The Advanced Women’s Health Podcast

What do naturopathic doctors actually talk about behind the scenes? In this episode, we (Dr. Alessandra Autieri, Dr. Lauryn Dingwall and Dr. Maryellen Tedeschi) sit down together to share the biggest lessons we have learned from working with women every day at Advanced Women's Health. We talk about why the boring basics still matter most, why "my blood work is normal" is rarely the full story, and why a normal A1C does not always mean your blood sugar and insulin are working well. We also share why the women who get the best results usually have an aligned care team and a strong community behind them. Then we finish with a little fun: the wellness trends we actually love, our most non-ND habits, and our favourite part of being naturopathic doctors. In this episode: Why you have to major in the minors: sleep, movement, water, fibre and protein Why we talk about sleep before we send you to the gym Lifting weights, starting small and picking one habit you actually enjoy Setting health goals that match your values How we read blood work to find dysfunction, not just disease Normal A1C but still insulin resistant? Why we run an insulin glucose challenge Why insulin is often the hormone to test before estrogen and progesterone Your symptoms are real, even when the labs surprise you How collaborative care works, and why it helps you get better faster Community, support and why habits stick when you are not doing it alone Wellness trends we love: wearables, red light therapy for endometriosis and lymphatic drainage massage Our most non-ND habits (yes, dairy, gluten and balloon arches) What working with women has taught us about resilience Mentioned in this episode: The insulin glucose challenge test at Advanced Women's Health The Advanced Women's Health app and community programs Clinically guided programs at Advanced Women's Health, including Advanced Metabolic Rehab and fertility programming: info@advancedwomenshealth.ca Atomic Habits by James Clear

Do you need hormone replacement therapy? It is the question we get asked more than any other at Advanced Women's Health, so in the final part of the midlife core four, I answer it. In 2002, one study stopped hormone replacement therapy in its tracks. Prescribing dropped, research slowed, and a whole generation of women were told hormone replacement therapy would give them cancer or blood clots. When I started practice ten years ago, women were begging for it because their doctors would not consider it. Since then, that data has been analyzed again and again, and the risks were not what we were told for most women. The FDA has now removed the black box warning from some forms of hormone replacement therapy. So the pendulum is swinging. And now that hormone replacement therapy is having its moment, everyone is being told to just take it. Neither extreme serves you. In this episode, I walk through the safety research, the timing question, how we use hormones in perimenopause, and why hormones alone will make you feel better without necessarily making you healthier. In this episode: The 2002 Women's Health Initiative study, and why its conclusions did not apply to most women What hormone replacement therapy actually is: estradiol, progesterone, progestins and all the acronyms Bioidentical vs synthetic hormones, and why we prescribe bioidentical at Advanced Women's Health Is hormone replacement therapy safe? Why topical estradiol is the gold standard right now How the risk of hormone replacement therapy compares to obesity and to drinking more than four drinks a week Who should work with an oncologist or cardiologist before starting hormone replacement therapy Is it too late to start hormone replacement therapy? The old 7 to 10 year window, and why it is being rethought The four big reasons women stay on hormone replacement therapy long term: bone, brain, heart and hot flashes Why vaginal hormones are an option at any age Hormone replacement therapy in perimenopause: progesterone, the estrogen rollercoaster and low-dose hormones Why we test hormones, blood sugar, nutrients, gut and inflammation before we prescribe On-label vs off-label use, and what informed consent really means Why hormones are brush strokes, not a set-and-forget prescription A recap of the full midlife core four series Mentioned in this episode: Strategic consults at Advanced Women's Health, to map out all of your options At-home serial urine hormone testing Listen to the rest of the Core Four series: Episode 100: Is It Perimenopause or ADHD? Every Woman in Her 40s Needs to Hear This Episode 101: GLP-1s and Protein in Perimenopause: What to Know Before You Start

If you have found yourself wondering whether you need Ozempic, HRT, more protein, or an ADHD diagnosis all at once — this episode explains exactly why that is happening and what it actually means. In This Episode, We Answer: Why do so many women in their 40s suddenly feel like they have ADHD? Is perimenopause causing my brain fog and focus problems? What is the connection between hormones and ADHD symptoms? Why are women being put on ADHD medications they do not need? What is the midlife core four and why does Dr. Sarah talk about it? Quick Answers (FAQ): Q: Why do so many women in their 40s suddenly feel like they have ADHD? A: Estrogen supports brain function, focus, memory, and word retrieval. Progesterone calms the nervous system and reduces inflammation. When both begin to fluctuate unpredictably in perimenopause, the result looks clinically identical to ADHD. Add nutrient deficiencies and chronic nervous system overload, and the picture becomes nearly indistinguishable. We go deeper into this at 08:06. Q: Is perimenopause causing my brain fog and focus problems? A: Possibly, but it is more accurate to say perimenopause is revealing a problem that was already building. The hormone shift makes the brain less able to compensate for inflammation, blood sugar swings, and nutrient deficiencies that have been accumulating for years. We go deeper into this at 07:18. Q: What should I investigate before starting an ADHD medication? A: Blood sugar, fasting insulin, inflammatory markers, iron, B vitamins, and choline. If these have not been assessed and addressed, the ADHD-like symptoms may resolve without medication. If they do not, you now have a clearer picture of what the medication is working on top of. We go deeper into this at 17:28. Q: What is the midlife core four? A: The four things Dr. Sarah hears about most in clinic for women in their 40s and 50s: GLP-1 medications, hormone replacement therapy, protein intake, and ADHD. They cluster together because they share the same root drivers — hormonal instability, insulin dysregulation, inflammation, and nervous system overload. We go deeper into this at 01:02. Connect With Us: Website: advancedwomenshealth.ca Instagram: @drsarah_nd | @advancedwomenshealth Book an appointment: advancedwomenshealth.ca Email for programs: info@advancedwomenshealth.ca Leave a review: wherever you are listening, it helps other women find this episode

If you have been told you are too young for perimenopause, your labs look fine, and you should just manage your stress — this episode is the conversation your doctor should have had with you. In This Episode, We Answer: Can you have perimenopause symptoms before your periods change? Why do my hormone labs look normal if I feel terrible? What does insulin have to do with menopause weight gain? Should I do a nutrition program before starting a GLP medication? Why do I feel like a completely different person? Key Takeaways: You can be fully symptomatic with anxiety, brain fog, sleep disruption, and mood changes years before you are technically perimenopausal by lab criteria. The late reproductive stage is real, it is under-discussed, and standard FSH and LH testing on a single day will miss it. You deserve help regardless of whether you fit a label. Insulin has been more directly associated with hot flashes, night sweats, menopausal weight gain, anxiety, and cognitive changes than reproductive hormones. A normal HbA1c does not rule out insulin dysregulation. A fasting insulin test is inexpensive and changes everything about how a plan is built. The best-performing GLP-1 studies had a three-month nutrition primer built in before starting medication. That nutritional education and habit formation is what produced better sustained results. This is what the headlines do not tell you. Quick Answers (FAQ): Q: Can you have perimenopause symptoms before your periods change? A: Yes. The late reproductive stage can begin in the late 30s and early 40s. Hormone levels on a single blood draw may appear normal while daily fluctuations are already causing anxiety, brain fog, sleep disruption, and mood changes. We go deeper into this at 06:43. Q: Why do my hormone labs look normal if I feel terrible? A: Standard FSH, LH, and estradiol testing on one day gives a single snapshot. Hormones genuinely fluctuate day to day in this stage, meaning a normal reading does not confirm a normal experience. We go deeper into this at 07:47. Q: What does insulin have to do with menopause weight gain? A: Insulin is a storage hormone. When it stays elevated, fat cells are locked in storage mode regardless of how little you eat. Eating less when insulin is high is like making less money when your savings account is locked — the checking account still feels empty. Lowering insulin unlocks fat burning. We go deeper into this at 14:04. Q: Should I do a nutrition program before starting a GLP medication? A: The trials that produced the best GLP-1 results included a three-month nutrition primer before the medication started. Participants learned macronutrient principles, built habits, and changed their relationship with food before the drug was introduced. Results were significantly better at 12 and 24 months. We go deeper into this at 22:38. Q: Why do I feel like a completely different person in perimenopause? A: Hormone fluctuations affect brain function, mood regulation, sleep, and stress response. The late reproductive stage adds a layer of inconsistency — good days and bad days with no predictable pattern — that makes women feel like they no longer know themselves. We go deeper into this at 06:43. Resources Mentioned: Andrea Donsky: @ andreadonsky on Instagram Menopause Reimagined Podcast Nourishing Menopause by Andrea Donsky: available at most Canadian bookstores and on Amazon in the US Website: wearemorphis.com⁠ Connect With Us: Website: advancedwomenshealth.ca Instagram: @drsarah_nd | @advancedwomenshealth Book an appointment: advancedwomenshealth.ca Leave a review: wherever you are listening, it helps other women find this episode The Advanced Women's Health Podcast is hosted by Dr. Sarah Wilson, ND, naturopathic doctor, clinic founder, and obesity and immunology researcher. This episode is crossposted with the Menopause Reimagined podcast by Andrea Donsky.

If you have ever wondered why your immune system turned on you, why it happened when it did, and why it seems to happen to women so much more than men — this episode has the clearest answer you will find anywhere. In This Episode, We Answer: Why do women get autoimmune disease more than men? What does estrogen have to do with autoimmunity? Can EBV (Epstein-Barr virus) cause Hashimoto's thyroiditis? Did COVID trigger my autoimmune disease? Is leaky gut real and what are doctors getting wrong about it? Key Takeaways: Women make up roughly 78 to 80% of autoimmune disease patients. The three most vulnerable windows are postpartum (the most common), perimenopause into menopause (where conditions like MS most often appear), and puberty. Estrogen gives women a more robust immune system overall but also makes it more likely to misfire into autoimmunity. The gut is accurately rated as important, but the treatment is where things break down. Gut lining integrity is the most underaddressed piece right now. Antimicrobials and elimination diets address bugs and food, but they cannot fix a lining that is already eroded. And you cannot eliminate all exposures when the lining is what is broken. Chronic illness is never just one thing. EBV, COVID, mold, Lyme, Bartonella, and Babesia are almost always found together with multiple stressors. Testing for one and treating one while ignoring the constellation is why so many people stay stuck. Quick Answers (FAQ): Q: Why do women get autoimmune disease more than men? A: Before puberty, boys have more immune dysfunction. After puberty, the pattern reverses because estrogen significantly amplifies immune activity — which protects women from infections but also makes autoimmune misfiring more likely. The three most vulnerable windows are postpartum, perimenopause into menopause, and puberty. We go deeper into this at 00:42. Q: Can EBV or mono cause Hashimoto's thyroiditis? A: Yes, there is a well-documented link. EBV establishes lifelong latency in B cells and reactivates when the immune system is stressed. Through a process called molecular mimicry, antibodies made to fight EBV proteins can mistakenly target thyroid tissue because the proteins look similar. We go deeper into this at 19:00. Q: Did COVID trigger my autoimmune disease? A: Possibly, or it accelerated the onset of something you were already predisposed to. COVID's ACE2 receptor gave it access to far more tissues than most viruses, creating widespread inflammation and a higher chance of immune confusion. New research suggests COVID may accelerate disease onset in genetically predisposed people rather than cause it outright. We go deeper into this at 17:00. Q: Is leaky gut real? A: Increased intestinal permeability is a real, measurable phenomenon seen in celiac disease and IBD. The debate is whether it is a cause or a consequence of chronic illness. Dr. Sarah's take: it is part of a system, not a single lock with a single key. Fix the lining without addressing the causes of lining breakdown and nothing sticks. We go deeper into this at 11:30. Connect With Us: Website: advancedwomenshealth.ca Instagram: @drsarah_nd | @advancedwomenshealth Book an appointment: advancedwomenshealth.ca Leave a review: wherever you are listening, it helps other women find this episode The Advanced Women's Health Podcast is hosted by Dr. Sarah Wilson, ND, naturopathic doctor, clinic founder, and obesity and immunology researcher. Subscribe so you never miss an episode.

If you have ever wondered how a naturopathic doctor connects brain fog, anxiety, bloating, and irregular periods into one cohesive plan this episode shows you exactly how that thinking works. In This Episode, We Answer: What happens at a first naturopathic appointment? Why do my symptoms feel so unrelated but my ND says they are connected? What is the AWH clinical framework and how does it work? Why are hormones not always the first thing an ND treats? How many appointments does it take to actually feel better? Key Takeaways: Every symptom on your list can be connected back to dysfunction in the same five to seven areas: blood sugar and insulin, gut health, liver health, nutrient deficiencies, nervous system, mitochondrial health, and immune or inflammatory dysfunction. This is why your ND is not treating symptoms individually but looking for the two to three root systems driving most of them. Hormones are not always treated first, but sometimes they are. If a patient is so depleted that they cannot make lifestyle changes, a hormone win can give them the energy and capacity to do the foundational work. It is not hormones versus foundations — it is how to tie them together. The two-week win matters. AWH practitioners aim for at least one clear improvement between every appointment. Health is not linear, and every appointment involves asking where you are now, where you have been, and where you are headed next. Resources Mentioned: AWH daily lunchtime clinical rounds: mentioned as an internal team tool for collaborative patient care Continuous glucose monitor: used at AWH for monitoring blood sugar in the maintenance phase Heart rate variability via smartwatch: used to monitor nervous system and stress response BIA (bioelectrical impedance analysis): used to monitor muscle mass Book an appointment: advancedwomenshealth.ca Advanced Men's Health: advancedmenshealth.ca Related Episodes: Episode 86: Metabolic Rehab Type 1, insulin and insulin resistance Episode 87: Metabolic Rehab Type 2, stress and liver dysfunction Episode 88: Metabolic Rehab Type 3, gut hormones and inflammation Episode 80: Mitochondria and fatigue with Dr. Sasha and Dr. Bianca Connect With Us: Website: advancedwomenshealth.ca Instagram: @drsarah_nd | @advancedwomenshealth Book an appointment: advancedwomenshealth.ca Leave a review: wherever you're listening, it helps other women find this episode The Advanced Women's Health Podcast is hosted by Dr. Sarah Wilson, ND. This episode features Dr. Ally and Dr. Bianca, naturopathic doctors at Advanced Women's Health. Subscribe so you never miss an episode.

f you have been curious about Botox, filler, or any aesthetic treatment but do not know where to start or who to trust, this is the episode to listen to first. In This Episode, We Answer: Is Botox safe and does it work long term? What is the difference between filler and Sculptra? What is PRF and how is it different from PRP? What should I look for when choosing an injector? What are the real risks of dermal filler I should know about? Key Takeaways: A good injector says no. If someone is giving you a laundry list of everything you need the moment you walk in, that is not the approach that produces the most natural results. Find someone who gives you the mirror first and asks what you love about your face. Vascular occlusion is rare but real, and every patient should know what to look for: severe pain that is getting worse not better, skin that turns white and does not refill with color. If your injector has not told you this, that is a red flag. Filler lasts longer than the product monograph says, especially high density fillers. Many people are adding to filler that is still present, which is how over-augmentation happens. Ask your injector to review your before photos before adding more. Quick Answers (FAQ): Q: Is Botox safe and does it work long term? A: Yes. The 2006 Botox twin study showed that one twin who received Botox consistently for 13 years looked significantly younger than the twin who had one or two treatments. The key is consistency and appropriate dosing. When Botox wears off, you return to where you were before, not worse. We go deeper into this at 38:30. Q: What is the difference between filler and Sculptra? A: Filler (hyaluronic acid) adds volume immediately and is dissolvable. Sculptra (polylactic acid) is a biostimulator that is reabsorbed after injection, then gradually stimulates your body to produce its own collagen over three to six months. Results from Sculptra can last up to two years. We go deeper into this at 27:00. Q: What is PRF and how is it different from PRP? A: Both are blood concentrates where your blood is spun in a centrifuge. PRF is spun slower and retains white blood cells including mesenchymal stem cells, creating a more concentrated healing response. Unlike filler, PRF cannot cause migration, allergic reaction, or lumps. Dr. Nicola uses it particularly for under-eye hollowing and brightness. We go deeper into this at 13:30. Q: What are the real risks of dermal filler? A: Common risks include bruising, swelling, and soreness. The more serious but rare risk is vascular occlusion, where filler blocks a blood vessel. If caught early and dissolved, it can be reversed. Signs include severe pain getting worse, and skin that turns white and stays white. In extremely rare cases, injections near the nose and glabella have caused blindness due to vascular anatomy in that area. We go deeper into this at 33:30. Resources Mentioned: Botox twin study (2006): search "Botox twin study" to find the photos Procedures discussed: Botox/Dysport/Xeomin, dermal filler, PRF, microneedling, Sculptra, HydraFacial, BBL, Moxie Laser Genesis, Morpheus8 Book with Dr. Dasha or Dr. Nicola: advancedwomenshealth.ca Related Episodes: Episode 83: Hidradenitis Suppurativa with Dr. Dasha — skin conditions from the inside out Connect With Us: Website: advancedwomenshealth.ca Instagram: @drsarah_nd | @advancedwomenshealth Book with Dr. Nicola (Squamish) or Dr. Dasha (Vancouver): advancedwomenshealth.ca Leave a review: wherever you're listening, it helps other women find this episode

If you have been told your hormones look fine but something still feels off, this episode explains what most fertility workups are missing. In This Episode, We Answer: What should my hormone levels look like throughout my cycle? What does low or high estradiol in the first half of my cycle mean? Why does progesterone matter for getting and staying pregnant? What does blood flow have to do with fertility? What are the signs that circulation to my ovaries might be affected? Key Takeaways: A single progesterone blood test seven days after ovulation is not enough to assess luteal health. What matters is the level, the stability across multiple days, and the length of the luteal phase. A short luteal phase can cause early pregnancy loss before you even know you were pregnant. All the egg quality supplements in the world only work if those nutrients can actually reach the ovaries via healthy blood flow. Circulation is the missing piece that connects everything else — hormones, egg quality, brain-ovary communication, and lining thickness. Post-viral changes, including changes associated with COVID, have measurably reduced ovarian blood flow in many patients. If you have experienced any circulatory symptoms since a viral illness and are on a fertility journey, blood flow should be part of your conversation. Resources Mentioned: Mira: at-home urinary hormone monitor used at AWH for cycle tracking across the full month AWH Fertility Program: clinically guided fertility programming launching soon, info@advancedwomenshealth.ca Acupuncture for fertility: discussed in context of circulation, egg quality, and stress response Red light therapy belts: emerging research in fertility and mitochondrial health Egg quality supplements mentioned: CoQ10, B vitamins, carnitine, N-acetylcysteine, resveratrol, vitamin E, vitamin C, Vitex/chaste tree Book a fertility consult: advancedwomenshealth.ca Related Episodes: Fertility Masterclass Part 1: Are You Actually Ovulating? Fertility Masterclass Part 2: The Immune System's Role in Getting and Staying Pregnant Episode 86: Metabolic Rehab Type 1, insulin and insulin resistance Episode 88: Metabolic Rehab Type 3, gut hormones and inflammation Coming next: Fertility Masterclass Part 4, structural anatomy and can egg and sperm actually meet Connect With Us: Website: advancedwomenshealth.ca Instagram: @drsarah_nd | @advancedwomenshealth Book a fertility consult: advancedwomenshealth.ca Fertility programming inquiries: info@advancedwomenshealth.ca Leave a review: wherever you're listening, it helps other women find this episode

If you have been told your painful periods are normal, your recurrent UTIs are just bad luck, or your fatigue is just stress, this episode is the conversation you have been waiting for. In This Episode, We Answer: What is endometriosis and who can have it? Can you have endometriosis without fertility problems? What are the symptoms of endometriosis beyond painful periods? What does endometriosis have to do with gut health? Does stress make endometriosis worse? Key Takeaways: Endometriosis is an immune condition, not just a hormonal one. The tissue responds to hormones, but the root is immunological. This is why it shows up after menopause, after hysterectomy, and in people with no menstrual symptoms at all. Recurrent UTIs with negative cultures, period-related digestive chaos, cyclical fatigue, hip pain that comes and goes, shortness of breath with your cycle — all of these can be endometriosis. The symptom picture is far wider than most people are told. Chronic stress makes endometriosis worse in two distinct ways: it causes lesion growth directly, and it sensitizes pain pathways so that the same signals produce more intense pain. Addressing the nervous system is not optional in endo treatment — it is part of the protocol. Quick Answers (FAQ): Q: Can you have endometriosis without fertility problems? A: Yes. Many people with endometriosis have no fertility issues. Some have no menstrual symptoms at all. The disease does not always produce the symptoms you would expect, and symptoms do not correlate with disease severity. We go deeper into this at 09:52. Q: What does endometriosis have to do with gut health? A: The abdomen is like a pool. Endometrial lesions create inflammatory chaos that affects every organ in that space, including the bowel. This causes diarrhea, constipation, incomplete evacuation, reflux, and nausea. And gut bacteria determine 40 to 60% of insulin signaling, which drives lesion growth. Gut health and endo are bidirectional. We go deeper into this at 10:18. Q: Does stress make endometriosis worse? A: Yes, in two measurable ways. Chronic stress directly causes endometrial lesions to grow. It also causes central sensitization, where the nervous system over-responds to pain signals, making existing pain significantly worse. We go deeper into this at 20:13. Q: What are the symptoms of endometriosis beyond painful periods? A: Recurrent UTIs with negative cultures, cyclical fatigue, lightning rod rectal pain, digestive symptoms that worsen with your cycle, pain with a full bladder, hip or rib pain that comes and goes monthly, shortness of breath with menses, and deep pain with intercourse. We go deeper into this at 06:26. Resources Mentioned: Related episodes: Episode 27 and Episode 30 with Dr. Lauryn Dingwall on endometriosis and fertility EMDR, somatic therapy, and hypnotherapy: referenced as nervous system tools used alongside medical and naturopathic treatment Book a visit: advancedwomenshealth.ca Email: info@advancedwomenshealth.ca Related Episodes: Episode 27: Endometriosis and Fertility with Dr. Lauryn Dingwall Episode 30: Endometriosis and Fertility Part 2 with Dr. Lauryn Dingwall Episode 92: Fertility Masterclass Part 2, the immune system's role in getting and staying pregnant Episode 88: Metabolic Rehab Type 3, gut hormones and inflammation Connect With Us: Website: advancedwomenshealth.ca Instagram: @drsarah_nd | @advancedwomenshealth Book an appointment: advancedwomenshealth.ca Leave a review: wherever you're listening, it helps other women find this episode

Up to 80% of pregnant people receive advice that directly contradicts current medical evidence — this episode cuts through the noise. In This Episode, We Answer: Can I drink coffee while pregnant? Is it safe to have sex during pregnancy? Should I be exercising while pregnant? Am I really eating for two? Do I need to "bounce back" after having a baby? Key Takeaways: Up to 200 milligrams of caffeine per day is safe during pregnancy according to current guidelines. That is roughly one 12-ounce cup of brewed coffee or two shots of espresso. Matcha is about 40 to 60 milligrams per cup. Exercise during pregnancy is not only safe, it is recommended. The 140 beats per minute heart rate cap has been removed. Canada's 2019 guidelines recommend working up to 150 minutes per week at moderate intensity, and research shows blood flow to the baby is protected even during high-intensity exercise. "Bounce back" is not a health goal. Your brain, your body, and your physiology have been reprogrammed in pregnancy to optimize your new role. Postpartum recovery involves your pelvic floor, your core, your hormones, your mental health, and your energy — not just what you see in the mirror. Quick Answers (FAQ): Q: Can I drink coffee while pregnant? A: Yes, in moderation. Current guidelines recommend staying under 200 milligrams of caffeine per day. That is one 12-ounce brewed coffee or two espresso shots. Matcha is lower at 40 to 60 milligrams per cup. We go deeper into this at 03:45. Q: Is sex safe during pregnancy? A: Yes, for most pregnancies. There are specific medical conditions like placenta previa, cervical insufficiency, and preterm premature rupture of membranes where pelvic rest is prescribed, and your provider will tell you if that applies to you. Otherwise there is no contraindication. We go deeper into this at 05:30. Q: Should I be exercising while pregnant? A: Yes. The old 140 beats per minute heart rate cap has been removed. Canada's 2019 guidelines recommend 150 minutes per week of moderate-intensity activity. Research using fetal heart rate monitoring during exercise has shown that blood flow to the baby is protected, even at high intensities. We go deeper into this at 10:15. Q: How much extra food do I actually need during pregnancy? A: Almost none in the first trimester. A modest increase in the second trimester and a bit more in the third. "Eating for two adults" is not what the evidence supports. We go deeper into this at 15:00. Resources Mentioned: Canada's 2019 Pregnancy-Specific Physical Activity Guidelines (free access online) Related Episodes: Fertility Masterclass Part 1: Are You Actually Ovulating? Fertility Masterclass Part 2: The Immune System's Role in Getting and Staying Pregnant Coming next in the fertility series: circulation and structural fertility Connect With Us: Website: advancedwomenshealth.ca Instagram: @drsarah_nd | @advancedwomenshealth Book an appointment: advancedwomenshealth.ca Leave a review: wherever you're listening, it helps other women find this episode

If you have a regular period and assume that means you are ovulating, this episode will change how you understand your cycle, your hormones, and your fertility. In This Episode, We Answer: How do I know if I'm actually ovulating? What does AMH actually mean and is mine too low? Can I have a regular period and still not ovulate? Why does it take so long to get a fertility diagnosis? What blood tests should I ask for if I'm trying to conceive? Key Takeaways: Having a regular period does not mean you are ovulating. A bleed can occur without ovulation, and the only way to confirm ovulation is by tracking LH, progesterone, and estrogen through the cycle. Not just on day 2 or 3. AMH is a useful marker of ovarian reserve but it is not the complete picture. Primordial follicle pools do not contribute to AMH. A low AMH with a normal antral follicle count can indicate ovarian inflammation, stress, or follicles stuck in arrest, not necessarily permanent diminished reserve. Not ovulating has consequences far beyond fertility. Progesterone and estrogen affect the immune system, brain health, glucose metabolism, muscle development, sleep quality, and inflammation. If you are not ovulating at any age, it is worth understanding why. Quick Answers (FAQ): Q: How do I know if I'm actually ovulating? A: A period alone does not confirm ovulation. You need to track LH and progesterone across your full cycle. At-home urinary hormone monitors like Mira can show you the full picture. Blood work on cycle day 2 to 4 (FSH, LH, estradiol) plus a progesterone test 7 days after ovulation gives a clearer view. We go deeper into this at 07:00. Q: What does AMH actually mean and is mine too low? A: AMH (anti-Mullerian hormone) is a marker of how many follicles are actively developing, not a direct count of all your eggs. Primordial follicles, which are eggs in reserve, do not contribute to AMH. A low AMH does not necessarily mean you have no eggs. It can mean your follicles are stuck and not being recruited due to inflammation or stress. We go deeper into this at 18:00. Q: Can I have a regular period and still not ovulate? A: Yes. Dr. Sarah describes a patient who bled every 30 to 40 days but had no evidence of ovulation on cycle monitoring. The bleed was not a true period because no egg had been released and no progesterone had been made. We go deeper into this at 09:30. Q: What blood tests should I ask for if I'm trying to conceive? A: At minimum: FSH, LH, and estradiol on cycle day 2 to 4. AMH. Progesterone 7 days post-ovulation. Prolactin. Thyroid (TSH, T3, T4, anti-TPO, anti-TG). Two-hour insulin and glucose challenge test. Inflammatory markers (ESR, CRP). HbA1c, vitamin D, iron, ferritin. If PMOS or PCOS is suspected, add testosterone and DHEA. We go deeper into this at 49:00. Resources Mentioned: Mira: at-home urinary hormone monitor used at AWH for cycle tracking AWH Fertility Fellowship: advanced fertility training for AWH practitioners Nature article referenced: "Anti-Mullerian Hormone as an Ovarian Reserve Marker in Primary Ovarian Insufficiency" Book a fertility consult: advancedwomenshealth.ca Email the team: info@advancedwomenshealth.ca Advanced Men's Health (sperm-side fertility): advancedmenshealth.ca Related Episodes: Episode 81: PCOS is now PMOS, what does it mean for you Episode 86: Metabolic Rehab Type 1, insulin and insulin resistance Connect With Us: Website: advancedwomenshealth.ca Instagram: @drsarah_nd | @advancedwomenshealth Book a fertility consult: advancedwomenshealth.ca Email: info@advancedwomenshealth.ca Leave a review: wherever you're listening, it helps other women find this episode

If you have been wondering why your supplements and fitness routine are not moving the needle, Dr. Sarah is answering the questions patients are actually asking in clinic. In This Episode, We Answer: Is muscle mass really that important for inflammation and metabolism? How much protein do I actually need to build muscle? Does my protein intake change if I have insulin resistance? Are probiotics actually worth taking? Do I need to worry about pre- and post-workout nutrition before fixing my basics? Key Takeaways: Muscle is not just for strength. It is your main glucose disposal site, a source of immune-signaling compounds called myokines, and a key factor in bone health, insulin sensitivity, and longevity. Building and preserving it is one of the highest-yield things you can do for your health at any age. Your protein requirements depend on your metabolic state. A metabolically healthy person and someone with insulin resistance need different amounts and types of protein to stimulate muscle growth. One gram per pound is a reference for healthy people, not a universal prescription. Most people do not need a probiotic. In many cases, gut symptoms come from too many bacteria, not too few. Adding a probiotic to an already-overgrown environment can make symptoms worse. The more important question is why the terrain allowed those bugs to overgrow in the first place. Quick Answers (FAQ): Q: Is muscle mass really that important for inflammation and metabolism? A: Yes. Muscle is your main glucose disposal site, produces immune-signaling compounds called myokines, supports bone density, and plays a direct role in regulating inflammation. The research shows low muscle mass and high inflammation are closely correlated, though the causation runs both ways. We go deeper into this at 03:45. Q: How much protein do I actually need to build muscle? A: For metabolically healthy people eating animal-based protein, 25 to 30 grams per meal is enough to trigger muscle protein synthesis via leucine. But this number changes significantly if you have insulin resistance, high inflammation, or are older. There is no universal answer without knowing your metabolic state. We go deeper into this at 10:45. Q: Are probiotics actually worth taking? A: Sometimes, but most people do not need them. Many gut symptoms come from bacterial overgrowth, not bacterial deficiency. Adding more bacteria to an overloaded environment worsens symptoms. The goal is to understand why the terrain allowed the overgrowth and fix that, rather than use a probiotic as a long-term fix. We go deeper into this at 25:00. Q: Do I need to worry about pre and post-workout nutrition before fixing my basics? A: No. If you are dealing with insulin resistance, the priority is getting your general daily meals right first: protein at every meal, stable blood sugar, consistent timing. Micromanaging your post-workout protein shake while eating a chocolate chip muffin for breakfast is backwards. We go deeper into this at 19:30. Resources Mentioned: Advanced Metabolic Rehab program: advancedwomenshealth.ca Clinically guided programs: info@advancedwomenshealth.ca Advanced Men's Health: advancedmenshealth.ca Dr. Sam: Dr. Samantha Maloney, ND, AWH Brooklyn/Whitby location

If what used to work has stopped working and nobody can tell you why, this episode is for you. In This Episode, We Answer: Why am I gaining belly fat in perimenopause when nothing in my diet changed? What is visceral fat and why is it different from regular fat? Can perimenopause start in your 30s? Why can't I lose weight no matter what I do in perimenopause? What labs should I get to understand my hormones and metabolism? Key Takeaways: Perimenopause is not just a hormonal event. It is a metabolic one. When hormones fluctuate rapidly, the body shifts from depositing subcutaneous fat (under the skin) to visceral fat (around the organs). These two types of fat do not respond to the same interventions. Caloric restriction and resistance training alone are not enough to address visceral fat in perimenopause. The research is clear on this. You also need Zone 2 cardio, specific protein and carbohydrate targets, and a plan that preserves muscle while losing visceral fat. DHEA is what Dr. Sarah calls the secret hormone of resilience. When levels are appropriate for your age, it supports metabolic resilience, stress resilience, and muscle mass. It is almost never tested in standard care and almost always worth checking. Quick Answers (FAQ): Q: Why am I gaining belly fat in perimenopause when nothing in my diet changed? A: Rapid hormone fluctuation causes the body to shift from depositing fat under the skin to depositing it around the organs. This visceral fat does not respond to the same strategies as other fat and requires a different approach. We go deeper into this at 11:25. Q: What is visceral fat and why is it different from regular fat? A: Subcutaneous fat sits under your skin. Visceral fat sits around your organs in your abdomen. Visceral fat is metabolically active in a way that drives inflammation, insulin resistance, and cardiovascular risk, and it does not respond as well to caloric restriction or standard resistance training alone. We go deeper into this at 11:25. Q: Can perimenopause start in your 30s? A: Yes. Perimenopause is defined as the 2 to 10 years before menopause, and for some women that window begins in their late 30s. Hormonal fluctuation-based weight changes can also happen postpartum and when going on or off hormonal contraceptives at any age. We go deeper into this at 09:36. Q: What labs should I get to understand my hormones and metabolism? A: For this pattern, Dr. Sarah looks at DHEA, morning cortisol, a two-hour insulin and glucose challenge test, inflammatory markers, lipids (HDL, LDL, triglycerides), and a liver panel. Together these build a metabolic map of what your body is doing with glucose and fat. We go deeper into this at 17:23. Resources Mentioned: Visceral Adiposity Index calculator: https://www.advancedwomenshealth.ca/vai-calculator Advanced Metabolic Rehab program: advancedwomenshealth.ca Clinically guided programs: info@advancedwomenshealth.ca Advanced Men's Health: advancedmenshealth.ca Related Episodes: Episode 86: Metabolic Rehab Type 1, insulin and insulin resistance Episode 87: Metabolic Rehab Type 2, stress and liver dysfunction Episode 88: Metabolic Rehab Type 3, gut hormones and inflammation Connect With Us: Advanced Men's Health: advancedmenshealth.ca Instagram: @drsarah_nd | @advancedwomenshealth Book an appointment: advancedwomenshealth.ca Clinically guided programs: info@advancedwomenshealth.ca Leave a review: wherever you're listening, it helps other women find this episode The Advanced Women's Health Podcast is hosted by Dr. Sarah Wilson, ND, naturopathic doctor, clinic founder, and obesity and immunology researcher. This is the final episode in the four-part Metabolic Rehab series.

If you have been told bloating, joint pain, allergies, and weight gain are unrelated, this episode connects the dots. In This Episode, We Answer: Why can't I lose weight even though I eat well? Is my gut health affecting my weight? What do gut bacteria have to do with fat storage? Why do I have such bad food cravings and food noise? What is inflammation doing to my metabolism? Key Takeaways: Ozempic, Wegovy, and tirzepatide are synthetic versions of hormones your gut makes naturally. When those gut hormones drop from yo-yo dieting, poor diet, or gut bacteria imbalance, weight loss becomes very hard regardless of effort. Your gut bacteria affect how many calories you extract from food, what hormones tell your body to store or burn fat, and what cravings you experience. This is biology, not willpower. A probiotic alone will not fix this. The pattern requires testing first (ESR, CRP, urate) to understand what is driving the inflammation, then a personalized plan based on those results. Quick Answers (FAQ): Q: Why can't I lose weight even though I eat well? A: Your gut bacteria may be extracting more calories from your food, lowering the gut hormones that control fat storage, and sending cravings signals to your brain that override your intentions. We go deeper into this at 12:00. Q: What do gut bacteria have to do with fat storage? A: In mice studies, transplanting gut bacteria from an obese mouse into a lean mouse causes the lean mouse to gain weight. In humans, giving lean microbiome bacteria to an obese person causes rapid weight loss. These bacteria are directly controlling the hormones that decide whether your body stores or burns fat. We go deeper into this at 12:30. Q: Why do I have such bad food cravings and food noise? A: The bacteria in your gut send signals to your brain instructing it to seek high-fat, high-sugar foods, because those foods feed the bacteria. The food noise you are experiencing may be coming from the bugs in your system, not from a lack of willpower. We go deeper into this at 13:00. Q: Is my gut health affecting my weight? A: Yes, and in multiple ways: calorie extraction, gut hormone production, insulin signaling, inflammation levels, and cravings. We go deeper into all of this starting at 11:30. Resources Mentioned: Advanced Metabolic Rehab program: advancedwomenshealth.ca Clinically guided programs inquiry: info@advancedwomenshealth.ca Advanced Men's Health: advancedmenshealth.ca Herbs mentioned: berberine, nigella (black cumin seed), resveratrol, glutamine, N-acetylglucosamine Related Episodes: Episode 86: Metabolic Rehab Type 1, insulin and insulin resistance Episode 87: Metabolic Rehab Type 2, stress and liver dysfunction Metabolic Rehab Type 4: Perimenopause and Visceral Fat, coming next in this series Connect With Us: Website: advancedwomenshealth.ca Advanced Men's Health: advancedmenshealth.ca Instagram: @drsarah_nd | @advancedwomenshealth Book an appointment: advancedwomenshealth.ca Clinically guided programs: info@advancedwomenshealth.ca Leave a review: wherever you're listening, it helps other women find this episode The Advanced Women's Health Podcast is hosted by Dr. Sarah Wilson, ND, naturopathic doctor, clinic founder, and obesity and immunology researcher. Subscribe so you don't miss the final episode in this series.

If you gain weight in your middle when you're stressed, can't tolerate things you used to, and feel like diet and exercise are making things worse, this episode explains why. In This Episode, We Answer: Why do I gain weight when I'm stressed even if I'm not eating more? Why is my belly fat not responding to diet and exercise? What is cortisol actually doing to my weight? Does stress cause fat storage? Why do I feel flat, unmotivated, and burnt out all the time? Key Takeaways: Stress causes your liver to release glucose into your bloodstream. When you're sitting at a desk, that glucose has nowhere to go except fat cells. This is called auto-generating fat, and it happens completely independent of what you eat. Eating less and exercising more can make this pattern worse. If your body reads calorie restriction and intense exercise as additional stressors, it generates more fat, not less. Cortisol isn't the whole story. The initial stress response (fight, flight, freeze, fawn) runs on epinephrine and norepinephrine. Cortisol comes about 20 to 30 minutes later. Both matter, and they affect your metabolism differently. Quick Answers (FAQ): Q: Why do I gain weight when I'm stressed even if I'm not eating more? A: Cortisol signals your liver to release glucose into the blood. Since you're not moving, that glucose converts to fat. It's independent of food. We go deeper into this at 13:45. Q: Why is my belly fat not responding to diet and exercise? A: If stress is auto-generating fat, no amount of calorie restriction or cardio will outrun it. You need to address the cortisol and liver piece first. We go deeper into this at 14:30. Q: What is cortisol actually doing to my weight? A: Cortisol on a healthy circadian rhythm is beneficial. When it stays persistently elevated, it drives glucose dysregulation, fat storage, and eventually hormone and immune dysfunction. We go deeper into this at 12:00. Q: Why do I feel flat, unmotivated, and burnt out all the time? A: After years of chronic stress, the body starts to shut down the stress response because it isn't helping. That shows up as flatness, low drive, and feeling switched off. It's a physiological pattern, not a personality problem. We go deeper into this at 16:00. Resources Mentioned: Advanced Metabolic Rehab program: advancedwomenshealth.ca Clinically guided programs inquiry: info@advancedwomenshealth.ca Advanced Men's Health: advancedmenshealth.ca Heart rate variability tracking: Oura Ring, WHOOP, Fitbit (mentioned as tools used in-clinic) Continuous glucose monitors (CGM): used in-clinic for real-time stress and glucose tracking Related Episodes: Episode 86: Metabolic Rehab Type 1, insulin and insulin resistance Metabolic Rehab Type 3: Fat and Inflammation, coming next in this series Metabolic Rehab Type 4: Perimenopause and Visceral Fat, coming this summer Connect With Us: Website: advancedwomenshealth.ca Advanced Men's Health: advancedmenshealth.ca Instagram: @drsarah_nd | @advancedwomenshealth Book an appointment: advancedwomenshealth.ca Clinically guided programs: info@advancedwomenshealth.ca Leave a review: wherever you're listening, it helps other women find this episode

If you've ever felt like you're doing everything right and still can't lose weight, this episode is for you. In This Episode, We Answer: Why can't I lose weight no matter what I do? Is my metabolism broken? How does insulin resistance affect weight? What labs should I get to understand my metabolism? Why do I crave sugar so badly? Key Takeaways: Insulin is a storage hormone, not just a number on a lab. When it stays high all the time, your body can't access stored fat for energy, no matter how little you eat. Feeling hangry between meals (that hungry, shaky, angry combination) often isn't actual low blood sugar. It's your brain sensing it can't access fuel efficiently, which creates a stress response on its own. A standard ferritin test can miss anemia entirely if you're also inflamed. Ask your doctor for a full iron panel, not just ferritin alone. Resources Mentioned: Advanced Metabolic Rehab system: advancedwomenshealth.ca Advanced Men's Health (partner support): advancedmenshealth.ca Finally Lose It: A professional woman's guide to stop dieting, fix your hormones and overcome weight loss resistance Related Episodes coming next in this series: Metabolic Rehab Type 2: Fat and Inflammation Metabolic Rehab Type 3: Perimenopause and Visceral Fat Metabolic Rehab Type 4: Stress, the Liver, and Weight Connect With Us: Website: advancedwomenshealth.ca Advanced Men's Health (partner support): advancedmenshealth.ca Instagram: @drsarah_nd | @advancedwomenshealth Book an appointment: advancedwomenshealth.ca Leave a review: wherever you're listening, it helps other women find this episode. Quick Answers (FAQ): Q: Why can't I lose weight no matter what I do? A: Weight loss is driven by hormones, not just calories. If insulin stays elevated even after fasting overnight, your body never gets the signal to burn stored fat. We go deeper into this at 12:04. Q: Is my metabolism broken? A: Probably not broken, but it may be stuck communicating the wrong message. Insulin tells your body whether to store or burn fuel. When that signal stays stuck on "store," weight loss becomes hard regardless of effort. We go deeper into this at 08:34. Q: What labs should I get to understand my metabolism? A: A fasting glucose and HbA1c only show part of the picture. A two-hour insulin and glucose challenge test, plus markers like uric acid and free fatty acids, show what's actually happening when you eat. We go deeper into this at 17:55. Q: Why do I crave sugar so badly? A: When your body can't efficiently access stored fuel between meals, your brain senses a shortage and pushes you toward quick energy, usually sugar or refined carbs. We go deeper into this at 13:58.

Dizziness. Headaches. Random food reactions. Bloating. Palpitations. Period pain that doesn't make sense. If you've been collecting diagnoses — endometriosis, MCAS, POTS — and seeing a different specialist for each one, this episode is going to connect the dots no one else has. Dr. Michelle and Dr. Karina dive deep into histamine, mast cells, and how conditions that seem completely unrelated are often driven by the same underlying mechanisms. In this episode they cover: What histamine actually is — an inflammatory messenger released by mast cells, and why antihistamines only block one piece of a much bigger puzzle The gut-histamine connection — how gut bacteria imbalances increase histamine production, and why some people react to foods they were totally fine with yesterday Mast Cell Activation Syndrome (MCAS) — a systemic, more intense version of histamine intolerance, with symptoms ranging from skin flushing and hives to brain fog, palpitations, and breathing issues POTS (postural orthostatic tachycardia syndrome) — how histamine creates vascular leakiness, why standing up can trigger dizziness or fainting, and a simple at-home heart rate test you can try The EDS connection — how a genetic collagen defect (Ehlers-Danlos Syndrome) compounds the vascular issues seen in POTS and MCAS PMDD and hormones — why histamine fluctuates with your cycle, and why PMDD often has a histamine and inflammatory component The nervous system's role — both external stress and internal stress (nutrient deficiencies, blood sugar swings) drive mast cell instability The 6 health pillars AWH uses to map it all out — insulin & blood sugar, gut & liver health, nutrient deficiencies, oxidative stress, energy production, and nervous system regulation Also in this episode: an update on AWH's new patient onboarding system, the Advanced Metabolic Rehab program, and what's coming this summer — fertility deep dives and "the core four" of perimenopause. Resources & Links 🌐 Book with Dr. Michelle, Dr. Karina, or any AWH practitioner: advancedwomenshealth.ca 📧 Ask about clinically guided programs (Metabolic Rehab, Fertility & more): info@advancedwomenshealth.ca 📲 Follow Dr. Sarah: @drsarah_nd 🏥 Advanced Women's Health: @advancedwomenshealth 🎙️ Mentioned: Episode 3: Understanding Histamine Intolerance with Dr. Michelle Mussar, ND — Dr. Michelle's original histamine deep dive

You're exhausted. You've been told your labs are normal. And you still feel terrible. Dr. Michelle and Dr. Steph are breaking down the real reasons behind chronic fatigue in women — and why it is almost never just one thing. In this episode, they cover: Nutrient deficiencies — B12, iron, vitamin D, and why being "in range" isn't the same as being optimal. Plus: why ferritin can actually be falsely elevated during inflammation and mask an iron deficiency Insulin resistance and blood sugar dysregulation — the energy crashes, brain fog, and cravings that come from riding the blood sugar rollercoaster all day. And why fixing the gut is half the equation (40–60% of insulin signaling is determined by gut bacteria) Sleep dysfunction and cortisol — why blood sugar drops at 3 AM trigger a cortisol surge that wakes you up, and what's really happening hormonally in perimenopause and menopause Thyroid dysfunction — why a TSH alone isn't enough, what Hashimoto's has to do with fatigue, and why the autoimmune piece goes underinvestigated Immunological fatigue — what happens when your immune system is constantly fighting something (infections, autoimmune activity, endometriosis) and why that by itself creates deep, unrelenting exhaustion Chronic infections — recurrent UTIs, strep, cold sores, mono, shingles. When infections keep coming back, the immune system needs investigation — not just antibiotics Oxidative stress and mitochondrial dysfunction — the cellular rusting that happens when the body can't keep up with its own cleanup, and why this is especially common post-viral illness 📍 Resources & Links 🌐 Book with Dr. Michelle, Dr. Steph, or any AWH practitioner: advancedwomenshealth.ca 📲 Follow Dr. Sarah on Instagram: @drsarah_nd 🏥 Advanced Women's Health: @advancedwomenshealth

If you've ever had a recurring boil in your armpit, groin, or under your breast and been told it's just ingrown hair or a sign of poor hygiene, this episode is for you. Dr. Sarah and Dr. Dasha are diving into hidradenitis suppurativa (HS): a chronic inflammatory skin condition that is far more common than most people realize, deeply connected to insulin resistance and immune dysfunction, and almost always misdiagnosed or dismissed. Here's what they cover: What HS actually is — a chronic inflammatory disease of the hair follicle, not an infection, not caused by poor hygiene, and absolutely not your fault The three Hurley stages — from a single boil to interconnected tunnels and scarring, and why catching it early matters Where HS shows up — armpits, groin, under the breasts, buttocks — and why it's so often mistaken for ingrown hairs or shaving irritation The root causes — immune dysregulation, insulin resistance, genetics, gut dysbiosis, and a significant metabolic component (Dr. Sarah has never seen a single case without underlying metabolic dysfunction) Food and lifestyle triggers — high insulin-demand foods, histamine-rich foods (bread, vinegar, fermented products, alcohol), smoking, and sedentary behavior Why exercise actually helps — and why the "sweating makes it worse" myth is causing real harm What treatment actually looks like — from dietary shifts and targeted supplements (zinc, vitamin D, doxycycline at low doses) to biologics and surgery for severe cases The hormonal piece — androgens, the cycle connection, and why "estrogen dominance" is not the right explanation What an AWH visit looks like — from assessment and staging through to a flare plan and a maintenance plan Takeaways from this episode: HS is not caused by poor hygiene — it's an immune and metabolic condition If you have recurring boils in classic locations AND PCOS/PMOS or insulin resistance, get screened A fasting insulin test isn't enough — a 2-hour glucose challenge reveals the real picture Low insulin demand eating and managing metabolic health are foundational to managing HS Sweating does not make HS worse — exercise actually improves outcomes If a provider just gives you one thing and sends you home, that's a red flag — this condition requires a comprehensive plan There is hope — this condition can be brought under control with the right team 📍 Resources & Links Book with Dr. Dasha or the AWH team: advancedwomenshealth.ca Follow Dr. Sarah: @drsarah_nd Follow Dr. Dasha: @dr.dashaleneva Advanced Women's Health: @advancedwomenshealth

You've had your appointment. You have a plan. And then you go home, and real life is still there. That gap between knowing what to do and actually doing it? I've been thinking about it for 10 years. And I've finally built the answer. In this episode, I'm walking you through the brand-new AWH onboarding system. 18 months in the making, designed to hold your hand through your first month so that this time, your plan actually sticks. Here's what's included: Daily education Meal plan templates Movement programming Community cohorts The AWH app All of it: $27 a month. And if you're a current patient, your first month is free. Just email info@advancedwomenshealth.ca . Resources & Links Book a visit: advancedwomenshealth.ca Follow me on Instagram: @drsarah_nd Advanced Women's Health: @advancedwomenshealth