldn't be all that you do.

We see a lot of, you know, yoga, pilates, also not bad. But we really need to build some more muscle so that we are able to combat the insulin resistance that is how our world is really make pushing our bodies into this insulin resistant way. And then, of course, food and toxins, which are the harder places for patients to make movement, but ultimately can make a lot of movement there. So I always say start with the foundation. Stress, sleep, and exercise master.

And then let's talk about diet, and let's talk about toxins so that you can be in the place where you are decreasing that inflammation to the degree you can.

Dr. Mark Hyman
And what does a diet look like?

Natalie Crawford
Diet's so such a hot topic for people, isn't it? An anti inflammatory diet's one that's gonna heal your gut health. It's gonna improve your gut microbiome. You know, your gut microbiome is essential in estrogen metabolism. It's also that protective barrier for how much inflammation you're gonna be exposed to, and we know it is correlated with fertility rates.

Your gut microbiome needs fiber. Fruits, vegetables, which have lots of antioxidants, lots of fiber rich food. Almost everybody I see needs to eat more of them. From fertility data and hormone data Yeah. More servings of fruits and vegetables is correlated with getting pregnant faster and better outcomes if you're doing fertility treatment.

Core of the diet. We wanna then leverage these whole foods. We want healthy fats, the olive oils, avocados, nuts, seeds. Fat is the backbone for hormones. You need cholesterol to make hormones.

And I still see specifically a lot of women who still go to the low fat product, just almost out of habit or, you know, what the food industry has told people to do. So we don't wanna be afraid of fats and specifically those healthy fats. We wanna leverage those. Most people need more plant based protein. Doesn't mean you have to be completely plant based, but plant based protein is great because you're hitting multiple needs at once.

Yeah. You're gonna get fiber, and you're also gonna get protein goals.

Dr. Mark Hyman
And vitamins and minerals.

Natalie Crawford
Vitamins, minerals. So a lot of people are not leveraging them at all, and we say that.

Dr. Mark Hyman
Talking about, like, frankenfoods that are No.

Natalie Crawford
We're not talking about processed foods. Right?

Dr. Mark Hyman
Processed plant based foods or vegan. Those are terrible for you. Those are actually worse than actually

Natalie Crawford
eating 100%. We we really are limiting processed foods, quote, health foods that are processed. Yeah. But we're talking about, you know, beans, lentils, there's legumes, soy, like, things that can be really advantageous to hit on multiple markers of your health at once. And then when it comes to animal based meat, because animal meat does not have fiber in it, we wanna make sure that we're incorporating really high quality meats.

Then this is, of course, a limitation in nutritional data Mhmm. Is that we look at certain different food groups, and everything's grouped together. Yeah. Right? So your McDonald's hamburger is in the same food group as

Dr. Mark Hyman
even 50% meat, I think.

Natalie Crawford
Well, so everything's kinda grouped together, so we have to take it as it is. But what we know and we do look at different types of animal meat. Eggs look beneficial. They have really high in choline, you know, healthy fats. So eggs are great.

Fish, of course, with omega three fatty acids look really lovely. People who consumed more servings of red meat had poor embryo quality, lower egg counts, and worse stage of endometriosis. Not all red meat's created equal. I tell patients you don't need to eat it every day, though. There's healthier protein based sources if we're looking at every single day.

Dr. Mark Hyman
At a feedlot cow versus a regeneratively raised

Natalie Crawford
They're not all the same. We agree

Dr. Mark Hyman
with ranch near Austin, Texas is

Natalie Crawford
a different thing. I was like, but we're in Texas, so we do have to tell people, you know, don't consume this food every single day because if you are, you're limiting exposure to the other foods in that protein category that you could get as well. But the biggest mover there is avoiding the ultra processed foods. So no ultra processed foods, the added refined sugars. We wanna make sure when it comes to carbohydrates, we have the complex carbs over the refined ones.

But I

Dr. Mark Hyman
feel like to be careful of that because the the complex carb thing is is an older categorization. Like You're right. Okay. White bread is a complex carb, and that's just like sugar. So Correct.

It's more around the the you mean whole food

Natalie Crawford
We want the whole food carbs, and we want things that ideally a lower glycemic index. Yeah. Meaning, to eat the same food is not gonna cause as

Dr. Mark Hyman
much pet peeve of my

Natalie Crawford
That's great. We wanna be really clear for somebody who's listening what we mean by words. So having a food that doesn't cause as much glucose in your blood is going to help fight against insulin resistance. Yeah. And then when it comes to thinking about dairy and gluten, more people have sensitivities to those than to other food categories.

And that doesn't mean that everybody has to avoid them.

Dr. Mark Hyman
Praise the Lord. Hallelujah. Doctor's saying that. I can't believe it.

Natalie Crawford
But it means that we Wow. I recommend that if you, you know, have symptoms of inflammation or unexplained anything or you're trying to optimize, be your own CEO of your health Mhmm. You should give yourself the time to remove that food from Mhmm. Your You know, eat really eat really anti inflammatory, remove gluten and dairy, and then you do a trial of introducing it back in, and you'll notice the difference.

Dr. Mark Hyman
That's right.

Natalie Crawford
If it causes inflammation in you, you will know, and then that's not a food that you should be consuming because it's not good for your individualized body.

Dr. Mark Hyman
Right. So the idea is, like, if an elephant's been standing on your foot your whole life, you don't really don't. When the elephant gets off your foot, you're like, oh, I feel better. And then when it steps back on your foot, you go, oh, ouch. Exactly.

And that's what happens.

Natalie Crawford
That's a great analogy because I don't eat gluten obviously now.

Dr. Mark Hyman
Right.

Natalie Crawford
But if I get exposed to it somewhere like, now I'll have terrible stomach, all my inflammatory symptoms. Like, I'm so aware of it. Yeah. Because now I know how well my body can function without it, and I'm much more aware of what happens when I am. But you might have said, I've eaten gluten my whole life.

How could I be allergic to it or be sensitive to it? It's really that you've been accustomed to such a high level of inflammation every single day. You're just not aware of it anymore.

Dr. Mark Hyman
And that's you know, you know, I I've been doing functional medicine for thirty years, and and I, you know, realized that there was a way to reset people by a short term kind of reboot with a more extreme diet that removed all processed food Yeah. All sugars, dairy, gluten, and just focus on whole foods. And it I call it the ten day detox diet, and it is unbelievable. Like, I I I it's almost like a miracle.

Natalie Crawford
I do

Dr. Mark Hyman
I don't wanna sound like

Natalie Crawford
Very similar thing in the book. I take everything down to whole foods, then we do a little trial, couple weeks of add back in, remove it again. If you were sensitive to it, you know, try again, and really tell me to give people I agree.

Dr. Mark Hyman
You And it's it's amazing.

Natalie Crawford
Your life. How many people that were sensitive? So many more

Dr. Mark Hyman
than that long. That's why it's ten days. You just remove us for ten days. You know, we see a seventy percent reduction in all symptoms from all diseases in ten days. Whether it's gut issues or mood issues or sleep issues or joint issues or skin issues or whatever it is.

Mhmm. I had a guy come up to me at Cleveland Clinic, and he said, doctor Hyman, did the ten day detox. Have rheumatoid arthritis. It went away. Is that possible?

I'm yeah. It's possible because it happened. You know? Like and another woman would, like I believe on psychiatric medications and not psych hospitals her whole life. She's like, I I'm not depressed anymore.

Natalie Crawford
Once you know how well your body can function, like, it's a lifelong change for you.

Dr. Mark Hyman
Yeah. So it's important. I think what you're saying is important. And, yes, stress, sleep, and and and muscle is key, but diet is

Natalie Crawford
the only thing. The needle the biggest on diet for most people. Right? Even if they are, quote, healthy, when we start really looking at healthy, because we touched on it but didn't, processed foods can masquerade as health foods as well. You often get a double hit from them because a lot of the food wrappers do have some of those toxins in them, so you're getting inflammation from toxins.

You're having how it's processed. It's directly causing inflammation. We didn't

Dr. Mark Hyman
really we didn't really hit on this, but I think, you know, you you Trudy talked about it, which is that the environmental toxins, not just toxins are bad, they are hormone disruptors. Correct. And they're they mimic estrogen, and they're combinatorial. In other words, it's not like one plus one equals two. They might one plus one equals a thousand.

And so they really screw up hormones in a in a way and screw up fertility. So can you talk about that?

Natalie Crawford
They do. And I have a whole chapter on toxins because I'm so passionate about it. When it comes to environmental toxins, there's different categories. We've got endocrine disrupting chemicals, heavy metals, plastics, behavioral toxins, and they are all impactful in different ways. The category we're most afraid of is the endocrine disrupting chemicals.

Like you said, they actually each chemical works differently. They can work at the thyroid, the brain, the ovaries, the adrenal glands. They can cause early puberty, early ovarian failure. They really can disrupt just from your day to day life, your ability to get pregnant. And more concerning is many of them live in your body forever and can get passed on, then get passed through the placenta, and they can impact your child as well.

This isn't fearmongering, which is the narrative I get from colleagues sometimes that toxins are everywhere. You can't control them, and you're just scaring people. Mhmm. I think people are brilliant, and they can make good decisions if they have that data in front of So we wanna really look at these endocrine disruptors, which some of the top categories come in plastics, in fragrance, and then in the PFCs can come in our water, actually, and in some of our cookware exposures. So here's my recommend skincare.

Oh, yep.

Dr. Mark Hyman
So And household cleaning products and our food.

Natalie Crawford
When it comes to toxins, we wanna look at your home first and foremost because that's where you spend most of your time, and you can move the needle the most. Let's look let's just go through it very quickly. Your kitchen. So plastic doesn't deserve a place in your kitchen. You don't need any plastic.

Dr. Mark Hyman
Plastic cutting boards are terrible.

Natalie Crawford
Say plastic cutting boards. Exactly. I was gonna say that's one of those things that a lot of people just held on to it. We really want

Dr. Mark Hyman
Plastic storage container.

Natalie Crawford
Plastic storage kits. I mean, think about a cutting board. You're cutting your food, getting on your knife, and literally putting it back into your next food. The plastic storage containers and then kid products, plastics, cups, plates, bottles. To the degree you can.

We'd rather see stainless steel and glass and then wooden for cutting boards being better options.

Dr. Mark Hyman
Is silicone okay?

Natalie Crawford
Silicone's okay. I'm for the data we have right now. For babies? For babies, it's gonna be a much better choice than plastic is going to be. I prefer glass bottles and then stainless steel for plates.

But, know, we make the best

Dr. Mark Hyman
grandson. I'm asking for a friend.

Natalie Crawford
There there's a great company that makes stainless steel kid

Dr. Mark Hyman
Yeah.

Natalie Crawford
Like, eating ware too that could be amazing.

Dr. Mark Hyman
Alright. Thank you. I'll get that note on that after.

Natalie Crawford
One of the examples, you know, I remember getting really upset because my daughter is I was actively doing research on the perfor perfluorinated chemicals in fellowship, obsessed with how there's so much data, how bad for us they are, how they are forever chemicals.

Dr. Mark Hyman
The PFAS, I mean

Natalie Crawford
PFAS is one of them, and that we didn't know about them. Nobody was talking about them and, you know, getting rid of the Teflon, not touching thermal paper for receipts.

Dr. Mark Hyman
Credit card receipts, gas station receipts.

Natalie Crawford
Just don't take your receipt. Don't you don't need it. And, yes, is one single touching a receipt gonna make a difference? No. But we have these repeated exposures.

And let's think about people who maybe are a cashier. You're touching a receipt all the time. Wear gloves. Yeah. Right?

You're somebody who's has a higher risk. Yeah. We wanna really reduce that. But I remember being postpartum and really upset thinking that we had glass bottles at home, but we had to take plastic bottles to day care. And, you know, this is where we say we control what we can because we can't control everything.

Right? So, really, the sneaky sources in our kitchen, plastics, and then especially when plastic gets hot, to go food containers. So if you're ordering DoorDash and it comes to your house

Dr. Mark Hyman
Yeah.

Natalie Crawford
That container is often going to be very laid in with some of these chemicals. And, you know, we're all gonna order to go food at times, and we can't control that exposure. But what we can do is put it on a plate immediately or put it into glass storage if we need to keep it warm. And many people I know will eat it out of that container. They don't wanna do dishes that night.

But we need to be making the choices where we can. You mentioned fragrance, and this is a big one and a pet peeve of mine. Consumers need to understand that here in America, we don't have protection or regulation against many chemicals like other countries do. Yeah. And in fact, we have the opposite where people love to make money, and we have misleading marketing tactics as well.

Fragrance often has phthalates in it, and this is why so many of us are talking about limiting fragrance where you can. But there's a big difference in product labeling in unscented and fragrance free. Fragrance free means that there is no fragrance in this. No added fragrance. It does not have fragrance.

Unscented means it does not have a scent, but we can put a scent in to mask a scent to make it

Dr. Mark Hyman
I see. So it's like it zeros it out, but it's

Natalie Crawford
Zeroes it out, but it's toxic for you.

Dr. Mark Hyman
That's sneaky.

Natalie Crawford
So that's sneaky. And something we It's

Dr. Mark Hyman
like gluten free Lays potato chips.

Natalie Crawford
Right. But but worse is one of those things I liken it to the gluten free fries, but they're put in the fryer with all the other fried food. Right? Right. Labeled like it would be good for you.

But in reality, if I ate that, it's causing a huge inflammatory burden in my body. So if you're trying to get laundry detergent or bath product, shampoo, conditioner, and it says unscented, instead, we wanna go to fragrance free. That's where we wanna choose instead. So there's little things, and I have some comparative charts in here so that you can look at your products and say, is this something that is going to be okay? Is this safe?

Does this have hidden toxins? Because we don't have this language. We're not taught this yet.

Dr. Mark Hyman
That's true. And I I'm on the board of the Environmental Working Group. I've mentioned it before.

Natalie Crawford
Yeah. Love

Dr. Mark Hyman
EWG. Wg.org has great resources for skin care.

Natalie Crawford
They do. You can you can you can put in your product, and you can see its score, what's potentially in it, and you can search for other ones that can be better options.

Dr. Mark Hyman
Alright. Well, I'd like to wrap up by talking about sort of the next cycle, which is aging and and reproductive health and perimenopause, and how how you've made a connection between fertility and aging. How how are those linked?

Natalie Crawford
Let's think back to my favorite analogy of the vault. So you're born with all the eggs you're ever going to have. Every single month, you have a group of eggs coming out of that vault. Already talked through how one of them ovulates. The rest of the eggs die, and the next month, you have another group.

What's really fascinating is that when you have more eggs remaining or, generally, you're younger, more come out of the vault every month. And as we start to get older, fewer eggs come out of the vault every month. In every woman, you will be out of eggs. That's menopause. Right?

Ovarian failure. You're out of eggs. The ovary now can no longer respond to the brain signals. But we also talk about for fertility specifically, but also for female hormonal health, it's not just having eggs. It's the function of the ovary that is so important and its ability to respond to the brain signals.

And this is where inflammation, fibrosis play a huge role. Chronic inflammation and insulin resistance can actually get into the vault and decrease the number of eggs that you have. If you have an autoimmune disease, you have a chronic inflammatory disorder Yeah. If you smoke cigarettes, these can get into the vault and decrease the number of eggs. You will go into menopause early.

In the fertility lane, you'll go get a test diagnosed, and you'll be diagnosed with a low egg count, which is good for women to know they may make different decisions about this. But the next step of that that so often patients aren't told is if you have a low egg count now, you're going to go into ovarian failure early. And we know that ovarian failure, the earlier you go into menopause, the higher the risk of these same health outcomes that are associated with if you have infertility. It's this underlying cellular health, how proper estrogen production is so crucial for fighting inflammation and for day to day function for women. Because it's And

Dr. Mark Hyman
then if you ever premature menopause, you get more heart disease, more cancer.

Natalie Crawford
Heart disease, cancer, stroke, metabolic syndrome, Proteins. Exactly. The same things that we see higher rates of even if you just have infertility. So there's such a tight correlation with chronic inflammation underlying what is going on and how protective female hormones are. So it's these same tenets of doing what you can do is is one way that we can help our ovaries function longer.

Right? Thinking about ovarian health, not just going through menopause and perimenopause and making the experience better, although that's one piece of the puzzle, But, also, how long can I get the ovary to last? How can I improve its function? And the ovary has a job that's not just ovulation. It still functions even when you're out of eggs and still makes hormones just differently.

Yeah. And interfering with that process is impactful for your health, your life, and your inflammation. So these five lifestyle principles that we're talking about, that's so important to start looking at earlier. I'm a huge advocate for women checking their ovarian reserve, getting an AMH blood test, which function does Part

Dr. Mark Hyman
of our function panel.

Natalie Crawford
I talk about it all the time because, I mean, this is important.

Dr. Mark Hyman
Most doctor Lambert what that is.

Natalie Crawford
Well, actually, Mark, the American College of OBGYN, ACOG recommends that you don't screen AMH in patients. I'm adamantly opposed to this. They say unless you have infertility, women don't need an AMH level. Their reason is that it's not associated doesn't cause infertility, which maybe maybe not true. Because if you have a low egg count that's due to endometriosis, for example, that absolutely can contribute to infertility.

But we'll say it for sake, two equal women, one has a low AMH, one has a normal. They say it's too difficult for a woman to find out she has a low AMH and too stressful when it's known to cause infertility. But that woman who has a low AMH, one, deserves a evaluation for why, might find something that's going to change her life. Maybe she'll take out gluten, get her Hashimoto's treated, get surgery for endometriosis. But, also, she very well may make different decisions for her family planning.

She might freeze eggs, embryos. She might try for her family sooner. You know, my husband and I were together for a very long time before we started trying for her family, and I we could have started earlier. I was waiting for this perfect time in medical training that doesn't exist. She may do nothing, but then she's the one who makes the decision.

Maybe she says I'm not ready for kids, but I'm gonna change how I eat. Yeah. And I'm gonna look at all these lifestyle principles so that I can do what I can for my egg quality and my ovarian health outside of it.

Dr. Mark Hyman
Yeah. I had I had a friend who was did function, and her she she was about 32, and she had very low AMH. And she's a vegan. I'm like and she also had all these all these other nutritional deficiencies that we found in her labs, and I'm like, hey. You know, probably not a good idea for you to eat that way.

You're probably gonna Yeah.

Natalie Crawford
It's a it's a biomarker for your ovarian

Dr. Mark Hyman
And her AMH went up.

Natalie Crawford
It's not a perfect marker. Right? A lot of our biomarkers aren't, but we've gotta leverage the data that's available to us. Yeah. And those are tools.

It's a tool in the toolbox. And I think it's unfair for women to say don't get it checked because it can highlight decisions you might make now that are different, how you approach your family building, and then also how you think about perimenopause and menopause because everybody will go into ovarian failure. Everybody will go through perimenopause or the years before ovarian failure where your hormones are becoming more dysfunctional. The brain ovary communication is worse. Decreasing inflammation will be a big piece to manage that puzzle, but also it's not normal to go into perimenopause in your thirties.

It is possible because women do go into menopause early, but that's highlighting an underlying mechanism that needs to be explored. So just because something will happen to you, understanding what can influence it happening, how you can delay that to the degree you can. And then if it is happening and you're 35 and you say, I have all these symptoms of perimenopause, you need to get evaluated for a bigger picture. What what I do dislike right now is this idea, well, that's just perimenopause and just deal with it. Because that same person may actually be going through perimenopause.

But maybe it's her Hashimoto's, her autoimmune thyroid disease that depleted her egg count, causing her to go into perimenopause early, and we need to treat that also.

Dr. Mark Hyman
That's so true. And and everything you're saying is so important because the very things that, you know, affect the biomarkers of fertility Mhmm. Also affect the biomarkers of longevity.

Natalie Crawford
Exactly. They're the same thing. It for young women, it is that first glimpse into your cellular health. And if we wanna think about ovarian longevity as an important life goal for women who wanna live long and healthy lives, if we can get women to start paying attention to this younger in their twenties and thirties, we're gonna have a new generation of women.

Dr. Mark Hyman
I agree. And I would also just make a shout out there for guys, for men.

Natalie Crawford
A 100%. Because because did focus female here.

Dr. Mark Hyman
Yeah. We we could do all another one on men. The thing about sperm is that it also is a vital sign.

Natalie Crawford
It is.

Dr. Mark Hyman
It is increasingly becoming a problem for younger and younger men.

Natalie Crawford
I completely agree. And we can look at it, and for men, even more so, I cut you off, but more so than women, it takes ninety days to generate new sperm. You can actively see how making one change Yeah. Can completely change their sperm parameters and improve their overall health as well because sperm and testosterone are made together. So often, I'll have young men, you know, hear something I say, and they're like, well, I don't wanna get pregnant, so I'm okay if it hurts my sperm count.

Sperm and testosterone are made together. Yeah. So surely, you wanna have normal testosterone because that's vital for men. And just like we talked about estrogen being made for women, chronic inflammation comes in and interferes with testosterone production in men. Yeah.

So all these same principles are really crucial for men to feel their best and have their longest, healthiest lives as well.

Dr. Mark Hyman
Absolutely. So this is such a great conversation. Your book, The Fertility Formula, Take Control of Your Reproductive Futures for Both Men and Women.

Natalie Crawford
Yes.

Dr. Mark Hyman
I think it's important for guys to think about this too. I think, you know, you you really have a lot of great resources out there. Tell us more about your practice, about your website.

Natalie Crawford
Yeah. I practice in Austin, Texas. So I own Fora Fertility, which is a

Dr. Mark Hyman
small r a.

Natalie Crawford
F o r a. Small physician owned practice. There's two of us there. And we really try to have more personalized fertility care for patients, not just this reactive model, but more proactive. And then you can learn more about me on Instagram at Natalie Crawford MD, or the website's nataliecrawfordmd.com.

Dr. Mark Hyman
Thank you for what you're doing. Thank you for seeing the forest for the trees. Thank you for discovering that all the things that I've been talking about for thirty years are actually a thing now. It's like it makes me so happy because, you know, for so many decades, was out there in the wilderness, and no one was talking about mitochondrial health or inflammation or the microbiome or insulin resistance or any of these things that are so fundamental to everything for

Natalie Crawford
every day.

Dr. Mark Hyman
So we could be talking about dementia. We could be talking about cancer. We could talking about heart disease or diabetes. We'd have the same conversation.

Natalie Crawford
Yeah. Everybody's saying the same underlying factors across all body systems, and hopefully that helps, you know, make the message even more impactful.

Dr. Mark Hyman
Well, thank you so much.

Natalie Crawford
Thanks for your

Dr. Mark Hyman
If you love that last video, you're gonna love the next one. Check it out here.