About Anna Cabeca.
Anna Cabeca, DO, OBGYN, FACOG, is triple-board certified and a fellow of gynecology and obstetrics, integrative medicine, and anti-aging and regenerative medicine. She has special certifications in functional medicine, sexual health, and bioidentical hormone replacement therapy. She is known for her work using natural alternatives and traditional healing modalities for managing menopause successfully. She is the creator of the highly acclaimed virtual transformation programs Women’s Restorative Health, Sexual CPR, and Magic Menopause. The creator of the alkaline superfoods drink Mighty Maca Plus and the vulvar anti-aging cream Julva, she has been interviewed by all major television networks and has been featured in InStyle, HuffPost, and Mind Body Green. She lives on Saint Simons Island, Georgia, with her four daughters and her dog, Sandy.
Hey, Dr. Pedram, Shojai back with another podcast. Excited to be here. Uh, this podcast is sponsored by the urban monk academy, which is the school I teach. And I wanted to make sure you knew about all the wonderful courses I got in there. Uh, I’ve opened up the reboot again for free. It’s a seven day lifestyle habit hack. You get access for 21 days? Absolutely free, lots of wonderful resources that I have in there for you just to give you a jumpstart, to change some of your ways and get yourself into the life that you deserve. Check it out. It’s that the urban monk.com/reboot. And it’s absolutely free. No brainer, go over there, get it, check it out. All right. Today’s podcast, dear friend, Dr. Anna Cabeca wonderful lady. Um, Hormone optimization is her game amongst many other things, but she’s not just a hormone replacement type of doctor. Looking at the functional needs of the body, figuring out what’s going on, fixing the underlying problems so that you’ve fixed the human that’s. How sophisticated medicine’s supposed to work. And that is not how lazy medicine works so excited to have her here without further ado let’s jump into my conversation with dr anna cabeca
Pedram: So good to see you again. Uh, I know it’s been a number of years back and forth with Covid and all the, uh, you know, the, the weirdness that’s happened in the world. Uh, but I’ve watched you, I’ve watched your work and you’re rocking it. So just really happy to see you still serving patients. There’s so many doctors I know that have left that right.
Pedram: It’s very easy to leave that. Um, but helping people, it’s what we got into this for. So thanks for that.
Anna Cabeca: You are welcome. You know, leaving the old model and entering a new model is what inspires me. Like creating a new model of medicine, new model of helping people where we are not. Um, um, It’s just a little harsh to say Pedram, but you know, you’ll understand what I mean. We’re not pimps of pharma or big insurance companies, and we’re not middlemen standing between patients and their insurance company that we are actually helping patients and empowering them to be in charge of their health. that.
Anna Cabeca: makes practice of medicine so much healthier and enjoyable.
Pedram Shojai: Yeah, and it’s hard because look, we, you and I both have colleagues on both sides of that. Arena, right? You have your pharma pimps, and then you have the folks that basically said, wow, that pharma model is really good. Let me replace it with my vitamin B 12. And so you have a lot of docs that are also just, you know, ad hoc throwing
Pedram Shojai: Supplements, like, you know, $1,200 a month of supplements at people saying this is your answer. Um, and that’s not it either, right? There’s a lot in the middle that has to do with patient empowerment and education and, and, you know, using their own brains and having agency in their lives. And so that’s, you know, I think that’s where a lot of the best doctors I know are coming together in the middle is saying, look, it’s not just a product-based thing.
Pedram Shojai: If you don’t fix lifestyle, you don’t fix humans.
Anna Cabeca: Right, right. Absolutely. And I always say it’s never just in a, a product, a pill, a program. I mean, there’s so much that goes into, you know, that whole, the physiology, the state of mind. The way we look at every day, the present moment, and oh my gosh, all the stuff I did not learn in medical school or residency.
Anna Cabeca: There’s just so much. And there’s the balance, you know, like there’s, there’s pharma I use, there’s, you know, things that I can do. Patients can . File through insurance companies for certain things. But the ultimate goal is that like you are the healthiest person out there and people look at you. You are radiating health, and that’s from the inside out.
Anna Cabeca: It’s not from suppressing your own hormones and replacing them. It’s from optimizing what your body’s producing naturally and replenishing So,
Pedram Shojai: I love this. And there are camps, um, a lot of our listeners, you know, and it’s gotten to the point where, you know, the, the podcast listener audience has this kind of, I know it all. I’ve listened to it all. So-and-so said, there’s some, you know, root out of, you know, Tibet that fixes everything. And you know, everyone’s heard all the hyperbole, everyone’s heard all the stuff.
Pedram Shojai: Everyone’s heard the A four M guys marching around saying, you know, just replace the hormones, right. Then, you know, the naturalists saying, you know, never take a drug in your life, and I love that you live right in the middle. Right. Is, let’s be pragmatic about this. People are tired. Right. So, you know, the, the theme for our talk today, you know, fatigue and weight gain, it’s happening on both sides.
Pedram Shojai: Uh, you know, men and women, um, are having these issues. We have menopause, andropause, and we have real issues that people are willing to spend money and time fixing. Then the question is, am I doing the right thing? Right. Um, and so let’s get into how this plays out when you’re in menopause, when you’re in andropause.
Pedram Shojai: Just so we can kinda set the table and then let’s, let’s talk about the solutions, uh, around it. Please. I.
Anna Cabeca: Yeah. Yeah. So very typical, uh, is that in perimenopause, so age 35 to 55, we’ll start with women. We see a rapid reduction in our, um, . Mother hormone, progesterone, we start to see this decline. And the, I consider progesterone. Progesterone is the hormone, certainly a, a supporting pregnancy, supporting healthy bones, but a healthy mind and memory.
Anna Cabeca: Progesterone is a neuro peptide. I mean, it really is this powerful mother hormone, progesterone and pregnenolone. And, um, our reproductive hormones are derived downstream from, um, . You know, cholesterol first, then progesterone down to D H E A then converts to testosterone and estrogen kind of in that order.
Anna Cabeca: And, um, with , Understanding what’s happening there. I consider progesterone like the lid to the pressure cooker of our lives, and as you lose that lid, boom, it’s like Pandora’s box of emotions, moods, havoc, unresolved trauma really can come up. And again, the memory loss, the presenting with worsening P M s, premenstrual Syndrome, anxiety, depression.
Anna Cabeca: Palpitations, difficulty sleeping, memory loss, um, loss of our edge, loss of our get up and go. Those are, and weight gain despite not doing anything different. I’m telling you, Pedram, those words, you know, Dr. Anna, I’m gaining weight despite not doing anything different. Like first I was like, yeah, sure, you’re not
Anna Cabeca: Show me. Look in your purse. There’s gotta be a Snickers bar in there somewhere and you know, or what’s going on. And, and this was and . The problem, like what we’re gonna talk about today in, in contrast, I mean so much of the sta the standard medical care hasn’t changed in 20 years with as much as we’ve advanced in science and specifically quantum science.
Anna Cabeca: We really haven’t advanced that much in our medical education systems. And that’s our standard allopathic and um, . You know, education systems in some degree, uh, less so. However, in our osteopathic education systems, that’s always been more holistic. But, um, . With that said, the progesterone, you know, losing that progesterone showing up with those symptoms and the crashing fatigue.
Anna Cabeca: The, uh, patient who came to me the other day and she’s just like, I just don’t feel like I’m like, I’m a good mama. I just wanna be, you know, I just wanna have energy to play with my kids. I. You know, I just want energy to do things again. You know, it means just like the basic essentials of life. And so we see that in the early perimenopause symptoms and we can fix that so quickly, as you know.
Anna Cabeca: And then for men, it’s also the weight gain, the slow weight gain, the um, Losing their competitive edge at the office. I mean, it’s subtle and the erectile issues that they become most concerned about as they, um, as they enter and exceed menopause, um, andropause, it’s such a slower decline, but it’s, uh, it’s almost all of a sudden they wake up and like, oh my gosh, where did this gut come from?
Anna Cabeca: Like, you know, I. Having difficulty having desire, lack of desire, and lack of wanting sex and ability to perform it. Like that’s, those are pro, you know, the predominant issues that I.
Anna Cabeca: see clients for.
Pedram Shojai: So the ivory tower, kind of traditional . Explanation for that has been, well, you know, the factories are getting tired. What do you expect? You’re getting older. Um, your testes aren’t producing as much testosterone, so here’s some testosterone problem solved. What’s the problem with that vector of thinking?
Pedram Shojai: I.
Anna Cabeca: Though there’s so many problems. The problem is it’s being applied to younger and younger people. Like we have a client in clinic who is 29 year old male who was a athlete, and um, he shows up to us on testosterone. He’s 29 year old, was not a steroid building, was not on an, you know, androgens or steroids for bodybuilding or anything.
Anna Cabeca: Nothing. But we know that’s going to significantly Cause a problem in their own reproductive hormones. But so like what were the reasons, and this is what we’re not asking, well, what are the reasons for these low levels of hormones of testosterone and men are women? What are the reasons? And you have to ask that question.
Anna Cabeca: So just giving testosterone is number one, going to put a bandaid on the problem and you’ll need more and more testosterone, but you’ll also suppress your body’s own natural production. And sometimes that’s irreversible. The, you know, or you can’t take the high, the expensive hormones anymore. And then what happens?
Anna Cabeca: Deep depression, deep muscle wasting, suicidal ideation, and those are real consequences of abrupt stopping of these hormones because your body’s been suppressed and not making their own. So this is why I talk about hormone replenishment not replacement. So it. We have to look at the reasons, the underlying cause, the root cause, even down to the cellular level, I would say, especially down to the cellular level that’s causing this suppression of, or the, you know, lack of testosterone to begin with.
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Pedram Shojai: so it’s obviously an ecosystem. There’s a lot going on, but . Typically, what do you see when, and, and we’ll stay on testosterone, then we’ll move back over to, you know, estrogens. Um, when somebody is not producing as much testosterone, what’s getting in the way? Are we inflamed? Are we, you know, confused with, uh, with all the xenoestrogens out there?
Pedram Shojai: I mean, there’s so many things people talk about that cause disarray in the body.
Anna Cabeca: Yep. So think of it as, you know, stress number one, the biggest hormone disruptor in the world. When we are stressed, we’re producing more cortisol. So our progesterone production will go down the cortisol pathway and there’s less for D H E A, less for estrogen and testosterone, which makes perfect sense, right?
Anna Cabeca: When we are stressed. You know, we’re not, that’s not the time to stop and make love and make babies right and support a healthy, uh, pregnancy. So stress is the biggest hormone disruptor I’ve seen. And there’s an energy to stress that is, you know, head to, you know, affects us head to toe. So, and the biggest hormone, we can deep dive into it more later, but is oxytocin.
Anna Cabeca: When we are in a cortisol state, high cortisol state, that’s a stress state. Fight, flight, freeze, um, escape. I like that one. So, I mean, we’ve just, you feel like you wanna escape. Your body’s in a high sympathetic tone. You are stressed. And so oxytocin gets suppressed. When cortisol goes up, oxytocin goes down.
Anna Cabeca: That’s the hormone of love, connection, like, you know, makes sense. If you’re in this stress state, you’re not gonna stop and you know, Uh, help love your love on your neighbor. So that makes perfect sense. The problem in our society and our constant, everyday stress and, and if we’ve experienced post-traumatic stress, that cortisol will then get suppressed and oxytocin gets suppressed at the same time.
Anna Cabeca: So there’s that physiologic disconnect on all our hormones run. Havoc. And I always say that’s the physiology of burnout. It’s physiology of divorce, it’s the physiology of depression. So when we are, you know, that’s the number one hormone disruptor. And then secondly, and a very close second are the xenoestrogens in our environment.
Anna Cabeca: The hormone disruptors from, I mean, it’s everywhere from the plastics, the, the, um, in the air, the Pesticides herbicides that get into our food. It’s almost impossible to find true organic nowadays because of the, um, you know, the legacy toxins that are in our systems. And we re need, really need to recognize that when we look at hormone disruption today, it’s not just, okay, this is, this is how you’re born.
Anna Cabeca: I mean, what, what, what are the hormone, the . Toxins that are in your bloodstream that were in the umbilical cord blood, like what is, what has affected your own body’s natural hormones? ’cause we, these are known hormone disruptors, so that’s really important thing to under understand too. And the the third is, Diet and lifestyle.
Anna Cabeca: So when we are more insulin resistant, we run more havoc with our hormones and create more inflammation in our body.
Anna Cabeca: So inflammation is right up there. When we are inflamed at the cellular level, I mean our reproductive hormones, um, suffer.
Pedram Shojai: So all three of these things that you mentioned, these kinda broad categories, although it doesn’t seem like this for many of our listeners, still fall well within the nexus of our control to a certain degree. Stress. Listen, it’s my reaction to the stressors out there. What am I doing? What’s my, my personal stress hygiene?
Pedram Shojai: What am I doing to lengthen my fuse? How do I set up my days and my rituals to, um, offload some of that stress? Um, you know, obviously there’s botanicals and things, but that is not an overall strategy, A lifestyle strategy has to be there. We can talk about that. That’s, you know, I’ve written books about that stuff.
Pedram Shojai: Um, xenoestrogens and the. Waste, the toxic waste that is everywhere around us. Yes, that is a problem, but within our sphere of control, we have air filters, we have water filters. We can curate how we shop and how we procure goods. We can not get the new nasty chemical, you know, imbued fire retardant sofa.
Pedram Shojai: There’s a lot of . Stuff that can be done there to minimize. And then obviously we can support our detox pathways. Um, and I’m sure we’re gonna get into that. ’cause the liv, the liver’s a big part of what you, you know, were talking about here. Um, and I think that that also becomes something within the nexus of our control.
Pedram Shojai: Right. Uh, and then diet, lifestyle, exercise.
Anna Cabeca: Absolutely.
Pedram Shojai: Everything, you’re talking about falls
Anna Cabeca: Sleep.
Pedram Shojai: you. Yeah. Sleep, you know, all these things fall back on you as an individual. And that’s, and, and I think that’s the biggest issue is people are feeling so disempowered and so beat up over this saying, you know, I, you know, what do you expect?
Pedram Shojai: Right? The world is, is toxic. What do you expect of me? And that’s not, that’s nowhere where you’re gonna heal. Right. So let’s, maybe let’s pivot into the liver and what it . What it needs for support in this world. And then let’s talk about, um, you know, the, the, the female hormones. Uh, before we get into kinda the differences between allopathy and kind of functional medicine, uh, remedies for this.
Anna Cabeca: Okay. Yeah, so the liver, I mean, we metabolize our hormones through the liver, so keeping it healthy is, um, Priority in our lives. And one thing that is so important to recognize is that it, it may be doing less and not more. So eliminating the exposure to toxins is the first way to improve your detox. I. To take away the burden, like the, like imagine a bucket full of toxins.
Anna Cabeca: Stop filling the bucket. So that’s, that’s the first thing. Now let’s empower like the emptying of the bucket. How do we get rid of these toxins to begin with? And when we think about, especially when it comes to hormones to the P four 50, enzymes to systems in the liver are disrupted by so many of these pesticides, herbicides, toxins that we’re exposed to.
Anna Cabeca: So the. Body detoxes in, in three predominant pathways, sulfation, methylation, and glucoronidation. So supporting these, pathways is important. That’s through nutrition that is solely and predominantly through our nutrition, how we’re nourishing our body.
Pedram Shojai: Yeah. And with that there are certain foods I’m, I’m assuming that are better for that. Um, let’s get into ’em now. Might as well.
Anna Cabeca: Yeah. Yeah. So, you know, part of, um, like this is the alkalinizing foods and vegetables that are rich in minerals. If you can find rich in mineral foods and vegetables, but for example, like the dark green leafies, but like broccoli sprouts, um, Uh, you know, uh, beet greens and our, uh, veg, you know, again, the vegetables that are predominantly, uh, nourishing our bodies and the, the what we eat ate.
Anna Cabeca: So how we’ve nourished our food chain. So to make sure that they’re at the highest nutrient value of whatever we’re eating, uh, sation. Think of your garlics, your onions and glucuronidation that can be. Um, think of, you know, again, vegetables, the proteins you’re eating that will help with, with that pathway as well.
Anna Cabeca: So for me, like, you know, part of my platform is ke what I call a keto green approach, looking at a balance between healthy, high protein, fat meals with the Izing detoxifying vegetables that we can add in there that are low glycemic. So we wanna look at these things that can be, um, added to us in incorporating superfood superfoods that we enjoy, like from our, from our, I always think about this from our, our diet.
Anna Cabeca: You know, it’s beautiful when you look at the history of, of medicine, the history of physicians. The physicians to the king. Prepared their food. And I would think like, how did garlic ever become a delicacy? I mean, seriously, because it, I mean, it’s antifungal, antiviral, it supports sulfation. I mean, there’s supports detoxification, and you think about these foods that became part of cultures around the world and being able to incorporate them for their medicinal values that makes eating even that much more enjoyable.
Pedram Shojai: Some people argue that there’s just not enough of the good stuff in the food that we’re getting, therefore we need supplementation. Um, what would you supplement? I. In kinda the modern humans toxic, uh, ecosystem. Like what, what, what would you add?
Anna Cabeca: Yeah, so I typically add, you know, I add?
Anna Cabeca: superfoods, including Maca, blend of Maca with turmeric and cetin to make coq 10 for energy. Resveratrol is an antioxidant, but also like the milk . Thistle, the vitamin C, the, you know, uh, methylated B vitamin. So those are, those are some of the key ones. And a supplement that I like a lot is, um, is like a sulforaphane supplement, so that can support, um, especially viral load within the body.
Pedram Shojai: You could eat a boatload of broccoli sprouts or also take. A supplement of sulforaphane. So, you know, and this is where it gets a little squishy, right, is you do gotta eat, you do need this, you know, minerals and co-factors and phytonutrients, uh, to support the detox pathways. Um, most of which you get through food.
Pedram Shojai: Uh, there are certain efficiencies that you could get through supplementation and it just makes sense because of the amount of, um, work. Our livers are now facing. Right. Um, but you gotta eat anyways, so you might as well eat in that way. And I, and I love the, the example you used of how, you know, the emperor, uh, had the kinda court physician directing their diet.
Pedram Shojai: Right. Um, we live in a world where you eat all you want and then the doctor shows up to try to fix it after the fact. And those . Are completely separate categories, but what goes in your mouth has nothing to do with, you know, the doctor until it’s too late, which is really kind of backwards.
Anna Cabeca: Yeah, no, absolutely. And and I think Hippocrite said a good physician will cure disease. A great physician will prevent it.
Pedram Shojai: Mm-hmm. . Mm-hmm. . So we have these xenoestrogens which we can support our liver to support. You know, clearing out through the different phases of, of, you know, detoxification. Uh, and then we also have this kind of nexus of control through how we move, right? We talked about how we eat. Um, how important is it?
Pedram Shojai: To move, how important is it to build muscle mass? And it’s, and it’s a bit of a chicken and egg argument, especially when it comes to, you know, testosterone because you gotta feel like it, you gotta move, um, you know, and, and do it. So how do you recommend this with people who are coming in flat to begin with?
Anna Cabeca: Yeah. Yeah. I think it’s, it’s number one. It it . It takes energy to make energy. So you gotta invest your energy where it’s going to give you the most bang for your buck, so to speak. So movement and muscle bearing exercises. I would say muscle is magic in menopause. I tell this to my audience all the time, and I never, you know, Pedram, I never, I.
Anna Cabeca: Love going to the gym. I’m always happy to leave. However, I’m always happy when I am done my, uh, physical activity. But we, our bodies are in motion constantly. Our bodies are energetic. We are constantly emotion, we’re constantly regenerating. So movement is part of our design. I. So we have to honor the movement over the last, over the pandemic, you know, easy 20, 30 pound weight gain on average that we’ve, what we’ve seen and experienced.
Anna Cabeca: And so the lack of movement, the isolation, the restriction has really played out significantly. And we see this creating an unhealthier population susceptible to more disease and a more immune dysregulation. So movement, like playing, dancing. And that’s so good for your mind too, like two stepping, um, I do whatever dancing you want, pole dancing.
Anna Cabeca: I don’t know if you do that Pedra, but that’s a really good
Pedram Shojai: It’s, it’s been a.
Pedram Shojai: Yeah, well, I, and the thing is, you have to feel like it, right? And so here’s where I think a lot of folks run into trouble. You’re in your late forties and fifties. You’re, you, you know, your, your workouts aren’t working out. Um, you’re not putting on any muscle mass. It’s too much work to get in there. You don’t feel like
Pedram Shojai: A superhero walking outta the gym. Um, and so you start to give up and then someone’s like, oh no, you need hormones, right? And, and so you start taking the hormones and you start feeling better and you start working out, and you start doing it. But now you are on the Tet, right? And so you’re feeling better and it, and it is an upward spiral, so I don’t wanna poo poo it.
Pedram Shojai: I’ve seen people’s lives turn around right on H r
Anna Cabeca: Absolutely.
Pedram Shojai: Um, and, uh, you know, they just, I, you know, the, my problem with it is I think most of them haven’t gotten enough . Kind of in plain English informed consent, right? It’s like you sign some papers and you say, okay, well sure let’s go. But you know, . If you truly understood what the implications were of shutting down your own factories, maybe you would think twice.
Pedram Shojai: So let’s talk about what that looks like and, and I, we still gotta kind of turn the pivot into the female, uh, hormones as well. But now that we’re here, what does that look like? Why, why functionally restore and support the body’s replenishment of hormones versus the replacement in your,
Anna Cabeca: Yeah, because yeah, it’ll work better. It’ll work better consistently and longer if we do that. So the same thing like, you know, whether our we’re, um, . The hormones that we’re taking can be a burden to our body’s own production, or it can be a blessing and we have to, we have to make it a blessing. And so this is where it comes to continually supporting detoxification, continually being aware of your toxic burden, doing the things like your sauna, your infrared sauna, sweating, huffing and puffing.
Anna Cabeca: You know, like really working on detoxing from the many ways we do not getting constipated like that, having . One or two bowel movements a day. I always like to, I always like to specify that because I always have that intake. Do you are, do you have constipation? They would say no, and I would examine them and I’m like, how many bowel movements do you have a day?
Anna Cabeca: Oh, a day? No, one or two a week. I’m like, that’s constipated. Like if you’re not having a bowel movement a day, that is constipated. So I’m like, well, how many bowel movements a day? Because toxins get a chance to reabsorb when we are constipated. So . Getting good night’s sleep, having regular bowel movement, supporting liver detoxification are, are three key things to supporting your body’s own natural production of hormones.
Anna Cabeca: We want to use our glands and organs versus suppress them and create lazy, lazy glands, lazy organs. So we want to continue to, to do that so the right way when we are, when we are. Supplementing and we are supporting, especially early on, we’re always working on our body’s own natural hormone production, and then adding in maybe in a postal way, the additional hormonal support when we need it.
Anna Cabeca: The big consequence is that when we don’t do it that way, other. Other issues continue. We, we haven’t improved your quality of life to a longstanding degree can be for the short term, but not for the long term. If we don’t continue to support the body’s own natural detoxification processes, regeneration processes.
Anna Cabeca: That’s why we, it’s regenerative medicine, rejuvenation, but it’s, um, for the long call we have to do it right. And I think that’s a problem I see in many of, um, what the hormone clinics are doing.
Pedram Shojai: It’s, it’s hard because all this really profound, important work that you just laid out sounds squishy. Because it’s like, okay, so what? So I have to clean up my body and I gotta detoxify and move and, and, and you know, it sounds like a lot of work and it sounds like, um, you know, it’s so much easier to just go take a pill or take a shot and all that, but if you’re taking the shot or taking the pill and none of these systems are working, let’s talk about what happens to the body that is now getting more and more.
Pedram Shojai: Endocrine burden more and more, uh, you know, hormones to conjugate in an already tired liver. ’cause I think that’s the part of the story that just isn’t told. And then two years from now, you felt great for a couple years, two years from now, now you’re a disaster, right? So what do you see in your clinic?
Anna Cabeca: So, I mean with that, like especially when people have come on longstanding hormones, I see a mental disruption. Like, you know, there is anxiety, there can be depression, there can be, I mean, so. That’s not uncommon. The other things is that we’ll see, you know, kidney disease, we’ll see elevated liver enzymes.
Anna Cabeca: We, we can see those things if they’re not addressed. And if we never address the reason the hormones were low, if it wasn’t just natural process of aging, post menopause, post andropause, or you know, the thesal journey. If it wasn’t just that, then we are affected by, um, . Those hormone disruptors or those toxins, or whatever it may be, is still affecting us.
Anna Cabeca: If it’s the blue light, like both you and I are sitting in front of right now, the blue light that’s affecting our hormone production causing low testosterone, we don’t really address that. We’re gonna be reliant on something outside of ourselves more than within the power of ourselves. And by design that’s, you know, I don’t know.
Anna Cabeca: I would just say that suboptimal living, it’s not why we started in the first place. We want to feel, um, as healthy as possible, not just in one area of our body, but completely head to toe. So I think the relationship issues is something else that I see requiring higher, higher doses of hormones. And I say that, uh, the dark side of testosterone is the dopa, you know, dopamine seeking behaviors, whether it be through, um,
Anna Cabeca: Uh, certain lifestyle choices, affairs, romances outside of your primary romance and divorce and things like that, that an une um, an uneven balance within the home. Partnerships, guy’s got his testosterone and Viagra and. The woman’s healthcare hasn’t been addressed. She hasn’t been treated for her sexual health or hor hormonal imbalance.
Anna Cabeca: And so now there’s a disconnect. Both have to be on the same page and it has to be done in a, in a, um, holistic fashion. So I think for me, it’s never just, like I said, it’s never just one thing. We have to take it from the holistic approach. We have to look at our toxic burden to generate high health and high healthy mitochondrial function.
Anna Cabeca: If we’re looking just at one thing, . Whether it’s testosterone or something else, then we haven’t really repaired the mitochondria, so.
Pedram Shojai: How long does it usually take? Um, you know, the problem is people are so damn impatient, right? So someone comes in and they’re, you know, a mess. Their, their hormones are off, but their liver is, is not functioning correctly. They are not moving the body the way it should. How long, in your experience does it take to really start to see physiological differences?
Pedram Shojai: To really start to say, wow, this is working.
Anna Cabeca: Not long at all. Not long at all. I mean, we can see a difference in a week. Improvement in how you’re feeling in a week. Definitely 16 days, and I’ve run this with patients I have with people I haven’t seen, clients I haven’t seen in my online programs. So my magic menopause program or uh, my Keto Green 16 program.
Anna Cabeca: In, in two weeks, we see an 80% improvement in symptoms. And this is what I noticed as a physician provider, as I learned this through my own health journey and my own struggles and my, and working.
Anna Cabeca: with my patients, is I put them through the first 10 day keto green hormone detox when in a 21 day . Modified elimination diet and follow up supporting detox, you know, adding supplement, supportive detox, some adaptogens in there as well, like my maca combination.
Anna Cabeca: And they would come back for their follow up to review their labs. Like, I’m like, I’m gonna do this, I’m gonna check your labs. I’m gonna, Eva, you know, evaluate this and we’ll decide in six weeks, four to six weeks, when in your follow-up visit, when I have all this information in front of me. But in the meantime, Do this program and let’s see how you do.
Anna Cabeca: They would come back, say, Dr. Anna, I feel better than I have in years. Or Dr. Anna. I didn’t realize how bad I was feeling till I started feeling good again. And then I just have to tweak a few things. Typically, if anything at all, like they are 90% better. I like to say 90% ’cause I’m still an egotistical physician, Pedra, and I like to claim like I got, I got 10% in this that you needed me for
Pedram Shojai: Totally, totally . It’s, you know, 21 days is nothing in the grand scheme of things. Right. And that’s the problem is we are so shortsighted. Um, and, you know, the, the flip side of the, kinda the promise of the pills and the potions is, you know, a hyperbolic and B, you know, um, Tomorrow, you will have results tomorrow.
Pedram Shojai: And people will, will do that regardless of any deleterious effects downstream. Right? And so that’s something that we, we all face right in clinical practice is trying to figure out how to manage expectations in a way that is, um, sane and reasonable. Right? Let, let’s talk about the estrogens. Let’s talk about the female hormones, um, because those are
Pedram Shojai: slightly different in how it expresses, right? But it’s also a huge issue. Menopause destroys lives, right? So what have you seen there?
Anna Cabeca: Yeah, so it can absolutely destroy lives, but it, I like to say that menopause is the time of opening up and not shutting down. It is a time to really like come out of the cocoon as the butterfly you were born to be, to really have that higher connection with spirit, a better enjoyment in life, and a more of Bois de Viva like.
Anna Cabeca: Just a joyful life. Right. And um, to present that way. And it’s so true that so many people don’t, ’cause they feel the suffering, they feel pain, they feel hot flashes, they feel less than instead of more than. And I want to empower that mindset shift. Because it is evolutionary. So such a blessing. It’s a blessing for generations to come.
Anna Cabeca: And so that’s where I wanna shift and empower women. And women have been made to feel that again, it’s outside of them. You have to take this and that. Believe me, I’m, I’m definitely gonna prescribe some hormones here. Uh, but I want you to know, I want my . Clients to know that it’s within them, they can totally heal this.
Anna Cabeca: And this is what I learned in my journey and that’s why I wrote the hormone fix. And it takes more than hormones to fix our hormones because when, um, when we are losing estrogen and we are declining in progesterone, predominantly that mood and memory hormone, we, um, . Get the memory, the brain fog, the memory loss, the, you know, lack of energy, the interrupted sleep.
Anna Cabeca: Those are all progesterone deficiency symptoms. We focus on the estrogen, but that is just, again, that is the, you know, downstream the last, you know, one of the last hormones we produce. But it.
Anna Cabeca: is important, but it’s important to address the, the, um, . Top-up hormones. And I like to give this example. So when I was in my mid forties and I was struggling as in my second menopause, part of my story was at 41, I was, uh, at 39, I was infertile and diagnosed early menopause and went on naturally to reverse that, to have my beautiful, uh, daughter at 41 years old, naturally.
Anna Cabeca: And so then at 48 I was struggling again and. Fitting hitting the spiral. And look, my hormones were dialed in. I’m a hormone expert, right? But what was happening was the weight gain despite not doing anything different, the brain fog, the memory loss. And so this is where I really recognized when, um, that when shift to a more of a ketogenic, like less reliant on glucose, more reliant on ketones for fuel, like the cloud lifted, my memory improved, my cognition improved, and
Anna Cabeca: As I focused on that with the alkaline component at the same time, ’cause a, a straight keto experience, especially for women, can put you into a, an inflamed state and more of an acidotic state long term. So you wanna add those alkalinizing factors, but lifestyle factors. So gratitude practice is very alkalinizing ’cause it’s increasing your oxytocin and decreasing the acidifying cortisol.
Anna Cabeca: So the hormones, . Really play a big role in that. But that concept of all of a sudden now I have better brain function, and I, and I went to the research to study, well, what is going on here? And lo and behold, gluconeogenesis in the brain is hormone dependent, estrogen, and most likely progesterone. So in order for our body to use the most, you know, our brain to, and muscle and heart, muscle and muscle, to use fuel, you really have to shift from a glucose dependent.
Anna Cabeca: Life’s, you know, fuel source to bumping into ketosis periodically, at least, to really optimize ketones as fuel and, and the cloud lifts, the memory gets clearer. The energy, you’re, you’re vibrating at a higher energy at this state. So if we don’t address that with all the hormones that we’re giving, we’re still not optimizing life.
Anna Cabeca: So that’s becoming more Insulin sensitive and managing cortisol re you know, . Kick-starting our circadian rhythm so that, you know, we, cortisol wakes us up in the morning and it’s nice and low at night so we can get a good restful sleep all through the night. And we really have to balance that to optimize our hormones.
Anna Cabeca: And so that’s a really important piece that. Is missed in the discussion around menopause and it’s critically important. It’s why intermittent fasting is important. No more snacking is important, is to kick, you know, is to kick our body into the state of a higher vibration, higher energy, and what I call the keto green state.
Pedram Shojai: Insulin and cortisol, um, the two kind of. Headliner drugs of our internal environment, right? Like we are eating too much sugar, we are stressing out too much. And so what I’m hearing here is those two dials have a lot more to do with hormones than we’ve heard kind of traditionally from the, you know, h r T world, right?
Pedram Shojai: It’s like you need estrogen, we’ll give you estrogen, um, but insulin is all about how you eat when you eat. Um, are you a time delayed eating fan? Like how do you do your fasting for your patients?
Anna Cabeca: Yeah, so I typically like, um, 13 to 16 hour fast. We know the research says that if you fast at least 12 hours, we, you know, 12 and a half hours, women with breast cancer have a significantly reduced risk of recurrence. So right there, that’s like every one of us should be doing that. And so 13 to 16 hours on average, you can also, again,
Anna Cabeca: Change it up, do one meal a day periodically, like Sunday, I’m like one meal a day Sunday. And you can feast during that meal, like enjoy it, but really focus on, um, changing these fasting intervals for women. I find breaking fast by 10 or 11:00 AM works so much better and stop, you know, eating after six or 7:00 PM and that interval again, depending on everyone’s lifestyle and, and what you’re dealing with.
Anna Cabeca: And I know, I mean, I. A single mom, I have a daughter. I haul horses for her ’cause she does the rodeo and she’s a teenager now, my youngest. And you know, sometimes I get home at nine o’clock at night and you know, we haven’t eaten. And so it’s like that’s a challenge for, so being prepared and trying to address those challenges, we know we’re gonna face head on and will make all the difference in the quality of our life.
Anna Cabeca: Too. But I get how, you know, being busy and being pulled in many di directions can force us to compromise our healthcare. But if we recognize the fact that if I’m not healthy, no one around me is gonna be healthy, then you invest more. You know that you’re worth the time and energy and planning that it takes to invest in yourself.
Anna Cabeca: And I want every woman to hear that.
Pedram Shojai: I love that. Um, and I, look, I’ve known you for a while. I’ve seen you juggling this, right? It’s, it’s a gargantuan task. Um, but I’ve seen you own it, right? Um, and, and not to say it’s easy, but to say that, you know, it’s, it’s your dragon, a sleigh, um, cortisol. In the time that we have left, you know, insulin is obviously well within our control.
Pedram Shojai: Cortisol is a little harder and squishy, right? Because the world keeps coming at us. Um, you know, the phone could ring at any moment with some news that we weren’t expecting. So how do you deal with cortisol levels with your patients? I.
Anna Cabeca: Yeah. And first it’s like, I like how you started in talking about stress and cortisol is that, you know, and you’re the only one who can upset yourself. So that’s a really good mantra. I.
Anna Cabeca: am the only one who can upset myself. And, and, um, I remember when I first heard that statement, I was like, oh no, I, my, you know, boyfriend at the time can really piss me off.
Anna Cabeca: I’m like, no, I get to choose how I react. To that. And so that’s A power statement and that’s a really powerful statement. So I am the only one who can upset myself is, is um, is, you know, a really good mantra to have. So that’s number one. Cortisol. I look at adrenal stress index on patients all day long ’cause I like them to see what is happening at the physiologic level of their, you know, at their body.
Anna Cabeca: And then . You know what gets measured gets managed. So looking at cortisol, your waking cortisol, midday, cortisol, evening, cortisol, bedtime, cortisol. Looking at cortisol pattern throughout the day is a really good indicator of, um, I. How your body’s waking up in the morning, what’s going on? Cortisol is tough to fix, and if we again, have had trauma, post-traumatic stress, sometimes we are in that cortisol is so suppressed and I deal with so many high functioning elite, high performance individuals that they perform through it.
Anna Cabeca: Right. Taking the time to reset your cortisol, you know, it’s a quick reset, is going camping for a week and, and . Nature. Wake up with the sunrise, go to bed with the sunset. No electronics. That is a powerful reset ’cause you’re also grounding getting the electromagnetic field. And so much good about that.
Anna Cabeca: Not all of us are going to go tent camping for a week. And if I go camping, I’m in my horse trailer. So we have that. So, When you just recognize sunrise, sunset, grounding in the morning, um, is a powerful way to reset cortisol. And then again, supporting our adrenal glands, supporting our body’s, um, own natural production of D H E A and cortisol is powerful.
Anna Cabeca: And then two HeartMath heart rate variability. Looking again, what gets measured gets managed. When we’re in a high cortisol state, we have very low heart rate variability, and that’s a stress state. If I look at that in a . Fetal heart rate monitor for a baby, I wanna get that baby out, right? Like . We see that loss in heart rate variability and we know we have a very stressed baby and we as an obstetrician, we’re like, okay, we gotta deliver you.
Anna Cabeca: And um, but in, and then we stop looking. Heart rate variability is a great indicator of what’s happening in our nervous system. So the practice of gratitude, the practice of meditation, the vagus nerve stimulation. All of these things can really help with resetting cortisol and, um, getting out of maybe a dysfunctional cortisol pattern.
Pedram Shojai: A lot of people I see in some of our sleep programs will come in with a flipped cortisol pattern, right? It’s supposed to be highest in the morning and lowest in the evening, and these people are like, Flipped backwards and then wondering why they’re wired and tired. Um, what do you do when someone’s cortisol curve is flipped?
Pedram Shojai: Um, in particular, I.
Anna Cabeca: Oh my gosh. Yeah, so the tired and wired scenario, it’s, it’s very, very common. And so first thing is how do you start your day? Are you starting like, That I really need to get an idea of how, what does this person’s lifestyle look like? How are they starting the day? What environment are they sleeping in?
Anna Cabeca: Is there, you know, is there toxins in the air? Do they have an air purifier? What’s the, you know, sheets, mattress, walk you. The sheets washed in. What chemicals are offgassing? What’s disrupting the sleep cycle at night? How are they waking up getting, you know, running right for that cup of coffee in the morning, or two or three?
Anna Cabeca: What’s going on there? ’cause then we’re just, we’re exhausting our body before we even have a chance. And so the whole idea of resetting the . Pattern is that, you know, working with more of a natural rhythm, the sunrises, sunsets or red light therapy or, um, a, um, a sunrise lamp. That light, using light in the morning to help cue the body, the.
Anna Cabeca: To make their hormones is key. And the same with evening the sun setting, using red light glasses, blocking blue light, watching the sunset, getting outside more. Those things can happen. And then cutting out carbs in your diet, cutting out the carbs to you know, that are gonna create . Um, increasing glucose, increasing inflammation, requiring more cortisol production.
Anna Cabeca: So if we do that, we give the adrenal glands a rest, we can reset that and then suppress it. Sometimes suppress that evening cortisol surge with some supplements that can, um, used, at least in the, the reset phase can be beneficial.
Hey, it’s doctor bedroom showed you. I a quick interruption here. I have. Mighty maca. I have Dr. Anna Cabeca. Actual products in my store. Now that’s how much I like her stuff. Mighty Mako has helped tons of my patients over the years, go to the urban monk.com/store. Go into supplements. You will find it there. And um i love supporting her work and i love supporting the people who need help with stuff that i’ve already vetted so check out the mighty Maka, check out her um her greens they’re all in my store the urban monk.com.
Pedram Shojai: And in my experience, that takes a minute. If someone’s had a flipped cortisol curve for six years coming in, wanting everything to change overnight, that’s just not how the body works. It’s not how the physiology works. Right. Um, so, we’ll, we’ll, we’ll take that again. Um, we’ll edit that part out. Um, I got dogs.
Pedram Shojai: So in my experience, you know, it doesn’t happen overnight. Obviously, if someone’s cortisol curve has been flipped, um, it, it can take weeks, right? To really bring it back and lasso it in. I mean, think about it, you spent 40, 50 years rowing in one direction. It takes a few weeks for the physiology to really turn.
Pedram Shojai: But, and I just want you to kind of lean in on, on this and, and, and, and give me your feedback because what I’ve seen clinically when that does happen is . All systems start to come back online in a way that one would want and one would predict. It just takes a while because the, their, their physiology has really driven in a particular direction and their cortisol’s kind of kept them in this stressed out, central nervous system activated state for so many years.
Anna Cabeca: So when you are able to flip the cortisol curve and you cortisol is doing what it’s supposed to do, in other words, peaks at the morning, wakes you up in the morning, gives you that energy throughout the day and and lets you rest throughout the night so you’re not waking up at three or 4:00 AM the light, your world has more color.
Anna Cabeca: I mean, it is so worth the time and energy to invest in. Recalibrating our body. So we are working how we’re designed to work for hundreds of thousands of years.
Pedram Shojai: Yeah. Yeah. There’s a lot in the last couple hundred years that’s pulled us off the rails of our, you know, physiology if you will. Um, you know, being under starlight and campfires at night, and, you know, it’s a whole other thing, but. Circadian rhythms and, and sleep. But they have a profound impact on hormones.
Pedram Shojai: Um, as does stress, as does insulin, as there’s a lot of things that we’ve talked about here. Um, but you. Look at it. All right. And that’s what I love about the way you practice. That’s what I love about, you know, your gestalt and all of this is you’re evidence-based and you’re gonna look at lifestyle, you’re gonna look at kind of functional parameters and fix the person, right?
Pedram Shojai: Not just the labs. Um, how can people find you? I know you have a lot of resources available. I know that you’re seeing patients clinically, which is so nice to hear, right? Um, help people find you.
Anna Cabeca: Yeah, so my website is dr anna.com, D r a N N a.com. So that’s the best way to find me an on social media at the girlfriend. Doctor, thank you.
Anna Cabeca: Pedram. I love everything you’re doing and thanks for having me on.
Pedram Shojai: Always a pleasure.
Okay. That’s a wrap. Love Dr. Anna Cabeca check her out. Dr. anna.com. Uh, her products are in the urban monk store, the urban monk.com. Go there, check out the store. There’s a link up top that says store, and then you could go to supplements and you’ll find all her stuff in there. Um, and I’m a big fan of the work she’s doing. Catch me in the next podcast