The Melanie Avalon Biohacking Podcast Episode #317 - Dr. Anna Cabeca

TRANSCRIPT

Dr. Anna Cabeca
I don't want to treat your disease when you get it. I want to prevent you from ever having a diagnosis of disease.

The fear around hormones is quite surprising. You have to have metabolic flexibility. There are days you need to feast. There are days you need to fast.

I'm very comfortable with the research on DHEA topically and even vaginally in clients with history of breast cancer.

Melanie Avalon
Welcome to the Melanie Avalon Biohacking podcast, where we meet the world's top experts to explore the secrets of health, mindset, longevity, and so much more. Are you ready to take charge of your existence and biohack your life? This show is for you. Please keep in mind, we're not dispensing medical advice and are not responsible for any outcomes you may experience from implementing the tactics lying herein.

So friends, are you ready to join me? Let's do this. Welcome back to the Melanie Avalon Biohacking podcast. Okay, friends, I think today's episode is going to quickly become a crowd favorite. It was such an honor to have Dr. Anna Kebecke back on the show. I adore this woman. I've had her on the shows so many times, but it's been a few years. And today's episode is all specific listener Q&A from you guys. It is a deep, deep dive into all things, hormones, and women. We're talking hormone replacement therapy, boosting your libido, how to correctly use progesterone, estrogen, and testosterone supplementation, sexual CPR, why FSH may be the one thing you really should be focusing on when you test, how to optimize your hormones when you're on birth control, intermittent fasting for women, the benefits of oxytocin, and so much more.

And of course, this episode isn't just for the ladies. Men, if you have women in your life, you need to listen to this episode. And Dr. Anna is so kind. She's giving my audience a 20% off discount when you go to dranna.com slash Melanie and use the coupon code Melanie Avalon. I cannot recommend her products enough, so definitely check that out. Again, that's dranna.com slash Melanie with the coupon code Melanie Avalon. I will definitely be stocking up on that new lube that she's creating that we talk about in this show. These show notes for today's episode will be at Melanie Avalon.com slash Dr. Anna, D-R-A-N-N-A. Those show notes will have a full transcript as well as links to everything that we talked about, so definitely check that out.

I can't wait to hear what you guys think. Definitely let me know in my Facebook group, IF Biohackers, intermittent fasting plus real foods plus life. Comment something you learned or something that resonated with you on the pinned post to enter to win something that I love, and then check out my Instagram, find the Friday announcement post, and again, comment there to enter to win something that I love. All right, I think that's all the things. Without further ado, please enjoy this fabulous conversation with my dear friend, Dr. Anna Kebecke. Hi friends, welcome back to the show. I am so incredibly excited and honored about the conversation I'm about to have, and to the backstory on today's conversation, I was actually, I did not realize until last night when I was pulling up all the prior episodes that this fabulous guest has been on for both this show and the intermittent fasting podcast, that this is her fifth appearance between the two shows, which is wild. I'm here with Dr. Anna Kebecke, and actually, Anna, you were my, on this show, I totally forgot this, you were my number six episode of this show, which is crazy.

Melanie Avalon
I think I actually record, I think you were so kind, you recorded with me before I even had the show. Like I was prepping to launch it, and that's how you know somebody is really kind and nice because it's a lot to go on a show that hasn't even launched yet.

You've been on that show, or this show twice, and then the intermittent fasting twice. We've talked about your books, so we talked about the hormone fix, as well as your book, Keto Green 16. You just do, so for listeners and friends, they're probably highly familiar with you, but for those who are not, Dr. Anna Kebecke, she's one of the most kind, just incredible spirited women that I've met, and we have met in person at Dave Astry's biohacking conference, which is really amazing, but her focus, she does so much for women's health, women's hormones, diet. Her Keto Green book, for example, is about really optimizing a keto diet and a lot of the pitfalls that women go through on a keto diet, kind of not doing it appropriately for their constitution, and then the hormone fix, as you can tell by the title, dives deep into all things hormones, and so I asked for listener questions, actually, for Dr. Kebecke today, and just got slammed with so many questions. So, Dr. Anna, thank you so much for all that you do, and thank you so much for being here.

Dr. Anna Cabeca
I am thrilled to be here with you. I always love our conversations, and I love how you show up in the world and the heart with which you show up. So thank you again for having me back on.

Melanie Avalon
all of that right back at you and what's crazy is you actually despite being on so many times the last episode was actually 2020 I think so this is way overdue basically is the point. Time goes by so quickly.

I know I know so so quickly um actually I was I was wondering are you are you working on any any future books or anything like that or like what are you what's your main thing right now that you're excited about?

Dr. Anna Cabeca
I'm working on a book proposal, re-submitting a book proposal about connection and oxytocin, my favorite hormone. This book, I think I last published Menupause in 2022.

So since then, I've been working on really what this book is and how it ties into our journey, our life, our, you know, becoming the self or the, that our heart and soul longs to be and how so much of our hormones and our relationships and our mindset and our, you know, our spiritual walk ties into all of this. So I'm excited to talk about that.

Melanie Avalon
Oh, wow, that is so exciting. I feel like, I feel like with the hormone stuff, people talk a lot about, you know, what we'll talk about on the show today, progesterone, estrogen, things like that, even even like serotonin and dopamine, but I feel like oxytocin kind of get, I don't know, it could be appreciated more and talked about more.

Dr. Anna Cabeca
Yes, it is the most powerful hormone in our body, so I'm definitely an advocate.

Melanie Avalon
So hearing what you're saying, I imagine that it's a deep dive into cultivating it naturally through your you know Your lifestyle and mindset and things like that. Are you also going to talk about literally last night?

I was seeing on a website something about like oxytocin spray that you put in your nose Are you going to talk about that that form?

Dr. Anna Cabeca
I will talk about alternate ways or prescription ways that you can use it. I think it's sometimes very handy as a crutch to come in and to help and help reset the nervous system, especially when we've been in such a long stress state and how that can affect our physiology. So as much as we can, there's nothing that works better than the lifestyle, the mindset, the hacks we do to increase oxytocin, oxytocin increasing behaviors in positive ways. I think that's such a critical, important piece of it.

But sometimes we do need that exogenous source of oxytocin to just help us get over that hump, to help us over that edge. And I know it's definitely been part of my journey in helping clients and helping myself through my own PTSD, through my own trauma, but just really recognize how critical it is to have my body keep making oxytocin on a regular basis. But with that said, Melanie, there's some fun things we can do. As prescribers, we can compound some ketamine with oxytocin as a therapeutic benefit and I can help in really some situations where there's a lot of neuropsychiatric inflammation. And so, yeah, so there's a lot we can do with it too.

Melanie Avalon
Oh my goodness. I cannot wait. I'm so excited. Do you, for the book writing process, do you write the book while writing the proposal or do you just start with the proposal and then write the book?

Dr. Anna Cabeca
So in each of my past three books, I did the proposal, and I had a ghost writer. My colleague Maggie worked with me weekly to get things out of my head and onto paper in a very digestible way.

And currently, Maggie, she's struggling and recovering with cancer. So I'm like, how am I even going to write this book without my Maggie? I have no idea. So I've been slowly jotting and writing and outlining. I'm like, OK, that's probably one of the reasons I've delayed getting the proposal in. Just I want her full recovery.

Melanie Avalon
Wow. Okay. Sending much, much love to her and to you with the book. I feel like I wrote one book and I was like, okay, I'm good now for like a while. It's a lot.

It's a lot to do. Oh my goodness. Well, okay. So like I said, I reached out for questions for you about myriad topics and people were so, so excited. I have so many, so I'm trying to figure out where to start. But before we jump into that, because it's been so long, your personal story, your focus right now with women's health and hormones, was that always of an interest to you? Or when did you really get into that in your life?

Dr. Anna Cabeca
So, you know, the saying your mess becomes your message, that is definitely my story. And I've always been an advocate for women's health and, you know, to go way back, I mean, when I was 16, my mom was 52 and she was undergoing cardiac bypass surgery. And I realized at that time that the surgery and the medication she was on were all based on research on men. So I really committed to be in research and women's health and then eventually did OB-GYN residency.

And then even with all that I know and all that I knew as Buddha as medicine too, when I was 39, I had my own journey of post-traumatic ovarian insufficiency, infertility, and then diagnosed with early menopause at 39 years old. And I was told I would never be able to have a child. And here I was, Emory trained at, you know, one of the best universities in the world and my doctor's bag was empty. In fact, I, you know, was prescribed antidepressants, anti-anxiety, I mean Xanax, etc. And I'm like, you know, I don't, that wasn't for me, but I took a sabbatical from my practice and that's where I traveled around the world on my healing journey for a year. And as a result of that, the medicinal foods like the maca and the kerosene and the, you know, turmeric and all these medicinal foods that I experienced along the way and the grace of God, not only did it reverse my early menopause, but I naturally conceived the child I was told I would never be able to have.

And when I was 41, I had my daughter Ava Marie. So that took me into another, you know, really lit me on fire to tell my patients, your diagnosis is not your destiny. Let's get to the root cause. We can empower your glands, empower your organs, address these issues. And it's a mind, body, spirit approach. We can't separate one from the other. And that's been really, that's my mission of empowerment to women in spite of what they're dealing with is this empowerment piece because our body is tremendous healing capacity.

Melanie Avalon
Oh my goodness. I love this story so, so much.

I'm super curious when you work with women. And I, you know, I imagine people come with all different hormonal issues and things that they're going through. And I think people often feel very, you know, alone and siloed and unique. Have you sort of identified like certain categories of hormonal issues that people are in? So like when you meet a new patient and they, and they tell you an example of what they're going through and like, I'll give you some examples today from listeners. Can you pretty quickly identify, you know, what's going on there or is it really unique puzzles for each individual person?

Dr. Anna Cabeca
Well, there's definitely foundations. I think for me, there's a foundational set for every patient I see that I want to address. Address the foundation. I would say our body is the cathedral of our spirit. And like any good cathedral, it needs constant renovation and repair. So I look at that piece as fundamental.

What's interrupting the foundation? What's creating havoc? What are the blocks here, physical or energetic, that are affecting an individual? I see patients here in Dallas, Texas. And I will tell you, pre-pandemic medicine is different than post-pandemic medicine, Melanie. I really have to look at immune system, the long-term effect of viral issues, whether it's infection or post-injection. But especially looking at some of these things that have come up, I would say each one of us is individual, but there's the core foundations that are across the board necessary.

Melanie Avalon
Okay, yes, I can totally, totally imagine that. Some basic questions about hormones in general, and we have a lot of questions about hormone replacement therapy.

So as far as, okay, so we have a question from Karen, and this is just a very foundational question, but she says, what are optimal hormone levels pre, during, and post-menopause? Estrogen, progesterone, should we test sex hormone binding globulin and why? When it comes to hormone levels, are there pretty definitive numbers that you're looking for with people, or does it vary by patient? What is that like?

Dr. Anna Cabeca
Well, it definitely like, you know, again, it's more than one thing. So when we look at someone's hormone levels, we can't look at it in a silo. And especially like we're considered estrogen, progesterone, testosterone. We have to look at them all, thyroid, DHEA, right? And I like to look at adrenal stress index because that can tell me that we really have an empty bucket that we're dealing with and that's why the hormones are low versus, okay, it's just ovarian insufficiency.

What's going on here? So when we look at these levels, I definitely measure sex hormone binding globulin, pre-menopause, I look at FSH, estradiol, and LH. You know, for my client wants fertility, we look at an AMH, which is the antimularian hormone, but that follicle stimulating hormone on cycle day two in the face, say, for example, of an estrogen, a 50 and FSH of five, that is good fertility, typically. That is a really good fertility. It's not taking a lot of FSH to increase estrogen production. So that tells me that's very good. In the perimenopause, the cycle day two, again, when we test matters, I give a whole module on this in my menopause course online, but when we test matters. So we can't test if you're on birth control pills, you need to be off birth control pills for a couple months. And when we start to see that FSH go up above 10 to 15, that's usually okay. Ovarian insufficiency may be hard getting pregnant. When it's up above 20, 30, 40, we know that's perimenopause to menopause range. And oftentimes postmenopause, you're not even being checked on this. But I would say optimal, we want to get that FSH down below 40 for sure.

Maybe even down below 20 for bone health and brain health. We always attribute it to estrogen, the higher estrogen, the lower the FSH. But there's many ways we can lower FSH. And that is that follicle stimulating hormone. It's called, I think it's really misnamed too. But anyway, it's a follicle stimulating hormone. We know when that number is high, we have a high amount of bone turnover, so risk of osteoporosis. So my patients that I've seen with diagnosis of osteoporosis and all these medications, I check their FSH and it's 119. And I'm like, okay, we've got to drive that down closer to 20 and check your bone turnover markers. And so we have underestimated the utility of FSH in managing the postmenopausal woman. So I want to say that too, the looking at these hormones and looking at them consistently helps guide our management and effectiveness of treatment. There's a lot, we can go hours on testing.

Melanie Avalon
So what would you call FSH? You said you think it's sort of misnamed. Oh my gosh.

Dr. Anna Cabeca
I think it really is it's it's so tied in to the entire HPA axis So we've focused on it's called follicle stimulating hormone because it it peaks at Obulation to well peaks in the first you'll get a bump. You'll get a bit of FSH in that follicle follicular phase the first two weeks of your cycle and you get a peak right before Oblation and then so that's why we want to see that nice and low It takes a little bit of FSH to stimulate the ovaries but the effect on the brain high FSH is associated with memory loss and Dementia, so we want to pay attention to that right?

So it's affecting on memory and High FSH is associated with metabolic brown fat converting to White fat so it increases weight gain waist gain without doing anything different and That high FSH is associated with that increased bone turnover and osteoporosis So it has these it's like a really master Hormone it's a master hormone Wow to the

Melanie Avalon
other ones have a similar effect like that? Or is it really FSH that has these really far-reaching effects?

Dr. Anna Cabeca
I think FSH has, there's, I've been scouring the literature to look at some of these studies. So I've seen predominant research with FSH, not so much with LH.

And sex hormone binding globulin is an interesting one because we want to see if we, we want to see how much hormone is free. And so that sex hormone binding globulin can help us manage also or assess the hormonal load on patients too. And if all of a sudden it jumps up or, you know, what, what's going on there, it can cause concern. So I think it's important to manage that too.

Melanie Avalon
I love this conversation. Um, actually we had a question from Claudine and it's something that you touched on there because you mentioned like something about the lack of testing sometimes post menopause and she said I'm four years past menopause and I'm still on the same HRT dose that I was on and perimenopause should I be having anything checked on a regular basis at this point? I feel like it's odd to not have my hormone levels checked and these doses adjusted but maybe that's just the way it is at this stage.

I should add that I'm on progesterone and estradiol patch. My OB doesn't seem concerned and I don't have a functional medicine doc at my disposal in Louisiana.

Dr. Anna Cabeca
Uh, it's a great question and I hear this a lot and and I was lecturing at harvard's women's health and menopause conference In boston, massachusetts this year and I heard this from Some colleagues and I was like, well, I I can't manage someone's hormones without checking You know, i'm not that good. I guess I don't know But um, I look at I was like, you know the body Your body fluids tell us Something and i'm gonna say i'm a gynecologist i'm gonna check every body fluid you have at some point or another Urine, you know vaginal fluid saliva blood serum I mean we're gonna you know, it tells us something and urinary hormone testing I am a fan of dutch testing, especially if you've been on hormones for a while I want to see how your body's metabolizing those hormones.

I want to see what your adrenal stress index is It's you know, if there's issues we will want retesting but if you know, if everything looks great great I like to look at serum levels too. I like to because with serum we look at the fsh lh sex hormone binding globulin full thyroid panel with thyroid Antibodies dheas hscrp inflammatory marker your hemoglobin a1c. I mean all of these play into hormone balance So looking at you know, looking at these factors really help us create healthy bodies and i'm a longevity position, right? So I want optimal aging and I want you. I don't want to treat your disease when you get it I want to prevent you from ever having a diagnosis of disease So it's a different mindset altogether And I think we have to educate our colleagues on this functional and integrative approach to hormone management of the post-menopausal woman it is

Melanie Avalon
impactful. You often say tests don't guess, right? Yeah, I can hear it in my head. Like I literally hear you saying it to me like over the years on the show. That's so interesting.

How do you feel? So here's somebody who is not actually doing the Dutch test. It was an anonymous question or anonymous member number 205 is what it was named. But she says my nurse practitioner has me on oral estradiol. I live in Canada. She says I hear so much about that not being the best way to take it but I've asked two MPs who I've worked with and they and they say it's the best way. My estrogen numbers are still good after three years on the oral estradiol. I'm 51 in post-menopause. I just want to know Dr. Kebecke's thoughts on this since we can't get a Dutch test here.

Apparently my NP keeps an eye on my blood work annually and has my best interest in mine. I also take oral progesterone, testosterone cream, oral DHA and thyroid meds to keep me in the healthy range. Wonderful.

Dr. Anna Cabeca
Yeah, I think this is a really good question and this is there is controversy but what we know from research so for this anonymous member 205 of that you're asking these questions and even though you can't get the Dutch test in Canada and quest lab core they do to 416 hydroxy estrogen metabolites you can get I know quest does a estrogen detox pathway. So you can see because I think I mean definitely looking at that detox pathway helps us safely manage your hormones.

There's other ways too but that's certainly one of them and oral estrogens in the research and this was studied oh my gosh I think this public this paper came out in 2017 by Dr. Kononiko and it was published in a cardiovascular journal and he is a cardiologist he looked at oral estrogen versus transdermal estrogens and the effects on cholesterol and clotting markers. What the research showed and in other papers this has been confirmed oral estrogens do increase inflammatory markers and risk of stroke. This was also evident in the women's health initiative study which showed although small there is an increased risk with oral estrogen and so for us as we age as I take care of women older and older and older I don't like my 70 year olds my six year olds I have them on transdermal. Many of my 50 year olds are on transdermal estrogens because I do not want to risk clotting factors. As a integrative physician I'm looking at certain markers for clotting and certain lab tests for plaque formation and testing like that too and we want to see those those markers reverse over time. We do that with transdermal estrogen better than oral estrogen so if you know if you're healthy you're great no cardiovascular disease normal echocardiogram CT calcium score of zero HSCRP less than one hemoglobin a1c less than 5.3 healthy adrenals you know all those other factors and you know maybe we can keep you on this oral estrogen a little bit longer but if there's other issues hypertension cardiovascular disease pre-diabetes for sure I don't want you on oral estrogen.

Melanie Avalon
So that actually makes me think of three personal questions from me. One is, so you mentioned the women's health initiative. So that finding that you were talking about with the increased risk from oral estrogen, was that related to the primary findings of the study or was that one of just the other findings they had? And I'm curious with women's health initiative in general, I'm really fascinated by how long it's seemingly taken to get over the fear of hormone replacement therapy from that study.

I'm curious why you think that is and the future of all of that.

Dr. Anna Cabeca
Yeah, yeah, I am I am really curious why that is too because estrogen alone arm is very very protective And even that with the longer term risk again It was not well tiered out for that oral estrogen increased very small increased risk of stroke Oral estrogen did not increase breast cancer and the progestins did we have the opportunity to use bioidentical progesterone either through regular pharmacies or compounding pharmacies so we have alternative to the Negative actors from that study the initial study published in 2002 in the follow-up study 20 years later So estu you know, I think we can feel that black box warning on estrogen Was never warranted was never warranted the scare about my patients were never taking off their hormones During this time and have you know, so since 2001 I knew what the literature was saying we had safe and effective forms Patients were consented and have done well to date. So It's really like the fear around Hormones is quite surprising.

I mean, you know, I would think Hey, I don't know. I really don't know why melanie. It's been propagated like this. You would say, okay, is this a industry over humanity type situation, I don't know but understanding the benefits of hormones is critical like we understand the benefits of Thyroid hormone in a deficient state I look at estrogen and progesterone the same way in my patients as if they had a thyroid hormone deficiency Why would I not treat them with the safest? most bioavailable form available and I think the fear is unwarranted

Melanie Avalon
Yeah, and you mentioned in the beginning how you noticed, you know, the lack of, you know, studying women in the medical literature. And I was listening last night to an episode, Dr. Peter Tia's podcast, and they were talking about the Women's Health Initiative. And they were theorizing or saying that basically, if it had been a study about men, and then they had, you know, kind of pulled the hormones and then men experienced all these effects that they probably would have really quickly righted that ship rather than, you know. So, yeah, it's just, it's really interesting.

Dr. Anna Cabeca
Absolutely. And I think even just recently, the warning label on testosterone was removed, right? Wasn't there an FDA warning label? That was removed.

But for estrogen, it's not touched. Why are you keeping it there? I mean, fear, when we think about this a lot, especially when I work with clients who have had breast cancer, it's not your estrogen that caused the breast cancer. It's not. What caused it? Inflammation, hormone disruptors, toxins. We have to address those things and create bodies that are inhospitable to cancer and optimize our health and hormone function. So,

Melanie Avalon
Yeah, I think I'd have to double check. But I think from the from the study's findings, it was like an increased risk of the equivalent of like one in 1000 women and it wasn't even tied to overall mortality.

It was just tied to like one in one 1000 had increased breast cancer risk. Just yeah, misunderstood.

Dr. Anna Cabeca
Yeah, and then that the progestin arm specifically and then we, you know, wouldn't.

Melanie Avalon
So then even another layer.

Dr. Anna Cabeca
Right even that other layer not you know like and then the concern okay we can't use progesterone and someone who've had a hysterectomy and that's not true. So progesterone helps our bone our brain etc but we want to use bioidentical progesterone not the progestins. So I think that's something that's been misrepresented in the medical as well as lay literature.

Melanie Avalon
That relates to my other question, which is my personal question, which is, I actually, when I was, how old was I? When I was 24, I think, my, the nurse practitioner, I was seeing like the holistic doctor actually put me on progesterone cream to help with my sleep. And I've used it pretty regularly, most nights actually, for years. I actually haven't used it in a while.

I tried it randomly the other night because I was not sleeping well, and it actually really helped my sleep. But I'm actually really curious. I feel like I've had a very casual relationship with the progesterone cream. Like I would just kind of put it on, it would help. I use it a lot. Is that okay? Like, should I, should I have been using it that young? Yeah, I'm just really curious.

Dr. Anna Cabeca
really good question. I always look at, okay, well, what's interfering with your body's natural progesterone production to begin with? And let's support your adrenal. So for me, like I would start you with one to two to three scoops of mighty maca day, the adaptogenic blend, because we see an improvement in day 21 progesterone and symptoms like that supporting your body's detox, your body's glandular production, it's adaptogenic. So it helps you in, in, you know, high stress and, and exhaustion. So it's a really nice blend.

So I typically start there and the detox like a 10 day hormone detect, for example, keto green 16 or 16 days, follow that program or the 10 day plan and the hormone fix. And let's see if we can reboot your system. We're still struggling now you're in your and typically that's that works that works and then okay, well, you're in your mid 30s. Now, we're starting to feel that you know, one or two weeks a month, not feeling as great. Let's add the bio identical progesterone on sometimes we have to do it earlier for short term reboot. But typically with supporting your body's own ovarian and adrenal function, we can go a long way to not have to be on it.

And typically in my younger patients, I want you to do that progesterone cyclically. So from ovulation to menses, basically ovulation to menses. With that said, a little bit on a daily basis, likely, you know, helps you get a good night's sleep, likely benefits outweigh the risk. It's just we don't have long term. Really good. I even even with me, I just followed this rhythm of trying to follow our bodies rhythm intuitively, so that we're never suppressing our body's own natural production. And certainly with like lower dose creams, we have less of a risk than, you know, 200 400 milligrams oral progesterone, for instance. Okay, gotcha. But still work on those adrenals. I'm sending you some mighty maka.

Melanie Avalon
And you just mentioned the cycling of it. What about women in menopause? So Taria said, should a woman in menopause take progesterone every day or should we cycle it with a routine break?

Dr. Anna Cabeca
Yeah, that is an excellent question. And typically, when I'm starting someone on progesterone post-menopausely, initially I'll have you do it pretty much every day and then go into one or two days off a week or three to five days off a month so that we can keep the receptor sites refreshed, let's say.

So that's post-menopausely been the pattern that I've worked with with my patients. Post-menopausely, I don't cycle patients to have menstrual cycles unless they really, really, really want that for some reason. I think of one patient in my practice that is in that camp. But the post-menopausely taking one or two days off a week or three to five days off a month, I prefer that. But some of us don't like to be even three days without a progesterone, can lead to brain fog the next day. But just in that rhythm can be really helpful and supportive.

Melanie Avalon
that's so interesting. So the like the patient, for example, that likes having this cycle post menopause, is it just creating an artificial hormone rhythm or does it actually? Yeah, artificial. Interesting.

So as far as taking these hormones, we have two questions about, you know, the age limits and when to take to take it like that. So Alice wants to know, is there an age limit for HRT or just estrogen? No doctor is willing to prescribe hormones for me at 68. The last doctor said it would cause a stroke. And then Annette wants to know she says, how long should you take estrogen and progesterone? I'm 61. No health problems. I do have a family history of colon cancer.

Dr. Anna Cabeca
Yeah, this is these are excellent questions. I love your audience, Melanie. They're so great. I know they are So like and I hear this a lot I have actually a long time client of mine that I you know had for many years and When I moved, you know, she's been seen by another doctor locally And when she turned 65 and listen, I've taken care of her since 2000 So when she turned 65 her doctor said well, I can't keep you on any more hormones That's it. And she's like look I'm a psychiatrist. I need my brain Like and this is you know, I need to stay on these hormones and I'm like, well, you know, she called me She said, you know, you know, dr. Anna what's going on here? Like she won't let me have my hormones What are we gonna do and I was like, well first, let me just reassure you the research and this last summer It a 10 million woman study Was published and it reviewed women on medicare who were on hormone therapy different different types Of hormone therapy and did this complete analysis and what we can say is certainly topical hormones and bioidentical progesterone choices are suited for longevity and healthy quality of life and lower morbidity and mortality So we can feel more comfortable using the right formulations that this is a safe This is a safe option and I i've seen clients again I wouldn't say okay now you're 65 i'm taking your thyroid medicine away or you're 65 i'm taking your insulin away. I mean that's ridiculous That is just ridiculous so i'm There's no reason if we're on healthy in in this case over age 65 i'm Would have you on transdermal oral progesterone is still fine But bioidentical progesterone, but I would still have you on oral and really work on optimizing all factors, but And I will say that You know to be a hormone therapy candidate you do have to Lifestyle nutrition intermittent fast all these you know, get out in nature Lift weights you have to do all those other other things to sleep well, but progesterone helps us sleep Well, so I again clients in their 80s So feel very comfortable with that for a net how long so the same thing like there's no reason To stop if you're on a bioidentical and I would say transdermal estrogen You know 60 or greater because again oral estrogens can increase blood inflammation and risk of blood clot But we can look at those markers too But bioidentical oral progesterone and or transdermal progesterone can be very beneficial And you know, how's your testosterone and dHEA? We want to look at those aspects, too So and with a family history of colon cancer, there's so much to that, right? We want to make sure we create bodies inhospitable to cancer.

Dr. Anna Cabeca
So it's not just the hormones it's all the lifestyle factors that create our health and longevity and our skip to our step and our twinkle in our eyes and especially and then this is one of the reasons I created my product jolva many doctors don't know how to You know compound hormones and so with jolva, it's a combination of of natural ingredients That works topically for vulvar and vaginal health and bladder health Because hormone our vaginal vulvar tissue urethral tissue are hormone sensitive So incontinence dryness pain discomfort if we're not supplementing with hormones We can really suffer significant consequences So again, not everyone but you know a significant a number of us also when we start getting small lines laugh lines It's happening down there. And so my first line of defense is using jolva daily Cliterest anus on that all that vulvar tissue it can make a really big difference So we don't want to have that atrophy the incontinence etc as we age and as well estrogen progesterone Testosterone dha all reduce that fsh.

So that decreases your risk for osteoporosis and dementia Why would I stop based on your age?

Melanie Avalon
I love this. And you gave me some jolba when I met you at the conference, I think last time. And I loved it.

And you also have one for your lips, right? Like your lips on top on your head, like those lips.

Dr. Anna Cabeca
I have to say at the girlfriend doctor, we take care of your lips above and below the hips. Yes.

Melanie Avalon
Oh my goodness. And actually, so you approached answering another question from a listener, which you just mentioned now how you need to be optimized with your diet and lifestyle while doing hormone replacement therapy.

And what's interesting is Janice asked a question, which I can imagine a lot of women might think which would be the opposite, which is maybe that I'll just read her question and you'll see. So she says, when in the perimenopause phase and hormones are on a roller coaster with estrogen dominance becoming an issue, is hormone therapy a good choice when you've optimized diet and exercise? For example, I've always been thin, fit, and healthy. I've had no issues returning to baseline body composition after each of my four kids. I hit perimenopause and the abdominal fat and inability to lose weight is the most frustrating part. Hormones are all over on a given day or month. How do we navigate this stage of fluctuating hormones? Basically, I find this question interesting because it sounds like she's thinking maybe because she's optimized diet and lifestyle that hormone replacement therapy isn't as much of an option. How do you feel about this?

Dr. Anna Cabeca
Yeah, I would say absolutely. So first like for like foundation, so I would say do my keto green 16 And that is hormone detox add in mighty maca start with the balance cream the second phase So progester topical progesterone and pregnant alone the second phase or get a prescription for oral progesterone For that luteal phase of your cycle and see how that Evens out always think okay.

We've got to detox the liver. We've got to improve the gut microbiome We've got it takes more than hormones to fix a hormone So when we're you've already optimized diet and exercise now, that's key There may be a little bit of a few tweaks that we want to further optimize But that's you know, that's the hard part. And so now the rest is just navigating what's you know, what's the best rhythm for you, but always start with detox and That liver detox and I always say sometimes we don't realize how bad we feel where we've been feeling till we start feeling good again And so that detox piece is really key

Melanie Avalon
You mentioned earlier the black box warning on testosterone being removed. Sandy wanted to know should testosterone be included with HRT and then also related Michelle wanted to know if there is a way to increase testosterone naturally.

She says, I live in Canada and I cannot get a practitioner who can or will prescribe it. My levels are very low. I'm 59 and suffer from lack of motivation, libido, and energy.

Dr. Anna Cabeca
Yeah, I love these questions. So I would say if something's like, if your hormones are low, why? So we want to ask, OK, well, why is my testosterone low? Is it because I'm very stressed? And I do think testosterone should be a part of hormone therapy.

And being able to compound testosterone into doses fit for women versus having to use a male formula, a gel, and then trying to guess how much you're putting on your body means just ridiculous. We can use compounding pharmacists for this and can really customize testosterone therapy for women. The little bit goes a long way. If you have children at home, you want to be in pets. You want to be conscientious that if you're using a topical cream, you don't want to transfer it onto children and pets.

And in this testosterone, if it's low and you're having regular cycles and everything else is good, we still want to dig into why. Is it hormone disruption? Was it a history of birth control pills? Is there some type of infection or adrenal stress perceived or real stress going on that could be affecting? Because testosterone is made from DHEA. DHEA is made from pregnenolone. And pregnenolone and progesterone are made from cholesterol. So what is interfering with the production of your testosterone? So I like to start thinking of things in this way and then say, OK, for testosterone, we need nutrients to support testosterone. Tyrazine, zinc, for instance, maka helps produce higher levels of DHEA and testosterone. So that would work on a full system approach to address that and then add in the testosterone in a physiologic way if it's low.

Again, we're looking at testing, but support the adrenals first. And then for Michelle's question, natural ways to increase testosterone is definitely exercise, good night's sleep, oxytocin-increasing behaviors. So when we get better oxytocin, we get lower strain on cortisol.

When we make a lot of cortisol, we're depleting precursors to all our hormones. We make cortisol from progesterone. So we want to make sure we're optimizing our hormones in that way and then adaptogens. In my Mighty Maka Plus, we studied that. And we saw an improvement in using two to three scoops a day. We saw an improvement in DHEA sulfate levels in the blood of 70% to 200% in two months.

So we see that. There's other supplements that can be used to increase testosterone. Mungbean extract is one of them. There's a product called Testiplex, and that's been studied to improve testosterone levels. So there are certainly things that we can do to improve testosterone levels naturally.

Melanie Avalon
Yeah, and I feel like testosterone is another one that's so misunderstood because I mean women we have more testosterone in our bodies just from like a, you know, an overall amount than right then than our other female hormones. Then estrogen.

Yeah. Yeah, absolutely. So a little bit, little bit miss, I don't know, identified there with being a male.

Dr. Anna Cabeca
representation and we've graphed it. We've done a misrepresentation graphically over time too. So yeah, I'm working on new graphs and correcting all of that too.

But yeah, testosterone is predominant because we make estrogen from testosterone. Yeah.

Melanie Avalon
Like I guess, but because we had these other quote, female hormones, I don't know. It's just really interesting that it became like the male hormone.

Dr. Anna Cabeca
Yeah, and increasing testosterone also lowers FSH. Okay, so that's another why that's part of this constellation of support.

But again, I say all this Melanie and you and I know that in the blue zones, the zones where there's our greatest age population over 100, they are not on handfuls of vitamins and they're not on hormones and all these other things. They have community, they have faith, they have nature, all of those and they have gratitude and appreciation for each other. All of those are oxytocin increasing behavior. So it all circles back to what are we doing on a daily basis to increase more oxytocin in our life.

Melanie Avalon
I love that.

I know one of the findings from the Blue Zones is they have a really high number of not even necessarily close relationships, which they do, but they have a really high number of just numbers of interactions with different people every day, which kind of speaks to like how we could implement that here is, you know, when you go to the grocery store, actually like engage with the grocer, like actually, you know, like, like talk to people, because apparently that seems to be pretty linked.

Dr. Anna Cabeca
when you get your Instacart delivered to actually go out and thank delivery person.

Melanie Avalon
Exactly. So, okay, so a fun, fun topic for listeners libido and all the things. Catherine wants to know, how can I increase my libido while on the birth control pill? And is there anything else I could be doing to increase mood? I'm in my mid to late 40s. Thanks and love what you do.

And I'll put a link in the show notes because I had on at the end of last year, Ricky Lake and Abby Epstein for their documentaries about birth control and everything. And that's really, really shocking what birth control can do to people. But yeah, so increasing libido while on birth control. And then we also have a question from Nydia. She says, Hi, I'm 50 years old, going soon to be 51. I have a Marina IUD and I'm not sure where I'm now. But when I decided to get it was because happy periods. I put it in when I was 45. Now I don't have them. I have the one for 10 years. My question is if I should remove it. In the beginning, I had no symptoms of anything. But now I have no energy, no libido whatsoever or desired exercise gain so much weight. And all I want to do is eat. I also fast 19 to 20 hours depending on work Monday to Friday and weekend I have longer hours.

Dr. Anna Cabeca
Yeah, yeah, improving. So with the marina IUD, you still do get systemic progestin, so we want to use bioedelical progesterone and pregnant alone. For me, I like the combination of the two. That's why I incorporated it in combination of my balance cream, but you can do it separate, topical or orally. But adding in that progesterone at 50, 51 is going to be game-changing. That's going to help you sleep. That's going to give you energy. That'll help your libido. So that should make a big difference.

The marina IUD and progestins also deplete B vitamins and magnesium level and can interfere with zinc. So supplementing with these vitamins and especially zinc, we know increasing levels of zinc can help with testosterone production. So looking at that and then adaptogenic, adaptogens. So for me, that's my combination Mighty Maca, extra vitamin C, can really support the adrenals and that can support libido too. And look at your hormones. Even with the marina IUD, you can still do a dutch test and those hormones can be evaluated to look at where else we can optimize.

And progestins can make weight gain. And if you're still, it's hard to tell when you have the marina IUD or what's happening with your ovaries. So checking an FSH. And if you're not having any spotting with the marina IUD, you don't know when is cycle day two potentially. So you may say, okay, well, maybe try with a new moon, but in two months in a row, see what that FSH and estradiol levels are at that time to kind of give you an idea.

If you have the IUD removed, do you have to worry about birth control? And if so, copper IUD is great. So is a vasectomy. So those are some things to consider to get this synthetic hormone out of your system and a supporting hormone detoxification.

I am really big on that. That's why I put detoxifiers in my supplements and it's part of my protocols and programs. We want to support phase one and phase two detox so that your body can use your own hormones better and you feel better. And looking at these cravings, craving issues, there's so much with that, adrenals, inflammation. Melanie, you were mentioning that I would say tests don't gas. One of the things I have my clients do in my programs is check urine pH and say, are you very acidic? That's going to be, and are we able to get you into ketosis and into an alkaline urine pH at the same time? Cravings will disappear in that physiology.

So in regarding to Catherine's question about addressing how she can increase her libido while on birth control pills, there's definitely several things that we can be doing. First of all, remember that birth control pills can suppress your, it suppresses your testosterone. So what are you going to do? You have to think of, is there another type of birth control, like a non-hormonal IUD that you can use? That would be a great option for you to get off the birth control pill, something to consider. And then also a multivitamin, magnesium, zinc, supplementation, and adaptogenic. I would put you on my Mighty Maka support and a keto green shake daily to help support detoxification.

Dr. Anna Cabeca
And then may add additional DHEA or testosterone if needed. And even progesterone the second, during your last two weeks of your pills, that may be something to help support you during this time in your mid to late forties with hormones and libido.

Melanie Avalon
The effects on nutrient status from these birth control mechanisms, like what's happening there? Is it, is the actual birth control decreasing the levels or is it the effect on the hormones and then that creating these nutrient deficiencies?

Dr. Anna Cabeca
Yeah, it's a great question. From what I understand, it's the metabolic effects. So it's effects on the mitochondria, it's effects on the metabolism and the processes, the intermediary steps in that metabolism.

Melanie Avalon
Yeah, so, so crazy. I also find it really interesting, the study they did where apparently how birth control changes your attraction to the type of man.

So, so basically when people are on, when women are on birth control, they are looking for a, I think like the type of man that provides like stability and safety and like can care for the child versus when you're not on birth control, it's more like a, you know, sexy erotic romantic thing. So basically women will be on birth control, women will be on birth control, meet a partner, be attracted to them and then go off the birth control and their levels of attraction will change to their partner.

Dr. Anna Cabeca
That's amazing information. I mean, that is so interesting.

Actually, a study looked at immune function and attractiveness. It was performed here at Texas Christian University, and it looked at immune function and attraction. So the healthier immune function is, the more attractive you appear to the opposite sex. I thought that was fascinating, too. But yeah, birth control pill, can you think, did that have any effect on my decision making?

Melanie Avalon
So maybe if you're on birth control and you're about to get married, go off of it for a little bit. Make sure you're still into your person.

Okay, another question for libido. We have two questions about red light therapy devices for it. Laura says, are any of these red light devices worth it? Are there any viable studies? And she's talking in regards to, this was when I was asking questions for people about libido. And then Patty said, I've often wondered if an inserted red light therapy device used vaginally or anally, cleansed to protect cross contamination, might help the pelvic floor and prolapse issues. I realize this might be off topic, but it is something I've been curious about.

Dr. Anna Cabeca
No, this is a great question. I love red light devices.

I think there's different brands that are available. I like the, there's the Fringe red light vaginal wand. It also has a blue light option if you're struggling with infections, the blue light option is good. But the red light, infrared light and the vibration really help repair that vaginal tissue and increase blood flow to the vaginal tissue. So I think these are great devices.

Melanie Avalon
Awesome. And then we have one that has a shout out to your jolva product.

So Cheddar says, is there any approved help with libido for breast cancer survivors? I used a DHA topical jolva previous to estrogen and progesterone receptor positive breast cancer. My GYN isn't comfortable approving the use of it now, but I do use vaginal estrogen cream. Yeah.

Dr. Anna Cabeca
That's a great question. So Chet, again, one of the reasons I created Jovah was for my breast cancer patients. And the research with DHEA and breast cancer is very, very favorable. And I have several articles published on my website to search breast cancer and DHEA. And again, we want to create bodies inhospitable to cancer. So while I may be comfortable with it, you and your surgeon and your oncologist have to be comfortable with it.

And then we want to look at those estrogen detox pathways again, too. Other things with libido, like Mighty Maka, increasing Mighty Maka two to three scoops a day, very helpful for libido. Looking at arginine for nitric oxide to help with orgasm, again, adaptogens can be very beneficial for libido. So I would start with that. And then address, keep looking. So I always tell my clients, I ask my clients how to diagnosis of cancer. So what did your oncologist or what did your doctor say caused the cancer? And they always say, I don't know. So well, let's see if we can't find out. We look at genetics, we look at your environment, we look at your toxic markers, we look at your inflammatory markers, your blood sugar markers, and your history and timeline. And usually we can figure it out. And then once we do and we have a plan of action and we start improving those things, you feel like that breast cancer was a diagnosis of your past, no longer pertains to you. You have a body that is inhospitable to cancer and you can move forward with making the best decisions for yourself. So yeah, keep asking those questions.

Melanie Avalon
So so beautiful and sending much love to cheddar and actually we had another another woman with breast cancer Danny She said HRT is supposedly so important for our vaginal and overall health But no one ever talks about the women who've had breast cancer and can't take HRT What help is there for us? My doctor put me on on an antidepressant for my hot flashes It hardly helps never mind vaginal atrophy and no libido help

Dr. Anna Cabeca
Yeah, so same answer to Danny really let's work on those adrenals read my book the hormone fix because it goes into all those The like spokes on the wheel the issues that affect our overall health So my book the hormone fix do the 10-day hormone detox in there and if you you know if it resonates supplement with my keto green shake and my mighty maka and I'm very comfortable with the research on DHEA topically and even vaginally in clients with history of Breast cancer, so it's definitely something you want to research bring up with your doctor with your oncologist You know I have great white papers on my articles on my website that go into the research in Detail so something you can print out and take to your doctor too So that can help and again for libido libido is complicated It's a reason I have so as a as a gynecologist you know you do your annual exam talk with your patients and then as you're ready to leave you ask is there anything else and Oh, yeah, doctor. I have below libido or you know, I don't have a sex drive anymore I'm like that is a five-hour conversation.

This libido issue is a five-hour conversation I build a whole course called sexual CPR on this because it's such an important issue intimacy increases oxytocin So we want to create that we don't want to be roommates with our spouse or lover We want to be lovers right and we want to have that intimacy and connection and so this whole course sexual CPR can help you revive the libido when it comes to Understanding the issues of intimacy. It's always comes down to well majority comes down to these main three areas issues of desire issues of disconnect in the relationship issues of disconnect and which again Physiology of fixed behavior so that can be physiologic and the third is discomfort if you have pain every time you do something Why would you want to that is one reason why I really became good at working with topical hormone therapy to help my patients? with this issue

Melanie Avalon
Oh, I love this. This is so interesting.

So desire disconnect discomfort. Can all of those be addressed or what desire do you think sometimes people just aren't, you know, meant to be desiring of each other?

Dr. Anna Cabeca
So with desire, there's so many issues that surround that. There can be, sometimes we don't realize antihistamines can interfere with desire. Like asthma medication, blood pressure medication, things like this can be interfering with desire. Toxins can interfere with desire or anything that can block our receptor sites. Iodine insufficiency, vitamin D insufficiency. All of these things can actually play a role with desire as well as limiting beliefs.

Well, hey, now I'm, you know, grandma, I have no business having a hot sexual desire, right? Like what's going on here? And this comes to reawakening our feminine energy, our womb energy, our feminine energy at any age, really aligning with that energy where we have desire for something in one area, we can have desire for other things in other areas. So what is lighting up our passion? What is bringing us pleasure? And as we focus on more of these things, we improve our overall passion, energy and desire.

Melanie Avalon
This is a really random question, but I'm just thinking about it. So you mentioned earlier making sure that the creams don't get on things like pets and kids.

If you're using any of these creams vaginally, is that a problem with intercourse transferring to the partner?

Dr. Anna Cabeca
with jolva created it clean enough to eat. So fine for oral sex and men need like 10 times as much DHEA as women. So when it comes to jolva, it's perfectly, perfectly safe.

Vaginal estrogens can transfer onto a male partner. They likely don't need any more estrogen than they already have circulating. So you want to be conscientious of that. And the same thing for doses of testosterone prescribed for women, a small amount, you know, what we use is like a very tiny drop in the bucket for a men's testosterone. So these are safe and I designed the products to be very, you know, compatible, safe. It's good, clean enough to put on your, if it's clean enough to put on your skin, it should be clean enough to eat. So, you know, concepts around these formulations, no parabens, no preservatives, none of those.

Melanie Avalon
things actually just while we're talking about that when it comes to my question when it comes to lubricants how do you feel about coconut oil because I've heard I hear both things I hear that it's like the perfect lube and then I hear that it actually messes up your vaginal microbiome

Dr. Anna Cabeca
Well i've been studying this for a long time because one of the things is you know We want to look we know with research that increased sexual satisfaction with use of lubricants now Specifically my focus has been on the post-menopausal woman creating a lubricant that works best for her And I would say your diy lubricant is fractionated mct oil 5050 with an organic liquid aloe vera and you can mix that up and out of the essential oil The combination works really good, and if you're using that intermittently You know that's it should not Significantly interfere with your vaginal microbiome, but with that said I wanted to create a water-based formula With aloe vera and hyaluronan and propanodiol instead of propylene glycol Which is in a lot of formulas so a very safe clean formula, so I'm going to send you I'm send you that It's not out on the market yet But you get a you get a really early one of it But it's really designed with a nice pH and a nice slip and feel and again clean Ingredients that are clean enough to eat so oh

Melanie Avalon
Yay. And when it's, I can't wait until it's like out, out, I would love to promote it.

I don't know. I'm very, I'm very small and lube is really helpful and it's hard to find ones that are clean. And then when I found, tried coconut oil, I was like, oh, this is amazing. But then I think it actually messed up my microbiome a little bit down there and I was getting concerned so then I didn't know what to do. Is the MCT oil more approachable or like a safer choice with the DIY version compared to like coconut oil?

Dr. Anna Cabeca
I think so because it it doesn't clog the pores as much doesn't stick around as much because again, it's very You know even at room temperature mct oil fraction mct oil is liquid So it's it's that but still it is mct oil. So you kind of have to worry long term But really i've had good feedback with that combination.

I don't know if it's because the aloes in it, but That's a nice combination with belvay. That's the name of the lubricant Okay, jelvis for every day and belvay is for play

Melanie Avalon
What is, how do you spell it? Volve, so like V-U-L-V.

Dr. Anna Cabeca
Yeah, VLVE and with the Oxent on the E, so Velve. And so the goal with this was adding moisture ingredients for as needed use to help and that be water-based instead of oil. But again, I still love that combination of MCT and Aloe Vera. This is another really nice condom safe option too.

And the other thing is that when we think of Agile Health as we age, we don't talk enough about vaginal probiotics, but like so much can disrupt the vaginal microbiome. I mean, sperm is semen is alkaline and that disrupts our acidic vaginal pH. So a couple companies make a good vaginal probiotics either orally or vaginally inserted. And so looking at the, like if ever anything's going on with our vaginas, y'all, make sure you get a good vaginal probiotic on board right away.

How about boric acid? Boric acid to reduce infection. I think boric acid, like typical doses, 500 to 600 milligrams twice a day for seven to 10 days. I think that's a good option.

Melanie Avalon
I used it when I, I just, I don't know, I got all inflamed and just like messed up down there and my friends told me to do the boric acid suppositories, vaginal suppositories, and it was such an interesting experience. It makes you literally like, I don't know, like all this liquid, like water comes out.

It's like very cleansing.

Dr. Anna Cabeca
Just cleansing, right? And follow that if you do a boric acid or a vaginal antifungal. If you have yeast infections, anything like that, always follow that in any oral course of antibiotics. Of course, we want to take a probiotic, but also anything vaginally.

Do one of these vaginal probiotics. They're predominantly have lactobacillus crispatus, lactobacillus inurs, and gasorae, and there's one other I can't remember today. Those four lactobacillus strains are very predominant in the vagina. So we want this to reproduce, we want to refeed it, essentially, replenish the healthy bacteria. The oral forms that have been studied are the vaginal balance product by microbiome, and then there's seed, VSO1, which is a vaginal inserted probiotic, too. So I think I'm really excited that we have these options available to us now because we really haven't had very much advancement in vaginal microbiome research in decades.

Melanie Avalon
So oh wait see cuz I adore see they actually sponsor this show and my other show I love them. Wait, do you say they have an a separate one for about?

Dr. Anna Cabeca
Vaginal? Vaginal. They have the VS01. Oh my gosh. You got to get them to send you that.

How did... Okay. I'm going to email them right after this. Yes. VS01 by seed. It's vaginal. And they give you a very nice timeframe, like take it Monday, Wednesday, Friday for two weeks or whatever the situation. And then every other week and then periodically for maintenance. And working with this with patients, it is beautiful. It works really, really well.

Melanie Avalon
Okay, that's amazing. I'll actually I'll give let's see how it is this show they sponsor I'll give listeners the link it's seed comm slash Melanie Avalon the code to five Melanie will get you 25% off And I'll go ahead and give that I'll give it later as well.

But we also have a code for our dr Anna's products, which really quickly do you know when the velvet though? Wait, how do you say it? They'll be you said it right? When is it coming out? Do you know well?

Dr. Anna Cabeca
We are essentially pre-releasing it for research purposes. We want you to do a survey if you get it as part of an early promotion.

So we are releasing it with our Summer of Love promotion and that is in the middle of June.

Melanie Avalon
Oh, okay. So because this actually airs, I think at the beginning of August. So will it be out then?

Dr. Anna Cabeca
Yes, it will be out. It will be out. Yeah, it will give you a link. It'll be a gift with purchase so that they can fill out a questionnaire after using it so we can get your feedback. So it'll be perfect.

It will be available and we'll get you a link for that.

Perfect.

Melanie Avalon
So we will put that in the show notes and then so if listeners go to it's dr. Anna calm, correct

Dr. Anna Cabeca
Yeah, I would it's do dr. Anna comm forward slash Melanie, but we'll have that for your audience.

Melanie Avalon
against perfect and you can use the coupon code Melanie Avalon to get a discount on your first purchase of products so definitely check that out I just love this so much we got a really interesting question from Rachel I had never heard this before so I was not familiar with this at all she said I recently learned that breastfeeding puts women into an almost menopausal state in terms of estrogen among other things I'm still breastfeeding my 18th month old and plan to let them self-ween which could be years is there anything I should be doing in the meantime to combat potential side effects or am I worrying unnecessarily I've tried researching but there's not much out there in terms of natural breastfeeding other than the positive health effects like reduced cancer risk etc my periods came back within a few months I'm not sure if that means I'm less susceptible to any negative side effects I'm 34 thank you

Dr. Anna Cabeca
Yeah, I think this is a great question from Rachel. And she's 34. Her periods are back. So the consequences of prolonged estrogen insufficiency, she's not experiencing that.

So she's getting the benefits of the oxytocin every time she breastfeeds. Remember, oxytocin is released when we nurse. And that's that bonding that we have with that bonding moments with our child. So she's getting the double benefit. Her baby's getting oxytocin. She's getting oxytocin from nursing. So that's really an empowering hormone, empowering physiology. And since her periods are back regular, and she's not having PMS, depression, anything, she's golden. So keep up with nutrients. I would add adaptogens if needed. But good, healthy greens, high-quality protein, healthy fats, you need a lot of good extra omegas when you are breastfeeding, because those babies deplete us from those omegas. So just keeping up your optimal nutrition is your best way, amazing.

Melanie Avalon
Well, almost through these questions, speaking of nutrition, we did get just a few. And one, I really appreciate this question because we talk a lot on the show, more on the Immigrant Passing podcast.

We talk all the time about the importance of protein and protein, protein, protein and moderate even higher protein diets. So Teresa, she says, I have a lot of Dr. Rebecca's books and I find the diets hard to follow as they are lower protein and end up being very low calorie. Is she making adjustments to make her plans higher protein? Does she agree that more protein is essential for women in perium and menopause? So what are your thoughts on protein?

Dr. Anna Cabeca
Yeah, no. So in my book, Keto Green 16, we really, you know, after the hormone fix, we really did focus on more higher protein containing meals. And also true in menu pause, except for the one, there's two, there's a fasting plan and a vegan plan. So that was the challenge to get enough protein. So always work with clients, because especially when creating menus, you want to look at what's your optimal protein amount that you need for you and optimize it, because we have clients that are 100 pounds to 300 pounds doing our programs, right? So we want to look at what's optimum for you and make sure that you are optimizing your protein intake. So a lot of the things with is one of the reasons that we add in the protein, the protein shake recommendations, the protein powder recommendations, as well as, in general, discussing how much protein your body needs is because most people aren't getting enough protein. So we want to make sure that you're getting that in there.

Keto Green 16, I wrote that book, so it was the easiest following 16 key foods in the menu. So when you're planning out for 16 days, you're not doing a whole other type of shopping for each recipe. So I tried to make those simple as possible in Keto Green 16. Yeah, that's it. But I think protein is critical. And eating the protein first, as my friend JJ Virgin always says, eat protein first, healthy fats, intermittent fast and stop snacking, those things are critical for optimizing hormones. And the reason I wrote menu pause was because you can't do the same thing every day, ongoing, you have to change things up. You have to have metabolic flexibility. There are days you need to feast, there are days you need to fast and try different menus. I look at a lot of handwritten three-day menu plans when I'm evaluating stuff for clients. And oftentimes I see like that darn chicken salad on everyone's lunch, every single day, I'm like, okay, this is no longer health food for you.

Melanie Avalon
things up. And reading that book especially keto green 16 would probably help Stephanie because she said it's so weird that this is up she's talking about me asking for these questions she said I'm going through a detox now and I have all sorts of issues with my digestion this has been on my mind but I'm a bit underweight so is so too much fasting and maybe keto is not good for me I just hear all sorts of opinions I love protein and it loves me back so people who are underweight trying to detox do you still advocate for fasting and keto or how should they approach that

Dr. Anna Cabeca
Well, I think like in this situation, you know, I'm going to say okay Well, what's your urine pH, you know, like when you've been fasting a lot It's going to be it can be in a catabolic state that can be breaking you down It's going to be hard to form muscle in that state or an acidic state And so looking at that urine pH can really help us see how you're interacting with your environment and how is your nutrition? In general, so I would look at this and say, you know, you need to again Flex things up and for stephanie, I would say refer her to my book menu pause and actually the carb up week Just interrupt what you're doing for one week with that carb up week And let's see how you how you do a bit.

You'll feel better have more energy sleep better And get stronger in that one week oftentimes I have my especially like olympic athletes that i've worked with they're so disciplined and they don't want to not fast and they don't want And they're not you know, they're exhausted i'm like, okay, you know, let's do our carb up week here And it's like it's like you've spent a week at a spa feels amazing. You have to keep that metabolic flexibility And that can improve how we do the same thing every day. I mean there are seasons for a reason and

Melanie Avalon
And then related to that and with the fasting, is there, so this is my question and Amy's question, Amy wanted to know, should women in menopause or perimenopause be intermittent fasting? And I guess I'm curious, because there's so many intermittent fasteners in the audience, does there need to be more fluctuation and change based on what decade of your life you're in?

Or how does the fasting change or need to change as we age?

Dr. Anna Cabeca
Yeah, so this is so critical and again write about this more in in my book keto green 16, but in perimenopause You know when we our brain uses glucose for fuel And it is hormone dependent But as we go into perimenopause then progester and estrogen levels start to decline Our brain is it shows impaired glucose metabolism. So our brain starts starving for fuel If we shift into ketosis We bypass is that mechanism and all of a sudden we're sharp.

Good memory Good cognition all the neuroendocrine vulnerable symptoms symptoms go away the brain fog the mood swings the PMS They go away So I think not only is intermittent fasting a good idea and perimenopause men pause and post menopause I think it's necessary. It's necessary and I would say, you know, 80 to 90, you know, I say 80 percent keto green That's usually with a 13 to 16 hour intermittent fasting window 10 percent fasting and 10 percent feasting So we have this you know, this kind of flexibility built in Not to be so strict on yourself, you know day in day out every day of the week just have Be able to say, okay, you know So I have a feast day coming up on such and such or whatever took maybe that's higher carbs or higher Healthy carbs so like your sweet potatoes and your good starches things like that So you can play with that a little bit but intermittent fasting is key And then what I found again, I brought my magic menopause online and intermittent fasting in 2014 So I have now 11 years of working with women all over the world with this and following some of them for every You know, I've had clients for you know Following this plan on you know in different ways over the decades And that's why I wrote keto green 16 and then menu pause So what I found is that there is and and this is the true depending on your genetics If you are a high former of uric acid this intermittent fasting or prolonged fasting one meal a day is not good for you It wasn't good for me carnivore wasn't good for me My uric acid went sky high and I started gaining weight even though I was having less than 10 20 grams of carbs a day.

It was like what's going on. I had to figure that out in 2020 to Help my own metabolism So I started asking these questions for my patients and I started digging into the metabolic research And looking at for our clock genes And again, we really need to look at clock genes in women as we age too But these clock genes are very active, you know from 6 a.m to 10 a.m. So if we're waiting till 12 or 1 or 2 we're missing the window of using our metabolic active Clock genes, so I typically say breaking fast by 10 a.m And eating preferably by you know, 6 p.m is more physiologically dynamic and impactful in a positive way for women in menopause and beyond so and the fact that Research has shown women who intermittent fast at least 12 and a half hours between dinner and breakfast Women with breast cancer who they studied if they fasted at least 12.5 hours between dinner and breakfast They had significantly reduced risk of breast cancer So that's powerful.

So we should be intermittent fasting

Melanie Avalon
amazing. I love it.

Well, this has been so amazing. It was really nice to have, you know, just all these specific listener questions. And I'm so excited. I know I do too. And I'm so excited about your new book. Are you finding it easy to find lots of studies in literature or what is the search like with that?

Dr. Anna Cabeca
It's it's oxytocin research is is challenging and I think because oxytocin is a very hard molecule to study But there's there's a lot out there. I've got to make another road trip I think and visit some of these leading researchers since I have a lot of questions I'm hoping to do that too and thinking of road trips one of the things I did last year and in my celebrating menopause journey, I Walked the Camino de Santiago and like I think one of the things that I recognize from all the things we do in Longevity hacking and anti-aging and age management or age optimizations.

I like to say is you know, really learning who We are without all our titles hats and roles. I was like I've really in that journey got to know myself and and Doing things like that are really powerful so I think celebrating the stage of life that we're in taking time to push our boundaries push our limits have fun explore is Some of the best medicine I can recommend I love it

Melanie Avalon
it so much really one last quick question if you could design if you had just like unlimited funds and budget and resources and you could design a study for your book about oxytocin what would what study would you like to do

Dr. Anna Cabeca
Oh my gosh. One thing I would do is a study on giving. I would like to measure people's oxytocin and then have them share their gifts. Like they can show someone how to garden or they show someone how to cook or they show someone how to do their finances or whatever. Like they are able to give of themselves what that does to their oxytocin levels because anecdotally it's a powerful experience.

I think it's why I do what I do, Melanie. Amazing.

Melanie Avalon
I love it. Well as a brief reminder for listeners, so go get dr.

Anna's books now and you can go to dr Anna comm slash Melanie use the coupon code Melanie Avalon to get a discount on your orders Which thank you so so much for that. So the last question I ask every single guest on this show It's been a while so you might not remember it from the last from the other times But it's just because I am so passionate about mindset and gratitude and all the things So what is something that you're grateful for?

Dr. Anna Cabeca
I am definitely grateful for my girls, my children, especially at the time of this recording and recently Mother's Day and just to really receive their love and it's really, it's powerful and I'm grateful to see young women feeling empowered in their bodies and able to show up authentically. So yeah, it's very inspirational.

I love this next generation.

Melanie Avalon
So amazing. Well, thank you so much, Dr. Anna. This has been absolutely amazing.

Is there any other links or resources you would like to put out there for people to follow your work, get the things, get your new book when it comes out of your book?

Dr. Anna Cabeca
Eventually, definitely go to dranna.com forward slash Melanie because we'll have that Bundle bonus with jolva and valvet for you guys as an option to check that out and At the girlfriend doctor on social media, so be sure to follow me there and of course my website at dr.

Anna calm

Melanie Avalon
Awesome. Awesome. Well, thank you. I so appreciate.

This was amazing. I can't wait to see you in a couple weeks. You're just the best. Thank you so much. Thank you so much for listening to the Melanie Avalon biohacking podcast. For more information and resources, you can check out my book, What Win Wine, as well as my supplement line, Avalon X. Please visit melanieavalon.com to learn more about today's guests and always feel free to contact me at contact at melanieavalon.com. And always remember, you got this.