Latest / Radically Genuine / 155. Dangers of Hormonal Birth Control, Period Repair & Women's Health w/ Dr. Lara Briden
Transcript
- Roger K. McFillin, Psy.D, ABPP (00:01.551) Welcome to the radically genuine podcast. am Dr. Roger McFillin. Today we're addressing a critical issue in women's health that affects millions worldwide. For decades, the medical establishment has overlooked one of the most important vital signs in a woman's body, her menstrual cycle. A woman's period is not just about fertility. It's a crucial monthly report card on her overall health. Regular pain-free periods are indicators of hormonal balance. proper nutrition and good general health. Conversely, irregular cycles, heavy bleeding, or severe PMS can be early warning signs of underlying health issues. Yet, for too long, we've treated the menstrual cycle as an inconvenience to be suppressed or regulated with synthetic hormones. This approach merely masks symptoms without addressing underlying causes. Even more troublingly, Hormonal birth control itself can cause the very symptoms it's often prescribed to treat. Mood swings, anxiety, depression. This leads to a dangerous cycle. Women are prescribed hormonal birth control, which can trigger or exacerbate mood disorders. These mood symptoms are then misdiagnosed as psychiatric illness, leading to prescriptions for more powerful psychotropic drugs. All the while, the underlying hormonal imbalance whether natural or induced by birth control goes unaddressed. By suppressing natural ovulation and hormone production, we're not just turning off a reproductive function. We're disrupting a complex system that influences everything from bone density, cardiovascular health, to mood regulation and cognitive function. On today's episode, we'll be exploring why the current paradigm in women's health Care needs to shift from merely treating symptoms to understanding and supporting the body's natural processes and how to address root causes rather than simply masking symptoms. To have this conversation today, I want to welcome Lara Bryden, who is a Canadian naturopathic doctor and the bestselling author of Period Repair Manual, Hormone Repair Manual, and Metabolism Repair for Women. Roger K. McFillin, Psy.D, ABPP (02:23.717) She's currently has a consulting room in Christchurch, New Zealand, where she treats many women with PCOS, PMS, endometriosis, perimeniopause, and many other hormone and period related health problems. lot of the listeners to the Radically Genuine podcast who are women, certainly reaching out on this topic as many of us awaken to a lot of the problems within Western allopathic medicine. the masking of symptoms and the causes a lot of their treatments or the problems a lot of their treatments cause. So Laura, I want to just welcome you to the podcast and first just kind of get a background information here for my audience just about who you are as a professional. What was the inspiration for the period repair manual and your work in women's hormonal health? Lara Briden (03:15.65) Great, Roger, thanks so much for having me. I'm really excited to be here. Yes, so I actually, just, I won't go too far back, but I will start with the fact that before I became a naturopathic doctor, I was an evolutionary biologist. I actually published peer-reviewed paper in sex differences and foraging behavior in animals. So I've, from the very beginning seen physiology and health through the lens of female biology. And then when I became a naturopathic doctor way back in the mid nineties, just, fortunately, I mean, I had the opportunity to be on the ground treating mostly women for a lot of things. can imagine back in the nineties, was, know, conjugated estrogen high dose kind of hormone therapy. There was, everyone was on the pill. There were hysterectomies. was kind of the wild west. It's not that different now in some ways, but it was, women were confronting. you know, facing a lot of challenges. So I had to put what I'd learned in terms of using nutrition and lifestyle changes and herbal medicine into action. And I had to see if I could get some results. And thankfully I did. So then I was just practiced full-time for a couple of decades, really. Some of that, during that time I moved to Sydney, Australia, practiced there for quite a long time. And I'm happy to report that women all over the world have the same. Physiology, the same sorts of problems, that doesn't differ by country. I'm now in New Zealand. But about 10 years ago, I decided to write Period de Peruménuel, which is my first book. And that was, I'll be honest, that was for my patients. It was from my patients and for them. It was drawing on all that frontline work I'd had with people. I'm very grateful for all the stories they shared with me, all the experiences I got to see firsthand. And I wrote the book. for my future patients thinking what they, wanted them to do was read the book before they came for their consultation because then they would have some level of body, what we call body literacy or like some understanding of what we're trying to do here. And that was my main motivation. And then I'm very grateful because the book has became quite popular and reached women and doctors and gynecologists all over the world. Lara Briden (05:35.21) It's been very rewarding and I do think we are in a paradigm shift around women's health. It's great timing for your podcast. We're a few years into this paradigm shift, but it's a very different landscape than it was even 10 years ago when I wrote the, started writing the book. Roger K. McFillin, Psy.D, ABPP (05:49.549) I certainly see the landscape changing and sometimes I wonder if it's just the social media algorithm that I'm in because what I see in frontline clinical practice is that most of my patients aren't being provided this information. They're still kind of under the, I guess the brainwashing, that pill for every ill. So I want to start with some basics here. Can you explain why ovulation is so important to overall health, not just for fertility? Lara Briden (06:15.604) In a nutshell, ovulation, regular monthly ovulation is how women make hormones. So men make them daily. The way I see it through my lens is because I'm a biologist, I tend to think, I frame it as female physiology as the standard normal default version of human physiology. And then we have the quirky male physiology, which is very quirky in lots of ways across many species. Male humans make their hormones daily, which is fine, works for you guys. We, during reproductive years, make them on a monthly pattern. of course, those hormones, the two big ones, ovarian hormones, estradiol, our main estrogen, and progesterone are beneficial for general health. They're not just for making a baby, even though they've been treated like that for literally decades. The analogy I give is to treat ovarian hormones as just this. add-on, optional add-on, you might need one day to make a baby would be like saying to men, you know, don't worry, you don't need your testicular function. You don't need your testosterone until you're ready to make a baby. So we're going to shut it all down with this medication and we're going to replace your testosterone with this other medication that's kind of like testosterone, but really a little bit like estrogen and like, you know, not like either of them. And it's going to cause some side effects and change your physiology and change the shape of your brain. But don't worry because that's what everybody else is doing. Roger K. McFillin, Psy.D, ABPP (07:42.299) Do you think conventional doctors are kind of informed of this? I hear some of the craziest things like just what you just said. I've heard doctors kind of minimize the importance of a period at all and even describing it as an inconvenience. Lara Briden (07:59.04) The old paradigm is that women don't need ovulation. That is 100 % the paradigm that has existed. There's many people been pushing back against that. There's a professor who's been very influential for me. She's an endocrinology professor in Canada, Professor Jarolyn Prior. She's a scientist. 40, like crazy number of like 45 years of scientific papers under her belt. She's just been at this, she's been a champion for women's health. And yeah, one of her great quotes that I often put out into the world is, know, women benefit from 35 to 40 years of regular ovulatory cycling, regular natural menstrual cycles, not just for fertility, but for, you know, prevention of osteoporosis, dementia, heart disease. And she even puts breast cancer in that. And that's because progesterone through her lens probably shelters us to some extent from breast. breast cancer, there's some debate around that, like there is around everything. But yeah, I think that's a really important message. And then one of the pushbacks to that, I don't know if this is a question in your mind, but I'll just put forward one of the questions that's said at this point, which is that, our ancestors never used to have as many periods as we do now. So on the one hand, making this argument that we need these regular cycles to make hormones to build metabolic reserve to build long-term health, certainly to build bone density as just the most obvious example. It is true that our ancestors didn't do it the same way. I addressed that a little bit in period of perimmanuel. They, of course, were pregnant or breastfeeding a lot more of the time. We're different from our ancestors in that regard and in many regards, but my answer to that is that's fine. Most of us are not going back to that life history, but at the The bottom line is the contraceptive medications do not mimic that state. There's been this narrative that they mimic pregnancy. is basically incorrect. mean, they mimic pregnancy only if they sort of shut down the signaling from the brain to the ovaries, but they do not provide the same hormones that pregnancy does. So during pregnancy, of course, we have a huge amount of estradiol and progesterone, the beneficial hormones that I'm... Lara Briden (10:21.452) talking about. So we can either make them monthly or we can make them, you know, with several pregnancies. Either way, we're getting a good dose of hormones and the brain is getting a good dose of hormones. And we know from some of the emerging research that, well, we know hormones change the brain, of course. They change the brain even just throughout a woman's menstrual cycle. It changes shape a little bit. so logically, women on contraceptive medication have their brains are also changed by it. which is quite concerning. This is like, you know, 2020s and we're just now figuring, you know, figuring this out, which explains a lot. Roger K. McFillin, Psy.D, ABPP (11:00.579) Yeah, I do want to get into a lot of questions about hormonal birth control and its effects. So you just started there, but I have some questions leading up to it because you see, you see a lot of women, especially adolescent girls are placed on hormonal birth control to regulate their, their period, quote unquote, regulate their period. And that included one of my daughters. So what are some of the common period problems that you see that might indicate underlying health issues? I opened this up by saying, Hey, this is a Lara Briden (11:04.022) Yeah. Yeah. Sure. Lara Briden (11:28.844) Yeah. Roger K. McFillin, Psy.D, ABPP (11:29.659) kind of a signal, it's part of a monthly report card on your health. Lara Briden (11:34.1) Yeah, it's called the fifth vital sign or the sixth vital sign, depending on how many vital signs doctors decide there are. This is not a radical fringe view that it's a fifth vital sign. ACOG or the American College of Obstetricians and Gynecologists came out with a statement, I quoted it in my book, I think it was like 2016, basically saying the menstrual cycle is a vital sign in that it's an expression of general health. So being able to have... Approximately monthly, it doesn't have to be a 28 day, approximately monthly ovulation means everything is working well. Like, you the woman is fully nourished. She doesn't have chronic inflammation or a disease state. She doesn't have insulin resistance, for example. And so, you know, that was, when they released that statement, my jaw hit the floor. I was like not expecting that. That was very different from... You know, that was kind of the beginning of a paradigm shift, I think. The fact that they would acknowledge that was amazing. They even say in that statement, doctors should be asking girls about their natural menstrual cycles and asking them, suggesting they track their natural menstrual cycles. So I'll just, I do have to respond to this narrative that the pill can regulate the menstrual cycle. That narrative is. like it's an emperor's new clothes situation. It's so incorrect that it's somewhat baffling. It's just not somewhat. It's completely baffling that it's survived this long, that it's still sort of hold on. It's, the menstrual cycle is structured all around ovulation, which is, you know, the releasing of an egg. But it's also, as I said, it's how we make our two main hormones because healthy ovulation usually comes on an approximately monthly cycle. That's the reason for a monthly cycle. to then sort of with oral contraceptives or with the pill, like to shut down ovulation, flatline hormones, and then induce a monthly bleed is completely nonsensical. Like there's no medical reason to bleed monthly. Lara Briden (13:48.444) on the pill. It's done to mimic a cycle, but it doesn't mimic it in any hormonal sense of the word. So it's really this kind of false reassurance. I will acknowledge, you know, it's important, you know, there can be a requirement to shed the uterine lining at some interval. And, you know, I think with being on oral contraceptives, like there will, if you don't allow a uterine lining shed at some point, it will just start to, you know, break through bleed and that's fine, but that doesn't have to be monthly. So then we get these weird like acrobatic thinking. So the idea is you have to have this, you can regulate the cycle by dosing these drugs monthly. And then about five years ago, there was like, well, actually you don't need a monthly bleed on the pill. So then the segue was like, well, so you don't need a monthly. So women don't need periods. You don't need a monthly cycle. And there's sort of this, somehow this illogical leap between you don't need a monthly induced bleed to you actually don't need monthly ovulation. And those are two very different things. And I know you did ask about, know, which I can answer now. What are the possible causes for a girl not having a monthly cycle? Should I? Yeah. Can I answer? Should I answer that part now? Multiple. So it's an expression of health. There's a, I don't know if your audience will resonate with this, is any sort of statistic people in the audience? There's something called the anachronism principle. which is from the first line of the novel, Anna Karenina, about how, I think you might know it, the quote is, there's only one way to be a happy family and there's multiple ways to be an unhappy family. So this idea that there's one way to have a menstrual cycle and then there's literally dozens or hundreds of ways for that not to happen. Basically any requirement that's not in place is gonna result in... and irregular cycles. So that's how it's an expression of health. I like in girls, like a really super common one, and I can't speak specifically what was happening with your daughter. Like there's lots of reasons actually, but a common one with young girls is, or with girls is under eating. Just simple fact of not nourishing enough is one. There can be other sort of medical conditions going on. Lara Briden (16:11.778) can influence it. There is also unfortunately kind of sort of a growing trend to kind of higher than normal androgens in girls. That's kind of an early PCOS or an early polycystic ovary state that can produce irregular cycles. There's also the fact that just as a baseline, takes girls, like when they first get their period, they're not expected to be regular. I mean, they are a normal cycle in the early couple of years would be, even if it's coming every 45 or 50 days, that's pretty good. early cycles, a lot of them won't have actually ovulation as part of them, which is why they can be quite heavy in the beginning. So that's all part of the maturation of the menstrual cycle. So on the one hand, there's this expectation to let the girl sort of develop her menstrual cycle, hopefully with relatively few symptoms. And then if it's really not coming, starting to build into a monthly cycle, then start to do some troubleshooting. Yeah, investigate. Other examples might be gluten sensitivity, zinc deficiency. These are all various troubleshooting topics that I explore in my book. my experience is most a lot of the time, especially with teenagers, their body's pretty dynamic and responsive. So that's one of the things I've been able to learn on the ground is treating teenagers and just helping their bodies to... do their thing and yeah, get a mature into a regular menstrual cycle. Roger K. McFillin, Psy.D, ABPP (17:44.463) I've been treating adolescent eating disorders for over 15 years and amenorrhea is a sign of a nutrition deficiency, anorexia of course. But was reading your book, I learned something for the first time that a woman might bleed but not be ovulating. So what are some of the signs that a woman might not be ovulating even though she's having regular bleeds? Lara Briden (18:06.241) Yeah. Lara Briden (18:12.692) Yeah, that's a great, it's great that you picked up on that. Professor Jerilyn Pryor, the endocrinology professor I mentioned earlier, she's published a few papers on what she calls subclinical ovulatory disturbance. So all these situations where you would still have a bleed, kind of just the uterine lining just letting go, but there was no hormonal architecture of the structure. There was no ovulation. And through Jerilyn's lens, that's a problem long-term because with a cycle like that, you don't get progesterone, the second hormone coming online. You don't get all of, know, progesterone's benefits for the brain and bones. yeah. So. And ovulatory cycles or cycles with even a, what's called a shorter luteal phase. there may have been ovulation, but not a like really robust one. Not a, you know, not a lot of progesterone production. This is sort of on a gradient. So there, Again, when I said earlier, like everything has to be going well to have a menstrual cycle. That's because everything has to be going well to ovulate. Ovulation is the engine of the menstrual cycle, the main event. the first on the, you know, if ovulation starts to wobble or not happen, you're first going to get the shorter luteal phase or a less robust ovulation. Then you're going to cycles where you're still making estrogen, but not ovulating. Those are anovulatory cycles. And then eventually you might just get. no cycles at all. So that's, you know, there's a gradient there and all the same reasons apply. So any of the things like stress, being undernourished in any aspect, really, like the body's waiting for full nutrition in every respect, because the stakes are high. I'll just say for the, for the brain, for this to all happen and for the, the female body to ovulate, It's because the brain, the hypothalamus has to be convinced that everything's okay to make a baby. And even if this is a hundred percent true, even for women who, obviously young girls who don't want a baby yet, it doesn't matter if you want a baby, this is how the body works. seeing through that lens, you just need to persuade your, brain that everything's okay. You know, there's no, yeah, there's no inflammation. There's no, like, Lara Briden (20:34.978) over exercise or so. Yeah, that's the situation. And it's good that you bring it up because I've realized, of course, it's difficult sometimes when you know a lot about a topic to then kind of. This is why I love questions from my followers and my readers and my patients as I get their perspective. I have heard that a few times of people because you've always been presented, well, this is the way the menstrual cycle works. You just ovulate and then you have a LUTL phase. But then there's Yeah, this fact that a lot of the time that's not happening and it's hidden. This is why Professor Pryor calls it subclinical. Just getting a bleed is no guarantee that you ovulated. So the way to know if ovulation is happening, we have this beautiful built-in sign, which is a change in basal body temperature. So progesterone, the hormone we make after ovulation raises Body temperature by about 0.3 degrees Celsius. I think in Fahrenheit, that's about 0.5. It's subtle, but you can pick it up with a basal body thermometer, like under the tongue in the morning, or a lot of the wearables are tracking this now. And knowing if and when you ovulate, and as Professor Pryor says, making ovulation visible through a temperature change is body literacy. So that is a term I used earlier. I see now the term body literacy is used for all manner of things out there, but it was coined by a colleague of mine, Laura Werschler, was speaking specifically, she coined it back in the nineties, about the presence of ovulation and sort of knowing if and when you ovulate is the origin of that term. So it's not rocket science. It's pretty easy. Anyone wearing like a... I mean, not to drop brand names, like, know, or a ring or there's different, you know, armbands and things are like the, the, like watches and stuff. lot of those can all track basal body temperature. A lot of them are integrating now with the menstrual cycle to give that information. But as a little history lesson, when Apple first released its watch, whatever that was called back, this would have been, you know, don't know, eight or nine years ago, they didn't include the menstrual cycle. Everyone in my field was just like, Lara Briden (22:55.242) What? Like the most, they're tracking so many things and just like this most obvious metric to track in the standard human, standard default version of human was not included. They just never occurred to them actually, I guess, to put that in there. So, and of course, so, on the topic of body literacy or temperature tracking, can be used for avoiding pregnancy as well. That's, another topic and the people who are into that and fertility awareness method are very passionate about it. Yeah. Roger K. McFillin, Psy.D, ABPP (23:27.151) So we've been talking a lot about like an irregular period or amenorrhea. What about on the other end of the spectrum? Cause I see this quite often where women is placed on hormonal birth control because they might be having like multiple periods a month potentially, around like mood dysphoria around their cycle as well. So is there anything that women who are having multiple cycles per month should be concerned about? Lara Briden (23:57.472) Right. So the multiple cycles, the multiple bleat, they're not cycles, the multiple bleat a month. If just by definition, if a woman's bleeding like every two weeks, that is not ovulatory. Like that's not a cycle. There isn't enough time for ovulation to happen in that short a time. So a lack of ovulation, which I've just been describing could be hidden, could happen with kind of somewhat normally regulated bleeds. could happen with very bleeds far apart. It could happen with. Roger K. McFillin, Psy.D, ABPP (24:00.603) Not a little bit. Lara Briden (24:25.696) you know, bleeds really short together. again, in that situation, one of the goals would be what I call obstacles to ovulation. Like why are you not ovulating? Like common reasons for frequent cycles that you've just described would be polycystic ovary syndrome. PCOS is hugely common. So if people don't know what it is, it affects about at least one in 10 women, probably more as associated with higher levels of testosterone or androgens, which the female body is. a good situation. It's associated with insulin resistance and metabolic syndrome and it's on the rise. So that's one potential cause of frequent cycles. Another one is perimenopause. And my second book is all about perimenopause. So we might just leave perimenopause for the moment, but if a woman's over 40 and her periods are doing weird things, that's sort of topic. And that also perimenopause is essentially about progesterone. leaving the scene. But in terms of other things, right, like there's pain, there's heavy bleeding, there's a condition called endometriosis, which I guarantee some of your listeners have and are thinking, well, listening to me and thinking that's all well and good, but what about the debilitating pain of endometriosis? you know, there are a lot of conditions that need troubleshooting. I try to address most of those. In my book, some are easier to address than others for sure. And I will just acknowledge that contraceptive medication, even though it can't regulate cycles, it can suppress symptoms. So there's no doubt it can relieve the symptom of, for example, heavy bleeding. It can give some relief for period pain. It can also give some relief for some of the mood, as you alluded, like a hormonal sensitivity or like mood symptoms from the ups and downs of hormones. So at the same time, it can produce mood symptoms. So there's that paradox. So I'm the first to acknowledge that these medications can provide some relief. And certainly, for example, the hormonal IUD, which is relatively new on the scene the last 20 years or so, can dramatically reduce menstrual Lara Briden (26:44.778) low. So there is a place for some of these, certainly some of my patients do use the hormonal IUD. We can explore that a bit more. But I just think the idea is to use them... Well, to first acknowledge there are other treatment options for many of these things, but also it's one treatment option in the toolkit and just to understand what it is and what it can do and what it can't do. It can provide relief, but it can't, and it can... obviously prevent pregnancy, but it can't regulate a natural menstrual cycle. And for my patients, my goal for them is I want them to have their own hormones. If at all possible, I would rather they not be in a situation of ovulation suppression because I want estradiol and progesterone for them, for their benefit, for their brain health, long-term brain health, for their bone health. And a lot of them, if they come to me as their patient, they want that too. They're trying to find a way to manage their symptoms, but also be able to cycle and make their own hormones. Women are starting to value that more as it becomes more clear to more women that female hormones are good, basically. They're a good thing. Not a, as you say, not a pesky annoyance to be switched off. Roger K. McFillin, Psy.D, ABPP (28:04.261) Let's stay on the topic of PCOS because as you noted, it is on the rise. And here in the United States, there's a lot of attention right now to the work of Bobby Kennedy and a lot of these health influencers. There was just recently a hearing in front of the Senate and we have all these endocrine disrupting chemicals that you can find in cosmetics, in household products, in our food. How much Do you think that is playing a role in the rise of these hormonal disruptions in PCOS? Lara Briden (28:39.446) Yeah, it's hard to tease it all apart. So a few things I can say. So my third book is about metabolic health. about, yes, insulin resistance and kind of pre-diabetes. I think somewhat of the topic of the meeting that you just mentioned. So I'm very passionate about that as well. One of the statistics I included in that new book is that one paper estimated that In terms of the epidemic of insulin resistance or metabolic dysfunction, probably about 15, 1, 5 % of it can be attributed directly to endocrine disrupting chemicals. So I think, you know, they're definitely part of it. And one thing to understand about, well, it's quite sobering and sad, but one thing to understand about a lot of this, especially the endocrine disrupting chemicals, is that they... they are creating epigenetic effects. people might have now hormonal dysregulation, not from just the endocrine disrupting chemicals in their immediate environment, but from what their parents were exposed to or even their grandparents. So epigenetic means this genes get switched on and off and then that gets inherited. That is a big factor in polycystic ovary syndrome or PCOS. another thing we do know is that And the statistics on this are crazy. So if a woman, if a female fetus, a female is exposed to androgens or kind of high androgen or male hormone type exposure in utero, and some of that could be from environmental toxins or an endocrine disrupting chemicals, she's then five times more likely to develop PCOS. I know if you follow health... risks and very often they're talking about, you know, 80 % increase or something like that. This would be like a 500 % increase in five times higher risk of PCOS if there's that kind of exposure in utero. And that could just be from, you know, a mother who has higher than normal androgens. at some point it could have been from, the scientists do think that in that regard, yes, environmental toxins have probably played a role in the... Lara Briden (30:57.222) amplifying rapidly accelerating epidemic of polycystic ovary syndrome. There is also the weird modern food supply is playing a big role in that because insulin resistance or metabolic dysfunction is a driver of PCOS. I wouldn't say it's the ultimate cause. Again, it's kind of hard to tease it apart, but it's definitely in there because in females, this vicious cycle gets set up. in females higher than normal androgens or testosterone, promotes or causes insulin resistance or metabolic dysfunction or pre-diabetes, depending on what you want to call it. And that in turn, insulin resistance promotes higher androgens in women. So you get this vicious cycle. Yeah. Roger K. McFillin, Psy.D, ABPP (31:44.121) I wonder before we talk about getting off hormonal birth control, I recently wrote a sub stack on this and came across a lot of research, some things that are like really important here that synthetic hormones can amplify existing emotional struggles, new ones, leading to feelings of anxiety, depression, irritability. Teenage girls who use birth control pills are more likely to cry, sleep too much and experience eating issues than their who do not use hormonal birth control. Teenagers on hormonal birth control had 130 % higher incidence of symptoms of depression. Teenagers using hormonal birth control had an increased incidence of depression even after stopping the pill. Hormonal contraception use doubles the risk of a suicide attempt and triples the risk of suicide. So this is something that is a pretty serious concern. And I know I think the first step is to not get on it in the first place, but unfortunately I think a lot of people were placed on it by their healthcare professionals for the range of reasons that we kind of discussed. So let's transition to like getting off of it. What can women expect who are trying to get off the... Lara Briden (33:04.502) Yeah. Roger K. McFillin, Psy.D, ABPP (33:09.896) hormonal birth control and what can they do to kind of manage the symptoms that they're likely going to experience? Lara Briden (33:18.752) The way to think about it is that it all comes back to, certainly when I'm working with patients, my first question will be, what were your cycles like before they were shut down with the pill? So just keep in mind that combined contraceptives are essentially an on-off switch for that brain ovarian function. So when the standard pill or when on a combined contraceptive, there's radio silence, like there's nothing happening between the brain and the ovaries. And so predicting what that's going to then look like when that starts up again is going to depend on what was happening for her before. Thinking that the pill kind of masks things. So if the main problem before was period pain or the main problem was irregular cycles or mood, then removing the... off switch or removing the concept of medication will just very often the previous issue will reemerge. And that's why there's no like one size fits all roadmap of what to expect when you stop the medications. You're just unveiling kind of what has always been there. So when I'm working with patients, one of my very first questions will be, what were your periods like, your real periods before you started the pill? And also, many did you have? I do want to touch on a, just expand on the concept of maturation of the menstrual cycles. So again, in Professor Pryor, for Jerelyn Pryor in my book, she'd provided me with a paper that, where they found that they concluded that it takes on average, it takes about 12 years for a woman to mature, a girl or woman to mature her menstrual cycle. So to fully mature that communication between the brain and the ovaries and get achieve what's like, she calls a robust, healthy, know, fully mature menstrual cycle with a good level of progesterone. That takes up to 12 years. Doesn't mean it takes 12 years to reach a regular cycle. So, you girls should be able to reach a somewhat regular cycle younger than that. But like to fully get there is about 12 years. And so of course, if you shut it all down at 13, you know, that's just hit the pause button on that maturation process. And so someone like that. Lara Briden (35:45.762) If that was my patient, say, how many years of menstrual cycling did you get under your belt before it was all shut down? Because that'll help me understand how regular it's going to be now and how much progesterone you'll be able to make now at 30 something coming off it. So that's one consideration. Obviously, I've always asked about, there pain? Was there skin breakouts? Was there mood? What was happening? And just to try to get ahead of the the ball a little bit and like make some plans to put in place some treatments to ease those symptoms. A big one, it's really worth mentioning is post-pill acne. So a lot of the pills, especially the Yasmin, the medications with the progestin, Josperinone is a very particular anti-androgen progestin. So just to point out, there's no progesterone in any. of hormonal birth control. There are always various types of progestins and progestins have all different effects. So this one, the very common one is strongly anti-androgen or anti-male hormone. then when that's removed, a lot of women, depending on just genetically and kind of where they're at with their skin, their skin oils will erupt. Like they get this, it's a withdrawal syndrome. I characterize it as a Drosperinone. withdrawal, it takes about three months to kick in and then they just get an androgen surge, like worse than they ever had before. So these might be women who, their skin was maybe a little bit bad, but that wasn't why they went on the pill specifically. then they get, when they come off it, they're like six months later, they're like, my skin is just so inflamed, so erupted. And my experience working with women for almost 30 years, they... they blame themselves. like, well, that must be me. I must be broken. I must just have like terrible hormones or, know, rather than so part of my job around that has been reframing. It's like, no, this is actually withdrawal syndrome from this medication you were on for a long time. So in many cases with a patient like that, would have been on, yes, tried coming off it. Six months later, their skin was so bad that they're like, well, I'm broken. I must require this medication. And they go back on. And then at some point, Lara Briden (38:05.826) I get a chance to talk to them and then it's like, well, okay, so we know that's going to happen. That happened last time. So let's make a skin plan in advance of coming off. Let's know this is, you know, coming and plan for it and also know it's temporary, right? The thing about withdrawal syndromes is you, it's very helpful for people to know that it won't last forever, that these aren't permanent symptoms that they have. This is just their body adjusting. So that's an example of a, you know, strategy coming off. The pill, there's all different ones, you pain. Yeah. Roger K. McFillin, Psy.D, ABPP (38:37.285) Can I ask you, because I've seen this for women who go back on the pill because of those skin issues, and you described it as a withdrawal symptom, how long will that last? Because I think it's like the anxiety and the shame and all the struggle with that is what leads them to go right back on it. Lara Briden (38:44.705) Yes. Lara Briden (38:49.666) I Lara Briden (38:55.714) Totally. Shame is right. picked that there's a lot of shame around it. Women are like, this must be me. I'm just, I'm broken. Sadly, I would have to say, I'd have to be honest, it's about two years. Yeah. But it doesn't mean it'll be that bad for two years. In fact, I can say with confidence, a lot of my patients and followers, I have a whole podcast episode on how to do this, you know, get off the- how to prevent post-pill acne, hair loss and weight gain, which kind of often go together. It's not going to be as, the second time around, won't be as bad as before because they'll be ready and they'll have like zinc supplements at the ready and they'll have changed their diet and you they'll be, it'll be easier. And also they'll be like, I know this isn't going to last forever. So two years would be maybe a more of a worst case scenario. Sometimes within a year it's slowing down, but it's skin has a long. trajectory like you can't expect because once pimples form like they last a few months like they kind of go up and down with inflammation, but they're not you can't just you know immediately Clear skin unfortunately, but if women a lot of the in my book I think I even have some of the closing sentences, you know play the long game trust your body play the long game Understand, you know what's happened in this case. It's been a case of withdrawal and you have confidence in your body and you know this, things are going to improve. And I think just even just giving women trust in their own bodies back has been a hugely rewarding part of my work. Like I said, your body wants to be healthy. It wants to have healthy cycles. It wants to have no pain. It wants to have clear skin. In my clinical experience, most women can get there. For some women, it's a bit of more of a winding road and for some women it's easy, but it's, you there's always a way to achieve close to symptomless periods. Roger K. McFillin, Psy.D, ABPP (40:54.351) Yeah, let's get into some of those interventions if we can. I know I'm always interested in diet, lifestyle changes, if there are supplements that help address menstrual health issues naturally, things of that nature. Can we just start with diet? I'd like to ask a lot of my guests who come on, do you believe there's an optimal human diet? There's so many different, we'll call them fads that exist in the healthcare communities. Right now, ketogenic is something that's being used in mental health, carnivore-based diets, carnivore-based diets with like fruit and honey. Like you see these combinations. There's other people who are going to say more Mediterranean. Then there's the vegetarian, vegans out there. Everyone has their thing. I know what makes me feel well, or I know what I see in clinical practice, but I'm just kind of... interested in just your thoughts when you're trying to restore women's health, what kind of diets are you suggesting? Lara Briden (41:57.014) Yeah, I'm happy to talk about this. And I'll just say that two things. The diet that works for general health for women is going to be the diet that works for their period health. I remember one of the early Amazon reviews, I should go back and try to find it, of period repair manuals. I just loved it. She's just like, wow, I had no idea that what you eat could affect your period. Yes, it does because menstrual health is an expression of general health. So yes, finding the diet that works. that reduces inflammation, maybe reduces allergy symptoms, that helps with gut. Whatever the diet that works for those things is going to be the diet that works for periods for the individual. In terms of, do I think there's one perfect diet? No. My third book is all about this, where I do explore metabolic health. do think, and I think everyone from all the camps that you just described, everyone can agree that the modern process diet is not. good for humans. It's definitely through my biologist lens, that is not suitable food for homo sapiens. Something has gone very, very wrong with it. In chapter two of my metabolism book, I try to survey all the different things that's gone wrong. Obviously, the ultra-refined starches, think, I don't know what guests have said about this on your podcast or where you stand, but I'm pretty confident through my biology lens that high dose linoleic acid or high dose omega-6 polyunsaturated fat has done something very bad to health. yeah, yeah, I know it's controversial and I'll just say too much about it apart from obviously linoleic acid is an essential nutrient. So there's that, but also now one paper I read estimates it's now 90 % of fatty acid intake of a lot of people, nine zero. And it used to just be like a tiny amount. Like we used to mostly eat saturated fat actually. Roger K. McFillin, Psy.D, ABPP (43:31.855) So those are like the seed oils that a lot of people are cooking in or that are placed in foods. Lara Briden (43:57.806) and a little bit of polyunsaturated. The more I looked at the research researching my metabolism book, the more I was thinking, something has gone very, very wrong. It's quite an active, it interferes with mitochondria, it interferes with the endocannabinoid system, it seems to increase hunger, it's like doing linoleic acids, doing some weird things. So know that's somewhat controversial, but it sounds like you've had other guests maybe talk about seed oils. I can confidently say a human diet should not include 90 % little air acid in no sense of the word, no sense of it. So then it's funny, the Mediterranean diet, I talk about that in metabolism repair for women. It's such a nebulous, it's become such a just nothing kind of term. Like I even saw one scientist say, the Mediterranean diet can be tailored to fit any cultural tradition. I'm like, well, how is that? the Mediterranean, like, isn't that just a whole food diet? Like at that point, like if you could substitute anything for it, then isn't it just whole food? And then, you some people are saying a Mediterranean diet is mostly plant-based. That is incorrect. It's totally not. I mean, they do not, I don't know where that came from. That just seems like, you know, wishful thinking to me. That's weird. I have a section in my new book and all my books actually, I make a gentle case for. an omnivore diet, that's through my biologist lens, we're omnivores. Like to pretend that we're not omnivores seems very weird to me. know, our ancestors ate, loved animal products, you know, relied on it. That's very important for nutrient density. So, but then beyond that, like, you know, how far you go with it, like what the exact proportion of animal versus plant foods should be. I do think there's quite a bit of diversity in that, which makes sense. It's going to come from ancestry to do with of microbiome. So I think some people are just sort of calibrated to perhaps do better on a much more animal-based diet versus some people feel a lot better with a lot more plant foods, but still animal foods, just if you're trying to dial up those two things. And then of course, there's clinical situations for an intervention like a keto diet can be beneficial. I totally, yeah, certainly in the mental health. Lara Briden (46:18.826) space, I think there's some very interesting work being done using keto as an intervention. so I think that's interesting and I that could be quite helpful. I don't have a lot of experience prescribing ketogenic myself, but I am aware of the research. And one thing I will say is one thing with a ketogenic diet, women do just need to watch their cycles because it does seem to be, again, depending on how she's sort of hormonally calibrated, going super low with carbohydrates can switch off ovulation. It depends on the individual. I think it obviously depends on sort of calories. I think if there's enough calories coming in in the form of fat, she can avoid that. it's just, you it's one of the troubleshooting things to consider. I guess because women, have this great barometer. So if a diet switches off ovulation, that to me, that's a sign that that is not as sustainable. diet for health for her in the long term. mean, maybe short term is just trying to sort of address some symptoms and then it's okay to lose your period for a few months. That's not a problem at all, but long-term ovulation is how we make hormones. So a diet that would switch off ovulation is not going to be sustainable. I would think. And one thing to say about that too, just for people who are troubleshooting that or trying to figure out diet and ovulation, there's a lag time. So it's four to six months lag time. So you can go on a diet, example, a restrictive diet is like, you're fine, you're fine, you're fine. And then four to six months later in you lose your period. then likewise going in the other direction, like when you reintroduce perhaps carbohydrates in that scenario, you're not going to immediately get an ovulation. There's this, you know, this I describe in period of perimmanuel, there's a hundred days to ovulation that like the follicles developing, the brain talking to the ovaries that takes, they need some time to respond and get ovulation back online. Roger K. McFillin, Psy.D, ABPP (48:20.923) There often seems like there's a lot of common sense in this, like going back to whole foods, most bioavailable nutrients, making sure you're not going extreme and other ends. Like I think rest restricting animal based products can be really problematic potentially then also restricting your diet to only that could be problematic as well. You have to understand where, you know, how your body responds to such things and, and, to be like really mindful and aware. But what I'm hearing from you, and this is like a very important takeaway. Lara Briden (48:28.247) Yeah. Roger K. McFillin, Psy.D, ABPP (48:50.421) is that this stuff takes time. And when you're going off the birth, hormonal birth control pill, it's going to take time to restore your, your health. And you have to be patient with that process. There's things you can do obviously to minimize the adverse response to it, but it is a, it is a process that is going to take some time. Your body will restore health for the most part. Most people you're working with you are going to restore your health. And if you change your diet too, And you're working that it's not something that's going to be a quick fix. This is like trying to make some lifestyle changes. Lara Briden (49:22.828) Can I, I just want to say a couple more words about, plant-based diets. just sort of to help people cut perhaps get a framework for it. So one of the, observations I've made clinically and is backed up a little bit by research that hasn't been a lot, normal cows milk, normal cows, dairy products that contain a protein called A1 casein. for some individuals is quite inflammatory and can create sort of a histamine response and gut issues. And so this is, there's growing research around this sort of A1 casein sensitivity. And I specify A1 casein because goat and sheep and A2 dairy like Jersey cows don't make it. Yep. Roger K. McFillin, Psy.D, ABPP (50:09.903) I want to differentiate between raw milk and pasteurized. Does that occur in both raw milk and pasteurized milk or are we seeing this more pasteurized milk? Lara Briden (50:20.416) This would also be in raw milk is my understanding, but I do wonder, I don't have a lot of experience with, raw milk, but some of it, it's from Jersey cows, depends on the breed of cows. So, some cows don't make A1 casings. So there is, yeah. So some sort of nuance on that, but in all my books, I talk about some people, it's about one in three people. would say, I say most people are actually okay with dairy, like dairy protein and don't get this reaction, but. a good portion of people do. And you know who they are because they're the ones who had recurrent ear infections when they were kids. They had tonsillitis. They had this like immune reaction going on from the very beginning. And then as adults, this can start manifesting as period problems, pain, heavy bleeding, premenstrual mood symptoms for sure. There's actually a study down at Deakin University in Australia where they were, I think it might've got derailed by COVID. I'm trying to find out the... status of the study, but they were trialing kind of A1 versus A2 casein dairy and premenstrual mood symptoms. I'm like, yes, please, you know, give us this data. That would be so fascinating. so I'm not sure of the status of that, but yeah. So the reason this relates to plant-based is I've said, I've had this on the ground experience with patients. They're like, my, they'll, they'll say, you know, my periods are amazing since I went plant-based. And I'm like, you the pain's gone, the bleeding's reduced. And, I believe them, you know, I think through my lens, I think one of the big things that's happened for a lot of them, when I hear the individual stories and I hear how they probably had dairy sensitivity from the very beginning, when they went plant-based, they went dairy free. And it was just, it's one of these things often with diets, cause we're doing like whole sets of changes. And then we don't necessarily know which part of the change has made. the difference. I wrote a blog post about this. This is my experience with patients and this is through my lens, what is happening. So there can be this immediate shift in health going plant-based, but beneficial sometimes it's the honeymoon period. Most of it's from getting off dairy for anyone who's had a dairy sensitivity. It's dramatic for periods. Sometimes you can also get the same result just from cutting out A1 dairy. then, unfortunately what happens with plant-based and Lara Briden (52:42.402) I'm trying to be as gentle around this as I can, but it's not, it doesn't provide the nutrients that we need. It doesn't provide what homo sapiens need, particularly our brains. It's a plant, plant foods are just, they're great in lots of ways. And, you know, I have lots of good things going on with them, polyphenols and they feed the microbiome and lots of great things, but they don't provide, you know, the carnitine, the taurine, the zinc, the iron, the like, you could just go on and on like the B2, the B6, all these things that the brain The human brain requires, our brain is very nutrient hungry, right? Like the homo sapiens brain needs so much. long-term, so what I've observed, I have observed with patients, many patients over the years, is depending on where they're at, if they're early plant-based, they'd be like, this is great. I feel so much lighter, I feel so much, that's the dairy-free. And then like 12 months in, 18 months in, they hit a wall. And that's when some of their storage, so the liver does store like vitamin A, B12. So when some of those stored nutrients start getting depleted and their tissues just really deplete, their immune system will start crashing, the anxiety that like it's the hitting the wall, the vegan hitting the wall at around, I've seen it. And I've had these conversations and sometimes the person is, agreeing and sometimes they're like, it can't be that. like, I think it's that. So I'm pretty clear that we, as humans, we need some animal-based foods. You know, I'm pretty sad about, you know, what I've seen with patients who, you know, have to sort of become convinced that they don't. I don't know how many of your listeners will be upset with me framing it this way. don't know. Okay, good. Roger K. McFillin, Psy.D, ABPP (54:34.969) Yeah, I wouldn't think so. I think I've been pretty open about this as we're treating eating disorders as long as I have as well as just anxiety and mood. I just see the challenges of somebody who's just malnourished on a plant-based diet. And I think what's worse about it now is that there's plant-based is like the new fat free. You see this in all the grocery stores, it's more processed junk. Lara Briden (54:39.82) Yeah. Lara Briden (54:49.313) Yep. Roger K. McFillin, Psy.D, ABPP (55:00.431) where they're labeled plant-based, so people think that they're getting a healthier diet, but they're sick. They look metabolically sick, nutrient deficient to me, and you can see it in their skin and their hair and a number of things. And it's nearly impossible for me to help someone who is in an anorexic state trying to re-feed to be able to gain any weight on a vegetarian plant-based diet. Lara Briden (55:00.673) I know. Lara Briden (55:23.5) Yeah. Roger K. McFillin, Psy.D, ABPP (55:28.987) It's just a, it's a real, it's a real dramatic struggle and getting people who haven't been eating, you know, animal based products back into it as a real, can be a real challenge. Lara Briden (55:40.556) So one of the phrases I've used in clinic many times, and so I decided to put it in my third book, as I'll say to people, like hand on heart, you know, if you're determined to continue exclusively plant-based, we're going to have to lower our expectations of how healthy you can be. So earlier I was saying, you know, I trust the body, the body knows what it's doing. Like, you know, it wants to have healthy periods. For someone, it is not none of that animal-based nutrition coming in, that's in many cases, just not going to be possible. And it's sad. It's hard as a clinician, isn't it? It's like, just want you to be well. I want you to get better. it's, Yeah. Roger K. McFillin, Psy.D, ABPP (56:21.371) How about supplements? Are there some like core supplements that you find yourself recommending for women who are trying to just address these menstrual health issues? Lara Briden (56:31.266) You have to give a plug for zinc, the humble, radical, humble but radical little nutrient zinc. It's very important in mental health as well. I'm sure you know it's, it's, it's one of the nutrients we do not store. So we do need kind of a regular supply of zinc coming in. The best source is animal foods, although there is zinc in some plant foods. And I've just found clinically that supplementing zinc can really improve certain period symptoms, especially period pain. was a clinical. my knowledge, one clinical trial, I think there may have been more of zinc for period pain, zinc versus placebo. And they found, this isn't teenagers specifically, but they found, they concluded that zinc reduces period pain as much as the pill does. And then they made this funny comment in the paper, which I just never forget. It's like, but you know, zinc is cheaper than the pill. I'm like, right. It's cheaper. And also it doesn't switch off. menstrual cycle. there's that. zinc, would be a therapeutic dose, would be about 30 milligrams a day. Always take zinc with food. I have to put that out there. I'm sure if people have tried zinc on an empty stomach, they'll know it can create nausea. It's not a harmful thing, but it's not pleasant. so yeah, that's one of my top ones. I love it because it's inexpensive and accessible and almost anyone can locate and afford a zinc supplement. Some others that I magnesium is also, you may have had other guests talk about magnesium. It truly is like, it does a lot in the body and it definitely does for periods as well. And magnesium is one of the modern, it's one of the missing nutrients that we have. And that's actually, that's actually more just from processing and also, depleted soils and the fact that the body well, peas out basically actively removes magnesium, you during the stress response to kind of fire up the nervous system. So we're just getting this constant, yes, it's one of those minerals that it can be very helpful. It's very helpful for premenstrual mood symptoms. One paper even proposed it's like, you know, is magnesium deficiency like one of the main drivers of premenstrual mood symptoms? I wouldn't go that far. There's lots of different drivers, but it's, again, it's an easy one to... Lara Briden (58:54.23) fix. A lot of the time in my books and down here, I prescribe this magnesium and to combine with the amino acid taurine. Those two things together are just really good for GABA receptors and mitochondria. that combo seems particularly beneficial. so down in Australia and New Zealand, we have these great magnesium taurine. They're magnesium glycinate, so magnesium joined to the amino acid glycine, which is also very beneficial. And then with like a three gram dose of taurine, and taurine is one of the animal-based nutrients, by the way, is I think one that we were meant to have. Taurine is a neurotransmitter, arguably it's its own neurotransmitter and it's also just generally supports brain health. Roger K. McFillin, Psy.D, ABPP (59:42.571) Improving sleep. Magnesium and taurine together, from what I understand, has been beneficial for people who having difficulty sleeping. Is that accurate? Lara Briden (59:53.218) Yeah. Yeah. I mean, yes. well, again, cause they, mainly cause they support GABA tones so they can just generally have a calming effect on the nervous system. They, don't have to be taken right directly before bed. find it clinically even just taking them at some point during the day, a good therapeutic dose would help to stabilize the nervous system enough to improve sleep. There's a new, magnesium, which I remember the exact chemical name of it. It's a, Magnesium tori, but it's not just magnesium tori, it's like an acetyl. It's somehow got something else in there that makes it more absorbable and potentially, I guess, cross the blood brain barrier. So it's magnesium and tori that is somewhat sedating. So that is also being used for sleep. Yeah. And it's great because it's not addictive. Roger K. McFillin, Psy.D, ABPP (01:00:38.523) Yeah. In the United States, it's more than 50 % of Americans are magnesium deficient. And we're pushing so many SSRIs, antidepressant drugs and other psychiatric drugs in this country. I often wonder, and since those drugs, like when you examine their effectiveness in clinical trials, it's not much of a difference between those drugs and a placebo response. just question why don't we... Lara Briden (01:00:47.84) Yeah. Roger K. McFillin, Psy.D, ABPP (01:01:09.541) prescribe like magnesium and taurine and then it could have that expectation effect that the placebo response that we see with the with these other drugs plus were All likelihood solving an issue. That's a real problem is gonna have these beneficial effects Obviously, I know the answer to it. There's nothing you know, the money's not in it in the same way But like for all everyone who is who's listening, you know, there's things you can do that can that can help your nutrition could help your health but also Lara Briden (01:01:28.802) Yeah. Roger K. McFillin, Psy.D, ABPP (01:01:39.451) is part of that where we've kind of been culturally conditioned. We have this consciousness around we have to take something or do something from a professional in order to yield a response. And like that's something that we can do that's going to be effective. Lara Briden (01:01:53.666) want to just respond to that a little bit because something I observed clinically, it's logical, right? So people have this sense that the more severe and distressing the symptom is, the kind of more medical or stronger intervention they must need. So I definitely do get some response from even some of my patients to be like, well, that can't be enough. They're like, my period pain is really bad. Like, you don't understand. there's no way that just as, you know, coming off dairy and taking zinc would do it. And I'm like, well, in my experience, can. So like there isn't necessarily, even though it seems logical to part of our brain that we must have to match the kind of, it must be, has to be prescription only to match the severity. But that's just not how the body. works. And I can say from almost 30 years of clinical experience, sometimes some very simple changes that feel like there's no way that should be enough are enough. Like that's just how the body works. Even, you know, very distressing symptoms can resolve with some fairly simple interventions, even though it might take a little bit of time. Again, I have to sort of, you know, insert the play the long game, you know, obviously, depending on the how distressing the symptom is, people are going to need some shorter term support, but also just trusting, you know, the symptoms, a lot of these symptoms can resolve. And I can say that with, you know, absolute certainty with even like quite severe period pain, it can respond to some very easy things. I will say one more thing about severe period pain, I guess on that topic, if that's okay. It's almost always involves gut inflammation. So this As I'm sure you've had many guests talk about the role of gut inflammation, intestinal permeability that plays a big role in mental health conditions as well. there's this bacterial toxin called lipopolysaccharide or LPS. When it enters, it's coming from the gut. It's usually coming, it's coming from the small intestine. Usually it's coming from something called small intestinal bacterial overgrowth or SIBO. Some of your listeners may know about this. Very common. And it creates a lot of inflammation and then those bacterial toxins. Lara Briden (01:04:06.966) You know, leak into the bloodstream potentially, they just leak into the proximity, like into the pelvis. And that is highly inflammatory. the immune system does not like seeing LPS outside of the gut. It really kind of freaks out about that, depending on the person. So with a lot of my patients, if, if, well, for lots of symptoms, premenstrual mood symptoms, but especially for period pain, pelvic pain, if there's SIBO or IBS or gut issues, that becomes the number one priority is like address that. And then the pain in general will reduce quite a lot. And that includes even if there has been a diagnosis of endometriosis, which... Roger K. McFillin, Psy.D, ABPP (01:04:47.833) So what contributes to the leaky gut? Lara Briden (01:04:50.978) Well, I mean, there's lots of drivers of leaky gut. I mean, obviously stress, alcohol, there's like a long list of things that promote leaky gut. but I would say gluten, potentially gluten sensitivity is another big one. And for context, and you know, a lot of people are fine with gluten, but for those people who are reacting to gluten, it's, it's hugely important for them. Like that may be the number one thing they need to do is to avoid gluten in their case. But one of the big drivers of. leaky gut or intestinal permeability is what I just said, it's called SIBO. It's often diagnosed as IBS or irritable bowel syndrome. It's not the only cause of irritable bowel syndrome, but it's this overgrowth of the normal gut bacteria, but up in the small intestine where they're not supposed to be. And it causes bloating. It's very uncomfortable. that's in my reading of the literature and my clinical experience, I think that's one of the biggest drivers of intestinal permeability. fortunately quite easy to treat. So that's the great thing. Like I'm a very practical clinician. I'm like, I want something that we can treat like a lever to pull to then, you know, improve everything downstream from that. treating SIBO just, you know, like quickly is this is where the low FODMAP diet comes in. This is probably where, to be honest, this is probably where a lot of benefits from a low carb or keto diet are coming in. It's not just that. I mean, again, the ketones themselves are beneficial and there's lots going on. But just getting out of the diet, all that refined carbohydrate that's feeding the bacteria in the small intestine, I think is one of the immediate or most proximate benefits of going lower carb is you just knock back that small intestinal bacterial overgrowth. So there's different ways you can do that. And then I do rely on a herbal medicine, a phytonutrient called berberine. quite a lot clinically. It's quite well known for its benefits for metabolic health, but it also can help with mental health. It does lots of things, but it can knock back that small intestinal bacteria overgrowth and reduce inflammation that way. It is one of the supplements that's a little harder to use because it can interact with medications, especially with psychiatric medications. So people do need to talk to their pharmacist or think carefully about using berberine, but I'm just mentioning it as a... Lara Briden (01:07:15.784) Example of something that I often prescribe for pelvic pain, period pain. might say, let's do a couple of courses of this. I wouldn't prescribe it long-term, then with the expectation too that probably premenstrual symptoms will improve with something like that, treating the gut. So that's an example. Roger K. McFillin, Psy.D, ABPP (01:07:36.313) Yeah, I mean, that's really important. It just occurred to me, we were talking earlier about how men produce hormones on like a 24 hour cycle. So they kind of cycle with the sun and women are on a, a monthly cycle kind of cycle with the moon. So would you see that there would be maybe different nutritional needs at different points in their cycle or are other lifestyle needs based on mapping out that cycle? Lara Briden (01:07:43.958) Yeah. Lara Briden (01:07:50.071) Yeah. Lara Briden (01:08:01.364) Yeah, that's a great question, Roger. mean, there's whole group of people who are really into this, charting cycles, eating with the cycle, even exercising kind of with the cycle. There are definitely subtle differences between the follicular phase and around ovulation and the luteal phase in terms of our subtleties around mood and energy use. You can, I tend to not want my patients doing too much micromanaging because I worry a little bit that, you know, paying that much attention to detail, depending on the person can create more anxiety than it helps. But for the right person, I think if they feel empowered by it, I mean, just a couple of just broad strokes things that are true. So leading up to ovulation when both testosterone and estradiol or main estrogen are kind of peaking. women will naturally, well, we'll have stronger muscles, we'll have a greater resiliency distress, reduced appetite. So women kind of go into this more outgoing, seeking behavior, like more just wanting to go out and do stuff and naturally lower hunger during that time. And then after ovulation, that does shift and women might feel a little more introverted, which is not a bad thing because I've been introverted, but just a little bit more and hungrier and just you know, the end, if, if people can track that and just feel empowered by it and realize, yeah, women, don't, we live in a world where we're expected to kind of be exactly the same every day, but, women can to some extent structure that structure their lives around that. would just again, clarify that it doesn't mean, because this can sort of then move into, well, are women, you know, can women do jobs? Cause they have different brains at different times of the month. It's not like you can still do whatever job it is you have to do. You could still do it at any time of the cycle. So it's not a handicap in that sense, but it can be, some subtleties around it. also broadly, again, through my biologist lens, I would say women have sort of just a higher nutrient requirement than men do for certain things. it's just... Lara Briden (01:10:23.102) it being a reproductive female. So after menopause, it all changes. So like that's a little different, but like being in those reproductive years, it's a very demanding time. Even if you're not actively in a pregnancy, but just like having cycles, the body has a lot of requirements to be able to do that. And one example is taurine, the amino acid that I mentioned earlier, women have a higher requirement because estradiol actually increases the requirement for taurine. So this is one reason I've kind of looked through my, you know, angle on things, thought, I actually find that men, back to plant-based just super briefly, which has, cause plant-based diets have no taurine. think men seem to be able to get away with it a bit better, but women crash and burn a bit sooner. And I'm wondering if it's just partly cause we just have higher requirements for certain things, especially zinc, especially taurine. yeah. So in answer to your question, yes. And if people want to explore, you know, eating with your cycle or like this, this like whole world, like there's whole like online groups that do this and you can track your cycle with temperatures and really get into it. Roger K. McFillin, Psy.D, ABPP (01:11:26.895) Yeah, that's great. One final question, because this has actually been extremely beneficial. Final question, I guess, is like interacting with the medical system. I mean, that's like one of the biggest challenges right now for a lot of women who want to advocate for themselves with this like alternative ways of kind of like addressing a lot of the problems that that we've presented today. And you go into the health care system and the allopathic medical doctor. Lara Briden (01:11:29.452) Mm. Roger K. McFillin, Psy.D, ABPP (01:11:54.201) really kind of dismisses a lot of the things that we discussed today. What kind of, I don't know, recommendations would you have as a way of kind of educating or just like working with the contemporary medical provider in Western societies? Lara Briden (01:12:12.546) Yeah, as you would have seen in period of peri-manual, actually in all my books, I have sections, how to speak with your doctor, trying to make those conversations as productive as possible. Just trying to get everyone on the same page because like, just as an example for what we've been talking about today, women are like, I want to have my own cycles. I want to ovulate. I'm sold on the idea that, know, estradiol and progesterone are beneficial. So that's, you know, going, going in, that's what they want. But their doctor's thinking, well, I just want you to not have symptoms. Like, so why don't you just... I don't understand why you don't just take the pill, which could eliminate symptoms. Like, why are we overcomplicating things? So like they're coming from different perspectives and you know, like, know, I work with a lot of doctors, like I'm friends with a lot of them. So I know, you know, they're, just trying to give women, you know, the best life they can. That's, that's their motivation. So I think the, the, the, in some of the, to speak with your doctor's sections, I just like frame it as to say, right, okay, I get, you know, I totally get that. just taking the pill could likely, not necessarily always, but might eliminate some of these symptoms. But I want to have natural cycles. Just make that the starting place. I'd like to do this. I'd like to able to ovulate monthly, and I'm sold on the idea that that's important. And you can see this research from Professor Pryor who says this is important. so given that, what are my options? And then also very specific questions like troubleshooting, irregular periods, like just ask the doctor outright. Like have I been screened for gluten sensitivity? Has my prolactin been tested? Do I have insulin resistance? Is it possible that I'm not eating enough? Like just kind of questions to move the conversation forward because it is true that for troubleshooting some of these period problems, especially the missing periods one, the doctor has to be involved. Like they're likely going to be the ones that have to sort of order some of those blood tests to rule out different possibilities. The feedback I've had from around the world is yeah, doctors do respond to that kind of approach. guess if you sort of say, you know, what it is you're trying to do. And I'll just say, started the podcast, the interview with just saying we're in a paradigm shift. do, this has changed a lot. So 10 years ago, it was to say anything about the pill was immediate smack down on Twitter. Like I can tell you, like it was like immediate, like it was like. Lara Briden (01:14:36.2) you, you know, the pill is like, you know, saved women as like, it's feminist, you know, important feminist icon and like just smack down, like, don't even say anything about it. That was about 10 years ago. And so I lived through that, or even before that, before social media, that was similar. And now, in 2024, just getting, you know, most people will be like, yeah, you know, I've heard about that research around how it changes the shape of the brain. I've heard about the depression risk, and that's concerning and Yeah, of course, pill withdrawal bleeds are not menstrual cycles. Yeah, I understand that. that's the change we've come through, which is encouraging. Roger K. McFillin, Psy.D, ABPP (01:15:17.209) Yeah, that's a good thing. You can see the challenges for me as a male psychologist. I've asking these questions, bringing it up. I work with sometimes parents who have, who have like just teens who have like real disruptive moods and like severe depressions have been suicidal. You know, broaching this topic, it's not, it's not an easy one because a lot of people still see it as term in terms of like, you know, freedom for a woman to prevent. pregnancy, but also now it's being treated for a range of other health conditions. And so it's very, very difficult. I'm hoping episodes like this, you know, help inform people to understand the risks. And that's really what I think is most important is there has to be value here for informed consent. So people understand that there's alternatives to what the allopathic medical doctor is telling you and knowing that there are risks for what often is just minimized, you know, the hormonal birth control is minimized, SSRIs, the risks are minimized. This is over and over again, we're seeing this problem. And there is a paradigm shift or an awakening that's occurring and you can listen to podcasts like this and you can be informed on a lot of different issues, things that necessarily weren't available to us previously. And this is the rapid shifts that are occurring globally of the informed consumer or the informed patients. That is bringing about challenges and interacting with doctors and major medical centers and so forth because they're not used to being challenged like this, but it is an informed populace. And I want to just really thank you for your willingness to come on the Radically Genuine podcast today. And we had, I think, a real thorough conversation about a lot of different issues. Where can people find you? What are your books? Where can they get them? Lara Briden (01:17:03.084) Great. Thanks so much for the conversation, Roger. Yeah, it's great to, yeah, talk, talk it all through. So I'm easy to find. I'm at my blog is larabradin.com. I still have a blog, old school. and my books on my social media is at larabradin and I have three books. So period repair manual, we've been talking about today, hormone repair manuals for women over 40. And then metabolism repair for women is all about insulin resistance and metabolic health and for women of any age. Roger K. McFillin, Psy.D, ABPP (01:17:32.219) Yeah, I think I'm gonna have to bring you back to address the other two books at a later time because this is really important information and I know there's a yearning for it from those who are listening to podcasts like mine and to our really, you know, considering all these alternative ways to be able to achieve just general wellbeing, you know, and you can see how everything's kind of well connected, right? We talked today about the period as a very strong indicator of health and... Lara Briden (01:17:35.732) Yeah. Lara Briden (01:17:54.699) Absolutely. Roger K. McFillin, Psy.D, ABPP (01:18:00.671) I'll say it a million times. mean, my concern where we are still even in 2024 in the United States is that women's health problems are being often misdiagnosed as psychiatric. I hope that a conversation like this helps people understand the complexity and allows us to kind of progress forward in being able to understand women's health issues and protect them from harmful interventions. So Laura Brighton, I wanna thank you for a radically genuine conversation.