June 25, 2024 • 28 mins
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Unlock the secrets to managing PCOS and thyroid issues with guest, Dr. Erica Armstrong, a leading expert in functional medicine and author of "The PCOS Thyroid Connection: A Functional Medicine Approach to Treating the Root Cause." Discover why women with PCOS are three times more likely to develop thyroid disease, specifically Hashimoto’s thyroiditis, and learn about the shared root causes like inflammation, gut health, and nutrient deficiencies. Dr. Armstrong emphasizes the importance of comprehensive thyroid screening and a functional medicine approach that includes advanced lab testing and collaboration between healthcare providers.
Navigate the often confusing world of dietary recommendations for PCOS with practical advice from Dr. Armstrong. Say goodbye to ineffective fad diets like keto or carnivore and learn how balancing blood sugar through key nutrients like magnesium, zinc, B vitamins, and omega-3s can make a significant difference. We debunk myths about the harm of cruciferous vegetables, highlighting their crucial role in estrogen metabolism and gut health. Plus, get valuable tips on advocating for yourself in medical settings to ensure you receive the necessary thyroid tests.
Experience the transformative impact of integrating functional medicine into traditional healthcare practices. Dr. Armstrong shares her passion for providing personalized care and the importance of a holistic approach, from advanced testing to nutrition.
Mentioned in the episode:
The book: https://amzn.to/4etfaZ9
Thyroid Test Kit: https://s.thorne.com/I2xbM
Find Dr Erica Armstrong: https://rootfunctionalmedicine.com/
Ig: @rootfunctionalmedicine
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Welcome back to an Amber a day.
I'm your host, amber Fisher,and today I have a very special
guest.
I have Dr Erica Armstrong, whois Institute for Functional
Medicine certified practitioner.
She is also the author of thePCOS thyroid connection a
functional medicine approach totreating the root cause.
And guys, I read this book.
(00:20):
I sat down and read it, eventhough I you know my attention
span is like this these days.
This book gripped me.
I told her before we startedrecording.
I was genuinely so impressedwith this book, with the amount
of detail, even just as aresource for PCOS Take the
thyroid piece out of it.
(00:40):
It's a great resource for PCOS.
So I will have a link in thedescription or the show notes.
So if you guys want to take alook at this book I know it's on
Amazon and stuff like that, sohighly highly recommend.
But we're going to talk alittle bit about it soon.
Erica, would you introduceyourself to us?
Tell us a little bit about you.
Speaker 2 (01:01):
Yes, and thank you so much for the kind words.
I am founder and CEO of RootFunctional Medicine, which is a
nationwide telehealth practicewhere every member has both a
doctor and a dieticiannutritionist.
If you're not familiar withfunctional medicine, the core is
finding the root cause.
So we put the whole picturetogether, connect the body
(01:24):
systems and figure out whatactually is driving disease so
that we can reverse it andoptimize health.
So we specialize in PCOS,thyroid, gut health, hormone
balance and autoimmuneconditions and other things, but
those are the top things thatwe treat.
Speaker 1 (01:41):
Amazing.
That's really cool.
So you guys work nationwide.
I like that.
You have a dietician witheverybody.
That's nice.
Nutritionists love that.
Speaker 2 (01:52):
Nutrition is core to functional medicine.
Since we started.
Speaker 1 (01:56):
Yes, I love that.
Okay, so we're here today totalk about the PCOS and thyroid
connection, which I know is ahot topic.
I get asked about this a lotand I'll admit that I don't know
as much about the thyroid as Iwould like to, but I know that
these two things overlap a lot.
(02:17):
I see it all the time in mypractice.
So I'm anxious to kind of getyour expertise on how that works
, what the connection is andmaybe some things that our
audience can implement now.
So can you explain a little bitabout PCOS and thyroid issues
and kind of how they connect orwhat the overlaps are there?
Speaker 2 (02:36):
Yeah, so at baseline.
These are the two of the mostcommon hormonal issues.
Women with PCOS are three timesmore likely to also have a
thyroid disease than womenwithout PCOS, in particular,
hashimoto's, which is the mostcommon type of hypothyroidism.
Over 90% of those withhypothyroidism in the US have
Hashimoto's.
(02:56):
That's an autoimmune conditionwhere your thyroid is being
attacked and then unable toproduce enough thyroid hormone
over time, and so one studyactually showed that Hashimoto's
was present in 23% of womenwith PCOS almost a quarter of
women with PCOS.
So it's really important, ifyou have PCOS, to have thyroid
(03:16):
on your radar for screening.
So there's a lot of ways thatthese conditions overlap, but
the largest one, especially thatwe see in our functional
medicine practice, is that theyshare root causes, and so in our
practice we have the doctor andthe dietician working together,
putting the whole storytogether, figuring out root
causes and utilizing advancedlab testing as well as the
(03:38):
conventional testing, whichincludes full thyroid panels for
everyone with PCOS, and so thatis how we were able to figure
out over time that, hey, theseconditions are popping up all
the time and they're sharingroot causes, and we've actually
diagnosed a lot of thyroiddisease when there has been
previous PCOS or diagnosed bothof them together.
(04:00):
Because of this, we feel thatit's important for everyone with
PCOS to have a full thyroidpanel as part of their yearly
health maintenance and then, ifsymptoms warrant it.
So, um, there's several rootcauses, um, why these conditions
occur together.
Um, I wrote about this in mybook and broke it down by
chapter of you know the mostcommon root causes.
(04:21):
Thank, thank you.
So the biggest root cause isinflammation, which is usually
coming from the gut, becausethat's where the majority of the
immune system lies and it's.
Some other root causes areadrenal health, nutrient
deficiencies or insulinresistance, but that's why it's
(04:42):
important to also work with afunctional medicine team, so
that you can work with someonewith advanced training in these
root causes, like gut health andmicrobiome balance or adrenal
testing, and so we can put thewhole picture together.
The other root cause I didn'tmention was mitochondrial health
and mitochondria you mayremember as a powerhouse of the
(05:03):
cell.
It's the energy producing partof the cell.
Each egg in the ovary hasalmost 600,000 mitochondria in
it to produce enough energy forovulation to occur, and so that
is why taking care of themitochondria are very important,
so that you ovulate.
Then, after ovulation, comesthe natural period.
(05:24):
So that is the synopsis of theroot cause.
Speaker 1 (05:28):
Yeah, that's great, that's most.
That's all the stuff that welove to talk about on this
podcast all the time, and I lovethat.
You know that.
I that makes a lot of sense tome that the thyroid connection
with PCOS would have a lot to dowith inflammation and
inflammation has a lot to dowith gut health.
And speaking of mitochondrialhealth, shout out to we did a
(05:49):
podcast.
It was published.
Well, let's see when this onecomes out.
Look back to January.
But we did a podcast on PCOSand mitochondrial health, which
might be interesting to you ifthat really resonated with you.
So, yes, I am fascinated.
Okay, so we know that thisoccurs a lot.
We know that there's a lot ofconnections here.
(06:10):
What I'm curious about arelet's say, you have PCOS,
because this is a functionalPCOS podcast, right?
So everyone listening probablyhas PCOS.
So if you suspect that youmight also have thyroid issues,
what are some signs of that?
I know that a lot of thesymptoms, like irregular periods
and things like that, canoverlap, but what are some of
the thyroid specific signs thatwe should look for to ask for
(06:33):
more testing?
Speaker 2 (06:34):
Yeah, this is where it gets tricky because a lot of
them, a lot of the symptoms, arecommon.
So both can cause irregularmenses.
Both can cause ovarian cysts.
With hypothyroidism, theovaries can even appear
polycystic on ultrasound due tothe infrequent ovulation.
With hypothyroidism, both canlead to infertility.
(06:55):
Insulin resistance is actuallyfound in both conditions.
It's well documented with PCOSbut not as commonly known with
hypothyroidism.
But thyroid hormone affects howyour cells break down sugar and
how well your cells can take upsugar and insulin into the into
the cell.
So that can affect your energy.
Both cause weight gain or theinability to lose weight and
(07:17):
both can cause hair loss.
So it is so fun, yeah, yeah, todifferentiate what might, what
might be going on.
But I would say, if, if you'renot improving with basic PCOS
guidance, or you know your labsare looking great but you're
still having symptoms, it's timeto dig deeper.
(07:39):
Or, like I mentioned earlier,like I think, at least once a
year have a full thyroid panel.
I know we'll probably talk moreabout you know how to get that
done.
Speaker 1 (07:50):
Yeah, I mean I think that's such a good tip because
what I've noticed I don't runthe labs myself but I partner
with doctors who will run themfor my clients and a lot of you
know.
Conventional medicalpractitioners will just run a
TSH right, and then what they'relooking for is a range that,
like you mentioned in your book,is a really exaggerated range.
(08:12):
And what we're looking for infunctional medicine, functional
nutrition, is a much smallerrange, which I believe in your
book you go up to 2.5, right ForTSH.
So conventional med is usuallylike up to four and they don't
worry.
So I see a lot of people whoare like three right, and you
know they're kind of hanging outin that like subclinical
(08:35):
hypothyroidism range wherethey're not getting appropriate
treatment.
But perhaps if they had a fullpanel you could really kind of
see what's going on with.
Let's tell our audience what isa full panel.
You could really kind of seewhat's going on.
Let's tell our audience what isa full panel, what things would
be tested for.
Speaker 2 (08:50):
Yeah, you're going to get a lot of different advice,
but the four core things thatyou really need are the TSH, the
free T4, which is the majorityof the hormone that the thyroid
is producing.
The free T3, your thyroidproduces a little T3, but most
of it is converted from T4.
And then thyroid antibodies, inparticular the Hashimoto's
antibodies, which are TPO.
(09:11):
So those four are.
You're going to get your yourbest bang for your buck on those
four tests.
Speaker 1 (09:16):
Yeah, and that the antibodies one is key because
there can be folks that at leastthat I've seen, and tell me if
this is your experience too,where the rest of the panel
looks relatively normal, ish, um, but the antibodies are really
high and then sometimes, likeeven the, the prescription
(09:38):
thyroid medications, if the, ifthe antibodies are really high,
it almost seems like it justdoesn't do that much or it
doesn't really help that much,because Hashimoto's is, you know
, autoimmune in nature andthere's that inflammation
connection and so if we're nottreating that root cause, you
know, you're just kind ofthrowing thyroid hormone and it
might help a little, but itdoesn't usually kind of treat
(10:00):
the root.
Speaker 2 (10:01):
Yes, the inflammation is still brewing if there's
antibodies there.
But that is a great point.
That is exactly when we want tocatch it.
When the antibodies are high,it's usually early because the
rest of the thyroid hasn't beenaffected yet.
It hasn't attacked the glandenough to make the thyroid low
functioning.
But we catch it with theantibodies are high.
Really key in on the gut healthand try to stop the production
(10:24):
of thyroid antibodies.
Speaker 1 (10:26):
Why do you well, I know you know inflammation, gut
health, all of that but why doyou tend to see high antibodies
in folks?
Is it like go back to justpurely gut health?
Are there like food allergiesthat play often?
Are there?
Is there an adrenal connectionthere?
What do you think?
Speaker 2 (10:45):
Yeah, I think all of the above.
I know this is a littlecontroversial in the PCOS
community, but in particularwith Hashimoto's, there's plenty
of evidence that gluteningestion can lead to higher
thyroid antibodies, and so oneof the things we would likely
recommend is a trial off ofgluten or screening for celiac
disease first.
Speaker 1 (11:07):
Yeah, you are touching on a controversial
topic, but personally I've seenenough issues with gluten
intolerance, dairy intolerancein my PCOS clients that it's
usually something that we wantto look into, especially if
there are thyroid antibodies.
If there's any kind ofautoimmunity, I usually see that
(11:30):
there's some sort of foodallergy or severe food
sensitivity at play, becausethat's part of where that
inflammation from the gut iscoming from and it's kind of a
little bit of a chicken or anegg situation.
The food sensitivity therefirst and then that kind of made
the gut you know all that stuff.
Or was it the other way around?
(11:50):
Probably that, but nevertheless, you've got that going on.
You're going to have to dosomething about it in order for
you to really actually makeprogress.
So I agree, I'm a fan of theapproach.
This leads into our next kind oftopic.
So there are some dietrecommendations for PCOS that
(12:10):
personally, I stay away from inmy practice, but they are common
and so some people may havetried them.
Things like super low carbdiets, keto carnivore diet I've
seen um well, I've seen a lot ofpeople also talk about like
dangers of eating too manycruciferous vegetables and stuff
because of the goitrogens.
So are there any commonlyrecommended nutrition practices
(12:32):
or diets or whatever for PCOSthat you don't like, for you
know these two things togetherdon't like, for you know these
two things together?
Speaker 2 (12:45):
Yeah, great question.
So, kind of to start at the top, I think you started with some
of the fad diets.
Fad diets usually don't work,that's why they're fads.
And so we do have some corenutrition advice that we start
with and then we personalize itto the individual.
So, starting with number one,balancing blood sugar.
Whether or not you have insulinresistant type PCOS or not, even
at the adrenal PCOS, balancingthe blood sugar is going to be
(13:06):
step one, and it's alsoimportant for thyroid, since it
can affect both things.
So, and then we want to replacethe important nutrients, so
especially magnesium, zinc, bvitamins these are all been
found to be much lower in womenwith PCOS and then omega-3s for
inflammation and coenzyme Q10,as we were talking about that
(13:27):
mitochondria.
That is the first nutrient thatstarts the energy production,
and so it's very important forovulation.
And then, like we were justtalking about, screening for
celiac or gluten sensitivity,especially if you have thyroid
disease or Hashimoto'santibodies Celiac is actually
five times more likely in peoplewith Hashimoto's.
So then we would personalizethat advice whether or not
(13:49):
gluten should be avoided.
And then eating for gut health,so increasing fiber as
tolerated and that diversity ofphytonutrients.
So, that is the way we approachnutrition at Root.
A couple of things about thecruciferous veggies you
mentioned.
Um, you would have to eat a tonof cruciferous veggies to be
worried about a goitrogen, whichmeans it can lead to a goiter
(14:11):
or like a thyroid nodule.
Um, but I think the benefits ofcruciferous veggies far
outweigh any potentialtheoretical harm, because
they're anti-inflammatory,they're detoxifying, especially
for estrogens.
They're fiber-filled, bloodsugar balancing.
So if you want to furtherreduce your risk, you can just
cook them, which will break downthose compounds.
Speaker 1 (14:33):
Yeah, I was going to mention that in your book you
talk a bit about the astrabalome, which is, you know, the gut
based kind of estrogenmetabolism and detoxifying
process, how importantcruciferous vegetables are for
us to actually be able tometabolize our estrogen properly
.
And that's also that's onereason why it's key that our gut
(14:54):
, you know, is balanced and thatwe have the right balance of
bacteria in there, and then weeat to support those with fiber,
like you mentioned, because allthose excessive estrogens can
cause a lot of issues.
So cruciferous veggies arepretty amazing.
Do not avoid them.
Now, I could see like apotential if somebody was like
chugging, I don't know, broccolisprout powder or something like
(15:17):
maybe, but it's just, it's kindof like this thing that I see.
I see a lot of people reallyvillainizing different parts of
food.
You know like lectins or youknow things like that, and it's
just, I think we get, we losethe plot a bit with all of this
stuff with nutrition.
I think sometimes when you knowtoo much about nutrition, you
start to kind of like dig down alittle bit too much and kind of
(15:41):
I don't know, you villainize,you start villainizing stuff
when the reality is that look atwhat the majority of people are
eating on a day-to-day basis,right, and how could we make
this a more whole foods diet?
How can we make this moreappropriate?
It's like we really don't needto worry about all of this other
stuff.
One thing I do want to talk toyou about is a common complaint
(16:01):
that I get from clients, whichis that they know about full
thyroid panels.
They know about the connectionbetween PCOS and thyroid issues,
they've done their researchright and they struggle to get
the testing.
I sometimes have people go inwith a list of labs and, by the
way, in the book you have agreat list of labs to ask for,
(16:23):
which are all things that Iwould ask myself.
So the issue is not theknowledge base or having the
resources to know what to askfor.
It's getting their requests met.
So they go to the doctor andthe doctor's like you don't need
that, or that's not medicallynecessary, whatever.
So any advice for thosesituations?
Speaker 2 (16:44):
Yes, I do have a benefit of a previous history in
the conventional world.
I was a practicing familymedicine doctor before I jumped
ship and realized thatfunctional medicine was the way.
So it is unfortunate thatpeople are feeling dismissed and
that this becomes a negotiation.
But let me give you a couple ofkey points from the doctor's
perspective why they're hesitant.
(17:06):
So the number one reason isthat they'll order this test and
then insurance won't cover themand the patient will get a
large bill and they'll end upmad at the doctor.
After that happens to you a fewtimes and people are real mad at
you, you kind of put up yourguard like I'm not sure if I
should order this because you'regoing to get a bill, sometimes
like over a thousand dollars.
So that happens.
(17:27):
And then the second big reasonthey won't order it is they
don't have any time outside ofthe visit to review it, and so
if you have a lot of labs that'spiling up in their inbox,
they're only paid for the timethey spend in the visit.
Okay, so, knowing that from myprevious history, the way to ask
is to tell them that or toactually try to figure out the
(17:48):
cost of labs through yourinsurance before you ask for
them, tell them you're aware itmight not be covered and you're
okay with an out-of-pocket billif you are so that's a really
good tip.
Speaker 1 (18:00):
Yeah, I, I love that.
I actually I have.
I asked that question a lot andnobody's ever said that.
But you know a good friend ofmine who I run group programs
with.
Her name is Hannah Mule, theconscious nutritionist.
She is a PA and so she's.
You know she's talked a lotabout the perspective being on
the conventional side, becausewe tend to sometimes more
(18:21):
alternative people get, theytend to really villainize you
know, conventional medical andthe system has issues, don't get
me wrong, but it's.
It's usually not thepractitioner's fault, well, not
always the practitioner's fault.
A lot of people go intoconventional medicine with, you
know, big hearts.
They want to help, they want todo what they can, and then
they're kind of like chained tothe system that they can't
(18:41):
really fix from the inside.
Speaker 2 (18:44):
Yeah, and then you know, offering to review them in
a follow-up visit, which isgood, to have a discussion and
get your questions answered.
Anyway, I think that willsquash the number one and number
two hesitation that your doctormay have.
And if you do call yourinsurance and find out they're
going to be super expensive.
There are direct orderingwebsites out there that you
could use it.
You know, if you're saying, hey, I can get this, can I follow
(19:05):
up with you with the results?
Speaker 1 (19:07):
Right, and I do know of Thorne does have a full
thyroid panel home kit.
That can be done.
So there are some home kits andthings that you can get.
I do recommend always havingsomebody with knowledge here to
review things with, because youcan get the tests run all day.
But if you don't know how tointerpret them, then but that's
(19:29):
where, if you're able to, afunctional medicine practitioner
is so nice to have on your team.
I know it's not feasible foreveryone the way that things
currently are, but If you canmanage it it is really really
helpful.
Let me ask you this actually sowhat inspired you to start work
(19:51):
really focusing on PCOS andthyroid Was?
it just that you saw it so often.
Speaker 2 (19:57):
That was a big part of it.
But actually back when I waspracticing family medicine,
which was about seven years ago,I kept seeing this pattern in
women in particular, who theyjust didn't feel their best.
They were struggling withfatigue or hair loss or skin
issues or bloating andconventional medicine, and I
didn't have the answers.
I was literally that doctor whotold you your labs are normal,
(20:20):
I don't know what's going on oryou can be referred to this
specialist.
They ended up withcolonoscopies.
They were normal and they wouldend up back in my lap and I
would be like I want to help you.
I feel like we're missingsomething here.
I feel like there is somethingdriving this.
Woman after woman can't keepsaying this to me.
I hear you, I believe you, andI had to go to functional
(20:41):
medicine and figure out how toapproach this differently, with
a completely different mindsetand a completely different model
of care.
And the more I learned, the moreit made sense and I started
putting a little bit of thatinto my family practice within
the limitations that I could,and the results that I was
getting were so much better thanI had in years and I was like,
okay, there's something to this,it really works.
(21:04):
I need more time with people, Ineed restrictions lifted, I need
to be able to order the tests Iwant.
I got to do this on my own, soI jumped ship and started root
about six years ago with adietician, because nutrition is
core to functional medicine.
And there, as we were able todo this advanced testing, we
were diagnosing so much PCOS,which is completely on under
(21:27):
diagnosed, as well as thyroidand, and diagnosing them
together.
And it was like it was justclicking and um, we were.
We were getting women to haveregular periods.
Within two or three months,they were getting pregnant after
even failing IVF, and theresults were so uplifting that
it just became my passion, like,okay, we do have answers, you
(21:50):
know they're, they're feelingbetter and they're achieving
their goals and and I need toshare this with the world so I'm
let's put it in a book I lovethat.
Speaker 1 (21:59):
I mean that that's a very similar story to me.
It's.
It's so nice.
I mean, a lot of us get intothis kind of work because we do
want to help, and I know formyself.
I had a lot of health issuesrelated to my own PCOS.
I had endometrial cancer when Iwas younger and so I went
through a lot.
I didn't want anybody else tohave to experience that.
(22:21):
But it's so frustrating to bewithin certain confines.
You know, even in like thedietetic world, right, there are
some confines with like what wewould traditionally recommend
for PCOS, for example, and itjust didn't ring true for me.
It was so frustrating to kindof run up against these walls
(22:41):
and then when you finallydiscover like, okay, this is how
the system works, this is thebody systems, right, this is how
it's all connected, and thenyou start, you know, being able
to kind of like figure out wherethings are going wrong and make
changes.
It's such a wonderful feelingand it's so empowering.
I love getting like pictures of,you know, ultrasounds and all
(23:03):
that stuff.
It's such a nice, it's just sosuch a one.
80 from from the previousexperience, right, so, um, I
love that and I think that thatpassion is is, um, what's really
nice and it's really important,and I and we need more people
doing this kind of work.
I love that you're reallyhoning in and specializing on
(23:24):
this like particular topic too,because I think, um, at least
from my experience, you know, Istarted out more broadly looking
at like functional nutritionRight, and as I kind of went
along, I just kind of got moreand more specialized because I
think there's just so much to besaid just about this particular
issue, right, like you wrote awhole book about it, like
(23:46):
there's so much, um, we needpeople who like really really
are thinking thoughtfully aboutthese conditions and everything.
So, anyway, I think it's reallycool.
So, um, speaking of the book,tell us about this lovely book
that I have read, that I reallylike.
Speaker 2 (24:04):
So it's based both on our clinical experience doctors
and dietitians at rootfunctional medicinectional
Medicine and it'sresearch-backed.
There's citations throughoutthe book.
We didn't just make this up andso it breaks down the root
causes.
It helps you figure out whatyours might be and then it gives
you steps that you can actuallydo to start to reverse those
(24:26):
root causes.
Um and so it does include evensome uh blood sugar balancing
recipes and a supplementschedule, a list of labs that
you should have.
Um and um.
Yeah, I mean it's.
It's a great place to getstarted, um for anyone.
And then, if you do decide youneed more personalization or
more testing, that's when youknow people reach out directly
(24:47):
to people like you and us atRoot.
Speaker 1 (24:49):
And you, yeah.
So and you said you're, youguys work nationwide, correct?
Speaker 2 (24:56):
Yes, we are a telehealth practice, so all of
the visits are done via computeror phone and then messaging in
between as needed.
Speaker 1 (25:04):
Okay, cool.
So if anyone's listening andthey wanted to work one onone
with someone in your practice,they'd be able to do that.
But I love that, you know.
The book is nice too becauseyou know you and I both know
functional work can be a littlebit the sticker price can be a
(25:24):
little bit tough for people atthe beginning and I think,
long-term most of us kind ofcome around to realize that your
health is worth investing inand it plays out later with cost
savings down the road.
But at the beginning it might benice to have a resource like
this where you can really readand learn and implement some
(25:45):
strategies and actually see inyour own body like, oh yeah,
this is working or there issomething to this.
And then if you get stuck oryou know you can't, um, can't,
dive deeper on your own, thenyou can, you know, reach out and
work with somebody.
But, um, yeah, I really likeit's very step-by-step.
The first actually the majorityof the book I would say is like
(26:08):
just it's really deep consciousinformation about the
connection between these things.
So I, like I said I will havethat linked in the show notes.
Um, but if we want to find you,where can we find you?
Where are you online?
Speaker 2 (26:25):
Yes, so our website is root functional medicinecom
and I'd say, on social, we'remost active on Instagram, so at
root functional medicine, andthen we do have a free get to
the root quiz on the homepagetoo.
That's easy, and then you'llget just a few emails with steps
that you can implement based onyour answers there.
So cool.
Speaker 1 (26:44):
I will have all that linked in the show notes.
Thank you so much for beinghere.
Erica, Appreciate it.
It's a really good conversation.
Speaker 2 (26:53):
Yes, thank you so much, of course.
Welcome back to an Amber a day.
I'm your host, amber Fisher,and today I have a very special
guest.
I have Dr Erica Armstrong, whois Institute for Functional
Medicine certified practitioner.
She is also the author of thePCOS thyroid connection a
functional medicine approach totreating the root cause.
And guys, I read this book.
(00:20):
I sat down and read it, eventhough I you know my attention
span is like this these days.
This book gripped me.
I told her before we startedrecording.
I was genuinely so impressedwith this book, with the amount
of detail, even just as aresource for PCOS Take the
thyroid piece out of it.
(00:40):
It's a great resource for PCOS.
So I will have a link in thedescription or the show notes.
So if you guys want to take alook at this book I know it's on
Amazon and stuff like that, sohighly highly recommend.
But we're going to talk alittle bit about it soon.
Erica, would you introduceyourself to us?
Tell us a little bit about you.
Speaker 2 (01:01):
Yes, and thank you so much for the kind words.
I am founder and CEO of RootFunctional Medicine, which is a
nationwide telehealth practicewhere every member has both a
doctor and a dieticiannutritionist.
If you're not familiar withfunctional medicine, the core is
finding the root cause.
So we put the whole picturetogether, connect the body
(01:24):
systems and figure out whatactually is driving disease so
that we can reverse it andoptimize health.
So we specialize in PCOS,thyroid, gut health, hormone
balance and autoimmuneconditions and other things, but
those are the top things thatwe treat.
Speaker 1 (01:41):
Amazing.
That's really cool.
So you guys work nationwide.
I like that.
You have a dietician witheverybody.
That's nice.
Nutritionists love that.
Speaker 2 (01:52):
Nutrition is core to functional medicine.
Since we started.
Speaker 1 (01:56):
Yes, I love that.
Okay, so we're here today totalk about the PCOS and thyroid
connection, which I know is ahot topic.
I get asked about this a lotand I'll admit that I don't know
as much about the thyroid as Iwould like to, but I know that
these two things overlap a lot.
(02:17):
I see it all the time in mypractice.
So I'm anxious to kind of getyour expertise on how that works
, what the connection is andmaybe some things that our
audience can implement now.
So can you explain a little bitabout PCOS and thyroid issues
and kind of how they connect orwhat the overlaps are there?
Speaker 2 (02:36):
Yeah, so at baseline.
These are the two of the mostcommon hormonal issues.
Women with PCOS are three timesmore likely to also have a
thyroid disease than womenwithout PCOS, in particular,
hashimoto's, which is the mostcommon type of hypothyroidism.
Over 90% of those withhypothyroidism in the US have
Hashimoto's.
(02:56):
That's an autoimmune conditionwhere your thyroid is being
attacked and then unable toproduce enough thyroid hormone
over time, and so one studyactually showed that Hashimoto's
was present in 23% of womenwith PCOS almost a quarter of
women with PCOS.
So it's really important, ifyou have PCOS, to have thyroid
(03:16):
on your radar for screening.
So there's a lot of ways thatthese conditions overlap, but
the largest one, especially thatwe see in our functional
medicine practice, is that theyshare root causes, and so in our
practice we have the doctor andthe dietician working together,
putting the whole storytogether, figuring out root
causes and utilizing advancedlab testing as well as the
(03:38):
conventional testing, whichincludes full thyroid panels for
everyone with PCOS, and so thatis how we were able to figure
out over time that, hey, theseconditions are popping up all
the time and they're sharingroot causes, and we've actually
diagnosed a lot of thyroiddisease when there has been
previous PCOS or diagnosed bothof them together.
(04:00):
Because of this, we feel thatit's important for everyone with
PCOS to have a full thyroidpanel as part of their yearly
health maintenance and then, ifsymptoms warrant it.
So, um, there's several rootcauses, um, why these conditions
occur together.
Um, I wrote about this in mybook and broke it down by
chapter of you know the mostcommon root causes.
(04:21):
Thank, thank you.
So the biggest root cause isinflammation, which is usually
coming from the gut, becausethat's where the majority of the
immune system lies and it's.
Some other root causes areadrenal health, nutrient
deficiencies or insulinresistance, but that's why it's
(04:42):
important to also work with afunctional medicine team, so
that you can work with someonewith advanced training in these
root causes, like gut health andmicrobiome balance or adrenal
testing, and so we can put thewhole picture together.
The other root cause I didn'tmention was mitochondrial health
and mitochondria you mayremember as a powerhouse of the
(05:03):
cell.
It's the energy producing partof the cell.
Each egg in the ovary hasalmost 600,000 mitochondria in
it to produce enough energy forovulation to occur, and so that
is why taking care of themitochondria are very important,
so that you ovulate.
Then, after ovulation, comesthe natural period.
(05:24):
So that is the synopsis of theroot cause.
Speaker 1 (05:28):
Yeah, that's great, that's most.
That's all the stuff that welove to talk about on this
podcast all the time, and I lovethat.
You know that.
I that makes a lot of sense tome that the thyroid connection
with PCOS would have a lot to dowith inflammation and
inflammation has a lot to dowith gut health.
And speaking of mitochondrialhealth, shout out to we did a
(05:49):
podcast.
It was published.
Well, let's see when this onecomes out.
Look back to January.
But we did a podcast on PCOSand mitochondrial health, which
might be interesting to you ifthat really resonated with you.
So, yes, I am fascinated.
Okay, so we know that thisoccurs a lot.
We know that there's a lot ofconnections here.
(06:10):
What I'm curious about arelet's say, you have PCOS,
because this is a functionalPCOS podcast, right?
So everyone listening probablyhas PCOS.
So if you suspect that youmight also have thyroid issues,
what are some signs of that?
I know that a lot of thesymptoms, like irregular periods
and things like that, canoverlap, but what are some of
the thyroid specific signs thatwe should look for to ask for
(06:33):
more testing?
Speaker 2 (06:34):
Yeah, this is where it gets tricky because a lot of
them, a lot of the symptoms, arecommon.
So both can cause irregularmenses.
Both can cause ovarian cysts.
With hypothyroidism, theovaries can even appear
polycystic on ultrasound due tothe infrequent ovulation.
With hypothyroidism, both canlead to infertility.
(06:55):
Insulin resistance is actuallyfound in both conditions.
It's well documented with PCOSbut not as commonly known with
hypothyroidism.
But thyroid hormone affects howyour cells break down sugar and
how well your cells can take upsugar and insulin into the into
the cell.
So that can affect your energy.
Both cause weight gain or theinability to lose weight and
(07:17):
both can cause hair loss.
So it is so fun, yeah, yeah, todifferentiate what might, what
might be going on.
But I would say, if, if you'renot improving with basic PCOS
guidance, or you know your labsare looking great but you're
still having symptoms, it's timeto dig deeper.
(07:39):
Or, like I mentioned earlier,like I think, at least once a
year have a full thyroid panel.
I know we'll probably talk moreabout you know how to get that
done.
Speaker 1 (07:50):
Yeah, I mean I think that's such a good tip because
what I've noticed I don't runthe labs myself but I partner
with doctors who will run themfor my clients and a lot of you
know.
Conventional medicalpractitioners will just run a
TSH right, and then what they'relooking for is a range that,
like you mentioned in your book,is a really exaggerated range.
(08:12):
And what we're looking for infunctional medicine, functional
nutrition, is a much smallerrange, which I believe in your
book you go up to 2.5, right ForTSH.
So conventional med is usuallylike up to four and they don't
worry.
So I see a lot of people whoare like three right, and you
know they're kind of hanging outin that like subclinical
(08:35):
hypothyroidism range wherethey're not getting appropriate
treatment.
But perhaps if they had a fullpanel you could really kind of
see what's going on with.
Let's tell our audience what isa full panel.
You could really kind of seewhat's going on.
Let's tell our audience what isa full panel, what things would
be tested for.
Speaker 2 (08:50):
Yeah, you're going to get a lot of different advice,
but the four core things thatyou really need are the TSH, the
free T4, which is the majorityof the hormone that the thyroid
is producing.
The free T3, your thyroidproduces a little T3, but most
of it is converted from T4.
And then thyroid antibodies, inparticular the Hashimoto's
antibodies, which are TPO.
(09:11):
So those four are.
You're going to get your yourbest bang for your buck on those
four tests.
Speaker 1 (09:16):
Yeah, and that the antibodies one is key because
there can be folks that at leastthat I've seen, and tell me if
this is your experience too,where the rest of the panel
looks relatively normal, ish, um, but the antibodies are really
high and then sometimes, likeeven the, the prescription
(09:38):
thyroid medications, if the, ifthe antibodies are really high,
it almost seems like it justdoesn't do that much or it
doesn't really help that much,because Hashimoto's is, you know
, autoimmune in nature andthere's that inflammation
connection and so if we're nottreating that root cause, you
know, you're just kind ofthrowing thyroid hormone and it
might help a little, but itdoesn't usually kind of treat
(10:00):
the root.
Speaker 2 (10:01):
Yes, the inflammation is still brewing if there's
antibodies there.
But that is a great point.
That is exactly when we want tocatch it.
When the antibodies are high,it's usually early because the
rest of the thyroid hasn't beenaffected yet.
It hasn't attacked the glandenough to make the thyroid low
functioning.
But we catch it with theantibodies are high.
Really key in on the gut healthand try to stop the production
(10:24):
of thyroid antibodies.
Speaker 1 (10:26):
Why do you well, I know you know inflammation, gut
health, all of that but why doyou tend to see high antibodies
in folks?
Is it like go back to justpurely gut health?
Are there like food allergiesthat play often?
Are there?
Is there an adrenal connectionthere?
What do you think?
Speaker 2 (10:45):
Yeah, I think all of the above.
I know this is a littlecontroversial in the PCOS
community, but in particularwith Hashimoto's, there's plenty
of evidence that gluteningestion can lead to higher
thyroid antibodies, and so oneof the things we would likely
recommend is a trial off ofgluten or screening for celiac
disease first.
Speaker 1 (11:07):
Yeah, you are touching on a controversial
topic, but personally I've seenenough issues with gluten
intolerance, dairy intolerancein my PCOS clients that it's
usually something that we wantto look into, especially if
there are thyroid antibodies.
If there's any kind ofautoimmunity, I usually see that
(11:30):
there's some sort of foodallergy or severe food
sensitivity at play, becausethat's part of where that
inflammation from the gut iscoming from and it's kind of a
little bit of a chicken or anegg situation.
The food sensitivity therefirst and then that kind of made
the gut you know all that stuff.
Or was it the other way around?
(11:50):
Probably that, but nevertheless, you've got that going on.
You're going to have to dosomething about it in order for
you to really actually makeprogress.
So I agree, I'm a fan of theapproach.
This leads into our next kind oftopic.
So there are some dietrecommendations for PCOS that
(12:10):
personally, I stay away from inmy practice, but they are common
and so some people may havetried them.
Things like super low carbdiets, keto carnivore diet I've
seen um well, I've seen a lot ofpeople also talk about like
dangers of eating too manycruciferous vegetables and stuff
because of the goitrogens.
So are there any commonlyrecommended nutrition practices
(12:32):
or diets or whatever for PCOSthat you don't like, for you
know these two things togetherdon't like, for you know these
two things together?
Speaker 2 (12:45):
Yeah, great question.
So, kind of to start at the top, I think you started with some
of the fad diets.
Fad diets usually don't work,that's why they're fads.
And so we do have some corenutrition advice that we start
with and then we personalize itto the individual.
So, starting with number one,balancing blood sugar.
Whether or not you have insulinresistant type PCOS or not, even
at the adrenal PCOS, balancingthe blood sugar is going to be
(13:06):
step one, and it's alsoimportant for thyroid, since it
can affect both things.
So, and then we want to replacethe important nutrients, so
especially magnesium, zinc, bvitamins these are all been
found to be much lower in womenwith PCOS and then omega-3s for
inflammation and coenzyme Q10,as we were talking about that
(13:27):
mitochondria.
That is the first nutrient thatstarts the energy production,
and so it's very important forovulation.
And then, like we were justtalking about, screening for
celiac or gluten sensitivity,especially if you have thyroid
disease or Hashimoto'santibodies Celiac is actually
five times more likely in peoplewith Hashimoto's.
So then we would personalizethat advice whether or not
(13:49):
gluten should be avoided.
And then eating for gut health,so increasing fiber as
tolerated and that diversity ofphytonutrients.
So, that is the way we approachnutrition at Root.
A couple of things about thecruciferous veggies you
mentioned.
Um, you would have to eat a tonof cruciferous veggies to be
worried about a goitrogen, whichmeans it can lead to a goiter
(14:11):
or like a thyroid nodule.
Um, but I think the benefits ofcruciferous veggies far
outweigh any potentialtheoretical harm, because
they're anti-inflammatory,they're detoxifying, especially
for estrogens.
They're fiber-filled, bloodsugar balancing.
So if you want to furtherreduce your risk, you can just
cook them, which will break downthose compounds.
Speaker 1 (14:33):
Yeah, I was going to mention that in your book you
talk a bit about the astrabalome, which is, you know, the gut
based kind of estrogenmetabolism and detoxifying
process, how importantcruciferous vegetables are for
us to actually be able tometabolize our estrogen properly
.
And that's also that's onereason why it's key that our gut
(14:54):
, you know, is balanced and thatwe have the right balance of
bacteria in there, and then weeat to support those with fiber,
like you mentioned, because allthose excessive estrogens can
cause a lot of issues.
So cruciferous veggies arepretty amazing.
Do not avoid them.
Now, I could see like apotential if somebody was like
chugging, I don't know, broccolisprout powder or something like
(15:17):
maybe, but it's just, it's kindof like this thing that I see.
I see a lot of people reallyvillainizing different parts of
food.
You know like lectins or youknow things like that, and it's
just, I think we get, we losethe plot a bit with all of this
stuff with nutrition.
I think sometimes when you knowtoo much about nutrition, you
start to kind of like dig down alittle bit too much and kind of
(15:41):
I don't know, you villainize,you start villainizing stuff
when the reality is that look atwhat the majority of people are
eating on a day-to-day basis,right, and how could we make
this a more whole foods diet?
How can we make this moreappropriate?
It's like we really don't needto worry about all of this other
stuff.
One thing I do want to talk toyou about is a common complaint
(16:01):
that I get from clients, whichis that they know about full
thyroid panels.
They know about the connectionbetween PCOS and thyroid issues,
they've done their researchright and they struggle to get
the testing.
I sometimes have people go inwith a list of labs and, by the
way, in the book you have agreat list of labs to ask for,
(16:23):
which are all things that Iwould ask myself.
So the issue is not theknowledge base or having the
resources to know what to askfor.
It's getting their requests met.
So they go to the doctor andthe doctor's like you don't need
that, or that's not medicallynecessary, whatever.
So any advice for thosesituations?
Speaker 2 (16:44):
Yes, I do have a benefit of a previous history in
the conventional world.
I was a practicing familymedicine doctor before I jumped
ship and realized thatfunctional medicine was the way.
So it is unfortunate thatpeople are feeling dismissed and
that this becomes a negotiation.
But let me give you a couple ofkey points from the doctor's
perspective why they're hesitant.
(17:06):
So the number one reason isthat they'll order this test and
then insurance won't cover themand the patient will get a
large bill and they'll end upmad at the doctor.
After that happens to you a fewtimes and people are real mad at
you, you kind of put up yourguard like I'm not sure if I
should order this because you'regoing to get a bill, sometimes
like over a thousand dollars.
So that happens.
(17:27):
And then the second big reasonthey won't order it is they
don't have any time outside ofthe visit to review it, and so
if you have a lot of labs that'spiling up in their inbox,
they're only paid for the timethey spend in the visit.
Okay, so, knowing that from myprevious history, the way to ask
is to tell them that or toactually try to figure out the
(17:48):
cost of labs through yourinsurance before you ask for
them, tell them you're aware itmight not be covered and you're
okay with an out-of-pocket billif you are so that's a really
good tip.
Speaker 1 (18:00):
Yeah, I, I love that.
I actually I have.
I asked that question a lot andnobody's ever said that.
But you know a good friend ofmine who I run group programs
with.
Her name is Hannah Mule, theconscious nutritionist.
She is a PA and so she's.
You know she's talked a lotabout the perspective being on
the conventional side, becausewe tend to sometimes more
(18:21):
alternative people get, theytend to really villainize you
know, conventional medical andthe system has issues, don't get
me wrong, but it's.
It's usually not thepractitioner's fault, well, not
always the practitioner's fault.
A lot of people go intoconventional medicine with, you
know, big hearts.
They want to help, they want todo what they can, and then
they're kind of like chained tothe system that they can't
(18:41):
really fix from the inside.
Speaker 2 (18:44):
Yeah, and then you know, offering to review them in
a follow-up visit, which isgood, to have a discussion and
get your questions answered.
Anyway, I think that willsquash the number one and number
two hesitation that your doctormay have.
And if you do call yourinsurance and find out they're
going to be super expensive.
There are direct orderingwebsites out there that you
could use it.
You know, if you're saying, hey, I can get this, can I follow
(19:05):
up with you with the results?
Speaker 1 (19:07):
Right, and I do know of Thorne does have a full
thyroid panel home kit.
That can be done.
So there are some home kits andthings that you can get.
I do recommend always havingsomebody with knowledge here to
review things with, because youcan get the tests run all day.
But if you don't know how tointerpret them, then but that's
(19:29):
where, if you're able to, afunctional medicine practitioner
is so nice to have on your team.
I know it's not feasible foreveryone the way that things
currently are, but If you canmanage it it is really really
helpful.
Let me ask you this actually sowhat inspired you to start work
(19:51):
really focusing on PCOS andthyroid Was?
it just that you saw it so often.
Speaker 2 (19:57):
That was a big part of it.
But actually back when I waspracticing family medicine,
which was about seven years ago,I kept seeing this pattern in
women in particular, who theyjust didn't feel their best.
They were struggling withfatigue or hair loss or skin
issues or bloating andconventional medicine, and I
didn't have the answers.
I was literally that doctor whotold you your labs are normal,
(20:20):
I don't know what's going on oryou can be referred to this
specialist.
They ended up withcolonoscopies.
They were normal and they wouldend up back in my lap and I
would be like I want to help you.
I feel like we're missingsomething here.
I feel like there is somethingdriving this.
Woman after woman can't keepsaying this to me.
I hear you, I believe you, andI had to go to functional
(20:41):
medicine and figure out how toapproach this differently, with
a completely different mindsetand a completely different model
of care.
And the more I learned, the moreit made sense and I started
putting a little bit of thatinto my family practice within
the limitations that I could,and the results that I was
getting were so much better thanI had in years and I was like,
okay, there's something to this,it really works.
(21:04):
I need more time with people, Ineed restrictions lifted, I need
to be able to order the tests Iwant.
I got to do this on my own, soI jumped ship and started root
about six years ago with adietician, because nutrition is
core to functional medicine.
And there, as we were able todo this advanced testing, we
were diagnosing so much PCOS,which is completely on under
(21:27):
diagnosed, as well as thyroidand, and diagnosing them
together.
And it was like it was justclicking and um, we were.
We were getting women to haveregular periods.
Within two or three months,they were getting pregnant after
even failing IVF, and theresults were so uplifting that
it just became my passion, like,okay, we do have answers, you
(21:50):
know they're, they're feelingbetter and they're achieving
their goals and and I need toshare this with the world so I'm
let's put it in a book I lovethat.
Speaker 1 (21:59):
I mean that that's a very similar story to me.
It's.
It's so nice.
I mean, a lot of us get intothis kind of work because we do
want to help, and I know formyself.
I had a lot of health issuesrelated to my own PCOS.
I had endometrial cancer when Iwas younger and so I went
through a lot.
I didn't want anybody else tohave to experience that.
(22:21):
But it's so frustrating to bewithin certain confines.
You know, even in like thedietetic world, right, there are
some confines with like what wewould traditionally recommend
for PCOS, for example, and itjust didn't ring true for me.
It was so frustrating to kindof run up against these walls
(22:41):
and then when you finallydiscover like, okay, this is how
the system works, this is thebody systems, right, this is how
it's all connected, and thenyou start, you know, being able
to kind of like figure out wherethings are going wrong and make
changes.
It's such a wonderful feelingand it's so empowering.
I love getting like pictures of,you know, ultrasounds and all
(23:03):
that stuff.
It's such a nice, it's just sosuch a one.
80 from from the previousexperience, right, so, um, I
love that and I think that thatpassion is is, um, what's really
nice and it's really important,and I and we need more people
doing this kind of work.
I love that you're reallyhoning in and specializing on
(23:24):
this like particular topic too,because I think, um, at least
from my experience, you know, Istarted out more broadly looking
at like functional nutritionRight, and as I kind of went
along, I just kind of got moreand more specialized because I
think there's just so much to besaid just about this particular
issue, right, like you wrote awhole book about it, like
(23:46):
there's so much, um, we needpeople who like really really
are thinking thoughtfully aboutthese conditions and everything.
So, anyway, I think it's reallycool.
So, um, speaking of the book,tell us about this lovely book
that I have read, that I reallylike.
Speaker 2 (24:04):
So it's based both on our clinical experience doctors
and dietitians at rootfunctional medicinectional
Medicine and it'sresearch-backed.
There's citations throughoutthe book.
We didn't just make this up andso it breaks down the root
causes.
It helps you figure out whatyours might be and then it gives
you steps that you can actuallydo to start to reverse those
(24:26):
root causes.
Um and so it does include evensome uh blood sugar balancing
recipes and a supplementschedule, a list of labs that
you should have.
Um and um.
Yeah, I mean it's.
It's a great place to getstarted, um for anyone.
And then, if you do decide youneed more personalization or
more testing, that's when youknow people reach out directly
(24:47):
to people like you and us atRoot.
Speaker 1 (24:49):
And you, yeah.
So and you said you're, youguys work nationwide, correct?
Speaker 2 (24:56):
Yes, we are a telehealth practice, so all of
the visits are done via computeror phone and then messaging in
between as needed.
Speaker 1 (25:04):
Okay, cool.
So if anyone's listening andthey wanted to work one onone
with someone in your practice,they'd be able to do that.
But I love that, you know.
The book is nice too becauseyou know you and I both know
functional work can be a littlebit the sticker price can be a
(25:24):
little bit tough for people atthe beginning and I think,
long-term most of us kind ofcome around to realize that your
health is worth investing inand it plays out later with cost
savings down the road.
But at the beginning it might benice to have a resource like
this where you can really readand learn and implement some
(25:45):
strategies and actually see inyour own body like, oh yeah,
this is working or there issomething to this.
And then if you get stuck oryou know you can't, um, can't,
dive deeper on your own, thenyou can, you know, reach out and
work with somebody.
But, um, yeah, I really likeit's very step-by-step.
The first actually the majorityof the book I would say is like
(26:08):
just it's really deep consciousinformation about the
connection between these things.
So I, like I said I will havethat linked in the show notes.
Um, but if we want to find you,where can we find you?
Where are you online?
Speaker 2 (26:25):
Yes, so our website is root functional medicinecom
and I'd say, on social, we'remost active on Instagram, so at
root functional medicine, andthen we do have a free get to
the root quiz on the homepagetoo.
That's easy, and then you'llget just a few emails with steps
that you can implement based onyour answers there.
So cool.
Speaker 1 (26:44):
I will have all that linked in the show notes.
Thank you so much for beinghere.
Erica, Appreciate it.
It's a really good conversation.
Speaker 2 (26:53):
Yes, thank you so much, of course.
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Welcome to Bookmarked by Reese’s Book Club — the podcast where great stories, bold women, and irresistible conversations collide! Hosted by award-winning journalist Danielle Robay, each week new episodes balance thoughtful literary insight with the fervor of buzzy book trends, pop culture and more. Bookmarked brings together celebrities, tastemakers, influencers and authors from Reese's Book Club and beyond to share stories that transcend the page. Pull up a chair. You’re not just listening — you’re part of the conversation.
On Purpose with Jay Shetty
I’m Jay Shetty host of On Purpose the worlds #1 Mental Health podcast and I’m so grateful you found us. I started this podcast 5 years ago to invite you into conversations and workshops that are designed to help make you happier, healthier and more healed. I believe that when you (yes you) feel seen, heard and understood you’re able to deal with relationship struggles, work challenges and life’s ups and downs with more ease and grace. I interview experts, celebrities, thought leaders and athletes so that we can grow our mindset, build better habits and uncover a side of them we’ve never seen before. New episodes every Monday and Friday. Your support means the world to me and I don’t take it for granted — click the follow button and leave a review to help us spread the love with On Purpose. I can’t wait for you to listen to your first or 500th episode!
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com