Acne, Weight Gain, Facial Hair, Hair Loss, Infertility: Is PCOS The Cause?

Mark Hyman, MD

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Dr. Elizabeth Boham: When somebody is eating too many of the refined and processed carbs, too much sugar, too many of those coffee drinks with sugar in it, juices, sodas, refined and processed oatmeals, cereals and pastas and breads and muffins, those foods that we've been grabbing too much of, for some people with some genetics that can really throw off this whole system in their body. Dr. Mark Hyman: Welcome to The Doctor's Farmacy. I'm Dr. Mark Hyman. That's farmacy with an F, F-A-R-M-A-C-Y, a place for conversations that matter. Today's conversation is going to matter a lot because it's a special house call episode with Dr. Elizabeth Boham talking about something called PCOS, or polycystic ovarian syndrome, which is a super common affliction that affects women that causes all sorts of misery from infertility to acne to facial hair to loss of hair on their head and weird periods. And it's just a miserable problem that affects millions and millions of women. And traditional medicine just doesn't do a great job at this. So we're going to get into it today and talk about this problem. So welcome, Liz. Dr. Elizabeth Boham: Thank you, Mark, it's great to be with you. Dr. Mark Hyman: All right. Well, let's get into it because this is such a common problem. How many people does it affect? Dr. Elizabeth Boham: It's amazing. 5 to 10% of women are impacted by PCOS. 5 to 10% of women, that's a lot of women. Dr. Mark Hyman: I mean, listen, if half the population of America is 330 million, if that's the population, half of that, it's like a hundred and, let's see, 65 million. And 10% of that, that's like 16 million people. That's a lot of people. Dr. Elizabeth Boham: Yeah. And PCOS or polycystic ovarian syndrome is a syndrome that involves irregular periods or not having any periods and androgen excess or changes in your hormone balance. But it is a syndrome. So that means that there's a continuum where some people have all aspects of PCOS and some people just have some aspects of PCOS. And we can talk more about that. So there may be more than this that we're not even picking up. It's quite common. And it's definitely something we're thinking about all the time when somebody is coming in and complaining about irregular periods or not having had their period for a bunch of months, a young woman that should be having regular periods. Dr. Mark Hyman: They get heavy periods, they can miss periods, they get light periods. What are the other symptoms that are pretty common? Dr. Elizabeth Boham: Yeah. So we see hirsutism, which is the growth of hair. Dr. Mark Hyman: That sounds terrible. Dr. Elizabeth Boham: Yeah, the growth of hair where women don't want to have it. So on their lip, on their chin, on their abdomen, in their belly area. So the hair is growing where they don't want to have it. And then they may have hair loss where they want to have hair. So they may have some male patterned hair loss, they get acne and typically- Dr. Mark Hyman: Wait, wait. So basically they're losing hair where they don't want to lose it and they're getting hair where they don't want it. And it's because of these high levels of male hormones. Dr. Elizabeth Boham: Yes. Dr. Mark Hyman: Like DHEA and testosterone that end up causing basically this male appearance, almost. Dr. Elizabeth Boham: Yeah. Their hair growth shifts because their hormones shift. Dr. Mark Hyman: So they are the women in the circus, that's what this is. Right? Dr. Elizabeth Boham: Yes. Well, some of them may have had some other things going on, too, to an extreme, right. But, yes, in general, yeah. You're starting to grow hair where you don't want it and not having good hair on the top of your head where you want it and all because there's been a real shift in your hormone balance in your body. And so when we actually check, we see high levels, like you mentioned, of that DHEA in the blood, we may see high testosterone levels or high free testosterone levels. And so those are some of the biomarkers that will show up when you look. Dr. Mark Hyman: They also get acne, bad acne. Dr. Elizabeth Boham: Bad acne, yeah. A lot of times in the lower jaw area acne and sometimes cystic acne. And then they'll often gain weight. Now, not everybody with PCOS is overweight. There's a lot of women, and we can even talk more about that today, there is a lot of women who don't have the obesity part of it. And they're just dealing with irregular periods. But for a good portion of women with PCOS, they gain weight because of the high levels of insulin that are going on. So, if they have high levels of insulin floating around, with PCRs, typically there is high levels of insulin. Dr. Elizabeth Boham: And we've talked about insulin so many times on this podcast, and you've talked about it many times. But that insulin is that hormone that helps us balance our blood sugar. So you eat a meal, the body makes insulin, that insulin tells your body to take your food and get it into your muscles so it can be used for energy. And what happens when somebody has insulin resistance is their body's not listening to that insulin as well. And they've got high levels of insulin. And that high level of insulin will cause people to gain weight around the belly. And so we often see with PCOS that weight gain around the belly, that belly weight. Dr. Mark Hyman: Yeah. So this sounds like a miserable condition. You get pimples, you lose hair on your head, you grow a beard, you are infertile, your periods are all over the place. This just sounds terrible. And traditional medicine has a very weird approach to it because the way I think about it is that it's called polycystic ovarian syndrome, which makes people think it's a gynecological problem, but it's actually a dietary problem. Right? Dr. Elizabeth Boham: Right. It's often a dietary problem. And it's not always dietary, which is so interesting right? Because we're we're learning about how toxins from the environment like BPA and plastics and we are learning about the microbiome and how that can be a trigger. So toxins and dysbiosis or imbalance in the microbiome are common. But things that we see- Dr. Mark Hyman: Toxins can cause insulin resistance. Dr. Elizabeth Boham: Absolutely. Dr. Mark Hyman: And the microbiome imbalances can cause insulin resistance and pre-diabetes, so it's all connected. Dr. Elizabeth Boham: It's all connected. And you're right. In a huge portion of people, it's dietary as well. But I think it's important to remember it's not always that, right? But there's a huge portion of people where they're just eating too many carbohydrates, too many refined and processed carbohydrates for their body or for anybody's body. But, those high levels of refined and processed carbohydrates really can be a trigger for this insulin resistance and weight gain. Dr. Elizabeth Boham: And then that insulin resistance shifts the hormone balance. And then you get this imbalance in hormones and you get the high androgens or testosterone and DHEA, and then the periods get irregular. But interestingly, as a syndrome, it's important that we pay attention to that individual person because it's very different. You may have 10 women in a room with PCOS and you may have 10 really different reasons for why they have PCOS. [crosstalk 00:07:43] They're really not all the same. Yes. It's really an interesting aspect for functional medicine doctors. Dr. Mark Hyman: Right. I mean that just speaks to the whole approach of functional medicine, just because you know the name of your disease it doesn't mean you know what's wrong with you, right? Dr. Elizabeth Boham: Absolutely. Dr. Mark Hyman: It's just this description of the symptoms, but not the cause. And so functional medicine is about the cause. It's about why, not what disease you have, PCOS, but why do you have that? Right. And traditional medicine, the symptoms are treated symptomatically. So what are the traditional treatments that you see regular doctors giving for PCOS? Dr. Elizabeth Boham: Yeah. So often, women will be placed on birth control pills because if they're having irregular periods or they're skipping their period, many times the physician will put them on birth control pills because it will regulate their cycle. They'll put them maybe on Metformin, because Metformin improves insulin sensitivity. Dr. Mark Hyman: It's a diabetes drug. Dr. Elizabeth Boham: Yeah. And then that can many times help with the weight gain. It sometimes helps with the acne and the hair growth or hair loss. And they'll often put them on Spironolactone which is another medication that helps with balancing the hormones and can help with some of the symptoms. Dr. Mark Hyman: Yeah. It's a diuretic and it just blocks the conversion of testosterone that really causes the hair loss called DHT. But it's really fascinating, but it really doesn't speak to addressing the root causes. So from a functional medicine perspective, what are the root causes for PCOS and how do we start to deal with these? Dr. Elizabeth Boham: Yeah, so, as you mentioned already, diet is huge. Diet has a huge impact. When somebody is eating too many of the refined and processed carbs, too much sugar, too many of those coffee drinks with sugar in it, juices, sodas, refined and processed oatmeals, cereals and pastas and breads and muffins. Those foods that we've been grabbing too much of, for some people with some genetics that can really throw off this whole system in their body. Dr. Elizabeth Boham: Another big common area are toxins. I see this a lot. I see a lot of what I think is toxin related. We know genetics plays a huge role here. We also know that what women are exposed to as a fetus, when what has happened to their mom, when their mom's pregnant with them, that really impacts their hormone balance and their metabolism later in life. Dr. Mark Hyman: So what the mom's eating. Dr. Elizabeth Boham: Yes. Dr. Mark Hyman: She's at Dunkin Donuts all day. Dr. Elizabeth Boham: What's fascinating with- Dr. Mark Hyman: Eating [inaudible 00:10:21] all day long with more sugar than three cans of Coke. I mean, yeah, people don't realize that. Dr. Elizabeth Boham: Yeah, So when they're pregnant with their baby, it's really important that they're paying attention to what they're eating, because if they're gaining too much weight or eating too many refined carbs or not gaining enough weight, it's interesting. So if they're not gaining enough weight or they're gaining way too much weight or they're eating too many refined and processed carbs and sugars that really throws off the fetus, that baby's metabolism. And so sometimes we tell our patients, you can just blame it on your mom. Dr. Mark Hyman: That's called epigenetics, the genes get tagged and messages of ... [inaudible 00:11:06] called the Book Of Life and where the bookmarks are in the book of life, you've got this whole genetic code but not all of it gets read. But you can bookmark different aspects of it, depending on what exposures you've had. And we know this from lots of research on epigenetics that what the mother does, what she eats, what she's exposed to, her thoughts, feelings, all those tag the baby's genes for what happens to them in the future and whether they get diabetes or heart disease or cancer, obesity. I mean, it's all programmed, but that doesn't mean it's not fixable. Dr. Elizabeth Boham: Absolutely, great point. Dr. Mark Hyman: You can actually modify your gene expression. And that's what functional medicine is all about is changing the environment. Then the big picture of the environment, meaning your diet, lifestyle, toxins, et cetera, et cetera. How all of those inputs affect your gene expression is what functional medicine is about. It's about modifying your lifestyle and your environment to influence your genes, to change your health in every aspect. Dr. Elizabeth Boham: Yeah. So for some people, it's harder for them than others. Some people come in and they're like, "It's just not fair. I have to be so much more careful than my friend Susie." Right. And it's true. Dr. Mark Hyman: It sucks. Dr. Elizabeth Boham: There are some people, yes, there are some people that have to be so much more careful with their diet. I mean, we all should be eating a healthy diet, but some people have to be more careful with the carbohydrates than others. Yeah. Dr. Mark Hyman: I would say there are a few people who are better adapted to higher carbohydrate diets. And there are a few, I know a few of them. And those are the ones who stay skinny, eating anything. But when you look at the fact that 88% of Americans are metabolically unhealthy, almost nine out of 10 of us have some degree of insulin resistance, that should get our attention. It's probably the majority of us who don't do well with a lot of starch and sugar. And there's a continuum, right? Dr. Elizabeth Boham: Absolutely. Dr. Mark Hyman: Some can do more, some can do less. Some look at a bagel and they gain weight literally, because they're thinking about it and their insulin goes up and they put all the fat on their bodies. I want to jump back to something you quickly talked about which is toxins. And how would you explain how environmental toxins and what toxins influence hormones and influence insulin resistance, because both of those things are going on with PCOS. And I think it's something people don't understand. Dr. Elizabeth Boham: Yeah. This was impacting men more than women, but we realized Agent Orange. So when men were exposed, there may have been a few women, I don't really know how many women went to Vietnam, probably not very many. Right. Dr. Mark Hyman: Not too many. Dr. Elizabeth Boham: Not too many. So when they were exposed to Agent Orange in Vietnam, they have a much higher rate of getting diabetes with less weight gain. So that's when we started to say, "Oh, this is interesting. There's a real interesting connection between toxins in the environment and our metabolism and our weight." Dr. Mark Hyman: And then we get diabetes. Dr. Elizabeth Boham: And they get diabetes, Dr. Mark Hyman: Those who had Agent Orange exposure had lots more diabetes. Dr. Elizabeth Boham: Yes, lots more diabetes at less weight gain. So, I'm just going to make this up here, make up some numbers, but just so people understand. They may have only had to gain 10 pounds or 20 pounds to get Type 2 diabetes where a typical American maybe was gaining 50 pounds before they got Type 2 diabetes. Right. Just for an example. So they were getting Type 2 diabetes with less weight gain, meaning that there was more to it than just the weight gain. And that's when we realized that these toxins were damaging probably the mitochondria, the powerhouse of your cells. Dr. Elizabeth Boham: We also know BPA, that plastic that's been really- Dr. Mark Hyman: Bisphenol A. Dr. Elizabeth Boham: Yeah, really well studied to show there's a connection with insulin resistance. We've known for a long about the connection with breast cancer and BPA. But there's also this connection with insulin resistance and weight gain. So that hard plastic, they use BPA in the lining of cans or on receipts. Dr. Mark Hyman: Baby bottles. Dr. Elizabeth Boham: I know, right. Dr. Mark Hyman: Yeah. When you get your credit card receipt, your gas station receipt, the people say, "Do you want your receipt?" I'm like, "No, thanks. No, you take it," because I don't want to constantly expose myself. It gets absorbed through the skin. Yeah. Dr. Elizabeth Boham: Yeah. So, we realized that this toxin caused weight gain, insulin resistance and I'm sure there's a lot of other toxins that we haven't even figured out yet that are really influencing. Dr. Mark Hyman: Yeah, that's true. Pretty much all the petrochemical toxins, all the plastics and all the fossil fuel-derived toxins are endocrine disruptors. And I read way back when we were at [inaudible 00:15:44], I read a book called Our Stolen Future by Theo Colburn, which was about the ways in which these environmental toxins were disrupting reproductive health of animals and humans. And I was like, "Oh my God." Dr. Mark Hyman: And so what's going on is that these are not just one exposure, you're not just exposed to BPA. You're exposed to literally hundreds of these in our daily life through our modern living. And there are ways to reduce it. And I think the environmental working group has a great resource for finding out what household products, skincare products, cleaning products, food products that you can eat that are not going to be full of these chemicals. And you just go to ewg.org. So that's important. Dr. Mark Hyman: Hey everybody, it's Dr. Hyman, thanks for tuning into the Doctor's Farmacy. I hope you're loving this podcast. It's one of my favorite things to do and introducing you to all the experts that I know and I love, and that I've learned so much from. And I want to tell you about something else I'm doing, which is called Mark's Picks. It's my weekly newsletter. Dr. Mark Hyman: 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'll only send it to you once a week on Fridays. Nothing else I promise. And all you 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. Dr. Mark Hyman: Now, back to this week's episode. So let's talk now about the gut because most people don't really think that your hormones are connected to your gut microbiome, but it's incredibly connected. Dr. Elizabeth Boham: Fascinating. It's so fascinating, but they've shown that there's certain types of molecules from the gram-negative bacteria in our gut. So if the microbiome, if all of those trillions of bacteria are out of balance and there's an overgrowth of some unhealthy bacteria in our gut, these gram-negative bacteria have something on them called LPS or lipopolysaccharides that these things can then, these components can get into the body. And they've shown that this can trigger this insulin resistance in our body so that people, when they have higher levels of these abnormal bacteria will have more insulin resistance. Dr. Mark Hyman: That's absolutely right. There's a name for this. We call it metabolic endotoxemia which is a fancy way of saying that the poison crap in your gut leaks into your bloodstream and your immune system goes, "Ah," and starts creating an inflammatory response which then affects your insulin sensitivity. So anything that causes inflammation, right? Anything, stress, bad food, toxins, infections, microbiome nastiness, all that can drive inflammation that can cause insulin resistance. So you don't have to even be eating any sugar, right? But if your gut's a mess, for various reasons, then you have to fix the gut. Dr. Mark Hyman: And also, there's a lot of effect on insulin resistance, but there's also other effects in the gut around the kind of bacteria that are there and how they affect your metabolic processing of estrogens and other hormones. So it's really important to eat the right kinds of fiber and the right kinds of foods and to feed your microbiome and your inner garden. Dr. Mark Hyman: So we've talked about a lot of things. We've talked about diet, we've talked about stress, you've talked about environmental toxins. We've talked about the gut microbiome. All these things play a role. And so the job of a functional medicine doctor is to dig down and figure these things out. So how do we begin to assess these? I want you to share a little bit about some cases, but how do we assess because it seems like a lot of stuff that you go to the endocrinologist or the gynecologist. They're not looking at your poop, they're not measuring your toxin levels. They're not looking necessarily to insulin resistance very well. What do we look at that's so different here at UltraWellness Center and through the lens of functional medicine. Dr. Elizabeth Boham: I mean, I think that's what's critical about functional medicine and what we do is we get a really good detailed history and that gives us a lot of information. So when we take the time to get to know our patient and get all of the history of their life, their timeline of their life, what things have happened to them, what illnesses they've had, what disruptions they've had, what exposures they've had, what other things are going on in their body, that really impacts where we go and what we choose to look for. So you get a really good history first and foremost, and then that informs you what you want to test. You could test everything, but this ends up being a lot of tests. So what's important is to get a really good history so you know where to really focus. Dr. Elizabeth Boham: So for one person, it may be I really got to look at their gut microbiome. They've got this sort of history, I think that might be an area that we really have to focus on. I want to look at what the balance of the good and bad bacteria are. I want to see if they have maybe some of these lipopolysaccharide components that may be triggering inflammation and insulin resistance. Or maybe somebody else, you've got a sense based on their history and some of their other symptoms that it's more toxin related. Or somebody else, it may be more lifestyle related. And you've got to just really focus more on breaking that cycle of craving those carbohydrates. Dr. Elizabeth Boham: Because what happens for a lot of people is it becomes a vicious cycle, right? They eat the carbohydrates, the real refined, processed carbohydrates, their insulin goes up, but then they gain some weight, then they crave more and more of them. And it becomes this vicious cycle that gets out of hand. And I think that's important. Dr. Mark Hyman: It's so important. And we really don't just look at the hormone levels, which your typical endocrinologists or GI ... We look at those too because they're very helpful and informative to look at their testosterone levels, DHT and look at DHEAS and all kinds of things that we look at. But we also do look at toxin load. We're looking at the microbiome, we're looking at nutrient levels. We're looking at insulin resistance in ways that may not be looked at. So tell us about the first patient you had who was 20 and she had these really irregular periods and acne and bad digestive issues. How did that all get started for her? Dr. Elizabeth Boham: Right. So, she was 20 when she came to see me and she was frustrated with her acne. She was frustrated with our digestion and her issue, her periods were all over the place. She had a lot of ear infections as a child. So she was put on antibiotics and then ended up getting a lot of recurrent ear infections and more antibiotics and more antibiotics. And so I think that really just set the stage for her microbiome to be out of balance. And then she started having her period when she was 14, it never was regular. So from day one, she had an irregular cycle. Dr. Elizabeth Boham: So always, one month it would be six weeks and then two or three weeks, and then she'd skip a month and then she'd be eight weeks between periods. So always irregular. And then as you know, I'm not really that surprised just having done this for so long, but she also then in puberty developed a lot of acne. So probably because of some of the shifts in the microbiome, in her young, young years, and then just all of these things going on. Dr. Mark Hyman: And you see that a lot. You see kids. Dr. Elizabeth Boham: I see that a lot. Dr. Mark Hyman: There is a lot of ear infections, maybe she's eating dairy, which commonly can cause a lot of congestion. They throw the antibiotics at the kids and then they get a little older, then they start getting gut issues and they start getting acne and other things. So it's all connected. Dr. Elizabeth Boham: Yeah. So what we did is, because of her digestive issues and her acne and her irregular periods, I said, "I'm really curious about her digestive system. I really wonder what's going on in there and could this be the driver of her insulin resistance?" And so we did a test that looks at antibodies against different components in the digestive system. And one of the things it looks are these lipopolysaccharides, which are on these gram-negative bacteria, which, as we talked about, has been shown to trigger- Dr. Mark Hyman: These are bacterial toxins, essentially. Dr. Elizabeth Boham: Yeah. The insulin resistance. And when we did that test on her, she had really high levels which means that her levels were high enough to get into the body, to trigger these antibody levels to occur. So we also did a stool test and the stool test, it showed that she had an imbalance. She didn't have enough of the good bacteria. She had an overgrowth of some unwanted bacteria. So she had this dysbiosis. And so I said, "You know what? This is where we've got to start. This is where we got to focus to help both your skin, well, actually all your skin, your digestive system and your cycles, your periods." We did see when we did hormone testing that she had signs of PCOS, she had some high level of DHEA and her testosterone was a little bit high. And her LH FSH ratio was off. So we did see some signs on hormone testing that she had some PCOS going on. Dr. Mark Hyman: So Liz, when you treated her, you also took her off dairy. Dr. Elizabeth Boham: Yes. Dr. Mark Hyman: And I want you to talk a little bit about why dairy is bad, both for hormones and insulin resistance and acne, because she had all these problems. Dr. Elizabeth Boham: Yeah. So, as you can imagine, dairy products, both milk and cheese and dairy products coming from a cow are full of hormones. That cow, to make cow's milk, has a lot of hormones floating around. Those hormones get into the milk, even if it's organic. Dr. Mark Hyman: And there's more of the ones that aren't. There's like 60 different hormones in milk. Dr. Elizabeth Boham: Yeah. And some people are very sensitive to those hormones and they will cause acne production. They will cause more acne and then, of course, a lot of people are sensitive to dairy. So it can cause a lot of digestive unrest and digestive issues. Dr. Mark Hyman: And what's also interesting to me is, look, people consume dairy and dairy will spike insulin pretty high. Dr. Elizabeth Boham: Yes. Dr. Mark Hyman: A 300% increase in insulin consuming dairy, which I was sort of surprised at when I looked at the literature. Dr. Elizabeth Boham: Especially the lower fat dairy. And so for so long, we were going to the lower fat and then we were going maybe to the lower fat chocolate milk in school, all those things that were spiking insulin. Dr. Mark Hyman: And I would say for women with hormonal issues, I think dairy has got to go for most of them, to start at least, to see how it affects them. Dr. Elizabeth Boham: Absolutely. Dr. Mark Hyman: Because whether it's irregular cycles or whether it's PCOS or whether it's acne, whatever's going on. I think it's an incredibly hormonally disruptive food for so many people and a lot of people can tolerate it fine. But if you've got problems, you've got to start thinking about what you got to cut out. Dr. Elizabeth Boham: And I think what is really helpful a lot of times at the beginning when you have a lot of things going on and you're not sure how food's impacting you, sometimes to do a full elimination of a food or a group of foods is really helpful because it gives you a lot of feedback. So sometimes, if you just cut down, you don't really ... I'm not really eating much dairy. And I get that all the time. Dr. Mark Hyman: I've got cheese after dinner. No, I agree. It's hard for people to understand that a little bit can do a lot of damage. And the way I explain it to people is think about like a peanut allergy. Sometimes if you're just exposed to peanut dust, you can get an anaphylactic reaction. Right. That's how powerful your immune system, it responds to microscopic doses. Right. So I think that's important to remember. So what happened with this young woman? You treated her? Dr. Elizabeth Boham: Yeah. So because we found this dysbiosis or imbalance in good and bad bacteria, we needed to get rid of the dysbiosis. So we used an herbal combination to treat that. We also gave her a lot of good probiotics and prebiotics, the things that feed the good probiotics. And we took her off of dairy. We did more of a comprehensive elimination diet at the beginning. So we took her off of dairy, but we also removed gluten and a lot of other inflammatory foods and really focused on a phytonutrient rich diet. Dr. Elizabeth Boham: And I think sometimes, we don't think about how powerful that can be, right? Those phytonutrients, those components from our plant foods that have amazing qualities in our health, from lowering inflammation to helping detoxification, to helping the process of elimination of our hormones that we want to eliminate. So they really are powerful. And so when you help people get those eight to 12 servings of phytonutrients which come from your vegetables, some fruits, some- Dr. Mark Hyman: Nuts and seeds. Dr. Elizabeth Boham: Yes. Spices, teas, really, that can be really powerful for the body. Dr. Mark Hyman: Yeah. So it's not just about what you eliminate, it's what you add. Dr. Elizabeth Boham: That's very true. Dr. Mark Hyman: I want to change the name, call it the addition diet. Dr. Elizabeth Boham: Yeah, I like that. So, that was very powerful for her. We also added in some Inositol, a combination product that has some myo-inositol and D-chiro-inositol, which actually helps improve insulin sensitivity. So, we did this for a while as well. It can help improve the cell signaling in the body and improve how the insulin works. We also really repleted some deficiencies she had, she was low in D, vitamin D, which we know is important for insulin sensitivity. And she was low in vitamin A, which is important for skin. She was low in Omega 3 fats, which is really anti-inflammatory. So we replaced a lot of the deficiencies that we found as well. Dr. Mark Hyman: It's amazing. And then what happened? Dr. Elizabeth Boham: It was great because her digestion improved, that was the first thing that got better. And then her skin got better. And then after a few months, her period just started to really get regular for her. Dr. Mark Hyman: And honestly, Liz, I get so angry because ... I've been doing functional medicine for so many years, people suffer so needlessly from problems that do have solutions and it's not rocket science. It's not like we need to know some great new discovery in medicine. We understand biology enough now using the lens of functional medicine and systems biology, which is now gaining more traction and people are becoming more aware of it. But it's just so disheartening to me that it takes so long for people to get access. Dr. Mark Hyman: And I think I want to just sort of end with a case, a short case study that you have of a woman who had infertility, because this is a problem that affects one in seven women. We've covered it before on the podcast. But I think I want to dig into this particular cause because it is one of the most common causes and also easily remedied. And I can't tell you how many women that I've treated personally, I know sure you have, who have this problem and you fix it and then they get pregnant. Dr. Elizabeth Boham: Yes, we see it all the time. It's phenomenal. So this woman was 34 and she came to see me because she was trying to get pregnant. And she had been trying for three, four, four plus years, I think. And had not gotten pregnant yet. And her periods were really irregular and she was 34. So she was getting closer to that age where she was getting really concerned about the fact that she hadn't gotten pregnant yet. Dr. Elizabeth Boham: And she also noted that over the last few years she had gained some weight. She was about 20 pounds overweight. Most of that weight gain was around her belly, which was making her frustrated. And she didn't really feel like she was doing much different anymore. She also had to get some laser therapy done to remove the hair on her chin and on her belly. So she had had some laser therapy done and she was also struggling with acne. She was on birth control pills from the age of 17 to 29 to really regulate her period. But when- Dr. Mark Hyman: I hate that. I hate that. When I hear that sentence, "Oh, my doctor put me on the pill to regulate my period." I'm like, "Well, why is it irregular? And let's figure that out instead of just slapping you on the birth control pill, which is not side effects free." Dr. Elizabeth Boham: Right? No, it's not. No. But when she went off of the birth control pills, her periods were irregular since then. And she developed a bunch of acne. So she really came in, really for us to help her with her fertility. And so we did testing and we found that her testosterone level was high. Her DHEA was high. Her LH FSH ratio was off. And her insulin, her fasting insulin was really high. So her fasting insulin was 13. And we really want that to be like five. So it was high. And to me, that signaled, okay, this was an area, she's got insulin resistance, she's got PCOS and that's really what's driving all of these things that she's dealing with. Dr. Elizabeth Boham: And so when I got her diet history, which she filled out when she came to see me, she said she was trying to eat healthy. She was having oatmeal for breakfast. She was having that refined oatmeal that so many people are eating thinking it's healthy, right. Sandwich for lunch. And at dinner, she'd have some pasta with some chicken or vegetables on it. And so that's really where we focused. We really worked to lower that carbohydrate intake for her. We pulled away those extra refined and processed carbs. Dr. Mark Hyman: The oatmeal you think was healthy [inaudible 00:33:44] breakfast but it wasn't healthy for someone like that. Dr. Elizabeth Boham: No, and especially a lot of the oatmeals out there and the way that we eat them. If we're eating a bowl of oatmeal with not a lot of other stuff in it, there's none of the good, healthy fats and protein to balance that blood sugar. You can have a small amount of steel cut oats with a lot of nuts and maybe some coconut milk. And, for some people,.that can be a healthy breakfast, but for her, that's not how she was eating her oatmeal, it was spiking her blood sugar and it wasn't helping with her weight. It wasn't making her feel satiated and satisfied. Dr. Mark Hyman: It made her hungry, probably. Dr. Elizabeth Boham: Yeah. Dr. Mark Hyman: So what did you do? So, food first with her, we put her on the Pegan diet, right. We pulled away the extra refined carbs. We said, "When you're getting your carbohydrates, we want them to come from vegetables. That's where you're going to be getting most of your carbohydrates from, from the greens and the-" Dr. Mark Hyman: Broccoli's a carbohydrate. Dr. Elizabeth Boham: Yeah, exactly. It's a wonderful, healthy carbohydrate and really rich in all those phytonutrients. We worked to balance her blood sugar so she had a good protein source and fat source at every meal. And we got her exercising. She was really focusing more on the fertility and working and let that go. So we got her on a good exercise program, both that included some high intensity interval training and some good cardiovascular exercise and strength training. She was a healthy woman. So we just had to get her moving again more intensely. And within a few months, three months or so, she lost that extra 20 pounds, her periods regulated and she got pregnant. Dr. Mark Hyman: That's unbelievable. So basically, these are people who go to fertility doctors, spend tens of thousands of dollars. And what you're saying is all you do is take a good history and get all the starch and crap out of her diet and sugar, got her moving a little bit. She lost 20 pounds, her cycles regulated and she got pregnant. I wish it was this easy for most people. Some people it's a little more complicated. But you'd be surprised at how many people just following this simple approach can make a huge difference. Yeah. Dr. Mark Hyman: There was a book by one of the top Harvard scientists of all time, Dr. Walter Willett called The Fertility Diet that really focuses in on this whole idea of why we have so much infertility and why is it such a problem? So this is an area where I get nuts because, from a functional medicine perspective, it's relatively straightforward to sort through this using a very detailed history, the right kinds of diagnostic tests that you wouldn't get at your regular doctor, using a food first lifestyle approach, fixing the basic things you need to get fixed, whether it's diet, toxins, allergens, low grade gut issues, that all can drive problems. Dr. Mark Hyman: And we just see amazing results. And it's so satisfying. And I think your work is just so incredible, Liz, and I'm just so happy we're all here at the UltraWellness Center because we get to see miracles every day. And they're really not miracles, they are just application of good science. But they seem like miracles. And I'm just so happy to be able to do this and provide this in the world. And I just want to thank you for your amazing work, teaching functional medicine all around the world virtually now, of course. But you really have been a leader in the field. Dr. Mark Hyman: And we have probably over 60 years of collective experience here at the UltraWellness Center for functional medicine. So if you're suffering from any of these issues, we'd love to see you here at the UltraWellness Center in Lenox. We can do all virtual visits now, people can't make it here in person, and we'd love to see you. Dr. Mark Hyman: So if you love this podcast, please share it with your friends and family, share on social media, leave a comment, and maybe you struggle with fertility or PCOS and have you solve your problems and [inaudible 00:37:36], subscribe wherever you get your podcasts and we'll see you next time on The Doctor's Farmacy. Speaker 3: Thank you, Mark.