Dr. Kay Durairaj 0:15
Well, hello, hello, guys! You're listening to Beauty Bites with Dr. K, Secrets of a Plastic Surgeon, and today's podcast is going to be all about you, how to understand yourself, your nutritional status, infertility 2.0 I'm so excited to interview Rachel Swanson. She's a registered dietitian, a clinical nutrition expert. She's the author of Trying. It's a science-backed approach to optimize your fertility, and she has a lot of research-driven knowledge. It's rigorous. She helps women understand through really personalized biology, including hormones, metabolic function, the microbiome, and micronutrients, and all of our exposures in the environment. So all of this impacts your reproductive health. She has a great roadmap for women who are trying to conceive and preparing for IVF or suffering through PICOS, which is now renamed to a different name. We'll talk about that. She's super respected, and you've seen her on with lots of celebrities, including professional athletes, Vogue and Victoria's Secret models, and Fortune 500 executives. So, she is going to teach us all about the fertility conversation and the science of fertility as it relates to nutrition and women's bodies. And welcome to the podcast, Rachel.

Speaker 1 1:32
Thank you so much, Dr. K. What an honor it is to be here and talk about this subject with you. I'm just getting excited as you're going through the the bio and telling everyone what we're about to discuss today.

Dr. Kay Durairaj 1:42
Well, you've been known for taking a really scientific approach to personalized approach to fertility, and can you talk a little bit about that? I feel like so many of my patients have fertility issues, and it's sort of a silent conversation that people don't really-they're not that open about it, but there's a lot of it going around.

Speaker 1 2:02
Yeah, absolutely. And I guess just to just to set the stage for you, you know, when I discuss this topic, it's going to be quite a different discussion of how maybe it's it's approached right in conventional medicine or how it's approached by a doctor. So I think of you know a conversation around fertility is really going to be about a conversation about someone's systemic health, right? Which is a little bit different of a framing. And the reason why I do that and the philosophy behind that is because I see, you know, fertility problems, Doctor K, they're often a canary in the coal mine for underlying issues and for future disease risk. By the way, that's the case for both male and female, and the reason for that is because there's a shared pathophysiology. So the conditions that can essentially affect or hurt our fertility are themselves risk factors for you know cardiovascular disease, diabetes, cancer, so on and so forth. And so again, so that's kind of to set the stage. And I see here, as kind of we were talking about with our with our intro, that you know the standard of care and how we approach fertility and how we talk about fertility, it's very siloed, right? It's very reactive, and I think this is doing a massive disservice to women because it misses the first chance we have to intervene clinically and change, you know, that entire trajectory of of someone's life. So, anyway, kind of to to wrap that up, it's this is this perspective shift is what I call fertility 2.0. This is how I approach fertility. It's really the opposite of conventional medicine, we're going to be proactive, preventative, personalized. Right, we're going to optimize fertility with every lever we have within our control, and that and that's how I go about it.

Dr. Kay Durairaj 3:52
So that's fertility 2.0 It's the next generation of how you think about fertility.

Speaker 1 3:57
Exactly, exactly.

Dr. Kay Durairaj 3:58
Just beginning to think about pregnancy. I think there's so many factors. I think we think women think they can wait till they're 30, get pregnant, they'll have a baby by 35, but they don't understand how rapidly fertility levels plummet after age 25, even. So, what is the right nutritional strategy to kind of optimize you going into trying to get pregnant?

Speaker 1 4:20
Yeah, so. again, I know I certainly don't mean to reframe the question again, but again, just going off of this different approach and different philosophy. So a standard answer, like you ask anyone, sort of the the question that you just asked, and their answer will be something to the to the effect of you know here's what to eat to boost, you know, egg quality. Here's what to supplement with to affect sperm quality, right? Or hormones. But I think of those as all of the outputs. We actually want to shift our thinking to how do we work upstream of this to address the entire body and the root cause. Physiology of what impacts eggs and hormones to begin with, and by the way, this is all going to make sense in a second when we literally like dive into the pillars of all the pillars that were that affect fertility, like you know metabolic function, microbiome health, so on and so forth. But that is actually how we're going to approach it. That's a first principles approach, and what's very cool about this approach is I know something that you love quite a bit and talk to a lot of other guests about is sort of this longevity conversation, right? So first principles approach to fertility, it's going to be optimizing longevity at the exact same time, right? Remember, reproductive aging is the earliest manifestation of systemic aging. So again, before we kind of dive into all of the strategies I have, I have for you, and I have kind of outlined in the book. That's how I that's how I think about it. That's how we frame everything. So remember, instead of like listicles, bullet points of what to eat, we're going over pillars of how we affect our physiology, and you're going to get a lot of downstream benefit for the rest of your life and decades to come with that approach.

Dr. Kay Durairaj 6:09
That makes a lot of sense. Like I think eggs are the indicator of how vital the organism is, right? And like the literally, when you start to have decline of fertility, there is decline of longevity. So yes,

Speaker 1 6:22
exactly. I mean, you know, it's so funny. It's it's very when you say it's it sounds very intuitive, right? When you when you say that out loud and when you think about it that way. But Dr. K, no one's approaching it that way, right? But that that's exactly how I think about it. And to kind of double click on that, it's like I think you know when does kind of this follicular depletion accelerate? It's around what 30-730-eight, years old. Menopause around 50-one ish, where it's the ovaries like the first is the first organ to like essentially functionally retire, and decades before we do. But it's ironic that you know we aren't really even studying the one place that aging is showing up first, but these are so intricately connected. In my hope for this discussion at this time that we have together, I'll actually be able to make a lot of connections for you. Because again, I know some of your audience might not even be interested in having another and getting pregnant, but for them, maybe they're interested more in reproductive aging, right, and slowing that down. So I'll try to make a lot of interconnections during this

Dr. Kay Durairaj 7:24
conversation. I have read a lot on that. I think that ovarian aging and menopause is actually the most advanced trajectory of aging of the period of the woman's life. Like when menopause hits, literally, your organ systems are going haywire, and your aging is accelerated. It is accelerated aging, and like what are what are some biomarkers that people should be checking, or things that might be missed that they're not checking? Labs are looking normal, or doctor says you're fine, but you actually don't feel fine.

Speaker 1 7:57
Yeah. So I think that kind of leads us to some of the the labs, or really kind of the one of the pillars, right? One of the chapters of the book from the biomarker discussion is our metabolic related biomarkers. So I'll first I'll go I'll tell you exactly the biomarkers that I look for, but I guess to frame it as to why it's even important, right? Before I just shout things like insulin at you is because so metabolic health. Taking a step back, big picture, metabolic health is going to be one of the strongest leverage points that we have to optimize fertility. So the data is very very clear. It affects the quality of eggs, sperm, of embryos. It affects our hormones, it affects the chances of conceiving naturally, as well as IVF success rates too. So that's just kind of that's just skimming the surface in terms of how metabolic health impacts fertility. So that's what we're after before I before I give you the biomarkers, and that's why it's important. The problem is that you know one in 10 people in this country are considered metabolically healthy, and that's based off of five very basic biomarkers that arguably aren't even the best ones, Doctor K. Right? This is based off of the you'll remember the criteria for metabolic syndrome, right? It's based off of blood pressure and HDL cholesterol and triglycerides. So arguably not even the best, but hey, everyone has access to those at their physical exam. So you can so someone can always start there. In terms of the biomarkers for metabolic health that are very important, one of them is essentially looking at someone's insulin resistance. So the reason for that is because rising insulin is going to precede problems with blood sugar. So insulin resistance has been associated with fewer eggs retrieved, lower embryo quality. Lower IVF success rates, increase miscarriage risk, so on and so forth. That's why this is like one of priority number one in terms of that you know metabolic health bucket. So for insulin, in practice, what is normal does not mean what is optimal. So you know if you get your if you get your insulin done at LabCorp. Normal will be like you know anything less than 24.9, whereas in practice we actually want it to be like less than six. So this is a this is a huge gap right between what's normal and what's optimal for fertility outcomes. So that's one biomarker. Now of course we want to interpret that in the context of our other labs. So, like the little trifecta for metabolic health would be, you know, knowing your fasting blood sugar along with the fasting insulin, knowing your HbA1c, right? How much sugar is stuck to your blood cells over about a three-month window? The optimal levels I look for that we discussed insulin fasting blood sugar as it relates to fertility outcomes less than 90 is ideal HbA1c if we can get that if we can move closer to 5.0 that would be great but again that should always be interpreted in context of all the other labs there's another biomarker that's not necessarily something that you would get at your lab. You could it's it's really free for anyone as long as you have a tape measure. But another very very strong marker is is actually just using something like your waist circumference measurement. So anything over the clinically recommended threshold, which is over 30-five inches for for women in America. There's it's over the other threshold cutoff is actually over 30-1.5 for other ethnic groups. Like if you're Asian or Hispanic or Middle Eastern, so we have different cutoff points. That is actually a fantastic proxy for visceral fat. It's the visceral fat that has very strong fertility and pregnancy data. So I could keep going, but those are within the again metabolic health. Those are the biomarkers I would absolutely get start with. You know, prioritize. Luckily, there's so many direct to consumer labs these days, right? It makes it so much more accessible.

Dr. Kay Durairaj 12:24
I think that's so true. I never realized that that was a circumferential measurement. Now I'm going to go find a measuring tape. Yeah, I

Speaker 1 12:33
know. Now, now you're like, I, I wonder where where I sit there.

Dr. Kay Durairaj 12:36
I got to measure my husband. What is it for men?

Speaker 1 12:39
Yeah. So again, it's it's ethnicity depended, but over male, what we're looking for is less than or equal to 40 would be would be good would be ideal.

Dr. Kay Durairaj 12:50
Okay, that's perfect. I'm going to check that out, and then talk a little bit about like the idea that insulin resistance and PICOS go together. First, I think we should mention that PICOS has been entirely renamed this new metabolic type syndrome. I'm so glad that they've taken into consideration the metabolic side of

Speaker 1 13:11
PICOS. Oh my gosh, no, no kidding, right? What's so interesting about this is that you know, to take a step back and just to remind everyone, PCOS now PMOS is the number one cause of infertility globally. Right, this affects millions of women. What happens and what the research has shown us is that between 80 to 90-5% of women with PMOS have insulin resistance, right? I mean, that is that is striking to me, and that goes back to what we spoke about together in the first like you know minute of this conversation in regards to how it's not just a problem for fertility; it's a problem for later in life, right? PCOS substantially increases a woman's future risk of you know various disease outcomes, some hormone-dependent cancers, right? So on and so forth. I could list a a lot here, but that's very important to know. That's why we want to address it, and this is you know kind of fertility is the most important inflection point to address this prior to pregnancy, right? Otherwise, pregnancy complications can happen. Anyways, does that? I mean, does that stat kind of blow your your mind, Doctor K? Like 80 to 95 percent of women have insulin resistance with PMOs. And yes, to your point, guess what? Name name change. So instead of polycystic ovaries, it's essentially you know polyendocrine metabolic ovary syndrome, which very much reflects what's actually going on behind this.

Dr. Kay Durairaj 14:44
Yeah, it's so true. I've always kind of intuitively felt that women's women who are having a hard time getting pregnant once they get in shape, lose weight, lose centripetal body fat, like the estrogen stores balance and come out of the fat stores. And I think, yeah, intuitively. We've known this, but now for it to be labeled that way means that women will get much more detailed testing and earlier diagnosis and earlier treatment. So I think that's so important. Exactly.

Speaker 1 15:11
I mean, I'm very. I'm always very optimistic that that is going to, you know, it's not just about the name change. To your point, I mean, yes, that's fantastic for recognition, but what you and I care about, right? Clinically, is like how is this going to help downstream of that being able to have you know women maybe have more access to labs, having clinicians be on the same page that no, like these are actually very important to look at, so on and so forth. So look, I am I am praying and crossing my fingers more than anyone that this actually changes, you know, even billing and so on and so forth. So again, just we can have increased access to information and great biomarkers that can be utilized for.

Dr. Kay Durairaj 15:50
Let's say if you're a woman out there and you've been told that you have picos and you know you want to get evaluated better from the metabolic standpoint, what would you go back to the OB/GYN and ask them to do, or and how would you maybe change your lifestyle or diet to improve with this metabolic idea? Because a lot of women are told, "Oh, we think you have polycystic ovaries. You got acne. You got some hair. You got some weight. You know, they're put on some drugs, and then it's just ignore it after that. So, if you're one of those women, what should you do with your doctor?

Speaker 1 16:24
Yeah, exactly. So you know, if you have a doctor that isn't really caught up to speed on the on the latest research around this, and again, because of the name change, hopefully now everyone is going to get caught up to speed. I would-they're going to do sort of the standard reproductive hormones, right? I mean that that literally is their job. I would say what they they might not do is look at kind of like that trifecta that I spoke about for metabolic health, right? So your fasting blood sugar, fasting insulin, HbA1c is going to give you a much better picture of then how much kind of you know what what room for improvement that you have on the diet and lifestyle side of the equation. So, as an example, if I come in with PMOS to the doctor, I get I get labs. Maybe maybe my OB/GYN is is you know is is willing to order these for me. Great, I get those back. That doesn't mean she knows how to interpret them. So that's why I'm all about you know educating educating all the females out there so they know how to act accordingly. So insulin over you know nine or 10 in some subpopulations in the in the research that we've looked at that can actually increase for symptoms like you know acne like hair growth, and so it's very interesting. Again, look into the optimal range. If you're over 10 and you have a lot of symptoms, actually dropping that down could be very, very helpful for again more of that symptom management. Some people can can reverse this entirely. I don't want to make any claims that can't be back, but I'm just speaking to what I've seen in practice, what I've even done with my with myself to kind of reverse what's going on in terms of symptoms. So, okay, I, Doctor, I have a ton of strategies here on the on the diet and lifestyle side. So, let's dig into a few of them. But again, remember, even if someone listening right now does not have PMOS. What I'm about to say is just going to be about optimizing metabolic health, right? So it absolutely applies for you know insulin resistance. If you would like to improve glycemic management, still applies. Okay, so I would say again, what is I'm thinking about like what are kind of the relatively like first you know cheap free tools that everyone can use. I think the most underrated and underutilized tool that we have that everyone has is basically a food log, and I will go into why. So if someone logs everything that they eat for literally one week or less in in any app of their choice. To better understand their baseline, you will be able to quickly identify the areas that you need for improvement. Right? You do not need to pay a dietitian to help with that. You can actually just get started with that. In fact, I hope that no one wants to come into office and pay me to do that because you can you would do it at your in your home by yourself. So some of the targets that I look for again, this isn't going to be personalized, but this is like baseline, right? The targets that I look for. So say Dr. K, I'm reviewing your food log. Your food log. I'm going to say, okay, is she having a minimum of 0.7 grams per pound protein per her body weight? Right. So that is something that everyone can do for themselves. Then I might look at you know is

Dr. Kay Durairaj 19:54
Dr. Krams? I thought it was higher than that nowadays.

Speaker 1 19:56
So so minimum is 0.7 grams per. You can. A lot of individuals do have higher. Some people recommend 0.1 gram per pound body weight. However, I can tell you from clinical experience, going that high often stresses out a lot of men and and women, men and women, because you have to make you know like eating protein like front and center every single day. And again, I just see that as very, very stressful. Whereas if you're over 0.7, if 0.7 and over, that does not lead to different clinical outcomes. You know, if you're eating 0.8, so I would say, look, if you like a higher protein, great, go for it. But I'm just looking at like what is the minimum threshold that everyone needs to have. And remember, it's not point like the the past RDA, right? It's not 0.7 grams per kilogram. It's 0.7 grams per pound threshold. Again, you can eat higher than that if you would like to. The next thing I'm going to look at if I'm reviewing your food log is, is someone having about 14 grams of fiber per 1000 calories that they eat-that's going to help with glycemic stability. Then, if someone has you know insulin resistance, again they have high blood sugar, and I'm not really loving that. I'm going to make sure that they're kind of you know they're under 100 grams of carbohydrates per day. If they're over that and they're needing work on their glycemic control, you know we need to we need to lower that and distribute it better. So 100 grams carbs, you know, including all the fiber-rich carbs. I'm looking for kind of an even split throughout the day, not huge carbolases. Again, we can go much much lower than 100 grams, but that gets more into personalization. That gets into like are your where your labs are sitting, right? But that's again kind of like a baseline, 100 gram carbs and and lower. Then, for your log, you know we would be going into does this individual would they benefit with for a little weight loss, remember we discussed the thresholds of the of the waist circumference where fertility might be affected. Again, whether it PMOS or not. So you we might say like, okay, once we know the baseline, we can reduce it by 250 500 cows, kcal, so on and so forth. So these are just a few of the baselines again. This is free. This is going to be a great place for most people to start. Then, of course, we can get into all of the the tech, Doctor K, like the the speed boost, right? Yeah. In practice, I recommend continuous glucose monitors all the time. Yeah. You have one on right now. I love this.

Dr. Kay Durairaj 22:38
And then it's been so interesting. I am hypoglycemic when I re, you know, I don't even realize it, but I think I get cranky. And then I check my glucose, and it's a little low. Yeah. And then it's way I can never eat a naked carb. I just realized that I can every single carb shoots up my sugar, so I think I'm a little, you know, genetically prone to resistance. But it's been a long exercise for me to understand my inflammaging and to like get those low glucose levels. That's my goal. Like I have, you know, like the next 10 years to like get this really level and really good.

Speaker 1 23:12
Yes, absolutely. And I mean, to your point, we're talking about infertility, but for longevity, yes. I mean, we have good, you know, epidemiological data at least that shows you know the essentially the the lower the lower the better for for longevity related outcomes, right? What

Dr. Kay Durairaj 23:30
is a good low? I'm just going to pick your brain because I'm for my own purposes here. What do you think is like a super healthy baseline blood glucose?

Speaker 1 23:40
Yeah, so kind of a few ways to to answer that question. For the baseline, what we're looking at is I don't want anyone spiking above 140 So that's the first threshold that I would use. So like if you're if you have your lunch, if you have your dinner, and you're spiking above 140 that's those are the those are the meals that I would target first. So ideally, you know, we're just wanting to flatten the ceiling on that spike. We don't want to get rid of the spikes, remember, because if we do, that means you're eating something like I don't know, like butter and bacon and cream all all day long, and you're not spiking at all. So we're not trying to get rid of all the spikes, but we're looking at you know 140 140 and lower is a great place to start. We're always wanting to have the fasting blood sugar under 100 on those CGMs. Again, that's looking at the interstitial glucose, like I mentioned before. Under 90 is going to be ideal, and we're going to essentially we back calculate this. What we're looking for, Dr. K is for longevity purposes. Again, 5.0 for your HbA1c is going to be ideal, and that is ideal based off of the studies that I'm mentioning for for longevity. So you can essentially back calculate that out. So that's going to be an average of glucose of of 80 something milligrams. Deciliter, but you aren't necessarily going to get that view on the on the CGM. But it's going to give you all the trends that you that you need to know. Now, by the way, I've I've overseen 1000s of data points over the years for all the CG of all the people wearing CGFs that I monitor. I'm actually curious what what what foods spike you the most. Like, what have you noticed with meals, or what have you changed based off of you wearing it?

Dr. Kay Durairaj 25:23
Anything with sugar, like I definitely can't have like a sugary latte type drink. Those are out for me. Yeah, same. Yeah, carbs. It's all the carbs and bread, pasta, crackers, cookies. So like, no more naked carbs for me. I'm always going to get protein first or veggie first. And when I when I do that, the sugars are so beautiful and solid and stable. But like, yeah,

Dr. Kay Durairaj 25:47
I it has really changed my eating pattern. So I think that you do, and even just like a little walk after eating helps. And if I'm sedentary at a desk, I'll do the little calf and the calf muscles that we do-that contraction of your calf muscle is like your accessory heart, and it helps to metabolize a lot of your sugars. And what's

Speaker 1 26:09
what's super nice is I think about you at least like after you know before or after kind of after lunch after you eat is you're probably still seeing you know going in and out of patient rooms all day, right? So you're getting at least a little bit of movement. It's all about just like to your point, and with your calves, right? It's just how can we contract those muscles a little bit more. And I'm I constantly have to work at it too, right? I mean, I'm at a desk all day seeing people, so I'm like you know making myself now like stand up, walking the person out of the building, like walking the person like from the waiting room. Just anything I can do to kind of increase that movement because I'm actually very like you. So I've worn pretty much every model of CGM that you could imagine, and

Dr. Kay Durairaj 26:52
like the best. I'm just curious which one you like the best.

Speaker 1 26:55
Yeah, so I think for right now, I mean, of course, the there's a there's pros and cons of of both of them. So like for example, the Stello by by Dexcom, the the consumer version, of course, that's lovely because it pairs with the the O ring, right? And we love those kind of tech integrations where it can like look at our sleep data in with our blood sugar. But I have to say, I was I was actually quite impressed with with Lingo, which is Abbott's version, because I thought they did a fantastic job with the with the UX and UI, basically the user experience of the app. I was like, okay, okay, Lingo kind of coming in hot and surprising me on there, and so that's why I mean, to be honest, I think both are both are really great for consumer versions.

Dr. Kay Durairaj 27:41
Yeah, I'm wearing the Dexcom Seven, so people want to look that up. That one is-it's been really interesting, easy to use. I would say simplistic. I think the app is not robust enough.

Speaker 1 27:52
Oh my God! My

Dr. Kay Durairaj 27:53
Facebook showed me Libre, and the Libre was really way better in terms of like data points and data collection.

Speaker 1 28:00
Yeah, the the the Dexcom g7 is. I mean, I'm gonna. I mean, I'm gonna say it. It's it's it's pretty terrible in terms of yeah the user interface and kind of like looking back at at the data. But I would say for for you, I mean, the next time you wear one, you should actually try out the consumer versions. I think you will be pleasantly surprised about about how good they are.

Dr. Kay Durairaj 28:23
Okay, yeah. Okay, I'm gonna try the other one. What did you say the other one was that you liked?

Speaker 1 28:27
Yeah, lingo. So basically, Abbott's consumer version, and then Stello is is Dexcoms. But I mean, again, I don't I don't know how often you wear them, and if you wear them continuously. But I mean, if you're kind of like me, I mean, try them both.

Dr. Kay Durairaj 28:40
Yeah, I'm gonna try a one month experiment, so I'm gonna try each of them, and then I'll give everybody my recommendations. But yeah,

Speaker 1 28:46
absolutely, and and you know, to the point, and just on kind of the the topic of personalization, it sounds like you know you've integrated so much, like you know yourself and your blood sugar pattern so well. But you know, for for anyone else listening, it's kind of like for Dr. K and for myself, remember kind of the you know 100 gram carb threshold per day that I kind of look at. Like for somewhat for people like us, we're probably going to have to eat like much lower than that, just because we know our trends so well that like we can't actually handle large carb boluses at one time, whereas someone else that I manage, like maybe they're an athlete or or not, they actually do quite fine having a larger serving. So that's where we want to really personalize. And again, we want to personalize based off of if we're not wearing a CGM, you can look at those labs, right? Where is your fasting blood sugar at? Where is your insulin at? That is going to tell you how much you can leverage in terms of that diet and activity, and I guess it's it's also worth mentioning just in the back of my in the back of my mind, kind of the clinical brain. Of course, there are a lot of people that you know if they if someone has a history of kind of you know orthorexia like patterns or an. Disorder, or they just have a lot of anxiety around data. CGM is not going to be appropriate. All I could say to that is, is we got to know thyself, right? If something's going to produce more anxiety, that's actually going to be very counterproductive for our blood sugar, right? Because we can increase our blood sugar just based off of the stress response, which I've seen, by the way. I mean, I've literally seen executives go like I know when they're giving a board presentation that week because they're just their sugar skyrockets on their CGM. I'm like, oh, what what did you eat? They're like, no, I just I just had a presentation that was stressful.

Dr. Kay Durairaj 30:36
It's so true. I highly recommend everyone should wear one for a week or two. Ask your doctor, and they'll give you a prescription. Maybe it'll be covered on your insurance, or maybe you just buy the patient.

Speaker 1 30:45
Oh, oh my gosh! Yeah, again, go direct to consumer. Their their devices are are good enough that a prescription isn't even isn't needed.

Dr. Kay Durairaj 30:53
One, yeah, I think it's so interesting because my husband, I made him wear one too, and he it's it sucks for me that I can't eat the carbs, but he's enjoying them, and he's oh yeah. It doesn't do anything to his sugar, but I think I need more muscle mass to catch up to him. But it's very true. This idea that cortisol rockets you up. When I was in Europe, my sugars were like 80 to 90, and then I came back to the office, and they're 105 all day, like super, like the cortisol of like running around. Even though, and intermittent fasting too, I would have thought would have brought those sugars lower, but it didn't. Yeah. Oh, interesting. Well, tell me a little bit more about like the the idea that we can change our microbiome, and that might impact our fertility.

Speaker 1 31:37
Oh my gosh! Yes, this is again another so metabolic health one pillar; kind of microbiome health, another pillar. And this one is super fascinating because I know you've had experts on your podcast talk about, you know, like the gut microbiome health. But I actually want to expand upon that a little bit because there's actually several ecosystems in our body that we can leverage to our advantage because they affect fertility in different ways. So, again, from a big picture standpoint, how we can think about the microbiome in fertility is that you know it's it's our opportunity to basically interface with our immune system through our food and lifestyle choices. Like, how cool is that, right? So the reason why that's important, not just for longevity but for pregnancy, is a balanced immune system, right, is necessary to get pregnant and sustain a healthy pregnancy. I don't think there's any doctor that would ever argue against that. But how we go about that is kind of you know how can we optimize our microbiome in different ways. So there's actually Dr. k3 different ecosystems I discuss in the book that are relevant for fertility. So it's of course the gut microbiome, but also the oral microbiome and the vaginal microbiome. Now I can I can touch on all of them if you want, or if there's just one that you're interested in, I'm happy to happy to zoom in. I

Dr. Kay Durairaj 32:58
want to know all of them. I'm really into microbiome these days.

Speaker 1 33:01
Okay. Oh, awesome, awesome. So it

Dr. Kay Durairaj 33:03
correlates with diet so well, right?

Speaker 1 33:06
Yeah, exactly right. So to start, I guess from the from the from the top down. So the oral microbiome, I think about you know what happens in the mouth doesn't stay in the mouth. So if you have dysbiosis in the oral cavity, and that's basically paired with with inflammation. That sets the stage for periodontal disease. So, periodontal disease is not just an oral problem; that's a systemic problem. So that's why you hear in all these studies there are certain oral bacteria that are linked with you know heart disease that are linked with Alzheimer's disease that are now actually even associated with specific cancer types. So that's kind of the longevity end of the equation for fertility. That periodontal disease again dysbiosis coupled with inflammation. We see the well the science tells us research tells us that there's can be issues with sperm quality, reduced fertility potential, and even some higher risk of pregnancy complications. So again, I mean, this is the oral microbiome. This is very very interesting, right? Before we kind of get into like you know probably some like takeaways of each, I'll go into the to the other two and why they have they have relevance for reproductive function. So, the vaginal microbiome, you know, this is not being talked about enough. This is actually not talked about at all when I when I wrote this book. So, essentially, if this again another micro environment that we're talking about, if this ecosystem is out of balance, which is defined as you know the presence or absence of certain bacteria, we don't need to to go that nuance today. But that can create this kind of local immune response, right? Or this local kind of immune perturbation in that area. And it's like if we're creating new life here, right, in the uterine cavity, we we want it very. Balanced, right? We do not want that ecosystem perturbed by any by any means. That's why all of the research is coming out that shows a healthy vaginal microbiome is associated with getting pregnant faster. It predicts better IVF success too, whereas dysbiosis is unfortunately associated with the with the opposite outcomes. If I gave you some relevance, though, outside of fertility, again, I'm conscientious of the fact that not everyone might be on this listening to the podcast, might want a baby. So, outside of pregnancy, like you know, let's let's talk about perimenopause. So, when estrogen declines during perimenopause that also affects the growth of the beneficial bacteria we have here. That actually contributes to the urogenital symptoms that are extremely common and we see all the time in clinical practice. Right. So what that looks like is many women are you know presenting with infections that they've never had before because of that kind of downstream effect. So it just kind of goes to show how important all those bacteria. I mean, they're working in our favor, right? I mean, it's the it's the coolest thing. So that's the vaginal microbiome. A few kind of top and thoughts about the gut microbiome. And I know again, you've you've talked a lot about this, but look, I mean, depending on what's going on in here, it's either going to help or hurt our health in various ways. So I think about you know dysbiosis that can trigger the immune response, can trigger inflammation. That's because the endotoxin, right, that LPS is literally leaking into circulation and impacting distant sites. That includes you know the site where like spermature right called epididymis and speaking of other distant sites you know this very well Dr. K about skin health right if someone comes in they have terrible inflamed like acne maybe chronic eczema flares that provides us an opportunity to optimize the gut do you encounter this at all in in your practice,

Dr. Kay Durairaj 37:02
we see these patients with inflammatory red, rosacea skin, or acneic skin. They come in very inflamed, and more often than not, I think that this begins in the gut. And I recommend that we do a few things, like take gluten out of their diet, take milk products out of their diet, and supplement with a lot of fiber, like seven to 10 different fruits and veggies a day, and then we will recommend some good pre and probiotics. So, I think that's step one. Like, yes, we'll give you the acne treatment too, but we've got corsified, right? Yeah,

Speaker 1 37:33
but see, I guess I just want to take a take a step back for for your listeners because what I actually want to emphasize is everything that you just said. That that is what separates you know you from your colleagues, right? That separates good doctors from you know fantastic doctors. It's like you can use the exact same kind of acute clinical toolkit, like whether it's I don't know cortisone injections, maybe some steroid creep. Like you have all those tools, but you're like, no, there's something deeper going on, right? And that is what we need to change in order to change this trajectory. And so it's really fantastic to hear you say. And unfortunately, there is not a lot of doctors who are practicing this way. You're probably, you know, you're probably in this health bubble, right? You you speak to experts, to scientists. You're up on the latest research. You know all of this, but it's like you go to any other doctor with with the problems that you just described. They aren't talking about your gut. They aren't talking about a very simple elimination diet that is going to reduce all of the perturbation for the for their immune track and heal the gut lining, so it's it's really it's really awesome to hear you to hear you say that. And I

Dr. Kay Durairaj 38:47
guess philosophy. I think it's a whole different approach because, like, yeah, sure, something's broken. Can we fix it? Can we put out the fire with the medicines and the treatment? We can, but do you ask what caused the fire, and is it gonna keep igniting if we don't fix the cause? And like, so that's like, hopefully that's the thinking that we need to get out there. Like, it's all causative. If the gut is healed, you're not gonna get, hopefully, these type of skin barrier issues. And now there's some cool new products too that are probiotics that you can even apply to the skin surface, which you're not. Maybe you have wiped out all your good organisms, and you're too aggressive with your skin. And sometimes that's the other problem: is that people come in for medical treatments, and they get really aggressive microneedling or dermaplaning or lasering, and like the skin can't restore its barrier. So I think it's fascinating.

Speaker 1 39:36
Yeah, it it so is, and I think again, just just big picture, it's it's so cool that we have the opportunity to address, you know, kind of again first principles, or you call it, you know, a root cause approach, because that's how I approach, you know, fertility, reproductive function, longevity, and that's how they're all interconnected. And so, with the kind of the three ecosystems that I described, you know, optimizing all three. That's such a huge leverage point for fertility, but also that has pleiotropic benefit for the body and for the rest of our life.

Dr. Kay Durairaj 40:09
Yes, I mean, are there prebiotics or biotic bacteria that you think are super important? People have talked about Acromansia and kind of these bacteria that make a really good mucin lining to the gut. Is there a best practice to just buy it and take those tablets, or is it the diet that we need to fix first?

Speaker 1 40:30
So the the first thing that I always fix. I mean, look, they all kind of go together, but in terms of like ranking order of how people can think about this for themselves, is that diet always comes first? The reason being that if we don't remove the provoking agent in the first place of why this individual has you know intestinal permeability, right, and constant flare-ups, then it's kind of like yes, probiotics will will help, all these products will help, but like you know we're just kind of like throwing band-aids on it in a in a sense. I mean, really great band-aids. Don't don't get me wrong, but it's kind of like let me give you a parallel example, just the one that that I think of right now. It's kind of like you know practitioners who deal with individuals who have unfortunately they're very ill from like chronic mold exposures. Kind of like if that person is living in the house, still with like black mold and mycotoxins because of the water damage. They're literally living in the house. No good practitioner is going to start treatment until they remove sort of like basically they can either remove themselves from that environment or basically like completely renovate that area because it's like you can give the medications, you can give all of the binders and the supplements and everything under the sun, but like if you don't remove the provoking agent in the first place, then like how are we really going to get better? So I just say all that because I just want people to lock into the idea because Dr. K, like you and I both know, unfortunately, when it comes to probiotics, all of these supplements for the gut, I know people are getting recommendations from Instagram and TikTok and all these places, but a lot of times you don't actually need those. You you need to look at diet, do a very simple elimination diet to kind of see you know what's provoking you. Then yes, let's get into kind of the fun layer of the of the products of the probiotics. They have excellent data. I would say this: there's new research coming out all of the time, and so this is actually a great place to look at to help to have AI help you with you know the new risk research and look at some of this because again, it's like it's it's so hard to keep up on. I would say to be honest though, in practice, feasibility is not a concern for the clients that I work with in in concierge medicine. I'm saying that because we do run you know gut microbiome tests on everyone, and so my answer to you about which strains are appropriate for which person, I literally like hand pick them based off of the data that I see. So to your point, acromancya, GI

Dr. Kay Durairaj 43:04
testing, like stool testing to see

Speaker 1 43:06
it, exactly, exactly. So gut microbiome testing again. I don't need to do that if someone in my practice can't afford that, right? We just we just work off of their exactly what they're experiencing, and then I tailor the probiotic strains to that based off of the latest research and data that we have for that specific indication that they're coming in for. But again, if I have someone's microbiome analysis, I can easily see if they have like very sufficient levels of acromancia. Personally, Dr. And again, I know this this might. I mean, maybe you don't like this approach. Maybe disagree with this approach. But I actually don't like how everyone is supplementing with you know Acromansia or specific strains because a lot of people, based off of their gut microbiome analysis, like they're completely fine in Acromancy when in fact their bifidobacteria is like tanked, right? And so that's why we want to supplement that and support the growth of those keystones bacteria with specific prebiotics that are going to help that grow, right? And so I would, I that's why I really, really tailor it for individual in practice. And then again, if someone's like, well, I'm not spending over like 300 bucks to do a gut microbiome test, totally fine. Basically, know your goal. What is the outcome that you want? Then look at the data in terms of what probiotics are going to that are potentially helpful. It's probably going to be a lactobifido blend. Some are very well studied, right? So that's kind of a good place to start.

Dr. Kay Durairaj 44:39
I think that's amazing. What type of GI testing do you recommend if people wanted to get GI stool?

Speaker 1 44:46
Yeah. So for right now, you know the the one that I'm liking. And by the way, I I do change this answer based off of like which gut microbiome test is kind of leading in terms of you know accuracy. The the data so on and so forth so again if you ask me in a year this could be different if you asked me last year the answer would also be different right now I'm really liking Tiny the company is Tiny their their gut protest the reason why is very specific number one it's the whole genome sequencing so I I definitely want to have that? If someone has an acute sort of illness that they think is related to a GI pathogen, of course you would do PCR in that case. But I think for the conditions you and I are speaking about, we want the whole genome sequencing. And what Tiny does is really cool because they've actually added on these inflammatory markers that are very, very important from a clinical perspective, like Calprotectin and others. So that's a very cool aspect that basically no other tests are doing. So there's there's more than Calprotectin, but just to kind of give you an idea of of what I look at, and so that's the the company that I'm going with right now in in practice.

Dr. Kay Durairaj 46:00
And how do people reach out to them? Do they need a provider prescription, or they can just self purchase?

Speaker 1 46:05
Right now, I believe they do need a provider prescription. However, I do recommend actually looking. I mean, they could have changed that right a few a few weeks ago. They could have changed that last month, so I'm not up to date on that. There might be an option just to order. You know, maybe not the the pro analysis, but just one of the regular analysis. So definitely check that out. Yeah,

Dr. Kay Durairaj 46:24
website would be what.

Speaker 1 46:26
Yeah, I think it's so that one is going to be like if in Google, if you just type in tiny, you know, gut health pro, you're gonna you're gonna come up with that hit. And you know what I, you know, kind of just thinking about it in real time with you, I I'd imagine that they do have some direct to consumer versions. Again, maybe not the physician version, but because one of something very cool that their company does is allow you to order for your baby's gut microbiome, and so that's direct to consumer. You don't need a physician, so you know perhaps. Of course, I don't want to misstate of of what the company offers because I have by the way zero affiliation with them.

Dr. Kay Durairaj 47:04
Well, that's very cool. Well, I wanted to ask you in finishing up with this conversation, like some quick questions, like rapid reply. What's one food you love for fertility?

Speaker 1 47:17
Oh my gosh, this is these these rapid questions are like the bait of my existence, Doctor K. Oh God! Yeah, I I would say the one that might surprise you, Doctor K, is um is actually liver. Believe it or not, because it is one of the yeah it is the one of the most micronutrient dense foods we have on this planet. The reason for that, again, is actually it supports a lot of methylation pathways in our body. So it's rich in in B 12. It's rich in choline. It's rich in so many different things that it's really a heavy hitter. So what I recommend for this again, if you're just trying to really maximize the nutrient density of your meals, if you're trying to get pregnant, is I literally like have people just you know because who who loves liver and I don't know a lot of people that do. I have them like chop it up and literally just put it in like a in a bolognese like sauce right or in like a chili or like in meatballs. You don't taste a single thing, and so that's actually how I integrate it, and you get this like injection of a lot of different micronutrients that are very beneficial for fertility. And by the way, my book actually has those recipe examples because I get the pain point that that this causes. But that's that would be the the number

Dr. Kay Durairaj 48:36
one. What's your everyday product that you recommend swapping out?

Speaker 1 48:41
The oh, the I would go with yeah. From the let me take a different category. So like the endocrine disrupting category, hands down. If you are using any pans with Teflon, I would get rid of those right away. You need a non non Teflon pans because these these disrupt sperm quality. There is there is great data just on how all of the multiple points that this affects reproductive aging. It affects fertility. I know we we didn't go over that, but I could discuss an hour just on endocrine disrupting chemicals. But that would be kind of number one just right now you could do when you get home from from work today.

Dr. Kay Durairaj 49:23
Yeah. Okay. What's one best practice, best habit that supports both fertility and longevity?

Speaker 1 49:29
Optimizing glycemic control. That's

Dr. Kay Durairaj 49:32
a good one. One thing, one piece of advice for women preparing for IVF or pregnancy. It

Speaker 1 49:39
would be. It would. It would go back to priority number one, which is you know optimizing glycemic control and working on you know the the microbiome of what we just discussed. I'm I know I'm just I'm gonna slip in five more on that question, Dr. K. I know you asked for one rap rapid question. I just I can't do it. You know, stripping out all of the endocrine. Disrupting chemicals and really focus on BPA phthalates and and PFOS. So these are going to be you know make sure you're yeah yeah make make sure that you are filtering you know your your water at home with a reverse osmosis. Like I said, the get rid getting rid of the Teflon pans, getting rid of all of the products that you're using that have fragrance in them. That's a that's a good place to to start.

Dr. Kay Durairaj 50:23
Cool. Well, let's end with one fertility myth that you want to retire.

Speaker 1 50:28
I want to. Yeah. This. Well, I'll take it full circle for for you. The fertility myth that I want to retire is the one that a lot of doctors still believe, which is we cannot influence our rate of aging, and we cannot influence our egg quality. When, look, I spent the past three years writing a book that has over 400 studies refuting that, and so that is the the final myth. I would like to retire.

Dr. Kay Durairaj 50:59
I love it. Well, that was such a comprehensive, great overview. A lot of good snacks in there that you guys can take and implement immediately in your lives. Like things you don't need high tech. You just need to think about what you're actually doing with yourself. I I love this conversation. Thank you so much, Rachel, for coming on. And where can people find you and on your social media and your office.

Speaker 1 51:24
Yeah, my social media is at Rachel's RX on Instagram. My website is rachelswanson.com You can you can find me there. And thank you so much for having me, Dr. K. I'm like, wait, it's it's already over. We we have so many other pillars to discuss. But thank you so much.

Dr. Kay Durairaj 51:41
Part two of the podcast, or come in if you're in LA. You got to come visit me.

Speaker 1 51:45
Yeah, absolutely. I would. I would love to. So, so yes to

Dr. Kay Durairaj 51:49
both. Love it. That's it for now, guys. Don't forget to find me on my Instagram. It's Beauty by Dr. K. It's D R K A Y. Doing amazing things with people, spaces, longevity, wellness, all of the things we're doing to rebuild that foundational health for our patients, and our website is the same beauty bydrcade.com. You can find my brand new peptide skincare lunch there. Great products that have GHK, copper, glutathione, NAD precursors, and collagen and elastin peptides. So wonderful, and I can't wait to teach you guys more about longevity, wellness, and how the insides reflect the outside, and find me here on podcast every Tuesday-a longer podcast-and Fridays we do a five-minute Friday. That's it for now, guys. Stay beautiful.

Transcribed by https://otter.ai