Stressed about Stress? A Lifestyle Medicine Approach to Stress Reduction with Dr. Chhaya Makhija
In this evidence-based and wisdom-filled episode, we discuss how there are many ways to use science to start to feel better and achieve better fertility outcomes. We consider the following:
awareness
choosing your A team
trusting the process
connecting with your soul and allowing for transformation
breathwork and the relaxation/parasympathetic response
objective data to show it's working (heart rate, respiratory rate, blood pressure, continuous glucose monitoring)
other lifestyle medicine tools such as nutrition, exercise, and sleep
individualized care
Guest Information:
Dr. Chhaya Makhija is a physician entrepreneur, CEO and Founder of Unified Endocrine and Diabetes Care in California. She leads the premier Direct Care Endocrine Private Practice in California that integrates Lifestyle Medicine. Dr. Makhija enjoys hiking, outdoor workouts, yoga, and leading community-based wellness sessions that uplift and educate — including laughter yoga, health screenings, and educational events that inspire whole-person healing.
As always, please keep in mind that this is my perspective and nothing in this podcast is medical advice.
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https://calendly.com/loveandsciencefertility/discovery-call
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Please don’t let infertility have the final word. We are here to take the burden from you so that you can achieve your goal of building your family with confidence and compassion. I’m rooting for you always.
In Gratitude,
Dr. Erica Bove
Transcript:
Hello, my loves, and welcome back to the Love and Science podcast. I am so excited to have an amazing guest on this evening. We are recording in the evening. Her name is Dr. Chaya Makija. She is not only a colleague, but she's also a friend. She is a phenomenal human being. Her patients have tremendous outcomes, and she's just doing such amazing work in the world.
So let me tell you a little bit about her and why I wanted to have her on this podcast. So she is triple boarded in internal medicine, endocrinology, and lifestyle medicine.
And she uses all these ninja strings in the practice that she founded herself called United Endocrine and Diabetes Care in California. She has not just one but two practice locations, both in the Bay Area in Central California.
And she also has academic affiliations as well, which I think is so amazing because she is super evidence based. She also has a podcast called Hormones and Hope.
I have been on her podcast before. We'll put the link to those that episode in the show notes. And I think what's so cool about Dr. Makija is that she really does blend science with lifestyle tools to optimize outcomes. I think we're going to get into it.
So welcome, Dr. Makija. It's so, so wonderful to have you here. Thank you for being on the podcast.
Thank you so much for the introduction. Yeah, thank you. You pronounce the name absolutely correctly. And, you know, it's unified endocrine and diabetes care.
And, oh, yes, unified. Yes, really fine. But there was a reason I was trying to look for a terminology with synchronizes with complete or whole or integrative medicine, but I needed a different word.
And that's where unified came about.
Unified, right. And I it's like my doctor handwriting because I like to write everything myself. And I mean, but I think it is. That's such a great name for your practice because you really do unify so many parts of medicine that are otherwise fragmented.
And people are like, why am I not getting better? Why is my A1C not budging? Why is my thyroid stuck? Why don't I feel better? Right. Why am I stuck?
And because of your expertise and your tools, you're able to help people budge the needle to finally make progress that they haven't in maybe decades.
So I think a lot of my patients and clients feel stuck in their journeys. Maybe it's been a journey that's lasted months to years. Many of my patients and clients have been on this journey for years.
And so I'd love us to talk about how you approach holistic health care. Right. Like you have this holistic medical practice where you talk about hormones and just like love and science. Right.
We combine the emotional aspects and the scientific foundation. Like how do you think like what made you form your own practice and how do you approach a person in front of you who maybe feel stuck in their journey, in their health care journey?
Sure. That is that is a whole lot. But I'll unify your question because it's very close to my heart and dear and dear to me.
So, you know, when we talk about holistic health, I think every one of us who's entering into medical school, that's what we aim for.
Or that's one of the purposes that we decided to become a physician, right? A healer. And we never thought of that. Oh, I'll just be taking care of the heart or just the uterus or just the brain.
It has to be everything. So that's one of my main reasons to pick internal medicine, that it's internal. Right.
And internal is also touching our soul. It's touching our mind. It's touching the body. And then comes the science, which is also about the environment and the body and endocrinology because that's the fun part of medicine, which doesn't have one organ system.
It's from top to bottom. And there are so many chemicals, neurochemicals or neuroendocrine conditions that cannot be just visible or it's a lot of blood work that needs to be done.
And it has these plethora of symptoms. And what I enjoy is the complexity of it. And how can I simplify? So that becomes holistic because simplification is not just talking to the patient or reviewing the labs or examining them, but it's digging deeper, digging deeper into that human being to get or to get or solve the jigsaw puzzle and get the answers.
So with that being, you know, with that encompassing everything, endocrinology is a study of hormones. And we all know, at least now in this era with, you know, women's health taking more of a forefront and also people recognizing that Hawaii health is important, people recognizing that why are we stressed and they're being more aware that we are stressed.
Right. And that is a lot to do with our hormones.
Our hormones are these amazing messengers that cross talk with every cell.
And when they're messengers, we really need to take care of these messengers, because what we what we feed in is also being translated as what's going to be outside.
So it could be in the form of a disease. It could be form in the symptom. It could be in the form of an abnormal lab. And that leads to a set of diseases or conditions that's taking you to a physician that's taking you to now seek medical care.
So those are, you know, reasons that I really love this profession, love this aspect of of medicine. And now we combine that into clinical care and I'll be happy to share more details if you'd like to be more specific on these endocrine conditions.
Oh my goodness. I am so excited that you said it this way. I'm a reproductive endocrinologist, as you know, and I have never quite thought of hormones as messengers. I think of a conversation, but I think about like, you know, just as like thoughts and feelings are data.
Right. I think that each hormone truly has a story to tell. Right. Like if we think about it that way, it might even the hormones might tell a story about the soul.
Right. And we need the right listener, the right interpretation to be able to decode what what is happening. And, you know, it might not even be like one clear signal it might be, you know, a conversation that needs to be unpacked.
But I think if we look at the hormones as messengers, that's when we can start to understand what's going on and listen, and then have the space to take action.
That's so beautiful. Yeah. So, so I you know I'd love to get your perspective on stress and I think we started to talk about that a little bit like, why are we so stressed all the time, we know when we have chronic medical conditions, you know, infertility is one of them and recurrent loss like, like, what is it in our bodies internally that is going on that makes the physiology so altered.
Yes. So, stress, you know, I'll just say that I'm 45. And when I was in medical school, this was in India.
We never talked about stress. We, you know, if there were both exams, or if we had, you know, an event or you're standing up and speaking, or there was an debate going on.
And it has to be public speaking. We never ever even thought or the word never occurred to us that we are stressed. It's just that oh I have this I'm nervous or how am I going to perform and you put in the work and you go right.
So there is a lot that we've learned over time and we recognize because of the advancement in science and also the medicine or the clinical terminologies getting out in the public, right, or being available to all of us.
So stress if you read medical textbooks was first defined as a flight and fight response right or bear attacks you, you take protection, and you only need cortisol and adrenaline.
Those are the main hormones which help you with fight and flight response.
You don't need reproductive hormones and similarly reproductive hormones are not necessary for survival. I'm just talking about survival.
When they're not necessary, what happens is when we that bear attack is happening, our frontal brain is more active, as well as the adrenaline cortisol because we need those two hormones to take action.
Now, imagine in today's era 21st century.
We are up in the morning worried about how my day is going to go I have meetings I have deadlines I need to drive I'm commuting for 30 minutes let me just have my breakfast in the car oh I don't have breakfast let me just grab some coffee.
Oh the Starbucks line is too long. What do I do. Right. So there is a lot of fight and flight response or events happening literally every minute.
And that's not just for one day, it's happening consistently. And then when we are sitting with ourselves, right, what are we thinking.
Are we more into that negative notion very anxiety aspect of our lives of the future or, you know, worrying about what happened in the past, versus, are we still living in the present, we are more mindful of what we are doing what we're eating, as well as taking care of ourselves, you know, self care. Are we spending time in our relationships. Are we there to listen.
Right, not just express but are we there to to be available to our, to our family to our friends. So we've lost that time.
So the chronic stress is consistent, and you know when we talk about chronic stress it is cortisol and adrenaline and it's not necessarily just a cortisol.
So imagine if we are exposed to every minute of fight and flight response.
Every day, ongoing for months and years that is I'm getting attacked by a bear literally every moment, either a finduced, or it is through the environment.
What is going to happen to my reproductive hormones.
You know we all can answer that individually and I'm not saying that they are completely get suppressed, but there'll be alterations, there will be more chaos.
There'll be chances that you know the ovulation gets affected rather than just the menstrual cycles.
We have a very common terminology called female athlete triad.
It's a stressor because that female is not getting adequate calories early these daily events, if we are not appropriately learning how to respond.
That is going to create a long term changes and how our hypothalamic pituitary ovarian axis or hypothalamic pituitary and gonadol that's testosterone axis is responding.
It's hard because it's hard to measure. It's very subtle and I think we all know when we feel under stress and there's this concept of you stress that not enough stress is not good too much stress is bad.
But I think most of my listeners are female physicians and at the, you know, know, very least like female professionals you know like everyone is like rocking it out in their careers CEO is attorneys positions like, you know, many people have high power jobs which are stressful and then throwing on top of that the fertility journey where there's this constant like am I giving myself the right meds today am I showing up at my fertility clinic I mean a lot of these treatments are coming every other day.
You know, without sometimes even with only 24 hours of notice when the next appointments going to be. And a lot of my patients and clients are like, no, living in regret like did I make the right decisions in the past like that cycle didn't work out if I had only that x y z or, you know, also thinking about the future and like what if this next transfer doesn't work and I only have two more embryos and like what if I have to do another retrieval and it's you know I think this sort of bear analogy is so apropos because it's like well what if I cannot achieve my goal of being a mother, like, you know, I share this this is the last puzzle piece I met the love of my life I, you know, have the career all the things like, you know, this this this child, this gentle child, it but if it doesn't happen.
You know, I'm going to be missing this piece like forever and I think that threat of childlessness or that threat of not building the family. It feels so intense that it would be really interesting you know we have all these monitors right that we wear or rings and such like be super interesting to just understand the profile of those two hormones that you, you mentioned on the day to day, like moment to moment, because my senses that people's, you know, nervous systems, you know, access the stress hormone access is just very it's just very amped up all the time. It is yeah. So in clinical world, you know, I get a lot of referrals, either it'll be curbside consoles from physicians or actual referrals patients see me for mild elevation and cortisol levels, and specifically I run at 8am they're fasting and they're fairly having a decent sleep cycle. And you know usually the threshold is anything depending on the lab, 20 or 22 micrograms per deciliter for cortisol like the higher level, and most of them are running close to 30s.
Yes, and you know when I get to know about their life cycle, you know, many of them are more of like a type A personality in that category like the go go go but very high achievers but there's this constant worry, or the constant thoughts, which are lingering around through the day. And they are getting all the work up they don't have Cushing's disease they don't have Cushing syndrome, they are not over producing cortisol pathologically.
But I see this very commonly so yes if everyone starts getting these levels done, I wouldn't be surprised that many of us have this higher threshold. Now, what would be interesting is to look at, you know, during the day, and figure out.
But even if we don't have that tool right now, right, we have so much obvious evidence, because endocrinology is also your symptom endocrinology is also knowing what's happening in your life.
And there are so many diagnoses that we could make with that clinical discussion, and then labs are more as an adjunct or support to rule out certain conditions that are, you know, more grave or very some in terms of leading further to specific diagnosis.
So, so what's your approach to I mean this is fascinating to me because I don't see this in my practice sometimes you know every now and again I might rule out something but I'm not seeing patients with known mildly elevated cortisol levels so how do you approach somebody like that to help them to feel better to help them to restore physiology like what do you what do you do.
So that's why you know collaborative approach comes around right so once we are aware, or we recognized it right. And I'll tell you like half of the population population will recognize it or they will acknowledge that.
And then the other half, it's still difficult for them to comprehend that oh my gosh, am I, am I just causing a problem and itself in you so it's very difficult for them to get into a stage where it is more of like an acceptance.
And then they start working on it. So both of them need a very personalized approach and how we can address it. So say for example since we're talking about stress we're talking about cortisol.
Now adrenaline is something that cannot be tested because it varies very quickly and then you know we have other parameters. So we don't check serum adrenaline level or epinephrine or epinephrine level as such for daily basis but cortisol we do have a lot of evidence.
So, you know, one thing is recognizing it but also ruling out because the patient has probably come to you for some concerns or symptoms or an abnormal.
So I'm still going through this entire differential of, are there any other reasons that those levels could be higher.
Once you know that it is related to how we are living our lives. Right. The second thing is awareness.
And then comes okay what can I do. So a good good bunch of patient population and this is both men and women.
It depends on how they wind down the last 12 hours of their day.
Also impacts you know hyperglycemia insulin resistance. This is like a constant discussion even with my patients who don't necessarily have a lab test showing high cortisol but how they lead their lives.
You can see that on their hyperglycemia monitoring or CGM monitoring during the during the nighttime right. So our last 12 hours how are you winding just like we are living well did you say 12.
You say 12 hours I said 12 last 12 hours of our day that's a long time it is. I'm not saying we are.
You know just ready to go to bed after 12 hours of work. But how are we winding down. Okay. This is also dependent on your cortisol your circadian rhythm for men testosterone, because it is falling that circadian rhythm like if you check a 4pm testosterone we are actually checking for more of a natter level or a low level, which is physiologic and then if we have to look at the peak level it's mostly in the early morning hours in the morning yeah 8am similarly for cortisol. Right. So naturally physiologically for that homeostasis for that balance to occur our cortisol tends to rise.
So imagine 4 to 8am it's at its peak level and then it stays in that higher zone but it's not peak, but it's still at a higher level physiologically, and then it tries to get to a lower level so by 4pm 6pm.
So it's getting lower and lower and then the lowest is you know after midnight or 11pm for the graphs to explain. So that means like how are we winding down right and the cortisol physiologically is having this following the circadian rhythm.
So, you know, after 6pm 7pm so very commonly we talk about meals right when is your last meal at least two to three hours before you go to bed.
So, you know, you're spending in those three hours right it could be a walk it could be some time with your friends it could be some time with your relationships versus are you just spending all those two three hours with the screen time.
Right, exactly. And that's very commonly seen, you know, even sleep specialist even, you know, even primary care doctors really talk about these positive sleep habits or bedtime habits to be very specific.
So if we are up and about my adrenaline is going to be high. Right, I get excited watching something or I am, you know, I'm worried about something news channel you know that creates some angst and cortisol and adrenaline and they are going, you know, simultaneously participating in that stress response right. So we are not letting it wind down.
It doesn't get lethargic it doesn't mean that you're going to be fatigued it doesn't mean that you don't have to do anything and just sit and not and you know don't perform.
That's not the point, but it depends on what activities I'm performing latter half of the day, versus the early part of the day. Right.
It's so interesting that you say this because I'm imagining you know my patients and my clients going about their day you know their cortisol levels are what they are four to 8am right.
And then they go to work I think, you know, work is somewhat of a distraction sometimes they pop off at the fertility clinic on their way into work so they're rushing around trying to make sure that they get their ultrasound their blood make it to work right then they do their rounds or whatever they do for work. But then it's like, you know, I almost like imagine these like blips throughout the day you know they have that thought Okay, when's the nurse going to call about my estrogen level, right and then that's the thought and then it pipes down because they got a patient to focus on right so they keep plowing through work is sometimes a welcome distraction and then it's like early afternoon the nurses call maybe it's not good news and it's like that other, you know, stress again right and so then, okay got to power through the rest of the day got to finish the patients that are so no it's all that stuff. But then, you know, they go home and some people have partners and people don't.
But then there's like this open space where it's like, you know, sometimes that's really when the thoughts and the feelings and the fears and the concerns and the anxieties that those start knocking very loud because now there's not the distraction of the workday to to kind of drown that out.
So I, I wonder what this sort of like data would look like in people, female physicians on the fertility journey particularly undergoing this process of like, yes, there's like this baseline stress of like, trying to be a doctor trying to take care of the patients but then throughout that is this superimposed, you know, all the things that happen in the village or the appointments the waiting the calls and sometimes like I can't tell you how many times like even the speaker I coach somebody who was like, I told the nurse not to call I like sent the portal messages I said I'm in the middle I don't want to get this news. And like, you know, they just couldn't get the memo that this and maybe their workflow is that you know you just always call or whatever they're trying to get through there in a two but it's like, when you ask for a certain mode of communication that's not respected, then it adds even more stress right and you're calling the pharmacy and trying to get your medicines or maybe you got to get something clear with your insurance like it's just like this incessant stressful, like part of full time job in addition to what people are doing so what, what do you think that profile looks like and what do you think could help based on the tools that you have for your patients with these, you know, sort of mild but bother some elevations and stress like what what do you think could help my people to just like have a more steady hormonal state throughout the day. Yeah, yeah.
So, this is, you know, very important to know that we are not discussing that stress is not normal. You know there is a way that we can make stress very positive right so we can perform better, you know, there is a better output, or there's a better outcome in the future.
And that's why it's good to get a little nervous before your exams it's good to get nervous before you're going for a proposal, it's good before you're entering into a meeting where you have to present data.
All right, because it's going to help you perform even better. So there's a fine line between that stress versus this chronic stress that you're talking about, where it's where we are being exposed to it every day on a daily basis consistently and that becomes a routine. Right. And this is norm for us and if we have to live life this is how it's going to be the go go go go go go right. So that is what we are interested in breaking the cycle, because that is definitely going to help us on how we live our life now, how we perceive it. So one very important aspect which is also you know we have a lot of evidence regarding it is breath work. So when we talked about awareness, you know, yes you're getting all your medical expertise you're getting your evaluation so that you're not you know missing out on any major pathologies. But when you realize that okay there is this contribution of stress response, which is more chronic for me, and how I can address it.
You know, one is definitely seeking support. So I'm so glad that you know physicians actually seek out the coaching aspect of it which is very innovative and very much needed, because that may not happen every time in a patient's life.
It may happen every time in a patient physician relationship right because of the time and also access. So you know coaching and we have coaching and different aspects of of lives that we are, you know, that we are in this journey and we might have different fields that we need coaching for.
So that is definitely helpful, you know, seeking if I feel that there is a need for therapists and encouraging them that you know maybe there's a relationship issue which is leading to your stressors so let's address it.
But you know the tools in our hand I call it as like calm on the go, which is the breath work that you know we were initially discussing. So, in India, it's called as pranayama, that is your life, your breath is actually helping you to connect to your true self. You can call your true self as God or whatever you believe in. But you know your actual true self and your soul, right. So whatever you are thinking about connecting to and that could happen with breath work.
Now the science behind it is that when we breathe, so you're inhaling and exhaling every day without even noticing right it's it's unconsciously happening without me thinking that I'm making an effort to breathe in and breathe out.
But now this becomes more conscious. So when I'm aware that I'm breathing. That's the first step. The second thing is can I focus on longer exhalations, or when you're when you're breathing out, can it be longer, so 1234 is your inhale, it could be the same amount of counts for exhale longer, longer, longer. We use these techniques in the hospital when someone has superventricular tachycardia we asked them to bear down.
We do these messages, what are we doing we're actually stimulating the parasympathetic nervous system, right, you're stimulating the longest nerve the weakest nerve coming from the brain, which is the rest and digestive system.
Right so that's common the goal. So you don't have to think that you need to be in medicine to learn these techniques but you know this is a science, this is the evidence that stimulating parasympathetic nervous system is actually going to calm you down.
Right, it's going to mean we know this right our heart rates go down we all are obsessed with our smart watches and everything are yes, our breath our respirations we have like vital sign data.
Yeah, that, that you know this parasympathetic response is is sort of taking over, we, we not just feel better but our physiology changes which my understanding as a reproductive technologist please correct me if I'm wrong is that we have blood pressure, you know changes in a favorable way. And, you know, the, it just feels better right so I think that.
And I mean my understanding too is that if we have elevated cortisol that sometimes that even affects our longevity right our telomeres and all these, like it's not just like oh I feel stressed it's like, oh this actually has, you know, negative health consequences throughout the life and so our breath is it's always accessible to us it's always there we forget about it. And so how long would somebody need to do these techniques like in a just say I'm like, you know, maybe my next patient's getting room that I you know like how we go and our sort of our days are very busy like what, what do you need what's the minimum that you need to see like a meaningful change.
Sure. So that's not studied, or that number of times you do it, but the consistency right so it's like, Ling your muscle for this. So awareness when we talked about it.
Where am I getting more angst. Right, where am I just getting more irritated, right or where do I, where is my threshold of frustration like so low that I could anyone commenting anything I can get irritated and frustrated.
So recognizing those scenarios right. Our first thing is in the morning.
Right. When we talk about gratitude. When we talk about you know the everyday is like your first day of your life right and how it's it's my choice how I want to live it at least based on what I think right what's going to happen.
So if us don't know there's uncertainty. But that's a very good time where we can actually be, you know, accountable to ground ourselves benefits for a minute, even if it's for 30 seconds.
The next time is you know in the shower, because that's our own time. So rather than having you know 10 different plans occurring, or creative ideas that are sprouting when we take a shower good time to just get back into focus.
The third one is for my men which have like long commutes I always talk to them about because they think that they don't have time, but in the car.
They write to so I'm not being very biased but yes, women and men, but usually male patients love this.
This time, where they're by themselves and they can really focus on breathing while you're actually driving.
And then the next time it comes like any room that you're entering in where you feel like, you know what I don't know how this patient is going to respond I don't know how many symptoms, they'll be talking about or I have to share this abnormal result.
It was two breaths.
Right. But unless until we don't practice, you know, the last minute. It's not that it's going to just be a remedy and it's going to treat it.
The more we get in tune with it. Now we're becoming conscious. So, and I'm thinking like as we're in the waiting room being called for at the fertility office that's a great time to access the breath as if we're, you know, on the exam table waiting for an embryo transfer that's a great time to access the breath because, you know, thinking about sort of that fight or flight response. I would love to see a study looking at uterine receptivity, you know, because I truly think that people who are able to connect their mind and body and again, if it doesn't work, it doesn't mean that people didn't do this well enough. I want to be clear about that. But I think as many things that can be aligned physiologically to be helpful.
When people can have that mind body connection and have that sort of full body relaxation. That's when I think that people can be most receptive at the cellular level to an embryo. Right. And so I would like to bottle it up.
But in the absence of being able to do that, I think that thinking about some of your breathwork strategies, we drop from the head to the body, we become embodied, right? We are one with the breath.
And then, you know, not just that, we are not just are we grounded in the moment, which is super important. But then we have these physiological changes related to parasympathetic tone that just have like a world of benefit.
So I think that is amazing, amazing advice and suggestions on your part. And I would love to, you know, I always have whenever you get in meditations with my patients, we always breathe in to get there and then we breathe out.
But I think that it's a cost nothing, right? It's like not it's like nobody's trying to sell you this for thousands of dollars. Like it just truly it's always accessible to us and it can make such a difference.
Oh, absolutely. Absolutely. And you know, yes, you're right. We wish we had studies, but I look at so much of continuous glucose monitor data.
Oh, yes. Let's talk about these insane amount of blood pressure logs that I have patients give me because they are first interested in lifestyle interventions, right before they opt for medications and blood pressure, especially in that perimenopause, menopausal age group and then in the postpartum period.
It's been great. Amazing. You know, I'm talking about one aspect of lifestyle intervention that's breathwork, but there are other aspects too that we work on.
In my office, I wish I mean, I'm collecting data in my office every time if I see a patient and that's the first time like a new patient, their blood pressure, I have them practice like I'm going to check your blood pressure at the end of the visit, not at the beginning of the visit because you don't know who you're going to meet, what's going to the conversation be like, you know, what is how is this doctor like?
So their blood pressure is usually 10 to 15 millimeters of mercury lower in systolic, you know, that systolic blood pressure, not the diastolic.
And this I have, you know, I've collected plenty of data. So you already talked about blood pressure, continuous glucose monitor when they're practicing it and the rest and relax phase.
I usually start seeing the steadiness and this is mostly during the nighttime. So between 12 a.m. to 6 a.m. where if they start changing their habits just before bedtime, couple of hours, suddenly their threshold from here, flat is going lower.
Really?
Yeah. So once I collect more data, I could actually give you more milligrams per deciliter changes. But I don't need to increase your insulin anymore. Right?
If they're on basal insulin, I just give them these tips, you practice and then look at it again in a week.
Oh, that's so interesting.
Yes. And similarly after eating. So two hours after eating, you know, other than walks, you know, engaging in these exercises like breath work, even if it's for five, 10 minutes, especially post dinner.
Oh my gosh, I usually will see 10 to 25 milligrams per deciliter change that they're having the same meal, by the way.
And, you know, you're right that these tools, if we have more of these available to look at other hormones, they actually bring about more awareness.
And now you're powering your patients, your people that yes, now you know what's happening internally, you can see it and you make sure that you can correct it.
It's so fascinating. It's like just the body works better when we're not stressed and we need to learn how to access the tools to become less stressed to be able to get to that better physiological state.
Now, Dr. Makija, there are some fertility specialists who are actually having their fertility patients wear continuous glucose monitors.
And, you know, there's, I have this huge patient population in Vermont where there's like either borderline glucose intolerance or, you know, maybe even like, you know, pre diabetes even and and obviously if they have tissue diabetes and we work to reverse that before we can, we can do anything as best we can. But like, what do you what do you think about the role of, you know, insulin resistant hyperglycemia as it retains to the fertility journey and like, and what do you think about CGM as we think about like trying to help people with this part of their journey.
So break it down right so insulin resistance, prediabetes, diabetes. So I'll tell you my clinical experience that yes, GM, you know, it's approved for type two diabetes type one diabetes and for gestational diabetes, and still not approved FDA approved for prediabetes but I use it.
You know, patients are willing to use these tools and if they know the nuances which we learn together right.
They're able to like actually adapt to new changes new lifestyle habits, but with your own choices, not that just because a physician recommended that to them.
So within insulin resistance or prediabetes.
It does affect it depends on you know what the what the stage of that particular condition is right. So if someone has prediabetes that's you know a one C between that 5.7 to 6.4%.
So I usually encourage use of continuous glucose monitor, even though they're not FDA approved, so that even before they plan conception, you know within a month I usually have few weeks that they're able to bring their average blood glucose down because they're now they learn that oh my overnight blood sugars are higher than what happens during the daytime, or you know just extra post meal walks have been helping me to bring my spikes lower.
Or I realized that, ah, this food is not for me because every time I eat this I have these two three hour long phases of hyperglycemia. So I highly encourage we have CGM devices which are over the counter.
Right. So the really that was gonna be my next question is like saying somebody's not lucky enough to live in California where they can see you as your as their doctor, like, you know, how does somebody like say in Vermont, or New York or like anywhere else in the world, who doesn't have access to you like, how do people do this like what it what does it look like. Sure, buy them at the pharmacy. So either you know if you have one health care professional it doesn't have to be whoever can prescribe right sure, definitely ask that I just need a prescription for a continuous glucose monitor right now we just have two brands that's Dexcom and freestyle have a right to ask them, and they have a right to give you a prescription and say your health insurance doesn't cover it because you don't have type two diabetes or you're not on insulin.
That's okay just use good Rx you know use cosplay x pharmacy and use the coupons to buy it and they're pretty reasonable in price. And I suggest at least use it, you like to you two sensors or a month worth so now you learn your patterns, you learn what the nuances are.
And, you know, I have a lot of resources, so they can always go on the YouTube channel I always add on to like how to interpret CGM data.
But if your primary care physician or if your health care professional is not interested in looking at the data, no problem. At least ask them for a prescription. Now, still in the United States of America, we have both Dexcom and freestyle they have over the counter sensors.
You can just go to their website and order some for you you don't need a prescription. And they are also very reliable in terms of assessing patterns, not in terms of accuracy, but that's what you're looking for you're looking for patterns what's happening daytime what's happening when I'm excessively stressed what's happening when I don't sleep for a longer period.
And the food. Sorry, yeah the food like the food relationships. What do you think about somebody who doesn't have a diagnosis of, you know, pre diabetes but they're excessively stressed, and they want to understand their patterns like I'm just wondering, if there might be a role for some body awareness some stress reduction techniques and just like understanding the patterns of the physiology again not in a way that like makes people obsessive about this or it's not one one more thing but in a way that really does.
I know when I do breath work like my blood sugar does this even if I eat the same thing like I just I'm just imagining I'm so getting so excited to think about this actually because I'm just imagining all the potential benefits for somebody whose stress response is is sort of changing their glucose levels, and that they could do something about this with some of these techniques that you're saying. Yeah, you're so right. So I have this whole plethora of patients who don't have an abnormal A1C, even myself.
My medical students so I have them wear it so that they can learn about you know themselves because unless you don't know, you know, something that you can experiment with and then, then it's easier simpler to explain it to your patients.
So it's not that I had, I encourage you to use it to know what your body's saying, but don't use it without having the knowledge, knowing that it's a sensor glucose it's not a blood glucose it's not 100% accurate, and it's a delayed glucose level that we are getting.
So always think about that can I gather patterns. So when you're using it for 14 days at a time. Now you can understand when you go back, reflect on it.
The second thing to be aware of is that every spike is not abnormal. So please don't stop being fruits, because fruits are going to spike so it doesn't mean that you have high blood glucose, which is pathological or your pre diabetes or diabetes.
That being said, it's a great way to use it if you're trying to understand how is my sleep. How is my stress. How is my physical activity impacting my glucose level, and that could be a subtle reflection of your stress or the cortisol that you were talking about.
And in those scenarios just jot down all the notes so all these sensor apps, they have a note section so it's good to free texted, so that now when you go back seven days, you know, in the retrospective zone of analysis or analyzing the data.
That's when you can make a lot of conclusions that oh you know these are the days that I was restless, these are the days that I was worried about something, and you'll see more variations in the blood glucose.
That's super interesting. So, this is amazing because I think it's going to help a lot of people. Are there any other lifestyle medicine tools that you think you know might that people just might not know about in terms of like, you know, stress reduction or navigating this process overall health outcomes.
We all are aware of nutrition, so I won't talk about that physical activity. Yes, right. I would also want to encourage because you have you know your female physicians women physicians that don't just think weight is the parameter for your health.
You know we are moving further away from it. And I feel like many of them are really by a lot of worry anxiety concerns doubts about themselves and sometimes even shame with the weight on the scale and be it you know the productive age group or we have our females women in the perimenopause menopause age group. So in those scenarios right with the lifestyle interventions, but we're not talking about medications here your nutrition your physical activity.
We talked about stress management your sleep.
The quality of sleep is going to be very essential rather than thinking that I need six to eight hours of sleep.
And you know seeking that care is going to be very essential when you're discussing with your health care professional.
And you know we talked about the breath work right. But one important thing that I discuss with every patient and they actually report back to me so there is accountability is journaling.
So interesting. You know, because what I do is our patients when they are journaling and I asked them just copy your journal and send it to me via patient portal because show you that you've progress because we always forget that we've, we've come a long way through.
So you need someone else to remind you, even though they are your notes.
So, when, like in our common coaching program we learn about celebrating our wins. Yes, in patient care, I encourage journaling a whole lot.
It could be 30 seconds it could be one minute it could be just talking to Siri and jotting it down, but sharing it with me. The reason I say share it with me because now there is accountability.
And I again reshare their own wins their own progress. When I see them in person and they're like, Oh, I did not realize that I've come this way.
This, you know, at this place and it wasn't such such a short duration and it's they are marveled by their own journey.
It's amazing and I will say we do a version of that 11 science to as we look at the progress we look at the overall picture you know sometimes it feels like three steps forward and two steps back but I say we are always moving forward whenever moving backwards are always moving forward and I think to have a guide like you or me somebody who can objectively say look, look at the progress look at the growth. This is amazing.
Like that's the whole point. It's not just like is this one piece of data better is this, but it's like how do we feel as human beings and are we evolving. And I always tell my clients like you never asked for this fertility journey although it is yours and so like how are we going to navigate it in a way that it's happening for us, you know, not against us.
Because it's a chapter it's not going to last forever, but I do think that we can we can sort of lean in and say okay you know I'm going to make the best of this and I'm going to make some friends and I'm going to, you know, grow and and learn how that boundary is like whatever it is, to be able to move on so I think that's so beautiful.
I'm just so inspired by the same exact things, you know, it's it's it's just different worlds or different fields. Yeah, the same concepts.
And I think I remember now that like when I was a guest on your podcast I remember thinking like how, how many similarities we have into because I think we both have a tremendous interest in people achieving their highest potential right so many times people feel stuck because of lack of knowledge lack of agency or whatever it is but we have all the tools we need within us we just need a guide and some confidence and some accountability. And I think those are the key elements to kind of bring it to fruition, you know, so that's so beautiful.
So, is there anything else that you'd like our listeners to know in terms of your approach to medicine evidence based pearls that you've learned over the years I mean, we could even get into thyroid but I think maybe you know if we want to talk about that maybe a different episode like just in terms of just your experience and working with people over time and like really keeping the whole person in the purview.
That's, that's a very. I feel it's already an enlightening question. So, the answer is, is, is more nuanced but here is you know what I can speak from my heart about this right.
So, the answer is, you know, always talk about awareness awareness because unless and until we don't listen to our bodies. It's going to be very difficult to express what's happening right it's going to be very difficult to figure out who do I see care from.
And that's why we need some time with ourselves to not necessarily you're not trying to find yourself yet, but at least recognize that I'm going through this pain or the symptom or this condition and I need answers.
The second thing is yes we have the internet we have the Google search now we have chat GPT or different AI platforms, but still, you know, hormonal world is very complex and I'm not saying to scare anyone, but it's very complex.
Symptoms versus labs could be very different in terms of what yes going through. So, definitely seek expertise and if you don't find an answer don't hesitate for a second or third opinion.
Yes, because if you're suffering.
Sometimes it takes couple of doors extra doors that you need to knock before you get into the right room. Right. So that's very very important.
The third thing is, you know, you got a trust. Right. So you if you are aware about what you're doing, how you're doing it and then you're seeking the care, the trust within yourself, and the trust that you've given to your healthcare profession or someone that was going to guide you or your coach. That's very important because if we don't have the trust. It's difficult to believe the transformation. Right. It's difficult to get into that path of transformation.
So, you know, the medical expertise gets gets very important. Yes, we talked about you know lifestyle medicine or how lifestyle strategies can be very beneficial.
But trust me we cannot ignore the the science of the body we cannot ignore, you know, your evaluation your medical testing, and that has to be interpreted appropriately so you can find the best care.
So, I would combine all these rather than thinking that you know every condition every symptom is going to be resolved with, say, non pharmacological methods, so always unifying both those aspects but it starts with my awareness and then seeking that care.
And then trusting right and that's that surrender like I'm going to trust. I'm going to trust this transformation to happen and it's just so beautiful so, gosh, this has been so inspiring.
Thank you for opening my eyes to things that I didn't know about previously and also giving our listeners some tools that they can take with them actionably to not just feel better but to help them move through their fertility journey with more ease and more confidence and and with better outcomes that's the point. So, where can people find you if they're in California and they want to work with you, or near there and want to drive to you like how can people find you my friend.
Oh, thank you, Dr. Beau this was very fun, like it was like one of the topics that I really that's really close to my heart so thank you for asking these questions and giving me this platform.
I'm from California so my website is unified endocrine care calm, and you know you can reach me through there all the links are there for the phone calls but I'm also on Instagram on YouTube, you know Dr. Beau talked about the podcast.
I'm @hormonesathope and @triaMikijoMD just my name and MD is where I am on social media so I'll be happy to help you, or you can you can always add comments or messages in these platforms if there is more of a generalized question.
Thank you, Dr. Beau, for coming on to the podcast and I cannot wait to continue collaborating with you if I was in California I would see you in a hot second, because I cannot wait until the next time I can actually see you in person again.
Yeah, you wish that you don't have any endocrine disease or symptoms so that you can take care of your clients and you know because you're helping them to live live their highest potential yes.
Okay, my friend. Until the next time. Yeah, thank you.
