The Keto Diet Podcast Ep. #075: Everything PMS & Birth Control

March 4, 2018 By Leanne Vogel July 18, 2018

Interview with Dr. Anna Cabeca, chatting about hormone fluctuations and cycle changes from birth control and keto, PMS and why standard care falls short, natural forms of birth control, and so much more.

Some of the most common questions I get revolve around hormones: how hormones affect the body, hormonal symptoms, and the impact that keto can have on balancing hormones. Our hormones control so much of our overall health, and it’s important to acknowledge and honor their role in how we feel by paying attention to the signals we receive from our bodies when we become imbalanced. Unfortunately, it’s very easy to get overwhelmed by those signals and rush to treat them as symptoms instead of digging into the root cause.

This focus on treating the symptom instead of the root cause seems to be common in standard care, and it’s part of the reason I am so passionate about holistic nutrition. Our bodies are constantly communicating with us, and if we try to muffle that communication by treating the symptom instead of the root cause, our bodies will get louder and louder. Eventually, the symptoms will grow in number and intensity, and we’ll have a lot more work to do than if we just addressed the cause of the symptoms in the first place.

Women especially are conditioned to distrust our bodies and muffle the symptoms, but if we tap into our intuition and take a moment to pause and listen, we can find ourselves empowered to do what feels right for our bodies. That’s why I am so excited to chat with Dr. Anna Cabeca about PMS, birth control, and the steps that women can take to address their hormone health.

In today’s podcast, I chat with our guest Dr. Anna Cabeca, Emory University trained gynecologist and obstetrician, menopause and sexual health expert, international speaker and educator, and the creator of various supplements and programs that support and empower women in their health journeys.

This episode is all about how women can take control of their health, from PMS to birth control, plus how standard practice just isn’t cutting it, what women can do to support their hormones, and more.

Let’s get to the interview!

For podcast transcript, scroll down.

Show Notes + Links

• Subscribe on iTunes or your favorite podcast app
• Listen to my previous podcast episodes about hormones: Episode #42 Optimizing Your Menstrual Cycle on Keto and Episode #54 Weight Plateaus
• Get more from Dr. Anna Cabeca on her website and check out her online store for MightyMaca™ Plus, Julva®, and all of her online programs
• Check your beauty products to see if they’re safe on EWG’s Cosmetics Database
• Looking for hormone-friendly makeup? Check out Sweet LeiLani, Beautycounter, and take 15% off your order from Wild and Free with code HPURSUIT15
• Grab my FREE 26-page recipe booklet on how to prepare carb up meals

Timestamps

• How oral birth control affects your hormones (21:00)
• PMS standard care and why it’s failing (29:37)
• Cycle changes on keto (40:30)

Partners of The Keto Diet Podcast

Transcript for This Episode

Leanne Vogel: You’re listening to Episode Number 75 of the Keto Diet Podcast. Today we’re chatting about why you experience PMS, oral birth control affecting your hormones, the PMS standard of care and why it’s completely failing all of us, cycle changes on keto and so much more. So stay tuned.

Hey, I’m Leanne from HealthfulPursuit.com, and this is The Keto Diet Podcast. Keto is a low-carb, high-fat diet where we’re switching from a sugar-burning state to becoming fat-burning machines. Starting keto and maintaining it long-term can be quite a challenge if you don’t feel supported.

My 60-day program, The Keto Bundle, provides you with clear, step-by-step how-to on successfully adapting to a ketogenic diet, avoiding common ketogenic struggles, and healing your body completely and fully with a ketogenic diet. Go to HealthfulPursuit.com/bundle, and use the coupon code PODCAST all in caps, no spaces to get 10% off your order, exclusive for podcast listeners only. Now, let’s get this party started.

The show notes and full transcript for today’s episode can be found at HealthfulPursuit.com/podcast/e75 let’s hear from one of our awesome partners.

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Two great things for you guys today, the first is that I put together a free 26-page recipe booklet on how to prepare carb-up meals. You can get it HealthfulPursuit.com/carbup. Great for the lady or gentleman who is sick and tired of being stuck at a weight plateau, wants to balance their hormones and is like, “I need something different.” So you can head on over to HealthfulPursuit.com/carbup to get the free guide with over 50 recipes that show you which foods are best on a carb up and also how to prepare them easily.

The second thing is, if you really love hormones and you are all about them, I also did a podcast episode on this very podcast that you’re listening to, Episode 42, titled Optimizing Your Menstrual Cycle on Keto, that I highly recommend you check out. Because today we’re going to be chatting all about hormones with one of my favorite doctors to chat about hormones with, her name is Dr. Anna Cabeca, she’s an Emory University trained gynecologist and obstetrician, a menopause and sexual health expert and international speaker and educator.

She created the top selling products, Julva® an anti-again feminine cream for women, MightyMaca™ Plus, a super food hormone balancing health drink and online programs, Magic Menopause, Women’s Restorative Health and Sexual CPR. If you’ve heard Dr. Anna Cabeca talk, ever out in public or on podcast episodes or YouTube videos or wherever, you will know that she is one of the best speakers when it comes to hormones and how the body works. She just makes it so relatable.

I’ve been chatting a lot with Dr. Cabeca lately. We’ve been working on a couple projects together so it’s been really fun. The podcast episode today that you’re about to listen to being one of them. And then I also did a video interview with her just a couple of days ago, actually. And the video interview is for my upcoming 12-week keto, doctor approved video training program for women, where I’ll be showing you step-by-step how to create a fat burning body for life through weekly video tutorials, step-by-step guides, worksheets and interviews with leading keto experts, including Dr. Cabeca.

So if you want to know more about this program, when it launches in Spring 2018, be sure to head on over to HealthfulPursuit.com/member to be notified as soon as it comes out. I’ve been dreaming of this program for over a decade and I’ve been working on it for 4 years and it’s finally coming to fruition and I am just so excited to share it with you. So without further ado, let’s cut over to today’s interview.

The Keto Diet Podcast, including show notes and links provides information in respect to healthy living, recipes, nutrition, and diet and is intended for informational purposes only. The information provided is not a substitute for medical advice, diagnosis, or treatment, nor is it to be construed as such. We cannot guarantee that the information provided on The Keto Diet Podcast reflects the most up-to-date medical research. Information is provided without any representations or warranties of any kind. Please consult a qualified physician for medical advice and always seek the advice of a qualified healthcare provider with any questions you may have regarding your health and nutrition program.

Hey Dr. Anna, how’s it going?

Dr. Anna Cabeca: It’s great Leanne, thank you.

Leanne Vogel: Yeah, thanks so much for coming on the show.

Dr. Anna Cabeca: Oh it’s a pleasure to be here. I was telling, I’ve been following you and I love what you’re doing and how you’re getting good information out to people.

Leanne Vogel: Oh that means so much coming from you because I’ve followed you for quite some time and likewise, so I’m really glad to have you here. For listeners that may not be familiar with your work, why don’t you start off by telling us a little bit about yourself?

Dr. Anna Cabeca: Great. I am a board certified and trained Emory University trained gynecologist and obstetrician. I started my residency in Atlanta way back in 1955 and then came into medical practice in Southeast Georgia in 1999 and I quickly immersed both feet full on in into integrative medicine, bioidentical hormone therapy and became also a sexual health expert as well as an expert in bioidentical hormones.

So I’ve since become triple board certified now in anti-aging and regenerative medicine as well as integrative medicine. I just love learning, I keep looking for the underlying reasons for this, what our bodies are going through and as we transition in life. I really do work to empower women to balance their own hormones and to be their own best innate healer. Their own best innate physician, whether it’s getting pregnant and fertility, whether it’s menopause, and beyond.

Leanne Vogel: That’s amazing and such a beautiful introduction to the things that we’re going to be chatting about because today we really wanted to focus on PMS and effects of birth control.

We’ve never, well we’ve had one podcast episode chatting deep in with hormones, but we didn’t really touch on PMS. And this is a huge topic for many women. So first off, for those that may not understand what PMS is, can we chat about what PMS is and is it something that every woman experiences or just some? Or how does it occur?

Dr. Anna Cabeca: Yeah, no absolutely. So PMS is really a constellation of symptoms and it can be different for different women. It really can be experienced differently. But we consider PMS, which stands for premenstrual syndrome, this time of irritability, bloating, maybe weight gain, acne breakout, headaches, brain fog, agitation. That doesn’t sound very good just saying all that right? And it doesn’t feel very good if you’re going through it.

And in the United States, I think the statistics run that at any time in a woman’s life, 80% of us will experience PMS or PMS syndrome, this constellation of symptoms that occur. The time, usually 1 to 2 weeks before the first day of your bleeding cycle, which we call the first day of your menses. So the first day you start bleeding is the first day of your period.

So usually those 2 weeks prior is what we call our luteal phase, after ovulation until we have a withdrawal bleed, we’re not pregnant, we have a withdrawal bleed. So this area of hormone fluctuation we have during this premenstrual phase, we typically have an increased level of progesterone as our body after ovulation is designing itself to prepare for a pregnancy. So we have higher level of progesterone, usually higher levels of estrogen as well to thicken the endometrium to make this great bedding to keep a fertilized egg nurtured for a pregnancy. And then that pregnancy doesn’t occur, all the hormones drop, and we have our period and usually this tension of this elevated hormones releases.

So that’s what’s happening when we’re experiencing this PMS. Now there are cultures that experience very little or no, maybe 10% of the population will experience PMS. So it really leads into what are the underlying causes of these symptoms, right? And why it can be different causes for different people. It’s not always the same cause that creates these symptoms that don’t feel good.

I really do … You may hear someone say, “You’re very hormonal.” Or your spouse says one of those things that you tell men. These are things you should never say to your wife, spouse, girlfriend is that, “Oh you’re hormonal.” Or, “You’re having PMS.” We will claim it for ourselves but something you should not say to us, especially when we are out of balance.

And hormones are a good thing. Our hormones are doing a really good thing. But it’s other things that are going on here as well that create the imbalance of hormones and that’s when we don’t feel good. That’s when we feel premenstrual syndrome, anxiety, irritation, depression. For many people, anxiety and depression is the first symptom of PMS.

Leanne Vogel: And it sounds like there’s a bunch of different causes and some of them are hormonal? Or all of them hormonal? What causes PMS?

Dr. Anna Cabeca: Yeah, no there are so many, there really are many different causes. We look through the literature. But clinically, what I see most common is an estrogen, is a progesterone deficiency and an estrogen dominance. Even though both progesterone and estrogen are higher during this phase, it’s an overall lower load of progesterone compared to the estrogen. So an imbalance in progesterone to estrogen.

We’re not clearing off our estrogen as well during this part of the cycle. It can be just because we’re older and our eggs aren’t producing enough progesterone. Maybe we had an … We didn’t ovulate that cycle and then therefore we didn’t have a corpus luteum produce progesterone. So we can see these symptoms of estrogen dominance.

But most likely it’s because there are so many hormone disruptors in our environment, in our diet, in our lifestyles that create an estrogen excess within us, so we’re really out of balance here especially during this phase of the cycle. So hormone disruptors, estrogen dominance, those are typical.

Nutrient deficiency, such as deficiency in iodine, in zinc and magnesium, calcium and B6. Those are big culprits for why we also might get premenstrual syndrome. And another thing that many people don’t think about is a gut dysbiosis, so an imbalance… if you have irritable bowel syndrome, if you have constipation, if you have SIBO or small intestinal bowel overgrowth. If you don’t have healthy bacteria in the GI tract, you’re more likely and more susceptible to have PMS too. So those are some 3 big causes.

Leanne Vogel: That’s awesome and really clear causes. Now for people that may not know what a hormone disruptor is, can we go through a little bit of what that is? We’ve chatted about it on the podcast before, but I think a lot of people will think, “Hormone disruptors? I don’t have those in my house.”

Dr. Anna Cabeca: Right. And it’s like, “Do you drink out of a plastic water bottle ever?” There’s phthalates, those are hormone disruptors. If you look on any ingredients that you’re washing your hair with, putting on your face, washing your body with, they can be loaded with hormone disruptors.

So getting organic, clean, gluten-free, non-GMO products is a really important part of cleaning up things that could be creating an imbalance in our bodies, these hormone disruptors. What are we cleaning our house with? What are we putting in the dishwasher to wash our dishes with that then leaves a residue and we drink, right? So even things like that where we don’t even think, “Oh my gosh. Never realized I could be …”

Actually this is a true story, Leanne, I have to tell it to you. My cousin is a sommelier in the Middle East. He is very particular about washing his wine glasses, drying them by hand etc. He goes, “The worst thing for a wine taster is to drink wine from a wine glass that’s been put through a dishwasher.” He says the residue is horrible. It hadn’t even occurred to me, then I was looking … I’ve always used clean ingredients in my dishwasher, but I started getting better about water rinse and to be more conscientious of less is more in this case.

So little things like that, that you’re not even expecting can really cause hormone disruptors. What are we washing our clothes with? Are we using air fresheners? That Glade air fresheners, huge hormone disruptors coming through there.

So I think there’s looking in, what in our environment could be causing an imbalance to our body? What could be competing with our own natural hormones? They are disruptors because they compete and look like our own natural hormones and block the receptor sites. So can cause disruption, throw us out of balance.

Leanne Vogel: Would you say that makeup also falls in line with that?

Dr. Anna Cabeca: Absolutely.

Leanne Vogel: Like women that are working and putting makeup on every day, and men to, whomever. Just putting on makeup all of the time.

Dr. Anna Cabeca: Yes, absolutely. You have to, I have to wonder, because we see an increase in thyroid nodules and thyroid disease. We’re putting all these chemicals on our faces. That a little bit, once in a while, probably fine. Our body can filter it in and filter it out.

But accumulative things, the doses from putting on from shampooing with chemicals and then putting on makeup and then a spray or product in our hair. Something on our nails or our hand cream.

The average, according to some research by the Environmental Working Group, it’s estimated that we put, by the time a woman leaves the house in the morning, an average working woman will have over 100 chemicals on her body. That was really stunning. So I started really looking at my ingredients.

Leanne Vogel: That’s terrifying.

Dr. Anna Cabeca: That’s terrifying.

Leanne Vogel: I’ll include a couple of links in the show notes for the makeup that I switched over to because makeup was the last thing that I was willing to get rid of and clean up. But it’s true, when you start to look at all the things you’re putting on your body and the chemicals and the ingredients that you can’t read.

Yeah, to tie that to PMS is a big thing because you want to feel good and you don’t want to have PMS. Well there is a really good connection right there and motivation to clean up other things that you wouldn’t think would directly relate to your PMS symptoms.

Dr. Anna Cabeca: Right, absolutely. And then again, just thinking, our natural skin is so good. I mean I still, I like my eyeliner and my lipstick. That is 99% of my makeup, my eyeliner and my lipstick. But choose good, clean products. I have to ask, what do you use?

Leanne Vogel: So I actually, which probably isn’t that good for you, but I tattooed my brows and my eyeliner on my face. From the grand scheme of things, I’m not applying it every day, but there is that tattoo thing. But I think, “I have so many tattoos at this point. What’s a little line?”

But I personally use a mixture of different products. I really enjoy Beautycounter for their lotions and their face washing stuff. And then I use Sweet LeiLani, which is a Canadian company actually that has really good makeup coverage. So if I have media events, I use that for that.

And then there is an Etsy shop, I can’t remember the name of her business. I think it’s Free and Clear. Free and Clear, Wild and Free, something like that. She makes all her own products and they’re amazing. I use her mascara and all of the light coverups and mineral makeups that she uses. I really like them and there’s 2 ingredients to everything. What do you use?

Dr. Anna Cabeca: Yeah, no that’s good. No I have eyeliner tattoo too Leanne. I was like-

Leanne Vogel: Oh great.

Dr. Anna Cabeca: I did that way back when. I think my daughter is 18 now. So after I delivered my 18 year old, I put those eyeliner tattoos on, ’cause as an obstetrician, I’m like, “Man, I have to have my eyeliner right?” So I’ve had that for quite a long while, probably due for a touch up.

And then I just use, really I use very, very little. So I have used Bare Minerals, that’s been one of the products. For skin care I use Annmarie Gianni and so just keep it minimum. I do sometimes indulge into my lipsticks with some maybe not so desirable ingredients occasionally because I love my reds. But …

Leanne Vogel: I was just going to say reds are hard to find because I love my reds too and it’s very difficult to find a good red that’s safe.

Dr. Anna Cabeca: It is. It is hard. But I think one thing too, the Environmental Working Group ewg.org/skindeep your listeners can look at that site too to see how their products rank. That’s a really good site, ewg.org/skindeep and you can just look up your own products and see. That’s eye opening.

Leanne Vogel: Yeah, I know I did the same and then threw out all my stuff when it said that it was safe and then it wasn’t. Yeah, it’s brutal. But baby steps. It’s not something that’s taken me years upon years.

I remember when I first found out that perfume wasn’t good for you, I went home and just ditched all of the perfume. Just baby steps to that. That was 10 years ago and I just cleaned up my makeup act. It takes time.

Dr. Anna Cabeca: It does. It does. We have those things that we don’t want to let go of. But then again, if you’re feeling great, it’s sometimes hard to realize it. But you don’t want to … I have 4 daughters, so I’m like, “I don’t want them to experience infertility. I don’t want them to experience these things because of accumulated hormone disruptors.”

So when we can, choosing the right products and trying to model the right moderate use of products in general and just being natural, really walk into natural beauty as much as possible. Makeup free, clean products, and really try to engrain that into them. Because it does, we know that it causes PMS. We’re seeing increases in infertility, obesity and cancer, thyroid disease, immune system diseases. This is a sign of the problems with hormonal imbalance overall.

Leanne Vogel: More on my interview with Dr. Anna Cabeca after this message from one of our podcast partners.

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And how does birth control play into all of this? It’s something that I removed many years ago. I’m so thankful that I did. But can we go through how birth control affects PMS and these issues that we’re chatting about?

Dr. Anna Cabeca: Yeah, absolutely. When we’re talking about birth control, primarily we think birth control pills, right? Oral birth control pills. Certainly they have a time and a place for many of us in our life cycle. But not the way it’s being used currently.

Currently, I see women who have been on birth control pills way over 7 years… 20, 30, 40 years even now. Some women who have been on birth control pills even recommended on it through menopause. There’s just, there are problems with this. There’s problems with starting birth control pills too young. And there’s problem with long term use of birth control pills. We know this.

So one of the things that birth control, when we’re talking about oral birth control pills, we’re looking at estrogens and progestins. Progestins are synthetic progesterone. These synthetic progesterones disrupt our hormone feedback system also have negative side effects, negative consequences, can cause increase in bad cholesterol, can increase your risk of blood clotting. Can increase hair loss and disrupt your body’s natural bioidentical progesterone production.

So we also know that this excess amount of estrogen and progesterones disrupt a very important organism in our body, organisms, trillions of organisms, the microbiomes. So birth control pills orally definitely affect our microbiome. The way birth control pills work, they’re designed to shut off ovulation so that we don’t ovulate. We don’t have a natural release of a egg so these pregnancy level hormones are ingested to suppress, to trick your body into thinking it’s pregnant, you don’t need to ovulate.

So this long term, has negative side effects, negative feedback mechanisms, the birth control pills not only disrupt our microbiome but they use really important nutrients that are involved in our body’s hormonal balance and our body’s immune system and our neurotransmitter production. So our happy hormone production.

Those are specifically birth control pills deplete our body from several B vitamins, from magnesium. Those are 2 big ones that are really affected by birth control pills. So we need to always supplement when we’re on it. But look at non-hormonal ways to use birth control or to create birth control to our advantage, versus just suppressing and knocking out and tricking our system into doing something differently.

The other thing with oral birth control pills is that we know that long term use of progestins have negative consequences on the breast tissue. Can actually be harmful to the breast tissue in the long term, especially if we’re starting it early, like before age 16. But also longer term use. So we need to definitely look at where we are at in our life and look at what’s the safest, healthiest option for us at this time period. Fortunately, we do have some good, non-hormonal options now, or low hormonal options now too.

Leanne Vogel: What would those be? For those people that are like, “Oh my gosh. I’m on birth control. It’s not so good. What do I do?”

Dr. Anna Cabeca: Yeah, I think I forgot to mention too, with oral birth control pill, you risk blood clots. We know certain ones are worse than other. There was again, depending on the type of progestin in the birth control, which makes the difference. So there are, so with birth control you have oral contraceptive pills and then you have a vaginal ring called NuvaRing.

We used to think that that was really better because you’re not taking it orally, but the NuvaRing is pretty high dosage so you still have, there are still, there’s a lot of systemic absorption of hormones from that NuvaRing that probably counterbalance the benefit of it not being orally. So because it’s such a higher dose. If they had a, gosh it would be nice if it was a smaller, lower dose, but it’s not.

And then there’s the Depo-Provera injections. I hardly recommend them at all. There’s implants. There’s progestin implants as well. Again, certainly a popular form of birth control, but not ideal. But my preference is the non-hormonal IUD.

The ParaGard Copper T IUD. So it’s non-hormonal. It goes into the uterus. It’s small. It sits within the uterus and will keep a sperm from meeting an egg. So from a Catholic perspective too, we’re never actually getting a fertilization according to the research of and egg over an embryo. So there’s the ParaGard IUD, which is I think great ’cause it’s non-hormonal.

Now it is Copper T, so I always recommend a multi-vitamin zinc supplement. Anytime we have copper, there’s a copper, zinc balance in our body. Just from my clinical practice, I had a woman with a copper excess and never could trace it to the IUD, but from that time on, I always added zinc supplementation into my clients as well. Plus we need zinc for pretty much every hormone receptor site in our body as well it’s great for good skin, nails and clear complexion. Zinc is a good one to add in as far as a vitamin supplement.

There’s low dose hormonal IUD such as the, there’s the Mirena IUD, now the Skyla IUD, which is a lower dose than the Mirena, so it is one, if we’re having bleeding issues that we can’t seem to regulate with diet, nutrition and detoxification, this lower dose Skyla progestin containing IUD is an option. So that would be second on my list for IUDs. I’d prefer the non-hormonal and then go to the Skyla, the lower dose.

The IUDs are great. There used to be a lot of scary news about IUDs and them getting lost, things like that. I haven’t, that is by far an exception and very unusual circumstances. In my career I’ve never seen that. So there used to be scare about IUDs but it’s something that I’ve recommended for decades now and it works really, really well. It’s effective and can not throw out your body’s natural hormone production. So that’s a way.

And of course there’s temperature. There’s some great apps and thermometers that are Bluetooth and can actually, you can do the natural hormone rhythm method, so that you’re able to see your fertile cycles. There’s definitely a higher failure rate with these regimens as well as with condom usage. But those are out there too. With now Bluetooth apps and the connections to basal body temperature thermometers, they’re better. They’re making it easier for us, which is so nice.

Leanne Vogel: Yep, there’s an app for that. I have the app, it’s great.

Dr. Anna Cabeca: Do you? Which app do you use?

Leanne Vogel: It’s called Life, it’s the Life app. It’s really fun. It also gives you reminders of when I need to give myself a breast self-exam or when I need to start taking my progesterone before, I think I start on day 12. I don’t know, it tells me all of those things. It’s really great. I love it. I’ve been using it for a couple of years and no failure yet, so this is a good thing.

Dr. Anna Cabeca: Yeah, no absolutely. How great. Yeah, because that is. Now we’re getting really good about that accountability. That’s the key thing is we lose track. When is my period? When’s ovulation, etc.? So being able to know is definitely a great way, keeping track of your menstrual cycle to know when you’re fertile.

You mentioned a really key treatment for PMS and that’s adding bioidentical progesterone on board. Especially starting from time of after ovulation to the time either cycle day 28 or till your period, the first day of your menstrual period and using that to help counteract estrogen dominance is seriously a God send.

What happens now, I can walk you through. The typical presentation often we see as a gynecologist is when a woman comes in to the office. There’s the standard care method to treat PMS and then there’s the integrative approach. Shall I go through the compare and contrast?

Leanne Vogel: Yes please. This was my next question, so that’s great. Please do it.

Dr. Anna Cabeca: Okay, yeah. So typically a woman will come in the office and she’s having PMS symptoms like anxiety, bloating, weight gain before her cycle, maybe some headaches and brain fog, just irritability, like doesn’t feel like themselves. I always tell my clients, I say, “If you only hate your husband 2 weeks out of the months, it’s most likely your hormones, not your husband, right?”

But we’re not feeling ourself and we want to feel like ourselves and happy and content and peace in our body all month. So a client will come into my office and say that she’s having these symptoms, our standard approach would be like, “Huh. So 2 weeks out of the month. Let me just give you Prozac for that time period, and that’ll help with the anxiety, the depression, the mood.”

Well then the client comes back in, she goes out. She says, “Okay, well the anxiety and the mood’s better. But I’m having breakthrough bleeding. I’m still having cramping. My periods are heavy. I don’t like the way the anti-depressant’s making me feel. I’ve gained a couple pounds.” Or whatever the situation may be. And like, “Okay, well let’s put you on birth control pills and let’s just knock out these symptoms all together. We’ll just shut down your ovaries.”

So then the client will go back and couple months later, couple years later, whatever the situation may be and say, “Well I’m still having breakthrough bleeding, having brain fog, low libido.” ‘Cause the birth control pill’s going to knock out your natural testosterone peak so you’re not going to want to have sex or less likely to want to have sex. So low libido and breakthrough bleeding, some cramping, ovarian cyst formation now, and some breast tenderness prior to your cycle.

“Well, we’ve got you on birth control pills. We’ve got you on Prozac. We can try another anti-depressant and maybe with less of a side effect of cutting out your libido between birth control pills and anti-depressants. So let’s cut out your bleeding all together and do an ablation. Or let’s just go ahead and do a hysterectomy, take out your uterus and if you’re over age 35 we’ll just take out your ovaries while we’re there. And that’ll be the end of it, right? Then we won’t have to worry about that anymore.”

So the next time the client comes back, they’re like, “Man, I have no sex drive. I’m dried up down there. I feel like hot flashes, mood swings, etc.” So you’re back on anti-depressants and the next thing you know, you’re making an appointment with a divorce attorney and a psychiatrist. So that’s the standard of care model.

But so what did I learn in my medical practice in working to get to the underlying root? So if we address the underlying reason why we’re having PMS to begin with, then what happens is quite different.

So here, the 35 year old woman comes in and she’s complaining of premenstrual symptoms. I’m going to look at her and say, “Okay, well this is great information. Let’s look at whether some of the lifestyle habits and choices that could be possibly contributing to this. And possibly based on your age, let’s look at some hormone lab work and look at a progesterone. Let’s look at your thyroid. Let’s look at some red blood cell magnesium and red blood cell zinc levels. Let’s evaluate your DHEA, which is your adrenal hormone and see if there’s how your reserve is.

Are you operating from running on empty? Are you well nurtured as far as your hormones go? And let’s go ahead and detox you because I know we get exposed to so many chemicals and things in our body and our liver has to process our hormones, so here’s some nutrients and supplements and here is a modified elimination diet, a low-glycemic, so a low carbohydrate, a low red meat, only whole food diet that I want you to follow for the next six weeks and I’ll see you in and we’ll review your lab work.”

Well the patient comes back in, she’s completely asymptomatic. And I may or may not have added progesterone on at that time. So to give you an example, again, I’m an Emory trained gynecologist, I’m also an osteopathic physician. I went from operating 2 to 3 times a week, major operations 2 to 3 times a week to referring out 1 to 2 hysterectomies a year. So this is a huge difference in approach and outcome for our patients and for the health and wealth of their families as well.

Leanne Vogel: I was blown away when you were going through that whole process of the standard care and how far it gets. But I see that all the time. Women that come to my book signing events and they’re like, “Yeah I had a hysterectomy last year, no idea why. And now that I know what I know, why did I have that done?” And it’s terrifying.

All it takes, that’s a loaded statement, but a couple tests and adopting a different nutrition protocol with maybe perhaps a couple of supplements and like you were saying, progesterone if they need it and it seems a lot easier. And no lawyer bills.

Dr. Anna Cabeca: Right, no attorney bills. No divorce attorneys. Keep them out of our life too, right? Yes, we want to feel ourselves and we want to feel good and we want to have that connection and we can’t mess with it. We can’t mess with our design. Our body has a tremendous ability to repair itself.

As you’ve seen. ‘Cause you’ve hit on this and you’re a pioneer in the area of ketogenic diets and getting our bodies into ketosis and how important that is in really helping honoring our design, right? Honoring how our bodies are designed.

Leanne Vogel: Yeah, definitely. That’s been a huge benefit to me and also giving myself space. You know when you start to remove the insulin response of all these foods that you’re eating and you’re a more well-rounded person because your moods aren’t all over the place, really gives you time to focus on your hormones and take your body seriously and give your body space to heal.

There was something that you said with healing nutritionally. You mentioned going on a low carb diet. You also mentioned no red meat and I’d love to chat about why, how, what, where red meat?

Dr. Anna Cabeca: Yeah, no I’m a fan of all things meat, pretty much, grass-fed, etc. But when we are clearing up. When I have someone with symptoms and they’re having a hormonal imbalance, I want them to be relying on their own natural hormone production, not to receive it exogenously.

So during a detoxification, typically somewhere a 21 day detoxification program, I like them to eliminate red meat for at least 10 to 14 days of that time period because red meat takes a lot of energy to digest and break down. When we’re trying to repair and restore and also clean out the intestines, I don’t want anything, I want things to be digested quickly and absorbed well.

So I remove it for this time period and have clients go very vegetarian during this time period as well. So I have the saying, “No whites, no wheats, no sweet and very little red meat.” So that’s their mantra during this detoxification process. Then reintroduce, then reintroduce foods as they go along. But I take out glutens. I take out grains. I don’t want anything to decrease absorption. So that’s why I take out red meat during that detoxification process.

Leanne Vogel: Very interesting. You know I’ve never looked at it that way. It’s been quite interesting now that my hormones … And I actually used… Well I did go through a detoxification process personally while I was figuring out the whole keto thing and there were periods where I was fasting and doing that. And I found that that helped for the detox stuff.

And then I found when I was trying to heal my hormones, I ate a lot of grass-fed beef. I could not get enough grass-fed grass-finished beef in my body. I’m sure that really helped with all the fats in there and everything. It was the full fat versions. But now, I’m not a red meat person. I maybe eat it once every 2 weeks. I just can’t even think about eating it. So it’s also cool to see how your body transitions through different products.

I was having a conversation in the last podcast that I recorded of just allowing your body that space to figure it out. But I think it’s really interesting that you would remove red meat. Does that include pork as well throughout that detoxification process?

Dr. Anna Cabeca: Oh yeah, absolutely yeah. There’s probably seven, a few days that you’re completely vegetarian and then there’s a 72 hour bowel rest where I just have you do a protein shake or a bone broth or a fast.

But what you realized and what you tapped on was discernment, right? You’re able to listen to your body and know what it needed. At that time maybe you were iron deficient, you needed that red meat and you … It resonated, this is a healthy choice for you. So that was a good discernment.

And then now, I know definitely for my primary client base, or menopausal women like myself, or perimenopausal women and we need less red meat. Again, it’s that process of discernment. How healthy are we? Are we in maintenance mode? And then we’re okay. We’re not rebuilding, restoring, fixing, correcting. But over time too, we need less. And our body becomes very efficient at using what we take in.

I think that’s a big part of discernment, knowing and trusting, “You know what I feel like this and I don’t feel like … It’s like in pregnancy, your awareness to what resonates healthy for your body is typically heightened. So being able to tap into that intuition and that ability to figure out what is good for you and what’s not good for you, what your body needs and what it doesn’t need. It’s good discernment. That’s a good sign of a good, healthy body.

Leanne Vogel: Yay.

Dr. Anna Cabeca: Yeah, it’s all good.

Leanne Vogel: Took me a while but I’m getting there.

More on my interview with Dr. Anna Cabeca after this message with one of our podcast partners.

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Okay, so also to merge our conversation together when it comes together when it comes to hormonal birth control and keto, a lot of people, a lot of women specifically find that their cycle changes when they go lower carb. Can we chat about why that happens? Do you know why that happens?

Dr. Anna Cabeca: I know it’s so exciting.

Leanne Vogel: Yeah.

Dr. Anna Cabeca: Well I run a program called Magic Menopause and I tell my clients that you’ve been in this perimenopausal state or you’ve been recently menopausal, don’t be surprised if your period comes back in. There’s probably many factors to this, but one of the main factors in my opinion is certainly insulin sensitivity. You’re becoming much more insulin sensitive. So this really enhances your body’s hormonal flow.

Now for some people, it’s like resting your circadian rhythm too, depending on what you’re doing or where you’re at. So your monthly cycle as well as your daily cycle shifts. In ketosis, many people will go through sleeplessness initially. So we’re adjusting our body clock a little bit. We don’t only have a daily clock, we have a monthly clock as well. So that can be part of it.

But I think becoming more insulin sensitive and insulin interacts with gosh, all our hormones really. It’s so important for progesterone, for DHEA, estrogen. The list goes on. Insulin is so interactive to our reproductive hormones, so I think there’s a transition.

I would say in my clinical experience, and I haven’t read any research on this or research reports, studies, perspective, case control studies. But I see, and I would give clients, “Give your body 90 days. Give your bodies 3 months of cycles and it should even, it should regulate.”

So for my menopausal women, they may start having periods again for another, as long as they’re staying on, I call it keto alkaline ’cause for as we get older we really need to focus on those alkaline vegetables, those alkaline lifestyle choices and alkalinizing habits that help us, nourish us and balance our body and ground us.

So as they get keto alkaline, they may just resume their periods. The same with clients. They’ll have less PCOS. They’ll have less PMS. They’ll have increased fertility. I think a big hormonal factor is the ketosis is the insulin sensitivity.

Leanne Vogel: That’s awesome and I’m glad you touched on menopause, a whole other conversation for a whole other time. Perhaps even a project that I’m secretly working on that listeners will find out in about a month. But menopause, you and I, it’s happening. But not for this conversation because it’s a big one.

Dr. Anna Cabeca: Mm-hmm (affirmative).

Leanne Vogel: We touched on it a little bit, either with supplementing with progesterone, are there ways to supplement with progesterone or supplements that are beneficial when one is looking to balance their hormones? What’s your stance on supplementation? Do you have any favorites?

Dr. Anna Cabeca: Yeah, I definitely do. I’ve always worked to create solutions for my clients because really so few exist for women in medicine, women in health, and I keep looking to make things easy. So one of the things is bioidentical progesterone. I created a progesterone pregnenolone cream, we call it purer balance, PPR. It has USP, so bioidentical progesterone and pregnenolone, 20mg of progesterone with 10mg pregnenolone. These are our mother hormones. These are hormones of fertility or hormones of pregnancy or hormones of healthy brain function, bone function, protective for our breasts. These hormones are really, really helpful also for our serotonin.

So progesterone increases GABA, which is our feel-good hormone. So this second half, this luteal phase, if we’re experiencing PMS, I typically have clients start a bioidentical progesterone cream, start with a small dose, apply it to thin skin where you see veins, so lower abdomen, lower chest, inner arms, behind the knees, rotate sites and use it in the evening before bedtime from day after ovulation cycle day, typically depends on the PMS symptoms.

But if we’re not trying to get pregnant we can start earlier than ovulation such as around day eight or ten. But typically if we are, we want to start after ovulation. So day 13, 14 and use it until day 28 of your cycle and then have a withdrawal bleed down set out or until your bleeding starts naturally then wait till ovulation again or around cycle day 14, 12 to 14. So that’s perfect with progesterone and again to alternate, to cycle with progesterone, use it in the evening.

And another herb that I use and this is part of my world journey or my healing journey around the world is Maca. I combined Maca in with tumeric, resveratrol, cat’s claw, which is Una de gato and many other ingredients, mangosteen greens and reds and other antioxidants to really promote decreasing inflammation and supporting your body’s natural hormone processes as well as alkalinizing and detoxifying.

So maca in and of itself has been shown by itself to improve PMS symptoms as well as sex drive and libido. It’s maca, not matcha. Some people get it confused with a T. But maca, it’s spelled M-A-C-A and it grows only above 10, 11,000 feet in the Andes in Peru. It was the food that the Incan warriors reportedly would take before they went into battle to give them stamina, strength, etc.

And in Peru itself, if you’re not feeling well they say, “Have some maca.” If you’re infertile, they say, “Drink some maca.” So they would nudge my husband at the time and say, “Oh yeah, it’s the Peruvian Viagra.”

And so I dug into the research behind maca which is so cool is that it’s high in arginine, so that improves nitric oxide which improves blood flow. It’s how Viagra actually works by stimulating nitric oxide. It actually stimulates all 3 forms of nitric oxide. So maca is pretty cool in and of itself. Plus other proteins that are only specific to this plant and only naturally indigenous to Peru, the Andes. It’s been a tremendous beneficial supplement.

I just on New Year’s Day, seriously, I woke up with the best message on Facebook Messenger ever. This woman had told me, we have a growing list of MightyMaca babies. But this woman wrote, she said, “I’m 44 years old. I had 3 miscarriages and I was devastated. I just knew I had to heal my body. So I ran across your MightyMaca™ Plus formula and I started it and I just wanted to let you know and show you this picture of my daughter who is now 3 months old and couldn’t have done it without MightyMaca.” It was really cool to see. I just woke up with that email message the other day. So it was awesome to see that beautiful sentiment. So when we get to the root, if we empower the body, the body goes a long way in healing itself.

Leanne Vogel: Yes, it’s so true. And we’ll definitely link up to those supplements in the show notes for people that might be interested in taking a look. And my last question for you today is, what do you feel is missing in the keto space for women?

Dr. Anna Cabeca: Definitely the alkalinity component. You know, ’cause I think it’s hard … You do this really well. Your diet plans, your nutritional recommendations, you cover it. One thing I do with my clients, I have them test their urine. I created urine test strips that have a pH pad and a ketone pad. I want them to be alkaline and then push into ketosis.

One of the things I found in working with women over 40, myself included, is that when I try to do ketosis, or ketogenic diets, I typically would get very irritable. I call it keto crazy. Leanne, I don’t know if you’ve seen this among your client base.

Leanne Vogel: Yep.

Dr. Anna Cabeca: But keto crazy, and I’m like, “What the heck. This cannot be good for women.” And then it wasn’t until I really figured out that, “Well when I’m pushing ketosis I’m no longer alkaline.” Which I always had my clients detoxing, check their urine to see if they were getting an alkaline pH and then I… or we need more minerals. Or we need more greens, or whatever else is going on.

So I started getting me and then clients and now hundreds of women over 50 alkalined first and then into ketosis. It is like beautiful. It is enlightenment and it’s a fabulous feeling. It really does feel so much better. So I think that alkaline piece, women, we definitely need more carbs than men here. But we need the right kind. We need the greens. We need the alkalinizers and really important choices.

Important choices there for hormone balance so we can detox the toxins that are in our fat stored as we start to melt that away and really help our body maintain that balance. This is a really good state to be in, to combine the ketosis with alkalinity. And as we’re more discerning and sensitive and in tune with our body as we get older if we’re not medicated from our unawareness, this keto alkaline combination is fabulous. It’s excellent.

Leanne Vogel: And where can people find you, so that they can learn more about all the things you have going on? You listed off a bunch of cool projects that you’re working on and work that you do. Where can people find more information from you on all of those things?

Dr. Anna Cabeca: Yeah, great. So my website is DrAnnaCabeca.com so D-R-A-N-N-A-C-A-B-E-C-A.com thank you.

Leanne Vogel: We will include that link in the show notes today. So if you guys are over on HealthfulPursuit.com/podcast/e75 checking out all the resources for today’s show, Dr. Anna’s links will all be there as well. So thanks so much for coming on the show today Dr. Anna. I really, really appreciate it.

Dr. Anna Cabeca: Oh thank you for having me.

Leanne Vogel: That does it for another episode of The Keto Diet Podcast. Thanks for listening in. You can follow me on Instagram by searching Healthful Pursuit where you’ll find daily keto eats and other fun things. Check out all of my keto supportive programs, bundles, guides and other cool things over at HealthfulPursuit.com/shop. I’ll see you next Sunday. Bye.

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