Speaker 1 (00:00:00):
Welcome to the Dr. Gundry Podcast, the weekly podcast where Dr. G gives you the tools you need to boost your health and live your healthiest life.
Dr. Gundry (00:00:14):
According to a recent study, nearly half of American women struggle with hormone imbalance. And in my practice, this number is much higher because most physicians don’t take the time to really delve into proper hormonal testing. So, what gives? Why do so many women struggle with hormone issues? And why do these issues so often go undetected by medical professionals?
My guest today says you not only can help balance your hormones, but use them as your secret super power. And as a result, enjoy better relationships, better bodies, better sex life and better minds. She’s Dr. Stephanie Estima, a chiropractor with a special interest in functional neurology, metabolism, and body composition. She’s also the creator of the Estima diet, host of the better podcast and author of The Betty Body. We’re about to cover a lot of important topics. As Dr. Estima shares her approach to healing, modern science mixed with ancient wisdom to help you or the woman in your life find health. Stay right there. We’ll be right back.
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Dr. Stephanie Estima (00:02:46):
I am thrilled to be here. Thank you for having me.
Dr. Gundry (00:02:49):
So let’s start with your book, The Betty Body, that came out earlier this year. I got to know, what is a Betty body?
Dr. Stephanie Estima (00:02:59):
Yeah, this is a point of confusion. And maybe this is a fallacy in my marketing. We started a podcast at the end of 2019. The name of the podcast is Better with Dr. Stephanie. And the fans of our show, we started just lovingly calling them our Bettys and it was very sticky. They started calling themselves Bettys and I want to be a Betty, and I want to learn how to be better. And I’m a Betty. And we looked up the definition of a Betty in the urban dictionary and turns out there’s a definition for it. And I put this in the book, and I’m paraphrasing a little bit here, but Betty is a modern day queen. She’s a fully embodied woman. She’s quirky, she’s loving, she’s intelligent. She’s excited about becoming the best version of herself in every way.
And when I saw that definition, I said, oh my gosh, I am that person. I’m quirky and I’m loving, and I’m aspiring to be the best version of myself. So we named the book, the book is called The Betty Body after our fans. And after the pursuit of just trying to love and accept and optimize the body that you live in. It’s size agnostic. I’m not trying to tell you that you need to look like a size two or whatever size. It’s really about loving the skin that you’re in and optimizing what we’ll talk about today, your hormones and your metabolism and working on your body composition. So it’s really about being the best version of yourself in the meat sack that we all live in.
Dr. Gundry (00:04:40):
All right. I was trying to figure out if you were referring to, there was a cartoon character in the 30s-
Dr. Stephanie Estima (00:04:40):
The Flintstones.
Dr. Gundry (00:04:48):
Well, Betty Boop actually. Long before Betty Rubble.
Dr. Stephanie Estima (00:04:53):
That’s right. That’s right.
Dr. Gundry (00:04:56):
She was kind of an epitomy of the perfect proportioned woman, I guess. So it would be … Whatever. All right. So in the book you share a lot of your personal story about health and emotional struggles. Can you explain what you mean when you were at war with your body?
Dr. Stephanie Estima (00:05:16):
Yeah. This was part of the birth process of the book and my own story in that, for years, I really looked at my own menstrual cycle as this really pesky punishment for being a woman that came every month. It was really annoying. I often medicated. I was taking lots and lots of Midol and lots and lots of medications to really silence the symptoms that my body was trying to tell me. Partly because in schooling, even though my undergrad is a neuroscience and psychology, my professional degree, as you mentioned, doctor of chiropractic, we were not really taught about fertility. I mean, we have the basic, like this is a female menstrual cycle, but we’re not really taught about our fertility. And I think in society so often we’re really taught to fear our fertility as well.
I would every month, I talk about this in the book, when I would be going in to see patients, when I knew it was that time of the month where I would be in my week one or my bleed week, needed to take multiple pairs of pants, needed to schedule lots of breaks in between patients because of the discomfort that I was in. And it really wasn’t until I had a couple of major life events happen at the same time. Was going through a divorce with very young children. And my clinic actually burned down. I don’t know if I put that in the book, but my clinic burned down and I had to rebuild it from the ground up. And you do that at the same time as going through a divorce.
I mean, I’m great friends with the father of my children now, but I don’t care what [crosstalk 00:06:57] the divorce. At that time, it was really stressful, not sleeping very well, et cetera. But it wasn’t really until I went on this trip with my family to Italy, where I really experienced what it meant to have proper menstruation and how quickly I could actually turn that around. I know we’ll talk a little bit about that. But for me, for years, it was just my period, my menstrual cycle was just a punishment for being a woman. That’s sort of how I looked at it without really understanding that these were my body’s way of saying like, Hey girl, something’s wrong here. I just need you to pay a little bit more attention to me. Yeah.
Dr. Gundry (00:07:37):
You mentioned that this kind of wake up call happened in Italy, which is one of my favorite places in the world. I just returned from there two weeks ago, hiking in the hills above Portofino. So what happened in Italy that turned things around? Did you eat better or sleep better or all of the above?
Dr. Stephanie Estima (00:07:56):
All of the above and more. Someone who loves Italy as I do. I always feel like whenever I go there, like everything’s better. Like the coffee’s better. Even the little mom pops shops selling sandwiches, like everything is just better there. And what I did was I got a lot of natural sunlight. We went in the summertime, so we’d spend lots and lots of time at the beach. I would sleep. I would sleep in. I would go to sleep when it was dark. I would wake up when it was light. Lots of natural, low level movement. It wasn’t necessarily following very Estima diet. We’ll talk about what the Estima of diet is. Is not a very Estima diet friendly diet in Italy. I was enjoying the pastas and the gelatos and the pizzas and stuff, but a lot of post-meal walking.
We would walk to the place that we were going to have our supper. And then we’d walk along the beach. We’d walk in the town. We’d go to the little square where all the action was. A lot of low-level movement. And these were two main, coupled with being able to sleep and lowering my stress and not moving so much in my practice days. All of these together in aggregate over the course of just once, like towards the end of that trip in Italy, we were there for about three weeks. Last week of the trip I got my period.
And normally this would be the worst thing that could ever happen. Like I would be holed up in the hotel room, mask on, lights off, drugged up, but it was beautiful. It was easy. It was graceful. No excess heavy bleeding, all of that, that was really plaguing me for really decades before. I really was curious about if I could … I mean, like I said, everything’s better in Italy, but if you could take some of those basic fundamentals around health, low level movement, like generalized movement through the day, sunlight, getting outside in fresh air, sleeping in accordance when the sun is down, you’re inside, the lights are low and then you wake up with the sunrise.
And I brought all of those things back to North America where I live. I live in Toronto, so major Canadian city. Really wanted to experiment both with myself and my female patients. So I was already, at that time, running a nutrition program. It was ketogenic in its flavor and already noticing a difference in outcomes and prognosis from my male cohort versus my female cohort. Like men were like, this is like the best thing ever. Just dropping 20 pounds, like just blinking and it’s gone.
So started experimenting both with myself, like N of one, and then extending that experiment to the female patients that would let me. So we started playing around with their macronutrients and some of the basics that we talked about, like circadian fasting and getting movement in the morning, making sure you’re being exposed to sunlight first thing in the morning, sleeping, making sure the lights are dark in the evening, all of those things. And that’s part of the origin story of the book. This is why the methodology exists and I wanted to put it into a book for people to consume.
Dr. Gundry (00:11:15):
All right. That’s interesting that your male patients were going, “Wow, this ketogenic diet is great. 20 pounds fell off in a day and a half,” and I’m joking about that. And your female patients are going, “Hey, wait a minute, that’s not what I’m experiencing. And I hate my husband because he does this and it works.” I’ve certainly seen that as well in my practice that men seem to respond to this, just as a general rule, much better than most of my female patients. And we can go into that. But hormone imbalances, both in men and women, seem to be rampant today. Any thoughts on why that is? I mean, any part of your wake-up call will motivate you to figure out, okay, why is everybody so screwed up right now in their hormones?
Dr. Stephanie Estima (00:12:17):
It’s an interesting question. I think for our males, our beautiful male population, what we’re seeing is we’re seeing more of this estrogenization of them. Year over year, the data is very clear that our testosterone levels in our men are falling, and we’re seeing a lot more irregularities in their sperm. More so than would be considered normal, not only in sperm count, but in the quality of the sperm. And then with women, of course, we’re seeing a whole gamut of things. We’re seeing things like estrogen dominance in our women who are in their perimenopausal years. And even before that, I have seen a lot of women in their thirties, myself included. I would put myself before I really discovered this way of living, having just terrible periods, terrible menstrual cycles.
And then we also see more of a testosteronization of women as well. We’re seeing this androgen dominance through categories like PCOS, which is polycystic ovary syndrome for your listeners who are not familiar with that, where a woman, she either has too much testosterone, free testosterone circulating in her system, or she’s having trouble moving the testosterone into estrogen, which is just the natural way of things. We make testosterone, and then testosterone gets converted into estrogen, and that’s true for men and women. There’s a lot of different verticals that we can explore. I think that there is a huge amount of stress in this modern day life. And stress can be, I talk about this in the book, you can really divide stress into like eustress and distress, like good stress and bad stress.
And we’re very sedentary populous. So we sit and talk to our computers all day long, and you add in the pandemic where everyone’s sheltering in place and sheltering at home, not getting a lot of that low level general movement that I was talking about that I was experiencing a lot of in Italy. You get this reversal of light. We’re all told, put on your sunglasses when you go outside. Make sure you get your sunglasses on. Protect yourself from this evil thing called the sun. So we all have our sunglasses on, we have this sort of toxic sunscreen, which is maybe another conversation. And then in the evening, we are exposing ourselves to this really bright blue light via the television or our phones or our devices.
So there’s almost this reversal in light exposure that I think is affecting a vast multitude of things. One of the most important ones is sleep. Like I think most of my women that I work with complain of some type of dysregulated sleep on a regular basis. So what that means is that they may be able to have like one, two, maybe three good nights in a week, but there are multiple bouts of insomnia or they have a hard time initiating sleep or maintaining sleep. They’ll say, I feel tired, but my mind is racing. Like this tired and wired presentation.
And then there’s the whole conversation around endocrine disrupting chemicals that are being put in, we are exposed to plastics and in our food and the soil is nutrient devoid now. I believe it was Dr. Mark Hyman who said we only have 60 more harvest, something like that, before the soil is completely dead and is just sand. So I think that there’s a lot of different ways why we are stressed. And I know stress is such a sort of umbrella term where it’s like, well, what does that even mean? But it can be physical stress, chemical stress, emotional stress that is really weighing in on our physiology and on our biology as well.
Dr. Gundry (00:16:15):
Yeah. I agree with all those and certainly I’ve written about almost every one of those subjects in my books, and so I agree with you. One of the things that you noticed when you were in Italy, and it’s certainly true in many of the European countries that I visit is this idea of walking particularly after meals. I mean, you see it in Barcelona, on the Ramblas. You see it in Italy, people after a meal, they don’t just go sit on the couch and watch TV. And we do that. We walk to dinner. We actually choose a fairly far away place and walk there and then walk back, even though we’d rather not in a way, but it’s very typical.
If you look at the blue zones that Dan Buettner has described, and I spent most of my career in the only blue zone in North America, Loma Linda, California, they’re all in actually hilly cities. Every one of these blue zones is in hills. And one of the things they do, and certainly I’ve visited a number of these cities, is they walk. They walk up the hills, they walk down the hills. Just walking is so useful, particularly after meals or before meals.
And in fact, there’s a very famous study I wrote about in my first book, long ago. They had people walk 10 minutes before they ate versus walking 10 minutes after they ate dinner, and literally compared weight loss. And it turns out the people who walked before dinner had no change in their weight. And the people who walked after dinner actually lost weight. I postulated that it was almost like you had gone on a hunt and you hunted and you ate, and they said, okay, you captured the food you ate. We’re going to store whatever you ate. But if you eat and then walk, your genes say, oh, what the heck? We’re at it again. We shouldn’t store this stuff, we’re going to use it up. And I think these cultures have figured out some of these secrets that when you think about it seem fairly obvious.
Dr. Stephanie Estima (00:18:40):
And what you’re saying is, I mean, it’s a hundred percent true, and it’s such a powerful, when we think about these blue areas, these blue zones. We’re talking about powerful ways to modulate glucose regulation. That is one of the best ways. If you are someone who struggles, if you are on the spectrum, maybe you have metabolic syndrome, or even if you have Type 2 diabetes, one of the best things that you can do is go for a walk after your meal, as you very well know, and you just beautifully described this study. Because what’s happening is you have these big muscles, your leg muscles, your back muscles are keeping you erect. You have that contralateral arm and leg movement. The food that you’ve just eaten is being broken down into these constituents, which now can be thrown into the muscles, into these legs and back and everything.
Of course we know that once glucose gets into the muscle, it can’t get out again. So it stays there to be able to be used as a substrate for energy for the musculoskeletal system. I just love it. It’s one of the things I think we get wrong in North America. We are very much movement specialists. Like we get the, and I’m not blowing shade at Peloton or whatever, but we get on our Peloton bikes. We do this one class for an hour and it’s a super high end. Maybe it’s CrossFit, once they open up again or whatever, we do this very high intensity work for one hour or maybe an hour and a half, and then we sit for the rest of the day.
Whereas these European cultures or these blue zones as you’re describing, have a lot of lower level general movement through the day, like the gardening and the tending to the tomatoes and the walking to the Plaza and the walking to the butcher. We don’t really get that. There are some pedestrian cities I think in North America, I would say that San Francisco might be one of them, New York might be another, but for the most part, we’re driving cities. We drive to the grocery store. We drive to pick up our kids. We’re driving all the time, which is another form of being sedentary.
Dr. Gundry (00:20:44):
Yeah. It is interesting, people who live in large cities, and Toronto is certainly a large city, tend to have, as a general rule, lower weights than people who live in the suburbs because, like New York, for example, when we’re in New York, we will, whether we want to or not, walk five to 10 miles a day. We don’t take Subway, we don’t take cabs, we just walk. And even if you do take subways, you end up walking usually a considerable distance to your office or whatever. Cities should have been better designed for walking. Now the problem with Toronto is too cold. I mean, come on. Get over it. Would you? You need to move.
Dr. Stephanie Estima (00:21:31):
It does get cold in the winter, I’ll give you that. Yep.
Dr. Gundry (00:21:34):
All right. I’m going to throw out a patient from this week, and she’s actually a physician and she’s been seeing a hormone specialist. She’s 46. And that’s all I’ll tell you about her. This is the first time I met her, and she was seeing a hormone specialist because, let’s just say she lacked libido. So I looked at her hormone panel, her FSH, and for those people who are wondering, that’s follicle stimulating hormone, and it’s a good way of telling is perimenopause approaching? Are you in menopause?
So she’s on hormone replacement and she’s got an estrogen of 395. I remember this distinctly because it was two days ago. She has a testosterone of 996 with a free testosterone of over 20. And I went, “How long has this been going on?” And she said, “Well, it’s been about a year now.” I won’t tell you any more about the conversation. What do you think about that for hormone replacement? For libido in a woman?
Dr. Stephanie Estima (00:23:00):
So she’s complaining of low libido?
Dr. Gundry (00:23:02):
Yeah. This is how she got started on hormone replacement. This is not a test.
Dr. Stephanie Estima (00:23:09):
Yeah. I love talking clinical cases. And she’s currently on, just so I’m clear, she’s currently on hormone replacement therapy?
Dr. Gundry (00:23:20):
She’s on estrogen progesterone testosterone.
Dr. Stephanie Estima (00:23:23):
Okay. So I think when it comes to a woman and HRT or even bioidenticals, before that is a conversation that is even broached with the patient. I think that there’s value in making sure that there’s some foundational basics that are in place. Irrespective of her genetics and the way that she’s processing her estrogen, we want to make sure that we can amplify her liver detoxification, which is one of the main stays in terms of how estrogen is metabolized. And there’s a couple of different, without getting into the weeds of like 2-hydroxy estrogen, and 4-hydro … There’s three main metabolites of estrogen metabolism. We want to be promoting the antagonist, which is the 2-OH pathway, which is the metabolite that does not retain the ability to continue to activate the estrogen receptor.
The other thing you want to think about is lean body mass. How much muscle does this woman have? She’s 46. So she’s smack in the middle of perimenopause. And even though she’s still cycling, we want to make sure that we can increase her lean muscle mass, such that she is going to, A, kind of back to what we were saying with those blue zones, be a sufficient or efficient glucose disposal agent via more muscle mass. So we want to be thinking about resistance training. There’s going to be maybe some cardiovascular component in there, but the mainstay there is lifting weights.
I think that we also want to get things like stress and sleep under control and light viewing behavior. I mean, we can talk about the brain, what happens in the brain when you get early morning light in terms of the retinal ganglion cells. We won’t go down that nerd pathway, but I think that some of these foundations have to be in place before we consider hormonal replacement therapy. Because what can happen, like it seems is happening in this patient is we’re getting a lot of testosterone that is not necessarily being aromatized into estrogen.
And her estrogen at 395, that’s high. We want to be thinking about, and I’m assuming this is like picograms per milliliter. An estrogen in a woman, same with testosterone, is going to be cycle dependent. But now we have this accumulation of excess hormones in this woman’s body, and her body, it doesn’t sound like efficiently knows what to do with it. I think that the Women’s Health Initiative got it completely as backwards. I’m a big fan of it, if it can help augment a woman’s perimenopausal and menopausal symptoms.
But I think before we bridge that subject with her, we want to be thinking about how we can directionally already optimize some of these pathways, these hormonal pathways that I was just describing, like the estrogen metabolism, how can we get her going down that protective pathway? How can we be increasing her lean muscle mass so that we can improve her glucose disposal agent, and also maintain natural levels of testosterone?
If she’s a poor aromatizer, which it sounds like, maybe with the T at 996 and the estrogen at 395, maybe we have a problem with aromatization. Maybe we want to be thinking about how we can … There’s ways that we can help amplify that through the diet, taking in lots of green leafy vegetables that have compounds like indoles and diindolylmethane, and the sulforaphanes, which are going to help with that conjugation piece in estrogen metabolism. I mean, I don’t know her. There’s a lot of context that I would like to have in terms of her lifestyle, but that would be my initial thoughts on that woman.
Dr. Gundry (00:27:11):
Well, I like what you said. And maybe I think that’s the point we ought to emphasize. I agree with the same premise, before we go down a hormone replacement pathway, we need to find out exactly how that person is number one, producing the hormones they’re producing. And number two, how they’re metabolizing them. And I agree with you that so many times, particularly in my male patients and my PCOS patients, I see a lot of men with low T and they’re usually highly estrogen dominant. They’re carbohydrate eaters. To beat the band, they’re insulin resistant. They may not have been diagnosed as pre-diabetic because unfortunately in the United States, almost nobody measures a fasting insulin.
So anyhow, those guys, I can always get their testosterone and their free testosterone normalize just by changing their food, doing resistance training, same way with my females who have PCOS, a ketogenic diet and strength training, just does miraculous jobs for this in general. So I love what you’re saying. Let’s work with the person first, and then if we need to, then we can titrate in what we can’t accomplish with food and lifestyle. Is that paraphrasing you correctly?
Dr. Stephanie Estima (00:28:54):
That would be spot on. Absolutely. I think that these foundational basics of nutrition and resistance training, appropriate rest and recovery, these are all things that we need to be considering. Before I would say that any type of exogenous medication, whether it’s a hormone or whatever it is, corticosteroid, whatever it is, these are all unnatural to the body and we want to be able to optimize the way that we naturally process, have our own pathways processing. And then when we take these exogenous substances, we want to be able to optimize again, the processing of the desired effect of those medications.
Dr. Gundry (00:29:40):
All right. I want to backtrack for a second, because I think this is going to be very interesting to my listeners. I know most of my female patients don’t feel like this, but I think it’s interesting that you mentioned in your book, that a woman’s menstrual period when understood properly is a super power. You also talk about that menopause can be turned into a superpower. I think that’s fascinating. Give our listeners the pitch on why menstruation and menopause could be superpowers that you should embrace.
Dr. Stephanie Estima (00:30:23):
Yeah. Thank you for bringing this point up. I’ve been talking a little bit about, with our conversation, how I used to really hate my own cycle. I thought it was really punitive and I just thought it was this big rigmarole for nothing every month. And it was only after Italy, and then coming back to Toronto, working with my patients, where I actually started to really look forward to … It was almost like a report card. I was like, what is my hormonal report card going to be like this month?
When you understand the ebbs and flows of your ever-changing hormonal milieu, because as women in our reproductive years, this includes my perimenopausal ladies, we have a different hormonal composition every single day of the month. So that is going to have profound effects on what we should be eating, how we should be moving, what our mood is going to look like. Our energy levels are going to look like. Our receptivity, our libido, so our receptivity to sex and whether we are interested in it at all.
And all of these things are really important to consider for a woman’s health. I go into a lot of detail in the book around estrogen receptor. There’s basically estrogen receptors almost everywhere. There’s areas in the brain that are very sensitive, particularly these areas around verbal acuity and being able to pull and be able to floss your vernacular if you will. So there’s certain times of the month where you are much better suited to be on a podcast like this, or give a presentation, or ask for a raise. There’s different times of the month where we have that slight edge because of that hormonal composition that we are currently experiencing.
So I think once you get to understand your ebbs and flows, like when you are more introverted and it’s time to sink into your body. When you’re more extroverted and it’s time to network and chat and ask for that raise, once you understand that, this is what I’m talking about in terms of a superpower. I try to schedule most of my talking when I need to be giving a presentation or speaking as I am with you now, I try to schedule it around week two of my cycle and into week three, because I know that we have estrogen bathing my brain in these articulation centers. I know that I’m a little bit more extroverted. I tend to kind of skew introverted normally, but week two, I’m like super happy. I love everybody. People are good.
These little nuances in understanding where you are emotionally and physiologically, I think can have profound effects on your enjoyment in your life. And the same is true also in menopause. First, I just want to say, we tend to forget about menopausal women. We’ve been talking about menstrual cycles and I’m happy to go into as much detail as you’d like, but menopausal women are often forgotten about. We see this in Hollywood. We’re devoid of sexuality. As soon as we turn 50, it’s like we all wear cardigan sweaters and whatever. I have no beef with cardigan sweaters. There’s just no zest for life.
You and I, it sounds like you have a love for European culture as I do. The Greek say there’s a certain like Zoe, like a certain zest for life that I think is portrayed as lost, once we move into menopause. And I completely reject that. I think that all of the energy that we put in every month as women in our menstrual years towards the development of this endometrial lining, you can now take that energy because it’s no longer happening in your reproductive cycle.
And you can use that to call into your life, the things that are most important to you. And it’s likely if you’re a 55 or you’re menopausal woman, whatever age that happens for you, that you’ve been spending likely decades taking care of other people, your children, your career, your husband, or your partner. And so this is a time of almost reclamation where you can say, okay, I’m going to do what’s really good for my soul. I’m going to make sure that I do what’s good for me.
And so you can take this, almost sometimes the rollercoaster that can happen in the reproductive cycle, and then move that into energy that you want to create. And even though you don’t have a womb that can be reproductive, you can still be very productive. You can use that, in the book I talk about, your womb space being this like all chemical prowess. You can use your womb space to create and call in the things that you love. That’s a little woo, woo. That’s me getting into my feminine a little bit. I really feel strongly about that.
Dr. Gundry (00:35:26):
Speaking of getting into feminine, I know you’ve seen, and I’ve certainly seen in my practice, there are a certain percentage of women, and we can maybe argue what their percentage is, that their brain is so dependent on a little touch of estrogen that when their estrogen finally gives up the boat, most women will stop making estrogen. Unless they’re making it out of their fat stores, and we could get into that. I find that a small amount of topical estradiol, I mean, tiny amounts, just enough to even measure in picograms, all of a sudden, they’ll come back six weeks later and go, that was it. I mean, that’s it. My brain works again. What the heck? Do you see that in your practice?
Dr. Stephanie Estima (00:36:25):
I do. And this is kind of what we were talking about before. I love bioidenticals. I think that they can be an incredibly powerful augment to a woman. As I was saying, we have estrogen receptors on our lungs. We have estrogen receptors everywhere. And I talk about this in the book as well, even our libido. Like a lot of women in their late forties and early and beyond, we have this perception that their sexuality and their sensuality like that life is over. But part of that is because of a change in the hormonal composition. We have lowering T. We have lowering E. These are lowering estrogen or estradiol, as you were saying. And these are really important for maintenance of the vaginal wall, for lubrication, for orgasm.
And so a lot of women will say, gosh, my interest in sex, my receptivity to sex is really different. And even penetrative sex is very painful. I think the topical cream is great. You can do vaginal cream as well to help specifically with that. I’m a big fan of bioidenticals. A lot of times you can get them, I mean, I don’t recommend you do this, but you can get them from online retailers. I always recommend that you try to work with a functional medicine provider to help them titrate the levels for you. But this is something that I think should be available to every woman if she needs it.
Dr. Gundry (00:37:57):
All right. Let’s switch gears again. I miss snacks Dr. G. Are there any safe snack foods on the Plant Paradox protocol? I hear this question all the time from patients and followers when they start out on my lectin-free protocol. And I get it, snacks are hard to give up, especially if you have kids. And there aren’t many snacks that are made on my 100% Plant Paradox ingredients. That’s why I’m so excited to introduce you to Nature Nate’s LLC Popped Sorghum. Because it’s made with organic sorghum, one of the only lectin-free grains and healthy oils like coconut, avocado and olive oil. You get the delicious taste of popcorn without digestive issues.
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You mentioned that you were really eating different in Italy and that eating in the lifestyle there seemed to play a big part in your transition. So you created your own diet. Can you summarize it for us?
Dr. Stephanie Estima (00:42:26):
Absolutely. Yeah. It’s called the Estima diet and there’s two main phases of it. There’s a phase one, which is a therapeutic intervention of a ketogenic diet. And I would say that the way that I formulate my ketogenic diet is much more female focused. I mean, men can do it as well, but I’ve made sure that we have an abundance of the brassica genus. Like we have lots of green leafy vegetables in there. It’s not bacon butter burgers and repeat. It’s not tubs and tubs of sour cream. But there’s a therapeutic intervention of ketosis that can be modified based on the person. Like I’ve had my ladies with Hashimoto’s. I’ve had multiple sclerosis, like patients with MS.
We’ve extended this phase. In the book, I talk about it being a 28 day cycle. So one cycle, and then moving on to phase two, but some populations like my auto-immune women, I tend to keep them in phase one a little bit longer. So that’s phase one. It’s a 70, 20, 10. So it’s 70% fat, 20% protein and 10% carbohydrates. With the carbohydrates being from like mainly green leafy vegetables. Proteins, I love meat. I give vegetarian options in there as well. I love meat for a variety of reasons for women, iron and full spectrum of B vitamins. You don’t have to think about protein combining and all of that. However, you can also do it as a vegetarian. So that’s phase one.
Phase two is more cycling. So this is where we start to pair. We start to change the macro nutrients if you are in your reproductive years. We do that in accordance with your menstrual cycle. So there are times in the month where you are much more resilient to carbohydrate restrict. In the book, I talk about your bleed week or week one of your cycle is a great time to play with the ketogenic diet. I also talk about fasting protocols to try in this week as well.
In week two of your cycle, we see different hormonal composition in the woman. So we see testosterone rising, estrogen rising. These are anabolic hormones. So I like to help promote that by increasing the protein and the carbohydrates that week. So we will change from a 70, 20, 10, to a 40, 40, 20, or 50, 40, 10, depending on the person. But for ease, we’ll call it 40% fat, 40% protein, 20% carbohydrates. And the reason for that is I’m trying to activate these growth pathways.
So mammalian target of rapamycin is the main one that I’m after. With that, more protein and carbohydrate intake, which is involved in when you’re having more protein, you’re going to initiate something called muscle protein synthesis, which is kind of what it sounds like. It’s making new muscle proteins. Very important for my ladies. We’ve been talking about resistance training as a proxy for helping with keeping testosterone levels at a healthy level, at least directionally. You can also support that. You can also supplement when you’re having more protein. You can make testosterone and muscles in the kitchen by increasing your protein intake.
The reason why we go in and out is I almost want to hold mTOR, that growth pathway, I want to bring it down in those ketogenic weeks, like a spring, and then I want to let it loose for a week, in week two, and then in week four, I talk about returning to that higher protein, higher carb in week four. So we sort of are cycling in and out of growth, but it’s a strategic type of growth, because I like to pair the nutrition with a certain amount of activity, like certain types of activities, like resistance training and how you do that. Yeah. So we do keto in week one and three, and then high protein, high carb in week two. Well, I’d say, 20% carbs, we’ll call that moderate carb, higher protein in week two and four.
Dr. Gundry (00:46:38):
And you say you’re not going to eat a quart of sour cream and wash it down with a stick of butter. So where is your 70% fat coming from?
Dr. Stephanie Estima (00:46:50):
I am a big fan of monounsaturated fatty acids and polyunsaturated fatty acids. So MUFAs and PUFAs as they’re abbreviated. If you’re a meat eater, you’re going to not only be consuming protein and all the vitamins and stuff, but you get fat from that as well. So avocados, olive oil, it’s a Mediterranean-esque type of fat, where we’re getting most of our fat from.
And I talk about in the book, some people don’t do well … A typical traditional ketogenic diet is very high in the saturated fat realm. I don’t have a problem with saturated fat. There are some people who have a really hard time metabolizing SF. So what we do is we, I tend to err on the side of caution, and I give you more of these MUFAs and PUFAs, so more olive oil and more avocados and avocado oils and things like that. But you will get some saturated fat from the animal protein, if you’re a meat eater. You’ll also get it from coconut oil, if you’re consuming coconut oil as well, but we try to minimize the saturated fat.
Dr. Gundry (00:48:00):
You mentioned fasting. There’s a lot of online fear-mongering about fasting in women. So what say you doctor?
Dr. Stephanie Estima (00:48:13):
I’m a fan of fasting for women. I just think that it needs to be done intelligently. There’s been a lot of bizarre conclusions made about fasting. That somehow it’s an eating disorder or somehow not eating. I actually would argue the opposite is true. I think that eating when you’re not hungry is the eating disorder. At that point, you’re just soothing. You’re just soothing yourself. You’re trying to placate yourself. I think that fasting strategically for a woman can absolutely help with her growth hormone, with her testosterone levels, with her sleep, if she’s interested in weight loss or body recomposition, body recomping, I think it can be a very useful tool.
And again as you are a woman in your perimenopausal … Well, actually, we haven’t really spoken about this, but a woman as we age, we naturally become more insulin resistant. We want to really be thinking about ways that we can increase our insulin sensitivity. And one of the ways that you can do that is through carbohydrate restriction through keto, but you can also do that by restricting all macros. You can just fast. I think that that’s a really powerful way that we can sensitize ourselves to insulin.
And then of course, if you are cycling, if you are someone who is following that phase two of my program, when you do consume more carbohydrates, your body’s going to be able to make use of that, rather than your pancreas having to throw out a boatload of insulin like yourselves and be like, oh, I haven’t seen you in a week. I’d love to have more vegetables. Yes. Let me bring that into the cell.
I think that we want to be thinking about fasting as a tool, as we age, as something that is appropriate to help with insulin sensitization. You can manipulate fasting variables in three different ways. You can change the type of fast. You can change the length of your fast and the frequency of your fast. This is not to say that you should only just be doing a 24 hour fast all the time. I think that women, like we want to always be sensitive because in the culture that we live in, at least I can speak to my experience as being a woman, it’s very much like, you must always look 25 no matter what. You always have to look a certain way. You have to be a certain size.
I think that we want to be sensitive to women who are using fasting potentially in a … One of the contraindications that I outlined in the book is history of eating disorders is using fasting as a tool. But fasting can be really, really powerful for help reset the gut. We know that the endothelial lining of the cells in the gut, they turn over every three to four days. You can completely help with, we’ll call it GI distress that can happen as we age. The distention, the bloating, maybe belching or what have you. Fasting can really help with that.
And I outline water fasts. I also talk about bone broth fasting as a way to help with the lumen of the gut as well, because there’s a lot of really powerful components in bone broth in general that can really help with closing up the hyperpermeability of the gut. These Peyer’s patches. Sort of these junctions that open up if you have any of those GI symptoms that I talked about. And again, you can pair it with your cycle. So there’s going to be weeks that you are much more resilient and you can do much more aggressive fast, like just a water only fast or a longer fast, more frequently fasting in that first week.
And then there’s times like in your luteal phase of your cycle, the last two weeks of your cycle, where fasting aggressively is just going to be a miserable experience. And we’re actually not designed, especially in that fourth week, I talk about this in the book that, I really want gentle intermittent fasting that week. So it can be a daily time restricted eating protocol where maybe you’re doing a 12, 12, or a 10, 14, or maybe even a 16, 8. But really just being a little gentler with yourself. Your body is actually throwing in a lot of substrate into the endometrial lining. It’s throwing in glucose, amino acids, free fatty acids, glutathione, vitamin D, selenium, zinc, all the things are going into your endometrial lining.
We’re also hungrier. So, honor that. Don’t try to white knuckle it and just eat the same calories that you were last week. Like have a little bit more celery, have a little bit more kale, or more protein or more fat. Foods that are going to make you feel nourished and full without any, I like to say, like cutting the energetic cords. Without any guilt or shame around it.
Dr. Gundry (00:53:07):
All right. You mentioned that maybe eating continuously is an eating disorder, and certainly for the last year and a half with COVID-19, I’ve seen a number of patients that have put on what I call the COVID-19, and I’m sure you’ve seen that as well. I think there is a lot of stress eating for obvious reasons. Where does stress and managing stress fall into your program?
Dr. Stephanie Estima (00:53:47):
That was chapter two in the book. It was right after my intro. It’s that important to me. I think that we often dismiss stress like, someone is stressed if they’re screaming at the top of their lungs and they’re red in the face. Stress doesn’t look like that. You have chronic low grade stress or like we think about in the pandemic with people being at home and isolated from each other, and it’s a very scary world. The rules are changing every single day. That can be an incredibly laborious amount of stress on the body to try and process. So that’s the absolute first thing that we talk about in the book is really trying to get your stress levels right. And there’s a lot of different ways that you can do that. I mentioned meditation, who I was introduced to this through Emily Fletcher, who I know-
Dr. Gundry (00:54:39):
Yeah. We’ve had her on our podcast. Yeah.
Dr. Stephanie Estima (00:54:41):
Yeah. She’s wonderful. Her program, Ziva, has been a game changer for me. I meditate every day because of Emily, and I’ve noticed I’m a different person. I just get that extra space, like when I want to react and versus when I do react. Meditation just allows for that frontal lobe flex for me to be like, hold on, don’t yell at your kid. Just wait. Just a minute. Just a minute. I homeschooled my kids last year. I didn’t want them going to school with masks and I have certain feelings about that. And I said, “Well, I’m just going to hire a tutor and I’m going to do it myself.” So I had that. I was very stressed as well. So meditation saved me last year.
There’s a lot of different strategies that we talk about. I talk about the 2X breath that Emily taught us, which is more of a vagus nerve activation where you exhale twice as long as you inhale. And there’s a lot of other ways that you can mitigate stress. I think that as a society, we are very scared of our feelings. We run away from them. We dive into our work. We dive into other things in order to avoid the way that we’re feeling. So I go through, in some of the chapters, evening and morning routines that you can do to help buffer your stress response and to help bring down your cortisol levels in the evening when that’s important. When you need cortisol up as you need it right in the morning when you wake up.
So I talk about different strategies around gratitude practices and journaling. One of the things I talk about, which has been a game changer for me, I’ve done this over the past several years is just making the inside of my home look like nature. I live in Toronto, as I mentioned, we get all four seasons here. In winter, it’s dark. It gets dark at like five o’clock. And that means that all the lights in my house are off at five o’clock. We have dinner by candlelight. So things like that, that really helped to, again, back to that circadian rhythm of light and its impact on the brain and reducing that physiological stress response.
I could talk a lot about stress. I think that it’s super important and it has everything to do with your hormones. It’ll affect your menstrual cycle. It’ll affect your sleep. It’ll affect your reactivity. It’ll affect your partner. If you have a romantic partner, it’ll affect your relationship as a parent, with your parents and your children, if you have them. So really becoming awake to your triggers and how you become activated, I think is really, really profoundly important.
Dr. Gundry (00:57:24):
I want to finish up with another pet peeve of mine. I have two daughters and I have a wife. I guess I’ve been trained properly. But women get short shrift when they have complaints or when they have issues that they want their healthcare provider to look into. Quite frankly, I see that every day. A lot of times, healthcare providers toss this off as depression, or you’re a mother with two kids and you’re 40 years old, what do you expect? And they don’t want to do the blood work. They don’t want to listen. How do we get the word out to empower our female listeners, that this is not the way it should be?
Dr. Stephanie Estima (00:58:21):
Yeah. I think data is always key. One of the best things that you can begin to do is to track your, if you are still in your reproductive years, tracking your cycle so that when you do go to these appointments with your medical doctor or your primary, whoever it is, you can say, “Look at this data. For the last eight months, I’ve had a length of cycle like this, and now it’s changing.” So you can go in with some concrete data.
I’ll borrow from Dr. Aviva Romm, who was on my podcast. She’s a midwife and a medical doctor. And she was talking a lot about this dismissal for women’s medicine in general. This is like a historical problem. We’ve just sort of always been looked at. Even the word hysterical, when you say, oh, she’s hysterical, even that word, I’m a bit of a word nerd, if you look at the root of hysterectomy, hysterical, we’re talking about the uterus.
Dr. Gundry (00:58:21):
The womb.
Dr. Stephanie Estima (00:59:17):
The womb, exactly. One of the things Dr. Romm advise, which I thought was profound is whoever your PCP is, you never want to go into your appointment and be like, “Listen, Dr. Gundry said that I should be doing this, and if you don’t…” You never want to go in with this sort of combative, because all that’s going to do is it’s going to put that practitioner, like they’re human, that’s just going to put them on the defense. You want to go in and say, “Hey, you know what? I was just thinking like just as a total complete package, maybe we could explore what my hormones might look like.” And this is why maybe bring in a paper or two.
Another thing that would be really useful is maybe bringing in an advocate with you. A female advocate is preferred. Sometimes maybe you bring your partner if your partner is male and if the doctor’s male, there can be this kind of weird male bonding thing that can happen. The woman is just essentially getting bullied. So I would say, bring in a female advocate if that’s possible for you.
And then the other piece, again, borrowing from Dr. Romm is don’t get undressed until it’s time for the exam. Sometimes when you’re waiting in the room, the nurse or someone will come in and say, “Here’s the gown.” Saying something like, “Thank you so much for the gown, I’m just going to wait until I have a conversation with the doctor before I get into the gown.” Because if the doctor comes in, your rear is exposed. You’re already in this gown. There’s already this power differential, and you’re much less likely to say, “Hey, this is what I came in for.”
And the last piece I’ll say is just bring something to write on. Bring your questions that you already had pre prepared, so that you don’t forget. We have to love our doctors. They’re seeing hundreds of patients a day. They only have 10, 15 minutes with you. Another thing that I’ve often told my females, when I’m trying to work with their medical doctor is call the office in advance and say, “Hey, I would like a longer appointment with the doctor, because I have a couple of extra things that I would like to be able to discuss with her or him.” And that’s going to help so that the doctor’s not like looking at their watch saying, “Oh my God, I have 20 other people and I’m an hour behind.”
So if you give the office a bit of a runway and say, “Hey, can we book a longer appointment? Is there other times in the week that they take longer appointments?” You’re also going to be respecting the way that the doctor is running their clinic and you’re not coming in sort of all guns ablazing. Like my grandmother used to say, like a bull in a China shop. You want to come in delicately, respect the person in front of you. They are human after all. And try to get what you want with love. It’s like the old saying, you attract more bees with honey than you do with vinegar.
Dr. Gundry (01:02:11):
That’s true.
Dr. Stephanie Estima (01:02:11):
Yeah.
Dr. Gundry (01:02:12):
All right. So where can people find out more about you? Obviously you can probably get your book wherever you can find books.
Dr. Stephanie Estima (01:02:21):
Yeah. So any online retailer, you can find. The book is called The Betty Body: A Geeky Goddess’s Guide to Intuitive Eating, Balanced Hormones, and Transformative Sex. So, Amazon and Walmart and Barnes & Noble, all the places. I have a podcast that I’m really excited to be hosting you on very soon. You’re going to be coming on the Better with Dr. Stephanie Show. So we have a weekly podcast that you can check me in my workout. You can find me on the gram. You can find me on Instagram. I’m fairly active on Instagram as well. So that’s @dr.stephanie.estima.
Dr. Gundry (01:02:57):
Great. Okay. I warned you that we have an audience question. I’m going to let you have first dibs on this one because it’s right up your alley and mine. On Instagram @sharesouthart, I think I got that right, asks, if you want to lose weight, but like ice cream, which is more effective, non-dairy sugar-free with 240 calories or regular ice cream with 120 calories? Okay. Here’s our female expert on weight loss and ice cream.
Dr. Stephanie Estima (01:03:39):
All right. So Share, I think her name is.
Dr. Gundry (01:03:42):
Yeah, I think it’s Share. I hope.
Dr. Stephanie Estima (01:03:43):
Share. I have a couple of questions that are not answered, but assuming that the portion size is the same, maybe she’s not having this every single night as a tool for numbing, but maybe this is like a treat on the weekend, and she’s going for that walk after. Maybe she’s going for a walk after her ice cream. I like fat in my food. Whenever I have like a fat free yogurt, my face is in the fridge 20 minutes later. I would definitely go for the ice cream that has the higher fat content, preferably higher fat with lower sugar. So just from her description, it sounds like the 240 calorie one, non-dairy sugar-free with 240 calories would probably be the one that I would choose. If you’re having your dinner, I’d have that last. It’s pure sugar, so go for a walk afterwards.
And then I would just watch portion size as well. I think that when we’re trying to eat healthy, it’s not that you need to hit the mark a hundred percent of the time. I’m really a bit more flexible and there’s a little bit more ease. Like as long as you’re doing well, 80% of the time, of course, you can enjoy a glass of wine here and there. A bowl of ice cream as she’s describing. But there’s some ways that you can help to reduce the impact that is going to have on your physiology. The walking would be one of them. Of course you can always jump into a resistance workout if you can afterwards, or the next day or you can have a fast the next day as well.
Like we feast. So the ice cream would be like a feast. It’s really easy, calories coming in. And you can always just jump into a fast the next day as well. So that would be my answer. I think that calories do matter. Seems like the regular ice cream with 120 calories is about half of that. So again, you want to make sure that the portion control there, the portions are equivalent. So calories do matter, but I think it’s okay to have a bit of a refeed every now and then as well, if you’re doing all the other things that we’ve been talking about for the past hour.
Dr. Gundry (01:06:00):
I’m going to answer that question by taking you back to Italy, where we started this. So in Italy and France and Spain, the gelatos, or the gelas are in very, very, very tiny cups, and they are concentrated flavor. They are luscious fat-laden things. Particularly in Italy and France, they’re made with a two milk rather than a one milk, which is another favorite subject.
I think we can learn, and they actually are walking most of the time while they’re eating their gelato. Interestingly enough, a number of my patients who think they’re lactose intolerant, come back from Italy and say, “Guess what? There’s no lactose in Italian gelato.” And I say, “Well, yes, there is.” “Oh, but I can eat it, and I feel fine.” I say, “Yeah.” Because it’s a different breed of cow. But yeah. We should learn that these things in concentrated pleasure is kind of what we’re wanting, not the, oh, I’m going to take home a quart and finish it off, and it only has a hundred calories. You’re not going to get the pleasure out of that. We really aren’t. And it’s these little things that we can take away and take a walk with, that are far better off for you. So we just came around back to Italy. All right.
Dr. Stephanie Estima (01:07:33):
Take me there. That little piece of dolce. That little dolce in the evening is so lovely.
Dr. Gundry (01:07:38):
There you go. There you go. As long as we walk. All right.
Dr. Stephanie Estima (01:07:40):
As long as we walk.
Dr. Gundry (01:07:41):
Well, it’s great having you on the podcast and hope to see you on your podcast soon. See you soon.
Dr. Stephanie Estima (01:07:50):
Thank you. It’s just been a pleasure. You have so much energy. It’s just been a joy talking to you today. So thank you. Thank you so much for having me.
Dr. Gundry (01:07:57):
Pleasure. Good luck with the book and we’ll see you soon.
Dr. Stephanie Estima (01:08:01):
Thank you.
Dr. Gundry (01:08:03):
Bye. All right. It’s time for our review of the week from iTunes.
Speaker 4 (01:08:09):
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Kimberly Snyder (01:08:46):
Welcome to the Feel Good Podcast with Kimberly Snyder. My goal is to help you develop a holistic lifestyle based on our four cornerstone philosophy: food, body, emotional wellbeing, and spiritual growth. This holistic approach will help you feel good, which I define as being connected to your most authentic, highest self. And this is the place from which your energy, confidence, creativity, true power and true beauty will start to explode. Every week we provide you with interviews from top experts in their field, or a solo cast from yours truly, to support you in living your most beautiful, healthy, and joyful life. I’m your host, Kimberly Snyder, founder of Solluna, New York Times bestselling author and holistic wellness, nutrition and meditation teacher. Let’s get started.
Dr. Gundry (01:09:40):
Reverend Mr. Lane has a review and question combo. He says, I really appreciate tuning into your broadcast every week. I have adjusted my eating schedule to closer to a six hour window, and I’m very happy with that so far. I’m also reading The Energy Paradox and I am very excited about that.
I have a question for you, sous vide cooking, what do you think about it? Is there a way to reduce or eliminate certain lectins using a sous vide? I’m curious as to whether there has been much research into this yet. I’ll keep tuning in and I hope you get to my question. Well, Reverend Mr. Lane, we got to your question and thank you very much for your review. As many of you know, I’m friends with a number of James Beard award-winning chefs and Michelin star chefs. And I like to hang out with them and learn their techniques, and certainly a number of them really enjoy and benefit from the meat tenderizing aspects of sous vide.
And for those of you who don’t know, you basically seal whatever you’re going to cook, whether it’s a keto beef or a duck breast in essentially a sealed plastic bag, and you put it in a very low temperature controlled boiling water, for lack of a better word, and you cook it for a very extended period of time at very low temperatures. And then you finish it by quick cooking. And what it does is it makes the most melt in your mouth tenderized thing that you can imagine.
Now, I’m glad you asked this question because as a general rule, long, slow cooking does not have the temperature or the pressure to destroy lectins. I have quite frankly, never seen a paper talking about the effect of sous vide on breaking down lectins, but certainly long prolonged cooking, the equivalent is brazing in a way, certainly breaks proteins down. I doubt if it’ll work, but I wouldn’t count against it. After your question, I’ll tell you what, I’m going to look, like I said, I’m not aware of a paper, but I’m going to look again.
Thank you for tuning in. And as you know, please, please, please, put your questions and your reviews on iTunes, and maybe like the good Reverend Mr. Lane, I’ll be talking to you soon. I appreciate your questions because I’m Dr. Gundry and I’m always looking out for you. Disclaimer, on the Dr. Gundry Podcast, we provide a venue for discussion, and the views expressed by my guests do not necessarily reflect my own.
Thanks for joining me on this episode of the Dr. Gundry Podcast. Before you go, I just wanted to remind you that you can find the show on iTunes, Google Play, Stitcher, or wherever you get your podcasts. And if you want to watch each episode of the Dr Gundry podcast, you can always find me on YouTube at youtube.com/drgundry, because I’m Dr. Gundry, and I’m always looking out for you.
