PRECONCEPTION

020: What’s Stress Got To Do With It? w/ Brooke Kalanick, ND, MS, L.Ac

020

020: What’s Stress Got To Do With It? w/ Brooke Kalanick, ND, MS, L.Ac

Welcome to the Hey Mami podcast!

Our guest today is Dr. Brooke Kalanick is a licensed naturopathic doctor and women’s hormone expert. She is the co-author of Hangry: 5 Simple Steps to Balance Your Hormones & Restore Your Joy and the host of the popular podcast, The Dr. Brooke Show. 

Dr. Brooke specializes in PCOS, menopause, thyroid conditions, autoimmunity and various women’s hormone issues. She helps her patients get to the root cause of their hormonal imbalances and get back to feeling better with targeted diet and lifestyle habits. She teaches women how to understand their own hormone talk so they can finally work with their bodies, metabolism and hormones instead of being in a constant fight with themselves.

She lives in NYC and when she’s not busy in her practice or as a mother and wife you can find her on a #mantrawalk or lifting weights.

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

In today’s episode we are talking about how stress can impact hormonal health.

Highlights:

  • Dr. Brooke’s story
  • Hangry
  • Different types of PCOS
  • How to approach the stress aspect of cortisol dysregulation

Important Links

Find Dr. Brooke online

Hangry: 5 Steps to Balance Your Hormones & Restore your Joy

The Five Pillars of Real Self-Care

12 Tangible Tools from Hangry by Dr Brooke & Sarah Fragoso

Lab Guide

Quotes

“There’s the more classic PCOS, which has got an insulin resistance component. There’s the adrenal-based PCOS, which is more of an adrenal gland and cortisol issue. You’ll see that there’s an inflammatory type of PCOS.”

“We don’t always know the stresses that we don’t see. Like, how stressful is inflammation? How stressful is my blood sugar? How stressful is my essential fatty acid issues, or a nutrient deficiency, or a chronic infection, or an unhealthy gut?”

020: What’s Stress Got To Do With It? w/ Brooke Kalanick, ND TRANSCRIPT

Dr. Carrasco:                      Welcome back to the Hey Mami podcast. Our guest today is Dr. Brooke Kalanick. In today’s episode, we’re talking all about hormones, Dr. Brooke’s book, Hangry: 5 Simple Steps to Balance Your Hormones and Restore Your Joy in Your Life. We’re going to also talk about types of PCOS, and PCOS beyond insulin and ovulation issues. We’re going to talk about how stress management stresses women out. We’re going to discuss the upsides of stress. And then we’re also going to dive into stress responses beyond fight or flight.

Dr. Carrasco:                      Dr. Brooke is a licensed naturopathic doctor and women’s hormone expert. She is the co-author of Hangry: 5 Simple Steps to Balance Your Hormones and Restore Your Joy, and the host of the popular podcast, The Dr. Brooke Show. Dr. Brooke specializes in PCOS, menopause, thyroid conditions, autoimmunity, and various women’s hormone issues. She helps her patients get to the root cause of their hormonal imbalances and get back to feeling better with targeted diet and lifestyle habits.

Dr. Carrasco:                      She teaches women how to understand their own hormone talk, so they can finally work with their body’s metabolism and hormones, instead of being in constant fight with themselves. She lives in NYC. And when she’s not busy in her practice, or as a mother and wife, you can find her on a #mantra walk or lifting weights. Dr. Brooke, we know you’re a busy woman. Thank you so much for joining us today.

Dr. Brooke:                         Yes. I am so happy to talk with both of you.

Dr. Carrasco:                      Well, it’s a pleasure. Often we start our podcast just by asking the question, what is your story? And tell us why you do what you do.

Dr. Brooke:                         Well, probably like so many of your guests, I ended up gravitating towards naturopathic and functional medicine because of my own health struggles. So as a young teen with an erratic, heavy, crazy cycle, I got diagnosed with PCOS. And it was like most young women, just no explanation of what this was or what this meant. But just here, you need to be on the pill.

Dr. Brooke:                         And you’re probably going to have trouble having a baby. And you’re probably going to have diabetes when you grow up. And I was just sent on my way. And I was 16, so of course, I took the pill. And that can be a useful tool for some women. For me, I just never felt right on it. It definitely managed some of my symptoms. I had a more predictable bleed every month.

Dr. Brooke:                         But as soon as I would get fed up with how I felt on it and I tried to come off, and then everything reared its head. And unfortunately, just there was no other options in conventional medicine for me. And then I went to college and went to pharmacy school and was still really struggling. Ended up seeing a naturopathic doctor who I know now looking back, the things she did for me were so minor compared to some.

Dr. Brooke:                         I know both of you guys and myself too, we deal with a lot of really complex autoimmune cases and really complex issues. Mine was pretty straightforward. I had some cortisol issues. I needed to manage my blood sugar. I needed to look at my stress. She supported my thyroid a little bit. And I was like a new person. And so it really took me out of feeling like my hands were a little bit tied in the conventional medicine world, and to exploring other options.

Dr. Brooke:                         Because this was again, a condition that I had that I was like, “Oh my gosh, every woman needs to know.” If they have PCOS, there are so many other options, either in conjunction with conventional options or beyond that. So I really was helped by my naturopathic doctor a couple of different times. And so I decided to jump ship right as I was about to graduate and go to best year and become a naturopathic doctor.

Dr. Brooke:                         And I always knew that from there, I would work with women. I did not know how my practice would become so focused on exercise and some of the things that I ended up getting into later, this paleo focus, all these things that happened along the way as part of my journey.

Dr. Carrasco:                      Wow. That’s amazing. And then part of your journey is also the book that you’ve written. So tell us a little bit about Hangry. And can you share with our audience a little bit about what you talk about in the book, and why you wrote it?

Dr. Brooke:                         Yeah. Yeah. So I wrote Hangry with Sarah Fragoso. If you know the paleo world, and Sarah was probably the first woman on the paleo scene, which sounds funny now because paleo is such a big world and lots of women are blogging, and influencers on there, but Sarah was the first one in that world. And so I knew her long before she knew me.

Dr. Brooke:                         We both spoke at a conference and just really hit it off in the sense that our message was very similar. We were both moms. We had both been really burned out and had to come back from that. So we met and then got together, started our podcast, which Sarah is no longer doing the podcast. It’s just the Dr. Brooke Show. It was the Sarah and Dr. Brooke Show.

Dr. Brooke:                         But before she stepped away a couple of years ago now, we wrote Hangry. And so Hangry, the title is funny to us now because we all know what that feels like. But the book we originally wrote, we called Too Tired to be Happy, because we felt like we both had a lot of tools in terms of her background as a strength and conditioning coach and this food blogger in the paleo world, and then me, from a naturopathic and functional medicine standpoint.

Dr. Brooke:                         We had a lot of tools if we meet with a woman, that we can say, “Hey, here’s what’s going on with you. And here’s how we need to change how you’re eating, how you’re working out, all these different things. And get some of these things in line and you can feel better.” But what we found was most women were really excited with that information, but then they were too overwhelmed and worn out to actually do it. And so we-

Dr. Carrasco:                      Yes.

Dr. Brooke:                         Yeah, which I’m sure everyone can relate to.

Dr. Carrasco:                      Mm-hmm (affirmative).

Dr. Brooke:                         So we felt like we put all that information in the book, but I think what became the part we were the most proud of is looking more at a couple of things. One, all of the different ways that stress manifests for women and overwhelm. And if we can’t help women with that, they can have all the nutrition and exercise programs in the world, if they can’t get it done, then it’s not that helpful for them. So there was that piece of it.

Dr. Brooke:                         But also, so many women are like for me, for example, so I’ve got PCOS. Well, there’s certainly been times when I’ve also had some sort of cortisol problem. There’s many women also have a thyroid issue. And by the time they get to see me, and probably similar with both of you, they’ve got more than one root cause. They’ve got more than one hormone issue. And problem is they go and look for advice for that.

Dr. Brooke:                         And this diet for, let’s say, low thyroid is maybe a paleo or an autoimmune low grain, low inflammatory diet. Don’t exercise. And then they’ve also got PCOS. Now, this advice is like, well, you should be keto. You should be really low carbon. You should be exercising a lot. Maybe they also have adrenal issues. And so they get all this conflicting advice, and maybe they’re going through perimenopause where that advice is also very different.

Dr. Brooke:                         And so I felt like we needed to create a system for women that they could honor all of their hormone issues, instead of feeling like, well, if I do this diet that’s going to help with my PCOS and my insulin resistance, am I totally sacrificing my fibroid and my cortisol balance in the process? So teaching women that there is a hierarchy for their hormones.

Dr. Brooke:                         You may have all those issues. But if you address them in a specific order, you won’t end up creating one particular hormone balance trying to fix another. So teaching women to honor those more delicate hormone issues, like low thyroid, cortisol issues, then dealing with insulin resistance, and then dealing with estrogen and progesterone, which a lot of people found interesting when they read a book about hormones for women that for us, I put estrogen and progesterone at the bottom.

Dr. Brooke:                         Because if we don’t address those bigger metabolic issues, like thyroid, cortisol, and insulin, not much we go after just with estrogen metabolism or something like that is going to be as helpful as if we honor those things above. That’s what Hangry was about. It was trying to be a little more lifestyle and stress management oriented, but then also, help most women that are dealing with multiple issues. How do they know how to untangle that, and where to start?

Dr. Carrasco:                      That’s amazing. And it sounds like very, very helpful guidance. I’m sure that-

Dr. Brooke:                         Yeah, I hope so.

Dr. Carrasco:                      I’m sure that book probably took quite a lot of work.

Dr. Brooke:                         It did.

Dr. Carrasco:                      So let me ask you this, because a lot of our listeners want to get pregnant and many are dealing with PCOS. Can you dive in into the different types of PCOS, maybe the nuances that come with PCOS, especially when it comes to preconception health.?

Dr. Brooke:                         Yeah. So this is probably where I’m a little bit different than some blog posts and other experts you might have seen if you’re a woman of PCOS and you’ve been looking down at these different types of PCOS. So there’s a couple of them that I think get called PCOS. And that misses the point a little bit because they’re resolved with different things.

Dr. Maren:                          Mm-hmm (affirmative).

Dr. Brooke:                         So the most common types of PCOS that if women search, what type of PCOS do I have on Google, this is what they’re going to see. So there’s the more classic PCOS, which has got an insulin resistance component. There’s the adrenal-based PCOS, which is more of an adrenal gland and cortisol issue. You’ll see that there’s an inflammatory type of PCOS.

Dr. Brooke:                         Sometimes as well, you’ll see post-pill PCOS. So something that can happen after you come off a birth control pill or hypothyroid. So to me, the post-pill PCOS and the thyroid PCOS, I don’t know that we should even really call them PCOS, meaning polycystic ovarian syndrome that’s more associated with the underpinnings of inflammation, oxidative stress, and insulin resistance.

Dr. Brooke:                         Because you may have cysts on your ovaries, you may not be ovulating properly, you may even have some of the androgen issues. But they’re going to get sorted out. And for example, if it’s low thyroid, we can fix your thyroid and those issues with your ovulation, will return to normal. And if it’s the pill, we just need to oftentimes give yourself a little bit of time to get through.

Dr. Brooke:                         Sometimes there’s a rebound high androgen after the pill, and that will start to sort it itself out. If you didn’t have issues before the pill, you probably don’t have true PCOS after the pill. You’re just dealing with this post-

Dr. Maren:                          It’s almost like the umbrella is in ovulation versus PCOS, right?

Dr. Brooke:                         Yeah. And it can get so confusing. Well, so with those two, I’d say let’s just deal … I don’t really even call those PCOS. They’re just different kinds of ovulation problems. And when you look at the other three types, so we’ve got inflammatory, more like classic insulin resistance, and then the adrenal type, there’s so much overlap there, too.

Dr. Brooke:                         So you’ve got your conventional diagnosis, where you meet these certain criteria on a list. So it’s a syndrome, like some of our syndromes. There’s these things on a list that have to happen. If you have three or more, then we’re going to put you under this bucket. I think one thing that’s going to happen is we’re starting to understand more, the immune component of this condition.

Dr. Brooke:                         So there may be more of an autoimmune component, and these may be more related than it seems. So when we look at the different types, in terms of insulin resistance, adrenal-based, or inflammatory, I don’t typically count inflammatory as its own thing, because traditional PCOS, it has such an inflammatory component to it. So to me, that one is such a part of all of these issues. So I don’t tend to think of that one.

Dr. Brooke:                         So now, we’re dealing with, as its own entity, now we’re dealing with, is this more of a higher testosterone, insulin resistance type of thing? Or is this more of a high DHEA adrenal-based issue? So we’re going to come at those two a little bit differently. So one thing you have to have, if you’re going to say that it’s PCOS, which you’re not going to be ovulating properly, you’re going to have some high androgens for sure.

Dr. Brooke:                         And then if you’ve got the insulin resistance, we’re going to be going after that, in terms of lowering the insulin resistance. We’re going to be managing oxidative stress and inflammation in both of these. But the adrenal one is a little bit different, in the sense that it’s typically the DHEA that’s high and not the testosterone. So it’s an androgen coming from our adrenal glands and not so much our ovaries.

Dr. Brooke:                         This one oftentimes is misdiagnosed as PCOS. And it’s really hypothalamic amenorrhea, so that gets even more tricky, because both of those can have cysts on your ovaries on an ultrasound. They can have some issues with androgens, and you’re not going to be ovulating. That one, if a woman comes to me with that, the first thing you do is go back and look at some of the history, to see if we might have got a PCOS diagnosis when we didn’t really have that.

Dr. Brooke:                         And you can have both, too, which makes this extra confusing when you’ve got someone with that more high cortisol, high DHEA, dealing with the adrenal type picture. You could have hypothalamic amenorrhea in the mix of that. And again, this just goes back to the point of Hangry, is it might look like PCOS and you’ve been told it’s PCOS. So, what do you do? You start going off a really low carb diet.

Dr. Brooke:                         You’re probably exercising more, and that can really kick off some of the hypothalamic amenorrhea stuff. So this is where I think functional medicine is really great, because we can do some of that more nuanced testing to look at hormone metabolites, and see which things are elevated and get a better sense I think, with the model that we use in functional medicine, because I think there is quite a bit of overlap. So I oftentimes care less about what type it is.

Dr. Brooke:                         But I think women, it’s always good to see ourselves. We take a quiz when we look at an article and we’re like, “That’s me. And I don’t fit that classic PCOS picture, but this information makes me feel a little bit more understood.” I think that’s important. But I think what we always want to do is let’s look at what’s going on with this person. What are the lab saying? And what are your symptoms saying? And deal with that. And I care more about that typically than what we call it.

Dr. Maren:                          Yeah.

Dr. Carrasco:                      That’s a really good point. It is nice to have some … It’s almost validating when people know what to call it. But nonetheless, we all have different elements which influence whatever disease state we have.

Dr. Brooke:                         Yeah.

Dr. Carrasco:                      So if a woman comes to see you and you’re thinking maybe you have PCOS, we’re not totally sure. Maybe her workup was really limited in the past, but her periods are irregular. What does your workup look like? What might a patient expect, or maybe something they might expect to get from their doctor in California or whatever?

Dr. Brooke:                         Yeah. So a lot of times, we’re looking at some of the conventional testing in terms of, have you had an ultrasound? Have we looked at your pituitary hormones? Typically, the LH hormone is elevated when we’ve got PCOS. That’s the opposite of what we see in something like the hypothalamic amenorrhea.

Dr. Brooke:                         And then, do we look at conventional labs too, of the free testosterone, the total testosterone, the DHEA? Some of those female hormones, as we know, though, those can be a real snapshot. And some of our functional testing that looks at hormone metabolites can be really helpful. For example, some women with PCOS, and I’ve always fallen into this camp personally, my testosterone’s usually pretty normal.

Dr. Brooke:                         It’s never typically elevated, and never has been, but I have a lot of high testosterone symptoms. But when I look at something like a DUTCH test that shows me what I do with testosterone and how I metabolism it down that naughty pathway, that becomes a more active androgen metabolite. And then I get the breakouts. Mine, I’m more breakouts. Someone, get more of the darker course, or hair growth or the hair loss.

Dr. Brooke:                         Sometimes you have all of those things. But sometimes looking at those more functional tests can be helpful if you are still a little bit unclear because you’ve been told, well, nothing’s going wrong because you don’t have high androgens on your blood work. Sometimes we’re more sensitive to it, and it doesn’t take as much for us to have those issues.

Dr. Brooke:                         And then, regardless of what type I think you have, we’re still going to want to make sure we really check your thyroid really thoroughly. And I’m sure you guys have talked about that at length on other shows. Definitely make sure you’re screened for Hashimoto’s, because I always say Hashimoto’s and PCOS are like besties. They’re together quite often.

Dr. Brooke:                         And then, really doing a good workup on the blood sugar and the cortisol. Because to me, like I was saying in the beginning, I have really classic adrenal … I’m sorry, traditional insulin, resistance-based PCOS, but there’s been many times in my life where I’ve had cortisol disruption, too. So we always want to look at both sides of that blood sugar equation.

Dr. Brooke:                         And I like to look at their A1C, their fasting insulin, of course, their glucose. Really looking as well at daily glucose. That’s not just for people that have over diabetic issues. And we’re seeing this more and more now, people using continuous glucose monitors and stuff. And I think that’s a really great way for women to know.

Dr. Brooke:                         Not this off-the-shelf plan that’s like, okay, I eat this many grams of whatever, but actually looking in real time. It’s what does my body actually do with that? And creating The Brooke Plan, versus the Christine Plan. And they might both be lower carb, but they’re going to be really different, right? Because-

Dr. Maren:                          Yeah.

Dr. Brooke:                         … we have so much unique variability.

Dr. Maren:                          I agree, completely. I used a glucometer, because I had gestational diabetes. And I was also diagnosed with PCOS way back when, which was not a correct diagnosis. But the moral of the story is check your diagnosis.

Dr. Brooke:                         Yeah.

Dr. Maren:                          Anyways, I used a glucometer and learned so much about some surprising kinds of foods and how they affected my blood sugar. And yeah, like you said, we’re all individuals. We have a different tolerance for things like potatoes or rice, or bread or whatever it might be.

Dr. Brooke:                         And it’s so great to get that realtime feedback, right?

Dr. Maren:                          Totally.

Dr. Brooke:                         You don’t have to wait months until you check your A1C or your fasting insulin again. But what’s happening today, and I think doing that too, you can a lot of times see too, like wow, I didn’t sleep very well this week, and I can really see that. Or I’m really stressed this week, and I can definitely see that in my blood sugar, too. And remembering that it’s always not just about the carbs. It can be so many other pieces of that blood sugar equation.

Dr. Maren:                          Or exercise.

Dr. Carrasco:                      Yeah.

Dr. Brooke:                         Mm-hmm (affirmative). Mm-hmm (affirmative).

Dr. Maren:                          Like, I exercised this week and my blood sugar’s awesome, or my muscle mass is better and I have a better time tolerance for blood sugar.

Dr. Brooke:                         Yeah, I think-

Dr. Carrasco:                      Or you exercise and your blood sugar goes up, because it’s too stressful.

Dr. Brooke:                         Right. Right. There’s that side, too. I think that exercise is one of the most, especially if you have insulin resistance, it’s one of the most important pieces of your therapy, of your treatment is muscle mass. That’s where all that glucose can go. And for women with PCOS, if you’ve got insulin resistance and higher androgens, you may be someone that puts on muscle a little easier.

Dr. Brooke:                         I certainly am. And it took me a really long time to start to work with that physiology, instead of what I was conditioned to do, which was just become smaller. Realizing that that muscle mass actually is a real powerful tool for me to manage my hormones. It’s just, I’ve got a little bit different physique than what I was raised to think was what I was supposed to look like, right?

Dr. Carrasco:                      Yeah, that’s a great point. That’s a great point. Can we also dive into stress management? Because if we’re dealing with cortisol dysregulation, then how do you approach cortisol dysregulation? And then, how do you approach the stress aspect of cortisol dysregulation?

Dr. Brooke:                         Well, I think stress, it is such a huge term. When we say stress, that’s like everything.

Dr. Carrasco:                      Yeah. Life.

Dr. Brooke:                         Yeah. It’s so many things. And it’s become this real catchall term. So I think when you’re working with a provider like one of us, you’re going to be probably addressing a lot of the stresses you don’t know you have. Women think, “I don’t have enough time, money, energy.” Those are the things that are … And my life is really busy and overwhelming.

Dr. Brooke:                         And we are very familiar with that as a concept of stress, but we don’t always know the stresses that we don’t see. Like, how stressful is inflammation? How stressful is my blood sugar? How stressful is my essential fatty acid issues, or a nutrient deficiency, or a chronic infection, or an unhealthy gut?

Dr. Brooke:                         There are so many of those stresses that are going to put the heat on our system and on our hormones, that sometimes we need a little bit of help to figure out. Or it’s just, we’re not making necessarily that connection of missing a meal when our adrenals aren’t in a great place and might not be the best thing. That might be more stressful than someone else who can handle more fasting, because their HPA access, all that is working a little bit better.

Dr. Brooke:                         So there’s a lot of those physiological stresses that sometimes we need a little … That’s where testing or just talking to someone, or looking into a great book or something, that can help you dive into some of those things. So those are, I think some of the stresses that miss women sometimes because they don’t see those as a stress. But then there’s all the lifestyle stress.

Dr. Brooke:                         And I think there is no shortage right now of talking about self-care and talking about stress management. Yet, what do we see with most of the women in our practices and most of the women in our life? They’re still stressed out because I think, I don’t know. I feel like stress just needs a rebrand. I think it’s just, we’re scared to death of it. So every time something comes up that is stressful and we get worked out, we’re scared of what it’s doing to our health and our hormones.

Dr. Brooke:                         So I certainly think it’s wise for all of us to look at our overall stress load in our life, and see what can go. Many of us just have too many things on our plate. Sometimes it’s something someone else can do. Sometimes you can hire it out, you can trade it out. Sometimes it can just not get done. And that can be overwhelming in and of itself.

Dr. Brooke:                         And I think we have to go back to some key questions of, what matters the most to me? What are my core values? Because I don’t think any of us have figured out how to get more time out of the day. We’re all stuck with the 24 hours, so we have to prioritize. And I think taking some time to set your own core values. Most of us don’t do that as a part of stress management.

Dr. Brooke:                         Because when we’re going to come to some sort of choice point during the day of, am I going to work out, am I going to volunteer for this thing, am I going to do these, sleep in, not sleep in, do something else for my family, do something else for work, respond to those emails now or later, we’re going to always have a choice that can feel really stressful. And sometimes stuff has to get done.

Dr. Brooke:                         We can’t get everything off of our plate. And I think that’s really important, especially for women who are feeling really overwhelmed to know. There’s going to be stuff you have to get done. And part of that’s going to come down to, I have taken the time to find my core values, find what matters most to me. And then when we do that thing, it’s less stressful. The work still gets done. But coming at it in a different mindset and being really clear on, I know that this is the thing that matters most to me, makes those choices less stressful.

Dr. Brooke:                         And I think those opportunities to make choices from a different place, are the part about stress management that we’re not talking about. We’re still talking about taking alone time and not feeling selfish, taking time away from your kids to do something for yourself. And that’s all great. Those things all feel good. But I think how we go about our daily lives has set a bigger impact on how stressed we feel.

Dr. Brooke:                         And I think when we give something up, so if we decide that we’re going to work less to spend more time with our kids, I think too, there’s this idea that we can have it all and we can feel really great about all of it. And that does us a disservice, because when we choose one thing over another, maybe they both matter to us, there is a loss of something.

Dr. Brooke:                         We might lose income, or we might lose more success in our career to be home with our family. And we might have decided that our core values are such that I know that I want this thing. I want to spend more time with my family, and I want that more, and I’m co clear on that. But not acknowledging that we gave something else up, I think keeps us stuck in this overwhelmed unhappiness.

Dr. Brooke:                         Yeah. I don’t think that that’s helping us to tell ourselves we’re not missing anything. I think as most women, we feel this internal struggle and we acknowledge it, and we know that we made that choice from a place that really represents what we want most. We’re able to process the loss of that and let it go. And then that choice becomes less stressful. That was a very long-winded answer to it.

Dr. Maren:                          No, it’s so good though.

Dr. Carrasco:                      I think it’s wonderful. Yeah.

Dr. Maren:                          It’s like, why do we all need some therapy in our life?

Dr. Carrasco:                      Yeah.

Dr. Maren:                          It’s not going to hurt. And it just is like, we just have to really step back and really examine our priorities. But that is so much easier than it sounds.

Dr. Carrasco:                      Mm-hmm (affirmative).

Dr. Brooke:                         Yeah. And we don’t take the time to do that. I almost feel like we’re supposed to know what’s supposed to matter most, and we shouldn’t have to think about it. But I think we do. And I think we have to be oftentimes, where did this value come from? Why is this thing even important to me? Is this from childhood? Is this from an old boyfriend? Where did this even come from? Is this from society? Or does this really matter to me?

Dr. Brooke:                         And I think the other thing about stress is we think of it as all bad, but it wouldn’t be stressful to you if you didn’t care. Those choices are stressful because those things matter to you. And I think that lets us off the hook in a way, instead of like, this should be easy, I should be making these choices and feeling really good about it. And I think that’s when we see women just in this, they hit their 40s and they’re like, “I don’t even know what makes me happy anymore.”

Dr. Brooke:                         We had in Hangry, something we called the five pillars. And that was finding and committing to what works for you. And a lot of that’s the diet and lifestyle stuff. Opting out of overwhelm, full engagement living, being your best friend, and being who you are. And all of those things, if we’re not doing them well, and we haven’t taken a minute to figure those things out, are going to be really stressful.

Dr. Brooke:                         And they’re really big ideas. You’re certainly not going to nip those in our 30-day plan. Those are really big things that you’re going to carry with you. But all of that, I think creates the how we do what we do. We can go about our healthy diet and lifestyle and all of these things, feeling good or not feeling good.

Dr. Brooke:                         And what I was about to say a moment ago was I think so many women get to this point in their late 30s and 40s and they’re like, “I don’t even remember what I like. I know what my partner likes and my kids like, and my boss likes, and all of these things. And I’ve lost touch with who I am.” And that is incredibly stressful.

Dr. Carrasco:                      Yeah. When you don’t know, when you feel like you’re just surviving your life and taking care of everyone else’s needs, I think that a lot of women and a lot of moms are in that space. Also, I think a lot of younger women are in that space now, too. In a lot of my preconception patients, I’m seeing so much overwhelm and so much stress.

Dr. Brooke:                         Yeah.

Dr. Carrasco:                      Yeah. A few months ago, I was driving in my car and an old song came on. And I was like, “This song is from 1998. That was an easier time.”

Dr. Brooke:                         No global pandemic.

Dr. Carrasco:                      The world spun a little bit slower, I think. So this generation of women has a lot. The world is always turned on. There’s not a lot of time in the space between, I suppose.

Dr. Brooke:                         Yeah. And I think that 20s, you’re oftentimes building a career. And then, when do you start to make all these other changes? And so I think that with stress again, needing a rebrand, there’s some, again, really good things about stress. And like I said, if it didn’t matter to you, it wouldn’t stress you out. So it does point you back to your core values. If you feel like I’m spending too much time at work, it’s because your family really matters. And maybe it’s time to take a look at that.

Dr. Brooke:                         But I think too, we also don’t want no stress. Not that most of us are not in danger of no stress, but I think again, reframing how we think about it is important. Because most women, when I say how’s your stress management, they’re like, “Oh, Dr. Brooke, I’m sorry, I’m doing a very bad job.” They’re instantly apologetic and feel like they’re failing at it. I always say we want to be whelmed, we don’t want to be underwhelmed, because now we’re not growing and we’re not changing. We’re not [crosstalk 00:27:28].

Dr. Maren:                          Yeah, totally.

Dr. Carrasco:                      I like that.

Dr. Maren:                          Mm-hmm (affirmative).

Dr. Brooke:                         But we don’t want to be overwhelmed either. And oftentimes-

Dr. Carrasco:                      I would like to be whelmed.

Dr. Brooke:                         Just whelmed, just the right amount. Just enough to make you feel alive and feel connected to the things that really matter, but not so much that you’re totally wrecking your hormones and your happiness in the process.

Dr. Maren:                          Yeah, that’s such a good point. And like everything, it brings it back to balance. It’s like we can be so polarizing about certain things. And if we can just have a little balance, I think that’s key.

Dr. Brooke:                         Oh. And right now, it’s really tough to be anywhere online and not see the polarization. My husband is there-

Dr. Maren:                          Yeah, everything seems really polarized right now.

Dr. Brooke:                         I know. And I always say, remember, all of us experts on social media, we’re trying to be heard. So we’re going to take a polarizing angle, but I’m not sure that we’re doing a whole lot of good sometimes. I feel like right now, my husband is a standup comedian and there’s this concept in comedy that’s yes anding a situation.

Dr. Brooke:                         And I’m like, “That’s what we need in health and wellness right now.” There’s no, yes, we might need this scientific information. And we also need to pay attention to what we’re eating. It’s so black and white out there.

Dr. Maren:                          Totally. Yes.

Dr. Brooke:                         It’s not enough [crosstalk 00:28:33].

Dr. Maren:                          Agreed, 100%. Yeah, there’s a lot of that going on.

Dr. Brooke:                         Which is-

Dr. Maren:                          I won’t go down that rabbit hole, but-

Dr. Brooke:                         No, but I mean-

Dr. Maren:                          … offline, we can talk about that. But, yeah.

Dr. Brooke:                         But it’s the same thing with, let’s take the keto diet. This is a diet for everyone, forever and ever, amen. And that’s not reality. There’s times when that’s going to be a really great tool for someone, and there’s going to be someone where it’s never a great tool for them. And it’s like, here’s what it is and what it can offer you. And then, how does that fit with your hormones?

Dr. Maren:                          Yeah. Totally.

Dr. Brooke:                         Yeah.

Dr. Maren:                          Here’s my other thought with stress, too. I think we look at it so often as emotional stress and overwhelm from work, and just all the demands of our life. But I also think that people forget one of the huge stressors on our body is just a lack of physical health.

Dr. Maren:                          And so if we’re neglecting our health and we have some underlying issue, like gut dysbiosis or whatever it might be, that’s going to cause issues with our cortisol as well, right?

Dr. Brooke:                         Yeah. And I think this is the plague of women is there will be time for me to deal with that later, right?

Dr. Maren:                          Mm-hmm (affirmative).

Dr. Brooke:                         We start seeing this shift in our digestion. We start seeing this shift in more PMS. We start seeing our sleep get a little bit worse. And none of it feels immediately life-threatening. And you’ve got all this other stuff to do, especially if you have a family, too. It’s like, “Well, I’ll deal with that later.”

Dr. Brooke:                         And then it just is really hard for most of us to pay attention and be our best friend, and not make our hormones scream at us. Those little tweaks or those little symptoms that are the messenger in the beginning, are a little more subtle. And your hormones will keep shouting at you until you listen.

Dr. Brooke:                         And eventually, then we’re in a spot where it’s just sometimes a lot harder to turn it back around. Not that there’s no hope, but it’s harder when you’ve got PCOS and Hashimoto’s and rheumatoid, and something else going on than when you first just started having the inklings of those symptoms. But that’s just up to all of us.

Dr. Brooke:                         That’s the self-care of making sure that we’re addressing it when things change and when our hormones talk to us, which they do. And we get really mad at them. Women almost always email me, that’s how the opening email starts, is I hate my hormones. I’m like, “Oh, your hormones are just trying to save you from this crazy life you’re trying to lead.”

Dr. Carrasco:                      Yeah. Yeah. I think that when I had my first pregnancy, I developed preeclampsia. And then when I got pregnant the second time, I remember having this moment where I spent a lot of time being terrified that I’d get preeclampsia again. But then I had this moment where I just realized that my body, during my first pregnancy, was just trying to do the best that it could with the resources that it had.

Dr. Brooke:                         Yeah.

Dr. Carrasco:                      And I think that also, it was just such a huge aha moment for me because I feel like with many of my patients, our patients, their bodies are just trying to do the best that they can with the resources that they have.

Dr. Carrasco:                      And so I think taking away some of the blame that can come with having certain chronic illnesses or dealing with things in the body, I think that can also be very freeing. Because that causes stress like, “Oh, I didn’t do well enough for myself. So now, I’m in this mess.”

Dr. Brooke:                         Yeah. And I think that wellness has just become a competition, right?

Dr. Carrasco:                      Totally.

Dr. Brooke:                         I feel like that in that way, especially being on social media and stuff, and following …

Dr. Carrasco:                      Mm-hmm (affirmative).

Dr. Brooke:                         That’s really stressful to feel like, well, what if I can’t ever get my health into that kind of a place? And I think it’s a really big reminder for all of us to keep our eyes on our own paper. You’ve got your own set of genetics and lifestyle issues and priorities. And your more is going to be whatever works for you right now.

Dr. Brooke:                         And it’s not that we don’t want to strive to feel as good as we can and take as good of care of ourselves as we can. But I think there’s this pressure that so many women feel of like, how am I going to do everything when it comes to the organic food and the free range food and the grass-fed, and all the natural products? And I’m not getting exposed to any endocrine disruptors.

Dr. Brooke:                         And oh my gosh, I’m doing all this and my A1C still looks like this, or my cholesterol still looks like that. Or I still have something going on in my gut. And I think it’s not a competition. And there are so many things that go into making the health that each of us have. And we can’t let that be.

Dr. Brooke:                         If it’s a motivator to help you make better choices that work for you, great. If it’s a motivator to feel like, oh my gosh, I am not winning the wellness game, then that’s going to be another stress.

Dr. Maren:                          Yep, totally.

Dr. Carrasco:                      Yep.

Dr. Maren:                          This makes me think of my Peloton bike. They’re like, if the leaderboard helps you, keep it there. If it doesn’t, shut it down.

Dr. Carrasco:                      Yeah.

Dr. Maren:                          Sometimes it’s motivating to see what other people are doing, and you learn. But sometimes it’s not, and you just got to listen to that.

Dr. Brooke:                         Yeah, I know. Yeah, there’s a lot of input telling us we’re supposed to be more and do more, and be different.

Dr. Carrasco:                      Mm-hmm (affirmative).

Dr. Brooke:                         And it’s almost sometimes like a part-time job or a full-time job to suss all that out. But that’s when I think again, going back to knowing what matters to you and trusting that, will help you navigate the many, many stresses that are going to show up. There are certain stresses that are totally worth it. Writing that book, that was stressful, but I would do it again in a heartbeat. Having a baby, that’s stressful.

Dr. Brooke:                         Going through trials in your relationships, and hopefully you come out stronger. There’s just going to be things. And I just think that what we need to probably talk to women more about is, how do we get better at the stresses that matter to you? Because you can’t get rid of it. I don’t think any of us today on this call are going to get rid of our kids because they’re stressful. That’s like, how do I get better at this stuff that matters to me, right?

Dr. Carrasco:                      Right.

Dr. Maren:                          Yeah.

Dr. Carrasco:                      I love that.

Dr. Brooke:                         Unless someone, one of you guys has the answer. We all have an island we can go, where someone’s going to cook and clean and take care of us. But then I don’t think that’s happening anytime soon for me.

Dr. Maren:                          Yeah. No. A lot of times it’s just, we have to reframe some of these stresses. And it goes back to the beginning of your conversation. Really decide, what are our priorities? What do we want? What are these goals? And then maybe reframe some of the stress around them.

Dr. Brooke:                         Yeah.

Dr. Maren:                          Maybe it doesn’t have to be so stressful all the time.

Dr. Brooke:                         You always got to go back to it, too. Your priorities might change, and your health goals might change. And what used to work for you in terms of your health and your hormones will change, too. So don’t be afraid to go back and look at it and let go of something that you’ve been hanging on to, for something that works a little bit better now.

Dr. Maren:                          Mm-hmm (affirmative).

Dr. Carrasco:                      I think that’s really, really great information and advice. My grandmother left communist Cuba at the age of 55 and came to this country, basically a refugee. And had lived through many dictatorships by the time she left Cuba. But she looked to be 103. She went through a lot of stress, but she also had a lot of resilience.

Dr. Carrasco:                      And so I think to your point, stress isn’t always going to destroy us. It’s more about how you do the best with the situation that you’re in, and how you reframe and how you try to keep making a way for yourself, and a path for yourself. And so I agree that this generation is so afraid of stress, but there’s so many generations who’ve lived through very stressful and scary times. And many of those people thrived.

Dr. Brooke:                         Mm-hmm (affirmative). Yeah. I look at just even ancestral health right now. Our grandparents’ generation was not that long ago, and how many things they did differently in terms of how much activity they got, the food that they were eating. And I think it’s really great that we’re returning to it.

Dr. Brooke:                         More people are paying attention to fermented foods, and we’re paying attention to processed foods and where our animal meat comes from, and things like that if those are part of your diet, and eating vegetables and growing a garden. We’re doing so many more of those things. But yeah, it’s interesting that our grandparents, we can’t romanticize either how hard that life was.

Dr. Carrasco:                      The Great Depression, World War I, World War II.

Dr. Maren:                          Yeah, stress is a constant.

Dr. Carrasco:                      My grandparents’ dictatorships. It’s so-

Dr. Maren:                          Yes. It just goes to show stress, it doesn’t go away. It’s just how we deal with it and what we choose in life and all that. But yeah, it’s a good reminder of these things. Stress is a constant in our life. It just is.

Dr. Brooke:                         We’ve gotten new things in terms of [crosstalk 00:37:17].

Dr. Maren:                          It evolves.

Dr. Brooke:                         Yeah, and our light cues are all off. And there are so many things, like our phones. And there are so many things that are probably additional stresses for us right now. And you got to do the best you can. And we got to let ourselves have that be enough most of the time.

Dr. Maren:                          Yeah.

Dr. Carrasco:                      Yeah. Totally. Well,-

Dr. Brooke:                         And you can do better. You can. And sometimes your best still has to be good enough today, right?

Dr. Carrasco:                      Right. Right. Well, this has been a really, I think enlightening episode. And I hope that our listeners will read your book and will create their core values, so that they can navigate life as it shows up.

Dr. Carrasco:                      So, can we talk about where people can find you? And I think you also have a giveaway for our listeners, where maybe they can create, or they can follow your five pillars, I believe.

Dr. Brooke:                         Yeah. So Hangry is still available wherever you get books. Our paperback came out, gosh, at the beginning. I don’t know what happened to 2021. I guess it was the beginning of 2021 that our paperback came out, so that’s a great price on Amazon and online bookstores. My podcast now is just me, without Sarah, but it’s The Dr. Brooke Show. And then on social media and Instagram, I’m at Better by Dr. Brooke.

Dr. Brooke:                         Better by Dr. Brooke is also my website. And yeah, I can give you guys actually, two gifts if you want. There’s a PDF guide for both the five pillars. So the five pillars from Hangry are again, these overarching perspectives to take with life, to make it less stressful. But they’re not going to be things that you, again, master necessarily. I don’t know if ever. I still feel like I’m constantly getting new tools to work on those things.

Dr. Brooke:                         And then we also, because some days you meditate and some days you’re trying to live from the five pillars, but you get stressed out and you need to have tools that help you work through that and complete the stress cycle. So there’s also something called the 12 tangible tools. And those are more in the moment, I’m going to do this right now to get myself out of this stress response.

Dr. Brooke:                         And we did 12 because there’s going to be things that maybe I do when I’m stressed out, that really help me. And that might make Christine’s skin crawl. She might need something totally different. So I think we try to provide a lot of different ways to get through that. So hopefully, there’s something in there for everyone. So I can give you guys the links to both of those guides.

Dr. Carrasco:                      Oh, that would be awesome.

Dr. Maren:                          Awesome.

Dr. Carrasco:                      Awesome. Awesome. Awesome. Well, thank you so much for joining us today. So glad that our audience gets to learn from you. And I hope everyone enjoys this episode.

Dr. Brooke:                         Yeah. Well, thanks for having me.

Dr. Maren:                          Thanks, Brooke.

Dr. Brooke:                         Yeah, you’re welcome.

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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