Dr. Jolene Brighten is a women's health naturopathic medical doctor and author of Beyond the Pill. She believes every woman (and the men in her life) should get to know her hormones, because only by understanding how her body works can a woman make informed, healthy choices about interventions such as birth control. Hand-in-hand with eduction, Dr. Brighten also believes we need to flip the script in women's medicine – where everything is diagnosed is a “dysfunction” – and instead embrace that the cyclical nature of female hormones is actually a superpower.
Dr. Brighten’s new course, Balance Your Hormones, will be launching on Commune in early 2020. Go to onecommune.com and sign up for our newsletter to get our latest course releases!
Dr. Brighten: So I have a very interesting background, so I'm a nutritional biochemist who then went on to naturopathic medical school and then pursued my postdoc in functional medicine. So functional medicine, like naturopathic medicine, is really investigating the root cause. The difference I see with functional medicine is that we have more tools to organize the data and go a little bit deeper in terms of some of the lab testing that's available. But the basic premises is if you have a symptom or a medical condition, maybe even a diagnosis, we want to understand why. What is it about your physiology that kind of got off course and led you to where you are today?
I like to use the example of blood pressure for medication. There's a time and a place for it and it's absolutely great that we have access to these medications. However, rather than just looking at, okay, we're going to put you on a medication and fix the problem, we want to also look at, well what led to that problem to begin with? Is it stress? Is it a magnesium deficiency? Is there something that we can correct to get you off the medication? And this is something I encourage everyone listening and all patients to ask is when your doctor goes to pull out that prescription pad, ask them, "Well, what's your plan for getting me off of this?" Not all medications can be stopped, but there should be a plan it looking at what is actually driving this condition to begin with.
Jeff: And so would it be fair to say that you have taken the principles of functional medicine, essentially examining the root cause of disease and applied it specifically to women's medicine and female hormones?
Dr. Brighten: Oh, absolutely. So I'm pretty much a three year old, but I'm in my late 30s, where you know how they never stop asking why? That's how I approach things with my patients. And that's exactly what I'm interested in is that there's been this story in women's medicine that your periods in your hormones are just awful and they somehow make you the lesser when in fact they're just data points that help us understand where it is we need to support the body.
Jeff: Right. They're not dysfunctions.
Dr. Brighten: No.
Jeff: No. And so when women are getting their period, and I have a teenage daughter, so I'm kind of trying to be educated dad around this subject right now, there is a lot of symptoms that are coming up. There's acne, there's brain fog and inability to concentrate. There is often fatigue. There can be weight gain. What are some of the other symptoms that happen as women begin to get their period?
Dr. Brighten: Yeah. So we can also see anxiety, depression, mood swings. I will own it that I was totally that teenage girl who'd be like, "La la la, everything's lovely," and then I snap out of nowhere. And that can really be hormonally driven. We can also see extremely heavy or painful periods. And sometimes when women start their period for the first time, they're irregular, and this is not abnormal to see. If it persists, we definitely want to investigate, but we have to think, it's the first time that the brain and the ovaries have really started talking. It's almost like they're engaging in a dance and nobody starts a dance and gets it right the first time. There's got to be a little bit of a learning curve there. So irregular periods can be something we see. And it's interesting because there is research to support that it can take a good 10 years to mature the brain ovarian communication, which leads many experts to question, should we really be intervening on women's bodies with artificial hormones or other medications before their body's been able to go through that maturation process?
Jeff: Right. And the best example of artificial hormones is essentially-
Dr. Brighten: The pill.
Jeff: The pill. So when women are experiencing some of these symptoms, it has been the western medicine tradition to prescribe often, not all the time, the pill, right?
Dr. Brighten: Right.
Jeff: And that might work short-term for some of these conditions. But you might argue, although I'll let you make the argument yourself, that that might not be the best.
Dr. Brighten: Yeah. The best symptom management solution, right?
Jeff: Thank you.
Dr. Brighten: Yeah. I call the pill, like the pill for every female ill, because it's passed out. I think in this day and age we're more cautious with candy than we are with birth control pills. And I can understand that if you come from a medical training that's taught you that this pill can fix just about any female problem and it works quick, then why wouldn't you want to use that? But the problem is is we're not asking why or what's going on. So like we talked about those irregular periods, that can actually be a sign of hypothyroidism. So your thyroid gland that sits at the front of your neck has a big role to play in your reproductive health and if you're hyperthyroid and you're expressing symptoms in your menstrual cycle and we're only addressing your menstrual cycle, we can leave you in big trouble in the future because that thyroid disease goes undetected and is allowed to progress.
We see the same thing with polycystic ovarian syndrome or PCOS. That also can have irregular periods, acne, oily skin, hair starts growing in places you don't want it, and it's understandable that women want solutions for these symptoms. However, PCOS is rooted in a metabolic disorder. It's inflammation, insulin dysregulation, and these women are at higher risk for cardiovascular disease, diabetes, high cholesterol, high blood pressure. All of these things that I just listed are side effects of hormonal birth control as well. So while she may be trading acne for possible stroke risk, there is really no one there giving her that informed consent and giving her that information. Often it's, "We fixed your period," send you on your merry way, and nobody questions the fact that what was actually going on could have a bigger impact downstream.
Jeff: Yeah. And I mean, this doesn't just apply to teenagers obviously.
Dr. Brighten: Oh, no.
Jeff: But that's my reality, so I'm seeing it through that prism right now. For a teenager, and I think you can relate to this because I've heard a little bit about your personal story, this can be the subject of a lot of shame, of a lot of self-esteem issues. And someone says, "Okay, well here's a solution for that," in the form of synthetic estrogen essentially, and that can be a very attractive offering because you're going through a really, really hard time in your life mentally. But you're saying that there is an alternative to that of essentially being able to more naturally and holistically address and control your hormones, but how?
Dr. Brighten: Mm-hmm (affirmative). And I would actually flip the language, and I'm not shaming you because you're a man and you don't have these hormones.
Jeff: Help me out.
Dr. Brighten: Yeah. But it's not controlling our hormones, but it's working with them and embracing that we are cyclical creatures. I mean, really, we're not the problem. The problem is society is set up a lot through the lens of being a man who are not cyclical throughout the month, who don't have dips in their energy, dips in their mood. And on the flip side, we also have times where our brain fires like nobody's business and we are incredibly sharp. We have times where we navigate communication in ways that men only wish they could do because of what our hormones are doing. That's not to say that we're better. We're just different because of our hormones.
Now, with this, I am not anti birth control. I'm not anti birth control of any kind and I would not advocate for women to lose access to that. I'm a first generation college student and I'm the first one in my family not to get pregnant before 20. That's a really big deal. And what can I attribute that to? I had access to the pill and I used it for 10 years, but I started the pill because I had incredibly heavy periods. They were more than seven days. They were super painful. I couldn't go to school because I bled through my clothes. I had trouble taking enough ibuprofen without ending up with digestive upset and all the while, I thought my body was betraying me.
So my doctor was like, "Hey, there's a pill for that. We can shut the whole system down and it'll fix your period." I of course was like, "Sign me up." I had had these awful periods for three years. Nobody really talked to me about it, helped me understand it. It was my mom's history, my grandma's history, so we came to accept it as normal. And I think it's something we've lost sight of in a lot of ways is that just because something's common and that it's common for people to experience it doesn't make it normal.
With all this being said, I think we need to go into our sex education and how we really talk to women in very young years to help them understand their body, understand their hormones. I would've loved if someone said to me, "Those really heavy and painful periods, it's probably because you need more magnesium. You're eating too many Omega sixes in your diet and you need to switch to more Omega three fatty acids to alter your prostaglandins. And by the way, adding a little more broccoli can help with estrogen detoxification and then those periods won't be so heavy." That would have been a conversation I would've really enjoyed to have. Now, I'd be a liar if I said, "Oh yes, my teenage self would have just totally followed suit and done all of those things."
Jeff: You'd eat broccoli instead.
Dr. Brighten: Yeah, right? So maybe, maybe not. But at least hearing it and having the touchpoint of options and then understanding that my doctor passed me the pill with zero discussion of what it could do in my body. There's this thing in medicine called an informed consent. It's an ethical obligation for physicians to actually give you all the information you need to make the best decision for yourself.
Jeff: But do you think that physicians are actually educated enough themselves to provide the kind of guidance or the informed consent that you're putting forth?
Dr. Brighten: Absolutely not. Now, here's the thing. They have the foundation and they are whip smart. They can understand all of this, but your doctor doesn't know what they don't know, which is to say that if they're not trained in medical school, in the full what we call the parque and really getting all the information around birth control, then how can they relay that to a patient? And at the same time, doctors are busy, practices are filled. They don't get on Club Med and read research studies. They go to conferences, which then they rely on people to curate the information coming out and present it to them. And there's very much this dogma in women's medicine that isn't grounded in science, which is to say that birth control is completely benign, and the side effects and the risks that we see are so small, it's really not worth mentioning it to most women.
And the reality is is that birth control can and does kill. Now, yes, it's a small percentage, but when we start looking at risk factors, maybe like the breast cancer risk, it's a small increased risk. It's a moderate increased risk. However, we are talking about cancer. We're talking about something that impacts her and impacts everyone in her life. So we have to start opening up this conversation and really stop tip toeing around the idea that this is very much part of women's liberation and this is why women make more money, we graduate college at a higher rate, but that doesn't mean that we shouldn't have that conversation. It's not anti-woman. In fact, what I would argue is anti-woman is not relaying all this information to her.
But on the plus side, I will say, I've had women who say, "Well, my doctor doesn't get it. They just don't care." I mean, nobody goes to medical school and goes through what you go if you don't care about people. But I've had a lot of doctors write me after receiving a copy of Beyond the Pill, my book, from their patients or they picked it up themselves saying, "This has completely transformed the way I practice and I'm going to do things so different." I've also had gynecologists write me and say, "I've been in practice for 20 years. Do you know how many birth control prescriptions I wrote thinking I was doing her the biggest service ever?" And that I say, we can always learn from that and do better moving forward, but I think it's really hopeful thing to hear how many doctors are interested in really shifting this paradigm and helping provide better care for their patients.
Jeff: So what are some of the ramifications after you get off the pill? What happens there?
Dr. Brighten: Yeah. So for as long as you're on hormonal birth control, pills specifically, shuts down brain ovarian communication. So when you come off, it can take some time for them to start talking again. So perhaps you lose your period. It's actually in the research common if you had a regular, so every 28 day cycle before starting birth control, that your period won't come for a good three months after you stop. If it was irregular, we're talking PCOS symptoms or you never knew and your period came, then it could be six months or more. So we can see all kinds of period problems. Maybe your period comes back with a vengeance. Maybe you start having the worst PMS of your life. And for some women, for the first time in their life, they develop acne, like cystic acne. You might see neurological changes, like new onset of brain fog, mood swings, depression. We see gastrointestinal symptoms, so gas, bloating, constipation, diarrhea, and some women even go on to lose their gallbladder.
So we have to shift this conversation. I mean, so much of medicine is compartmentalized. And I mean, as we started this conversation, I mean, that's really what functional medicine does differently is we connect all the pieces and we look at the body as a complete system. And if you understand that your natural hormones impact every system in your body, then you can certainly understand that when you come off of birth control or while you're on it, it is having an impact on every single system.
Jeff: You talk a lot about food as medicine.
Dr. Brighten: Or just eating because I like that.
Jeff: Me too. I want to ask you, because we hear a lot about estrogen, but what are the primary female hormones? And then the follow up question to that is, what is their interrelationship with food?
Dr. Brighten: So our primary female sex hormones are estrogen and progesterone, and we also have testosterone. And then when we're talking about hormones, we look at things like insulin, we look at your thyroid function, we're talking about adrenal function and there's really a whole slew of hormones that are interacting in our body. But most women, when they're coming in with concerns around female hormone issues, it tends to be estrogen, progesterone, and testosterone. Now, when you understand that everything you eat and then absorb becomes every single cell in your body, you can certainly understand that, okay. Food has a major impact.
Now, let's take estrogen for example. This is one women are always super concerned about. When it's too low, we start to look at dietary fat and cholesterol. Now, I was definitely in this camp at one point where I was like, "Low fat all the time." That's a great way to crush your libido and wreck your hormones because women actually need fat to build their hormones. And then on the flip side, when we have excess estrogen, that can be an issue that maybe we're making too much, but it also can be an issue that we've got poor blood sugar regulation, so we're skipping meals, and I'm not talking about intermittent fasting. I'm talking about pounding coffee, running around with your kids, getting them to school, and then realizing around 1:00 PM you totally forgot to eat today, and then you're the hangry monster and nobody including yourself, enjoys that.
But it also can be an issue with poor fiber intake or low cruciferous vegetables. We talked about broccoli, broccoli, kale, cauliflower, or these cruciferous vegetables aid our liver in detoxifying our estrogen. So once we're done with estrogen, we've got to package it up and move it out of the body. We detox it through the liver and then it's excreted in our urine, but also through our bowels, which is how a low fiber diet can get you into big trouble. So there's two points to this fiber a piece. There's one, you have to poop every day to get your estrogen out. That's one of the ways you clear it. But the other is is that if you don't feed the good guys in your gut, you can actually get overgrowth of the wrong guys, which can cause dysbiosis.
And what happens in those bugs will actually reactivate estrogen and put it back into circulation. And then your liver is like, "Great, now I'm dealing with way more than I had ever planned on," and then in addition to that, you're likely being exposed to xenoestrogens, which are chemicals throughout our environment that can get onto the receptors of your estrogen, but they don't give you any of the benefits of your natural estrogen.
Jeff: Yeah. Wow, that's really interesting. So you're saying that maintaining sort of a healthy microbiome, a diversity of bacteria in your gut essentially helps you from elevated estrogen levels essentially, from bad bacteria stimulating over estrogen production. Am I understanding that a little bit?
Dr. Brighten: Yeah. A little clarification point is that, so your liver will process the estrogen and then as it's moving through the bowels, there's a process called reconjugation, which is where the bacteria can actually reactivate your estrogen and now you've got more estrogen in your system than your body was planning on dealing with. And for people who are listening, being like, "Oh my God, what do I do about that?" Well, one is you definitely have to take care of your gut health, but there's a nutrient called calcium D glucarate that can actually safeguard. So if you don't know what you're dealing with in your gut yet and you have symptoms of estrogen dominance, that's one thing that you can take that is going to help that entire system while you work on resolving whether it is, yeast overgrowth ... very common with hormonal birth control ... in your mouth, in your gut, and also in your vagina, or perhaps you have small intestinal bacterial overgrowth or just not enough of the good guys. I mean, if we get exposed to antibiotics, even just our water supply is inundated with it, I mean, that can have a real negative impact on our microbiome and that will affect your hormones. Your gut is everything in maintaining your hormonal health.
Jeff: You've got a mission. You can feel it, right? Can you clarify what that mission is for me?
Dr. Brighten: I'm on a mission to change women's medicine for the better. We need a lot more respect in women's medicine. We need women to have their stories heard and believed, for this idea that our symptoms are in our head or that being a woman is just inherently awful to go away. And really the way I see that we're going to be able to accomplish that is by putting the medicine in women's hands. There are a lot of people who say these things can't be done and I watch patients disprove that day in and day out. And so that's really what I've set out to do in the content that I put out, the interview we're doing right now, the book that I wrote was to teach women about their body, that their symptoms are their body's way of communicating to them, and if you have symptoms, that's an adaptation. That's your body's way of protecting you and also saying to you, "I need some help. Can you bring in the support?"
I think that there's been too much taboo about talking about women's bodies, our periods. Whether it's just getting your period, having a baby, having a miscarriage or going into menopause, we've been told not to talk about it because it's not polite and it makes people uncomfortable. But at the end of the day, we're all just a bunch of animals and this is very natural process we go through.
Dr. Brighten: What is shocking is that the majority of States within the US don't even mandate scientifically accurate sex education. So that means that anybody with any agenda that they want can really go in and perpetuate things that are just simply not true. I grew up in a very religious family and I was told I could get pregnant any day out of the month. And when I finally figured out that wasn't true is when I was in medical school. How ridiculous is that? You shouldn't have to go to medical school to understand how your body works and how your fertility works. And the majority of women, and I know they're really nodding their head right now listening to this, don't even know when they ovulate until they decide to get pregnant. And that's when their doctor decides to educate them or they seek out education online, when in fact, we're walking around with incredible data in our body. So it's not just about pregnancy prevention or when to get pregnant, but you can learn so much by being in tune with your body.
And I think what most people don't recognize is that you're going to notice what's not normal for you and when symptoms come up way before your labs show any kind of disease. And that's important because the sooner we can intervene, the more we can practice that preventative medicine everyone wants to get on and avoid things like pharmaceutical intervention and surgeries, which certainly have a time and a place, but if we can prevent that, I mean, that's what I call winning in medicine. And I also want to commend you just for even having the curiosity about how to talk to your doctor. A lot of dads kind of squirm away from that of like, "Oh, I don't know. That's uncomfortable," but it's very natural.
Jeff: Yeah, no, I think that that's one of the things that I hope that the course that we're doing together, amongst other things, helps to demystify or just get rid of that taboo around these topics and this language, especially as I relate as a man to talk to my daughters about it or to my wife about it and not worry about tiptoeing or walking on eggshells, that actually I can have this conversation with them honestly, even if they don't want to have it with me.
Dr. Brighten: Right? And I'm sure as you went through sex ed, they separate the boys and the girls and have those separate conversations, which is important because we need to have a safe space to communicate and ask questions. However, I've always wondered, well, when do the boys get the education about how a woman's body works and vice versa? Because it's really important. I think about how many people struggle in relationships. I have patients in my practice and they're like, "Well, my husband's upset because I'm not in the mood as often as him. He feels like there's something wrong with me, something wrong with him," and when we go through it it's like, "Oh, okay, so when your period ends, then you're really in the mood and that lasts for a couple of weeks and then as you're nearing your period, then your libido starts to diminish again."
That's a natural menstrual cycle. Again, you're a cyclical creature. If you can communicate that with your husband of like, "Look, this is going to be go time. I'm totally going to be in the mood, down for whatever. Make it happen, but during this week I actually need a whole lot more foreplay. I need a lot more pampering and know that if I brush you off, it's not about you. It's about where I'm at in my cycle."
Jeff: That would be so helpful.
Dr. Brighten: Right?
Jeff: Can you sit down and make that calendar with me?
Dr. Brighten: I know. Yeah. Well, and this is the really cool thing is not in this day and age we have fem tech. Oh my gosh. If I had period tracking apps and all these things ... I'm old like that. I have a paper calendar, so you can actually share data with your partner so your partner knows when your period's coming, what's going on with your cycle. I use a fertility monitor called Daisy and I use it as part of fertility awareness. That's how I prevent pregnancy with my partner, my husband and he knows. He sees the lights flash up and he's like, "Oh, okay, it's green light, go," which means that we're in the clear for unprotected sex and red light, no, means, "She's going to be in the mood, but she is potentially going to get pregnant."
My son, he's six and he will bring me the fertility monitor and we talk about it. We actually get on Instagram and he can tell you about the female reproductive system. We get out our Netter's anatomy book. He loves this book. And I remember the first time on Instagram we went live and he explained, "This is your endometrium. This is what you shed. This is why my mama was bleeding today." And there were women writing saying, "Okay, so your five-year-old actually knows more about how my body works than I do." And that was a moment where I was like, "Okay. I knew I needed to do this work, but this work has got to happen." So I guess I'm not on a warpath, but I will bulldoze through whatever it takes to get this information to women.
Jeff: Yeah. Well, God bless you for doing it.
Dr. Brighten: Thanks.
Jeff: It's so important. Thank you so much for sitting down with me today and for doing this course. I'm so excited about it and I'm a big fan. Thank you.
Dr. Brighten: Well, thank you so much. I really appreciate your time, the candidness of the conversation, and it warms my heart to hear how you want to support your daughter. Men, listen up, you can do this too.
Jeff: I'll report back. How's that?
Dr. Brighten: Sounds great.