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Episode 7: Polycystic Ovary Syndrome (PCOS) with Jessica Bennett, Certified Nurse Midwife/APRN

Updated: Jan 15

Podcast Drop Date: 12/28/22

Amber Warren, PA-C: Welcome to Functional Medicine Foundations podcast, where we explore root cause medicine, engage in conversation with functional and integrative medicine experts and build community with like minded health seekers. I'm your host, Amber Warren. Let's dig deeper. Welcome back, Amber Warren here. And I'm here with one of our women's health extraordinaire, Jessica Bennett. Jessica graduated with a Bachelors of Science in Nursing from the University of Vermont in 2003. After practicing as a nurse for ten years, she felt an unwavering desire to continue her education and pursue an advanced practice degree as a certified nurse midwife graduating with honors from Frontier University in 2014. Jessica set out to be a certified nurse midwife and has never looked back. Over the past seven years, she has provided women's health primary care with a particular emphasis on hormone imbalances, including thyroid conditions, PCOS, infertility, sexual pain and hormone replacement therapy therapy for premenopausal and post menopausal women she has experienced in full scoped well woman primary care including natural childbirth, GYN, annual exams, thyroid issues, hormone balancing, gut health and natural approach to managing mood disorders and diet and exercise management for weight loss. Her approach to women's health care is focused on prevention, total body wellness and patient education with a true passion for health, wellness and empowering women. She is immensely grateful to have the opportunity to pursue her passions every day, and we are immensely grateful, grateful that she is on our team at Functional Medicine of Idaho and Functional Medicine Foundations. So we're here with Jess.

Jessica Bennett, CNM, APRN: Thank you. Hi, and glad to be here. Yay.

Amber Warren, PA-C: And really, we wanted to talk about just kind of a functional approach to women's health. You're our first women's health guest guest, but also PCOS, polycystic ovarian syndrome. So let's just start with kind of your approach to functional women's health.

Jessica Bennett, CNM, APRN: Well, I think that I'm not the first guest on here, so we've kind of alluded to what a functional approach to health generally looks like. I mean, that doesn't necessarily change per se for women, but it does really my approach tends to be like our other providers, very individualized, right? So we look at the individual person when they come in because outside of our shared commonality as being women, because that is my focus I deal with only women is we are our own individual people, right? So we all have things that balance us and drive us. And our systems work inherently a little bit differently because of that. So it's really meeting people where they're at when they come in and really figuring out, you know, what the root of the system looks like. Because foundationally, we all kind of we're all mammals at the end of the day. So we all function very similarly and need certain things to balance us. So we always look, we I always start there. I always look at the root, right? We always look at the foundational things that kind of keep us balanced, healthy and well. Right? So gut health, we could, you know, hammer that home all day. Nutrition, sleep, love and connection, exercise.

Amber Warren, PA-C: Pillars of.

Jessica Bennett, CNM, APRN: Health. Yeah, just pillars of health. We always start there because essentially, like anything, if our foundation isn't strong, the rest of the house really can't stand. So working at the foundation and then kind of seeing what folds out, you know, kind of falls out from there. Right. So but really, it's it's individualized. Like we can't just broad stroke everyone's treatment. And I think that's really the struggle with medicine outside of functional medicine. Sometimes we would with conventional medicine, as we say, I think that a lot of people come in frustrated because they're just given the same blanket treatment program and they they are not being heard, as you know, for what they really are struggling with. I mean, I think the worst thing is being told nothing's wrong with you when you feel like, no, something's wrong, like I'm.

Amber Warren, PA-C: In my.

Jessica Bennett, CNM, APRN: Body, I don't feel good. And so a lot of times my approach is hearing that and seeing that and saying, You know what, Amber? I believe you. Yeah, I'm not in your body. So if you're telling me that this doesn't feel good, you're you're probably right. Right? So I think that's really where we start. We start at listening, being present, providing the space and really then just tailoring it according to what this person is capable of or what they actually need. Right. Because that's going to look really different for everyone. Oh yeah. Yeah, for sure.

Amber Warren, PA-C: Yeah. Not everyone's readiness is there, so we're also trained to just meet someone where they're at.

Jessica Bennett, CNM, APRN: Yeah. And know.

Amber Warren, PA-C: How to help them get there.

Jessica Bennett, CNM, APRN: For sure. An education, right? I have had a lot of women go, Well, how would I know this? I said, You wouldn't. No one's told you this. It's not out there. So it's it's not it's not like people are walking around with all this knowledge unless they're there researching and kind of diving in into it themselves. And when you're a busy mom of four or you're working three jobs or. Have you. It's just it's fairly overwhelming, right? You just don't have the ability. So it's really on us as functional providers to have gratefully we have the time, right? We have extended visits where we can just kind of delve into this stuff and really have this back and forth dialogue with our our patients and our clients. Like what do you know? What do you think's going on? And yeah, you're right. Actually, that's what I think's going on to. And, you know, just providing that support and providing that education is huge. And sometimes they just leave knowing och.

Amber Warren, PA-C: I felt heard.

Jessica Bennett, CNM, APRN: Yeah. And I think, I think we got a plan now. I mean it's not a matter of like let's take all these supplements and stop eating all these things and like extreme. Yeah. Because that doesn't really feel good to anyone. I mean there's some people.

Amber Warren, PA-C: Who are ready, who.

Jessica Bennett, CNM, APRN: Are ready and want to do all the things, but I find that fairly overwhelming personally. So I think that, you know, knowing that we're not going to ask you to give up everything you love or expect you to do unreasonable things is also really important and reassuring for people.

Amber Warren, PA-C: Yeah, or add more to that to do list that's already like, oh gosh, overwhelming for you.

Jessica Bennett, CNM, APRN: Yeah. Yeah. I mean, I think that half the time just being a woman with, with children and like, knowing how it feels like we're grinding our way through our life. Yeah, like I, I find there's some humor in it, right? We can be like, Oh, yeah. So when you have time. Yeah, why don't you go your time? Why don't you go get an hour a day? Why meditate and then like meal prep and just like, I mean, we get it.

Amber Warren, PA-C: Yeah, we're there, right? We're living.

Jessica Bennett, CNM, APRN: It. Yeah. So I think that's part of the part of the appeal. I mean, it's really why I love what I do is just being able to be honest and being able to be real with people. Right? And it's funny because half the time we start, we end up talking about our kids, right? And we talk about struggles with parenting. And it's not always just about the one thing they came in for because it's never one thing, right? It's so layered. Yeah. And it's it's, it's, it's kind of like a magical little process, right? Like, we are really able to sometimes come up with these aha moments for people where they're like, Oh, shoot. Yeah, that makes sense. I never thought that that would be affecting my sleep or that that would be affecting my libido for sure. You have five kids crawling all over you all the time. Like, I think you're like, Leave me alone, everyone just leave me alone. Yeah. And I think, like, with women, we just have a lot of expectations of ourselves and a lot of things that we. I think that a lot of things that we just hold ourselves to these unreasonable standards. So sometimes we just got to keep each other in check for sure. Right.

Amber Warren, PA-C: You're really good at connecting with your patients and helping them do that. Yeah. Let's let's dig into what what is definitely one of your specialties in areas of expertise. And we look to you as a, as a group of practitioners to, to be that leader in our group. So what is it? What does it look like? How has it changed over the last few years as far as the diagnosis and symptoms are concerned?

Jessica Bennett, CNM, APRN: Pcos So it's interesting because PCOS, polycystic ovarian syndrome, I also look at as also being what is sometimes referenced to as metabolic syndrome, because I think with the term PCOS and the polycystic ovaries is some people get caught up in the polycystic ovary part, right? Well I don't have cyst on my ovaries. Oc Well that's not always part of it, right? So PCOS is essentially an endocrine, an issue with the endocrine system, an issue with hormone balance sometimes, which includes I mean, I would say largely the majority of the time a problem with insulin regulation, insulin resistance in the body. And so what I find to be the most important part is figuring out when a woman comes in. Oftentimes it's with either irregular cycles, like she's not having regular periods or maybe they're too frequent. She's having infertility. Issues like time and periods are regular. It's just I'm not able to get pregnant like what's happening and or I have male pattern hair growth or I'm gaining weight no matter what I do. And so PCOS can present with various different issues for the individual right. But the common theme tends to be either always high androgen levels. So what androgens, what I mean are high testosterone levels. So usually what it takes is us exploring these irregular periods, these this lack of ovulation or these symptoms of kind of male dominant hormones. So you'll have acne hair, male pattern hair growth like an unwanted areas or hair loss. And usually what I do is say, well, let's unpack if this could potentially be a PCOS metabolic syndrome thing. And I, I don't really like people to like hold on to the diagnosis because I feel like I don't want you to ever identify with this is who you are now, because it really is something that can be manageable and reversible if we can just get at the root of what's happening. Right? So usually we look at a few key indicators. We look at insulin because oftentimes, like the way our pancreas releases insulin and response to food is going to really affect hormone balance.

Amber Warren, PA-C: So you're looking at a laboratory?

Jessica Bennett, CNM, APRN: Yeah, a laboratory and a laboratory, fasting insulin, a laboratory analysis of their adrenal function. So really just a snapshot of what level called DHEA. And it's just kind of a key indicator because generally you're going to be looking at elevated insulin levels, elevated DHEA, and then free and total testosterone. So all of those. Either some of them or all of them tend to go up with peaks.

Amber Warren, PA-C: And do you find your conventional colleagues or women that are coming to you that have seen some of these conventional providers before, are not looking at those things when they're trying to diagnose peaks?

Jessica Bennett, CNM, APRN: Yeah, generally what I see is they're looking at luteinizing hormone, follicle stimulating hormone, which both are hormones that are play a role in both the first part of their menstrual cycle for to stimulate the ovaries and the second part of their cycle for ovulation. They're also looking at prolactin, which is a hormone that kind of works with the pituitary gland, which is the thyroid, which connects to your adrenals. It's all kind of interconnected, right? But and they look at sometimes look at progesterone and hemoglobin e1c, which is a marker for diabetes, but never fasting insulin and rarely free and total testosterone. Sometimes if it's a certain provider, I've actually seen it from some midwives and some nurse practitioners, but rarely is there a fasting insulin.

Amber Warren, PA-C: Well, and beyond beyond that, what they're looking at with maybe free and total testosterone or a hemoglobin and C, we have optimal values within functional medicine. We have functional reference ranges that we're looking at that maybe some of our other colleagues aren't paying attention to.

Jessica Bennett, CNM, APRN: Yeah. So we understand the importance of pretty tight control in some of these variables. And the thing that I find a little disheartening, honestly, is when I have young girls coming to me as young as 18, right, who have been to another provider and their answer for their irregular periods was birth control or is right and OC so that so synthetic hormones to regulate your cycle. There is a hormone imbalance with PCOS so that will provide some benefit to cycle regulation. But my biggest concern is is there an insulin resistance? Because at the end of the day, that's going to be that's going to be the big deal that's going to provide like that sets these people, these women up for insulin resistance leads to type two diabetes, which leads to high triglycerides, high cholesterol, which leads to heart disease. Like if we if this kind of goes unaddressed another ten, 15 years, you have a pretty co morbid person, meaning they have now all of these diagnoses.

Amber Warren, PA-C: And if they're if they go on the birth control, the synthetic birth control, it it's a Band-Aid for their symptoms. They feel better, they look better, their hormones are functioning better, but you don't keep digging for the other stuff.

Jessica Bennett, CNM, APRN: Well, and at the end of the day, that doesn't take care of the insulin resistance, Right? So then they have this unexplained weight gain and they feel tired all the time. They just don't feel good. And then they want to have babies. They come off birth control. It's all back to the same square one, right? They they don't have normal hormone balance and they have insulin resistance and they can't get pregnant because they're not ovulating because it takes a special dance within our body between the estrogen part of our cycle and the progesterone balance when we ovulate. And if they're not doing that special dance on their own, they're not ovulating and they're infertile. So they struggle to get this balance because they've waited 15 years to try. And then they have such an extreme insulin resistance that the cells in their bodies are just not as metabolically flexible, you know, and then they have to go this whole infertility route. And at the end of the day, they'll put a baby in anyone. Yeah, but is this a healthy body to carry a baby? Right. Because we're now setting you up for potentially gestational diabetes and pregnancy in a high risk pregnancy and a baby that might be born early and spend the first four weeks of its life in the queue? What a stressful environment for both women and their babies, right? Like we don't. My heart goes out to people. I don't ever want them to have it for it to be harder than it should be. Right.

Amber Warren, PA-C: Well, and when I asked Dr. Bruce, our pediatrician in a previous episode, what's one piece of advice that you could offer our audience and your your pediatric population that's going to move the needle the most? His answer was you guys. His answer was you and the women's health team. Optimizing pre-conception care, optimizing these pregnancies to give these these children our pediatric population in our world, best outcomes, best chance at a healthy life. So you are so spot on.

Jessica Bennett, CNM, APRN: Yeah.

Amber Warren, PA-C: So it's interesting, I think a lot of times in functional medicine, a lot of my conversations with my patients is also let's make sure we're getting to the root or the root of the root, right? Because we can talk about insulin resistance or otherwise known as pre-diabetes. Do you use those terms interchangeably?

Jessica Bennett, CNM, APRN: Oh yeah. I mean, I usually use insulin resistance more. Yeah. Just because I feel like when I tell someone this is pre diabetic, they get a little triggered, right? Like, I don't want people to think. I never want to make it a fearful situation. I mean, we have so much more control over our own our own bodies than I think we're taught, right? So I always am run in the vein of empowerment and understanding. Right. Because it is so reversible. Oh, yeah, absolutely. You just got to know what you're doing and what you're looking for, right?

Amber Warren, PA-C: So that's where you really shine. So let's go back to root of the root. So some of the root cause issues of this insulin resistance that you're describing.

Jessica Bennett, CNM, APRN: Yeah. I mean, when you think about it, I, I mentioned already alluded to, I see people as young as 15 or 18 like in that range being sent over oftentimes her doctor, Bruce from Dr. Bruce or coming because they got a little frustrated with not really getting the answers in a little bit more conventional practice to their symptoms. And really what we're looking at is the why like you're so young. Yeah, where is this coming from? Sometimes there's just that genetic predisposition a little bit like there's a little bit of a pre diabetic diabetes thing in the family. But then we look at a lot of it's environmental, unfortunately. Yeah. Like without going down, you know, the crazy, crazy lane of all the things and the toxins in our environment, there are a lot of things that we could just start doing little by little to see what's impacting these young women, right? So I believe, like we've talked about this before in other episodes, but environmental things such as what are we putting on our skin, what are we cleaning our home with, which is kind of affects women a little bit more when we think about makeup and products, but also like we have menstrual cycles. So we're also putting products on and near our reproductive organs that can be pretty toxic. So we start kind of unpacking those things like what are we using conventional menstrual products? Are we using organic, are we using cloth options and kind of looking at that? Because those are honestly, if you think about it, directly near our reproductive organs.

Amber Warren, PA-C: So what are some of your favorite products?

Jessica Bennett, CNM, APRN: Well, honestly, for young, young girls, we're going to be looking at more organic options or potentially reusable. So there's a local company, Salt, which makes salt where they make menstrual cups. When you think about women that have never had children, though, I mean, the thought of using a menstrual cup is kind of overwhelming. So we tend to use like the salt where which are just reusable kind of underwear and organic options. There's honey pot and tops and some other kind of low toxin companies. And then outside of that, we we look at products obviously on your skin and use EWG and think dirty. We also look at food yeah a lot of I mean there's hormones in our food right So conventional meat and dairy happened to have probably a little bit more injected synthetic hormones. So we kind of start looking. A lot about within those products and those food items, you know, even organic, we're looking at a lot of hormones that are on our hormones. So, you know, kind of just asking people to start unpacking a little bit of like, what are you putting in your body when it comes to insulin resistance? We're looking at processed foods. Oh, gosh. Like being a kid is so hard. Being a kid with insulin resistance is essentially being a kid almost with type one diabetes. It's like all the fun stuff is going to be hard, at least when it comes to food. Right, Because we're looking at. Quick acting sugars and processed foods, which are often appealing for young kids. I mean, let's be honest, they're appealing for a lot of adults to write stuff that tastes good, but it's really inflammatory. And it also releases a ton of sugar quickly, which just asks our pancreas to just shuttle out all this insulin. Right. So it's making that insulin resistance worse. So we look at working with our nutritionists oftentimes to just provide like foundational education on these are going to be a really high glycemic foods, right? These are going to be your high glycemic fruits like bananas, melons, grapes. Those aren't going to be your friends.

Amber Warren, PA-C: We're glycemic being.

Jessica Bennett, CNM, APRN: High sugar.

Amber Warren, PA-C: Spiking sugar, spiking.

Jessica Bennett, CNM, APRN: Insulin. Right. So, you know, just giving them some things to start tweaking and looking at. Right. It's all about here's the information, do with it what you'd like, but here's where we could start just kind of changing things here and there and see how you feel. Because not only are they coming in, oftentimes women coming in with irregular cycles, there are cycles are heavy and they're crampy. And they just they speak to inflammation and a lot of estrogen, a lot of testosterone, not enough progesterone to kind of balance out the dance.

Amber Warren, PA-C: Are you seeing women and and making a diagnosis of PCOS that don't have insulin resistance?

Jessica Bennett, CNM, APRN: Yeah.

Amber Warren, PA-C: Yeah. And so what's what's your route there? What are you going after there?

Jessica Bennett, CNM, APRN: I mean, I think that's a lot of environmental, honestly. So there's there's two ways to kind of get to. Androgen dominance. So this whole like PCOS, some of it's not metabolic in the sense that there isn't that insulin resistance. So when someone has high insulin levels, they can essentially aromatase, which is like a fancy word for make into testosterone. So they're coming at it from, Hey, we kind of have this thing in our body where we're we're making more testosterone. We're not converting a lot of that into estrogen. But I'm also going to throw in a little insulin and convert that, too. So they're coming in at coming at it from two kind of ways. Whereas some there's other women that don't have the insulin resistance, they just have high androgens. And it's interesting because sometimes women also get that as a stress response from restrictive eating and exercising too much, and then they get a stress response actually to make more testosterone in their body and all of a sudden they stop having periods and they kind of. Induce this PCOS like symptom and hormone balance in their body. So it's yeah there's you'll see a various combinations and that's why I tend to be like I tend to say this is this is PCOS esque or this is metabolic syndrome, you know, and I'm just I'm trying to give them an understanding without completely labeling it, right.

Jessica Bennett, CNM, APRN: Because again, I don't want them to get too attached to it. I just want them to understand that there's something here that's imbalanced. And we're just going to we're going to try and work on getting to the heart of it, because historically, PCOS was very much diagnosed by what was called the Rotterdam criteria. It still is around. It was developed in 2003 and it actually was a medical opinion. It was like a consensus of individuals saying, well, this is what we commonly see. It wasn't researched, it wasn't evidence based. And it's really like outdated at this point. Right. Because to our point where we were just saying, like, it doesn't meet the criteria, it's not just high androgen levels, you know, and ovulation or polycystic ovarian ovaries. The two out of the three of those criteria, sometimes you'll just have like. One or three or two. I mean, it's it's various, but.

Amber Warren, PA-C: Well, and we're also trying to look upstream and find it, figure it out, unravel things before you could maybe even get a formal diagnosis of PCOS.

Jessica Bennett, CNM, APRN: Yeah. Or before it gets worse, right? I mean, and that's really I think that's the goal of most of what we do is like, how can we just how can we get the see where we're at and, you know, provide the balance so then it doesn't topple over further and we're just like so much worse off than we were.

Amber Warren, PA-C: So you spoke to restrictive dieting, that stress response over exercising that stress response? I think that I think our listeners would love to hear from you on what you're offering with regards to intermittent fasting. Oh, yeah, it's such a hot topic right now.

Jessica Bennett, CNM, APRN: I really feel that women, we're complex beings, right? We have our endocrine system. So our our hormone, our stress response system and hormone system, they, they work together. The HPA axis, the hypothalamus, the pituitary, the adrenal system. That's what drives hormone balance. And at the end of the day, we as I said, we're mammals, right? So our bodies function for survival. It's so if we have to choose survival before reproduction, our body is going to choose survival every day, all day long, which means if I choose to intermittent fast, 16 hours, you have a eating window of a marathon. Run all this stuff. My body is like, Hey, lady, I don't got time for this. I can keep you alive. So what I'm going to do for you, I'll make you a deal. I'm just going to pump out cortisol to keep you alive. So watch that DHEA number skyrocket and forget about your hormones like we like. You cannot afford to reproduce. So I know you want to reproduce, but I don't. We don't have time for that. Right? So there's it's a really delicate balance I have found. Women have a hard time going 16/8 Like there is a benefit to a short time restricted feeding window, maybe 1214 hours overnight for women because that insulin that's going that we have too much of.

Jessica Bennett, CNM, APRN: In these scenarios where there's some insulin resistance can really be utilized at night. Right. Insulin is serves a purpose that we use it to glom onto glucose and bring glucose into the cells. That's how we get energy. So when we're not feeding our body's glucose in the form of carbs or what have you with eating our brain and our organs, we need to fuel that night still so we can actually utilize this excess insulin that's wreaking havoc in our system and break down some fat stores and get energy into ourselves. So yes, intermittent fasting can be hugely beneficial for this insulin resistance in just metabolic efficiency. Sure. But if we push it too far with women, we are asking for trouble. I can speak to this personally because I've done this to my body like I've been fine with 14 hour fast, but the second I push it 16. You better bet my my adrenals take a hit and my thyroid. I have autoimmune thyroid stuff, my thyroid tanks and I have all these issues as a result. So again, it's just a really sensitive, sensitive balance.

Amber Warren, PA-C: And individualized.

Jessica Bennett, CNM, APRN: Approach 100%. And oftentimes I feel I hear women say, Well, I've been intermittent, intermittent fasting 16/8 and like working out and calorie counting and I keep gaining weight. Yeah, I'm like, yeah, your body's like, when am I going to eat again? So it just it holds on to it that it holds on to this as a survival mechanism because it's like as a mammal, it's like, when's the bear coming? Like, when do I need to run away from the lion? I feel the stress I got you. I'm going to pack it on regardless of whether or not you're like, Wait a minute, I have enough. You can take this extra adipose, this extra fat. I don't need it. But your body, it doesn't feel that it's it's stressed. So it's really it's a dance. It's a balance. So we really have to pay attention to those things and really individualized because I think we hear a lot of these like trendy fat, like it's a fad thing to intermittent fast on all the benefits. And yes, there are benefits, but you have to be.

Amber Warren, PA-C: Careful and look at the other.

Jessica Bennett, CNM, APRN: Side. Yeah, absolutely.

Amber Warren, PA-C: Let's dig in to treatment. I'm sure everyone wants to know approach with regards to gut health and supplements and stress management. What do you do?

Jessica Bennett, CNM, APRN: Well, I mean, the root of your system is your gut, right? It's like 70% of your immune system at least. And we're talking about we're talking about trying to down regulate that survival mechanism in the body. Malnourishment, you know, nutrient absorption is going to be key. So unfortunately, our our again, our environment is pretty toxic, like what's on our food. You know, how many how often have we ever had birth control pills? Like do we have reflux? Have we been taking antacids? Have we do we have chronic migraines or bad periods? Have we been, you know, downing ibuprofen? Like, what are we doing to our gut lining baseline that's maybe decrease its ability to absorb and assimilate its nutrients. So we always start there because if the gut isn't working well to absorb and assimilate things, you know, even the supplements that we're giving you, like you're not going to absorb and assimilate those. So. We want to make sure and ensure that the gut is really like impermeable in the sense that there's there's not little micro holes that are allowing things to kind of leach through to our system.

Amber Warren, PA-C: Or allowing toxins.

Jessica Bennett, CNM, APRN: Allowing toxins to get in activating. And that alone can activate a stress response, right? Our body like, whoa, don't know what to alert what's in here, which again, activates that adrenal system. Be like, Hey, what's going on? Like survival. We got to fight this, these toxins in this infection. And, you know, it's kind of all correlated, right? I'm it's all kind of dominoes. The dominoes fall. Yeah. If we don't start there. So we start got a simulation of the nutrients and then making sure the nutrients are there too. So and looking at some of those kind of hormone dominant foods and inflammatory foods. Right. So we started the gout. We start with oftentimes rehabbing the gut, making sure it's strong and fortified, looking at the nutrients, looking, working with nutrition. I'm working with people to kind of make these little changes and then we can work towards hormone balance, right? So if there is an insulin resistance, we can look at using herbal insulin regulators. So Myo Inositol or D chiro inositol, I mean, I think they used to call my own like vitamin B eight, but it's not really a vitamin. It's just a sugar molecule that helps regulate insulin utilization in your body. So how we we use insulin and the way our body kind of brings glucose into the cells, we can use something called Berberine, which is essentially herbal metformin, which, believe it or not, has been clinically tested. There's been National Institute of Health Clinical trials.

Amber Warren, PA-C: But we don't hear about it.

Jessica Bennett, CNM, APRN: No, no, we don't hear about it. It is been proven to be just as effective as metformin, which is a diabetic medication that serves the same purpose, like glucose regulation.

Amber Warren, PA-C: And metformin is not well tolerated.

Jessica Bennett, CNM, APRN: It didn't know it. It destroys people's gut, unfortunately, usually ends up in pretty significant GI side effects, which is why most people can't stay on it. Like they just don't tolerate it. Yeah. Thankfully Berberine doesn't usually do the same thing. You'll have a sensitive individual here and there, but generally not. So a combination of those two things, or maybe one of them, if not the other. We look at opening up detox pathways to right, because generally there are there are some toxins that are hijacking the system a little bit. So some nak some acetylcysteine which can help turn on some liver support, liver detox. It's actually also really good when we think about fertility at increasing the thickness and the viscosity of cervical mucus.

Amber Warren, PA-C: That.

Jessica Bennett, CNM, APRN: Is, yeah, cool. So it has like some other kind of beneficial side effects which, which is awesome. And we always want to detox when we talk about fertility, right? We don't want to give our kids our, our all of our junk, right? And then we usually because PCOS tends to be an imbalance on when we think of hormone production, we tend to drive the adrenal stress pathway and testosterone pathway really hard. And we actually, you know, DHEA is made on one side of the pathway, along with testosterone. Testosterone is actually made into estrogen. So we have a lot of women that have more of an androgen estrogen dominance and not enough progesterone, which like when we talked about this dance of like estrogen rising, progesterone rising and falling in a in a cycle, they don't usually have enough progesterone.

Amber Warren, PA-C: Why is that?

Jessica Bennett, CNM, APRN: Because they're just not driving that side of the pathway, Right? So their body is taking pregnant alone, which is a cholesterol hormone, and it's making way more adrenal stress hormones and testosterone and just not enough progesterone. So that's where you get the cycle irregularities. That's where you don't ovulate because there's just not, you know, these peaks and valleys in hormone production and like spikes to help you ovulate in terms of progesterone. So that luteal phase of the cycle after we ovulate like progesterone are dominant hormone.

Amber Warren, PA-C: Are you giving women progesterone like as a bridge while you kind of fix root cause.

Jessica Bennett, CNM, APRN: Well, it depends. It depends on their goals. It depends on how bad the hormone imbalance is. There are herbs such as Vertex, which is called Chase tree berry as well, or that encourages your body to make its own progesterone. So it's not it's not a progesterone replacement, but it just helping your body make its own progesterone. It kind of is just like a cheering squad for your ovaries, but it just it helps support that process. So in younger women, I feel like that can work a little bit better, especially because they're just so new into the whole cycle. All ovarian function that their ovaries can still be influenced. Sometimes when we've been in to a process for a while, like I said, we have a little bit more resistance, we're a little bit more inflexible. A lot of women, when they want to have babies, they want it to turn around sooner, right? So sometimes we we will work with a little bioidentical progesterone, never synthetic. I mean, synthetic hormones are just not great for our body, which is why birth control really isn't ideal. If we if we can avoid it. So, yeah, we're working on this balance of regulating blood sugar, insulin resistance, or just some androgen dominance, working on liver support and balancing out progesterone, that's usually kind of what that dance looks like. So good. Yeah. And I mean, a lot of women are pretty responsive to that, which is great. Yeah.

Amber Warren, PA-C: What are some of the I mean, for lack of a better term, like walls that women run into or, or pitfalls that you see in kind of your treatment recommendations where women struggle the most.

Jessica Bennett, CNM, APRN: I think dietary changes. Yeah. Okay. It's just hard. Like, let's be honest, food is expensive. Yeah, especially clean food.

Amber Warren, PA-C: And it takes a lot of time to prep good food and have.

Jessica Bennett, CNM, APRN: So much time. And even with the best intentions, everything's in plastic. Yeah. Yes. I mean, and everything, you know, even the healthy versions have, like, organic canola oil and sunflower oil and safflower oil, which.

Amber Warren, PA-C: Added sugar.

Jessica Bennett, CNM, APRN: We all know is inflammatory. So it's just, you know, even in our best with our best efforts, it's still like sometimes difficult to find healthy options. So that's where I really just encourage them to just make the small changes that they feel like they can. You know, a lot of times we're looking at dairy and gluten and refined sugar just because they tend to be the most inflammatory. Yeah, but oftentimes I start with just one thing. If we can just switch this item out, these items, let's just work on dairy. Yeah, let's just try and do organic and maybe a little less here and there. Yeah. Let's come up with a good option that you still are willing to eat for breakfast. Sometimes it's that I'm not hungry in the morning too. Right. And I don't eat. And the lack of self care. Yeah it's really good nutrients and actually feeding ourself because a lot of times women just go without eating because they're too busy or they're running their kids everywhere and they grab something quick, which is never a great thing. Generally, like statistically you're going to grab a, a bar of something. Yeah, right. Which is tends to be inflammatory and just processed. So I think it's like I think it tends to be more so that meal, meal planning and healthy food choices and really feeding our bodies the way they need to be fed.

Amber Warren, PA-C: You may or may not have just answered this, but I like to end every one of my interviews with If you had to mention one piece of advice, do you give your your patients that moves the needle the most for them, makes the biggest impact in their health outcomes? What would it be?

Jessica Bennett, CNM, APRN: I actually haven't talked about this yet. Oh, good. Mindfulness. Oh, God. And I know that sounds really silly, but just self integration. Yeah. I mean, we at least as women, we spend so much of our time outside of ourselves taking care of every single other person. Yeah. That we just really were in this fight or flight constantly. Like our body is like, Hey, are we safe? Because you are on all the time and when you're not on your, you're out. But are you really sleeping? No, because you're waking up at 3 a.m. and all the things. Yeah, right. Because our, our stress response systems are just hijacked. We live in a grind culture. We do not stop for a second. So a lot of times I'm just like 5 minutes. Yeah. Even, you know, like it's the mom that's. I'm just resting my eyes. Just rest your eyes, you know, just teach your body that it's not it doesn't have to run away from life. Right? So it's, it's, it's laughable in the sense when I say self care, but it's not, you know, spa days and, you know, 30 minute baths and, you know, because half of us can't go to the bathroom by ourselves, there's always like little hands under the door. So how did they find me? I know. So it's just it's more so like, what can we do to take a breath? And what does that look like for you? And is is that reasonable? But if we teach our bodies, it's safe to be in. To be us. Yeah. Like that's half the battle is like teaching our systems that it's fine and we're not in survival. Like, we can just start working on that root, like we can start unpacking that stress response a little bit more.

Amber Warren, PA-C: And when our bodies feel safe, that's when we can heal.

Jessica Bennett, CNM, APRN: Yeah.

Amber Warren, PA-C: Mean, that's what most people don't fully understand. I can give you all the supplements in the world. Yeah. You know, we can do all of the things that we're trained at and good at doing. But if your body doesn't feel safe and isn't ready to heal, it can't. Can't do.

Jessica Bennett, CNM, APRN: Its thing. Yeah. And do you feel like you deserve to feel well? Yeah. Right. So it's really like where, where does this come from. Right. And so, yeah, really I feel like inherently, like you are your internal compass. So in order to know what feels good and doesn't feel good, you need to sit in yourself and really tune in to that. Shut off all this other noise that's going to dictate how you feel about your life. Because what other people feel and think doesn't doesn't matter to your body. Right? Right. So that's my one piece of advice is really just trying to find the space to take a breath and feel safe. Yeah. And sometimes we have to help people do that. Yeah, right.

Amber Warren, PA-C: Yeah, we do, for sure. And give them ideas. Tips and tricks.

Jessica Bennett, CNM, APRN: Yeah. Or help them feel heard, which is half the battle. Yeah, for sure.

Amber Warren, PA-C: Jess, it's just an honor to get to work with you. I love your heart. I love your energy. I love your knowledge. Thank you so much for your your time today and for all the just wonderful pieces of advice you gave for for our women and our men that are supporting our women out there, right?

Jessica Bennett, CNM, APRN: Absolutely. They're trying their darndest.

Amber Warren, PA-C: Okay.

Jessica Bennett, CNM, APRN: Thank you. You're so welcome. Thank you, Amber.

Amber Warren, PA-C: Thank you for listening to the Functional Medicine Foundations podcast. For more information on topics covered today, programs offered at FMF and the highest quality of supplements and more. Go to Fun Med Foundations.

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