Latest / hol+ with Dr. Taz MD | The Future of Medicine is Holistic / Normal Labs but Nothing Makes Sense? PCOS, Mood & Brain Health Explained with Dr. Sarah Oreck
Transcript
- Dr. Taz: [00:00:00] Before we dive in, I just wanna say how much I enjoy hearing from you guys every week. Your dms on Instagram remind me of why I started Whole Plus in the first place, to make health simple, human and personal. Again, if you're listening right now and something from this show hits home, please send me a message at Dr. Dr. Taz: Taz md. Your stories inspire what we talk about next, who we bring on, and what we wanna dive into. Alright, let's get started with today's episode. Dr. Sarah Oreck: I'm that [00:00:30] person who I do everything. I've been on every diet. I exercise every single day and my waist always fluctuating. I do the work and nothing's happening and nothing's happening. Dr. Sarah Oreck: Or I eat exactly like my roommate. I eat exactly the same. I'm so active and yet I change clothing sizes every couple of months. And this is often meant, oh well you must be becau eating right. You must be lazy. You're really shame game. Right? The shame game. Yeah. And so that's where we start to, to see it. Dr. Sarah Oreck: This impacts so many things and. See that, oh, oh, I've been chronically depressed, chronically anxious [00:01:00] bulimia. I'm sometimes seeing as the, oh, this was a coping strategy I had, and then to finally understand what was underneath it is this revelation. Wow. But it doesn't Dr. Taz: come for a long time. My guest today, Dr. Dr. Taz: Sarah oric, is a reproductive psychiatrist and founder of Avita Health, who's changing the way we think about women's health. She believes PCOS isn't just a hormonal disorder, it's a mental health story too. We'll talk about how inflammation and insulin resistance affect [00:01:30] brain chemistry, why so many women go undiagnosed for years, and what needs to change. Dr. Taz: So emotional support becomes a part of every treatment plan. Dr. Sarah Oreck: We're finally starting to use that word inflammation. I think we're gonna start to see it not in PCOS alone, but in other diagnoses that. With all those autoimmune diseases that women have and men don't. Mm-hmm. Like, I think there's a big a misunderstanding and we just don't know enough about how inflammation impacts us. Dr. Sarah Oreck: And actually, you know, we talk about serotonin and dopamine, right? [00:02:00] But in psychiatry and in our brain, we're starting to think more about inflammation may actually be one of the core reasons for depression, anxiety, et cetera. This Dr. Taz: is a conversation about more than hormones. It's about healing the whole woman, body, mind, and soul as someone with PCOS. Dr. Taz: And a family full of women with PCOS. I probably know this disorder a little bit more than I actually would like to, and there are so many different manifestations of PCOS, polycystic ovarian [00:02:30] syndrome, but one of the ones that does not get addressed. That I'm dealing with currently with my own daughter is the mental health component of this disorder and how the androgens and the hormone shifting and the inflammation can actually change your mind. Dr. Taz: And what that means is issues with focus and concentration, memory, and even your emotions. And if you're thinking it's just an issue for people that are maybe in their teens or early twenties. Think again, this [00:03:00] entire issue with cognitive dysfunction and PCOS re flares as women go into perimenopause and menopause. Dr. Taz: I'm so excited about my next guest because we're gonna tackle PCOS in a conversation that's not just about hormones. But about your whole body and specifically about your mind, please join me in welcoming Dr. Orrick to the show. Dr. Orrick, welcome. Thank you so much for having me. We are about to talk about one of my favorite topics, partly [00:03:30] selfishly, because I have PCOS. Dr. Taz: Our entire line of women, if you look forward or backward, has PCOS or they had it and didn't know they had it. And I think I've seen every manifestation, and we've talked about that here on the show. We've talked about it in our clinics. We deal with it all the time. But you know what gets the most. Dr. Taz: Underserved or under recognized is the cognitive and the mental health component of PCOS and the learning component of PCOS. I have a 17-year-old daughter. I [00:04:00] am telling you, the week before her cycle, you know, probably two weeks before her cycle, she's a different human and it shows in her grades as well, you know, so, I mean, I think that. Dr. Taz: That we need to shed a little bit more light on this and what better person to bring this in. You're an integrative reproductive psychiatrist, right? Like marrying so many different fields together, you know? How did you fall into really diving into the world of PCOS and mental health? Dr. Sarah Oreck: So it's not necessarily about PCOS, my origin [00:04:30] story, but it's about medical gaslighting. Dr. Sarah Oreck: So when I was about, uh, preteen, you know, those really formative years, around 12 years old, my mom was in her early forties and started to experience what we now know as perimenopause. But she had to go to like. Eight to 10 doctors because everyone told her, you're too young. Yeah. That doesn't make sense. Dr. Sarah Oreck: And yet all of the symptoms were sort of very clear now in retrospect of what was going on. And I saw her sort of change in front of me. Yeah. She all of a sudden had a bout of depression, a lot of mental health [00:05:00] issues. So then cut to when I'm in medical school. Right. Deciding between ob and then I fell in love with psychiatry and I was privileged enough to go to a residency at Columbia University in New York. Dr. Sarah Oreck: Where they had women's reproductive mental health, where we studied how hormones and female reproductive hormones really impact the life cycle. Wow. Yeah. And so in these really big transitions, of course the path to parenthood is one perimenopause, but PCOS is huge, and I think I'm just seeing so many more women in [00:05:30] there. Dr. Sarah Oreck: Sort of adolescence mm-hmm. Into their twenties, dealing with these issues and yet being told a number of different things, not getting a diagnosis for a long time. And then I'm really seeing that in my private practice and finally being able to kind of give some answers to experiences they, they've been having for a long time. Dr. Taz: Why do you think, and by the way, that gaslighting piece, that was, that's what got me into this whole world. I mean, it was literally 18 months, 10 doctor visits told I was anxious, depressed, stressed. Yes, exactly. Dr. Sarah Oreck: Exactly. Dr. Taz: Here's a medication for this. A [00:06:00] medication for that. But I had PCOS, right? That's right. Dr. Taz: But anyhow, but why do you think that? We are not paying attention to PCOS and women's health or we're, or mental health in particular. Like, yes. I mean we could even talk about PCOS 'cause that's still not being diagnosed at the rate that it should be absolutely being diagnosed. But what, why do we think we're missing it? Dr. Taz: Why are clinicians missing it? Why are, you know patients missing it and understanding that interconnectedness, what's going on there? A hundred Dr. Sarah Oreck: percent. I think we know so little about women's health. Facts. Women's, you [00:06:30] know, women weren't in clinical studies until the nineties. Like there's just so much that's missing. Dr. Sarah Oreck: Yeah, and I think we're finally at the stage of like, we kind of start to understand this, but we need so much more research and funding. But it starts from the beginning. Do you remember PCOS being a huge thing? No. In medical school, like or in any of your training? No, no. Not at all. And so that's exactly right. Dr. Sarah Oreck: Like I don't even think an OB-GYNs are getting that much exposure, right. To here's how you diagnose and here's, so I think it's a failing in our education. And also I think there's a problem with the [00:07:00] education of, and, and people's health literacy around their menstrual periods, right? What that means. Um, and you'll even see that there's not that many people that understand how the length of their cycles. Dr. Sarah Oreck: Or what that even means. They think it's like the number of days you have your menstrual period. Right. And so I think there's so much in terms of education, both from a medical perspective, but also from just the lay public. Dr. Taz: Correct. And then I think too, like some of the treatment options, like birth control pills or you know, [00:07:30] spironolactone or some of these things that are traditionally used in PCO like mask. Dr. Taz: Yes. The mental health component too, you know, so it's like this. And Dr. Sarah Oreck: sometimes they make it better, sometimes they make it worse. Make it worse. That's yeah, Dr. Taz: that's right. Absolutely. So, and Dr. Sarah Oreck: there is enough validation, and I think this is why I feel like this is a really important moment of like, yes, there's symptoms of PCOS that can affect your fertility, that can affect your, whether your cycle comes on time, or what those cycle links are like, right? Dr. Sarah Oreck: But there's also individual independent mental health [00:08:00] issues. That need to be addressed. Dr. Taz: So let's talk about those. What are you seeing both in research and in your, you know, exam rooms when it comes to women with PCOS and mental health? What's happening? Dr. Sarah Oreck: I'm seeing that the women who are dealing with this, and again, it's hard to parse out, is it because you have all these other medical symptoms, right? Dr. Sarah Oreck: And all this medical gaslighting and you're not getting answers. But I'm seeing, uh, rates about four times as much in someone without a. Uh, PCOS increase in depression. So [00:08:30] four times the amount of depression, five times the amount of anxiety. Dr. Taz: Mm. Dr. Sarah Oreck: Five times Dr. Taz: the amount of anxiety. Yes. Dr. Sarah Oreck: And I think there's actually right, a biological mechanism to this, and I think we're finally starting to use that word, inflammation. Dr. Sarah Oreck: Yes. Thank you. But. I, I do think that, um, and we're, I, I think we're gonna start to see it not in PCOS alone, but in other diagnoses that, oh, with all those autoimmune diseases that women have and men don't Dr. Taz: mm-hmm. Dr. Sarah Oreck: Like, I think there's a big a [00:09:00] misunderstanding and we just don't know enough about how inflammation impacts us. Dr. Sarah Oreck: And actually, you know, we talk about serotonin and dopamine, right. In psychiatry and in our brain, we're starting to think more about inflammation may actually be one of the core reasons for depression, anxiety, et cetera. Dr. Taz: Absolutely, absolutely. And in our integrative world, we think of depression and anxiety is neuroinflammatory conditions. Dr. Taz: Absolutely. Right. Where the brain is literally on fire for different reasons. Yes. And it's different for everybody, but That's right. Um, [00:09:30] but so when these patients are coming in. Like, is it anxiety dominant? Is it depression dominant? Like how are you able to diagnose it? Do you check hormone levels and compare it to that? Dr. Taz: Like what are you seeing there? Dr. Sarah Oreck: It's varied, so I think. Obviously I see a lot of people because I focus on female reproductive hormones that are trying to become pregnant. Right. Okay. And so that path to fertility, honestly, and I don't know if you agree, is sometimes the first time people kind of get this diagnosis. Dr. Sarah Oreck: Oh, Dr. Taz: totally. A hundred percent agree. Yeah. 'cause like there's [00:10:00] no other, there's no other reason. I mean, Dr. Sarah Oreck: people have complaints, but they dismiss them. Right. Oh, you're just young. You're cycle acne is normal, hasn't been regular. Acne's normal and a teenage girl, all that stuff. And so this is the first time that I think people are getting these diagnosis. Dr. Sarah Oreck: I'm seeing these diagnoses increase throughout my career. I think there's also some exogenous, like we we that we can't control for. Obviously there's endocrine disruptors in in our in every day. Dr. Taz: Correct. Uh, Dr. Sarah Oreck: that may be contributing to this, but I am seeing more of a [00:10:30] diagnosis there and what I notice is. Dr. Sarah Oreck: I'm that person who I do everything. I've been on every diet. I exercise every single day, and my weight's always fluctuating. That's also another reason outside of the fertility, that people sometimes Yes, for sure. Yeah. Like I'm the person who has, I, I do the work and nothing's happening and nothing's happening, or I eat exactly like my roommate. Dr. Sarah Oreck: I sometimes in younger women, I eat exactly the same. I'm so active and yet I change, um, clothing sizes every couple of months. And this has often been, oh, [00:11:00] well you must be closet eating Dr. Taz: right. Dr. Sarah Oreck: You must be lazy. You're really a shame game. Right? The shame game. Yeah. And so that's where we start to, to see it. Dr. Sarah Oreck: Um, and you know, I think this impacts so many things. And then you see that, oh, then there's this, oh, I've been chronically depressed, chronically anxious bulimia. Dr. Taz: Mm. Dr. Sarah Oreck: I'm sometimes seeing as the, of this was a coping strategy I had, and then to finally understand what was underneath it. Is this revelation. Dr. Sarah Oreck: Wow. And it doesn't come for a long time. Dr. Taz: Right. And again, I shared [00:11:30] with you that I have a teenager and I've definitely seen the ups and downs mentally. Yes. With her hormones. Absolutely. Right. And then I see it in our patients too. Right. Same thing. How are you checking hormone levels? Is there a hormone pattern people should be, is it the blood sugar component of PCOS? Dr. Taz: Is it the androgenic component? Is it the estrogen dominance? Like what Dr. Sarah Oreck: Yes. Dr. Taz: Help us, like what's going on? So we're, Dr. Sarah Oreck: we are checking labs sometimes, of course, they're under the care of a reproductive endocrinologist. So that's sort of, you know, someone else is taking care [00:12:00] of that. Right. But I am seeing sort of these high levels of testosterone that no one's ever checked. Dr. Taz: Right. I Dr. Sarah Oreck: actually had a patient recently who came to me, had, had the story of fluctuating weight, anxiety, and depression. Um, and she's young, so it's been, oh, you have anxiety and depression, right. So does, you know Right. Most of your peers. Right. Um, fluctuate, like kind of very irregular periods, had had a really high testosterone for about like two years that her doctor, how old, just sat on how old she, uh, early twenties. Dr. Taz: Early twenties, [00:12:30] yeah. Yeah. Dr. Sarah Oreck: And just sat on it. Um, looks like it might be normal. Obviously the male pattern, sort of hair growth and hair loss and, um, you know, it's, it's those things that are like, uh, just challenging to see that it's kind of ignored by a lot of clinicians. So I like to look at testosterone. Dr. Sarah Oreck: Okay. I think sometimes that gives us some, uh, but obviously I think getting the ultrasound and how you're diagnosing it is. That broader dam diagnosis, we can talk about that, right? The two to three kind of [00:13:00] categories. Um, what's really interesting is the name is even a misnomer, Dr. Taz: right? Dr. Sarah Oreck: Tell us about that. Dr. Sarah Oreck: Um, well, tell us about Dr. Taz: the broader, let's go there. Uh, talk to us about the criteria for diagnosis. Yes. And there was a recent report that updated the criteria. It's not that recent. I think it was like two years ago, the 2023 or 2022. There was a, some sort of updated report on how to diagnose PCOS. I'm blanking on the organization that did it, but it. Dr. Taz: Segmented PCOS diagnostics by race. You know that, that how there's [00:13:30] a racial, you know, uh, components or components to a different story. But I don't think I'll have to go back and look at it. I don't think it talked about. Mental health. I think it talked about weight and they still don't talk about mental health. Dr. Taz: It's, it talked about fertility, it talked about cycles, you know, and anovulatory cycles. Yes. And all that business. Missing your cycle. Dr. Sarah Oreck: Hyperandrogenism. Dr. Taz: Yeah. Hyper andro. I don't think it talked about the, the cognitive or the, I can see that. Mental health, no, I, yeah. But anyhow, I haven't. Dr. Sarah Oreck: Seen that as any of the, the components. Dr. Sarah Oreck: Um, so really what we're [00:14:00] looking for is hyperandrogenism. This is this increased sort of male testosterone. But again, women also have testosterone, right? It's just a mis over. Um, and you kind of start to see the acne, the hair growth that is kind of unusual for women and the male pattern. Hair loss, frankly. Dr. Sarah Oreck: Yeah. That weight gain that's sort of in that middle area. Um, and what's interesting is when you do an ultrasound, what you're looking for, and it's polycystic ovarian, right? But what we're actually seeing is [00:14:30] follicles, right? So it's just a lot more follicles than you would see typically. Uh, but even that, it's, you know, that it has that mis That's why Dr. Taz: that high am MH is imp like I'll look for a high am MH Oh, that's interesting. Dr. Taz: Versus just, you know, a MH, you know, is usually used for fertility, right? Yes, exactly right. You have eggs. But if it's too high, that's assigned to me of PCOS as well too. Oh, Dr. Sarah Oreck: that's a, that's a, that's a great tidbit. Yeah. I don't usually do amms. Right, right. But, but absolutely. So I think, um, you know, those things are all significant, but again. Dr. Sarah Oreck: It's [00:15:00] hard to kind of pin down this diagnosis. Also, people, unless they're using a cycle tracker, like aren't tracking their periods necessarily. Sometimes people don't know or they've been on birth control for so long that they had no idea. Yeah. If they're anovulatory or not. Yeah. So I think that there are these significant systemic challenges. Dr. Taz: So one of the biggest things with the weight component of this right, is the blood sugar instability. And I feel like one of the ways I've been able to pick it up [00:15:30] too is just like reactive hypoglycemia, right? Somebody whose blood sugar is just maybe not necessarily high. Yeah. Everyone's always looking for like the high number's. Dr. Taz: Yeah. You know? Yeah. And it's not necessarily high and you don't necessarily Dr. Sarah Oreck: see that. Yeah. It's just Dr. Taz: up, down, up, down, up, down. For re, it's not their diet. Like they're not doing anything wrong, you know? No. So that's another one. How is insulin and inflammation and blood sugar tied to the mental health component? Dr. Taz: Oh, of PCOS? Yeah, this Dr. Sarah Oreck: is great. I think people think of insulin so much as just like. [00:16:00] What your body does. Right. And they kind of disconnect that your brain is so highly influenced by insulin. So I thought it was really interesting that you mentioned before we started. Mm-hmm. And I don't know if you're okay with me sharing the anecdote about your daughter of like, um, cognitively or in her like tests or the, the. Dr. Sarah Oreck: Kind of what she's doing at school, you can see that there's a difference, right, in these really, um, vulnerable times for her. And I think what we're seeing is that insulin sensitivity impacts your brain function. [00:16:30] And so when you are not and when you're insulin resistant, that impacts how you are cognitively doing. Dr. Sarah Oreck: And we actually think that that cascades down to the kind of neurotransmitters your brain is actually producing. And again. Mental health is way more complex, right? And depression and anxiety is not just serotonin syndrome, right? It's all these circuits. But all of these things working together is really important. Dr. Sarah Oreck: And we also forget how much female reproductive hormones actually impact serotonin production. And [00:17:00] then that downstream really impacts. Our moods, like it's no surprise that women have much higher rates of depression or anxiety during their reproductive lives. Hmm. And I think that's always kind of forgotten. Dr. Sarah Oreck: But without even a diagnosis of PCOS, our rates of depression anxiety are two times men. We only sort of start to have the same rates of mental health issues once we're post-menopausal post Dr. Taz: menopause. Yeah. Dr. Sarah Oreck: And yet we have these huge times, and I think PCOS [00:17:30] is gonna be this next. I think the next space where people really start to pay attention with mental health, especially because we're starting to see, and I've seen this with GLP ones, I don't know if we're gonna go here. Dr. Sarah Oreck: We can go anywhere. We can go anywhere. So I've started to see just the impacts it makes not only on weight, but on mood. Dr. Taz: What are you seeing Dr. Sarah Oreck: when it's, it's even secondary to it, but. Oh, you know, I don't have all these bright, all these food thoughts [00:18:00] anymore. This sort of obsession and compulsion around it. Dr. Sarah Oreck: But even independent of that, there's just not as much noise in terms of depression and anxiety. Do you think it's Dr. Taz: stabilizing the blood sugar and reducing the inflammation? I really, yes. And then it's taking down absolutely. The anxiety and the. Dr. Sarah Oreck: Or once you don't have that insulin resistance, your brain is sort of firing on all cylinders. Dr. Sarah Oreck: Yeah. You're able to make all of those neurotransmitters that you need. And so it's this really interesting phenomenon where I've had people start GLP one, then all of a sudden they're not [00:18:30] on SR SSRI anymore. Dr. Taz: Fascinating. So, okay, we have to talk about cortisol. Yes. What's your sense of cortisol? It's the cortisol's getting like hot right now. Dr. Taz: It's, well, just cortisol. I have again, a motivation for asking this question, but cortisol, along with insulin and its role in PCOS, how does that fit into the, I call it the PCOS triangle. How does that fit into it? Dr. Sarah Oreck: In, into the kind of mental health aspects? Mm-hmm. I mean, listen, we've kind of known for a while that cortisol is. Dr. Sarah Oreck: [00:19:00] So impactful in terms of anxiety, symptoms, panic symptoms. Right. It's that it's really that hormone that kind of spikes in us when we have that fight or flight sensation. And women so much of the time are experiencing that. And so for me it's like, of course this fits into that inflammatory picture and I think it's worsening mood symptoms. Dr. Sarah Oreck: Mm-hmm. But I'm also kind of thinking about how our nervous systems, because of some of the things that we're exposed to. Yeah. Some of the social media. Is already kind of worsening that. So kind of independently and [00:19:30] dependent on that. I think all of our cortisol levels are being deeply impacted. Totally taxed and rewired. Dr. Taz: So I'm gonna ask you another selfish question, and I promise I'm gonna show you where I'm going with this. But do you think that the diagnosis of PCOS is on the rise? Or do you think the occurrence of PCOS is on the rise? Do you think we're seeing more of it or do we just know more about it? I Dr. Sarah Oreck: know it's a little bit like autism spectrum disorder, right? Dr. Sarah Oreck: Where it's like. Which is it? Are we getting a little bit better at diagnosing? I think we're getting a lot better. And I'm so happy [00:20:00] about like a podcast like this, right? Because someone hears and says, Hmm, I've had weight issues, I've had these menstrual irregularities. I'm having anxiety and depression and cognitive issues. Dr. Sarah Oreck: Like maybe this is me. And I think people are seeking out, Hey, I wanna find out the answers. The answers right, right. Um, so I think that's really exciting and I think that's part of it. But I also think that there's some sort of, you know, environmental. Something going on. Yeah. Where we're impacting fertility rates big Dr. Taz: time. Dr. Taz: Yeah. Dr. Sarah Oreck: I [00:20:30] think we have a lot of endocrine disruptors in our midst and I, I do think it's impacting, you know, processed foods we think impact a lot of this. So I do think it's, it's probably both, frankly. Dr. Taz: Well, it's, it's interesting to me on so many fronts, again, personally, and then even if you look at South Asians, apparently like 75% of women have some form of PCOS in that community because they have such bad insulin resistance for whatever reason. Dr. Taz: Yeah. I don't know what the [00:21:00] origins of that are, but the study that really, and this is another one that just recently I saw, and it was fascinating to me, but it was actually from Placenta, the journal, and it was talking about prenatal exposure to cortisol. And androgens. Mm-hmm. Increases childhood behavioral disturbances. Dr. Taz: Well, before they even got to childhood, they talked about colic. Dr. Sarah Oreck: Yep. Dr. Taz: And irritability in the infant. Dr. Sarah Oreck: A hundred percent. And Dr. Taz: then the behavioral component Yes. For the child and then. [00:21:30] Poor the language. Again, I'm gonna misquote it, but poor, uh, poor ability to externalize feelings. AKA anxiety and depression as they moved into puberty. Dr. Taz: And tying it back to prenatal, the prenatal or the preconception environment, you know? Yes. Separately, if you look at studies, you see the studies on all the different chemicals, the phthalates. Mm-hmm. You know, um. You know, all the stuff basically, and how that is influencing a more androgenic, hyper, uh, [00:22:00] hyper androgenic environment or, uh, sort of a, a stored estrogen environment. Dr. Taz: Yeah. The two are often leaked together. Are you seeing some of that in Dr. Sarah Oreck: clinic? I'm certainly seeing, um, and you know, it's hard to tell, right? Because of course, a previous generation, right. Didn't test all to stop. There was Brook Shields also talking about postpartum vision. People don't really even understand that, uh, some mental health issues occur during pregnancy. Dr. Taz: Yeah. Dr. Sarah Oreck: And so this is why we, in our field, we've, in reproductive psychiatry, we're always a proponent [00:22:30] of, Hey, if it starts in pregnancy and there's untreated mental health issues that affects the baby. Yeah. So often people are just so preoccupied with, I've gotta do the best. I've gotta not take this, I've gotta not do that. Dr. Sarah Oreck: Wait, let's Dr. Taz: talk about that though. What is the connect, okay, so Chinese medicine is passionate about the, not passionate, but they've like are founded in this idea of the mom child connection, right? Health of the mom is connected, the health of the child. What is that connection when. The re the mental health of the mom beyond what we know, like [00:23:00] maybe the mom's not gonna be engaged and stuff like that. Dr. Taz: Yes. Is there another connection between what's going on with the mom and her mental health and the unborn baby? Dr. Sarah Oreck: Yeah, so actually it's connected to cortisol. Dr. Taz: Mm-hmm. We're Dr. Sarah Oreck: back to cortisol. So when, back to cortisol, when we are having sort of these, um, big reactions, anxiety, panic, you know, people often think just medications get to babies. Dr. Sarah Oreck: Right. But no. Your hormone levels, your cortisol levels, those are all transferred, baby getting to through the placenta, into your child, and ultimately that's [00:23:30] where we see some neurobehavioral issues in children independent of anything that mom did, right? Just that she had untreated symptoms that weren't addressed. Dr. Sarah Oreck: This is why it's so important to kind of get. Fat care. Yeah. Whether it's therapy or just support so you can get through this pregnancy and have the best outcome. But often people are just so worried about, you know, if I have to take a medication during pregnancy, right, am I gonna impact your child? And actually the answer is you not having, you know, you having the best [00:24:00] health possible and the most optimal health is gonna be the best for your baby. Dr. Taz: So for I guess any pregnant mom out there or any young woman thinking about getting pregnant, right? Like thinking about your mental health. Oh. And understanding where you are. And if it is changing, yes. As these hormone surges are taking place. 'cause of course they're gonna change. They're gonna change, you know, so your hormones are Dr. Sarah Oreck: increasing, your sex hormones like estrogen are increasing to levels that they never have in your entire life. Dr. Sarah Oreck: And then they're gonna plummet. To a level they never have in the [00:24:30] shortest amount of time, um, in the postpartum. So it really is a very, very impactful time. But I think we have this perception of somehow you're pregnant, so you're gonna be in this like, happy, happy, joy, happy end. It's this wonderful thing. Dr. Sarah Oreck: But I think for most of us that have been through it now, that it's not all no rainbows and butterflies, Dr. Taz: not at all. Um, do you treat the PCOS pregnant mom differently than another mom? Dr. Sarah Oreck: That's interesting. Um, [00:25:00] I think the PCOS moms have typically had a long fertility journey. Yeah, Dr. Taz: true. Dr. Sarah Oreck: And so that I treat everyone who's had a long fertility journey, almost like I say, you're, it's not just this pregnancy. Dr. Sarah Oreck: You've been pregnant in some ways for all of this time, right? That you've been thinking about this baby doing all of these procedures. So their, you know, prenatal period is sometimes two to three years. Wow. And that's really impactful. Right. By the time you do an egg retrieval or you get to IVF, right. Dr. Sarah Oreck: [00:25:30] They may try to do I UIs first and then Right. Which is intrauterine insemination and then in vitro fertilization. It's a long, arduous task. Very. Dr. Taz: So for those women, what is, what's their path? What do you recommend to them? I, I think Dr. Sarah Oreck: it's a lot of support. I always say. A village is so important. There's so many women that are dealing with similar things and if it's not necessarily PCOS, trust me, a woman has been gaslit in her medical sort of journey [00:26:00] somewhere in there. Dr. Sarah Oreck: Like do not, I would say PC Os is endometriosis. It's end. The two goes together. Yes, yes. Oh my God. I think one of the two and endometriosis is also this next, right. Um, so many connections with mental health as well, and sadly needs to have better diagnostic trait. I know. I mean that a surgery is the diagnostic tool. Dr. Sarah Oreck: It's ridiculous. It's ridiculous. Yeah. Um, so I think very similar in this way. Like you will find partners and more and more of us are struggling in this way. And I [00:26:30] think, um, you know, I think that village is really, really important in this time and going to sources that you're going to get evidence-based care from. Dr. Sarah Oreck: 'cause again, there's a lot of noise right now. Dr. Taz: How do, how does somebody know where to go though? Because there's a lot, you know, just on social media, there's a lot everywhere, you Dr. Sarah Oreck: know, and I don't know what your experience has been, but I've seen a lot of dismissal of PCOS by OBGYNs. Oh, all the time. Yeah, all the time in our clinic. Dr. Sarah Oreck: And that's like, and that's like the. That's like the [00:27:00] specialist you would think to go to. Same with endometriosis actually. Dr. Taz: Well, we still see like, oh, you don't have cyst on your ovaries. You're not, you don't have, you don't PCOS. Yes, yes. We still see that. I have patients come back and say, all time you, but that's not, that's one Dr. Sarah Oreck: of the potential diagnostic criteria. Dr. Sarah Oreck: But you don't need to hit that. Right, Dr. Taz: exactly. So we see that and we see a lot of it missed. But again, for somebody with mental who's having the mental health component of it, I guess it's twofold. What does the patient need to understand and what do we, the clinicians [00:27:30] need to understand? We each probably need a checklist of some kind to be like, okay, yes, this is the conversation we need to be having. Dr. Taz: You know, and then we can get into kind of like, okay, now that we're on the same page and we agree that whatever's happening is because of PCOS and the hormonal, here's what we can do and here's what we need to do. So help us through that. Dr. Sarah Oreck: Yeah. So I think this is why I created the company that I created called Avita Health. Dr. Sarah Oreck: Because I wanted to scale what I did, which was really small. Mm-hmm. So I had a private practice and most of the people who are like me, [00:28:00] reproductive psychiatrists, there's only 15 programs in this country. Oh wow. Graduate, maybe one or two medical doctors a year. That's not enough people for the, um. For all the women that need this type of care. Dr. Sarah Oreck: And so what I wanted to do with Avita is really be able to scale it and then teach all of the clinicians that we employ about all of these reproductive mental health issues. And we ask all of our patients about their cycles. What was your first period like? What is your cycle length? Dr. Taz: Right. Do Dr. Sarah Oreck: you have any other diagnoses? Dr. Sarah Oreck: Oh, [00:28:30] you have ma male pattern hair grow, though you have a lot of acne. And we start to put the pieces together because we think that's essential to the mental health treatment. So it's even like, can we start taking histories Dr. Taz: that are better? That Dr. Sarah Oreck: are better like any, for any mental healthcare. Of course I'm biased, right? Dr. Sarah Oreck: But I think you should. If if you're, if a woman's in front of you, how come you're not asking how many times history she's been pregnant. History, right? Hormone history. Um, and it's just not happening. A lot of people will say, I went to a psychiatrist and they never asked me anything. [00:29:00] They don't know how many times I've been pregnant. Dr. Sarah Oreck: They don't know if I have PCOS. Then starting to put that picture together because you can't just give medications and just therapy alone for PCOS, you have to have the other treatments. But it's, I think it's the education that, for us, is kind of what we're really working on, where we start to lay the foundation of like, these things are interconnected. Dr. Sarah Oreck: They're not really that independent from each other. Are Dr. Taz: there screening checklists that. A provider could put into place within their clinic [00:29:30] to be like, I would love that. You know, just like we have, you know, for, for, for like, for teenagers and you know how you have the gas or postpartum depression. Yes. Dr. Taz: Yeah. The postpartum, the eating disorder. We have these established screening, you know, criteria that we'll use in practice. Like I don't think we have an established one for PCOS, but what Dr. Sarah Oreck: does that require? That requires clinical study Dr. Taz: and consensus and consensus and clinical study and also Dr. Sarah Oreck: validation of those screening tools. Dr. Taz: True. Yeah. But Dr. Sarah Oreck: I think that. Right. That's a fabulous idea. Dr. Taz: So let's take it forward. So we all agree we're in the [00:30:00] exam room. We all agree that this is hormone based androgenic insulin, blood sugar based. Cortisol based, yes. Anxiety, depression, even bipolar sometimes OCD, all these different things. What's the next step? Dr. Sarah Oreck: So from a mental health perspective, we make sure that you are kind of connecting with that treatment team. That can help though it's hard to find, right? Because I said sometimes what we have people bouncing around different obs who are like, man, go like, you're fine. And. So then what we say is like, let's help [00:30:30] you in this kind of discipline or this area, let's help you with the mental health aspects. Dr. Sarah Oreck: But always kind of thinking about, okay, do you, is there, do you wanna try hormonal birth control? Do you wanna try spironolactone? Like, what are all, 'cause I think it's, it's, it's a interdisciplinary issue. Mm-hmm. I think too much of the time, like we haven't been doing that. Um, and so we certainly talk about evidence-based supplements that we like and we wanna integrate, but, you know, I, I, I really wish [00:31:00] that there was, um, more openness and discussion about this and I think education for clinicians as well. Dr. Taz: What are some of the best supplements for somebody with PCOS who's starting to have, you know, some of these mental health symptoms? Dr. Sarah Oreck: Yeah. You know, there's some small research about ceal. Dr. Taz: Yeah. Dr. Sarah Oreck: Um, and you know, some people do well with it. I think what's difficult with supplements generally is the lack of regulation. Dr. Sarah Oreck: Right, right, right, right. And lack of consistency between products, brands, Dr. Taz: and, yeah. Yeah. Is there Dr. Sarah Oreck: something you like to use in particular? Dr. Taz: We [00:31:30] have a couple of brands that, I mean, we stick to a couple of brands. First of all, patients will often deviate from that and try to find comparable. But we have brands that we trust and that we use. Dr. Taz: I use Saw Palmetto. Mm-hmm. To block the androgens. I've actually, and I'm so curious what you think about this, but I've started using deplin or Methylfolate Yeah. To help the anxiety and the depressive component of it. Dr. Sarah Oreck: Well, what's really interesting is that we sometimes see that people have some deficiencies. Dr. Sarah Oreck: Mm-hmm. And it can [00:32:00] actually help, even if they're on an ssri. Right. Help improve the effectiveness of that s medication. Yeah, exactly. So Dr. Taz: that's a big one for us. And then magnesium, we love. Magnesium was probably those. Probably my top three. And after that it, it gets very individualized. Some of the individualization that we do ties also back to the microbiome. Dr. Sarah Oreck: Yes. Oh, we didn't talk about that. No, that's a great, great conversation. Why ask you, I wanna Dr. Taz: ask you about that because I'll tell you what I see in practice, but I'm curious what you're saying in the research and like, you [00:32:30] know, uh, what's evolving in the field of psychiatry. What I see in practice, and I've talked about this before, is that there is a microbial shift in PCOS. Dr. Taz: For sure. And then there's also less diversity Dr. Sarah Oreck: is what we're seeing. Dr. Taz: Right. And then there's another microbial shift if you get pregnant, if you do IVF. Yep. If you do any of these things. Right. Yep. The pattern that we're seeing is usually a skewing towards candida. Mm-hmm. Or overgrowth yeast in the gut. Dr. Taz: And so the cognitive component that kind of ties in with that is of course tied to blood [00:33:00] sugar. Yes. Because candida and blood sugar is so interconnected, right. But it is the brain fog. So when people have a candida overload, it's like the brain fog. Sometimes it's depression, you know? Processing issues, like a lot of these different things. Dr. Taz: Yes. That's what I see in the exam room when I go to research. And I haven't gone recently to look at the microbiome in particular with PCOS. I don't see a lot. Dr. Sarah Oreck: Yeah. Dr. Taz: So I'm curious what you know of, I think that some Dr. Sarah Oreck: small studies I've been seeing and certainly like if we back up right. Um, the gut is a really [00:33:30] interesting Yeah. Dr. Sarah Oreck: Kind of. Um. Yet to be tapped into area for psychiatry. Dr. Taz: Yeah, true. Uh, so we Dr. Sarah Oreck: think about how there's so many, especially in the anxiety disorders connection with the gut. Dr. Taz: Yeah. Dr. Sarah Oreck: Oh, I get really like, not like the butterflies in my stomach. There is a brain gut connection. And in fact, when we start a serotonergic agent, for example, we say, you may have some effects on the gut. Dr. Sarah Oreck: And guess what? Because you have so many serotonin receptors in your gut, right? And so there have been. Really [00:34:00] interesting, um, kind of studies in psychiatry where they start to do transplants of, you know, fecal transplants Oh, yeah. And all sorts of things to actually help with mental health issues. Dr. Taz: Interesting. Dr. Sarah Oreck: But here, what I've been seeing is that there, there starts to be less diverse microbiome in the gut of people who have PCOS. And again, what we think is a healthy microbiome, we are all made up of. Terria. I know that's really gross to think about, but that's all we are. Those are facts. That's facts. Dr. Sarah Oreck: Yep. Um, and when you have more diverse [00:34:30] microbiome and not an overgrowth of a particular one, we think about that as sort of, um, a healthier gut. And we do see, and again, very early on, I think we just need so much more research on this that of course, that microbiome is gonna impact your brain health as well. Dr. Taz: Do you ever see psychiatry evolving to, lemme take a look at your microbiome. I hope so. Hope lemme take a look at your nutrients. Hope. Let take a look at some of this. I hope so. And can we see a shift from the standpoint of [00:35:00] a lot of mental health conditions? Dr. Sarah Oreck: I mean, I, we already see it in women of like, we can't continue to isolate. Dr. Sarah Oreck: Um. Isolate care by systems, right? By like organ systems, right? That's the failure, right? That's the failure, right? Where it's like, I only take care of this. And I'm like, but, but this is so interconnected. Yeah. And so I, I'm really hopeful. Though I'm less hopeful because of the lack of research and the cutting of funds. Dr. Sarah Oreck: Um, but I'm really hopeful that in some time we can get to a [00:35:30] much more personalized right approach to all approach to to medicine, but also realize like there's no way to disconnect. Yeah. Ovaries from the brain, from the gut. Yeah. And I think we're seeing this in PCOS, so I'm really excited about, um, certainly what we're doing at Avita to try to kind of improve, at least the education, the understanding of what's happening and then trying to connect the dots. Dr. Sarah Oreck: But I think we all have to do a lot of work, and I'm hoping that we can do it ahead of people being [00:36:00] so, um. I think, uh, disenfranchised right by the medical system and then turning to pseudoscience or anti evidence based. Right. Dr. Taz: Well, let's talk about it. You and I are both passionate about integrative care, so, and that's the merging of sort of these two worlds together in a thoughtful and Yes. Dr. Taz: Logical way, right? Absolutely. And trying to. Both use the patient's experience and the patient's journey and with their always as the expert lab lab say as the evidence and then marrying that to like all the stuff that's out there, you know, [00:36:30] so, you know, if we have, and we can break it up into groups, like if we have a teenager with PCOS experiencing mental health issues, what's the right integrative approach there? Dr. Taz: If we have, uh, a younger woman who's gone, as you've said through this very. Grueling in observation, fertility journey. What's the mental health integrated mental health approach there? Right? And then let's move into the postpartum period too, because there's yet another shift happening there too. So let's walk through those three. Dr. Taz: [00:37:00] Phases, maybe of the dominant mental health condition, what the right integrative approach is, and how we can help people listening and watching today. Dr. Sarah Oreck: Oh, absolutely. Um, so for each of these, I actually don't think they're that different. Okay. In terms of how I would approach them. But my take would always be, you can't divorce the context either. Dr. Sarah Oreck: Even if it's PCOS is the, the kind of etiology or the reasoning for a lot of these things happening. The person still lives in a context, right? They still live in a sort of [00:37:30] social environment. They still have peers, they still have parents, they still have loved ones. And so our approach is always this really holistic approach of tell me what's happening in your life. Dr. Sarah Oreck: Right. In addition to your body. Mm-hmm. 'cause I think they're so interconnected. Yeah. And those that have more support may fare better even if they have difficult symptoms. But if someone in their life is invalidating their symptoms is not helping them get the care, I can imagine that must be much harder. Dr. Sarah Oreck: Horrible. Yeah. Right. Yeah. Um, so for us it's context For us. It's, um, we [00:38:00] love sort of some eastern, uh, philosophies around mindfulness. This is why our evidence-based therapy is actually called act. Um, it's a wonderful, it's called acceptance and commitment therapy, which doesn't, doesn't mean you accept everything that's coming to you and you just don't do anything about it. Dr. Sarah Oreck: But it means, okay, I'm able to kind of confront that this is my reality. I'm able to take values, aligned actions, and this is really important because then you have a nice lens when you are going to specialists [00:38:30] of like, that's not aligning with my values. I'm not being listened to. Maybe this isn't the right place for me. Dr. Sarah Oreck: Unfortunately, we're still at a place where people more often than not, 'cause they don't get to go to, you know, you necessarily, or to Avita Health, right? Where they're still gonna encounter someone discounting their symptoms, someone invalidating their symptoms. And so, um, for us it starts there with like how people start to see themselves, the importance of their story and their narrative, and that their narrative [00:39:00] matters. Dr. Sarah Oreck: Um, and then applying that, um. We meet patients where they're, where they're at, you know, supplements I wish were regulated, right? And had more evidence-based, right? I'm like, let's do the studies, right? But there's no incentive to do studies, right? Because you can, you can just ask, access them. And um, so I think if, if that's where you wanna go, we meet you where you're at. Dr. Sarah Oreck: If that doesn't sort of fall into your values and you'd rather try the more traditional approaches, we will meet you there [00:39:30] too. I think it's really important that your physicians also meet you where they're at and to integrate things that are helpful. Like I went through IVF and I loved acupuncture every week. Dr. Sarah Oreck: Yeah. Dr. Taz: Yeah. Dr. Sarah Oreck: And that was really important to me, and it helped with my anxiety, actually helped with my nausea. Dr. Taz: Yeah. Dr. Sarah Oreck: More than any of the Western medicines that I was also taking. Well, I Dr. Taz: think too, it's important for everybody to understand, again, the sh the show. We both take a holistic approach. The show is called Whole Plus, but we don't. Dr. Taz: I think I can speak for you, but we don't want people parking [00:40:00] on, I'm not doing any of that. Yes, I'm only doing this, or it's, you know, I'm only over here and I'm not, it's like coming together. It's the coming together. Like if you've gone the supplement route. Therapy route. Right. And you have a mental health issue, you have anxiety and all this other stuff. Dr. Taz: I think it's important for people to understand that talk therapy, when you have hormone shifts is only gonna get you so far. Oh yeah. Right? Yeah. So if you've done that and it hasn't worked and you've tried supplements and it hasn't worked, but you are like struggling Yes. On [00:40:30] the inside Dr. Sarah Oreck: Yes. That there's no shame, right. Dr. Sarah Oreck: In kind of turning to, but, but we, we have this. Kind of social media is so wonderful in so many ways. 'cause it gives you access to things and, and it lets you see things you've never seen. But it also lets you see sort of the dark side of things, right? Yeah. And when you start to see this really world in a really binary way. Dr. Sarah Oreck: Yeah. The black and white, right. The birth control is bad. No it's not Right. It's, it's extremes for everything. It's, yeah. And so I think it's really how, and you keep saying it, but it's integration, it's integrating [00:41:00] all of the tools that we have to try to help you. All. The tools may not apply to you. I think knowing that they're there and they exist is important and also, but I think that openness also needs to come from the medical Dr. Taz: field. Dr. Taz: Yeah, definitely. So for staying now with our teenagers and our younger women, if they're on birth control, maybe for birth control, like truly for birth control, not for hormone regulation. Right. For Dr. Sarah Oreck: right. Dr. Taz: You know? Does that take care of the mental health component of all this stuff? Is that what you've Dr. Sarah Oreck: seen? Dr. Sarah Oreck: Sometimes [00:41:30] it does. Dr. Taz: Okay. And Dr. Sarah Oreck: sometimes it doesn't. Mm-hmm. Sometimes it worsens it. Dr. Taz: Yeah. Dr. Sarah Oreck: And I think it's. But that's not a question necessarily, an OB will ask, Dr. Taz: right? Dr. Sarah Oreck: Oh, you're just a teenager. What are you gonna do? You know, like, of course you're reflective. But, but I think, um, if we can kind of, um, empower people to say, oh, let me take this journal. Dr. Sarah Oreck: You know, I've been feeling really. For like three weeks outta the month. Right? Like I don't think that's a great outcome, right? Or being honest about I'm really lack motivation or I'm not [00:42:00] doing well in school during the two week, you know, during a certain time in the month. Like I think that's important. Dr. Sarah Oreck: And then for, I think for physicians and clinicians to take it seriously. Dr. Taz: What do you want the young woman or the mom going through IVF and IUI or now she's pregnant. What do you want her to do? Dr. Sarah Oreck: Um. In terms of, you know, getting that, I think getting the holistic treatment means right. Checking in with how you're feeling, getting that context. Dr. Sarah Oreck: Um, and [00:42:30] also, you know, um, certainly being with a practitioner that you feel like hears you and sees you, et cetera. Dr. Taz: So getting that team, getting Dr. Sarah Oreck: that team. Yeah. 'cause those women who have maybe struggled with PCOS their entire life, gone through fertility treatment, that's like a lot of medical back and forth. Dr. Taz: Mm-hmm. Dr. Sarah Oreck: I wish for them to have a really smooth pregnancy and birth. Even talk about birth trauma, but birth trauma can feel like one of the most challenging often, [00:43:00] you know, I think sometimes the place where women feel most invalidated is at their most vulnerable when they're giving birth. Dr. Taz: Wait, what do you mean by that? Dr. Sarah Oreck: Um, just that they're not listened to potentially during Dr. Taz: the delivery. Yeah. Dr. Sarah Oreck: Yeah. Not feeling, not cared for. Um, not like they're like a person in the room, like a, um, a member of the team. Right. Um, I can't tell you how many women come to us we're like, they, something really scary was happening. No one was communicating. Dr. Sarah Oreck: Of course, the team had to, you know, act, act. Mm-hmm. And like you [00:43:30] had a hemorrhage and they had, but like, I think it's important for someone on the team to realize that there's a human being there. Yeah. That needs to kind of understand what's happening in the narrative. And often with, with, uh, traumatic bursts, we build that narrative after. Dr. Sarah Oreck: Here's what happened, here's how I'm finally kind of understanding it, putting the pieces together. Um, but I think ultimately it's about you deserve a team that hears you and sees you and validates you. And I think that's the core of, you know, so [00:44:00] many of women's mental health issues. Dr. Taz: So you Dr. Sarah Oreck: said the Dr. Taz: word narrative a few times. Dr. Taz: Mm-hmm. Is a part of what we all can do. What's actionable, even in the current medical climate and everything happening is really tell our story in a way. That's not like blaming ourselves all the time. A hundred percent and shameful. Yes. Is that like the first step? Yes, and in some, everyone in way, that's what Dr. Sarah Oreck: our therapy is. Dr. Sarah Oreck: When, like when we suspect A-P-C-O-S diagnosis, we're obviously [00:44:30] we're, we're looking at labs, but we want to then empower that patient to say, here's what's actually happening, right? Here's how I'm gonna tell my story. And we even sometimes practice, here's how I'm gonna talk to my OB about what's going on. Dr. Taz: So you literally rehearse it. Yeah. Like you were about to act in a play or something like that. Dr. Sarah Oreck: Yeah. Yeah. Dr. Taz: That's brilliant. Dr. Sarah Oreck: Yeah. It's this really like, unfortunately we have to be there. I wish it wasn't the case. I know. Dr. Taz: But it's just we're 1993. I was looking at this stat. I know the other day. Oh, the clinical studies. Dr. Taz: Yeah, I know that's when women entered clinical. [00:45:00] That's when I entered med school. Yeah. That's why am I acting surprised that I, I went on a gas lighting journey, or so many of us had gone. You, well, you were just, you know, Dr. Sarah Oreck: so Yeah. About evidence that was about men, Dr. Taz: right. And told. To stay between these two lines. Dr. Taz: Yeah. You know what I mean? And to be clear. So it's always funny now, so to be clear, why we Dr. Sarah Oreck: were, uh, excluded from clinical trials and I I just love this 'cause it brings it back full circle, right? Right. Is because of menstruation. Right. Men, because mens were confusing and messed up studies. They confounded [00:45:30] studies. Dr. Sarah Oreck: That's the word. Right? You're right. Right. Like it was confounding. Womens confounding. Yeah. Isn't that cr So, so of course if our hormones confound things, well of course they have unique ways of behaving that sort of are essential to this. But I do think if you are listening to this and you have a young daughter or even yourself like. Dr. Sarah Oreck: You can write down here's, here's actually what I've experienced throughout my life in terms of my symptoms. And be clear that this is what your experience is. And some if someone invalidates that, they're not the right doctor for you. Dr. Taz: Yeah. [00:46:00] So telling your story to yourself. Rewriting your narrative. Dr. Taz: Taking the shame and the blame out of it. Oh, yeah. Universal, across and with weight Dr. Sarah Oreck: fluctuations. That's so prevalent. Dr. Taz: So prevalent. And then there's, well, we need to go there too. There's the eating disorder component of it. Have you seen a lot of that with PCOS and what's the, what's the tie in there? Oh, I see a lot of, Dr. Sarah Oreck: I think what I've seen is a lot of bulimia, Dr. Taz: frankly. Dr. Taz: Yeah. Tell Dr. Sarah Oreck: talk about that for a second. What I have noticed is, and it's a little bit, [00:46:30] and it's interesting because I think there's gonna be a schism mm-hmm. Like a, a division between the eating disorder world and this sort of ideas that we have around PCOS and inflammatory. Right. Right. Because I, my theory is. Dr. Sarah Oreck: These women have had this from the time that they started to menstruate Yep. And have developed these symptoms. And that insulin resistance, et cetera, has been part of the contributing factor for the weight fluctuations that then kind of get people to think, well, how the heck am I gonna [00:47:00] cope with this? Dr. Sarah Oreck: Right. Because I, and listen, there's societal expectations that we need to talk about and, and address of course. Right? Right. But I'm expected to look a certain way, be a certain size. Here I am. I eat everything I'm supposed to. I exercise, and yet I'm not able to do that. Yeah. I wonder what I could do. Dr. Sarah Oreck: Right. And then you get into maladaptive Dr. Taz: behaviors. Behaviors Dr. Sarah Oreck: like purging or over exercising or always Dr. Taz: restricting. Right, Dr. Sarah Oreck: exactly. Dr. Taz: Yeah. Dr. Sarah Oreck: And so I think, um, you see this in older women [00:47:30] who have been that person who's been on any, every single diet. Has been low weights, high weights, et cetera, Dr. Taz: patients like that. Dr. Sarah Oreck: Yeah. Like it just, and it's this constant gaslighting of it's your fault, you are just not doing it right. Mm-hmm. And I think, um, what we're gonna end up probably unmasking is that a lot of these sort of potential binge purge disorders like bulimia, nervosa, um, may have its origins in potentially right. Dr. Sarah Oreck: A-P-C-O-S or maybe this is the origin story. This is how this sort of, um, starts [00:48:00] to bubble up because it. Society has expectations. Right? My body isn't fitting them, what should I do? Right? Dr. Taz: And it's the cortisol and the other things driving it. A hundred percent. How do we treat those people? Dr. Sarah Oreck: I know it's hard. Dr. Sarah Oreck: It's hard. I wish we could intervene before Yeah. The maladaptive behavior start. Dr. Taz: Right. Dr. Sarah Oreck: And so I think we've done a good job and I, I don't know how you feel about this, but there has been this shift in body positivity. Dr. Taz: Yeah. You have a Dr. Sarah Oreck: teenager, so you know, it's, Dr. Taz: there's a shift, but it depends. Social [00:48:30] media is too. Dr. Taz: Prevalent and they are still bombarded with the images Yes. Of what perfection is supposed to be. And then if you take that and you take them out of the context where there are enough people that are shaped like them or look like them, it's a, yeah. Then all the body positivity in the world, like can't it? Dr. Taz: And there's almost like a, uh, when I listened to my daughter speak, there's almost like a backlash against body positivity. So it happened for like a little bit Now it's like, it happened for like a short period of time and now it's, it's [00:49:00] back. It's like. You don't look good and you don't look healthy, and don't tell me. Dr. Taz: That's body positivity. You know, there's a little bit of that going on. So I don't know. I mean, I, I, right, so Dr. Sarah Oreck: then when the comparison images are happening, I think that's really hard to not, like, not get wired in that way. And now I'm thinking about like all the popular models now are back to they are, we're back to like, you know Yeah. Dr. Sarah Oreck: Those very small standards. Yeah. Yeah. The wave standards again, that's absolutely right. Dr. Taz: But, you know, going back to really, I mean, I feel strongly about helping all these people 'cause I've [00:49:30] sat with them on their journeys and, you know, I'm, I'm in it with our own family. So, Dr. Sarah Oreck: but if you're going down and getting treatment for PCOS, for example. Dr. Sarah Oreck: I think you may be able to kind of get the help with the mental health issues. Mm-hmm. Get the help with the insulin sensitive, and then you may not ever get to Dr. Taz: that point. Right. Right. That's where I'm getting to. Yeah. Yeah. It's like, okay, write your story, take the shame out of it. Dr. Sarah Oreck: Yep. Dr. Taz: But let's also understand what these hormones are doing. Dr. Taz: Become hormone literate. At [00:50:00] any age. Yes. Oh my God. That is the best terminology Dr. Sarah Oreck: for it. Mean, can we all become hormone literate? Hormone literate? But most of us don't. Until I feel like perimenopause is a time. It's too late. It's too late. Dr. Taz: It's too late. You've had the babies, you've gone through your bulimia. Dr. Taz: I mean, it's too late. Yes, yes. You've gone through 80 rounds of IVF, like, you know, so if you can become hormone literate early and for the moms, you know, like. Get your kids hormone literate. Maybe we need to be testing cortisol in children. Yeah. You know, and understanding like pre, maybe there needs to be a [00:50:30] pre-pubertal assessment Yes. Dr. Taz: Before there's even a puberty assessment. Yeah. So we can catch these people a little bit earlier. Oh yeah. But Dr. Sarah Oreck: we need like, we just, we need so much more studies to be able to, but like, if we keep Dr. Taz: waiting. Do you think we can't get the rest of the community of clinicians on board with at least looking, Dr. Sarah Oreck: I think even if the studies cost is a problem. Dr. Taz: True. Right, right. Dr. Sarah Oreck: So then it becomes something that some people can get. Dr. Taz: Right. Dr. Sarah Oreck: But like, you know, getting out of network labs is But Dr. Taz: a cortisol [00:51:00] Dr. Sarah Oreck: level. Yeah. Oh, and there's, there's some companies that are doing, you know, cortisol levels. Like point of like doing it in your, a swab you can do and like checking it. Dr. Sarah Oreck: So there's, there's technology that's coming. Dr. Taz: There's technology, but there's also like through insurance. The clinician just has to be educated to order it. Yes, that's right. Right, that's right, that's right. And then a know what to do Dr. Sarah Oreck: with Dr. Taz: it. Correct. That's the second part of the story. Right. So yes. So much work to do, but [00:51:30] I think for anybody watching and listening, if they can at least start with the story and understand that they can become hormone literate. Dr. Taz: By understanding their own personal history, watching their children, kind of trying to create that foundation, like you were saying, for the hormones to live within, which is the gut and so many other things. And then moving into, okay, if we're seeing the patterns right, and you can see the fluctuation with the hormones. Dr. Taz: Get help. You know, get help. [00:52:00] Exactly. That's right. And like figure out what's going on there. What, is there anything that shifts or changes in the postpartum period? Dr. Sarah Oreck: Uh oh no. There's just like, especially as people are delaying childbirth, we're seeing, uh, so much coming. Kind of to a head when you're postpartum and perimenopausal Yes. Dr. Sarah Oreck: When you're having babies in your forties. Right. It's like, which one is it? It's almost like a, A fun, a fun game. Yeah. Uh, so I think it's just gonna, I think what's hard is that women [00:52:30] already have such a heavy mental load. Dr. Taz: Mm-hmm. Dr. Sarah Oreck: And I love what we're talking about, and yet so much of it still feels like it's on the patient Right. Dr. Sarah Oreck: To like figure it out. Right. Um, and I think unfortunately during this postpartum, that mental load just increases more. Oh, Dr. Taz: totally. Dr. Sarah Oreck: Yeah. And I think now more than ever, for example, the mental load is really being pushed on women. Figure out if that mascara is toxic. Figure out if those are safe diapers for babies. Dr. Sarah Oreck: You're on the wrong diet for babies. Yeah. Yeah. [00:53:00] Like I really wish that there was more that we could do, that our kind of government would do to really help guide, help regulate. Supplements, for example. So then I wouldn't have to be worried about like, does this have the active ingredient is this one? Dr. Sarah Oreck: Yeah. Yeah. And I'm sure you do so much research to kind of figure out what the right ones are, but like, ugh, those are just, you know, those are kind of, um, time sucks, right? For women. Dr. Taz: Yeah. Yeah. Yeah. I think that's, is there anything else that until we fix the two of us, go fix the entire [00:53:30] medical system, right? Dr. Taz: Like in the next two years so that everybody has access to everything. Is there anything else that you would like the clinician to do based off what you're seeing? Oh. And that you would like the patient to do based off what you know? Dr. Sarah Oreck: Yes. I think. Challenge yourself. And I, and I always say this of like, you learned so much in medical school, but I don't know if you were taught this as well, but it was like, things are gonna change so much by the time you leave here. Dr. Sarah Oreck: Right? Um, whenever you're a [00:54:00] clinician. I think a huge thing that I'm noticing in some of the younger people that are graduating, it's like knowledge isn't fixed. Dr. Taz: Mm-hmm. Dr. Sarah Oreck: You may have done something your whole career and you can still learn. Be curious. I learn Dr. Taz: every day. Dr. Sarah Oreck: Every single day. Every day from every single patient. Dr. Sarah Oreck: Yeah. I learned from you today. Yeah. Stay curious and start to set. It doesn't mean you did anything wrong, right? If you weren't doing it, if you weren't thinking about PCOS, if you were maybe dismissing some [00:54:30] symptoms, but you have a chance to do it differently tomorrow. To ask those questions, to be curious, and I think there's so much that we can learn from each other and just to be, oh, you're doing that. Dr. Sarah Oreck: What are you getting from that? Let me try that. And I think that kind of perspective is what keeps medicine interesting for me and what I think, again, continued curiosity and humility. I didn't know that, but now I might use that. Dr. Taz: Right. I love that. That's why I love medicine still. You know? I mean, I do [00:55:00] think if you have that creative curiosity, you understand that there's an expanded toolbox. Dr. Taz: You understand? You don't have to be so rigid with everything. Medicine's fun. Medicine's really fun. It's like a great career and you get to see people really change. But we do have a lot of, if you're open, you have to be open, open to change. It's, there's a lot of. Systematic stuff in place to not be open to change, to be rewarded for not being open to change. Dr. Taz: Right. And for people to feel like they're gaslit. Going back to how we started, you know, at the end of this journey, [00:55:30] I could talk, I know this is amazing, but also great, isn't Dr. Sarah Oreck: it great? And I think this so would inform kind of like the current situation that we find ourselves in like medicine challenges. Dr. Sarah Oreck: But you, you may have been wrong. Yeah. Totally. And now we figured something out. And isn't that so exciting? It should be exciting. And I'm sure you've seen that throughout your life. Like maybe I was doing this before and then I, a paper came out and all of a sudden. Dr. Taz: We were proven wrong. Right, totally. And we've seen that just in my time with the Women's Health [00:56:00] Initiative. Dr. Taz: Yes. And so many different studies that were Oh, there's an exciting Dr. Sarah Oreck: study that recently came up. Dr. Taz: Yeah, exactly. You know, so, you know, so much work to do. Right. But I'm hoping anyone who's listened or if they've watched this episode, at least the bell has gone off. Like, wait, there's a connection between my hormones, my PCOS and my anxiety, my depression. Dr. Taz: Even I would throw in the inability to focus and concentrate and learn. Yeah, yeah. There is such a connection between all of that. Oh, that's so right. And so I hope [00:56:30] that we've, you know, hopefully been able to spark that. But for anybody who's like wanting more and wanting to go on that journey a little bit more deeply, how can they find you and your work, if you'll share that with us? Dr. Taz: Of Dr. Sarah Oreck: course. So Avita Health, you can find us, avita health.com. We actually have an app that's available to everyone across the US and we're about to launch. PCOS focused content. Oh, awesome. And community. Awesome. So we're really excited about that. And we also have clinical care in California, New York, New Jersey, and Texas. Dr. Sarah Oreck: That's all in network. Dr. Taz: Amazing. Okay. So really trying to Dr. Sarah Oreck: [00:57:00] make that more accessible and affordable. And I'm on Instagram at Sarah oric MD and our Mota Health is also on Instagram at Avita Health. So please follow us for more tidbits and information. And we're actually gonna do a whole series on PCOS. Dr. Sarah Oreck: Amazing. It's coming Dr. Taz: out. Oh good. I would love to. Partner with you guys on that. That sounds incredible. And then final question of the day. What makes you whole? Dr. Sarah Oreck: Oh, I love that. I think conversations like this, um, you know, talking to, uh, [00:57:30] fellow women, fellow clinicians, exploring, being curious, learning new things, I think makes me whole, Dr. Taz: makes you whole well. Dr. Taz: This has been such a great conversation. I have enjoyed talking to you. Thank you for the work that you're doing. You thank I, I'm sure people will wanna learn more and you know, really kind of carry this torch forward and hopefully they'll spread the message Yes, when it comes to PCOS and mental health and all the things in between. Dr. Taz: And thank you all for watching and listening to this episode of Whole Plus, we post new episodes [00:58:00] every week, so I will see you. Next time. Thank you so much for listening to Whole Plus, if today's conversation helped you see your health in a new way, take a moment to leave a quick review. It only takes a few seconds, but it helps more people find the show and join our community. Dr. Taz: And if you wanna keep the conversation going, you can always find me on Instagram at Dr. Taaz md. I'd love to hear what resonated the most for you.