Hormones and Your Health with Aviva Romm

Trevor:  Hi there, I’m Dr. Trevor Cates. Welcome to ‘The Spa Doctor’ podcast. Have you ever felt tired, fuzzy, overly stressed, or just felt like something wasn’t right with your health; but you’re told that everything is normal? You might start thinking, ‘Maybe these symptoms are all in my head.’ Or, ‘Maybe I’m just getting older.’ Well, before you start making these assumptions, I want you to watch today’s podcast, because I think you’ll find some answers here.

Did you know that the answers for your health concerns might actually be in your hormones. When I say “hormones,” people often automatically think sex hormones, like estrogen, progesterone, and testosterone. Thyroid and adrenal hormones, they’re also hormones, and they play a big role in the way you look and feel. That’s exactly what we’re talking about today.

I’m excited to introduce my guest. I’m a huge fan. In fact, I actually asked her to write the foreword for my book. Thankfully, she said “Yes.” I’m also thrilled to have her on my podcast today. My guest is Dr. Aviva Romm. She is referred to as the ‘Face of Natural Medicine in the 21st Century,’ by ‘Prevention’ magazine, and named one of the ‘100 Women to Watch in Wellness’ by ‘mindbodygreen.’ Dr. Aviva is a midwife, herbalist, and Yale-trained MD, board certified in family medicine with obstetrics; as well as a graduate of Dr. [inaudible 00:01:28] Integrative Medicine residency from the University of Arizona.

Her focus is on the impact of stress on health, willpower, food cravings, weight, chronic disease, and hormone imbalance in women. She’s also an avid environmental health advocate, researching and publishing on the impact of toxins on women’s hormones, and chronic illness in women and children. Dr. Aviva is one of the nation’s leaders in botanical medicine, and is the author of seven books on natural medicine, including the textbook ‘Botanical Medicine for Women’s Health,’ and her latest book, ‘The Adrenal Thyroid Revolution.’ She is the author of the integrative medicine curriculum for the Yale Internal Medicine and Pediatric Residencies, and is on numerous scientific advisory boards, including ‘Prevention’ magazine. She lives and practices medicine in Western Massachusetts and New York city, and is a nationally sought-after speaker, author, and consultant.

In today’s interview, we discussion the connection between symptoms you might be experiencing, like fatigue, belly fat, brain fog, sleeplessness, skin changes, and more; and the connection with those with hormones. In particular, your thyroid and adrenal hormones. Dr. Aviva shares how to know if your adrenals and thyroid need support, and specific lifestyle, diet, and natural treatments to regain balance of your hormones, and get your health back.

She shares so much information in this podcast, so I wanted to remind you that we now transcribe these podcasts. This is a great one to check out on my website, TheSpaDoctor.com/Podcast, and maybe even print this transcription out so you can read it and use as a guide. Please enjoy this interview with Dr. Aviva Romm. Aviva, it’s so great to have you on my show.

Aviva:  It is so fun to be here with you. Thank you for having me.

Trevor: Yeah, absolutely. Let’s just delve in to talking about adrenals and thyroid, and that connection between the two. I think it’s so fantastic that you have your book out now, and that we have this information to share with people, because I get asked about adrenal and thyroid all the time. A lot of those people talk about them separately, but as you talk about, there is a big connection between the two.

Aviva:  Absolutely. Both you and I are trained in integrative forms of medicine, naturopathy, midwifery, and herbal medicine; before my MD training. The real big distinction what we learn in our types of training, and what medical doctors learn, is that we learn that everything is connected. There’s not really a separation between the immune system, the endocrine or hormone system, the nervous system. What is happening in our bodies, all this connected orchestra of instruments that are ideally playing in harmony together and creating something really beautiful, which is our healthy life.

What you learn in medical school is that there are really these different system silos. What happens in the nervous system has nothing to do with what happens in the hormone system, has nothing to do with happens in your immune system. It’s just well known now, even in really good science, that that’s not true. Interestingly, the adrenal glands, which are part of a whole access that is called the HPA, or hypothalamic pituitary adrenal access, is super interesting because it is sort of the exemplary system that pulls together the immune system, the nervous system, and the hormone system.

What happens when those systems are out of whack, when something is going on that causes stress in those systems, it has an impact all over our body. There’s really nowhere that we don’t feel it, because those systems regulate our digestion. They regulate the normalcy or cyclic nature of our hormones. They regulate our sleep, our resilience to stress, our appetite, our cravings, our willpower, our cognitive functions; so whether or not we have brain fog or clear thinking, and our immune system. For example, how well we are able to withstand infections that we’re exposed to, but also whether or not we did autoimmunity.

There are two really big, well, three really big connections that happen between that stress response system and the thyroid. One thing is that when we are overly stressed, whether that be because we’re not getting enough sleep, we’ve got a lot of going on in our lives. We’re taking care of our elder relatives, we’ve got teenagers that we’re raising at the same time. We’re trying to pay our bills, keep up with a 24/7 world that never seems to shut down. As women, we are particularly vulnerable because we have a hard time giving ourselves permission to pause, and to take care of ourselves.

What happens is that your body starts to recognize that you’re actually expending more energy than you’re replenishing. Just like in any energy crisis, what are we told to do? Turn down the thermostat and conserve energy. Well, what’s your body’s thermostat? Your thyroid. When your brain, when your body, is recognizing that there’s not enough energy, it dials back your thyroid to a slower functioning level. What can happen is that you have slow digestion, you get less blood flow to your skin and your scalp, so you can get dry skin, wrinkling, puffiness in your skin. Also, you can lose hair because your scalp is not being nourished as well. You become more fatigued. Your appetite can get out of control, because your body is fatigued. It’s making you crave starches and sugar. You don’t have enough energy for doing basic clear thinking and decision making.

That’s one of the ways, when your thyroid, when your adrenals are picking up, that your energy is depleted, or taxed. It actually sends chemical messages in the form of cortisol, a hormone produced in the adrenals, that prevents the thyroid from actively creating and using the important thyroid hormone that does all these functions of metabolism and energy in your body. One of the things I didn’t mention, but ‘metabolism’ is such a key word, is weight gain. I’ve had so many patients who have tried everything. They are really trying. They’ve worked on their diet. They’ve gone paleo. They’ve gone vegan. They’ve increased their exercise. They’re doing yoga, and spinning, everything. They’re really working at it. They still can’t lose weight. When you check their thyroid, it’s like you’re trying to push against an obstacle that’s fixed, which is how much thyroid hormone you’re producing.

Interestingly, the second thing is that rather than thinking of this as an illness or a disease, we have to think about it as what your body’s really trying to do, is get you to slow down, rest, and repair. Part of what happens is when we’re tired, we push against it. We eat more sugar. We drink more caffeine, things with caffeine in it. We’re pushing ourselves, and so we’re even further depleting ourselves.

Another important thing is that HPA access that I mentioned that regulates the adrenals also controls our immune system. It can make your immune system become hyperactive to your own cells and you can start to attack your own cells; which is what happens in an autoimmune disease. Also, when you’re really depleted and tired, old infections that you had a long time ago, like Epstein-Barr Virus, from mono, can get reactivated. We all know that when we’re tired, when we’re more fatigued, when we’re run down, we tend to get sick more.

Well, one of the kinds of sickness that can happen is this reactivation of old viral infections. When those get reactivated, certain different processes can happen in the body that start to make the body attack any tissue where those viruses either have gotten harbored, or that look like those viruses. Your body thinks it’s trying to kill the virus, but it’s actually attacking your own tissue. The thyroid is especially vulnerable to that. Those are some of the ways that the adrenal and the thyroid are deeply connected.

Trevor:  Wow, that’s amazing. You just covered so much information in like five minutes. [crosstalk 00:09:57] Thank you.

Aviva:  It’s so fascinating.

Trevor:  It is. It is so fascinating. The thing is is that people going to see their doctor because they’re tired, and they’ve lost the drive. Maybe then that makes them feel kind of depressed. Their doctors will say, “Okay, well you just … You’re just stressed, so here, take this antidepressant, and, you know, get more sleep.”

Or whatever, and they’re not explaining what you’re talking about here. People think it’s all in their head. They think, ‘Oh, I’m just crazy. I’m just stressed. I need to slow down.’ They don’t realize that there’s actually a physiologic hormonal reason that this is happening.

Then, it starts with that. Then you gain weight, and then you can’t sleep, and then you have problems with your skin, and all these things then come on top of it. People go back to their doctor, and then they’re prescribed something to help them for their sleep. “Oh, you just need to eat.”

Aviva:  Their blood pressure, and their blood sugar, because now they’re eating sugar because they’re so tired. Now their blood sugar’s up. I can’t tell you how many times I have sat across from a woman at my desk, in my medical practice, or consulted with someone on the phone, and had this audible sigh of ‘oh,’ and watched women’s shoulders just drop.

It’s like, “Thank you, Dr. Romm, because all this time, I really started to think that maybe it was in my head, because I’ve seen five doctors and they all said ‘Just take an antidepressant,’ or ‘You’re fine.'” Or, maybe they got blood work done, and the blood work wasn’t abnormal enough to get a diagnosis. Then, you’re told you’re fine by someone who you should be able to trust as an authority, and it’s very confusing; and these women go home. That disconnect between what we’re actually feeling and what we’re being told can add to the depression and anxiety, and further disconnect between what’s going on in our bodies.

It’s really just such a powerful thing to explain to women, “One, this is not your fault. Two, you’re not crazy. This is not all in your head, and there are things that you can do about it. There are reasons it’s happening, and there are things you can do.” It’s just like, “Oh, thank you.” People cry. I keep tissues in my office.

Trevor:  Absolutely. Yeah, what a relief to hear that. Also, another thing that people are told is “Well, you know, you’re getting older; and so, this is kind of to be expected. You’re going to be, you know, more tired, and you’re not going to feel the same. You’re not going to have the same sex drive. You’re not going to, you know, feel as youthful.”

I feel like there’s so much related to our hormones that we can do, that there are things you can do to feel great, in your 30s, 40s, 50s, 60s, beyond that, even. I’m so excited to talk about that today. Where do you start with people? Say they come in with these things. How do you test? How do you determine what’s really off with adrenal and thyroid?

Aviva:  Great question. When someone has symptoms that are very classically thyroid-related, a lot of what I mentioned, the weight gain, the hair loss, dry skin, constipation, fatigue, depression, anxiety, poor sleep, changes in appetite. It may be several of those, or all of those, and there are other symptoms, too. Carpal tunnel syndrome, joint pain, weakness; these are all symptoms that you can have with slow thyroid. That’s a medically solvable issue, and readily fixable, in the short term with thyroid supplement and then the long term with lifestyle changes while we’re complimenting, and then we can see whether someone can come off that thyroid supplement, which some women really can. I always check for thyroid.

I also check for other things. We want to make sure that we’re covering the basics. If someone’s really tired all the time, I check for iron deficiency anemia. I make sure their B12 is normal. I check all the basic medical things that are important to make sure everything is okay, and then thyroid panel is part of that.

If their thyroid panel comes back abnormal, showing that they have Hashimoto’s or hypothyroidism, then I will add in a few additional tests. Particularly testing for hidden viral infections, because I’ve had many women come into my practice who test positive for Hashimoto’s, who also test positive for Epstein-Barr Virus. I also check for celiac disease and gluten intolerance, because those are also known and very reversible conditions that lead to very reversible Hashimoto’s. Super important that I check for anything that can be a classic underlying cause.

Then, what I’ll usually do is depending on what the thyroid levels are, I will either say “Hey, what do you feel about this? Your thyroid levels are kind of borderline where conventional medicine would still think they’re normal, but in an integrative or functional approach, I would consider this Hashimoto’s or hypothyroidism.” The difference between the two of those is Hashimoto’s is an autoimmune thyroid disease, where a hypothyroidism is just more generics, low-functioning thyroid. You can have hypothyroidism without Hashimoto’s, but you can’t have Hashimoto’s without hypothyroidism.

I’ll ask them, “You know, we can take several approaches here. We can take three months, or six months, and try to reverse all of these root causes, and wait to see if you need a thyroid supplement, replacement, thyroid hormone replacement.” Or, if they’re feeling really badly and it’s seriously affecting their quality of life, they can’t go to work or keep up with their regular functioning, or not even that severe, they’re just really struggling, and their labs are abnormal enough.

I might suggest, “You know, what you will probably feel like night and day if you start thyroid hormone supplementation while we’re spending the next three, six, twelve months, depending on what the imbalances are and what we need to turn around getting those, and then we can see if you can come off.”

With adrenal, usually the symptoms are fairly classic. Even still, wearing my due diligence medical hat, I still make sure to check for other things that can be look-alike illnesses, or conditions that we want to make sure that we’re taking care of, like some of the ones I mentioned. Anemia, for example, is a common one that makes people feel really tired, can affect your appetite, et cetera.

Once I know that I’ve ruled out, as we say in medicine, all the medical things, if what’s left is still the classic symptoms for adrenal, I don’t necessarily even do any testing. If it’s on the fence, we’re not quite sure, then I will run what’s called a 24 hour salivary cortisol test; where someone literally spits in a tube, four different tubes, sends that into the lab, and we can look at the rhythm of cortisol. Cortisol has, in healthy people and otherwise not strained and taxed people, has a very normal, predictable curve where it’s high in the morning, it starts to go down throughout the day. It reaches it’s lowest in the late, late night, around when we’re going to bed, and then starts to pick back up again over the course of the middle of the night. I’m looking for disruptions in that curve. There are very specific patterns that can tell me is someone depleted? Are they on overdrive? That can help us to select what we need to do to support them.

Some of it is, I wouldn’t say common sense, but you’re sort of educated knowing that you can see what the patterns are, what the symptoms are. That can often guide me to making the decision. If somebody has classic adrenal disease symptoms, which are a very specific set of symptoms that could mean they have a severe adrenal insufficiency, like Addison’s Disease. Then I’ll get specific cortisol testing that’s a little bit different. It’s conventional testing that can tell me if we have a more serious problem going on. If somebody is, the shape of their face has changed, it’s called a moon face. Or, they’ve specifically lost muscle, or they’re having very severe weakness, I might check normal conventional cortisol testing as well.

Then, from there, we really start with the specific lifestyle changes, dietary changes, sleep habit changes, stress management. It’s honestly not rocket science. It’s probably what we should all be taught to do in kindergarten, instead of learning about Christopher Columbus. We learn all this stuff all our lives, and we just never learn about self care and how food can be our medicine, or how sleep can be our medicine. We’re so pressured, as women, by this 24/7 go-go-go lifestyle that we actually have to really deliberately start to learn, as women, to give ourselves permission to pause.

Hit the stop button and say, “I’ve got to get some time for self care. I’ve got to get some time for sleep. I’ve got to get out of this driven mode into a mode that allows my body to repair and replenish.” Also, depending on the symptoms and depending on the collateral conditions, because when you have this problem going on for long enough, this syndrome that I call “Survival Overdrive Syndrome.” It’s that survival system getting stuck in overdrive. You can end up metabolic syndrome, polycystic ovarian syndrome, high blood pressure, hormonal imbalances, sleep problems, menopausal symptoms, high cholesterol, high blood pressure If I didn’t say that already.

A lot of women that come to me, they’re in their 30s, 40s, and 50s, and they’re already on multiple medications for depression and anxiety; which are also part of this system being out of balance. Chronic inflammation, autoimmune disease. They’re on a statin for their cholesterol. They’re on an anti-hypertensive for their blood pressure. I can’t tell you, not everyone can come off of every medication; but what I have seen has really been astonishing to me in terms of even just two weeks of shifting the diet, shifting the sleep, and adding in a little bit of self care.

Not even exercise, just the things I’ve already mentioned. You don’t have to work hard to add in exercise; which is great if you can, because movement’s really important. I have seen women lose 15 pounds, four inches, come off of cholesterol and blood pressure medications, drop their thyroid dosing levels, come off of sleeping pills, antidepressants, anti-anxiety, ritalin. It’s been really astonishing to me just to see what, in medical school, I was taught was inevitable facts of aging, bad genes, or a woman’s own bad habits, or her personality and all in her head.

Trevor:  Yeah. Wow, that’s fantastic. It’s truly more of a holistic approach. I think it’s so important to do this. One of the things that you mentioned, I’ve heard you say, is the term ‘inflammaging.’ Tell people about that and what that is.

Aviva:  Inflammaging is a term that really just encapsulates all of the processes that happen when we have [inaudible 00:21:12] inflammation that has an impact on our selves and our tissue [inaudible 00:21:18]. This includes everything from our skin to our organ systems, to our really important organ, our brain; but also our energy levels, our sleep, our joint health. When we have inflammation, inflammation is a very important lifesaving process. It allows us to be able to, for example, fight infections. You get a splinter and it turns red, and it gets inflamed, it gets hard, that area hurts to the touch. That’s inflammation. What the body is doing is it’s trying to gather it’s resources very locally to neutralize the infection that might happen if that splinter was infected with a bacteria, or if it stayed in your skin and started to fester.

What you see locally is the same thing that happens more generally in your body: pain, redness, heat, and swelling. Those are the classic signs of inflammation. When you think about things that are happening as we age, pretty much all of them are due to inflammatory processes that our bodies are no longer effectively calming, cooling, and keeping under control.

We start to have this out of control inflammation. Ways that you know that you have out of control inflammation are [inaudible 00:22:38] not expect. 30% of people who have depression probably have depression due to something called brainflammation, which is inflammation in the brain. When we think about inflammaging, what’s one of the big things that we’re all worried about is cognitive loss and dementia; but that is exactly what’s happening in the brain. It’s out of control inflammation due to what’s going on in our bodies. Actually, depression, at least 30% of depression is due to that same kind of process, due to inflammation in our bodies that have gotten across what’s called the blood-brain barrier and is affecting our brain tissue.

We think about things like wrinkling. I love that model, Cindy Joseph. She’s in her 60s. She has beautiful gray hair, and she has wrinkles. Wrinkles, to me, are just a pathway showing how we’ve lived our life. They show our laughter. They show our sorrow. They show our grief. Then, there’s out of control inflammation that leads to excessive wrinkling; wrinkling or aging beyond what we think or expect we should have at our age. It’s also leathery-ness of the skin, dryness of the skin, skin discoloration, those patches, those red spots that people get. Those are all signs of inflammation and inflammation depositing in our skin.

While I think we will wrinkle no matter what, the rate and intensity at which we’re wrinkling, and the health of our skin, has a huge [inaudible 00:24:04] … has a huge impact on it. Also, chronic inflammation changes the way our cells respond and die, or out of control reproduce. Out of control reproduction of our cells is cancer. Even cancer can be a result of this out of control inflammation. Other things, too, though, Trevor, that are related to inflammation are weight around our middle.

A lot of women say, “Oh my gosh, you know, I hit 50, I hit 55. I gained 15 pounds. I have no idea why. There’s nothing I can do to lose it. I’ve tried everything.”

We also know that women around that age often start to have sleep disruption, and more stress. We’re caring for elderly family members sometimes, caring for we have our teenagers, or our kids in college. It can be a stressful time, and there may be some protective mechanisms around gaining a few pounds at that time, it keeps our estrogen up, it protects our bones. What you said earlier, we’re told that some of these things are just a normal fact of aging. Gaining 15 pounds when you turn 50 is not just a normal fact of aging. It’s often a result of this out of control inflammation, especially if that is around your middle. All of a sudden, you’ve got these muffin tops that you didn’t have before, or belly fat. That’s really important because that belly fat is also producing even more inflammation. It goes on and on.

We think about getting elderly, and we think about becoming more stiff in our joints. I’ve seen people in their 80s and 90s, who are not that way at all. They’ve had healthy lifestyles. They’ve eaten a healthy diet. They get movement, and they’re not getting stiff. Their body is staying lubricated, and inflammation is not settling in their joints and making their joints painful, and stiff, and hard to move. It goes on and on, and on. How these simple things that we’ve been told are out of our control, really do have some origins in things that we can start to turn around, ideally when we’re younger, but can get a handle on at any time in our lives. It’s really never too late to start.

Trevor:  That’s great. I’m so glad you’re saying that. It’s not too late to start. It doesn’t matter what age you are, it’s not too late to start. Don’t worry about the past, just focus on now and what you can do. Let’s talk about, I love this idea of talking about inflammation because I talk about skinflammation and how a lot of skin issues are the result of inflammation. You’re saying something similar here. What do you recommend for people to help reduce that inflammation?

Aviva:  Great question. One of the most elusive but simple things that we can do is actually start to pay attention to our sleep cycles. When our sleep is not healthy, when we’re not getting to sleep easily, when we’re waking up multiple times during the night, or waking up and we’re still not replenished, inflammation is almost impossible to control. What I start recommending my patients do right away is start to work with getting a healthy time that they go to bed, and a reasonable amount of hours of sleep. Seven to eight hours a night of sleep, and try to wake up at the same time every day.

It’s interesting. A lot of people say, “Well, I’m going to … If I … and I can’t sleep more. I wake up at. I’m going to sleep late if I go to bed later, and try to regulate my sleep cycle.” What I found is the most helpful thing to do is set your wake-up time. If you set your wake-up time for about 7:00 or 7:30 every morning, and try not to take a nap at all that day. Maybe if you need like a 20 minute catnap, just a power nap is what I call it, in the afternoon. That’s fine, but if you sleep more than 40 minutes, you’re actually resetting your hormones, and it’s going to be harder to go to sleep at night. If you wake up at the same time every day, and then try to settle into bed at the same time every night, that allows you to get about seven hours of sleep.

In a very short time, really in a matter of a week or two, your body will start to get the message. It’s like, “Okay, I got to get with the program here. If it doesn’t, there are nice wonderful herbs and supplements that you can use to help promote sleep and support sleep; but starting with sleep is always the most important for me to start.

There are some things that you can do right off the bat, though, to help your sleep. In addition, so I mentioned waking up at the same time every day, trying to get to sleep at the same time every night. Here’s one that probably most people haven’t heard of: a number of studies have shown in women who have high stress jobs, particularly nurses, that when you get home at the end of the day, if you do something to decompress your workday stress, even for just 15 minutes, it can completely reset your cortisol. When your cortisol is too high at night, that’s usually what keeps you from falling asleep, because cortisol suppresses melatonin, which many of us have heard about. People take melatonin to help them sleep.

If your cortisol is high, it prevents your melatonin from going up. High cortisol, low melatonin is a recipe for sleep disaster. Just doing something, like 15 minutes of turning on some loud music and dancing, or taking a walk, or taking a quick hot shower, and doing a nice loofah, or a brush down in the shower. Just something that helps you decompress could completely reset your cortisol and help you get better sleep at night. That’s just a great trick any of us can do.

It’s one of those things you can say “Oh, I have kids. I can’t do it.” No, no, no, no, no. Your kids will be thrilled to have you turn on some loud music and dance for 15 minutes before you make dinner, or while dinner’s cooking. That’s an easy one to fit in.

Doing something to decompress at bedtime, again, is really important. One of the factors that keeps us from sleeping and helping to regulate our cortisol is getting exposed to blue light too close to bedtime. Where is blue light coming from? From our kindles, our iPhones, or smart phones, and our computers. I recommend a digital detox for at least 30 minutes before bed. No electronics before bed. Ideally no TV, either. Getting yourself in that wind-down mode, doing your beautiful skincare before bed, brushing your teeth, flossing your teeth, taking a hot shower, or hot Epsom salts bath, getting in bed, reading a book. Then three minutes, even one minute if that’s all you can do, of deep breathing. I guarantee you, that decompress after work, a 30 minute digital detox, and a nice bedtime ritual; then setting your alarm to get up at a reasonable similar hour every day, can do wonders for inflammation in your body.

The other thing is when our sleep is poor, or when these stress systems are disregulated, we tend crave more carbs, and we tend to crave more sugar because we’re searching for energy. Those foods, carbs, processed carbs, processed foods, and sugar, are a big inflammation promoter. As you know, from working with skincare, one of the big turn-arounds that a lot of women say they get when they’re struggling with chronic acne is getting all the sugar and all the processed foods out of their diet. It feeds a viscous cycle, and it also is just so bad for our immune system, our stress system, our blood sugar, our weight. Getting out the sugar, getting out the processed foods, and it’s easier when you’re getting more sleep and getting more rest. Those are a couple of the really big shifts that I start with right upfront.

Sometimes honestly, just getting better sleep and shifting the diet, adding more vegetables, adding more dark berries like blueberries and raspberries and blackberries, they can be frozen, even, to the diet [inaudible 00:31:25] … nutritional intake starts to help reduce inflammation. Berries, green vegetables, all our vegetables reduce inflammation. Sometimes, that’s all I need to do. I don’t even need to get fancy with herbs and supplements. It’s just those simple shifts that everyone has within their control.

Trevor:  Yeah, absolutely. We’ve been talking a lot about lifestyle choices for people.

Aviva:  Yeah.

Trevor:  Lifestyle things, I think that’s a huge part of all of this. I am sure you agree, and that’s what people can get started with right away today. What are some of the other tools that you use in your practice? Those supplements, and the things that you use to help people get an extra bit of support?

Aviva:  Yes. Depending on what’s going on with any individual woman who comes to me, I will do usually a targeted therapeutic diet. Some people just need a little tune-up. They just need a little help, but most of the women who come to me have been to many doctors. Sometimes they’ve even been to some of the super celebrity doctors, and they finally find their way to my office because they’ve really not gotten a targeted plan that works individually for them. They may have gotten a protocol that’s more generic.

One of the things I start off with right away is what many people in our work call an elimination diet. I call it a reboot. You know when you’re on your computer and you have too many programs open at once, and you start getting that spinning signal. The only thing you can do … it’s like your computer is so overwhelmed, the only thing you can do is shut it down and reboot it. I feel like food does that a little bit to our bodies, too. It creates so much information overload. We’re dealing with chemicals in our food, from pesticides and herbicides, and the environment, that our bodies have never been exposed to in evolution; so our detoxification systems get overwhelmed. Our guts get overwhelmed. A lot of the ingredients in our food, plus some of the medications we take, cause so much disruption in our gut that our microbiome gets damaged, our gut lining gets damaged and we get leaky gut. All of these factors can lead to massive inflammation in our bodies.

One of the things that I start out with right away is a food reboot. We get rid of all of the big triggers that we know are common inflammatory triggers for women. As I mentioned, sugar, all the processed carbohydrates, any foods that are really heavily contaminated with herbicides and pesticides, for example. We try to go as organic as someone can afford to right up front. I know organic can be a little bit more expensive, but I have to say, as a medical doctor who has worked in hospitals and ICUs, and seen what happens when we don’t pay now, our bodies pay later. Really, the investment in ourselves, it’s not that much more. It’s so important.

I start with a month, actually, where I’m working with a woman on a very targeted food and nutrition plan where we’re taking out the things that are common triggers but adding in also just tons of vegetables. Honestly, eight to ten servings of vegetables a day. We get in smoothies, we get in salads, we get in cooked greens, to really help bolster her detoxification systems, her elimination, and her nutritional status. That is a huge shift. It’s not just always just ‘clean up your diet a little bit.’ Sometimes it’s a very targeted diet. Some women need to go on what’s more like a paleo diet. Some women need to be gluten free and dairy free. Some women actually benefit more, if they’ve been eating a lot of heavy foods, a lot of meat, a lot of processed foods, to go on a more vegan diet for a while. It really is about finding what’s best for that particular woman at that particular time in her life.

Looking at her own individual sleep patterns. There are many different sleep disruptions that we can have, so working with her to figure out what her unique sleep disruption is and why that’s happening. Let’s say she is somewhere between 46 and 56, and she’s having perimenopausal or menopausal sleep disruption. I might bring in specific herbs like magnolia bark, or philodendron, or black cohosh, or vitex, or chaseberry is another name for vitex, that we know helps support natural progesterone production. Natural progesterone production can help improve sleep in perimenopausal women with certain sleep disruptions. It’s really looking at the individual pattern of what’s going on with that individual woman, and how I can work with her.

A really common deficiency amongst women in the United States is magnesium. Signs that you might have a magnesium deficiency are intense cravings for chocolate, especially before your period. Or, even if you’re not cycling anymore, intense cravings for chocolate in the afternoon, or any time, after dinner is a common time. Twitches around your eye, or muscle cramps. People often have restless leg syndrome, that can be a symptom of low magnesium. Something as simple as adding in 400 to 1,000 milligrams of magnesium a day, and if there’s sleep problems, particularly adding them at night can make an enormous difference in feeling better and sleeping better, and having better elimination, too. There’s a kind of magnesium called magnesium citrate that can be really helpful for constipation.

Working on gut health is an important part of my protocol. We know that the microbiome and the stress system are intimately connected. When the system is overly taxed by stress, it can damage the microbiome. Also, a damaged microbiome, let’s say from dietary choices, or overuse of antibiotics, can also signal the stress system that there’s distress in the gut. That causes an overall systemic reaction. Working on the gut is super important. Diet makes a huge difference in that, working on constipation. Working on the health of the liver, because the health of the liver is really important in overall elimination. Making sure that the body’s detoxification systems are optimized. We often are not getting the nutrients in our diet that we need to support the liver’s natural detoxification.

Then on top of it, the overwhelming exposure that we’re getting from the environments that our ancestors didn’t get, even before 60 years ago. The chemical exposure that we’re getting is just unprecedented in our entire evolution on the planet; so making sure that those detoxification [inaudible 00:37:49] … with supplements, but also and especially important with food, are optimized, is another important thing that I do.

All of these things, and I kind of do them according to what imbalances women are seeing based on questionnaires, and I include those exact same questionnaires in my book. What I really try to do with this book was I know that not … You’ve seen women all over the country are so hungry for doctors like us, but we’re far and few between. There’s aren’t enough of us to meet all the need. What I did was try to create a book that is almost like the experience of working with me in my office. It’s compassionate, it’s fun, it’s loving. It’s also really informative and also very science-based, not in an overwhelming way where you have to read the science, but where the information is based on good science that you can feel is reliable medical information.

I started out with the questionnaires. Here’s how to figure out what I would help you figure out in my office. Is it your gut that’s imbalanced? Is it your sleep? Is it your stress system? Is it detoxification overload? Is it possibly medications that you’re being exposed to, environmental toxins like heavy metals or chemicals in our food, or our body products, and how do we identify those? Then you can tailor the plan, it’s super simple to tailor the plan to your actual needs, emphasizing those areas that are your biggest pain points. Throughout that, it helps with a general plan: here’s how to do the food reboot. Here’s how to get better sleep. Here’s how to take better care of yourself in general.

One of the most important things I think I found, and I’ve had to really learn to put this into practice myself, is hearkening back to that idea that we really have to give ourselves permission to pause. So much of what’s happening is that so many of us, most of us I would say, are running on empty all the time. The plan that I’m working with increasingly in my practice, in my blogs, when I talk about my ideas in my podcast and in this book, is how do we stay replenished? How do we live our lives from that place where we’re above the empty line on the gas tank so that we can give our best selves to the world, that we can be our best selves for ourselves and for those we love.

Also, to forestall what is … Not even forestall, but to completely prevent what are not inevitable diseases. It is not inevitable that we develop diabetes, or high blood pressure, or any blood sugar problems, or sleep problems, or thyroid problems. Or, age in a way that doesn’t feel beautiful and wonderful, and healthy, even if we do get some wrinkles and gray hair.

Trevor:  Fantastic, fantastic. Where can people find your book, because I’m sure people right now are like, “Okay, where’s her book? How can I get it?”

Aviva:  The two easiest ways to get access to the book right now are AvivaRomm.com/BookBonus. That page has some gorgeous gifts with it that even amplify your success with the program. You can only fit so much in a book, so I actually had to cut 30,000 words, believe it or not, out of the book. Instead of just putting that material on the back-burner, I turned it into a complimentary cookbook and a complimentary self care journal. AvivaRomm.com/BookBonus. You can just get the book right there and get these gorgeous gifts as well. Or, if you just want to check it out and see if this is for you, you’re not sure yet, you can go to AvivaRomm.com/FreeChapter and guess what you get there? The free first chapter of the book. You can also just follow me over at my website, AvivaRomm.com, super easy to find.

Trevor:  Okay, great. We’ll have those links up on my website so people, if they’re driving, don’t have to pull over and write that down right now.

Aviva:  Good idea.

Trevor:  Yeah. It’s great information. I’m so glad that you figured out a way to put the questionnaires in there to help people figure out how to navigate all this, because I’m sure as people are listening to you, they’re thinking ‘Oh my gosh, this is overwhelming, and there are all these hormones, and there’s stress, and all these different things, and inflammation, and how do I know if that’s an issue for me?’ I’m really glad that you’re able to simplify it.

Aviva:  Yeah, the book is a very elegant, straightforward four week blueprint that you can pick and choose what you want, or you can just follow it all the way through. It’s laid out for you, to the point where my publisher thought I was crazy, but I actually gave four full weeks of meal plans.

You don’t even have to stand in front of the refrigerator and think, “What should I eat?” Or, “What should I shop for?” The meal plans are modifiable whether you’re vegan, or paleo. I gave you shopping lists. It’s really laid out for you, because here it’s a book about essentially overwhelm, and how do we overcome overwhelm in our lives? Making it hard wouldn’t have been fair. I made it really as easy as possible. Women who don’t even want to read the science behind it can just skip right to the plan. You can skip right to the questionnaires. Even the science, it’s so fun, so interesting. There’s one section of the book called ‘Not Tonight, Honey. I’m in SOS,’ which SOS is an abbreviation for ‘Survival Overdrive Syndrome.’ It’s just talking about low sex drive and how this whole pattern can lead to that exact phenomenon.

Trevor:  Love that, I love that. That’s great. You covered so much information right now, I think it’s very apparent that you give a lot of information, and that you’re just willing to … I’m sure your book is the same way, just full of it. Full of information to really help people, and giving so much to them. I appreciate that. Thank for having that-

Aviva:  Thank you, thank you.

Trevor:  Available for everyone. I also want to thank you for writing the foreword for my book. I really appreciate that, and it’s so fun. I love what you talk about, self care, and things like that. It’s so great to take that time for ourselves, right?

Aviva:  It really is. I’m so honored that you asked me, so thank you for that gift. Your skincare products are in my shower. It is such a great permission to pause moment for me when I’m … Showers are my sort of sacred place. They’re the place where I just tune everything else out. I get great ideas. I just feel that water washing all the tension away, and my now special ritual as part of my shower is your skincare products. They have a special place on a special shelf.

Trevor:  Yay, perfect. All right, well thank you so much, Aviva, for your information today and all the work that you’re doing to keep us all healthy.

Aviva:  Sure a pleasure. Thank you for sharing with your tribe.

Trevor:  I hope you enjoyed this interview today with Dr. Aviva Romm. As you can tell, she’s a wealth of information. So much great information that she shared today in this podcast, so considering how generous she was in this information, you can probably only imagine how much great valuable information is in her book. I hope you’ll check out her book and I certainly appreciate all the knowledge that she shared. There’s even more in her book. I put all that information on TheSpaDr.com website under the podcasts. You’ll just go there, and you’ll see the links to her book, and find out more information about Dr. Aviva.

Also, while you’re on the website, I invite you to join ‘The Spa Doctor’ community and subscribe to the podcast on iTunes so you don’t miss any of our upcoming shows. If you haven’t gotten your customized skin report from TheSkinQuiz.com, I highly recommend that you do that. It’s free. It takes just a few moments to complete. You’ll find out your skin type, which correlates with the specific underlying root causes that might be holding you back from having clear, glowing, youthful looking skin naturally. Go to TheSkinQuiz.com and check that out. Also, join me on social media, Facebook, Pinterest, Instagram, Twitter, YouTube, and join the conversation with me. I’ll see you next time on ‘The Spa Doctor’ podcast.