January 9, 2020
[00:00:48] “Boundless” Book Launch Party, Etc.
[00:02:47] Podcast Sponsors
[00:05:19] About This Podcast
[00:06:31] Guest Introduction
[00:09:07] An Overview of How the Pill Works
[00:16:04] Dr. Brighten's Thoughts on Supplementing W/ Progesterone
[00:23:43] Why women are not equitably represented in the scientific community
[00:33:18] Real-Time Consequences of Being on The Pill
[00:41:36] VIP Text Cub and Podcast Sponsors
[00:45:18] Effects of The Pill on Athletic Performance
[00:57:16] How to Go About Getting Off the Pill
[01:08:38] More Natural Birth Control Alternatives
[01:20:07] Final Take on The Pill
[01:22:45] Closing the Podcast
[01:24:15] End of Podcast
Ben: On this episode of the Ben Greenfield Fitness Podcast.
Jolene: How does this impact on how we build community, something that's absolutely essential for health and longevity. Since then I've had skin issues, I've had neurological issues, and doctors will say, “No. That should only affect your reproductive system.” Except that every system in the body is impacted by hormones that we have in fact been doing harm by perpetuating this inherent bias that just by having female on your chart means that your symptoms are not revealed.
Ben: Health, performance, nutrition, longevity, ancestral living, biohacking, and much more. My name is Ben Greenfield. Welcome to the show.
Mic test one, two, one, two, one, two, three. Hey, look, there it is. It works. Thanks to the wonders of technology. I'm here again and I have a really good show for you today about the pill. This one's going to be a doozy. I think you'll dig it. I did want to mention a couple things. First of all, “Boundless” book launch parties are happening in January across New York City and L.A. So, if you want a good excuse to go to the Big Apple or go to whatever they call, Los Angeles, January 16th, big book launch party in New York City. And then January 29th, 30th, and 31st, all times for you to come and hang out with all the cool cats in L.A. So, you can get access to the book at boundlessbook.com. And the calendar of events for all of the book launch parties is at BenGreenfieldFitness.com/calendar.
I also have a request. If anybody knows anybody at TEDx, let me know. Jump into the comment section and leave a comment on this show because I gave a TEDx talk in Coeur d'Alene several months ago and it turns out that the powers that be at TEDx have banned my talk from being allowed on the TEDx website due to the fact that folks may try some of the highly edgy and explicit biohacks that I talked about in that particular TEDx talk and it could be potentially dangerous and harm the health and safety of TEDx viewers. I think that's ridiculous personally and I would love to get this talk published on the TEDx website and not banned from the TEDx website. Free speech, right? Anyways though, so if anybody knows anybody at TEDx, let me know. I do think that the talk would be beneficial for a lot of folks to see and would love to get it up on the website. So, there's my ask for you.
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Alright, a ton of you have been asking me about oral contraceptives and birth control, and especially the pill, which I've mentioned a few times in previous podcast episodes is something that I'm not the hugest fan of. But of course, I'm not a physician who is an expert in hormonal contraceptives. I do, however, know and have talked about this in the past that women on the pill are more likely to be prescribed an antidepressant, and there is an increased risk based on research for things like autoimmune disease, heart conditions, thyroid issues, adrenal issues, even breast and cervical cancer. And then there's some of just the annoying issues like vaginal dryness, and hair loss, and lower drive, sometimes fatigue or brain fog, increased susceptibility to infection, and this is an issue that I think a lot of women deal with.
So, I decided, I finally, after getting a lot of requests from you all to interview this person on the show. I just had to finally hunt her down and get her on. She has actually written a book called “Beyond the Pill,” which you might be familiar with. If you're not, you need to read it because it highlights a lot of these issues. But I wanted to get into some of the nitty-gritty of this on the show as well. So, her name is Dr. Jolene Brighten, and she's a functional medicine, naturopathic doctor. She specializes in women's hormones, and also specializes in managing a lot of the long-term side effects that are associated with hormonal contraceptives, and also alternatives to those.
She's a real wealth of knowledge and I really appreciate her take on all of this stuff. Everything that we talk about today you can find at BenGreenfieldFitness.com/beyondthepill. That's BenGreenfieldFitness.com/beyondthepill, which again is also the name of Dr. Jolene Brighten's book. And I just realized that the name of one of my kind of more popular books is “Beyond Training.” So, we've got two books with similar titles, which means we're totally on the same wavelength, Dr. Brighten.
Jolene: Yeah. And I have to say in this intro when you're like, “I had to hunt her down,” I'm like, “Being hunted by Ben Greenfield, I think that should be added to like top 10 fears people should have.”
Ben: Yes, yes. Well, not with a weapon, more with a virtual assistant I had to [00:08:07] ______.
Jolene: Oh, yeah. No, totally. But I was just thinking like, “No, I've seen you work out.” If you tried to hunt me in real life, I'm prey, I'm prey.
Ben: Yeah. I don't know. We will go there. This is turning into like a zombie apocalypse type of type of scenario. Yeah. Now, whenever I read a book that I'm really interested in or I just hear over and over and over again that I need to interview someone, I literally do have this lady who I work with in the Philippines. She's one of my virtual assistants and she's just like a ninja. I'm like, “I need you to find this person.” Also, I'll send her a study. I'm like, “Find the lead author for this paper. I need to get them on.” And within like five days, she's like, “Here's their Skype, here's their phone number, here's their email, and here's the date you're going to interview them.” I'm like, “Holy cow.” So, yeah, professional stalker services. They come in handy.
Jolene: That's amazing, that's amazing.
Ben: Yeah. Alright, so anyways, you wrote this book. You wrote this book, “Beyond the Pill” and I think a really good place for us to start would be how the pill is working exactly because that'd be a good way to also explain the different phases of the cycle and how the pill is impacting those. My audience loves the science, loves the nitty-gritty, and we certainly have time to get into this. So, can you get into how the pill works exactly?
Jolene: Absolutely. I was a 10-year pill user myself. Really grateful for birth control. I'm a first-generation college student and I can look back to this tool that I utilized. And yeah, it wasn't until I actually got into [00:09:46] ______ medical school that I understood how birth control worked or even how my menstrual cycle worked. Now, when it comes to the pill specifically, I think the most important thing for people to understand is it works at your brain level. Now, there are so many stories, basically. They go around about birth control, and that, “Oh, it's just impacting your ovaries.” Well, let's back it up. How do the ovaries know when to ovulate? Well, the brain signals to the ovaries.
And so essentially, when you take the pill, it's a high enough dose of hormones that you will digest it, your liver will try to process it, and then it's going to impact the brain by shutting down brain ovarian communication. Now, really important to understand is that not all of the pill is going to be absorbed in the small intestine. It actually will make its way into the large intestine, which we can get into why that's a problem further down the line. But you have to understand that when people say, “Well, I'm taking a low dose hormonal birth control,” well, comparatively speaking to the first iteration of birth control, it is lower dose. However, it's still a high enough dose that your system tries to essentially detox it out, but there's enough hormones to tell the brain, “Shut down communications to the ovary.”
So, we don't fire off follicle-stimulating hormone, FSH, and we don't fire off luteinizing hormone, LH. So, we don't get follicles ready, and so we don't mature an egg for ovulation. And because LH doesn't spike, we don't ovulate. This is all fantastic if you don't want to have a baby, but when we wake up to the reality that birth control works at the brain level, we can start to understand why women have complained of mood alterations, and essentially, neurological symptoms since the introduction of hormonal birth control.
Ben: Okay. So, basically, when you're shutting down FSH and LH, can you compare and contrast that to what should normally be happening to FSH and LH during a normal menstrual cycle?
Jolene: Totally. So, even while we're on our periods, so day 1 is the first day that you have a flow, and even while we're on our period, we are getting eggs ready, and that is by way of follicle-stimulating hormone telling the ovaries, “Let's mature an egg.” So, we're going to mature some eggs, and then we're going to pick a winner, and we're going to ovulate. Now, during a normal menstrual cycle, that is without any hormonal interruption, we will see that FSH rises and estrogen rises in the first half, what's called the follicular phase. Then we're going to spike estrogen, and then we're going to spike luteinizing hormone. So, estrogen goes high. It tells the brain, “Release luteinizing hormone.” Luteinizing hormone tells the ovaries, “Release an egg.”
Now, this is the best part of the menstrual cycle. In that, once we ovulate, what's left behind is a structure called the corpus luteum. That structure secretes progesterone. Now, what you find in birth control, every single form of hormonal birth control is progestin. Progestin does not have the same benefits of progesterone. And in fact, we've never had a long-term study to tell us what happens to a woman's body, let alone her brain, when she is essentially put on birth control after starting her period and stays on it for decades at a time because progesterone stimulates the GABA receptors in our brain, which helps us feel chilled out and calm.
It also helps with fluid retention. So, women on birth control will experience weight gain sometimes. There's a whole lot of reasons that can be, but one is water retention because they don't have natural progesterone, they have progestin, which isn't going to have that diuretic effect. And when our progesterone is right, we feel chilled out and calm and in love with life. We're not finding ourselves crying all the time, feeling really irritable, having depression. And most notably when progesterone is low, we experience anxiety, which is why some experts believe being on hormonal birth control can lead to anxiety.
Ben: Is it a myth that progestin that's used in these birth control pills is made from pregnant mare horse urine?
Jolene: That's Premarin, and that's actually when the–back in the day, they were trying to make bioidentical hormones and come up with all these hormones for postmenopausal women, and that is made from horse urine. And that's when we have those stories that–stories, excuse me, studies that showed horrific outcomes with hormone replacement therapy. And especially when we give estrogen, it's not challenged by progesterone or–and this is most specifically for bioidentical hormone replacement therapy. That's where we can get in really big trouble because estrogen left unchecked can stimulate tissues to grow, and those tissues can sometimes be cancer tissue. So, in the breast and the uterus. And as you were talking about with hormonal birth control, that synthetic estrogen and progestin is associated with increased risk of certain cancers. So, like breast cancer, liver cancer, brain cancer. On the flip side, it does decrease ovarian cancer and endometrial cancer as well.
Ben: Okay. So, now, what about this progestin, would it actually shut down or downregulate the body's own ability to make progesterone?
Jolene: Absolutely. So, we see this with the hormonal IUDs. Once upon a time, women were told by their doctors that progestin delivered via an IUD was localized and stayed in the uterus. I actually was just lecturing in Vegas and had to say the uterus is not like Vegas. What happens there doesn't always stay there. And what we found out is that the progestins do go systemic. And what's really important is how did this get started, this idea that it stayed localized. Well, we actually didn't know the metabolites we needed to be measuring in the blood. So, you place progestin, you measure progestin, you're not seeing it, except that we forgot that the body will actually metabolize these hormones, as will the different organisms that live in our body. We actually have no idea what the microbiome is doing with these hormones. But when it comes to these IUDs, we do see that some women stop menstruating and stop ovulating. We thought if a woman stops ovulating, it's because it's impacting her body at the brain level.
Ben: Okay. So, the other thing I wanted to ask you about, just a little bit of a rabbit hole here on progesterone, is–and I asked this actually a little bit selfishly because my wife actually started taking under the supervision of a physician progesterone and saw a noticeable increase in like evening energy, drive, sex drive, and there's definitely something that's occurring with the use of progesterone, but I'm curious if you as a practitioner actually endorse the use of progesterone, especially in women who are approaching like perimenopause or even postmenopause.
Jolene: Totally. There isn't time and a place for the use of hormonal replacement therapy. And so my take is always if you need progesterone, why? Like, if we think you need progesterone, why is that? Are you not ovulating regularly, like we see with polycystic ovarian syndrome, or as you enter into menopause, or you're not actually? So, in perimenopause, it's like a kid trying to drive a stick shift for the first time where it's like, “Oh, we're jerking, we're going, we're stopping, we're going, we're stopping.” And the body is like getting ready to call it quits and enter into menopause, which is when we stop ovulating.
So, in those times, we won't have adequate progesterone. We always have to ask why. And so like if you're a 25-year-old and you don't have enough progesterone, we want to work on the root cause. That doesn't mean we wouldn't also leverage bio-identical progesterone. And you're absolutely right, it has profound impacts on women's health. As I already explained at the brain level, it can help with anxiety, so it can help dissipate anxiety. In addition to that, when you're taking oral progesterone, it can help you get better sleep. So, insomnia or tossing and turning all night, those can be symptoms of low progesterone. And so taking an oral progesterone can certainly help with that.
And it's so much of research, and let me say there's very little research in women's health comparatively speaking to our male counterparts, but so much has been focused on estrogen that we've negated the fact that women need progesterone in terms of brain health. So, progesterone is involved in creating the myelin sheaths. So, for people who don't know what that is, I like to call it basically the outer orange covering of those ugly extension cords. We've all seen that. Well, why do we have those coatings? So, that we can have electricity conducted efficiently. So, we need the same thing in our nervous system.
We also know that progesterone is involved in neuroplasticity. So, this is really important to understand that if you're on progestin, that's not going to give you the same benefits. Neuroplasticity is absolutely essential for us to be able to learn new things and be adaptive. We also know that progesterone is important in our bone health as well. Well, so much of medicine and science will talk about estrogen, progesterone is absolutely essential in addition, so as testosterone. We don't want too much of it, but the right amount. It goes beyond just drive. It's also for our brain health, our bone health, and it modulates the immune system to help keep inflammation in check.
Ben: Yeah. The other interesting thing is I read this brief book. It was a couple of months ago. I think it was called “Adrenaline Dominance” by Dr. Platt, Michael Platt. And he actually talked about the use of progesterone in kids and in males who have adrenal fatigue issues and kids with ADHD and ADD. He was almost like treating progesterone as kind of like a coverall treatment for a whole host of issues. Is that something that you've also seen utilized or that you utilize in your practice is progesterone for males or even for children?
Jolene: I don't currently treat children, so I haven't used any hormone replacement therapy with them. With men, there are men who absolutely do benefit from having progesterone. And we know from the female perspective that one of the best ways to optimize our hormone is to actually have our environment signal to our body that the environment is very safe. We roll out of the holidays, for example, or we have a really stressful event. Maybe we're not sleeping as much. We're eating more junk food. We're consuming more alcohol. We're restricting our calories.
Now, there's certainly a case to be made for caloric restriction and longevity and intermittent fasting. However, if you're someone who is already totally stressed out in every way possible, your environment is signaling not to you, then caloric restriction might be one more way that you signal that the environment is not safe. Now, if your body perceives the environment is not safe, I think so many of us think like, “Oh, yeah, we're modern humans in a modern world. We're actually very old organisms trying to catch up to the fact that like we have a cell phone in our hand.” But our body doesn't know if there is a lion chasing us. These stress signals are because there's a lion, a predator of some kind chasing us, like waiting to eat us.
And in all of that, what would your body do if it believes the environment's not safe? It would shut down a reproductive health. Reproductive viability is very, very expensive. And in addition, your body is really smart. It knows that if the environment's not safe, maybe because there's not enough food, then you can't actually grow a viable organism and you won't be able to feed it once you birth it. In addition to that, your body knows that babies make a lot of noise and it wouldn't be the best idea if there's a predator around and if you're running all the time from these potential predators.
So, in all of that, if we are–and so what does this all do? It impacts this stress response. And so that fight, flight, or freeze response, or what's known as the sympathetic nervous system, which is a big player in that is our adrenal glands. So, if the adrenal glands are working hot and heavy, then absolutely, bringing your progesterone can help support that because the brain signaling is going to shift to say, “Let's make cortisol instead of making these reproductive hormones.”
Ben: Yeah. That's interesting. So, that could be an alternative birth control method would be for women to engage in frequent long periods of intermittent fasting to downregulate fertility, right?
Jolene: But the problem with that is that then our brain, our bones, our heart, all of our other systems would start to be impacted in a negative way. And I think this is–
Ben: I was joking, by the way. I would endorse that.
Jolene: Oh, I know you're joking.
Jolene: But there are people who will say that. There are also people who will say like, “Oh, well, if I don't want to get pregnant, I want non-hormonal birth control. I will just do X, Y, and Z,” like some extreme thing to try to shut down your cycle. But we have to understand, it was a joke, but it's a very interesting point to raise that every single system in our body has receptors for these hormones. That means your natural hormones, they impact every single system in your body. Those synthetic hormones in hormonal birth control do the same. They're meant to dock on these receptors. And when you use hormonal birth control, you're flooding your system oftentimes with more than what you would make physiologically, and it's not even what you make physiologically.
When you look at progesterone and progestin at the structural level, they are not identical at all. They're not identical. And so this is where the conversation gets really interesting when doctors begin to dismiss women symptoms. When women say, “I start a hormonal birth control, and ever since then, I've had IBS-like symptoms. Ever since then, I've had skin issues, I've had neurological issues.” And doctors will say, “No. That should only affect your reproductive system.” Except that every system in the body is impacted by hormones.
Ben: Yeah. I want to get into that a little bit more, some of the biological impact of the pill and some of the more concerning effects. But back to that fasting piece, I've worked with a lot of active females, a lot of active lean females and I really discourage intermittent fast that lasts longer than about 12 hours, especially in that population because of this that a protein molecule, kisspeptin, I don't know if you're familiar with that one, but it helps to stimulate gonadotropin-releasing hormone. And you tend to see a really big downregulation in a kisspeptin production. And so the hypothalamus doesn't release GnRH, which is basically the signal to release the LH and FSH you were talking about.
So, essentially, you can downregulate fertility, especially in women who are trying to do the same type of intermittent fasting protocol that initially was championed by guys like the guy that wrote “The Warrior Diet” book, Martin Berkhan, I think it is. A lot of these other folks who are endorsing hot and heavy intermittent fasting periods. I just see over and over and over again, women get effed up by long intermittent fast versus getting cellular autophagy through like exercise, a little bit of sauna, a little bit of cold, but not long periods of time without eating. I encourage a lot of the women I work with to kind of cut it short about 12-hour intermittent fast, and then just like occasionally, like a couple times a year, do like a fasting-mimicking diet, and maybe one or two times a month do like a dinnertime to dinnertime fast. And I just find that in women who do that, they tend to be a lot more stabilized hormonally.
Jolene: Mm-hmm. And you bring up a really interesting point in that. The majority of research on intermittent fasting, and even the ketogenic diet, have been done on men, the majority of. I mean, we are prescribing a lot of pharmaceuticals to women that we've never tested in women. The trials have all been done in men. And so oftentimes, women will try to keep up with the male counterparts and they can't. I mean, women are very sensitive to caloric intake and caloric deficits. And rightly so, when we go back from the perspective of biological evolutionary perspective, we can understand that like we just state a human life, like we are the creators of the future of the human species.
So, of course we're going to be different. And in that, some days people will say, “Oh, well, are you saying women are weaker or the lesser?” No. Actually, I think that our differences between males and females are such perfect complements to one another. It's interesting about intermittent fasting. And I do agree, 12 hours isn't hard to do, like you shut down the kitchen at 7:00 and you don't eat again until 7:00. It's great for your gut health. I mean, it's great for so many things. We could have a whole episode on just that.
If you're going to be successful with something like the fasting-mimicking diet or doing some intermittent fasting, the time in your menstrual cycle that you'll most likely have the best success and fill your best is going to be around ovulation, when your testosterone is rising. So, if you go too extreme, you could shut down ovulation. But at the same time, that's a time where–I mean, I'm not advocating anybody not sleep and not eat, but that's where you can get away with a little bit more. So, as testosterone rises, we find that we have more energy. This is where women can get away with like six hours of sleep and not feel terrible.
Intermittent fasting is generally more successful at that time. Whereas once you get into the luteal phase, and specifically like the week before your period, there's shifts in insulin that happened, an insulin sensitivity. That is your body is like, “There might be a baby here. Let's eat more food.” And so women will see that they need more sleep, they might have a decline in energy, and they're having cravings. They're more hungry. And this is something that, as I talk about in “Beyond the Pill,” if you are craving, if you're like, “I just want to eat bread and sugar,” like your body is really saying, “Can you grab some sweet potatoes and some yucca and get some root vegetables in?” which is great for supporting your microbiome, and that's going to help with estrogen elimination, but it's also what your body is needing in that time.
And I appreciate that you are very cautious in not prescribing a one size fits all for men, women, and everyone. In that, I think that there's also some things that women can understand, there's a nuance about their cycle. In that, if you're like, “Oh, I'm going to start my period in three days and I'm trying to start intermittent fasting, and I'm a failure,” and you start that negative self-talk. No. You're a cyclical creature and you need to honor that cycle. And also just honor how you feel.
Ben: Yeah, yeah. And it's actually a really good point that you make about women and studies because I think it was up until like the mid-'70s where the FDA actually banned women from participating in human clinical trials. It originally was like just pregnant women because they didn't want to do harm to pregnant women. But the law, it was weird law, like it applied to women who were not sexually active, or who used contraception, or who were homosexual, and it actually wound up inhibiting a lot of the research from applying to women. And still, I think it's like 8 out of 10 studies are heavily focused on men, and it might be a little bit higher than that in animal studies.
And part of that too is based on the researchers themselves being primarily male. I think it's like 30% of scientific researchers right now worldwide are female. So, we've got like a 70% skewing towards male researchers. And then also, the number of subjects is higher than that that are male versus female. And so yeah, it really is interesting when you look at a lot of studies and you just read an abstract or a headline at first glance. It can pay to dig in and actually look at the sex differences or whether that was even taken into consideration for a drug development, or even a supplement development. So, it actually is a pretty important issue that you bring up.
Jolene: Mm-hmm. And it actually wasn't until the '90s that the FDA said, “We actually need to start studying women. When it comes to all this, we need to bring women in.” I know that some women are going to hear this and they're going to get really upset, and I totally hear that. And at the same time, coming from a research background, we have to understand that studying women is really expensive and really inconvenient. So, when it comes to studying women, we have to have them tracking their menstrual cycle. Being a cyclical creature over a, essentially 26, maybe 32-day period, that can definitely impact outcomes.
And you're right about the animal models. They mostly like to study male animal models, and it's the same thing. It's more complicated. Researchers, they want it to be super clean. There can't be any other variables that could be impacting the outcomes. And yet we have to question that because if that's the way you're conducting the research and you're essentially–maybe you're just studying males or you're cherry-picking the population, you're putting them through a bottleneck in the study to get statistical significance, and then you're saying, “Okay, and this applies to the general population and everyone.”
And then we have people starting to put up their hands saying, “But this actually doesn't work for me, and I'm actually having a different experience.” Researchers well understand that when we introduce things to the general population, we're going to see differences. Researchers are very much like, there's going to be gray, and not everybody is going to have the same outcome when it comes to pharmaceuticals or medical interventions. And yet there's a disconnect when we get into clinical practice where doctors will say–they're like, “No, it's black or white. There's a study or there's not.”
Women have complained of mood symptoms since the introduction of hormonal birth control. It wasn't until 2016 that we saw a very large study over a million women who were tracked that they showed. Yeah. If you start birth control, you're 23% more likely to not only be diagnosed with depression, but to also receive a prescription to treat it. That is to say your depression was so much impacting your life that they felt, the doctor felt a pharmaceutical intervention was needed. And what's been interesting spiraling out of those studies is to find that as much as we vilified the synthetic estrogen, it was the synthetic progestin that's been so problematic. And the researchers have gone on to show increased suicidal ideation that is women are more likely to take their own lives, especially in our adolescence. And just in 2019, we had a study come out showing that if you've ever used hormonal birth control as an adolescence, you may be forever at a higher increased risk of developing depression.
Ben: Holy cow.
Jolene: I know, right? That was me. That's most of us. We started it before our brain was done developing. That's before age 25. There's a researcher, Dr. Jerilynn Prior, who has been questioning this for a very long time and doing research and saying, “Adolescents are very vulnerable when it comes to establishing that brain ovarian communication, consistent ovulation.” That's really a decade process and yet we're coming in with synthetic hormones and disrupting that. And when women complain of symptoms, we're saying, “There's not a good enough study to validate what you're saying.” We have to understand that we're lacking studies, and the lack of evidence does not imply safety.
Ben: Yeah, yeah. And that's a perfect segue into some of these issues with the pill. You already got into the depression issue. One, this might seem kind of like a silly issue, but I've brought it up on the show in the past and people always ask about it. I'd like to hear from you whether this is myth or fact, but this idea that your ability or a woman's choice of a male partner is affected by the pill because she actually tends to choose a partner that is more, I believe, genetically similar to her based on scent when on the pill, thus, resulting in two genes matching up that result in a less genetically robust offspring that might be more susceptible to infection or immune issues or something like that, almost like choosing a partner that is too similar to the woman. And then also, another more recent one was about a woman's inability to be able to properly empathize or identify facial expressions, which might also affect mate choice when on the pill versus not on it. Are either of those situations actually accurate?
Jolene: Oh, 100%. So, let's break this down. I actually talked about this in “Beyond the Pill,” and I have had so many patients tell me these stories. And after reading “Beyond the Pill,” we have had so many messages coming in of women saying, “Yes. While I was on hormonal birth control, this is what happened to my marriage. When I came off, this is what happened.” So, let's break this down. So, first thing we have to remember is we're animals, and as animals, we have the eight senses. And one of those is our sense of smell.
People have heard of like pheromones and being attracted to a partner. So, what's going on there? Well, we have this complex called the MHC complex. It's on our cells and it is involved in our immune system. As women off of hormonal birth control, we will detect that and we will select for a male counterpart. That is as genetically dissimilar to us as possible. And that is in theory, so that we basically get as much gene variety as possible.
Ben: Right. So, basically, you don't marry your brother.
Jolene: Yeah. So, when you're on birth control, you're more likely to be attracted to someone genetically that's like your cousin, which is weird. Every time I say that, people are like, “Eew.” I'm like, “I know, right?” So, they've done studies on this multiple times looking at, okay, there's this MHC complex. Women are detecting the genetics of their male counterpart. Interestingly, on the flip side, in exotic dancers, they've done studies that if you're ovulating, you're more likely to be tipped more. You'll make more money. If you're on hormonal birth control, you'll make less money. This is about men now being attracted to women, and it changes. Whether you're not, you're on hormonal birth control. And these are the things that like–as soon as I start talking about this, is when people are like, “Oh, so what would you–you want to see teen pregnancies? You want to see women not having controlled their bodies?” No. I would never say that, but we need to have an informed consent in taking this medication and understanding what's taking place.
Now, they did this other study that was really interesting. In that, they had women come in, and the computer screen in front of them said, “Manipulate all these faces to be more attractive.” And so women sat down. They're not on hormonal birth control. They start manipulating faces. For every man, they made them more masculine. So, this is where I'm like, “Anybody who's seen Disney's Beauty and the Beast and Gaston sings his little song about how he's so masculine, that's exactly the features –“
Ben: Gaston. Gaston, Gaston, Gaston.
Jolene: Those are exactly the features we're talking about. So, that strong jaw, that chest. But on the face, looking out for that alpha archetype. So, what does this mean from the evolutionary perspective? The defender of the tribe, the person that if you made it with them, they could protect you and they could protect your offspring. They put women on hormonal birth control. They bring them back several months later. The women begin to manipulate all the men's faces to be more feminine. They start to reduce the jaw structure. So, fascinating.
So, when we're on hormonal birth control, what are we actually prioritizing in mate selection? Well, as it turns out, Kanye may be right, she is a gold digger. In that, we prioritize how much does our mate make, how much money does he make, and how smart is he. That translates to modern-day society's alpha male, like who can protect you. However, women who come off of hormonal birth control–so you're on it, you select your mate, you come off of it. Now, how attractive they are becomes much more important to you, and you're much more likely to initiate divorce.
Now, to your point of like the facial recognition, women actually don't pick up on the subtle social cues in the same way. That study came out and researchers were–they were like, “Well, we probably would have noticed it if this was like really that big of an issue.” And I just laughed. And I actually said to my husband, I'm like, “Yeah. You all notice when we get a haircut, if it's subtle, I don't know that you would have really noticed it.” And when we go back to “you're an animal,” the subtle facial recognition, the subtle social cues can be the difference of life and death, and not to be like, “Oh, so extreme in that.”
But truly, as women, it is something that we are more likely to be impacted by violence against us, right? It's harder to defend ourselves, and they know I'm walking the line here. I don't want to offend anybody, but at the same time, we have to start asking the question, if we're not picking up on these subtle social cues, and some researchers have been asking this question, how does this impact how we mother? How does this impact on how we build community, something that's absolutely essential for health and longevity? And in addition to that, if we are seeing these changes happen, how might that impact us in the workplace? There's just so many questions in how birth control is altering women and how that's actually altering society as a whole.
So, we can't ignore this. And what I think is really just a head-scratcher is like, “Why are we only now starting to ask these questions? Why is it only now we're like, ‘Wow, what my birth control be doing to women on all these different levels?'” When we've had it introduced, I mean, it was introduced in society really in the 1960, is started out you had to be married if you wanted to get access to it. But yet here we are, now we're in 2020, a whole new decade, and there's so many questions that have been left unanswered.
It was actually Dr. Elizabeth Kissling in Scientific American back in 2019, who stated that the use of hormonal birth control, the way that we've been using it is one of the longest and largest uncontrolled trials we've ever had. It's a huge experiment, and we haven't answered nearly as many questions as we need to. And part of that is because there's this backlash and this stigma of like, you cannot question a woman's right to have access to hormonal birth control. That's not what we're doing. We're questioning what impact does this have on women so that they know what to look out for to stay safe. And they know if they opt in to this voluntary drug, what impacts it might have on their life long term.
Ben: By the way, I use antlers in all of my decorating. You know what quote that's from?
Ben: That's Gaston. That's like his manliest quote, “I use antlers in all my decorating.”
Jolene: I'm going to have to say that I love that you're quoting Beauty and the Beast right now. You're like–
Ben: Oh, I've seen all the Disney's, yeah. And that's definitely a sign of manhood, whether or not you use antlers in your decorating.
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So, what about the effects of the pill? Because we do have a lot of exercise enthusiasts who listen in on athletic performance. Do you know of any studies that have looked at the pill in relation to exercise?
Jolene: Oh, yeah. This is fascinating. So, women have been given hormonal birth control. So, their male coaches would say like, “Oh, your menstrual cycle, it's going to get in the way of things. Let's put you on birth control, and that's going to make you a better athlete.” Except that hormonal birth control, in shutting down your ovaries, it can shut down testosterone production by as much as 50%. It then alters your liver at the genetic level to express higher amounts of sex hormone-binding globulin. Now, that liver is not betraying you. It's like, this is way too many hormones in our system. We've got a gobble of some of these synthetic hormones to keep our bodies safe, except it's going to grab onto that testosterone as well.
Testosterone is essential for muscle mass, for energy production, for bone health. So, in that way alone, it can actually inhibit women's athletic performance. And recent studies have come out showing that women on hormonal birth control, athletes specifically, they fatigue faster while on birth control. Their muscle gains are less. Endurance goes down. So, now, researchers are saying, “Don't put your athletes on birth control. Actually, leverage their menstrual cycle. You can work with their menstrual cycle to make tremendous athletic games.” And you know who just did this? The U.S. soccer team.
The U.S. women's soccer team decided to do what people like me have been shouting about for years, which is work without women's menstrual cycle to–make an exercise plan that's conducive to what her body is doing. They just crushed it, and I think that's phenomenal. One of their coaches and all, he actually created a whole app around this so that you can plug in your data of your menstrual cycle and start working your routine around that. And so just briefly, if we know that in the follicular phase, so you're on your period, your testosterone and estrogen are rising, your energy is going to go up, you're going to stimulate muscle mass. This is when women, about a week after their period, they're like, “Whoa, I can lift so much. I can run a marathon, like, there's so much more I can do.”
Whereas when we get into that luteal phase, and specifically leading up to our period, that's a great recovery time. That's a great time to recover your body, work on stretching. And when I've worked with–and not just stretching, but just being really mindful of like, you don't just stop moving. You don't just say like, “Oh, well, I'm going to get my period soon. I'm just going to stop moving.” No, no, no. But when I've worked with patients in this way and I'm like, “Okay, I want you to dial back this week, and then I want you to go hard this week,” they make tremendous gains in their fitness goals.
And in addition, being on hormonal birth control, there are women who have complained of waking. Now, as I said earlier on, this can be water retention. So, if you start birth control, you gain weight, you stop it, you lose weight right away, likely, it was water retention. Hormonal birth control is inflammatory. They've done studies. They measure C-reactive protein, a marker of inflammation. They put a woman on birth control. And sometimes that CRP shoots up about three times the amount. So, that's also going to cause weight issues as well.
But when we factor in long-term hormonal birth control use, we've got the downregulation of testosterone. We've also got issues in terms of thyroid hormone. That can lead to us gaining weight. What is one of the hallmark symptoms of hypothyroidism? Unexplained weight gain in all of that. We've got the inflammatory piece as well. But we also have to account for how hormonal birth control is depleting nutrients. So, there's lots of nutrients. This is one of the biggest nutrient drug muggers there is. And we've got studies that go back to the '70s showing magnesium, zinc, selenium, B vitamins like B12, folate, B2, B6, and CoQ10, vitamin C and vitamin E. What are we going to impact besides the entire body? Mitochondrial function, mitochondrial health.
And so we have to start looking about peace as well. And so when they've done the studies on waking in women, they are like, “Oh, on average, it's not that significant.” Except when you get into how that was done, they basically were like, “This woman gained 50 pounds. This woman lost 20 pounds. This woman gained 70 pounds. This woman lost 10 pounds.” Add it all up and take the average up. Not that big of a deal. Now, what about the woman who gained 50 pounds? Or what about our body type? Like, I'm 5'5″ maybe on a good day. If I put on 10 pounds, it's a big impact on my body compared to another woman who would be 6-foot tall. So, these are the kinds of things that are very individualized that we have to start talking more about.
Ben: Yeah. And for me, having looked at some of the exercise physiology data, it's interesting because another very popular drug right now is metformin, which is being used off-label. It's kind of like an anti-aging and drug, not only to reduce glycemic variability, but to possibly have some other effects on downregulating mTOR activity and increasing autophagy, et cetera. But when you look at the exercise literature, not only do you see a drop in the ability to be able to proliferate new satellite cells, post-exercise. So, you see a drop in the ability to be able to build muscle.
But then the other thing is about a 4% to 5% reduction in VO2 max, or maximum oxygen utilization during exercise, which is almost exactly the reduction that studies have found the pill causes in athletes, that for the average exercise enthusiast might not be that big of a deal. But when you talk about like a cyclist or a swimmer or rower going from, let's say, VO2 max of 65 down to, whatever, 5% of that would be–so let's say they're going down to, whatever, 61 from 65. That is the difference between first and tenth place in many cases.
And then the other thing is that it can also downregulate your ability to be able to utilize glucose during exercise. You actually see an upregulation in fatty acid utilization during exercise in women who are on the pill, and you'd think that that'd be a good thing, right? You'd think, “Oh, it's turned me into a fat-burning machine.” But the problem is it's not doing that by increasing mitochondrial efficiency. It's doing that by suppressing your ability to be able to burn glucose for those intense bouts of exercise or those intense spurts. And so you're basically able to dig less deep, related to what you were alluding to about increased or decreased time to exhaustion on the pill, or decreased force production capacity. That's because you simply can't engage in glycolysis quite as readily because your blood glucose levels are lower. So, it kind of screws exercise performance from both an endurance, and also a power and strength standpoint.
So, in my opinion, what you've just alluded to this idea of adjusting exercise, and even timing of competition based on the natural cycling, I think that's a field that I'm really interested in seeing developed over the next few years. And I know there are some really good folks who are doing this like Dr. Stacy Sims. She had a book that came out a few years ago called “ROAR,” which really gets into how to time your exercise, whether you do yoga versus weight training based on your cycle. And then I don't know if you know Alisa Vitti. She has a book called “Flo.” That also gets into this a little bit, like, how to time your movement and exercise based around your natural cycle.
Jolene: Mm-hmm. Yeah. I think those are all great resources. And then at the same time too, I think we should also listen to our body and tune into that because sometimes I will say that women–and I want to just be really clear because I'll have women say, “Man, I have a competition, but I'm going to be on my period. So, I think I'm going to fail at this. I'm going to come in last.” And like, okay, firstly, your mindset is everything. And secondly, sometimes women are on their period or leading up to their period and they're like, “I feel like I could go harder. Is that wrong?” No. Honor your body and listen to that, and know that there may be things that you want to shift.
We can't all plan all these things. So, like, I'm an international speaker. People will ask me like–so one of the best times is post-ovulation. Right around that post-ovulation, your lips are going to be plump, like people want to listen to you, you're more attractive, your brain is firing in a way that your linguistic capacity goes up. And yet people will say to me, “Oh, so do you schedule everything around your cycle?” No. Life doesn't work that way, okay? The world is not set up that way. But if you know these things, you can actually start to alter your behavior. So, if you're like, “Yeah, I usually get really tired around this time, but I have a competition,” okay, maybe you need to be getting in bed like 8:00 p.m., 9:00 p.m. Maybe you need to bring on like your more supplements in terms of your supplement regimen. Maybe you need to make sure that your diet is dialed in in a different way.
And so, you can work a lot with your intuition as well and understand that you–like the world is not going to revolve around your cycle, but you can understand these things to get the experience, the performance, whatever it is you're going for. You can make that happen by just shifting these simple practices. And I do think we're going to see this research absolutely explode. I mean, with what the U.S. soccer team was able to do, I think we're definitely going to see that a lot of trainers and athletes are going to take note. We also know that there was recently that athlete who came out about how her Nike trainer destroyed her body, and how they kept cutting calories, and all the things they were doing were like the opposite of what a woman's body needs. And she went from being like the best of the best to like, “I can't even compete anymore,” and she's been very vocal about this.
And so I think that we're going to see a lot of the athletic world with just a lot of the world waking up to the reality of like, we have been trying to take these cyclical creatures–and then, they're cyclical too just over a 24-hour period, but we've been trying to basically fit this square peg into a round hole, and there's a better way. And we can actually, instead of treating our hormones as if they're these terrible things that are burning, we can leverage the superpowers that they're really designed to give us. And that is why I think we're seeing millennials and younger generations rejecting hormonal birth control at a higher rate than what we've ever seen. I think one, they've seen the women that have gone before them. They don't want to have those same experiences. But two, they also recognize they want to know their body and they recognize that there is strength in their hormones, things that they can leverage.
And we finally have gotten away from that place where older generations, they–and I say older like as advanced generations, they very much have this story where being a woman meant you couldn't get a job, you were too emotional. And so they never wanted to talk about the fact that our hormones do influence our mood. We have to recognize that everybody's hormones influence their mood. If men's testosterone get too low, they're going to be crying all the time. They're not going to be motivated. They're not going to get out of bed, like, they're going to be a mess. And so understanding that everyone's hormones are influenced by their mood. And if women are having mood symptoms because of hormones, that's a symptom your body is saying, “We need a little help here.” As I teach you in “Beyond the Pill,” you can come in, you can course correct, and you can actually leverage that so that you get that strength, that performance. Again, whatever the goal is, you can work with your body and work with your hormones to achieve it.
Ben: Now, if somebody's listening in, let's say a woman is listening in, or maybe a guy is listening in and he wants to approach his significant other about getting off the pill, can you just stop cold turkey? And if not, why not?
Jolene: Mm-hmm. Okay. So, when it comes to hormonal birth control, it's an all-or-nothing situation. So, with devices, it makes a little more sense, right? Remove the implant, remove the IUD, remove the NuvaRing, don't replace that patch. But when it comes to the pill, sometimes women are like, “Well, I'm going to go ahead and wean myself off.” That's a really bad idea. And here's why. One is you won't be protected against getting pregnant. So, it's only effective if you take the dose the way it's designed.
And so understand that the 99% effective at preventing pregnancy that the pill gets is if you are a perfect user. If you're a typical user, it's about 91%, which is to say that 9 out of 100 women using hormonal birth control, the pill specifically, will get pregnant in a year using it. Now, when you come off, it is a cold turkey. You just need to stop it. You don't want to lean off because the other thing is that if you're cutting your pill in half or quartering it, and these things are tiny, so it's hard to do, your brain isn't getting enough hormone to be shut down. So, it's going to be like, “Okay. Let me tell the ovaries to fire off. Wait. No, we're not going to fire off.”
I've had women write me and they're like, “I'm getting hot flashes now and I'm having acne, I'm having all these symptoms,” and it's like because you're messing around with your chemistry in a big way, like you were messing with it before. And understand that hormonal birth control, when you come off of it, it's a huge hormonal shift, and we often forget that piece. Doctors are like, “Just come off, everything will be fine,” until it's not. And most often, it's not. So, it's an all-or-nothing situation.
As I talk about in “Beyond the Pill,” if you started hormonal birth control for symptom management, which is almost 60% of women these days are actually using it for painful periods, heavy periods, acne, regular periods, understand that when you come off, those symptoms are going to come back. So, whatever symptoms you use to treat the pill with or any form of hormonal birth control, those are going to come back post-pill unless you've done something like changing your diet, changing lifestyle practices to really work on the root of those issues. Now, if you have those symptoms, you should give yourself a good three months to prep.
So, often, women will hear some of these things and they're like, “I just need to get off right now.” If you have endometriosis, if you had cystic acne, prep your body for a good three months. As you were talking about with metformin, often, women get prescribed hormonal birth control. If they're polycystic ovarian syndrome women, PCOS, they're also going to get metformin. That's going to take a big impact on your microbiome. So, the pill isn't completely digested in the small intestine. It actually will make its way into the large intestine. And research studies have compared it to antibiotics in terms of what it does to the microbiome. But how many people do we know that take antibiotics every day for decades on end? That just doesn't happen. So, things like that that we're going to have to work on in support, and we never want to see a woman jump off of birth control. If you get cystic acne right away, or your periods are terrible because of endometriosis, you're going to feel like a failure, you're going to go right back on it.
So, prep your body a good three months. If you started hormonal birth control and you started it just because you didn't want to get pregnant and there was nothing else going on, it doesn't mean you're in the clear when you come off. It doesn't mean you won't have symptoms. In fact, I've never seen a patient who doesn't have symptoms coming off of hormonal birth control unless they do the work to really support their body in that transition. I outlined all of that in my book. I give you a meal plan. I'm not dogmatic. My training, I started in chemistry, went into nutritional biochemistry. There is no one size fits all. There is what's true for you, and that's what we need to understand.
So, you'll get very nutrient-dense diet lifestyle practices. I give you quizzes so you can dial in your supplement protocol and figure out, it's all–it's very much me being a scientist and I want people to build their user manual to their body. I want them to test what is true for them and understand that it will probably change over time. So, if you've had no symptoms, no issues, you start hormonal birth control for pregnancy prevention, you can end it at your next end of your pill pack. If you have a device, you need to have a doctor remove it. And if you've had the Depo-Provera, which is the synthetic progestin injection, that takes about 90 days to wear off, so to speak. So, you're going to have to ride that one out. It doesn't mean you can't be doing things in the meantime. You absolutely can, so you can totally be supporting your body and making that transition as you're coming off of that.
And so in all of that, it's also important for women to understand that just when you stop doesn't mean that you won't need to further take care of your body. And so on average, you're going to need to spend a good three to six months supporting your body as you come off of it, especially if you got your period of 14 and three cycles later, your doctor put you on birth control, and now you're 44. Your brain ovarian communication was never really solidified. It was never really established. And this is what I think is part of post-birth control syndrome when women say to me, “It feels like I'm going through puberty again.” And I'm like, “Man, puberty might be a necessary process for all of us to go through as much as like none of us liked it. It might be a necessary process to go through.”
And so everything that I just talked about, those symptoms coming off, that's part of post-birth control syndrome, which on average is going to pop up about four to six months after stopping hormonal birth control. And the tricky thing is that it can come on later, which if your doctor isn't really tuned into that and you go into them 8 months later, 12 months later, they're going to be like, “No.” Well, if this was because of birth control, then you would have had symptoms immediately, except that a lot of women, they take a week break on the placebo. So, why would they have immediate symptoms? Like, they're cycling with birth control to get that drug-induced withdrawal bleed. Not a period. It's a medication-induced withdrawal bleed. I think that's really important language for us to clarify on there.
Ben: Yeah. And I know that you have a whole protocol, like you just alluded to, laid out for post-birth control syndrome, but it's coming at it from a variety of angles, like addressing the leaky gut issues with–I think some of the nutrients you talked about are like slippery elm bark and marshmallow. I'm a huge fan of things like aloe vera extract, and colostrum, and a lot of these things I can help to heal the gut. And then you've got like a detoxification protocol, healing some of the metabolic or mitochondrial damage, replenishing nutrients with very nutrient-dense diet. I think you're even, correct me if I'm wrong, a fan of organ meats or encapsulated organ supplements or things like that as very nutrient-dense sources. But it's kind of like a whole system that you need to be able to manage that post-birth control syndrome.
Jolene: Mm-hmm, yeah. No, I am a fan of organ meats. You'd be hard-pressed to find anything more nutrient-dense in our food supply.
Ben: Yeah. It's basically nature's multivitamin.
Jolene: Absolutely. I mean, all the time with patients, I will prescribe beef heart, and they're always like, “Oh, that's gross.” I'm like, “Okay. The very first time I was going to eat beef heart, I'm like –” my small human who is now–he just turned seven, he is hardcore. He's like anything. He's been eating bone marrow since he was like an infant. And yet his mom is like squeamish about this stuff. But I tell people, “Take 25% beef heart. Go to your butcher. Get grass-fed beef heart and say, ‘I want you to grind up 25% beef heart. And then I want you to get ground beef. Put it together. Make a burger.'” Time and again, everyone's like, “That is the best burger I've ever had.” I'm like, “Yeah, it is.”
If you think about it, these organs are what our body prioritizes. So, when people are like, “Why is my skin, why is my acne the last thing to heal?” Well, because your heart is more important, your liver is more important, your lungs are more important. Your body will prioritize these systems, and those organs are going to get the most nutrients. They're going to be taken care of. That heart muscle works so hard. Why wouldn't it be rich in mitochondria, CoQ10, B vitamins and nutrients you need to run your energy and to do what you need to do?
So, I am a fan of organ meats. And when it comes to basically rehabilitating your body after birth control, you are going to need to focus on every single system. And I take you through it in a way that's not overwhelming, in a way that's like, “Okay. I take a quiz. I choose my own adventure. I know how to get dialed into these things.” And for women who are listening to also understand that I wrote this book, it's called “Beyond the Pill,” because I wanted to give women solutions to their hormonal issues beyond just passing them the pill. As I said, it's 58% of women, that's our most recent survey that's come out, 58% of women are using hormonal birth control because of symptoms. This is the go-to of doctors. You have acne? Let's give you the pill. You have headaches? Let's give you the pill. You don't want to deal with heavy periods? Let's give you the pill.
We need to ask why and we need to do better for women. And if they choose to use hormonal birth control, that's 100% their right too, and they deserve to be supported in that. And a big missing piece in this whole conversation around birth control has been what can happen? What should you identify? When should you get to your doctor? What can you do to take care of your body while you're on it? Because it's not an all-or-nothing conversation. And women absolutely deserve the right to choose as much as they deserve the right to have access to the education they need, and to know what are the signs and symptoms of a heart attack of women? It's different than men. What are the signs and symptoms of stroke? Like we've all heard, birth control can lead to a stroke. But how many women actually even know what a stroke is?
The thing that I didn't really expect when I put this book out was how many women's lives would be saved from this. This is just a crazy thing. Over the last year, we've had women writing us saying, “If it wasn't for reading your book, I wouldn't have advocated for myself in the ER. I could have died.” We've had women with pulmonary embolism. Women who are having a stroke, their doctor was like, “You just have a headache. Take some Midol and go. Take some ibuprofen.” And yet they advocated for themselves by being able to identify these things and were able to save their own life.
I had these parents writing. Their daughter went to the ER. She was dismissed and sat home. Her mom had read my book. Her mom's like, “Uh-uh, that sounds like a stroke. Go back.” She sent her daughter back. Her daughter went back, and sure enough, she was having a stroke and she had been dismissed. And what I'm saying right now about dismissing women, this is way more common than we even recognize. There are studies that have come out showing women are more likely to die of a heart attack than men, were more likely to be told, “Your symptoms are in your head. You're overly emotional. Go home.” And then we die. And that is medical gender bias for which medical schools are changing their curriculum. They're changing how they teach future physicians because they recognize that we have in fact been doing harm by perpetuating this inherent bias that just by having female on your chart means that your symptoms are not real.
Ben: Now, are you a fan of, as an alternative to the pill, any type of cycle tracking methods?
Jolene: Yeah. So, there's a whole table in my book. Chapter 13 is dedicated to non-hormonal birth control options because look, my mom was a teen pregnancy. So, I'm like, “Step one, if you're going to come off birth control, let's have a backup method if you are sexually active with a male partner.” And so in that, the number one contraceptive that women love if it works for them, it has the highest efficacy rate, that means it works and women love it, is the copper IUD. If you have heavy painful periods, no, it's most definitely not going to work for you.
And in addition to that, anytime we have a medical intervention, even including medical devices, we want to track our symptoms and we want to get some baseline labs so that we can make sure that this is working for us on the individual level. Not just because it worked for a sister or a friend does it work for you. So, there's the copper IUD. We also have barrier methods —
Ben: Wait, are you worried about copper toxicity at all with the copper IUD?
Jolene: In some women. So, we'll actually measure this and we'll also measure zinc as well with my patients. So, when you look at the studies, what's really interesting is when you see the conclusions, they'll say, “Hmm, the copper doesn't go systemic.” Yet if you have a copper storage disease, you shouldn't use this method. To me, the researchers are seeing something that like just hasn't been disclosed yet. It hasn't come out. So, yes. Again, the uterus is not Vegas. What happens there doesn't always stay there.
And so if women are being told, “If you have a copper storage disease, you shouldn't use a copper IUD,” to me as a doctor, I want to screen. I want to screen what are their baselines. She gets a copper IUD. I want to screen again. We also screen thyroid as well because I've seen thyroid be affected. I don't have any research studies to say like, yes, copper IUD directly impacts the thyroid, but if you think about it, your thyroid does need some of these nutrients that can be displaced by copper. This is an area where we need studies. So, yes, we want to look at those baseline labs and then we want to have her tracking her symptoms.
So, ideal for any reproductive medical intervention is track your symptoms at least an entire menstrual cycle. Three is even better. And when I say this like with the copper IUD is that maybe you go on it and everything's fine, and six months later you're like, “Wait, what are these clots? What are these really heavy periods? What is going on here?” And gaslighting is real in medicine. Your doctor will tell you that you misremember your period. But if you haven't written down, it's impossible to make you second-guess yourself because your personal data in front of you. And that's why the baseline labs are also important as well.
The question we're always trying to answer is what's true for you? What works for you? I may be able to say, “This research study says that this wouldn't happen except that it did happen to you.” So, okay. Well, how do we help you? Because you're the person sitting in front of me who's asking for my help. So, we talked about the copper IUD. The other thing is barrier methods. So, we have cervical cap. Diaphragm is much harder to get a hold of and condoms. Nobody likes the female condom and I understand that. Male condoms can fail if they're not put on correctly. This is why I definitely advocate that women know how to place a condom appropriately as well. And understand that if you get started without a condom, yeah, there can be semen released and that can be problematic.
But what's important about the condom discussion is that often women are given hormonal birth control when they're going off to college. “Here, have some birth control. Study hard. Don't get pregnant.” And no one really talks to them about the barrier methods that need to be in place. When you're on hormonal birth control, there have been studies showing you are at increased risk of contracting HPV, and even possibly HIV. We need more information on this for sure. But a barrier method in a non-monogamous relationship is super important.
Now, for women who are like, “I don't want any devices. I want to work with my natural cycle.” Well, that's funny because there's actually an app called Natural Cycles. And there's also Daysy. And Daysy is a fertility monitor. Natural Cycles is the first FDA-approved contraceptive device, and this is where the Femtech industry is on the rise, and it's so awesome to see. So, what does this all based on? It's actually based on fertility awareness method. And what's interesting is that the concept of developing the pill is actually based on the findings, the foundation of fertility awareness method, which is tracking your signs and your symptoms. I mean, way back in the day, they were like, “Huh, we think there's something to this cervical mucus.” But by the way, we need a better term than mucus. Men can ejaculate mucus.
But in that, there is a window when we can get pregnant. I remember, there's this moment, so I'm sitting in class in the medical school and my teacher says, “There's only one day out of the month a woman can get pregnant. Here I am on the pill and like this.” It's like that pan in moments where it's like, “Dan, dan, dan.” I'm like, “Wait, I've been suppressing my hormones every day under this fear-based concept that getting pregnant is so easy. I can pregnant any day of the month.” I mean, ask women who are struggling with fertility and they're like, “If I knew how hard it was to get pregnant, I don't know if I would have ever used birth control for as long as I did.”
So, we can only get pregnant one day out of the month. Sperm is tricky. It hangs around. It can live five or six days and your uterus will actually cultivate it and be like, “Hey, good little sperm, let's take the best of the best of you and keep you alive.” And that is evolution's way of making sure that you are more successful in procreating. So, then the egg is released. There's sperm there waiting, waiting. And interestingly, the egg gets to decide. It's not the strongest swimmer and like, “Oh, the sperm penetrates the egg.” The egg is like, “You're cool. You can come in. Let's make a baby together.”
So, in that, this is really where knowing your own body–I actually advocate that everybody starts to understand fertility awareness method because it's one of the best ways to understand your body. And as I talked about in “Beyond the Pill,” getting together with a fertility awareness expert, someone who coaches this, teaches this, can help you so much get dialed in. And when you understand, so as I go through my book, there's the lowdown on your hormones, you can understand how your hormones work, how your menstrual cycle works, then we get into the period problems chapter.
When you understand and you're tracking your symptoms, what your hormones are doing when your symptoms are coming on, there are so many women who have written me that are like, “Oh my god, my acne is because the testosterone rising. All these years, I've been using Accutane and antibiotics on this stuff. I needed to make these shifts. How easy was that?” So, it can be great for understanding your body working with your symptoms. And at the same time, when we look at the research with perfect use, it's on rival with hormonal contraceptives, and that's because when–so there's some people who are like, “Oh, so I can't have sex during my fertile window.”
Okay. One, there's a lot more than vaginal penetration that you can do. So, it's not that boring. You can get creative. And also, you can use the barrier method in this time. I talked about–I think it's only fair to present the research and talk about that the withdrawal method when done correctly, it only has a 4% failure rate. I don't advocate it. I don't tell my patients to use it as a primary method because I don't like any method where a woman's not in control. Like, she can't be in control of what happens. Sometimes those male hormones, they get the best of your brain, they override your judgment, and you don't want a whoop situation.
And so when it comes to birth control, it's very individualized. What risk of getting pregnant are you willing to take? What risk of possible symptoms are you willing to take? What is your genetic predisposition? Like, if your Factor V Leiden, you have a mutation or MTHFR, I really say you want to think twice about using hormonal birth control. My patients who have a Factor V mutation, which is a clotting mutation, I'm like, “No dice. You cannot be using hormonal birth control. Your stroke risk is way too high. Your cardiovascular risk is way too high.”
Ben: So, scary.
Jolene: Yeah. And we can screen all of these things and know that and be able to offer that individualized birth control option. I think as the future, as we go forward, we're definitely going to see iterations because women globally are putting their hands up being like, “I want something better and why the heck do I not have something better yet science?”
Ben: Yeah. Have you ever heard, by the way, of the–it's a newer one, it's called the OOVA? It's like a urinary measurement. I think it's tracking–I don't know if it's tracking LH or progesterone or estrogen, or what it is, but it's relatively new. Someone just told me about it, O-O-V-A?
Jolene: I haven't seen that one. But what I'll say is that there are women who are like, “Oh, I'll just test my LH and then I'll have protected sex, or I'll abstain from sex.” And yet you have to understand that what happens is that testosterone is going to spike in your cycle roughly around day 10. So, what's that going to do? Libido goes up. Suddenly, you're like, “My partner looks really good right now.” And if you're having unprotected sex and then you're like, “Oh, well, then I'll abstain when my LH spikes,” it's too late. That sperm is already there and you're increasing your chances of pregnancy.
And so the symptothermal method of measuring your body, basal body temperature, so your eyes pop open first thing in the morning, you pop a thermometer under there. You can paper chart. Taking chart of your fertility is a great book for that. You can use the apps like Daysy or Natural Cycles. There's also other apps where you can manually plug it in. That will help you understand when your temperature spikes, which is synonymous with the ovulation, that's going to be your sign of ovulation, but also looking for fertile cervical mucus.
So, there's actually a comedienne, Amy Schumer who–she had this great skit where she talked about like–it looks like someone blew snot in her underwear. That is exactly what it's like. It's that raw egg white consistency. And I can't even tell you how many women that I've had call my office after getting off of birth control and they call, they're freaking out. They're like, “There was this weird goopy discharge. I think I have an infection.” I talk to them through it and I'm like, “Congratulations. You just ovulated, or you're getting ready to ovulate.” And they're like, “I've never seen this in my life.” I'm like, “Yeah. That's the sign of ovulation. That's also why there should be no shame ever about the need of lubrication for sexual intercourse because as cyclical creatures, there are times where we have more lubrication and there are times where we do not.”
So, understanding all those symptoms, you can even go further and understand cervical position, but I mean, I think that can be helpful. It's very interesting to get to know your own cervical changes, but it's not totally necessary in pregnancy prevention. Getting that temperature spike, paying attention to your drive, your energy, your mood, and then that cervical mucus is really essential.
Ben: Yeah. Look, I mean, I think a big part of it for me comes down to the fact that the pill is incredibly convenient. But in very simple terms, convenience always comes at a cost. And in this case, the cost is a lot of biological damage from–we've pointed out to stroke cardiovascular risk, autoimmune issues, leaky gut, nutrient abnormalities, a lot of these things that just are not readily apparent or made readily apparent for women. And that's why I wanted to interview you was because I think just so many women and their partners are unaware of these issues. And I know that it's–I mean, honestly, it reminds me of the whole cell phone 5g conversations going on right now. The phone is freaking convenient. Wi-Fi and Bluetooth are so convenient, but it's not as though there's zero biological cost to the use of them.
And just in the same way you have to introduce smart utilization of technology, I think you have to utilize smart introduction of birth control methods that are more natural than the pill and reflect a lot of what you provide in the book and some of the pointers that you gave out in this show. So, I mean, it's the human inherent tendency towards laziness and convenience. And when that's paired with advertising and pharmaceutical interest, it just creates this shitstorm scenario where a lot of women are hurting themselves.
Jolene: Yeah. And when we're told that it's completely safe and if we're having symptoms, that's just you, you're just broken. I mean, it really fuels the fire in all of that. And I think that's really such a big part of my message is that the pill isn't bad. All of these ways of preventing pregnancy aren't necessarily bad, but that might be bad for you. And that's what we need is that individualized discussion and that informed consent. And if women are going to go on hormonal birth control, that's when you need to be on a prenatal or multivitamin. You need to be making sure that you're tending to your microbiome, eating a variety of fiber, considering probiotics, probiotic-rich food coming in.
You need to track your metabolic health. I mean, if you're on a pharmaceutical that can lead to insulin resistance and inflammation, you need to keep tabs on that. I don't care if you're 22. Your cholesterol may go up. Your high blood pressure may come on and we have to be educating women in this, and having them also understand how their body works to begin with. And then quite frankly, it's downright dangerous to put women on birth control for symptom management without ever asking why she has those symptoms in the first place.
Ben: Yeah. Well, we've kind of scratched the surface of what's in your book, “Beyond the Pill,” and I think that anybody who wants to take a deeper dive should read the book. And I've been taking a lot of notes, so I'll also link to any other books I mentioned, some of the studies and all the notes that I've taken during this conversation because I always am writing things down as we're talking, and then I put them together in shownotes for you guys along with the transcript. So, that's all going to be at BenGreenfieldFitness.com/beyondthepill. The transcriptions always come out usually about a week after the audio is released, but that's always available for you to review some of this information as well or use keyword search terms to go through the transcripts.
And I really encourage you to reach out to a loved one if you know that they're on the pill, and sometimes it doesn't work so much coming from you personally, but if you just have them listen or read the book, that's my MO a lot of the times with my wife. Like, I don't want to shove health information at her, so I'll just have her read something. I think that everybody should at least pay attention to what you're saying, Jolene, read the book and follow what you're doing. So, thanks for coming on the show and sharing all this stuff with us.
Jolene: Yeah. Thanks so much for having me. It was such a pleasure to chat with you.
Ben: Awesome. Well, folks, the shownotes again are at BenGreenfieldFitness.com/beyondthepill, and I'm Ben along with Dr. Jolene Brighten signing out from BenGreenfieldFitness.com. Have an amazing week.
Well, thanks for listening to today's show. You can grab all the shownotes, the resources, pretty much everything that I mentioned, over at BenGreenfieldFitness.com, along with plenty of other goodies from me, including the highly helpful “Ben Recommends” page, which is a list of pretty much everything that I've ever recommended for hormone, sleep, digestion, fat loss, performance, and plenty more. Please, also know that all the links, all the promo codes that I mentioned during this and every episode, helped to make this podcast happen and to generate income that enables me to keep bringing you this content every single week. So, when you listen in, be sure to use the links in the shownotes, use the promo codes that they generate because that helps to float this thing and keep it coming to you each and every week.
My guest on today's show, Dr. Jolene Brighten, is a functional medicine naturopathic doctor and the founder of Rubus Health, a women's medicine clinic that specializes in women's hormones. She is recognized as a leading expert in post-birth control syndrome and the long-term side effects associated with hormonal contraceptives. Dr. Brighten is the best-selling author, speaker, and regular contributor to several online publications including MindBodyGreen. She is a medical advisor for one of the first data-driven apps to offer women personalized birth control recommendations.
You might be familiar with her also as the author of Beyond the Pill: A 30-Day Program to Balance Your Hormones, Reclaim Your Body, and Reverse the Dangerous Side Effects of the Birth Control Pill.
Out of the 100 million women (almost 11 million in the United States alone) who are on the pill, roughly 60 percent take it for non-contraceptive reasons like painful periods, endometriosis, PCOS, and acne. While the birth control pill is widely prescribed as a quick-fix solution to a variety of women’s health conditions, taking it can also result in other more serious and dangerous health consequences. Did you know that women on the pill are more likely to be prescribed an antidepressant? That they are at significantly increased risk for autoimmune disease, heart attack, thyroid and adrenal disorders, and even breast and cervical cancer? That the pill can even cause vaginal dryness, unexplained hair loss, flagging drive, extreme fatigue, and chronic infection. As if women didn’t have enough to worry about, that little pill we’re taking to manage our symptoms is only making things worse.
Dr. Brighten specializes in treating women’s hormone imbalances caused by the pill and shares her proven 30-day program designed to reverse the myriad of symptoms women experience every day—whether you choose to stay on the pill or not.
Featuring simple diet and lifestyle interventions, this podcast will be a crucial step to reversing the risky side effects of the pill, finally finding hormonal health, and getting your badass self back.
During this discussion, you'll discover:
-An overview of how the pill works…9:38
- Brighten is a former user of the pill; didn't understand the ramifications until studying in natural medicine
- It works at your brain level
- How do the ovaries know when to ovulate?
- The pill distorts FSH/LH levels, thus affecting ovulation, menstrual cycles, etc.
- Causes mood alterations and even difficulty getting pregnant once off the pill
- What normal FSH/LH levels should be sans the pill
- Day 1 of the period begins the “flow” of maturing eggs
- FSH and estrogen rise
- Once ovulation occurs, the corpus luteum secretes progesterone
- Every form of birth control produces progestin, not progesterone
- Weight gain is common
- Water retention due to lack of progesterone
- Moodiness is common
- Key point: A woman stops ovulating because the pill is affecting her body at the brain level
-Dr. Brighten's thoughts on supplementing w/ progesterone…16:03
- There's a time and place for it, but first ask “why” you need it
- Can help w/ anxiety, sleep quality,
- Women need progesterone to strengthen the myelin sheath in the brain; also w/ neuroplasticity
- Important for bone health and the immune system
- Book: Adrenaline Dominance
- Book: The Warrior Diet
- Some men can benefit from progesterone supplements
- A safe environment is vital for progesterone levels
- Stressful environments affect natural progesterone levels
- The body will produce cortisol rather than reproductive hormones
-Why women are not equitably represented in the scientific community…23:43
- Lean females should use caution while participating in intermittent fasting
- Laws forbidding women from participating in studies have inhibited accurate data
- The scientific field as a whole is underrepresented by women
- Article: Women aren’t properly represented in scientific studies
- Article: Science is male-dominated
- Basic economics: it's cheaper and easier to study males, be it humans or animals
-Real-time consequences of being on the pill…33:30
- It affects which partner a woman is attracted to
- Makes a woman less attractive to ideal partners
- A woman may not be attracted to their partner when they come off the pill
-Effects of the pill on athletic performance…45:20
- Shuts down testosterone production by as much as 50%
- Affects energy, bone health, etc.
- Fatigue faster
- Leverage menstrual cycles (Ex. U.S. women's soccer team)
- Affects both endurance and power/strength negatively
- Book: ROAR: How to Match Your Food and Fitness to Your Unique Female Physiology for Optimum Performance, Great Health, and a Strong, Lean Body for Life
- Book: In the FLO: Unlock Your Hormonal Advantage and Revolutionize Your Life
- “Listen to your body”; design your lifestyle around your cycle as much as possible
- Woman athlete accused Nike of destroying her body w/ their training regimen
-How to go about getting off the pill…57:15
- “All or nothing situation”; don't wean yourself off
- The brain is confused w/ reduced amounts of the pill if taking smaller quantities
- Women use the pill for symptom management, vs. birth control
- The symptoms will return if you don't adjust your lifestyle
- Prep the body for 90 days before going off the pill
- Protocol for Post Birth Control Syndrome, like addressing leaky gut issues, like slippery elm bark, marshmallow, aloe vera extract, colostrum, CoQ10
- Organ meatsare good (nature's multivitamin)
- Focus on every system in the body
- Women have been able to save their own lives, advocating for themselves w/ doctors, in the ER, etc. (medical gender bias)
-More natural birth control alternatives…1:08:38
- Copper IUD is among the most popular
- Beware of copper toxicity
- Indirectly affects the thyroid deleteriously
- Carefully track and notate your own personal data
- Female condoms suck
- Females should know how to apply male condoms
- Natural Cycles app
- Ancestral Supplements organ capsules
- Oova birth control tracking method
-And much more…
Resources from this episode:
– Book: Adrenaline Dominance by Michael Platt
– Book: The Warrior Diet by Ori Hofmekler
– Article: Science is male-dominated
– Book: In the FLO: Unlock Your Hormonal Advantage and Revolutionize Your Life by Alisa Vitti
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