Author: drmegnd

I’m going to teach you 3 main things today –

#1 – What basal body temperature tracking is and why it’s important

#2 – What charting is

#3 – Why you need to pick a mothod to interpret the data you gather

And if you have no idea what I am talking about it, I am going to explain it – and PS. this is also a YouTube video!

Let’s start with WHAT IS Basal Body temperature tracking – This a practice where a woman takes her basal body temperature every morning and uses that data to learn about her cycle.

When tracking your “BBT” aka basal body temperatures, you must follow some basic temping rules in order to get good accurate temperatures.

1. A thermometer that goes to the hundreths place
2. Taking your temperature at the same time each morning
3. Being consistent – roll over and wake up and put the thermometer in your mouth (reduce any extra movement that can increase your basal body temperature)
4. You must have 4 hours of consequetive sleep for the reading to be accurate. If you are breastfeeding, are a shift worker, or tend to wake up in the middle of the night, you need to get a wearable thermometer called TempDrop, which I will explain in another post.

The next thing you need to learn is how to CHART! Charting is where you take your basal body temperature data and put it on a chart. Then you connect all the dots of temperatures, to create a line. It looks something like this:

When you are charting you have multiple options HOW to chart:

1. You can paper chart – which is buying a paper charting notebook or creatine one yourself and doing the data input manually – this is geat to customize what your charts look like and to add in any symptoms you are also tracking in your cycle
2. You can chart on your phone using an App. Kindara is the app I recommend for NEW charters – it’s free and easy to use, and I have no affiliation with them.

Most importantly, DO NOT USE APPS THAT ARE PREDICTIVE – like Natural Cycles. This can result in an unplanned pregnancy. Your cycle changes each month, so you do not want an app to predict for you when you are safe for unprotected sex and when you are not fertile. The only way you can safely make those decisions is to interpret your data… which leads us to our last point.

You need to pick a method – methods have rules you must stick to in order to properly interpret your data. Put simply, a method teaches you how to interpret the data you take. Data includes basal body temperatures, cervical mucus, and cervical position. Cervical position changes throughout a womans cycle – and this can be felt by inserting one or two fingers into the vagina and feeling for the orientation of the cervix. When a woman is fertile the cervix is high, soft, open; when is is not fertile the cervix is low, firm, closed.

Common methods:

1. Taking Charge of Your Fertility aka “TCOYF” (also is a book by Toni Weschler) – this is my personal favorite, as you can buy the book and teach the method to yourself
2. Sensi-plan
3. Marquette
4. Billings
5. And more

Combining your data about temperatures, cervical fluid and cervical position gives you what we call your “chart,” which is the display of your data – which allows you to easily look at apply your methods rules. There is a chart created for each menstrual cycle.

Women who use this type of natural birth control, which is most commonly known as the fertiltiy awareness method, like this method because it helps them learn the times in their cycle were they can go unprotected with their partner vs using a barrier method or withdrawal method.

Charting helps you determine when your fertile window opens and when it closes.

This allows you to know when you are fertile, and when you are not, so that you can either time sex to achieve pregnancy, or you can abstain or use a barrier method to avoid pregnancy.

And in case you haven’t heard, this idea of natural birth control works because WOMEN ARE NOT FERTILE EVERY DAY OF THEIR CYCLE!!

What makes a woman fertile is the time the egg stays alive (which is only 12-24 hours) + help from cervical mucus that extends the life of the sperm and shuttles the sperm to the egg. Sperm can live inside the body for about 5-6 days in the right conditions. This is why you need RULES to interpret your data because you can’t have unprotected sex whenever you want and not get pregnant. Creating a chart, and using a METHOD to interpret your data allows you to have the tools to make the right decisions throughout your cycle.

Lastly, this birth control method is best used for:

1. women in stable monogamous relationships
2. young girls wanting to understand their bodies and their cycles
3. women of any age trying to assess for ovulation, or figure out period problems
4. cycling women of any age who wants to learn more about their cycles

We are going to go more in-depth in subsequent posts. I purposely left out a lot of info because this topic needs to be broken down into separate articles.

If you found this information useful, please share it with someone who needs it! And see this video on YouTube, if you’d like a video explanation!

How do I supporting my microbiome with diet is common question I get in my practice. Today I am going to take you through three different points: 1) how the gut flora works, 2) why diversity is important, and 3) my favorite foods to support your microbiome at home.

There is about 6 pounds of bacteria in your colon – and this is what makes up what’s called your “microbiome.” We have more bacteria inside us and outside us on our skin, than we do actual cells in our human body. We live in a symbiotic relationship – we could not live without our microbiome, and they need us to provide a safe home. We start to build our microbiome from the moment we are born, and this process continues throughout our lives with our exposure to other humans through touch, the great outdoors, and different bacteria on foods.

 All those experiences are important, because we want to have a diverse microbiome. All bacteria have a role in the gut – whether it is to make mucus, produce butyrate, make vitamins, or to support other bacteria. We want MANY types of bacteria to THRIVE. There are many different bacterial families in the gut, and different bacterial species make up that family. The types of flora you have in your gut are based upon your experiences as a human – if you were born vaginally or C-section, or who you’ve kissed or had sex with, or where you’ve travelled or what kind of dirt you ate as a child. Our microbiome can also be ALTERED by different types of drugs, especially anti-biotics, and for ladies – the hormonal birth control pill. We can rebuild the microbiome if we need to take antibiotics – so there is good neww. But studies do show, that some humans can have large changes in their flora over time, where whole families of bacteria can be absent in the human gut upon testing!

Let’s talk about testing for a second – you can find out what kind of gut bacteria you have, and the kind of intestinal health you have, based on your scores on a stool test. I use these often with patients – the results tell me if the sample is diverse, what kinds of pathogens are living in the gut, what kinds of good bacteria are living there, and if they have a healthy gut lining or not, or whether there is inflammation in the gut. One thing I love about stool testing is that it can tell us if you have healthy levels of butyrate in the gut – butyrate is one of 4 types of Short Chain Fatty Acids – or SCFAs for short. SCFAs are produced by healthy gut bacteria (AKA normal flora) when the bacteria eat and ferment different kinds of fiber. The butyrate produced helps protect the gut healing and prevent against food allergies, leaky gut and other gut problems. It also helps keep the pH of the intestines LOW, which means pathogens like bad bacteria and yeast cannot grow!

People who have low butyrate are often quite sick, they react to a lot of foods, they have chronic health issues, and they have multiple gut symptoms. But GOOD NEWS – having a diverse diet – meaning you eat a bunch of different foods, especially a lot of different plan foods – means you will support your gut bacteria so they can thrive! You can use supplements like taking butyrate orally, and taking probiotics orally, but the best bet is to support with diet.

My favorite foods for a healthy microbiome are:

1. In short, ALL VEGGIES
2. Fermented foods – like fermented sauerkraut, fermented carrots, real pickles, pickled beets
3. Inulin containing foods like banana, burdock, chicory, dandelion, artichoke, jicama, garlic, onions
4. Brussel sprouts, broccoli, broccolini, cabbage, cauliflower, collard greens, kale, kohlrabi, mustard greens, turnips
5. Green veggies (especially anything green and leafy)
6. Sweet potatoes, beets, winter squashes, carrots
7. Celery, parsley, cilantro, cucumbers
8. Food fibers like chia, flax, psyllium, acacia
9. If you can tolerate them: beans and whole grains, like black beans and oats

In fact one reason why people initially feel so well on a paleo or a vegan diet, compared to the standard america diet, or the keto diet, is because of the sudden influx of plant foods feeding their microbiome!

For more in-depth explanation – please see my video on YouTube – click here. Be sure to share this article with your friends and family who need to hear it!

For many years I’ve been frustrated with the diagnosis of PCOS for my patients. PCOS is a syndrome – which means it’s a cluster of symptoms that have no other medical explanation. This is a poor representation of what’s going on women’s bodies who have PCOS. There are established mechanisms that show us what causes PCOS, and give us a road map about what to do about it. And I am going to discuss those mechanisms with you in this post.

To be diagnosed with PCOS, you need to have 2 out of the 3 following criteria:

• menstrual irregularlity
• hyperandrogenism and/or hirsutisim (high male hormones in the blood and/or male pattern hair growth like on the chin)
• polycystic ovaries on ultrasound

These three points are called the Rotterdam criteria, which were established in 2003 — which is 17 years ago and, in my opinion, is very outdated!

Luckily, because I am a naturopathic doctor, I look beyond these symptoms to figure out the real source of dysfunction. The type of dysfunction on a biochemical level is how we determine what TYPE of PCOS you have.

The most common symptoms of PCOS are:

1. Irregular cycles – cycles that skip, or that are long
2. Chronic an-ovulation (consistently not ovulating each cycle)
3. Hair growth, like hirsutism on chin and neck
4. Obesity or weight gain
5. Jawline, neck or chin acne
6. Hairloss (sometimes)

Other common symptoms that aren’t always recognized as PCOS symptoms are: blood sugar issues including hypoglycemia (low blood sugar levels), feeling HANGRY or spacy or irritable in between meals, brain fog that eating relieves, and stress.

There are 4 types of PCOS:

1. insulin resistant PCOS
2. ovarian androgen PCOS
3. adrenal androgen PCOS
4. inflammation driven PCOS (this can include Post-birth control pill PCOS)

Insulin resistant PCOS means that chronic blood sugar issues have created “insulin resistance” which means that your cells are no longer sensitive to the signal of insulin. Insulin is a hormone created by the pancreas that circulates in the bloodstreams and “opens the door” to allow cells to take up glucose (fuel). When diet is high in processed sugar and carbohydrates, along with obesity, blood sugar spikes are common, which cause spikes of insulin and a flooding of insulin into the blood stream. This leaves cells overwhelmed with the signal of insulin so they begin to ignore it, ultimately leading to insulin resistance.

I commonly treat insulin resistant PCOS with a blood sugar stablizing diet – high in vegetables, high in fiber, high in protein, moderate fat, and low proceessed sugars and carbohydrates. I will also use supplements including inositol, berberine, chromium, and biotin. In fact, studies have show that 500 mg of berberine three times per day was superior to the use of the drug metformin, which is the first line treatment for PCOS.

Ovarian androgen PCOS means there is an increase in testosterone and DHEA-S from the ovaries. There are many reasons for this, one of those is that excess insulin leads to an increase in adrogen production form the ovaries. Another is LH, or leutenizing hormone, which is the signal from your brain to your ovaries to stimulate ovulation. LH will chronically go up over time as the ovaries become less responsive and less healthy to create an ovulation response, triggering the brain to release more LH. The combination of elevations of insulin and LH leads to an increase in ovarian androgen production. Increased insulin levels also inhibits production of SHBG by the liver, leading to higher levels of free androgens.

I commonly treat androgen excess with supplements like saw palmetto, pygeum, and nettles. Zinc is helpful too. Sometimes the use of bio-identical progesterone is warranted.

Adrenal androgen PCOS means there is an increase in testosterone and DHEA-S from the adrenal glands. The main reason for this is chronic stress. Stress also (commonly) leads to blood sugar issues. As more and more insulin remains in the blood stream, the conversion of adrostenedione (another male hormone) to testosterone is facilitated at a greater rate, leading to higher levels of circulating androgens. Stress can be physiological, mental, emotional or spiritual – so it’s important to find the stress and remove it, or practice stress management.

Supporting the hypothalamic pituitary adrenal axis is crucial for balancing adrenal health. Many herbal adaptogens are amazing for helping the body adapt to stress and calm the overactive or stimulate the underactive HPA axis. I commonly use herbs like ashwagandha, rhodiola, eluetherococcus, panax ginseng, licorice, and holy basil to suppor the adrenal glands. These herbs should be recommended to you by a medical professional who knows your exact medical history. They are powerful herbs that really work, but they are not a one-size fits all type of approach.

Inflammation driven PCOS is due to the fact that high levels of insulin are inflammatory AND/OR there is another source of inflammation in the body that is throwing off the menstrual cycle, leading to anovulatiory and long irregular cycles. It’s important to assess the body holistically to find the source of the dysfunction and remedy it. Sometimes inflammation driven PCOS can be caused by metabolic syndrome that commonly occurs in overweight women with PCOS.

Estrogen can also be an issue in PCOS. Elevated synthesis of estrogens occurs because increased aromatization (conversion of testosterone to estrogen) of the increasing levels of androgens caused by increased insulin or via production from ovaries. High levels of insulin also add to the conversion of adrostenedione to testosterone, and then aromatization of that testosterone. The estrogen pool is also affected by the fact that low levels of progesterone, due to long cycles and chronic anovulation are contributing to a low progesterone/estrogen ratio.

So all that’s cool – but why do I have hairs growing on my chin?? I’ll tell you.

Increased androgens leads to hirsutism. Increase in ovary stimulation due to LH leads to enlarged/cystic ovaries. The body is trying to fix chronic anovulation by increasing LH, but ovulation often does occur due to decreased FSH levels, since no egg will be matured for release. Women with PCOS often have lower levels of FSH, and FSH is needed to “prep the egg” and mature eggs for ovulation. Up to 15-20 follicles are stimulated each cycle, and the that egg matures first will be the “chosen one” that gets to be ovulated.

Fertility issues with PCOS arise because dysregulations in FSH/LH means there is no egg readied and ovulated, so fertilization and conception cannot occur. High estrogen/progesterone ratio adds to the oligo-ovulation issue and infertility. Progesterone is often low in women who have PCOS because progesterone is only made with ovulation OR if a woman falls pregnant. Sometimes bio-identical progesterone can be very useful in PCOS women, but it needs to be taken under the care of a qualified practioner. Progesterone is not a fit for all women with PCOS.

Treatment for increasing fertility in PCOS women usually starts with treating the reason behind the woman isn’t ovulating regularly each month. Here I love to use menstrual cycle symptom tracking along with basal body temperature tracking to assess if a woman is beginning to ovulate consistently, and later when to time intercourse so fertilization can occur and a baby can be made!

Vitex, beta-carotene, B-vitamins, zinc, and seed cycling can be very beneficial for a woman who is trying to acheive regular cycles for pregnancy or general health. Vitex is an herb that is used in a low dose (around 200 mg), taken each morning, and can improve ovulation. Vitex should not be taken long term, and I do not use it in my patients for over 6 months at one time.

Other treatments that can be helpful for women with PCOS are eliminating food allergies and sensitivities, especially dairy. Other inflammatory foods are often removed, like gluten and soy, with much benefit, though that effect differs on the person. I will often recommend liver support as well to help lessen the burden on the liver that comes from the need to detox excess hormones from the system.

The last type of PCOS that I will mention, that I see commonly in my patients (though I don’t usually call it PCOS – I call it ovarian dysfunction instead) is irregular and anovulatory cycles after stopping the birth-control pill. This is so common, I see it almost weekly. The reason why it can take time for cycles to restablish after coming off the pill is because the synthetic hormones in the pill block the brains stimulating signals to the ovaries to get them to produce hormones. So it’s like your ovaries and your brain need to learn how to communicate again, and your ovaries need time to “relearn” how to establish a menstrual cycle rhythm again.

Treatment of post-pill PCOS includes a variety of approaches I already discussed above.

PCOS is not a life-long sentence. I hope you were able to clearly see how the biochemistry of PCOS is KNOWN – so we can do something about it. You don’t have to suffer – you can regulate your cyle and become pregnant naturally with a natural medicine approach!

For more explanation on this topic – see my video on my YouTube channel here.

A few weeks ago I released a video where I spoke about a follower’s question “how do we make healthy choices daily, weekly, monthly? how do we prioritize certain exercise or nutrition goals plus life goals? what does a weekly wellness template look like?”

Well this is the answer. I’ve created a downloadable resource for you to print and fill in with your weekly goals. We are more likely to stick to habits when we track them, and especially seeing a visual representation can be very powerful!

Examples of items to include:

Vegetable intake, protein intake, supplements, walks, lifting weights, reading, meditation, language learning, gym time, research, hobbies like gardening, cooking… The possibilities are endless. Design it however you’d like to track habits / increase personal responsibility 😉

The first week I did this exercise I tracked the use of my WaterPik (a home-use dental water-flosser), if I went on a walk that day, if I had a smoothie or taken my fish oil, if I had a generous serving of greens that day, my water intake, if I had posted an IG post, if I took out my contact lens by 6 pm, and if I had read through any of my reading pile!

Click the link above to download. If this resource has been helpful for you – share with your friends!

During this series we’ve been talking about the hormonal effects of weight loss, but that’s just ONE piece of the picture…

Weight loss is physical issue but there’s a huge emotional side to weight loss also. This series is specifically geared to people who need to LOSE BIG – as in 20 to 50 or more pounds. But todays article is more for someone losing weight of any amount, big or small.

I wanted to discuss weight and food/body issues, because body size is a highly emotional topic, because what we believe about our bodies usually is tied to many deep things, like what our parents taught us about our bodies, what we were modeled as a child, what information we took in that came from society, etc.

It all adds up to a lot of emotional bagage in our head.

AND I BELIEVE, THAT IF YOU DON’T FIX YOUR MENTAL WORLD, YOU CANNOT FIX YOUR PHYSICAL WORLD!

Now this is a bold statement, however, I see this every week when meeting with my patients.

So often we want to make weight loss totally separate from our other physical goals! But especially with weight loss, we CANNOT DO THIS. Never have I talked to a patient about weight loss and NOT addressed some part of their mental world.

I see this in men who are entreprenuers and building companies. I see this in young women who are “battling” their weight. I see this in middle aged women and moms who have been overweight for a long time.

So let’s get into this… First I want to tell my story. I am passionate about this because of my own journey!

As a teenager I was overweight, and it was very soul crushing. I was learning so much about the world during this time, and everything society was telling me was that you had to be skinny to be “worthy” and loved. At the time I was not eating well, and I didn’t have an exercise routine. My mom had been making our diets more nutritious, but I wasn’t on board.

I finally decided that enough was enough… and I started running and lifting weights daily after school, and watching my diet. I did south beach diet for a while, and I learned a lot about insulin and carbs. I also saw a naturopathic doctor who helped me discover my Celiac disease / gluten intolerance, and helped educate me on healthy foods.

I lost a lot of weight healthfully.

But then I went to college, didn’t know how to safely eat in my schools cafeteria, dabbled in Veganism, started overtraining, and I lost the freshman 15 that I had never gained. PLUSSS some. Sophmore year of college I was 126 lbs, highly active, and working towards my Human Biology degree. I thought I looked great. I was in a size 2. I felt strong. But looking back I realized so many things.

My body was screaming to be fed. I was undereating calorically and macronutrient wise, but I was still eating a lot of food (super low calorie vegetables and proteins). My diet was pretty low-fat. I lost a lot of hair. I wasn’t sexually active, but I had zero libido (I probably didn’t even know what that was at the time), and I had extreme vaginal dryness.

LONG LONG LONG story shortened… I woke up and healed, but it didn’t come until I took an intuitive eating class in medical school as an elective. Most of the schools nutrition students were required to take this course. I was recommended the course by a friend and decided to take it (why not? I said).

The course CHANGED my life.

I remember sitting in front of the professor, who casually walked into the room with a cookie from the cafeteria, and she BEAMED. And she spoke so casually and positively about the cookie and how much she loved cookies and how excited she was for the cookie. My jaw must have been on the floor because I literally had ZERO idea that I could have this type of relationship with food. I realized that yes, I had lost the weight and become healthy. But in medicial school my weight was creeping up, I had moved to the dark and rainy NW, and I had left sunny California, so all my routines were totally changed.

I knew I could NOT “see” food the way I did for the rest of my life. I knew I needed change.

I ended up going to therapy… one of my therapists was a marriage and family therapist. Together we discussed a lot of parent-child relationship dynamics from my childhood. The other was specifically focused on food/body issues. Without both of them, I WOULD NOT be where I am today.

I am not 126 pounds anymore, thank goodness, but I am a healthy weight, I don’t “WATCH” everything I eat, and I experience food freedom daily. I eat a whole-foods well rounded diet, and I don’t overtrain anymore.

So now you know why I am so passionate about this topic — the thing I want you to take away from this video is that YOU HAVE TO ADDRESS YOUR INNER WORLD TO LOSE WEIGHT AND KEEP IT OFF LONGTERM.

How do we address the inner world? First steps is I like to ask people a few questions, since many people will say they need to lose 5-10 to more pounds

1. Why do you want to lose weight?
2. Have you been at this weight for your whole life?
3. Have you yo-yoed a lot?
4. Any history of disordered eating or eating disorders? If so, what kind?
5. Do you have a past history of dieting?
6. What’s your internal dialogue like when it comes to your body?
7. … when it comes to food?
8. What is your relationship with food like?
9. Any past history of trauma? ANY KIND

and with these… we begin to piece together your story. These questions help me figure out what to do next.

For instance, some have a healthy relationship with food and body, but some health problems caused the weight gain, so we proceed treating those. Some have very poor relationship with food and body, that they didn’t even realize so we refer out to a counselor for therapy. Some people have a huge history of trauma that they have no idea is related to their weight loss issues or their being overweight.

OBESITY IS NOT JUST PHYSICAL, IT IS A MENTAL DISORDER.

Bold statement, but I see it in my patients, this is especially true for the morbidly obese.

Many self worth or mental issues can be BURIED under years of coping mechanisms, so it doesn’t always come out immediately. So if I am referring out… I usually recommend a combo of therapies depending what the person has tried.

1. eating disorder savvy nutrition savvy therapist
2. marriage/family therapist
3. body positive health coach
4. talk therapy, CBT, or EMDR

And to wrap things up, this discussion comes with a few caveats…

We are all incredibly special and capable because we are humans, and I believe we were all created with a purpose, but I also refuse to subscribe that being overweight is healthy. I see this often become mixed up in todays culture… We are moving away from shaming “fat” people to embracing obesity and calling obese people “beautiful” AND completely ignoring their health condition, because we are trying to make everyone feel included.

Inclusivity can be a great thing, but I think with body weight, it has the potential to really go south.

I don’t believe you can have “health at every size.”

I believe people are in different spots and EVERYONE IS DIFFERENT.

I am mostly speaking to overweight people who don’t acknowledge their excess body fat is an issue or people who use health at every size to justify being over weight – I HAVE SEEN this.

Not everyone is going to be in an ok place to be making body changes, so don’t take this the wrong way. Not everyone is in a space to lose weight. I wish America as a country would own that we have an obesity problem and now we are glorifying it as a society. I don’t believe in health at every size because some of those people, if you ran their blood work, would look like a physiological mess. Fat is an endocrine organ. Fat is inflammatory. Inflammation leads to disease and chronic illness. This has been well established in all the medical literature.

So how do you determine a healthy body weight for you?

1. Hunger / energy / cravings / sleep / mood has to be in check, balanced, and functioning smoothly
2. Weight has to be within the BMI scale
3. Body composition matters more – get your body fat tested, I like water testing
4. A weight you can easily maintain with a diet that’s based in whole foods and is sustainable each day that includes healthy fats, all varieties of vegetables, and healthy proteins
5. A weight where your labs look good – HBA1C, glucose, insulin, cholesterol, hormones, chemistries, etc.

For more explanation on any of the topics discussed above – find this video on my YouTube!