PRECONCEPTION

017: What Is Restorative Reproductive Medicine? w/ Naomi Whittaker, MD, OBGYN

017

017: What Is Restorative Reproductive Medicine? w/ Naomi Whittaker, MD, OBGYN

Welcome to the Hey Mami podcast!

Our guest today is Dr. Naomi Whittaker, a fertility surgeon focused on women’s restorative reproductive medicine, compassionate healthcare, and education.

She is a board-certified OBGYN and a fellowship trained surgeon who specializes in the Creighton Model FertilityCare System and NaProTechnology, which works cooperatively with a woman’s body to treat the underlying cause of gynecologic issues and infertility, such as endometriosis and PCOS.

Dr. Whittaker helps women improve their gynecologic health, and avoid/achieve pregnancy in accordance with their natural fertility using the latest research, medicine, and surgery.

Dr. Whittaker earned her medical degree at Creighton University School of Medicine and completed her residency in OB/GYN at OSF Hospital in Peoria, IL. She then completed the Saint John Paul II Fellowship in Medical and Surgical NaProTechnology at the Pope Paul VI Institute in Omaha, Nebraska.

She is currently practicing in Harrisburg, Pennsylvania.

Or listen on Apple Podcasts | Spotify | Stitcher | TuneIn | YouTube

In today’s episode we are talking about Restorative Reproductive Medicine, and how using this methodology helps to diagnose and treat women’s health issues and infertility.

Highlights:

  • Dr. Whittaker’s story
  • Restorative Reproductive Medicine
  • Hormonal birth control
  • Dr. Whittaker’s methodology for treating PCOS
  • The types of PCOS
  • How common is endometriosis?
  • When does Dr. Whittaker know that somebody needs surgery for endometriosis?

Important Links

8 Steps to Reverse Your PCOS: A Proven Program to Reset Your Hormones, Repair Your Metabolism, and Restore Your Fertility by Dr. Fiona McCulloch

Facts About NaPro ebook

NaProTechnology.com

Follow Dr. Whittaker on Instagram

Quotes

“I think that medicine has relied too heavily on birth control.”

“Our cycle is kind of the window to the inside of our body to see what’s going on inside.”

017: What Is Restorative Reproductive Medicine? w/ Naomi Whittaker, MD, OBGYN TRANSCRIPT

Dr. Carrasco:                      Welcome back to the Hey Mami Podcast. In today’s episode, we are talking about restorative reproductive medicine and how using this methodology helps to diagnose and treat women’s health issues, especially infertility.

Dr. Carrasco:                      Our guest today is Dr. Naomi Whittaker. Dr. Whittaker is an OB/GYN fertility surgeon focused on women’s restorative reproductive medicine, compassionate healthcare, and education. Dr. Whittaker is a board certified OB/GYN and a fellowship trained surgeon, who specializes in the Creighton Model FertilityCare System and the NaPro TECHNOLOGY, which works cooperatively with a woman’s body to treat the underlying cause of gynecologic issues and infertility, such as endometriosis and PCOS.

Dr. Carrasco:                      Dr. Whittaker helps women improve their gynecologic health, avoid and/or achieve pregnancy in accordance with their natural fertility using the latest research, medicine, and surgery. Dr. Whittaker earned her medical degree at Creighton University School of Medicine and completed her residency in OB/GYN at OSF Hospital in Peoria, Illinois. She then completed Saint John Paul II Fellowship in medical and surgical NaPro TECHNOLOGY, at the Pope Paul VI Institute in Omaha, Nebraska. Dr. Whittaker is currently practicing in Harrisburg, Pennsylvania. Welcome to the show. Thank you. So, so, so much for being here with us.

Dr. Whittaker:                   Oh, thank you so much for having me.

Dr. Maren:                          And I think you baby post call too, so like an extra, thanks and props.

Dr. Carrasco:                      Yeah. Extra thank you for staying awake and talking to us about this.

Dr. Maren:                          Because for all the-

Dr. Whittaker:                   Oh, no. My pleasure.

Dr. Maren:                          … people listening, when you’re a surgeon and an OB GYN and all the things, that’s no joke.

Dr. Carrasco:                      Yeah. You do your shift and then you show up for this amazing interview, so thank you.

Dr. Whittaker:                   Oh, of course.

Dr. Carrasco:                      So we really want to start just learning a little bit about why you do what you do, kind of your story, what led you to practice medicine, the way in which you practice. And then we can dive into learning more about what restorative reproductive medicine is.

Dr. Whittaker:                   Sure. So, yeah, every time I tell my story, it’s a little different. I think I’m learning more about myself as I tell it. But when I was eight, that’s really when I really felt the calling to be a physician, from seeing my family physician really treating our whole family, physically, of course, but also emotionally, it affected us spiritually, and as a unit. And I just saw how powerful that was and how transformative it was and that it had a deeper meaning. And so that really compelled me to pursue that path. And so I took it very seriously from a young age.

Dr. Whittaker:                   So my parents, also, they’re immigrants. They fled communism in Poland. And so my father was always someone to encourage me to pursue big dreams. I came to this country for freedom and you can do anything. So he also implanted that in my mind, even though my parents were nothing close to physicians at all. My dad does construction and my mom’s a social worker in a prison. She was at the time working in a prison. So she dealt a lot with emotional healing. So I think that’s also why I was able to tap into that, so that’s what my drive was young.

Dr. Whittaker:                   Then I did make my way into medical school and didn’t realize what my path was at that point. I did love family medicine, endocrinology. I loved working with my hands. I didn’t know this would all come together, because I really do love the part of the endocrinology of problem solving. And through this process, I did, also, grow up as a young woman and didn’t know much about my cycles at all. And actually, kind of grew resentment towards my own cycles, having painful cycles, and just not a lot of guidance through puberty either.

Dr. Whittaker:                   So both of those are interesting parallels at the same time. And when I went into medical school, I was on the pill at that time. And I went to a lecture about Creighton Model system and NaPro TECHNOLOGY. And at that time I knew nothing about the science of the menstrual cycle, even though I was in med school. And it was kind of a optional lecture, it wasn’t part of the curriculum actually.

Dr. Whittaker:                   So I went and my mind was just blown about the science of the menstrual cycle, and things I didn’t know. And at this point what I was 22 or 23, and I knew nothing about my cycles or fertility. You think, I don’t know, everyone tells you… Well, basically, you feel ashamed about the pain or if you bleed heavily, if you have issues with that like, you kind of feel ashamed. So learning about women’s health kind of started to change my perspective into seeing the amazingness of that and the beauty and why it was designed. And so that first changed my own personal journey to see the beauty of the design. And so I had my own personal growth from that.

Dr. Whittaker:                   We started our family, when my husband got back from Afghanistan, this whole process just went together. And then I had a difficult experience with my own OB/GYN at the time, not valuing… So in my own personal beliefs, now that I knew from charting with the Creighton ModelSystem, also, just kind of a little paternalistic type medicine, and I got a C-section and just some of the things that he said to me, just led me to feel the opposite of empowered really.

Dr. Whittaker:                   So at that time I was deciding, I was in my third year of medical school, where we’re looking at all the different rotations. And then I jumped into the other side of… I turned from the patient into the student, and so I was able to see the other side, and I watched my first C-section after I just had my own, and that was eye opening, of course. A little much [crosstalk 00:06:44]-

Dr. Carrasco:                      No.

Dr. Whittaker:                   … too soon.

Dr. Carrasco:                      Yeah. TMI.

Dr. Whittaker:                   Yes. I’m like, “Oh, my gosh, that just happened.” Okay. I’m glad I didn’t know. What else? So then I saw just… I did my regular OB rotation, and then I was able to shadow NaPro TECHNOLOGY surgeons, too. And I saw just big differences and I thought, wow, this is an opportunity to give something different to women that I think… I don’t know, some women are going to really… Well, I think many women would benefit from, and it’s just so different that I want to make a difference in the world. I don’t want to just follow an algorithm of medicine. And I also saw how it’s not only physically healing, but it’s affecting the whole family unit.

Dr. Whittaker:                   You get the complexity and how it’s interesting that endocrine part, that puzzle to solve. And then, yeah, you’re helping build families, helping women feel better. So I was able to help, really, the whole family unit using my hands, and helping them emotionally, physically, and spiritually as well. So it just kind of all fits. And I also love the subject for so many… But I was just so interested in reading the OB/GYN textbooks and just loved the rotation, and just being there for women when they’re vulnerable. And yeah, I did fight it a little bit, because of, like you alluded to-

Dr. Carrasco:                      Just the lifestyle.

Dr. Whittaker:                   … I don’t want to… The lifecycle. I was like, “I do not want to get used to [crosstalk 00:08:37]-

Dr. Carrasco:                      I have to tell you like, so I’m family medicine, so is Christine, so we know we’ve done, I don’t know, a few hundred deliveries ourselves, but it’s such a powerful, beautiful, emotional transcendent moment when you can be the person to help bring that new human into the world. There’s nothing like being at those gates.

Dr. Carrasco:                      I wanted to share something. I think that there’s a couple of things we have that I wanted to share that we have in common with you. So I also knew I wanted to be a doctor by the age of nine, and my mom escaped communism from Cuba.

Dr. Whittaker:                   Oh, my gosh.

Dr. Carrasco:                      And Christine’s husband served in Afghanistan.

Dr. Maren:                          Yeah. My husband was Army. Was your husband Army?

Dr. Whittaker:                   Yes. Army National Guard.

Dr. Maren:                          Yeah. Awesome.

Dr. Carrasco:                      So got some more ties there.

Dr. Maren:                          Small world.

Dr. Whittaker:                   Yeah. It is.

Dr. Carrasco:                      So tell us a little bit about, something that, also, stood out to me in what you were just sharing is, when Christina and I both became involved and learned about functional medicine, and went to our first lecture, it blew the glass ceiling off of everything that we-

Dr. Maren:                          Yes.

Dr. Carrasco:                      … had learned. Because even though we were doctors and we’d gone to medical school and learned so many different things, nothing had been explained in this way. And then we felt like we could serve so many people with using this other system. So it sounds a lot like the way that you felt when you learned about this other methodology. So tell us about it. What is it? How does it work? How does it serve?

Dr. Carrasco:                      And, honestly, for our patient population, for our audience, most of our patients want the most, I would say, natural, non-invasive technology needed in getting pregnant. And so some of our patients do require fertility treatments, but having other options or looking at that lens differently, I think would be very powerful.

Dr. Whittaker:                   Yeah. I mean, there are many ways to describe it, but one that comes to mind would be, it’s basically what classic REI was supposed to be or what it started to be, which is, reproductive endocrinology and infertility. So back a long time ago, at least at some point, many of these REI doctors were trained to find the underlying endocrine issue and treat it. I mean, it’s just what I think medicine-

Dr. Carrasco:                      Root cause.

Dr. Whittaker:                   Root cause, right? That’s what medicine is. So we use the Creighton Model chart, which is a system where we teach women to chart their cycles in a scientific and standardized way. So they chart their symptoms down, and I’m trained to interpret this language of charting, and it’s kind of like my EKG. Cardiologists can interpret an EKG, I can interpret the menstrual cycle by reading this chart.

Dr. Whittaker:                   And so being able to have this chart is key, because the menstrual cycle is very complicated. And in that way, I’m able to assess what’s going on, quite quickly and easily, even though it’s pretty complicated, use that to run tests that are specific in the cycle, I have to time them specifically in the cycle to actually make sense of them. And then I can use that information to treat.

Dr. Whittaker:                   And so the treatment sometimes is very minimal. And of course, the more complicated the issue and more serious, the more involved the treatment can be. But sometimes it’s as simple as, let’s say, we’re talking about gyne issues. But if we’re talking about specifically infertility, I’ve had women with 10 years of infertility get pregnant on a mucus enhancer, so-

Dr. Maren:                          Wow.

Dr. Carrasco:                      Amazing.

Dr. Whittaker:                   So it’s not always… I mean, that’s rare, tenures usually you’d need a lot more treatment than that, but, yeah. So it can range from typical standard approach that you think of like, Clomid, though Clomid is not my favorite, but one of that group of Clomid, Letrozole, I also use Tamoxifen for ovulation medications, if needed.

Dr. Whittaker:                   We first see if someone’s ovulating though. We don’t just put everyone on 50 milligrams of Clomid, which is different. So usually reproductive endocrinologist will just assume a woman isn’t ovulating, put her on Clomid-

Dr. Carrasco:                      First visit, they’ll give them the prescription, that’s what I always see with my patients. And it’s like, “Well, did they assess anything?” “No. They said just to start taking it.” “Okay.”

Dr. Whittaker:                   Right. Exactly. And so Clomid does have, not only side effects, but it does dry up cervical mucus for a lot of people, it can then the lining of the uterus. So in some cases, if they don’t need it, it could be doing more harm than good.

Dr. Maren:                          Interesting. So what does it look like when they chart? What do you ask a patient to do specifically?

Dr. Whittaker:                   They go to Creighton Model certified FertilityCare instructor or practitioner. They go through an 18 month rigorous program to teach these patients. So first they go to an intro session. And so that introductory session may have a group of couples there or individual women, and they learn the science behind the menstrual cycle, more than a lot of physicians learned in med school-

Dr. Carrasco:                      Yes. Yes.

Dr. Whittaker:                   … in that session. And that’s usually free, that intro session, too. And so, they learn about the hormones about how to do observations, and some history too. It’s just really, really informative. It’s something I think every woman should really know.

Dr. Maren:                          Yeah. Totally.

Dr. Whittaker:                   Yeah. And so-

Dr. Carrasco:                      And every doctor.

Dr. Maren:                          And every doctor, right?

Dr. Whittaker:                   Well, of course, doctors should know more than patients, but-

Dr. Maren:                          So do they monitor their temperature and their cervical mucosa or their cervical position? Or what do they actually check? What do you have them-

Dr. Whittaker:                   No. Yeah. So it’s just writing down… So we’ll start at the beginning of the menstrual cycle would be, plotting down the bleeding patterns, if it’s light, moderate, heavy, and then throughout the cycle, they wipe from front to back, that’s the only observation they need to do is wipe. So takes just a few seconds every day, and you’re doing it anyway. And so before and after a woman goes to the bathroom, she’s going to wipe. And before and after going to the shower, before and after having a bowel movement, everything. And so it just takes a few seconds each time. And she’s going to look for cervical mucus on the toilet paper. And if there is mucus, to finger test it and see the appearance of it. And she’s taught, even with the picture dictionary, by this practitioner, what these look like and how to write this down.

Dr. Whittaker:                   And there’s actually a special system. So clear, you put K, for example, lubricative, you put L, and depending on the stretchiness, you put a number to it. And so it’s very scientific and standardized in that way. And so, also, it’s a very individualized, because this practitioner meets one-on-one with a woman, because, of course, women have so many different types of observations and cycles. And to make sure it’s a very effective, a woman needs to meet one-on-one with a practitioner frequently, at the beginning. And then they space it out, just to make sure a woman has confidence, in case she does want to use it to avoid pregnancy. Also, you want to be accurate, so that you have good data, because we do use this data and we do calculations on that. And so we do have numerical calculations of mucous cycle scores. We calculate the luteal phase, which is the time from ovulation to the next cycle.

Dr. Whittaker:                   And so all of these numbers also mean things to us, not just the appearance of the chart, but what a woman writes down. I can use that data to understand what’s going on and see if it’s improving. So a mucous cycle score, is it improving based on what we’re doing? The luteal phase, is that pretty regular? That’s the part of the cycle that we want to be consistent, that luteal phase. The first half of the cycle can be irregular, but once ovulation happens, the period should start about the same time each cycle from ovulation. So all those things are important. So we’re trained to know what’s abnormal, because a lot of people don’t even know what’s abnormal.

Dr. Maren:                          Yeah. Totally. One of the interviews we did earlier in the season is with the author of a book called The Fifth Vital Sign. Have you heard of that book? It’s like-

Dr. Whittaker:                   Yes.

Dr. Maren:                          Yeah. So she talked a lot about the fertility awareness method, which sounds a little bit different than the Creighton method. But I don’t know, I mean, they both sound like things that every woman and every doctor should know about. Pay attention to your cycle, it’s a vital sign. It really is. And that’s why I think, we can talk maybe a little bit about birth control and your thoughts around it. But I mean, there’s a time and a place for everything, right? There’s a time and place for birth control, obviously, but it really does sort of take away all of that data that can be so useful. Not only if we’re trying to get pregnant, but just if we’re struggling with other issues like PCOS or endometriosis or painful periods or whatever. So tell us about, what are your thoughts around that?

Dr. Whittaker:                   Sure. So I think that medicine has relied too heavily on birth control. That’s what the patients that come to me say or have experienced. For example, PCOS is a common one, women may not have a cycle for six months, and they’re told, “Well, this will regulate your cycle. Come back to me when you’re trying to conceive.” When really we know with PCOS, that’s a red flag, that there are other medical issues that that woman is at risk for. And we should really be looking deeper and educating her about that. That she’s at increased risk of heart disease and high cholesterol and vitamin D deficiency, and things I would want to know young, because you can do things about them, and you can prevent a lot of the issues that may come down the road and prevent infertility a lot of times.

Dr. Maren:                          Totally.

Dr. Whittaker:                   And some of these women are told, “Well, you’re either going to have difficulty conceiving or just come back,” obviously, making the assumption, they’re going to have difficulty conceiving. But then they have to wait until they want to conceive, and then they try 12 months. And then-

Dr. Carrasco:                      And a lot of times-

Dr. Whittaker:                   … they can get the work up.

Dr. Carrasco:                      Right. Or they’re like, “Come back when you want to conceive, and then we’ll just send you to IVF.”

Dr. Whittaker:                   Right. Then you’re on this quick timeline, then you’re ready to get pregnant, and then now you’re behind. And then, of course, IVF is, as far as for PCOS, PCOS is the worst diagnosis to use IVF for. Because the issue is not that they can’t ovulate, it’s that they’re very sensitive to these hormones. You just need to correct them, and then when you give them IVF meds, they overreact. And PCOS is, actually, pretty easy condition to treat, if you understand it, and has a very high success rate.

Dr. Carrasco:                      So what’s your methodology of treating PCOS? We have a big audience of women with PCOS. And I think that, like you said, a lot of clinicians just to kind of like kick it down the road and try and suppress with birth control. You’re not really regulating the cycle, because I mean, you’re just manipulating it, but you’re not regulating, you’re not fixing anything, [crosstalk 00:20:37] but just masking it. Yeah. So how do you approach PCOS using the NaPro or Creighton Model in your practice?

Dr. Whittaker:                   I love when they chart, because then I can see really what’s going on. And if they may have other issues, because oftentimes they may have endometriosis or thyroid system dysfunction, like Hashimoto’s, all those go together. So charting is key to figure out, is she just ovulating sporadically? Or is she not ovulating at all? Or trying to ovulate, I should say. The chart can suggest ovulation, but not confirm. Does she have signs of endometriosis? And so we can figure out all the issues that are going on. And hopefully, even before she gets married, that’s the best time to do all this, I think.

Dr. Whittaker:                   But for PCOS, so the number one step, the first step is to get labs and to figure out why she has PCOS, because there are different types of PCRs. And the most common one being insulin resistance, but that doesn’t necessarily mean that every woman’s insulin resistant. So if she is, they know to educate her on the cause of her PCOS, and why she may be having difficulty losing weight and other issues that can come with it. And then educating her about how to address those issues, such as diet changes, lifestyle changes, diet, exercise, low-glycemic index foods, myoinositol, talk about the nutritional deficiencies like magnesium, zinc. And maybe even other tests such as cholesterol, especially if they’re a little older, and then addressing all those potential issues.

Dr. Whittaker:                   And testing hormones after ovulation, since usually those women have progesterone deficiency, that’s the main issue with PCOS is a progesterone issue. So they just need a little progesterone sometimes to help their cycle kick back into gear. Of course, it depends on the severity. So for milder cases, they may respond very well to just myoinositol, supplements, and some progesterone, and maybe vitamin D supplementation.

Dr. Whittaker:                   And then depending on the severity, of course, they may have other issues or very resistant PCOS. So we, maybe, start them on some ovulation medications, if we determine they’re not ovulating. And for women with severe insulin resistance, very high testosterone, very large ovaries, they may be a candidate for surgery as well. And so, what I’m able to offer those women is a bilateral ovarian wedge resection.

Dr. Whittaker:                   And so what that can do is, I cut a wedge out of the ovary to make the ovary a normal size, and it functions much more normally. And these women, their testosterone goes down tremendously. I’ve seen it go down by 70%. It does help with insulin resistance.

Dr. Carrasco:                      DHEA-S too?

Dr. Whittaker:                   I don’t know about that. I think the adrenal type, I tend to avoid the wedge resection, because I think it’s a different source.

Dr. Carrasco:                      Got it.

Dr. Whittaker:                   I think it’s mainly the insulin resistant type that needs the wedge resection, so I have not been doing it for the adrenal type.

Dr. Carrasco:                      That’s fascinating. I didn’t even know about this. Did you know about that, Christine?

Dr. Maren:                          No. I’m blown away.

Dr. Carrasco:                      Blown away.

Dr. Maren:                          The things we don’t know.

Dr. Whittaker:                   You might have you heard of ovarian drilling. Have you heard of ovarian drilling?

Dr. Maren:                          No.

Dr. Carrasco:                      No.

Dr. Whittaker:                   Okay. Yeah. So there’s whole history too, see this all goes back to the history of REI. So Stein-Leventhal syndrome is what PCOS used to be called. So Stein and Leventhal, they originally were like, they found these ovaries, and they’re big, and they’re like, “Oh, this is weird.” So they took a big biopsy and these women would cycle normally. 95% of them would resume-

Dr. Maren:                          Wow.

Dr. Whittaker:                   … cycles. And so that’s how the ovarian wedge resection was discovered, so it was discovered in the 1930s. Now back in the ’30s, their surgical techniques were very different. They would probably do laparotomy or a big incision, like a C-section scar. And I don’t know what suture they would use or what techniques they would use or even if they would close the ovary, but those very early surgical techniques led to a lot of scar tissue.

Dr. Whittaker:                   So these women, many of them would ovulate right away and get pregnant right away. But they would have issues down the road from scar tissue and secondary infertility. And so with the invention of Clomid in the ’60s, medicine was like, “Oh, this is going to change everything. We don’t need surgery. Clomid is going to just change the world.” But it takes medicine about 10 to 20 years to figure out something’s not that great. So by the time-

Dr. Carrasco:                      Translation gap.

Dr. Whittaker:                   We’re slow in medicine, we don’t catch on. So we think we’re a little bit too optimistic and naive-

Dr. Carrasco:                      We’re like Y2K right now.

Dr. Whittaker:                   Yeah. By the time they figured it out, that Clomid had about a 28% success rate, not what they had hoped, then IVF came around and a lot of physicians forgot or in training weren’t taught anymore the wedge resection, because they thought it would be needed. And then what only what people remembered was all the scar tissue, so it had bad-

Dr. Maren:                          Connotation-

Dr. Whittaker:                   The people-

Dr. Maren:                          … or whatever.

Dr. Whittaker:                   Yeah. Everyone was just associating it with the scar tissue, but at the same time, surgical techniques were advancing and minimally invasive surgery would come later. And that’s what I use. It’s completely now. But then-

Dr. Carrasco:                      Do yo use robotics?

Dr. Whittaker:                   Yes. Yep. I use the da Vinci robot-

Dr. Carrasco:                      Awesome.

Dr. Whittaker:                   … to do just a minimally invasive, eight millimeter incisions to do this. And I do close the ovaries in a technique where the edges are smooth. You don’t even see the suture. And so with that, the scar tissue is minimal to none.

Dr. Maren:                          Wow. That’s awesome. Can you-

Dr. Whittaker:                   And it works very well.

Dr. Maren:                          PCOS, I think is a lot more common than people think. I feel like the data’s like 10% of women have PCOS. Is that right?

Dr. Whittaker:                   Right.

Dr. Maren:                          Can you walk people through like the types of PCOS? You’ve mentioned insulin resistance, you briefly kind of said the adrenal type. If we were a patient in your office and we were like, “I think I have PCOS. What causes it?”

Dr. Whittaker:                   I mean, I would focus on those two common ones. Basically, I mean, any type of an ovulatory disorder can make ovaries look PCOS, polycystic, right?

Dr. Maren:                          Yeah.

Dr. Whittaker:                   Because it’s building back follicles that never ruptured. So anything that’s going to cause an ovulation can cause a polycystic appearing ovary. Now the criteria for PCOS is you can have two out of the three criteria: elevated testosterone, polycystic ovaries on ultrasound, and/or irregular cycles. But I would say the most to comment… I mean, there’s a post pill type too, but I don’t usually see that too much. I see, mainly, insulin resistant by majority. I mean, I think the estimate is 70% and the best book to go over this, is the Eight Steps to Reverse your PCOS by-

Dr. Maren:                          Oh, cool.

Dr. Whittaker:                   … Fiona McCulloch [crosstalk 00:28:27]-

Dr. Maren:                          Oh yeah.

Dr. Carrasco:                      Oh yeah.

Dr. Maren:                          She’s so good, we love her.

Dr. Carrasco:                      We love her. Yeah.

Dr. Whittaker:                   Yeah, so that’s if you really want to get into it. But I’d say a majority is insulin resistance and the next biggest group would be the adrenal type. So the only way that is from labs, so for every PCOS patient, I order a two hour glucose test with insulin levels to see if they have the insulin resistant type. So that’ll tell you, that one test will tell you do you have the insulin resistant type or not? And the ones with really high testosterone, typically, have the high… Sorry, the insulin resistant type. Those usually go together.

Dr. Maren:                          And adrenal PCOS, I think is super interesting, because they don’t have insulin resistance. And often it’s the opposite, where I find that a lot of those women… Obviously, you see a lot more than I do, but I see a lot of women who are interested in getting pregnant and they’ve been diagnosed with PCOS by a fertility doctor, but they don’t have insulin resistance. But they’re the very high stressed, type A patient who exercises a ton, probably over exercises, restricts her meals a lot. It’s like, makes sense that she would be that adrenal picture. So how do you diagnose her? And what do you recommend for treatment for somebody who has adrenal PCOS?

Dr. Whittaker:                   Sure. That diagnosis would be based on, usually, they have polycystic ovaries on ultrasound or irregular cycles or late ovulation or anovulation, and then their labs show an elevated DHEA-S level, which happens from the stress causing the adrenal glands to secrete that hormone.

Dr. Whittaker:                   As far as treatment, I’d say her book has a list of treatments that I look into and recommend patients look into, since my training didn’t focus as much on this, but more on the surgical aspects. But her book talks about different-

Dr. Maren:                          Like adaptogens.

Dr. Whittaker:                   Yeah, adaptogens, ovarian adaptogens, like vitex and, what, licorice and all that. Yeah, there’s some great companies that have like a formulary of a combination of those, plus of course lifestyle changes, right?

Dr. Maren:                          Yeah. Totally.

Dr. Whittaker:                   Basic things like you said, like starving yourself and eating too few-

Dr. Carrasco:                      Overexercise.

Dr. Whittaker:                   … calories and overexercising, and a lot of it is addressing childhood trauma, too, if you’re carrying that or stress from work, all of those things add up. And so trying to figure out that woman’s root cause, if she needs counseling, I’ve done that too. A lot of things have, have come out of that lab value alone and then they’re like, “Oh yeah, this makes sense. It’s all coming together.

Dr. Maren:                          Totally. Totally. I mean, I think the next… Endometriosis, how common is endometriosis? I mean, we said PCOS is like one in 10 women, isn’t endometriosis have a similar-

Dr. Whittaker:                   That’s what they say. They also say what with infertility, like 50% have endometriosis, which that’s not true. It’s way more than that. I would have to look at my patients’ data. So my bias is I think it’s majority of people, 80 plus percent, I would say, of infertility have endometriosis. So it probably depends on the population, but a big red flag that I have for endometriosis is, of course, painful periods. But a lot of women with infertility just have infertility, not painful periods. But on the chart, I’d look for tail end brown bleeding, at the end of the period of at least two days or more.

Dr. Maren:                          Oh, that’s fascinating.

Dr. Whittaker:                   So that’s my secret.

Dr. Maren:                          Say that again, that’s so good.

Dr. Carrasco:                      Tail on bleeding?

Dr. Whittaker:                   Tail end-

Dr. Maren:                          Tail end-

Dr. Whittaker:                   … brown bleeding.

Dr. Maren:                          … brown bleeding.

Dr. Whittaker:                   So at the end-

Dr. Maren:                          That’s fascinating.

Dr. Whittaker:                   … of the cycle, of the period, when there’s like this brown bleeding, most people don’t even notice it or know it’s a problem, but if you’re charting, you’re trained to look for it. And of course, if it’s once in a while, I’m not as concerned, but if it’s pretty consistent or if it’s two days, three days, four days, especially, more than three days, there is evidence of this. There is some data, non-NaPro data to also validate this. But, yeah, especially two, three, four days of brown bleeding at the end of the period, like just spotting. That is abnormal.

Dr. Maren:                          So they might have a normal or a moderate heavy bleed or whatever for day one, two, three, four, and then they have like brown bleeding for like three, four or five days or something. So they think they have-

Dr. Whittaker:                   Yes.

Dr. Maren:                          … this 10 day period, but the end of their period, they’re just kind of spotty or I think, typically they probably call it spotting, but it’s that like tail end brown bleeding. Oh, that’s fascinating.

Dr. Whittaker:                   And what that is, is the lining of the uterus is unhealthy, and so it’s shedding abnormally-

Dr. Maren:                          Of course.

Dr. Whittaker:                   … and showing inflammation. It’s the one… What’s really cool is we… Our cycle is kind of the window to the inside of our body to see what’s going on inside, because it’s shedding. And so that’s when we see the lining really, where it’s inflamed is going to be at the end. And so we see that-

Dr. Maren:                          Coming off-

Dr. Whittaker:                   … coming off inappropriately. Yeah.

Dr. Maren:                          What do you think is like the underlying root cause of endometriosis? Is there an auto-immune component? What’s underlying that?

Dr. Whittaker:                   So this is a controversial topic, of course. And we’re taught… Well, I think a lot of the endometriosis surgeons that are kind of on the cutting edge, do not agree with the theory that we were taught in med school, which is retrograde menstruation. So I would say that’s likely not the cause, where when you have a period, the blood seeps out of the tubes and implants in the abdomen. That’s likely not the case. What I think is that women are born with it. And at the onset of menstruation, those hormones, especially estrogen are triggering these to activate.

Dr. Whittaker:                   One thing to support this theory is that we definitely see it more on people with uterine anomalies, for example. So when women have this too, there is some immune system dysregulation. Is it the chicken or the egg? I’m not sure. I have another theory with that, that the immune system is sensitized to it. So at first, it’s attacking it, and over time, as we get older, the effects get worse and worse and inflammation is worse.

Dr. Whittaker:                   So I think that’s why infertility… I definitely see women 25 and under that are much more able to overcome very advanced endometriosis and get pregnant. And as we get older and towards that age of 40, where autoimmune conditions are so prevalent, I think that sensitization over years, especially if we are moving on with our life and just not paying attention to our health and maybe, not only the stress and eating a lot of sugar and doing all of those things that are going to worsen our immune system, we’re doing all these things to also maybe not help it. So over all these years, I do think our immune system is attacking ourselves more and these implants more.

Dr. Maren:                          Okay. So you brought up like a couple things in my brain, so the way that I think, and I’m just going to… You tell me what you think of this theory. So it’s like, we say a lot “Genetics load the gun, environment pulls the trigger.”

Dr. Carrasco:                      Pulls the trigger.

Dr. Maren:                          So there’s this environmental-

Dr. Whittaker:                   Yes.

Dr. Maren:                          … trigger. They’re born with the genetics, then at some point, maybe, there’s this environmental trigger. But with autoimmune disease, I think of this like triad, where there’s, the triad is a genetic predisposition, which we can’t really change like you know. But then intestinal hyperpermeability, so we focus a lot on gut health because of that. And then this environmental trigger, which could be like high stress, or it could be something else crazy, like toxic mold exposure, something like that, that just like triggers the genes.

Dr. Maren:                          And so when I think about like celiac disease, so when we look at celiac genes… I wish there was like a genetic test to look for endometriosis, because I just wonder if there’s something else underlying it, where it’s like, yeah, a lot of us have the genetics for this. And a lot of us [crosstalk 00:36:47] can go our whole lives with those genetics and it never gets triggered for celiac disease. But then a lot of times it’s like something triggers that whether it’s like food poisoning or whatever, just really unhealthy lifestyle choices or not unhealthy lifestyle choices, it just maybe got unlucky with something else or pregnancy or something triggered those genes. So I don’t know, that was just like word diarrhea.

Dr. Carrasco:                      But it sounds also like the endometriosis might be like… it’s this structural issue that already exists. Is that what you’re saying? That you’re born-

Dr. Whittaker:                   Yes.

Dr. Carrasco:                      … with it structurally, it just exists. The tissue exists outside of your uterus. Is that what the theory is?

Dr. Whittaker:                   Yes. So, yeah, you got these endometrial like tissue, so glands that should only be inside the uterus, similar tissue. It acts a little differently is in the abdomen and causing inflammation. The body sees it as foreign and wants to attack it and clear it, and it’s trying to help you.

Dr. Carrasco:                      And that, possibly, this is congenital, that’s like mind blowing.

Dr. Whittaker:                   I think it’s congenital-

Dr. Maren:                          It is.

Dr. Whittaker:                   … because I’ve seen-

Dr. Maren:                          It really is.

Dr. Whittaker:                   From both personal and what I’ve seen, I had very bad periods, very young, and I was in the fetal position when I was a teenager, really, I mean, what 14, 15. Well, also we see… I see this in young teenagers 15, 16 sometimes, and sometimes very advanced. You would think, if they weren’t born with it, you would think they would only be early stages in young women. And by the way, yeah, a lot of physicians frown upon surgery in young women, so that’s a controversial topic. But we also see, the appearance is very different in young women too, so that’s just an interesting note. They’re usually these halo lesions that are very painful.

Dr. Carrasco:                      Wow.

Dr. Whittaker:                   And I don’t know if you’ve heard a lot of women say, “Well, my periods were very painful as a teenager and over time-

Dr. Maren:                          Yes.

Dr. Whittaker:                   … they seemed to have gotten better.

Dr. Carrasco:                      That was me.

Dr. Whittaker:                   Yeah.

Dr. Carrasco:                      Mm-hmm (affirmative). I got a little brown tail too. I’m going to have to like learn Creighton model now, or see if I can come to consult with you.

Dr. Maren:                          It’s so interesting. Yeah. Wow.

Dr. Whittaker:                   Yeah. [crosstalk 00:38:59]-

Dr. Maren:                          Maybe it’s just [crosstalk 00:39:00]-

Dr. Whittaker:                   … my periods don’t-

Dr. Maren:                          … genetics piece.

Dr. Whittaker:                   Yeah.

Dr. Maren:                          Like your mom got something and passed it along or two generations ago or who knows?

Dr. Carrasco:                      I’m going to blame communism in my family.

Dr. Whittaker:                   Yeah. Definitely, the stress, definitely, triggered-

Dr. Maren:                          Something.

Dr. Whittaker:                   Yeah. I mean, my mom was fleeing communism when she was pregnant with me, did that have any effects on me getting endo?

Dr. Carrasco:                      Right. Yeah. I mean, and we know that epigenetics definitely make cellular changes within people. I mean, that’s been documented clearly in the literature, so that’s so fascinating. Wow. And-

Dr. Maren:                          Tell us, who needs surgery? When do you know that somebody needs surgery for endometriosis? And then, what does it help besides symptoms? How does that correlate with somebody who wants to get pregnant? And I don’t know whether or not she’s having fertility issues, but how do you decide that?

Dr. Whittaker:                   Sure. I have different types of patients that present to me for surgery, usually a lot of patients know they want it before they get to me. And they know this, because they’re suffering, some of them are single and just suffering. It’s destroying their quality of life either for a few days a month or every day of the cycle. So that’s one subset of women, whether they’re trying to conceive or not, a lot of those women are not, so that would include teenagers. And people, like teenagers, who don’t want to be on the pill, for example, and they want to get more to the root cause of the issue and they know something’s really wrong and maybe their pain is causing them to vomit, it’s so severe. Those are the people that I see as far as pain category.

Dr. Whittaker:                   My other category is infertility patients, who may or may not have pain, so there’s two groups there. One group has a lot of pain and they just put up with it, because everyone told them to or, “Oh, my periods are painful. You need to suck it up.” Or they’ve talked to physicians-

Dr. Maren:                          That is not normal.

Dr. Carrasco:                      I’m like, “That’s just normal,” but no, it’s not normal.

Dr. Whittaker:                   Right. And physicians to have kind of done the same, even if they have infertility. The patient will say, I had one with secondary infertility, and had pain in her c-section scar every cycle. And she’s like, she talking to the infertility doctor, and she said, “I have pain every time during my cycle, in my C-section scar. I think I have endo.” She’s like, “Oh no, we’ll just, it doesn’t matter. My treatment of IVF is similar to chemotherapy. We don’t need to treat directly the issue. We just use IVF.” She said that to her, and she totally ignored her-

Dr. Carrasco:                      Her completely.

Dr. Whittaker:                   … symptoms. And the patient, she knew, and so she came for a second opinion, and had advanced disease, of course, also in her C-section scar. So the sad thing that I want to point out too, is that women put up with this pain their whole life and they suffer and they may go to work, they may not. And we were told this is normal and that we need to suck it up because we’re women, and they don’t get treatment. And then finally, when they were trying to conceive, then finally they’re going to do it for someone else, to get pregnant. And that to me is really sad that that’s kind of what we’ve trained women to think. That’s common to approach it that way.

Dr. Whittaker:                   So, of course, if they have infertility and pain at this point, they kind of really want surgery at that point, usually. I don’t ever try to push anyone, but at that point, a lot of women are ready to find answers. And sometimes all the testing has come back normal at this point, and I ex I describe it as, getting your car into the mechanic to just get a real tune-up to look in the engine of the car. You can run diagnostics all you want, but sometimes, if everything up is coming up negative, just to look in the hood of the car and to see what’s going on. Since ultrasound is not very good and labs can only do so much, so that’s a subset of women.

Dr. Whittaker:                   And then another one is just infertility and all the tests are negative or they failed IUI, or don’t want to do IUI IVF. And they feel like there’s something more and they’ve had a lot of testing and they’re ready to look. And so I look in the uterus, check the tubes and look in the abdomen with the camera. Because sometimes other testing, you just can’t… There’s nothing like looking and seeing-

Dr. Maren:                          Yeah. I know. [crosstalk 00:43:28]-

Dr. Whittaker:                   … what’s going on.

Dr. Maren:                          … a better test for endometriosis diagnosis. Some sort of… Is there anything coming out? Is there something that’s going to eventually telling us.

Dr. Whittaker:                   I’m telling you, that tail end brown bleeding, and history. Those two things-

Dr. Maren:                          Painful… Yeah. That’s [crosstalk 00:43:42]-

Dr. Whittaker:                   … I almost never… I think I have one a year that come back… Out of my diagnostic laparoscopies I really think I have one a year that do not have endometriosis.

Dr. Carrasco:                      Wow.

Dr. Maren:                          That’s very interesting.

Dr. Whittaker:                   I think you can’t get better than that.

Dr. Maren:                          So what about treatment options? Besides surgery, what other treatment options… What do you tell people with endometriosis to do?

Dr. Whittaker:                   I mean, so diet changes, doing an elimination diet or Mediterranean diet, some kind of anti-inflammatory diet. You can do Omega-3s. You can, gosh, so many… N-acetylcysteine is a good one.

Dr. Carrasco:                      That’s awesome.

Dr. Whittaker:                   Sorry?

Dr. Carrasco:                      No. I was going to say that’s awesome. I didn’t realize that NAC.

Dr. Whittaker:                   NAC is the only thing that I have found to actually shrink endometrioma size.

Dr. Carrasco:                      Really.

Dr. Maren:                          Fascinating.

Dr. Whittaker:                   Birth control pills, nothing is proven to shrink endometriomas that I know of, and I could be wrong, so if you do find that-

Dr. Maren:                          Is it like 900 milligrams or what dose do you use?

Dr. Whittaker:                   600 milligrams, three times a day, for four days a week is what they did in the study, I think it was in Italy. And so some of these women, their endometriomas shrunk just a little bit. It’s not going to dramatically improve, but it can help with the pain and the size a little bit. I really don’t like leaving it in, but some people, if they’re older or not trying to conceive or their symptoms aren’t horrible, they may want to buy some time to avoid surgery for endometriomas at least, I’m talking about. Because, that’s really the only thing that most sonographers are going to pick up. Otherwise, all the other endometriosis is going to be very small and superficial, too small for an ultrasound to pick up, at least.

Dr. Carrasco:                      I’ve had some success in my practice using LDN to help with endometrial pain, endometriosis pain.

Dr. Whittaker:                   Yes. Yes. I do use that as well-

Dr. Carrasco:                      Yeah-

Dr. Whittaker:                   … definitely.

Dr. Carrasco:                      … I love it.

Dr. Whittaker:                   Low-dose naltrexone. It’s amazing.

Dr. Carrasco:                      It’s a godsend. Honestly, because I think that it just hacks God’s chemical in our brain.

Dr. Whittaker:                   Yeah, it can be used [crosstalk 00:45:47] for basically anything too, right? And-

Dr. Carrasco:                      I think it helps with that autoimmune stuff.

Dr. Maren:                          Yeah. Exactly. I think we messaged back and forth about that clinical trial, which isn’t, it’s like going on near you, but they’re studying low-dose naltrexone. How much do you know about that trial?

Dr. Whittaker:                   I mean, I read this brief synopsis. They didn’t put a lot of data out, since it’s ongoing right now. Yeah. Like you said, the arms of the study, they’re both on birth control. Yeah. And one is on LDN and one’s not, so I feel like that’s going to be –

Dr. Maren:                          We would like a study without-

Dr. Whittaker:                   … problematic.

Dr. Maren:                          … everybody being on birth control, right?

Dr. Whittaker:                   Yeah. Yeah. Because that’s going to be a confounder and-

Dr. Maren:                          Yeah. Totally.

Dr. Whittaker:                   It definitely helps, I would say, the pain and maybe it helps with inflammation and implants too.

Dr. Carrasco:                      [crosstalk 00:46:35], yeah.

Dr. Whittaker:                   I don’t know. I would love to know.

Dr. Maren:                          It’s one of those things like where I feel like the risk is really low to use it, so usually it’s like worth a try. I mean, it’s probably not going to hurt.

Dr. Carrasco:                      I mean, it also helps with fertility, I think.

Dr. Whittaker:                   Yeah. Oh, it definitely does. Yeah. There’s-

Dr. Maren:                          Yeah. For sure.

Dr. Whittaker:                   … some evidence of that. Dr. Phil Boyle, in Ireland, he’s a NaPro doc, he has some YouTube videos on it.

Dr. Maren:                          Yeah. I’ve seen somebody.

Dr. Whittaker:                   You found it.

Dr. Maren:                          Yeah.

Dr. Whittaker:                   Yeah. Cool.

Dr. Carrasco:                      Yeah.

Dr. Whittaker:                   Yeah. And you can use it for PCOS and higher dose, twice a day.

Dr. Carrasco:                      Oh, wow.

Dr. Whittaker:                   Ovulation induction resistant PSOC, it can be used for hypothalamic amenorrhea in higher doses.

Dr. Maren:                          Oh like what kind? How high a dose, like 10 milligrams?

Dr. Whittaker:                   I want to say it’s 25, it’s either 25 or 50, twice a day.

Dr. Maren:                          Wow.

Dr. Whittaker:                   I’d have to look it up.

Dr. Maren:                          Yeah. Cool.

Dr. Whittaker:                   But it’s higher for cravings, it can help for like food cravings, that’s the twice a day dosing.

Dr. Maren:                          Yeah. Primary care doctors I think are sometimes using it in like weight loss-

Dr. Whittaker:                   Yeah. Contrave is the name brand.

Dr. Maren:                          Oh, okay. I didn’t know that. I’ve been out of primary care for like long enough where I forget everything.

Dr. Whittaker:                   Yeah. Contrave is Wellbutrin plus naltrexone together.

Dr. Maren:                          Oh. Okay.

Dr. Carrasco:                      Yes. Yes.

Dr. Maren:                          That makes sense. [crosstalk 00:47:56]-

Dr. Carrasco:                      I have seen that. I have seen-

Dr. Maren:                          … primary care doctor.

Dr. Carrasco:                      … some patients use that.

Dr. Maren:                          He was like, “I use naltrexone sometimes.” And I’m like, “Like LDN?” And he’s like, “What are you talking about?” “Low-dose naltrexone.” And he’s like, “I don’t know what you’re talking about.” No, that makes sense. Contrave, got it. Yes. Cool.

Dr. Carrasco:                      Well, I think our time is up, but we are so excited that you came on and your wisdom is amazing. I think probably we’d love to pick your brain more at some point, because-

Dr. Whittaker:                   Definitely.

Dr. Carrasco:                      … the work that you do seems… I mean, it doesn’t seem like there’s many people… I don’t know if there’s many people in the country that do the work that you’re doing. Do people come to see you from all over the country or just in your local area?

Dr. Whittaker:                   Yeah. So there are different levels of NaPro training. The NaPro Surgical Fellowship trained physicians, there’s about 32 of us, ish-

Dr. Maren:                          Not very many. Wow.

Dr. Whittaker:                   … around the country. Yeah.

Dr. Maren:                          Yeah. Awesome.

Dr. Carrasco:                      Wow.

Dr. Whittaker:                   And then you have medical consultants, who do a mini version of our training. And so they are able to deal with a lot of patients, but may or may not be able to do surgery, but they often can do less complicated cases or get the work started, and then refer they’re hard cases to people like me.

Dr. Carrasco:                      Sure, yeah.

Dr. Whittaker:                   Yeah. So I don’t know how many medical consultants, hundreds of medical consultants, but yeah, there are not that many. There are not enough. That’s [crosstalk 00:49:19]-

Dr. Carrasco:                      Yeah. Not enough.

Dr. Maren:                          But I think there will be more, because people want that.

Dr. Carrasco:                      This is necessary.

Dr. Maren:                          Patients want answers. And really, I think just as we see in the work that we do, they want to understand the root cause. I mean, it just isn’t acceptable really, for many of us to just say like, “Okay, just take birth control pill, and you’re going to be all better.” Because I’m not going to be all better with the birth control pill. That’s like really what led me to getting into medicine, was I stopped having my period and I was like 18 and they gave me a birth control pill. And I’m like, “Why… that doesn’t fix it?” I mean, it was just intuitive, but I’m like, “Why would I want to take a birth control pill? What’s wrong with me? Why am I not having my period?” So yeah, anyways, thanks for the work you do. Thanks for being here. It’s super interesting.

Dr. Whittaker:                   Well, thanks for spreading the word. Stuff like this, empowering patients is going to push doctors to work a little harder, to help answer hard questions and it’s just going to-

Dr. Maren:                          Doctors work hard enough, to do well.

Dr. Carrasco:                      To dig deeper.

Dr. Maren:                          Dig deeper.

Dr. Whittaker:                   Dig deeper. Excuse me.

Dr. Carrasco:                      Yes. Dig deeper.

Dr. Whittaker:                   Yes. They work very hard. It’s not that. They want to help. But to realize, oh, maybe I could look into something a little more and maybe look at it a little differently. And so it’s just going to be a push from the patient end, because yeah, doctors, I don’t know, are stretched very thin, unfortunately, which is probably part of the problem too. There’s a lot of societal issues that need to be improved, to-

Dr. Carrasco:                      Absolutely.

Dr. Whittaker:                   … probably supporting physicians too. But I think getting this knowledge out like you guys are doing is the main way to do that. And then other young women who are going to enter medicine, are going to be motivated, who would hear this, or young women who are struggling are going to be motivated to go into medicine and make change.

Dr. Carrasco:                      Correct. That’s it. That’s how it happens.

Dr. Maren:                          Totally.

Dr. Carrasco:                      And so where can our listeners find you?

Dr. Whittaker:                   On Instagram is probably the best way, NaPro fertility surgeon or you can search my name on Instagram.

Dr. Carrasco:                      Okay. Awesome.

Dr. Maren:                          Awesome.

Dr. Carrasco:                      And then if people wanted to learn more about NaPro, in and of itself, there’s an ebook, right?

Dr. Whittaker:                   Yes. Naproebook.com, or there’s naprotechnology.com. Yeah. There’s different resources on my Instagram page too.

Dr. Carrasco:                      Okay. Wonderful. Well, thank you so much for coming on and we really enjoyed meeting you, and thank you for doing this post call.

Dr. Whittaker:                   Oh, of course, so nice to meet you both.

Dr. Maren:                          Likewise, thanks again.

Dr. Whittaker:                   Uh-huh (affirmative). Thank you.

Alejandra Carrasco M.D. and Christine Maren D.O.

Hello! We are Alejandra Carrasco M.D. and Christine Maren D.O. We founded Hey Mami because we felt a lack of support for fellow mamis. As physicians, we see women every day who struggle with fertility, are forgotten about postpartum, and have put their health on hold for years while they raise a family. We’re here to change that.

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