[01:00:00:00 - 01:00:23:14]
 (Gentle Music) Hey, Dr. Mindy here, and welcome to the Live Like a Girl podcast, where I bring you icons, disruptors, educators, scientists, and doctors that show you what can be possible when you love and celebrate the female body you are blessed to live in. Let's dive in.

[01:00:26:02 - 01:01:27:15]
 When I launched Fast Like a Girl into the world, I braced myself for a lot of things. What I did not brace myself for was my inbox filling up with hundreds of thousands of messages from women in their 20s and 30s, all asking me some version of the same terrifying question. I don't have a period. What do I do? I remember sitting with that genuinely shocked, not because periods stopping is rare, because it had become so normal that these women didn't even know it was a red flag. They thought it was just what their body did now. Here's what most of them didn't know. 15% of women in America live with a condition that hijacks their cycle, their skin, their hair, their mood, and their metabolism all at once. And in some Middle Eastern countries, that number climbs closer to 20%.

[01:01:28:23 - 01:02:55:17]
 And of all the women who have it, somewhere between 70 to 80% are never diagnosed at all. They spend years being told their labs are fine, their ultrasound looks normal, they just need to eat less and move more. Sound familiar? Meanwhile, some of them end up in eating disorder clinics instead of an endocrinologist's office because nobody connected the dots. You know this condition by an old name, PCOS, polycystic ovary syndrome, a name that sent women running to Google, finding no cysts on their ovaries and walking away convinced they'd been misdiagnosed. This year, that name changed. It is now referred to as PMOS, polyendocrine metabolic ovarian syndrome. Finally, acknowledging that there is a metabolic piece to this hormonal condition. And I think it might be one of the most important shifts in women's health this year because a name isn't just a label, it's whether a woman gets taken seriously in an exam room. This is why I have brought you Dr. Thais Alibadi and Mary Alice Haney, founders of the podcast, She MD.

[01:02:56:21 - 01:03:11:16]
 Dr. Thais Alibadi, known to her patients and millions online as Dr. A, is a Los Angeles OB-GYN with 30 years in women's health and one of the loudest voices behind the name change.

[01:03:12:18 - 01:04:32:08]
 Mary Alice Haney is an entrepreneur who spent years building brands rooted in femininity before turning her focus to women's health. Together, they built Ovi, a platform giving women a free way to check their own risk and they co-host the She MD podcast built entirely around the idea that women deserve real answers about their bodies, not dismissal. In this conversation, we go deep into what's really happening at the cellular level when a woman can't lose weight, no matter what she does. We talk about why insulin resistance can hide inside a thin body, just as easily as a heavier one. And we dive deep into how something as ordinary as the plastic your water sits in might be quietly disrupting your hormones. We also get into something bigger than any diagnosis. Both of these women told me without hesitation, that if women ran this world, it would look completely different, safer, kinder, healthier. And I happen to agree 100% with them. So without further ado, PMOS, Dr. A. Mary Alice, take it away.

[01:04:33:15 - 01:07:54:04]
 Dr. A. Mary Alice, I am so excited to be back with you. So thank you for joining me again in a conversation about women's health that, in my opinion, ties very deeply to metabolic health. So thank you for being here. Oh, my God. Thank you for having us. I'm so excited. You know, I'm definitely not an expert in metabolic health, but I'm very experienced, but I would consider myself extremely experienced in PMOS. And I would love to talk about it on your podcast, because it's a condition that affects 15% of women in this country. And if you go to Middle Eastern country, that percentage goes all the way up to about 20%, 23%. So it's a significant number of women around the world that are affected by this condition. Majority of these women are dismissed in the current healthcare system. They go through life never getting diagnosed. And I would say 75 to 80% of these women, probably more, are never diagnosed. They're diagnosed, they're not being treated correctly. But let's start, but just to fill everybody in, I think the biggest news of the year is that we changed the name of PCOS. And what do you feel about that? Why did we change it? It's a really important part of the conversation. I think it was the most important thing that could have happened, because for years, I mean, I've been in women's health for 30 years, and for 30 years, I had to fight to explain to physicians, to healthcare providers, to patients that polycystic ovary syndrome is not cysts in your ovaries. And commonly, patients would say, I went to my doctor and I didn't have any cysts on my ovaries so I don't have PCOS. And it was an uphill battle. So by changing the name to polyendocrine metabolic ovarian syndrome, it basically explains the condition. So there's absolutely no confusion. This is a condition that affects hormones. It's directly related to our metabolic health. It affects the ovaries. It affects ovulation. And it's a combination of these symptoms that makes this PMOS diagnosis for patients. Because these patients present with different symptoms, it's always been very confusing to diagnose these patients. So I would love to take a minute to explain it to your audience. Yeah, and explain the symptoms, because there's a lot of confusion in the comments on my YouTube. I really see exactly what you're talking about. So when we talk about PMOS, like I said, it affects on average 15% of women. And in order to diagnose it, women need to meet two out of the three criteria. The first one is ovulatory dysfunction or an ovulation. Which means what? These are women who basically have irregular cycles, meaning their cycles are more than 35 days or they get eight cycles or less per year. And their cycles are very unpredictable. If you ask them, they never know when they're getting their periods.

[01:07:55:06 - 01:09:53:21]
 Number two is elevated, these are women with elevated testosterone symptoms. What are those symptoms? The most common, we call it haircitism, which means facial hair, body hair. These are women who usually laser their hair, they do electrolysis, it doesn't go away, it all comes back. They have acne. I always say if you're 25 and older and you're still struggling with acne, make sure you're not missing PMOS. So that's an important one. They have hair thinning, which is mostly male pattern up front. So commonly, these are the most common symptoms. They can have hyperpigmentation under their armpits or in their groin, less common, but mostly is the facial hair and body hair and the acne and the hair thinning that they deal with. So that's the second criteria. And the third one is when the polycystic ovary comes in. And polycystic, the old name, does not mean cyst on the ovary. These are frozen follicles inside the ovary and we can go into it why this happens. But these patients usually have more than 20 follicles per ovary. And if you look at the ovary, it's a specific finding on ultrasound. We call it a string of pearl. There are these follicles in the periphery of the ovary and it's a classic presentation. You can't miss it when you do an ultrasound. Unfortunately, you can have these patients get an ultrasound and I don't know, a majority of the time, the doctors will say, "Oh, you have so many eggs. You're fine." And they miss diagnosing it correctly. So recently they added another option for this third criteria, which is elevated AMH. Anti-malarian hormone is a hormone that gets released by the follicles. And if you have a very high AMH, that could meet this third criteria without needing an ultrasound.

[01:09:55:02 - 01:10:10:21]
 So patients need to meet two out of these three criteria, irregular periods, elevated testosterone symptoms, and you don't have to have a high testosterone in the blood. It's the symptoms of high testosterone. And the third one is PCOS ovaries on ultrasound or elevated AMH.

[01:10:12:00 - 01:12:48:21]
 It's important to understand that when it comes to teenagers, we cannot use the AMH value in the third criteria because young women have a lot of eggs and that can be confusing. So I'm always hesitant to diagnose a teenager or label the teenager with PMOS, but I watch them very carefully. They need to meet the other criteria, which is irregular period, and elevated testosterone symptoms. Okay, so let's go to the ovulation symptom because one of the things that shocked me when I put Fast Like a Girl out into the world because the whole premise of that book was to learn to fast according to your menstrual cycle is the hundreds of thousands of women that messaged young women, 20 and 30 year olds, that said, "I don't have a period. What do I do?" I was absolutely shocked. Now, of course it could be, you know, they were on birth control. Some of them were incredibly thin. But how would you know if your ovulatory dysfunction was because of something else or was because of PMOS? That's a very good question. So when in the first criteria, when I said irregular period, first of all, you have to make sure that you're not dealing with any thyroid dysfunction, that the patient's prolactin is normal, that you're not missing any other conditions like adrenal PCOS, which we call it, you know, it's the DHEAS levels that go up in the blood. So you want to get a basic hormone panel to make sure these patients don't have other reasons. You have to make sure they don't have an eating disorder, they're not anorexic, they're not on birth control. So you have to rule all of that out. When it comes to PMOS, 70 to 80% of PMOS patients do not ovulate or have irregular ovulation. Of the ones, 20, 30% who report regular cycles, even those patients are ovulating sometimes. And 40% of the women who report having regular periods, even when they ovulate, the environment is not ready for implantation. And that's why I think Mary Alice wanted me to talk about is besides the three criteria, generally speaking, PMOS is the leading cause of infertility on the planet, and we can talk why that happens.

[01:12:49:23 - 01:21:03:17]
 75% of these women gain weight and they have a very hard time losing it. Many of them have mood disorder, they struggle with anxiety, depression. There is a high percentage of these women who end up having eating disorders or disordered eating, they end up in eating disorder centers as a teenager, but instead of someone diagnosing them with PMOS, they end up in a psychiatric office getting psychiatric care and no one diagnosis them correctly. And without treating the underlying condition, these patients are never treated and they stay in that system, unfortunately. So when we talk about PMOS to generalize it, these are patients who struggle, majority of them struggle with weight, they have anxiety and depression, they have mood disorder, they have acne hair, lost facial hair, body hair, they have a hard time losing weight and they have irregular period. But there's so many different varieties of these symptoms. And only 75% of these patients gain weight, 25% of them are lean. So imagine you combine all these different scenarios. You have one who's lean and has acne and has irregular period. You have another one who has facial hair, body hair, has an eating disorder and is gaining weight and can't lose it. And there's just so many combinations of these symptoms. That's why it's so complicated for doctors to diagnose. And that's why the simple criteria, if you follow what I told you of how to diagnose it, there's not gonna be any confusion. If you meet two out of the three criteria, you have PMOS. You do not need to have a high testosterone in your blood. You do not need to have an ultrasound if you have a high levels of AMH in your blood and you're not a teenager. Follow the guidelines that I just mentioned. And if you think you have PMOS, then I wanna go into what these pillars of PMOS are and how we treat. Okay, so let me go one step before that. In preparation for this interview, I actually went into my YouTube comments. And what I found there was that a lot of the women who have been diagnosed with PCOS are, as you know, what we call a lean phenotype. And they don't present as struggling to lose weight. And they actually, as a core group of people, are very confused, especially in the renaming of this, because they don't present as somebody who has metabolic syndrome. So what I'd love to talk about is just insulin resistance, how it shows up in people, the variety, all the different ways it shows up, and what we can start to do to help these women might have a high hemoglobin A1C, they maybe have some insulin resistance, but when they look in the mirror, that's not what's going on. That's such a good question, and I'm so glad you brought it up. So as I mentioned, 25% of PMOS patients are lean. They're thinner than you sitting here. But the only difference between PMOS, regular, the classic PMOS and overweight PMOS, and lean PCOS is just their weight, nothing else. Everything else is the same. Now, lean, if you take a lean woman, a lean girl, let's say, who doesn't have PMOS, who's, let's say, 24 years old, she's five nine, she weighs 135 pounds, let's say, and you take the same girl, same height and weight, who has PMOS, the girl with PMOS at tissue level has insulin resistance. Fascinating. And that's why I want you guys to understand. I've never been overweight in my life, ever, except when I was pregnant. I've never, ever struggled with weight, but my hemoglobin A1C was 5.6, 0.1 away from becoming prediabetic. Isn't that crazy? It, and you know, because-- I've seen a few like that. Because your environment makes a difference, your habits, everyday habits make a difference. You know, there's so many factors, as you know, that affects our metabolic dysfunction, but there are a lot of us, and I don't have, I've never had PMOS, but 50% of women are insulin resistant. As we get older, we become more insulin resistant. And north of 90% of us at some point in our life, we'll have some metabolic dysfunction. But it's important for those lean PMOS patients to know that at tissue level, they do have insulin resistance. And that's why when they go to get pregnant, right, if we, and they're not getting pregnant, I actually put them on metformin, and lean PMOS patients respond really well to metformin and ovulation stimulation when they're trying for pregnancy, better than the overweight patients. And they can have PMOS, or they cannot. They could be perimenopausal, they could be menopausal. So it's not just, you know, we created Ovi, which is our other platform. We created GMD to give women the best information. You've been on our podcast. We have the greatest minds in medicine and the greatest women that come and talk about their health journeys and why they're there, and give the best scientific and medical information. But when I met her, and she was telling me about PMOS at the time when we were starting the podcast, she said, "This is my life mission. 15% of all women have it, 75% of them don't get diagnosed." So on Ovi, we have the exact calculator. You can actually go for free, everyone listening, and calculate the exact questions that she just talked about to see if you have the likelihood of having PMOS. But to your point, metabolic dysfunction comes across all women, starting from the teenage years until after they are menopausal, which is why we started Ovi. And Dr. A can talk about the medicine about that, which she gives to her PMOS patients, she gives to her perimenopausal patients, because at the core of all of this is metabolic dysfunction. And it's presenting in different ways. And you can have the same symptoms of PMOS as you do when you're perimenopausal. Like she said, we both take Ovi and we're perimenopausal, we don't have PMOS. But-- Well, I'm post-menopausal. Well, I'm perimenopausal. You're supposed to say I'm proudly post-menopausal. I am proudly post-menopausal. Yeah, yeah. So let's stick with this insulin resistance for a moment because I think PMOS is offering us a very interesting insight that insulin resistance doesn't always present as weight gain. And I think we might have to go, that's a really good understanding. So do you feel that hemoglobin A1C is still a really good? No, okay, talk, how would somebody know on labs? So you know what? I have patients who are, PMOS patients who are very overweight, they're younger, and they still have a normal hemoglobin A1C. That doesn't mean they don't have insulin resistance. You still have to address it. So I don't chase labs, I always treat the condition. You have to look at the patient, every patient is different, they present differently. You can't say, okay, so if your hemoglobin A1C is 5.7 or less, I'm not gonna treat you. Because then you're probably overeating, you probably need to exercise more, your diet is not good. And that's why these patients get so frustrated all the time and that needs to stop. So what I wanted, when we talk about PMOS, at its core is insulin resistance. And I'm sure your audience have heard it all, but I would love to explain it in the--

[01:21:05:00 - 01:23:51:18]
 Dr. Away. In the Dr. Away related to PMOS. So they can understand why this happens. So when we eat carbohydrates, our body in a simple way breaks it down into glucose and glucose stimulates our pancreas to release a hormone called insulin. The job of insulin is it opens up the receptors on the surface of the cells, mostly on the muscle cells, to basically take that, open up these channels, to take the sugar from the blood and put it inside the cell where it turns into energy. This is what's supposed to happen. But like I said, 80, 70, 80% of PMOS patients have insulin resistance. So what happens to them is when they have carbohydrates and their body breaks it down into glucose and glucose stimulates their pancreas to release insulin, their cells are insulin resistant, right? So they don't respond to this insulin well. So these channels don't open up at an optimum level. So some of that sugar bounces in the blood and pushes this insulin to go up. And that's when we get these insulin spikes. As insulin goes up in the body, it does several things to a PMOS body. Number one, it tells their liver that the cells, the tissue is not using this sugar as a source of energy. You need to clear this sugar, take this sugar and store it as fat. The fat that we store with this high insulin scenario is a visceral fat, is a fat that goes around our organs. And this visceral fat is highly inflammatory. It's different than the fat under our skin. So it causes an inflammatory process in the body, number one. And that inflammation in return makes the insulin resistant worse. So one of the first things that happened, these patients cleared the sugar and stored as fats. So, and then they start complaining of weight gain and they feel a complaint of inflammation. They're tired, they have brain fog, they don't feel well. The high insulin also tells the liver to stop making the sex hormone binding globulin. Sex hormone binding globulin is a protein in the blood that grabs onto the free testosterone in the blood because as women, we don't want to have too much testosterone. When the levels of the sex hormone binding globulin goes down because of that high insulin, then we get higher levels of free testosterone. And that's when the patients start having complaints of acne, hair loss, facial hair, body hair and other symptoms of high testosterone.

[01:23:52:20 - 01:24:13:18]
 The high insulin also stimulates. PMOS patients are insulin resistant everywhere except their ovaries. Their ovaries are actually very insulin sensitive. And this spike in insulin stimulates the ovaries to release testosterone.

[01:24:15:00 - 01:28:54:23]
 And this testosterone causes several things. The acne, the facial hair, the body hair, the hair thinning, all of that. But as the testosterone goes up inside the ovary, testosterone is toxic. It creates an inflammatory process inside the ovary, an inflammatory environment that's toxic to the little follicles. Every month, a certain number of antral follicles are recruited to come to the surface. One of them becomes dominant, ovulates, right? And whatever follicles are left behind, turn into a corpus nudiole, says to secrete progesterone to get the pregnancy going. And I can go into the menstrual cycle and what happens. But what happens when you have testosterone secreted inside the ovary, the follicles freeze and one of them doesn't grow. When the follicles freeze, you get that polycystic looking ovary on ultrasound, right? When you don't ovulate, you don't get a period. So your periods become irregular and the testosterone causes all these symptoms. So that's another cause for, that's another thing that the high insulin does. But the high insulin also crashes the blood sugar by clearing the sugar out of your blood, right? By storing it as fat. When your sugar crashes, then it causes release of cortisol because your body says, we're in a fight or fight, we need to release cortisol. That cortisol makes patients irritable, causes more cravings, binge eating. You have already an inflammatory process that and the insulin resistance that affects your binge eating and cravings. So now you have a situation where the insulin is up, the inflammation is up, the testosterone is up, right? You're not ovulating, so progesterone's down and you have all these follicles in the ovary that are halfway mature and they're secreting a lot of estrogen irregularly. So now you have erratic levels of estrogen being secreted that can cause irregular bleeding. And all of this then affects their mental health because in our brain, we have a limbic system which is our emotional headquarter all of our emotions come out of the limbic system. And we have a prefrontal cortex that acts as a brake to control these emotions in the limbic system. For the limbic system to be calm, it needs high progesterone ovulation, it needs normal levels of estrogen, it needs normal levels of testosterone and it needs low inflammation. What happens to a PMOS brain? Inflammation is up, testosterone's up, estrogen is erratic and progesterone's low. So then you have a limbic system on fire, anxiety, depression, irritability, anger, PMS, PMDD, binge eating, cravings, lack of motivation, all of it. And then you want a prefrontal cortex to act as a brake and just control everything. Well, the prefrontal cortex needs low inflammation, normal levels of hormone, good sleep, PMOS patients are not good sleep. Sleep are low stress, these people are very stressed out. And so then you have, so you have this limbic system on fire and you have a prefrontal cortex that the brake is not working. So you have a car going 100 miles an hour down the street and the brake doesn't work. That's why these patients struggle with anxiety, with depression, they're on antidepressant, they end up in eating disorder centers. I always say you want to find PMOS patients, go knock on the eating disorder centers. They're all sitting behind those doors. Dr. A actually said that to me when I first finished, she goes, she said, I want to change the world for women's health and that's why we started the podcast. But then she said, if I could get every 17 year old into my office, I would shut down fertility clinics and I would shut down eating disorder clinics. And we had one of the best podcasts, one of our favorite podcasts is with Greg Renfrew, she started Beauty Counter and her daughter Phoebe. And it was, I mean, I get chills just even talking about it. She, her journey with PMOS and being in these eating disorder clinics and just, and how she kind of came out the other side of it and it was life changing. And I think that-- Her validation, when you diagnose them. These women are told, these girls are told, you're crazy, it's in your head. Like nothing's wrong with you, stop eating.

[01:28:57:15 - 01:30:04:20]
 Okay, so I want to go back to, again, beautiful explanation. I agree, that was quite a journey you took us on. So thank you both of you. But I want to go back to why a cell becomes insulin resistant. Because again, in the research for this podcast, I found some interesting statistics showing that it's not just too much glucose, you're not just eating too much sugar. But there's some research showing BPA plastics, and I really want to know your opinion on that. I found a very interesting one on sunscreen, a chemical in sunscreen. This was a 2025 review on PMOS and the toxic, it's called oxocrylene. Have you ever heard of that? No. That makes women in this, they were looking at PCOS when it was named that, and they were finding that BPA plastic and the sunscreen toxin makes these women insulin resistant. You know what, I'm by far no expert in,

[01:30:06:13 - 01:32:57:14]
 why someone becomes insulin resistant. But I will tell you, 30 years in medicine, I feel like that's why I started by saying our environment makes a difference. Our genetics load the gun, but the environment pulls the trigger. And I don't think it's just sunscreen. Everything we're exposed to, from the water we drink, from the food we put in our mouth, from everything we apply on our skin, whether it's a perfume, whether it's a sunscreen, whether it's a shampoo, it's your cream, it's your makeup, that, those get absorbed. So there's so many different ways that these toxins disrupt our hormones, make us insulin resistant, affect our cognitive health, increase our inflammation. If you think about it, when we talk about longevity, what is longevity? At the source of it, if you want to fix longevity, you have to lower insulin resistance, you have to optimize metabolic health, but you also lower inflammation. But everything we do every single day, so it could be, yes, it's a sunscreen, I don't think it's just sunscreen. I think that we're exposed to so many toxins every single day, and it's overwhelming. You know, I was in Europe, and it was so hard for me to find water in glass. Every restaurant we went to, everywhere you went to, there was water in plastic, right? And I was with a friend of mine, he's like, well, I'm not gonna drink for three weeks. I'm like, I couldn't do that. Do you know what I'm saying? Oh, because of the plastic? Because of the plastic. Wow, that's a step. It's not just PMOS. I mean, on the podcast, we've had so many experts, there's a rise in breast cancer in young women, in all cancers. Oh, yeah, no, yeah. So we're not just, when you're looking at women's health in general, metabolic health is a huge part of it, but it's also, like you said, there has to be a correlation between the rising cancer of young women, between the PCOS symptoms, between all of this. Listen, visceral fat causes inflammation. Inflammation, these cytokines, they get released. They can increase your insulin, make your insulin resistant worse. These are androgens that are getting secreted from your ovaries, make your insulin resistant worse. Everything is related, that's why 40%, this is my opinion, 50% of my PMOS patients struggle from leaking gut. And these are patients who say, you know what, when I eat, I get so bloated. In 2014, I started prescribing GLP1s to my patients with PMOS. That's 12 years ago. So none of these meds are really new. The first time they came to market,

[01:32:58:15 - 01:36:37:10]
 it was a cholicity back then. I don't even know if people know about cholicity now, but it was a diabetic medication, it was a GLP1, but I learned it from a cardiologist who told me, don't send me these overweight patients, just give them cholicity and they lose their weight. So I started going down this rabbit hole and I started treating my patients and these patients would come back and say, my periods are back. My inflammation's so much better. That happened with Fast Like A Girl. You know how many people, once we got their insulin resistance under control, we got another hundreds of thousands of messages that people were able to get pregnant, they're getting their periods back. This is why I'm obsessed on metabolic health because it's like the core of all hormonal problems and it's multifactorial. At the core of perimenopause issues, PMOS issues, it is this metabolic problem that causes all these things. And you know when, I don't know if you guys remember, I'm sure you do, but when Ozempic exploded a few years ago, people were like, it's a miracle medication. I got pregnant. Why do you think? Anytime you address metabolic dysfunction, anytime you blunt that insulin spike that I just explained, when insulin goes down, then A, you don't make visceral fat, your inflammation goes down, but when insulin goes down, you don't stimulate the ovary to release testosterone. When testosterone goes down, the follicles start maturing as they should in a normal menstrual cycle, then ovulation happens. You don't have these follicles frozen in the ovary and that's how people get pregnant, but they thought this is a miracle drug, but it's not just Ozempic. You can get someone pregnant giving them metformin. As she said, you can give them the OV supplement that we created. So anytime you address the metabolic, it can be diet and exercise. It can be fasting like you were talking about. Anytime in any way, when you address the underlying condition, which is insulin resistance and metabolic dysfunction, if the puzzle gets solved, the brain fog gets better. The weight fluctuations go away. I have patients, you know, we give them OV supplement, they come back and they're like, "My PMS is getting better, I'm so confused." Well, I just explained to you what happens in your brain when you have metabolic dysfunction, when you have testosterone, when you have inflammation. And when you fix that, your brain health gets better. Your PMDD gets better, you're not suicidal anymore. Yeah, so outside of drugs and supplements, what do you give your patients? Like here's the basic guideline for metabolic health. Here's what you might think about eating and fasting, I'll just be really clear. We've seen so much change in our community with fasting and the research is conflicting. And some of it says fasting will help PSOS or PMOS. Some of it says that calorie deficit does the same thing. I'm a fan of fasting over calorie deficit. So there is some interesting, and I'm obviously a continued fasting fan. But what else, my audience has heard me talking a lot about it, what else can they be doing? Everything you talked about, I always tell them your body does not process sugar, like another, I sometimes get two sisters, one is tiny, and the other one has a BMI of like 35.

[01:36:38:17 - 01:38:03:01]
 And it's so hard for me, and especially like let's say they're a year and a half apart and it breaks my heart because the other sister says, well, how come this, and what's wrong with me? And what do parents tell them? Well, you're eating too much. You know, it's because, and they're not eating. I have patients who come to my office, they're like, I cannot possibly eat less than what I do. I cannot possibly exercise more than what I do. And it's really hard for these teenagers especially, especially in our world right now in social media where everyone's face tuning their bodies and their faces and everything. So it becomes more challenging. But what I always tell them, you know, the way I see it, and for me, especially when I get young PMOS patients, I do everything in my power to make sure they don't go down the path of an eating disorder. I think because their self-esteem gets affected, they go down this path that's very lonely, they're hiding, they're lying to their parents. So I do everything in my power. The first thing I do with my patients is education. I want them to understand why this is happening and how it's not their fault. I validate them because if you explain, and what I just explained to your audience, I really take this time with every single PMOS patient. That's amazing, you're a unicorn.

[01:38:04:05 - 01:42:34:01]
 But you know, because what do, you know, listening to this, one of the most popular podcasts on the planet, they bring in OBGYN, and they ask, the host asked her, so how do you treat PMOS? Back then it was PCOS. What do you think she said? Birth control. Medication. Birth control. Oh, I found that in my research. That was the solution for everything. Everything. Everything. So you tell me, I'm not against birth control. Birth control can help, but does birth control address your metabolic dysfunction? Right, no. No. That's why these patients get frustrated. So if they don't understand it, and you're handing them a birth control pill, they're gonna go try it for three months. They're still gaining weight, they're still bloated. Maybe their symptoms of high testosterone gets better. Their periods get regular, and their testosterone symptoms get better. But that's it, right? It doesn't affect their metabolic dysfunction. So education is very important. You need to know, and just like Mary Alice said, that's why I started GMD with her, because we literally explain why these things happen and how you fix it, right? Sometimes you have no choice but getting prescription medication. Sometimes you can fix it with diet and exercise. Not all women are built the same. But no matter where you are in the PMOS journey, your diet, your exercise, your sleep, your stress level will make a difference. So you have to look at it holistically. You can't just throw birth control at someone. You can't just tell them diet and exercise is your only solution. I've seen women, that's when they go down the path of an eating disorder, exercising six, seven days a week, eating 800 calories, and they can't drop one pound because their leaky gut is not addressed, their metabolic dysfunction is not addressed, or their insulin resistance is so severe that they really can't do it and they need help. So what I tell my patients is, A, watch what you're eating. Limit processed meat, processed food. Try to eat more of a plant-based. Plant-based, you have to be careful because sometimes when you can't eat meat, patients start eating a lot of carbs. And that can backfire in PMOS patients. A carbaterian. Yes, yes. Because you need protein. So you need protein. So I always say start with a healthy diet. I love when these women go to a nutritionist, have someone that follows them, teaches them what to eat, what not to eat. Mediterranean diet. And you know what, even like chocolate, ice cream, one of my pet peeves with PMOS is when they drink soda. I literally wanna vomit and you'll be surprised how many people drink three, four cans of Coke every day. Yeah. You can't-- You know, even diet soda can make you insulin resistant. And it makes your cravings worse. Yep, exactly. You know, so diet is not just for PMOS, it's for everyone on this planet. Limiting toxins that enter our body, whether it's the air that you breathe, it's the water that you drink, it's the food that you eat or the product that you put on your skin. These are the four ways you're getting toxins in your body. And you know, we can't get it to 100%, but if you get yourself to about 70, 80%, then you've done enough, that's amazing. You will help your health. Exercise, I think for me personally, and that's just my opinion, some exercises are inflammatory to me and a lot, do you know what I'm saying? I like this. So, you know, for a period of a year, I used to do EMS, you know, electric muscle stimulation, where you would wear the vest and it would like literally zap you for 20 minutes. And I felt terrible afterwards. And it was just too much for me. I felt like my muscles were inflamed, everything. It wasn't a calming, like for me, and that's why I let patients decide, for me, walking, hiking, yoga, swimming, are more calming. Maybe it's my age, but I have such a stressful life that I need exercises that are mind and body, that I'm not just weight, I love weight-bearing exercises,

[01:42:35:13 - 01:42:41:14]
 but I might not do well running on a treadmill or running up the hill. I would never be able to do that.

[01:42:43:14 - 01:43:44:00]
 Where does fiber fit in? Because I've been doing a lot of research recently on how powerful fiber is for feeding the microbes that will make the GLP-1 hormone. And as you're talking, I'm like, here we are again, at a world that doesn't get enough fiber in every single day. And I think about the woman you said, who's like, I eat all the time, I eat really well, I'm doing everything right. And I feel like I've become the spokesperson for fiber. Like, come on, we gotta get more fiber in. I think our diet, you know, I was in Europe for three weeks. You can eat whatever you want. Yep, yep, I know. And I literally came back and I've lost maybe three, four pounds because I would get 15,000 steps a day. And I was eating pasta, I would eat stuff that I would never dare eat at home because I would just blow up. I just feel like our food, our bread, our gluten,

[01:43:45:04 - 01:44:30:16]
 our hormones, the meat, and even in this country, organic means nothing. You know, you go to Europe, the strawberries are tiny. You have to have five strawberries that would equal one strawberry in this country. I remember when I moved from Iran to this country, one of the things that shocked me was the size of the fruit. Right, the fruit that we eat. I'm like, how can a strawberry be this big? Do you know what I'm saying? Or how can, like you don't see that anywhere else on the planet. So, and you know, when you're in Europe, you really don't see morbidly obese patients. When I moved to this country, I was 17 years old. I had never seen a morbidly obese patient in my life, ever.

[01:44:31:20 - 01:47:41:00]
 So our food is a huge problem. I used to have clinics in downtown Los Angeles and I would deliver a lot of patients. And one day I was eating lunch outside of the hospital on a bench and you know, I was at the entrance and these kids for the children's hospital, they were going in and out. And these eight year old boys had breast tissue. Yeah, oh yeah. Which I had never, like you cannot, that's the, yes. So I think that's why I say the toxins, the four toxins, whether it's air, water, skin and food, those four need to be addressed. Whether you have PMOS or not, whether you're perimenopausal or not, it should be, every single person needs to be educated about these toxins. But it's sometimes it's impossible when your food that you eat is McDonald's. Yeah, the toxic, my clinic was a detox clinic for the last 10 years that I had it. We did heavy metal detox, we did plastics, I mean, everything you can think about. And I finally stopped, you know, as I moved into the world I'm in now, I don't talk about it as much, not because it's not relevant, the solution is not easy. And it's a very depressing topic. We live in the most toxic time in human history. And if you're going to get yourself hormonally balanced, you're gonna have to start to learn the language of toxins. But you know what's interesting on the podcast, and you're one of the experts that I'm gonna talk about this too, because you came on GMD. I don't care if it's a brain doctor, heart doctor, endocrine doctor, every single medical expert has said that it's not a peptide, it's not a vitamin, it literally is exercise, food, sleep and stress. You have to fix those. And then the, you know, we talk a lot about PMOS because there's so much shame with these young girls they come in and they're saying, you know, I eat nothing, I exercise, I can't, you know, and so you have to give them OV and you have to give them metformin and you have to give them GEO, and there's no shame in that. There are conditions that happen that once, if you really have done everything you can with diet, exercise, sleep, stress, like you need help, your body is not working properly. So there's no shame about that, but every major person who has ever come on the GMD podcast, when you ask them, tell me the top things, it always are those four things. Yeah, yeah. And when we put somebody, I wanna go to the metformin thing because it's come up a couple of times. And I'm also curious about GLPs and what you think of this because what I'm concerned about, I'm not anti-medication, but what I do get concerned about is if you put somebody on a medication that pharmaceutically balances out their insulin system, you gotta make sure they're still motivated to keep their lifestyle in good order. And what has been your experience with that?

[01:47:42:04 - 01:47:47:06]
 I think we live in a world of shortcuts. Yeah, it's true. Everyone wants a shortcut.

[01:47:48:06 - 01:50:01:08]
 I had a patient yesterday who lost 22 pounds in three and a half months. And that's like massive, right? That's massive. Because the GOP wants-- And is it healthy? Is it healthy is the question. And I mean, she's really overweight, so it's fine. I'm okay with that, but she was questioning whether it was fast enough. And I was like, and you know what I always tell my patients is that your body is not a light switch. So I can't just say on, off, on, off, even if I give you a supplement, give it four months. If you start exercising, give it a few months to notice a difference. There's nothing I can do that overnight, but right now people want overnight solutions. So when I say, why don't we do diet, exercise, the supplement, and then you, you know, maybe I start you on metformin in three, four months. No, no, no, but can I start with GOP once first? And then, and I understand in a way because they've been dismissed for so many years. They just don't want to deal with it. They don't want it. They don't want it. They have so much trauma. These literally my endometriosis and my PMOS patients have PTSD and they need trauma work because of years, years of dismissal, years of dismissal. Yesterday I had a mother and daughter from Florida. I had two sisters from Australia. I had a couple from San Francisco. I mean, this doesn't make sense. Why do you have to travel for the most basic things? And I always say, that's why I started the GMD podcast because I literally arm you with the information. And if you listen to it, you're going to become your own health advocate and you don't need to fly from Florida to come and see me. I literally wanted to, like I was so heartbroken. So heartbroken. Why is it that you have to fly across the country for me to teach you about perimenopause, hormone replacement. And this is a patient, she was, the mom was 55.

[01:50:02:13 - 01:58:14:19]
 She's never had a coronary calcium scan. She doesn't know her ApoB levels. She hasn't had a bone density, which I think is very important. But because the guideline says 60, nobody checks it. Her mammogram and ultrasound are way overdue. She had breast cancer since the diagnosis. No one ever did an MRI of the breast on her. And the list goes on and on and on and on. And she didn't have a genetic testing. I mean, it's just, it's so overwhelming for me. And I always say standard of care for women's health is in the sewer system. And that's standard of care. And when people come to me, they're like, well, is this standard of care? No, it's not. The care I'm giving you is a mile above the ground. Excellent. Your standard of care is in the sewer system. The standard of care doesn't even teach these women about diet, about inflammation, about metabolic dysfunction. They know nothing. Right, because they're not trained in lifestyle. That's the big thing that I think we need to admit is that they're not trained in lifestyle. Help my audience identify how to find a good doctor. Because I agree with you, and I used to say to people, fly wherever you can to get a good doctor. Because the healthcare system that you're operating in is completely crumbling. So is there a way to find a doctor like you? I would say, again, I met this woman on another podcast talking about GLP ones. And literally the next day went to her office, knocked on her door and said, "You're my next mountain. I'm gonna get the kind of care that you give to every woman out there so that they can have the knowledge and tools to be their own health advocate." As a woman listening, listen to what you have available. Because the kinds of doctors like Dr. A are so far and few between that you need to walk into the doctor in your town, if you can find one, saying, "You need to give me this test, this test, this test, this test. And if you don't, I'm gonna leave and go find someone that will." And that's what you have to do. I mean, in my opinion, as a patient and somebody that has-- I couldn't agree with you more. And I know people get upset, but I can't wait for a day that I will be replaced by a robot. Because women, yeah, I will celebrate that day. And I will happily, happily retire. Because a robot will not dismiss a woman who's complaining of painful periods. A robot will not dismiss a 42-year-old who's complaining of brain fog. A robot will not forget to do genetic cancer testing on someone who has family history of cancer. A robot will calculate a woman's lifetime risk of breast cancer every single time. A robot will never dismiss a woman. And it's my dream to train that robot. And I will do it one day. We're gonna do it. We're working on it. I love where you're going with this. I mean, I think we're still obviously a ways away. But what you just said, I kind of go to two places because right now they're showing that AI is getting health information wrong about 50% of the time. But then I also go to, how sad is that? Because so many people become doctors because they care. The word doctor actually means to teach. But somehow in the system, I don't know if it's the insurance system. I don't know if it's the expectation of the patient. I don't know what it is, but I really hope people are hearing that you need to take control of your health. You need to go and do your own research and don't put up with gaslighting and condescending behaviors from somebody who has a white coat. But why is there so much dysfunction there? I think I would blame insurance companies. Yeah, agreed. Number one. Because they don't pay us enough to see a patient. I stopped taking insurance because my office, I was seeing like 50 patients a day because they would literally come and sit emergency. Everybody wanted to come in and they would wait for hours to be seen. And one day I looked at my office manager, I'm like, I'm gonna hurt someone. I'm gonna miss something really major because I'm burnt out and I can't do this. I wanna spend time with my patients. I need to explain what's wrong with them. I need to tell them what end... Let me tell you, I wanna talk about this because I know you have an audience of perimenopause menopausal women and a well-woman exam right now. What is a well-woman exam in our world right now? A woman walks in once a year, the doctor does a pap smear, does a bimanual exam that means nothing. Maybe they do a breast exam. Maybe you get an order for a mammogram if you're 40 years or older. And maybe if you're younger, you get an STD test and a birth control and out you go. That's not a well-woman exam. No, no, not at all. But that's all they have time for because they have 15 minutes. Yeah, 10 minutes, right, with a patient. So that's why what Mary Alice was saying, if you arm yourself, if you know that if I'm telling you, let's talk about breast cancer. If you have five minutes, if I have five minutes, because I want your audience. Yeah, please, please, let's do it. Yeah, so I always say if you know your first name, if you know your last name and your date of birth, the fourth thing you need to know as a woman is your lifetime risk of breast cancer. You cannot go through life not knowing your lifetime risk of breast cancer. You need to know what that number is at age 30. It's a simple formula, Tyre Kuzik, we have it on GMD. It's for free. Free. You can go calculate your lifetime risk and I tell you exactly what you need to do with the percentage that you get. All you need to know is the density of your breast in order to answer the question. If you don't know it, you can leave it blank and the density of your breast, you get it from your breast imaging, usually from a mammogram. If you're young and you haven't had a mammogram, you skip it. The rest of it is your height, weight, family history, whether you've been on hormones, whether you're Ashkenazi or not, you just fill out the question and it will tell you your lifetime risk. If your lifetime risk of breast cancer is 20% or more, you fall into the high risk category, which means you have a higher risk of developing breast cancer. For women with lifetime risk of 20% or more, they need to start breast imaging as early as 30, not 40. So this concept that you need to be 40 to get a mammogram is completely misleading. Your mammogram timing has to do with your personal lifetime risk. That's beautiful. Okay, that's number one. If you have dense breast tissue, which 50% of women on the planet have dense breast tissue, in addition to the 3D mammogram, you don't want a 2D, you wanna ask for a 3D mammogram, you need to have a breast ultrasound, so we don't miss anything. For women who fall into the high risk category, which is 20% or more, in addition to mammogram and ultrasound, they need to ask their doctor for a breast MRI. A lot of times, your doctor will say, you don't need it. It's not true. High risk patients need MRI. The most common breast cancers, which is ductile breast cancer, gets picked up on mammogram and ultrasound easily. But the second most common type of breast cancer is the type of breast cancer that I had, is lobular breast cancer. Those can go missed on breast imaging on mammogram and ultrasound, they get picked up on MRI. So if you're high lifetime risk, you need to ask your doctor for a breast MRI. If your doctor is not given it to you, switch or educate them, but you need to get that MRI. If you have family history of breast cancer,

[01:58:15:20 - 02:00:10:18]
 or ovarian cancer, or pancreatic cancer, ask your doctor for genetic testing. Well, this is just women's health, but if you have family history of colon cancer, if you have melanoma in your family history, if you have any kind of cancer, I want you to ask for genetic cancer testing. In my office, I do the myrias test, or different genetic tests. I like the myrias test, it's by company Marriott, but it basically checks for 63 cancer-causing genes, and you wanna put a check in front of it. You don't wanna miss that, it's a simple blood test. Do not miss it. If you have family history, ask your doctor for genetic testing. And the Marriott actually calculates your tirecusic for you. So if you don't wanna go on GMD, you don't feel like doing it, Marriott will calculate your tirecusic risk, and they will tell you whether you fall into the high-risk category. The third thing they do, which I love, in addition to calculating your tirecusic and checking for the major genetic mutations, like the BRCA mutation, check2this.plb2, they look in your DNA for tiny little markers. These are markers that individually don't do anything, but some of us walk around with tons of these markers that can push your lifetime risk higher. I've had patients that by history, their tirecusic is 18%, but when I do the myrias test, because they have tons of these markers, their lifetime risk goes north of 35, 38%. Wow, wow. She saved a lot of lives and you can save a lot of lives with that. Know your lifetime risk, do your genetic testing, and if your lifetime risk goes above 35, 40%, there are ways that you can reduce that risk. One, you can take a medication called Tamoxifen every day for five years and reduce that risk by 50%,

[02:00:11:22 - 02:01:12:20]
 or in my case, my lifetime risk was 37%, even though I had no family history, no genetic mutation, but I chose to do a double mastectomy, and when I did my double mastectomy in the tissue, they found breast cancer, even though my breast imaging was all negative. Why am I saying all this? If you're a woman, know your lifetime risk of breast cancer and be your own health advocate and ask for the correct imaging. Okay, well, speaking of density, I think this was an info dense. (Laughing) We talked so fast, we tried to make sure that as much information is there. Thank you, it's funny too, because I talk really fast too, and so I'm gonna give the advice to the people listening, they go back and re-listen to this and take notes. I'm gonna finish it with this. This podcast is now called Live Like a Girl. Like a Girl is my brand. I love it. And I'm really diving deep into concepts that affect women because our bodies are so different. So what does living like a girl mean to each one of you?

[02:01:14:17 - 02:02:55:21]
 I love that, first of all, I just love that. I think that 53 years old, and I've always lived like a girl, meaning I've created brands that are steeped in women, whether it was a fashion brand or now this GMD brand. And I've done it in a very feminine way. I've never tried to be a male in a work environment. I've used being feminine, being Southern, being kind, being nice, being able to do things. And what I consider like a girl, I think that if more women and girls led this world, we would not be in the situation that we're in right now. So I think just really loving my femininity, loving the fact that I'm female and leading with that always in everything has really served me well. So that's what it means to me. I love that. That was beautiful. For me, I would say, obviously I love women. I think we're dominant. I think we're smart. I think we're the best breed possible. I have four daughters. I'm an OBGYN. I've surrounded myself with women and I've always wanted to be in a world where women ran the world. I think the situation of the world right now is not because this person's a Democrat, this person's a Republican. I think the problem is that men are running this world. Thousand percent. If I could have a mic, I would tell every young girl on this planet, not just this country, on this planet. I come from Iran. Look at what's happening. We look at what the government is doing to the people of Iran.

[02:02:57:02 - 02:05:30:21]
 I think women need to start taking positions of power and to make our world a better place. It would be a world where there's no wars, that women don't get attacked. They don't get raped. Children don't die. Everyone's protected. As women, we bring life into this world. We never take it away. For me, live like a girl is live your best life, but educate yourself, empower yourself. We are really special and we should be running the world. Yes. Oh, mic drop! I, a thousand percent agree. You guys are amazing. Thank you so much. I'm sure everybody will come find your podcast. Anywhere else we can point them and the OVA. So it's the SheMD podcast. It's every week. Sometimes we have amazing bonus episodes. Anybody with metabolic health issues from PMOS to perimenopause and menopause, we have options for every woman. It's o-v-o-v-i-i.com and our social media handles. It's Dr. Taiz Ali Abadi. She's got amazing content and the SheMD podcast. So just find great information wherever you can. And I just want to thank you for also what you're doing. And we have you on our podcast. I think we might put them out at the same time, which would be fun. I'd love to do that. I actually love to do that so we could support each other, but women supporting women. So thank you so much for having us. I can't leave without saying this. We created the OVA platform for women with PMOS. If you listen to this podcast and you think you might have PMOS, go take the questionnaire like Mariala said. And if you have the likelihood of having PMOS, take the supplement. If your doctor is dismissing you, this supplement will help you. It will help with insulin sensitivity. It will help with inflammation. It will help with carbohydrate absorption. It'll help with all of it. And as you fix that metabolic dysfunction, the symptoms will start improving. Yeah, amazing. Well, thank you both and keep screaming it from the rooftops. Well, I know. Yeah, I appreciate you both. Thank you. Okay, bye. Bye. Thank you so much for joining me in today's episode. I love bringing thoughtful discussions about all things health to you. If you enjoyed it, we'd love to know about it. So please leave us a review, share it with your friends and let me know what your biggest takeaway is.