Busting Myths About Sex & Reproductive Health w/ Dr. Jolene Brighten

24:57Even if you can't see the sun, trust me, every dermatologist is telling you to put on sunscreen because the UV rays still get through. That's going to help degrade melatonin and support you in spiking your cortisol first thing in the morning as you should. Now, as cortisol goes through the day with you, it's going to decline and it should be at the lowest in the evening. However, in some people, what we'll see is that instead maybe they're spiking at 10 a.m. and they're having tremendous anxiety at work. And it's correlating to that really stressful drive they took, going in, having a meeting every Monday morning.

25:28We're seeing this pattern of stress that's causing a spike in cortisol, and then they later plummet. In other people, and what some people will call adrenal fatigue, it's a common thing for people to say. And I don't ever like to finger wag at like layperson terms. But your adrenals are not tired. What is actually happening is we have HPA dysregulation. So the H and the P are in the brain and the A is the adrenal glands. So it's the way the brain and the adrenal glands are talking. And with that, sometimes what we can see is what I call a reverse cortisol curve. And this is really common in parents whose infants have literally trained them to stay up.

26:07People are like, I will sleep train my baby. I'm like, watch them sleep train you, friend. So instead of spiking in the morning, they're spiking in the evening. And so they're wired and tired. They're so fatigued. Their body's tired. But their brain just can't stop. They wake in the morning. They have headaches. They're feeling so tired. They're the people that are like, they have the coffee bugs. It's like, don't talk to me until coffee. You know, all of those. Anytime I see that, I'm like, check your adrenals, friend. Check your adrenals. So that's some of the things that we can see going on.

26:40What can you do for your adrenals if they are not functioning correctly? Yeah. So we always want to know why, like what's going on. So there is the more extreme case of Addison's disease. So when people say adrenal fatigue, I'm like, that's adrenal fatigue. Because in Addison's, that's an autoimmune condition. It's rare. President Kennedy actually had it. So he had that darkening of his skin. You have to be on hormone replacement therapy eventually for those adrenal glands. And you can have like Addisonian crisis. which is you're going to be hospitalized. It's life threatening. So that is more of the extreme.

27:15But for most people, it's going to be chronic stress nonstop. That can be psychological stress. It could be infections, people living in their house with mold. Like it can come up a lot of ways. And so we have to identify what the stressors are and try to mitigate those, remove them. It's not so easy. You know, I'll see colleagues who are like, you know, I tell people they need to quit their job. And I'm like, well, people need to make money. That's the society we live in. So, and to me, it's like, there is, there are situations where we have tremendous stress that is relentless that we do need to get out of.

27:47But a lot of the times it's how people are managing their stress. So what's interesting is that we look at things like mind body medicines, doing meditation, deep breathing, going for walks, all these things that, you know, Those people were sometimes like, oh, you know, whatever, that mamzy pamzy stuff. Not only is it so good for your stress, it builds resiliency. It actually makes you stronger in the face of stress and able to recover faster. And we also know that not only is it associated with lower depression, anxiety, but also like hot flashes, night sweats, things that happen in menopause.

28:25These mind-body practices can have a tremendous benefit. So there's the mind-body. There's how we manage our stress. But there's also our nutrition. And, you know, I'm a nutrition scientist, so I'm always about like, how do we eat in a way to optimize? Our adrenal glands are one of the most concentrated tissues with vitamin C in our body. So they need a lot of vitamin C. And so with that, you can be eating things like bell peppers. Usually people go to citrus fruit. I'm a big fan of like start the morning with like some lemon juice and some salt in it. So you're getting electrolytes. Electrolyte balance in the body is really important for adrenal health as well.

29:02So you're just enhancing your vitamin C. But bell peppers are actually an excellent source, peppers in general. Eat Mexican food, everybody. Get your peppers. So getting vitamin C, vitamin B5, mushrooms, shiitake mushrooms are actually an excellent source of that. And looking at how can you manage your blood sugar throughout the day, not from the like how am I managing my insulin and getting like super myopic on it, But instead, looking at like, how am I starting my day? Most people are going to do best to have high protein in the morning and bring in fiber as well. So for men, we want to get about 30 grams of fiber a day.

29:42And women, about 25 grams of fiber a day. And for most people, we're going to want to hit at least 30 grams, like 25, 30 grams of protein in the morning. More if you're lifting weights. More if you have a larger body. And the reason for that is because we used to do this calculation of like you need 0.8 grams per kilogram of body weight of protein. That is too low. And we've known it's too low for a very long time. Most people are getting so much less than that too. I know. And you'll hear a lot of people argue like, oh, we don't need that much protein. And I'm like, you know, my back when I was doing nutrition research, it was on sarcopenic obesity, which is the loss of muscle mass, the infiltration of fat and the risk of cardiometabolic events of, you know, diabetes, of having a heart attack, having strokes like all of this goes up.

30:35having a fall and breaking your bones, like losing your ability to walk on your own in life, like this all goes up. And so if people are like, well, you know, what does that look like? I say, you know, think about the round M &M, the round M &M guy, you have skinny arms and skinny legs and this big round body. And what's happening is we're getting fat infiltration around the organs. So visceral adiposity, that is the worst. We don't want it. I'm always like, Look, you got a booty and thighs. I don't care. Keep your fat there. It's around your organs. We've got a problem. Okay. So good.

31:13Speaking of that, progesterone. So everyone talks about testosterone and estrogen nowadays, which we will address it in a second. But this is one of those that you write a lot about and talk a lot about, too, that I never hear about, to be honest with you. So address that topic for a second because I think this is one of these things. People listen to a lot of podcasts. They may hear something. I don't think they probably heard this way before. Yeah. Well, let's live up to that. Okay. So the only way to progesterone is via ovulation. And so the ovaries make progesterone via a temporary endocrine structure known as the corpus luteum.

31:50So once an egg gets released, there is a little structure left behind that produces progesterone. So if you're not ovulating regularly, like perimenopause, PCOS, which is polycystic ovarian syndrome, or for another reason, you're not making progesterone regularly. Now, progesterone becomes the main hormone of your luteal phase. So in the menstrual cycle, we start our period. That kicks off the follicular phase, and estrogen is in charge. Estrogen is going to rise. Along with testosterone, they're going to spike around ovulation. This is why you're going to want to have sex more. You think about sex more, estrogen, testosterone.

32:23Once you ovulate, here comes progesterone. And progesterone should take the lead over estrogen. Estrogen should still be present. But now progesterone is finishing up getting the endometrium, the lining of the uterus, ready for pregnancy, potential pregnancy. Your body's always like, let's get knocked up, whether you want to or not. But it's also really nourishing for the brain. It helps with anxiety. So we know that when progesterone is low, we can feel more anxious. That's because of how it interacts with the GABA in our brain. So the GABA receptor, that is going to dock GABA, which is a chill out neurotransmitter.

33:00So non-excitable time. And that's really lovely so that we can get good, nourishing, restorative sleep. And so progesterone's also been shown to be helpful in building the myelin sheath. Those are how nerves are conducting all the messages, how I'm talking to you right now. And it's also involved in cardiovascular health, in bone health. It does a lot in the body. I'm just sitting here listening to you thinking, what an amazing time we're in. I know, right? That we know these things about ourselves now that really most people were unaware of even 10 years ago, 15, 20 years ago. The other thing that's become more common, I told you that I'd take it, is hormone replacement therapy.

33:40I wonder, and it's okay if you don't like it, but I'm wondering how you feel about that. And is there an appropriate age, an appropriate reading level, a testosterone level drops below a certain amount? Or do you believe you can cure all of that, I guess, naturally, nutritionally? Oh, I wish. The thing about the ovaries is when they're done, they're done. And we know that also men's testosterone declines as they age as well. And what people need to understand about this is that for a long time, people have touted like it's a natural process, like you should let it happen. But we're living so much longer.

34:19Right. So it's like one thing when you went through menopause at 51, which is the average age, and then you passed away at 60-something. But now if you're living to 80-something, that's a long time to live. And when we lose these hormones, our brain becomes impacted. So we see increased risk of dementia. Our cardiovascular system gets impacted. So to your question about when do we start it, as close to menopause as possible. with perimenopause we will not necessarily start like estrogen early on it may be progesterone that we're bringing and the reason for that is because once you stop ovulating which is what's happening in perimenopause it becomes more irregular and once you're done and it's been 12 months now you're in menopause which is where everybody focuses is like let's focus on menopause this one day event yeah and then we're post menopause but i'm like there's this 10 years you know, seven to 10 years before menopause where you might be struggling.

35:15So progesterone being the first to go is one of the first things that we usually look at bringing in and then bringing in estrogen in that later phase of perimenopause before you're transitioning into menopause and then continuing it. If we do that, there's some research saying that estrogen replacement therapy is performing better than these lipid drugs in women when it comes to cardiovascular health. If we do that closer to menopause, then we are seeing benefits in terms of possibly preventing dementia. So there's a lot of benefit to bringing these in. And I think it's really important for people to understand because there's been a couple of large studies.

35:58We actually, I think we used hormone replacement therapy for almost like 60 years before they started to do, They decided to do a randomized control trial. And I know it's a long time, right? And then they did it. But, you know, there was a couple of studies and they just weren't great because one of the studies, they were basically taking, you know, more advanced age than what we would start. And who already had cardiovascular issues. And it showed that, like, yeah, they had stroke, they had heart attack because this isn't a treatment. It's a prevention. We have to come in earlier. Another study, they wanted asymptomatic women because otherwise they would know they were in the trial if they got better.

36:36They'd be like, oh, I'm definitely getting the real thing. No placebo here. So, you know, this is not who we typically use it with. There's usually symptoms and that's why we start using it and looking into it. The other thing is that they had smokers in the group and other people in the group who already were at higher risk. But the problem with these studies is that the women were beyond where we would start somebody on hormone replacement therapy. They had already been without hormones for, you know, a decade or more. And so I think it's really important to understand that a lot of recommendations have been based on research that doesn't correlate with how we actually do hormone replacement therapy.

37:14I am a fan because I would like my patients to all remember a well-lived life and not end up with dementia. To have a strong pelvic floor and urinary tract symptom to where they don't develop urinary incontinence is one of the primary reasons women go into nursing homes. To be able to not have vaginal dryness, to be able to enjoy sex. Is there a correlation? This is one of my next questions. Yeah, yeah. Is there a correlation between hormone levels and lubrication? Oh, yeah. There is. Yeah. Because I've had other people tell me they didn't think there was. So there is. Oh, yeah. That would be lovely, right, if it didn't work that way.

37:53So let me, like, back it up and say this. So there is a phenomenon known as arousal non-concordance. What that is is it doesn't matter how in the mood you are or your hormones or anything. Your genitals are not getting the memo and they're just not lubricating. Also, it depends on where you're at in your cycle. So this is how we know that it is correlated with hormones is because if you're about to ovulate, estrogen is up, you are going to notice that it's easier to self-lubricate. If you are in the later phase of your cycle, that late luteal phase and progesterone is up, it's going to be more difficult to self-lubricate.

38:27But at no point is lube ever a bad idea. I actually say in the book that a lube-free bedroom is a place where good sex goes to die. Yeah, you do say that. Yeah. So with that, we also know that's one of the signs and symptoms of being postmenopausal and having low estrogen is the vaginal dryness. So and we're not talking just like, oh, I have difficulty self-lubricating with sex. We're talking about things can get so dry that wiping with tissue paper, you can just go to the bathroom and you bleed or that it's dry and the tissue sticking together. I've had patients that are like, it feels like I'm walking their sandpaper in my vagina.

39:02It's a horrible feeling. But the other thing about estrogen that often goes overlooked is that estrogen helps with the cells creating glycogen, which is a sugar that feeds the lactobacilli species. They're who keep the pH down so that we do not get infections as regularly. And so it's also really important for vaginal ecology. Okay. Really good. So, by the way, in a minute, I'm going to ask a question for someone younger. So stick with me. But one thing, and I'm not a doctor, obviously, listening to you talk, I proved I should have never gone to medical school. But I'm 52. And at my age, when I meet people near my age, 10 years younger, 10 years older, I can almost immediately tell whether they're on hormone replacement therapy.

39:49And I feel this, and I mean this the right way. I almost feel some form of sadness for those that have not at least investigated and pursued it because I'm like you're aging right before my eyes to an extent that maybe isn't necessary. Yeah. And I have friends of mine that are in their 70s that when I take a just visually look at them or their vitality or their strength or how active I know they are sexually and physically compared to other friends of mine that are even 10 years younger. Yeah. But from a hormonal perspective, the 60 year old is much older than the 70 year old. And I'm thinking that this stuff isn't even very expensive.

40:26Some of it. And by the way, I'm not carte blanche recommending it. For example, my testosterone impacts negatively my HDL, which is already genetically very low. So I have to be careful. There's no across the board recommendations here. Like you got to know what it's doing to your body and get your labs drawn regularly. But one thing that's a remarkable to me is you take my audience. That's all these folks that are really trying to live a better life. They're working on their minds. They're working on their fitness and their body. They eat clean, yet they almost never get their labs done. Yeah.

40:53They never look at their body and their blood. I'm such a data junkie. I'm always tracking. I know you are. I just went and got my full MRI body scan this morning with Pronovo. You did. You did it. I do one once a year as myself. Oh, that's amazing. And Peter Diamandis was sitting here four hours ago doing a conversation. We were talking about that very thing. Yeah. Now, some of these things I feel sometimes frustrated to discuss because some of them are more expensive and some folks listening can't afford it. But a lot of these things like getting your blood drawn, usually if you have insurance even, that's going to be covered.

41:22And so just this is how you'll know. You can't tell from the outside of your body, getting these things looked at. Let's talk about something for someone a little bit younger. And it's the topic that you talk a lot about on your social media, which by the way, you should be following her there too. But also I want to know the impact of taking the pill if you're a woman. What's your overall belief about taking the pill? What should somebody know, A, about taking it and when they're on it, what's happening in their body, and what potentially happens when you get off of the pill and that impact. Okay.

41:51This is a big question. So if I miss any of it, you just let me know. All right. I wrote a whole book on the topic. So firstly, I want to say that the pill has a necessary place in women's health. And I think there's a lot of people who are like, it's just a pregnancy prevention drug. And then they think like, oh, you could just do all these other methods. And the reality is, is that there is no one size fits all for contraceptives or for pregnancy prevention. We have to counsel the patient. Same as like hormone replacement therapy, although this is not the same because hormone replacement therapy has more benefits than necessarily the pill does for some people.

42:31So it just depends. Right. So the first thing I'll say is that we do need access to the pill, IUDs, the whole works. Barriers, yes, especially if you're in a monogamous relationship, barriers should be on point. But the pill has utility in terms of somebody, as you were just saying, like not everybody can afford screening labs. Not everybody can afford the treatments available. It's unfortunate. I really wish that we lived in a society that gave everybody access. It's so frustrating to me that one topic, not to interrupt you, but the disparity in health care between those that can afford it and those that can't.

43:06It is it is the great secret gap in our country, not just the wealth gap. It's the health treatment, health prevention, help welfare gap. It's something that I'm going to be on a major crusade about the next 10 years of my life because it's not fair that somebody with a little bit more means can get full body MRIs in their labs done and afford hormone replacement therapy and talk to somebody. That's why podcasts are so great. I can put the world's best expert on this in front of anybody who's on any budget can listen to this right now. I didn't mean to interrupt you. No, no. You're totally fine.

43:36No, this is a conversation. That's how those go. It's totally cool. So, you know, what I was saying, though, so let's say somebody has polycystic ovarian syndrome. Now, me, in a perfect world, would prefer that we are working on diet and lifestyle and we can get everything dialed in. But maybe they don't have the budget. They don't have the means. Like, there is something that's a barrier. And they're not ovulating regularly. They're going to be at risk of endometrial hyperplasia if they're not getting their period. That is where the lining of the uterus builds up. And after years of that, they're going to be at risk of endometrial cancer.

44:10So I can prevent cancer in someone by giving them the pill until maybe their life situation changes or they can adopt a lifestyle that would help them. With PCOS, by the way, for everyone listening, the new recommendations just came out. The international recommendations say that everybody should have lifestyle and nutrition as first-line therapies. It should be part of the conversation. So it is important. It does have utility. But not everyone can do that. Not everybody lives in a safe environment. So I did two years of clinical rotations in a homeless youth shelter. These are women who don't have doors to lock.

44:49These are women who cannot protect themselves. And an unintended pregnancy would be detrimental to their life. And so I just say that because I am going to say some negative things about the pill because I think that we have to weigh the pros and cons for everybody. But we also have to recognize that there has been utility for the pill and that utility still exists. And while I would love us not to just treat symptoms without looking into it, not everybody can look into why we have symptoms. So that's the first thing I'd say to know about the pill. So if you have irregular periods, if you are finding you have painful periods, if you have acne, if you have symptoms that your doctor throws into the bucket of lady part problems and the first thing they pass you is the pill, pause.

45:36Because that's going to mask whatever is going on. We can't test your hormones at that point. We can't – you know, there's things that we can't do to work you up to understand what was actually the cause here. And why that's problematic is because we already have conditions like endometriosis and PCOS. that are underdiagnosed, that leave women to suffer, that have consequences like infertility that they don't even know about because they're just past the pill or they're ignored by health care. So that is one piece. The other piece is to know that just because your doctor may tell you like, oh, the side effects are so minimal.

46:09Don't worry about it. They don't discuss you with it or they dismiss you that whatever you're experiencing is true. And that I think is the biggest problem. Women are past the pill and then they're gaslit about their experience. What do you mean by that? So you go on the pill. You find that maybe you are part of that population that has adverse mood effects. Yeah. And you're told, oh, no, it couldn't be the pill. It's just you. Your life changed. Like you have a chemical imbalance. Yeah, you introduced chemicals in my system. Right. And then I became depressed. And so it can be something like that with mood.

46:46Noticing weight gain. So from the studies, we're like, it doesn't really cause weight gain when you look at the average. You're not always going to be the average. We expect in statistics that when we have a bell curve, there will be these outliers. We expect that. And yet when doctors prescribe treatments or, you know, especially in the case of like the pill, they're so quick to be like, no, the research doesn't show it. Therefore, what you're feeling and experiencing is not true. And this is why I tell people, if you're going to start the pill, write down your data. What's your mood like? Just go through everything.

47:23And then you can track it. Because a doctor will always successfully gaslight you if you do not have things written down and you do not have that right in front of you. Because, and I shouldn't say always. Some of you will be very good at this. But what I say is that when you write down your data, your doctor starts to gaslight you about things. I'm like, this is for my Star Wars fans out there. You literally look at it and you Obi-Wan Kenobi. You're like, these are not the droids you seek. Like you are not going to basically mess with my mind right now because a lot of times doctors will be like, you're misremembering.

47:54No, no other woman has this. I've never had a patient experience. You start to doubt yourself. So track your data so you can know what is true for you and what's not true for you. Okay. I'm really glad you talk about this because, again, I want to categorize myself clearly again. I'm a layman. But I have a daughter, and we don't give millions of young men a chemical in their body when they turn 16 or 18 or 19 or 20 years old. But let's just be real. There are millions and millions of young girls in the world today that are prescribed that pill so their parents can sleep better at night. and there's also been a mental health crisis amongst our young people for a very long time and I have to wonder whether in some cases there's correlation there and if you have a young daughter or if you're a woman in general this is a place to at least evaluate whether or not it's making an impact on you because I can tell you in my sense if it was reversed and we had millions of young men that were being prescribed medication young in their life and by the way as you've said plenty of reasons to be prescribed, may be okay for most people, but it's not even one of the places that we're looking to see if it's affecting brain fog, mental health issues, weight gain.

49:13Could the weight gain be connected to the mental health issues? All these things in general. So I'm so glad that you discussed this and everybody listening to this, that if you are a young person or you have a daughter, this is something to at least evaluate and to wonder. And you're right. I have had friends all of my life say, I felt different when I took it. The doctor told me that's not reported. The doctor told me that that's not one of the causes. And so you are introducing a chemical to your body. It's going to do something somewhere somehow. Right. So. Well, I have to share with you that.

49:43So for IVF and people, this is on my YouTube. If you're like, have more questions about all the details. I put it in. I share about my life. But I needed to start the pill and only be on it for 10 days because there was a whole timing issue of like, you know, when you're going to Europe and this and that. And like life was just crazy. And so I had to be on it only 10 days. Only a few days in, my mood tanked and was bad. And not only was I feeling ragey, but I was like crying and feeling depressed. And I started to gaslight myself like, this can't happen this quickly. No, there's no way. Like, it's because you wrote a book about it and you're just like tricking yourself.

50:20And my husband's like, dude, you have to get off that pill. Like, you are not yourself. And I'm like, okay, it's not just me. and I bring that up because that was a short period of time I also started to break out with cystic acne and you were looking at me now everybody my skin is clear and this is something that my doctors also were like when I had come off the pill I got cystic acne I started having issues they were like no it's not the pill it can't be the pill I'm like no but like that's the thing that changed so when it comes to teens I am like right there with you like that is such Like I have boys right now.

50:59I also, you know, if they end up in a heterosexual relationship, I don't want anybody's life being hijacked by an unplanned pregnancy as a teen. And for everybody who's like abstinence only, read the book. I talk about the research and what Amsterdam and Germany have done differently and how they have such vastly better outcomes. So but I digress. OK, so let me go back to teens. They are at higher risk for not only depression, but also suicide. So that makes you be like, oh, my God, maybe I shouldn't they shouldn't take the pill. You can change formulations and that can change people night and day.

51:37So this is important to understand is that just because one pill doesn't work for you doesn't mean another pill won't. And what I tell parents and what I tell patients is monitor. With teens, it's hard. They don't always want to talk to their parents. So their bestie needs to be dialed in. I start dodging your texts. I'm not interested in the things I used to. I'm not showing up to like my dance practice, gymnastics, the golf. I don't know. Whatever you loved. These things start to change. Hey, can you let me know or let my parents know or what is the procedure to make sure that we get help? I love this.

52:10I want to stand just for one more second. I want to ask you about the pineal gland because I am fascinated with it overall for a lot of reasons that aren't even just physical but metaphysical even. But – and again, this is just me. I'm not an alarmist or anything like that. And again, I just want to say this. I've had enough friends have young daughters that some of their acting out, whether I'll give you, I'll just say it. Yeah. They got on the pill. And prior to that, they weren't partying real hard. They weren't. They weren't. Yeah. They weren't doing what they were before. Now, as part of it, just it's the age and the pill correlated with that age.

52:47And that's a rebellious age. But or is there more self-medicating going on? Is there some more anxiety, angst, wound up, whatever it is that I think you just really need to watch your young people and your young girls if they've been prescribed a pill to not just their attitudes, but some of their behaviors and watch a little bit more closely. I just had a daughter get out of those adolescent years and now she's a sophomore in college. And so I had a lot of young girls running around my house for a long time. and it's just interesting that during those years when this stuff starts with some of them some of the other stuff started as well now you might say take the pill out of the equation guess what dummy that's when kids start getting into alcohol and drinking i get all that but i also it's been fascinating to me in conversations with friends of mine how correlated some of those behavior changes were yeah so i want to make sure that it's just we need to make sure that we're we're, you know, doing everything we can for the young ladies in our lives.

53:47Well, to that point, there are so many confounding variables, right? This is why we can't say the pill causes depression. Because there's so much going on. We can say there's a correlation. And what we do understand, there has been some research showing that we are more prone to engage in risk-taking behavior when we're on the pill. That some of us can have basically a blunted cortisol response in the brain in the way that people with PTSD came back from war can so that you don't respond in the same way. There's a PhD researcher, Dr. Sarah Hill. She wrote a book called This Is Your Brain on Birth Control and it is all about just the brain aspect.

54:27It was crazy. Her and I were writing our books at the same time and mine came out at the beginning of 2019. Hers came out at the end of 2019. But when we got copies and read each other, we were like, we were finding the same stuff Like in the research and coming to the same conclusions. But yeah, she talks a lot too about how she came off the pill and she felt like, you know, she didn't know who she was on the pill. Like she was a different person off of it. There's a lot of women who say that. And there's a lot of doctors who are like, no, that's just not true. That doesn't affect you. Well, how do we know unless we listen to women who tell their stories?

55:03We can't just always look at only the research and expect that like that's going to give us every bit of information. It's almost like clinical experience has gone out the window and listening to your patients is like just, you know, this thing that we don't do because either they fit into the box or they're wrong. Yeah. Well, the other thing, too, is like attitudes and emotions are a very difficult thing to monitor and understand in any kind of data or any kind of study. It's just difficult to know that. It's not something we just take a lab test for and we have data for. Yeah. But I've just heard this enough that you're the first person to ever talk about it that I'm familiar with.

55:40By the way, I'm just really grateful that today's so good and so different and that you flew from Mexico to do it. But before you go, we should talk about glands a little bit, too. So I mentioned earlier the pineal gland. So what should we know about that? The pineal gland has something to do with like melatonin and your circadian rhythm and what else and why does it matter? So we talked. You guys got to rewind it. Go back. We talked about cortisol rising. And I said expose yourself to light. So that light is going to pass through your eyes. It's going to affect the pineal gland. That's going to help.

56:10We're going to degrade and break down melatonin. And we're going to say it's time for cortisol to come up. In the evening, it's opposite. You need melatonin to rise for cortisol to come down. So if you are struggling with uraterinals, you have to sleep in a completely dark room. Get the temperature down. And that means sometimes you have to get an eye mask. But the other thing is that, you know, people are always like, avoid your electronics before bed. That would be great. I have enough people with ADHD that are like, I have to scroll until my brain shuts up and numbs out and I fall asleep. Amber glasses, blue light blocking glasses, put on, you know, get an app or change your screen so that it's filtering that blue light.

56:49Because that blue light is going to break down your melatonin. Now, in the book, I have a whole diagram about how sleep disruption affects all of our hormones, putting us at risk of infertility, inflammation, diabetes, the whole work. So people often are like, oh, well, just if I'm skipping sleep, right? Quality restorative sleep matters as well. And why, you know, there's a lot that happens during sleep. But when we talk about the hormone melatonin, it's an antioxidant. So it's protecting us against free radicals. And it's not just protecting our brain, but in women, it's also protecting our ovaries.

57:22It's protecting our hormone producing centers as well. And so that's why we want to have a good bedtime routine. I think it is one of those blessings of being a parent is that you do get into a routine. I feel like in your 20s, you're just like, I'm invisible. I'll never sleep. I'll be fine. I seriously was like, I'll stay up till midnight, settling in med school and then get up at 5 a.m. and teach a weightlifting class and do all of this stuff. And like now my 40 year old self is like, you should slap. Is it sad that one of my favorite times every single day is when I go to sleep? I love sleep.

57:56I love sleep. I love that. A lot of you are nodding right now, but you get into the bed and you're like, oh, gosh, like when I was young, I didn't give a crap about sleep. I'm like, I can't wait to do this. I don't know what that says about my in the middle of the day awake life, but I can't wait for sleep. Well, I think it's like part of it, too, is that you intuitively know like this is when your brain detoxes. This is when the cleanup happens. You have really essential hormones that are rising. So around 10 p.m., we're going to see like growth hormone rises. And so you have to be asleep to be getting the benefit of all of these hormones and the whole mechanisms that consolidate memory.

58:37I think that's true. I also think like it's the time of day where I'm guaranteed to be disconnected. I'm not texting or emailing or having to talk to anybody during that time. Okay, if you stuck around to the end, I get to ask one of the most important questions at the end. Because you talk a lot about this and a lot about it lately, too. So the last thing I want to ask you about is our thyroids. Because it's like a lot lately I hear you talking about this and the book. But this is something that it's kind of like when you say, they've got a thyroid issue. Like the only time you ever hear is if someone's gained a significant amount of weight and they go, oh, it's the thyroid thing.

59:08But this is really critical. And I get my levels monitored and I'm on some medication for it myself. But talk about the. I said twinning. Me too. Good, good, good, good. So talk about the thyroid. Let's just address that before we go. It's important. It is super important. And I've been talking about it for a very long time. So it's a butterfly shaped gland. It sits at the front of your neck. And the thyroid is going to affect every single system in your body. So thyroid hormone, specifically T3, which is the active thyroid hormone. There's a receptor in every cell in your body for it. That's how crucial it is.

59:42And that is why it's sometimes hard to get diagnosed because maybe you're presenting with brain fog. Maybe it's constipation, dry skin, hair loss. Lateral third of your eyebrows is starting to disappear. Or maybe it's subtle, like you have heartburn and joint pain and your voice is kind of gravelly and deepening. These can be signs that your thyroid is too low. So it's not always just energy alone. It's not just being cold and it's not just the weight gain. It's literally any cell in your body means any system in your body can start to present. So the most common we see is hypothyroidism. And within the United States, the most common reason is Hashimoto's thyroiditis.

1:00:21That's an autoimmune condition. You literally kick your own ass. So your immune system. So I'm going to talk about Graves. So everybody in Hashimoto's, the antibodies dock onto the receptor. They flag the tissue for destruction. the immune system comes in and destroys it. In Graves' disease, which is much more rare, that's excess thyroid hormone. Everything's amped up, but you still feel tired sometimes, but you're anxious. You're finding that you have maybe diarrhea, you're sweating a lot, you're shaking. With that, it's an autoimmune condition where the thyroid is actually antibodies docking to it that stimulate it to produce thyroid hormone.

1:01:01So we've got these two autoimmune conditions. In a perfect system, you know, I don't know. I don't want to think we're imperfect just because we need thyroid nets, but in a perfect world, your brain, the pituitary signals TSH, that signals the thyroid. So when your doctor just measures TSH, they're just measuring the brain hormone, which is an indirect measurement of the actual hormones that the thyroid produces. It's useful, but it's not enough information. What should they measure? You want to measure TSH, free T4, that's what the thyroid produces, free T3, that is the conversion that needs to happen, primarily in peripheral tissues like the gut and the kidneys, and then looking at those antibodies.

1:01:42If you've never had a TPO and thyroid globulin antibody, it's really important to have those screened because the antibodies come first when it comes to hypothyroidism, and then the thyroid disease where you need medication, that comes second. So this is what we most commonly see in the United States. People often are like, oh, just give iodine because your thyroid needs it. In developing nations, maybe that would be the solution. But I caution people with Hashimoto's because the research has shown us when there is a deficiency in selenium and we bring in thyroid, it can actually cause an autoimmune flare and you can feel a lot worse.

1:02:18And while we just talked about all the thyroid symptoms, it's important to understand that even with thyroid medication coming in, you may not still feel good. Because if the autoimmune condition is still progressing, we have to address that. You're in a highly inflamed state and your body knows that it's time to slow down and to really just get you to simmer down and go to bed so that you can heal. So we want to do thorough testing, make sure that we understand what's going on. And then, as you were saying, sometimes hormone replacement therapy is necessary. You can live without estrogen, testosterone, progesterone in menopause.

1:02:56So you can go through menopause. You can live without those. You can never live without thyroid hormone. It's absolutely essential. And that's important for people to understand because, you know, my website, drbrayton.com, I have a ton of information about best diets to be eating for thyroid, which, by the way, So everyone knows my jam is to fill you with nutrient-dense foods, not take everything away kind of approach. I'm like, what can we eat to maximize our thyroid health, our adrenal health, our immune health altogether? So looking at that piece, we want to be working on the nutrition aspect.

1:03:31But if enough tissue has been destroyed, you can't out-eat your way out of it. It's kind of like, you know, in menopause, how if your ovaries stop, I cannot help you eat anything or exercise or do anything to make them make hormones again. If you lack thyroid gland, you're going to have to have thyroid hormone replacement. Gosh. I'm just sitting here listening to you thinking in my own life how important – we talked about genders earlier. I think about how important the female doctors in my life are. So the reason I wanted you here today is I want the world to have access to you as at least their virtual mentor and doctor.

1:04:12And I wanted to put you on display to say, listen to this woman's brilliance. And you all heard it here today. Like my heart doctor is Dr. Amy Donin. My, I guess, longevity and wellness doctor is Dr. Gabrielle Lyon. I know, Gabrielle. I know you do. That's awesome. And now my go-to in everything here is you. And so I really enjoyed today. Like, I'll be honest with you, they're flashing the time up on the screen. I'm like, I thought we were like 25 minutes in and we're an hour in. You're such a treasure of information and you're such a light in the world. You do something that everybody that I love that's an expert at what they do does well.

1:04:54Let me tell you what it is. they take incredibly complicated things and they're so intelligent that they can break it down into simple easy to understand terminology so that people that aren't experts in that field can take advantage of their wisdom and their knowledge you do that that's why i wanted you by definition you do that better than anybody that i know oh thank you well it is it's rare you're every room you walk into you're the smartest person in the room but i don't know about that. I do. But, but unlike most people who are that way, you feel no need to prove it because you're really there to serve and to help and to heal people.

1:05:29And I just want to acknowledge you for that. I think you're remarkable. Oh, well, thank you so much. I truly do. Really appreciate that. Like you are definitely trying to get me to come back. Oh, no, no. You're coming back. I got to feel like there's another book here soon. So I hope that I hope that you definitely come back. So guys, if you have not done it yet, you can go It is this normal, judgment-free, straight talk about your body. You can follow Dr. Brighton anywhere on social media. You can go to drbrighton.com. You can follow me on social media at mylet.com. You can get my book, The Power of One More.

1:05:59Go get them together, right? If you're going to get her book, The Power of One More Book is my book. Get one more book. Oh, yeah. Besties. Besties. Get them on your shelf. I loved this today. Thank you for traveling so far. Yeah, thanks for having me. Totally worth it. Millions of people just got healthier right now today. All right, guys. God bless you. Please share the show. Max out your life. And remember, you were born to do something great with your life. Take care. This is The Ed Milad Show.