October 24, 2025 • 40 mins
In this episode of The Eye-Q Podcast, I sit down with Dr. Jen Pfleghaar, DO, ABOIM, to explore what really happens to women’s hormones during perimenopause—and how to navigate it with grace. We talk about hormone imbalances, migraines, liver detox, cycle syncing, fasting, and how faith and integrative medicine can help restore balance, energy, and peace of mind.
Dr. Jen Pfleghaar is a double board-certified physician in Emergency and Integrative Medicine. She earned her medical degree from Lake Erie College of Osteopathic Medicine, completed residency at St. Vincent’s Mercy Hospital, and fellowship at the Andrew Weil Center for Integrative Medicine. She believes true wellness thrives when body, mind, and spirit are aligned with God’s design. Diagnosed with Hashimoto’s, she became passionate about autoimmune healing, hormone balance, and root-cause medicine. Dr. Jen co-authored Eat. Sleep. Move. Breathe., serves on the boards of the Invisible Disabilities Association and American Board of Integrative Medicine. Through her practice, Healthy by Dr. Jen, she provides virtual care and shares education as @integrativedrmom. She lives on a mini farm in Tennessee with her husband and four children. She loves cheering at her kids’ games, lifting weights, reading Scripture, and tending to her chickens. Her newest book, The Perimenopause Reset, was written on a mission to change the health of 500,000 women navigating perimenopause—empowering them with faith-based, science-backed strategies to reclaim their energy, clarity, and joy.
Jen Pfleghaar, DO, ABOIM
Website: https://www.healthybydrjen.com/
Facebook: https://www.facebook.com/integrativedrmom
Instagram: https://www.linkedin.com/in/drjenpfleghaar
YouTube: https://www.youtube.com/@integrativedrmom
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Episode Transcript
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(00:00):
Another low hanging fruit is controlling stress because if we
have high stress that is going to increase cortisol, that is
going to deplete your progesterone too.
If you're stressed all the time or say you know, you're fasting
in the wrong part of your cycle.So there's a lot of these things
(00:21):
and honestly, women and perimenopause, it's that age
where, you know, they might havea career that they're working
on, they have kids, they have a husband, they have aging.
Parents, welcome to the IQ Podcast.
I'm Doctor Ronnie Bannock here to help you boost your IQ with
powerful insights that connect your eyes, your brain and your
(00:44):
whole body Wellness. Hello everyone, and welcome to
the IQ podcast where you can gain insights into your vision
health, your brain health and your overall Wellness and raise
your IQ. I'm your host doctor Ronnie
Banik, America's integrative ophthalmologist and today I'm
honored to share the stage with Doctor Jen Flagar, who is a
(01:07):
double board certified physician.
She is trained in emergency and integrative medicine and Doctor
Flagar her was diagnosed with Hashimoto's after which she
became passionate about autoimmune healing, hormone
balance and root cause medicine.Doctor Jenna is Olson author.
(01:27):
She's co-authored Eat, Sleep, Move, Breathe, and her newest
book, the Perimenopause Reset was just released a few weeks
ago. And she hopes that this book
would lead to a mission or guidepeople on a mission to change
their health. And she hopes to reach at least
500,000 women, helping them navigate perimenopause and
(01:49):
empowering them with faith-basedscience back strategies to
reclaim their energy, clarity and joy.
Welcome to the IQ podcast. Doctor Jen, it's a pleasure to
have you here. Hi, thank you, Doctor.
Ronnie. Well, I wanted to start off with
a question that I asked most of my guests, which is you are
trained in traditional medicine,right?
(02:11):
You are an emergency room physician.
So how is it that you found thispath where now you incorporate
integrative strategies and functional medicine as well and
faith-based strategies into yourtreatment protocols and
diagnosis strategies? We all go through the
traditional medical school, right?
And we are kind of groomed plus train to take these tests and
(02:36):
these tests are basically match diagnosis with treatment which
is a pharmaceutical usually. And even though I went to DO
school, which AT still, who was an MD, created doctor of
osteopathic medicine to look at the body more of a whole, but we
really got away from that. And in the ER I just came very
disillusioned with conventional medicine.
(02:58):
And what I was treating in the ER was chronic things that could
have been prevented. Not only that, I mean, I would
have patients coming in with chronic belly pain and they were
going to GI, they were going to their family doctor, They were
taking the medicine, right. And still not getting better.
So I was like doing diet plans. I was seeing more and more sick
kids. So I was reading about lime and
(03:20):
mold. And I remember when I think I
was pregnant with my, my second boy and I looked at my husband
and here we are. I like just, you know, a couple
years out of starting an emergency medicine and I'm like,
yeah, I need to go back and do an integrative medicine
fellowship because I was readingall this on my own.
I wanted to get board certified because I knew if I didn't have
(03:44):
the actual training, first of all, I wouldn't read the stuff I
didn't want to read, right? And and then also I wanted that
board certification. So when I communicated with
conventional doctors, I could say, look like this isn't woo
woo. This is real science evidence
base back to medicine. Supplements are OK.
They work with our body and it just was really important to me.
(04:07):
So from that just kept, you know, learning about hormones
and now that's my main passion cause so many women are
suffering, actually 8 million women in perimenopause right now
in the US So that's why my mission of 500,000 seems like a
lot, but it's really, it's really not 'cause there's so
many women. Yeah.
And then hormones, peptides, youknow, all of these things just
(04:31):
it's kind of like drinking from a fire hose, right?
When you touched into integrative medicine, there's so
much to learn and it's beautifulbecause like you and I, we will
never stop learning. In the integrative world.
There's no ceiling, you know? We just keep learning and
expanding and collaborating witheach other.
And who benefits the patients? And it's beautiful.
(04:52):
Yeah, Now I love hearing your story.
And I have to say, Doctor Jen, you're truly a Unicorn.
I would say as an emergency roomphysician, because in my
experience, my my father is actually an emergency room
physician who's now retired. But, you know, in my experience,
most patients come in and out ofthe Ed, But to have a doctor
provider who actually sits with them and tries to figure out,
(05:14):
OK, why is this happening? And let's talk a little bit
about other things. The root cause of it, diet,
hormone, stress, lifestyle, you know, all of those other things.
Were you able to do that in an emergency department setting or
is that kind of why you have established your practice
outside of that type of care? Well, we just moved to Tennessee
this year, so I still need to get into AER here.
(05:37):
But when I was practicing in theemergency room still, I had my
private practice and I still work shifts in the ER.
I would have that time. I worked in a lot of critical
access ER. So it was very nice because I
had more time and I was working a lot of night shift, which
isn't good for my health, but I would be able to sit down and,
and talk with these patients. I remember this one patient, he
(06:01):
was a, a vet, he was in the Armyand he got injured so was
discharged, had a lot of PTSD, kept coming to the ER young
healthy guy for chest pain. And every time it was ruled out
normal. So I sat down with him and his
mother because everything was normal again.
And I'm like, well, what's goingon?
Like are you sleeping well and are you eating well?
(06:21):
Just through the basics. And he broke down and was like,
actually his dog, his support dog passed away.
So, so that was a whole thing. And then he got a new dog and
the dog was keeping him up all night.
Then he injured his back probably because of lack of
sleep. And, and you know, I, I really
spoke with him. I actually gave him a copy of
the Eat, Sleep Move, breathe book because I would carry that
(06:44):
those in the ER and I would givethem to people as a, a resource
to these patients because they are going to their primary care
doctor, but they only have a 10 minute appointment.
They can't talk to them about the pillars of health.
And you could be on 100 medications, the best
pharmaceuticals, you know, and if you're not sleeping or not
(07:04):
getting good restorative sleep, your body is not going to heal.
Your brain is not going to clearout, you know, through the
lymphatics. It's not going to detox.
You're going to have brain fog. It's just this ripple effect.
So in another example, like a woman that was, came in and she
had ovarian cysts. So we ruled out ovarian torsion,
made sure there was no infection, all those things
we're doing the conventional medicine.
(07:26):
But then I, I sat down with her.I'm like, tell me about your
family history. And she's like, oh, my mother
had to have a hysterectomy when she was 30 because she was
bleeding so much. And I'm like, OK, you have an
estrogen metabolism problem, which could be coming from liver
health or it could be coming from gut health.
And, and I talk about all of this in my book, The
Perimenopause Reset because we have to start now and pay
(07:50):
attention to these things because I, you know, I truly
believe God designed our bodies beautifully.
But because of all the environmental toxins stress, the
environment we live in now, things get mismatched,
miscommunicated. So the goal is to bring things
back into homeostasis. And, you know, I just sprinkle
(08:10):
integrative medicine in during those ER visits as just an extra
service. And some patients are open to
it, but some aren't. You know, like I'm sure you've
noticed, not everyone wants an integrative ophthalmologist.
Some people are just they they can't even fathom it.
Yeah, no. Well, I really applaud you for
taking that extra time and really trying to dig deep and
(08:33):
figure out what's going on. I often find myself in the same
situation where patients are coming in just for a routine eye
exam and just things are not going well.
You know, their eyes are inflamed, they're very
uncomfortable, their quality of the vision is not good.
So I sit down and I ask them what's really going on.
And inevitably it'll be one of those pillars of health, as you
mentioned, is not ideal or it's not optimized, whether it's
(08:56):
their sleep, their diet, they'renot able to manage their stress
level. So I think as providers, we do
owe it to our patients, even if it's a short amount of time in
maybe one or two minutes, talking about some of these
things and then guiding our patients to the right Ave. so
that they can get help. It's really, really important to
have those conversations. Well, I wanted to switch over to
(09:16):
talking about something that really is in your area of
expertise, Dr. Jen, which is hormones, especially hormone
fluctuations during this time inmany women's lives with that we
call perimenopause as they're transitioning into menopause.
Can you just explain, first of all, to give our audience, like,
what is the overall pattern that's happening during this
(09:39):
time? What's happening to our hormones
and what can people expect during this period?
Yes, perimenopause is kind of a weird phase, right?
It's, it's before menopause where menopause is a year
without a menstrual cycle. And this is where your estradiol
levels eventually go to to zero.Well, some women, they'll still
(10:02):
have conversion of estrogens in their fat cells to estrone, but
basically estradiol, which is protective for the heart, for
the eyes, for the bones, for everything.
Estradiol is very important. That is going to plummet.
So what happens before that? Well, in perimenopause, which
could be 5 to 10 years before menopause.
(10:23):
I mean, I am seeing this earlierand earlier in women and I think
from stress, I think the pandemic, a lot of reasons.
But when we start to age, when we go through aging, our
progesterone is just on a decline.
So progesterone is the hormone that is most prominent during
(10:43):
that luteal phase or that second-half of the cycle.
Progesterone is what when the egg is implanted, it is going to
maintain the endometrium into that nice fluffy space for that
egg to sit. And then our body produces more
progesterone until the placenta takes over.
So what happens is we're having that progesterone decline.
(11:04):
Well, we know that there are some women that are more
estrogen dominant or they don't detoxify their estrogens as well
or their progesterone is low compared to their estrogen.
And then these are the women that are getting symptoms such
as irritability before their cycle, heavy cycles.
And and this is what we see in perimenopause because that
(11:25):
progesterone is declining and then we will get a little bit of
erratic estradiol levels, so. It's really about the balance
between the two. That's what you're.
That's what you're saying. Yes, yeah.
And sometimes we have like an extra ovulatory cycle because
the follicles aren't as robust. So the body's like did did she
(11:47):
ovulate or no, was that a follicle or not?
So, so then sometimes there's another surge of SSH follicle
stimulating hormone and in another, you know, burst of
estradiol. So we so then we have an even
even bigger unbalance and what is that going to lead to more
symptoms? So sometimes these women that
have been regular every 28 day cycle, you know, every month all
(12:10):
the same, not so heavy cycle, they'll be like, I'm getting
heavy cycles now out of nowhere because their progesterone is
declining, right? And then one symptom that
happens a lot is like anxiety orpalpitations.
We see poor sleep, all of this. So these women in perimenopause,
they don't know what it is. So that's why awareness is good.
(12:32):
They're like, I don't feel like myself.
My body's changing, but I've changed nothing.
And they go to their doctor and this is like their recipe for
perimenopause is to put these women on birth control and an
antidepressant all the time. I've seen that so many times,
yes. Yes, yes, and for and for you
for eye health like or migraineswith or without aura, you know,
(12:56):
dry eyes, well-being on an oral birth control can make those
worse and make the eye worse. So I, I'm sure they come to you
and you're like, oh, they put you on that like, great.
So there's easy solutions to this.
Well, it's very emotional for women too, because they go to
their doctor and they're basically told they're depressed
(13:17):
and something's wrong with them and they're put on these.
And then the other crazy thing, I'm sure you've seen this, some
of these women, they are put on oral birth control at age 40 and
they stay on them 15 years. So you don't even know if
they're in menopause. You can check, you know, FSH and
stuff, but we know that oral birth control is pretty toxic.
(13:39):
It's going to increase risk whenyou're taking oral estrogen of
stroke of cardiovascular factors.
It's going to increase your riskof migraines.
If you have migraines, you're actually not supposed to be on
oral birth control, but still happens and they're using it off
label. Birth control is not, you know,
labeled for for perimenopause orcontrol symptoms.
So. What is a good alternative then,
(14:01):
like from an integrative standpoint for these, you know,
with these women who are going through these changes?
What do you typically recommend?What can they do or maybe
something that they can do with the provider?
Yeah. So it can be complicated, right?
So sometimes it could be liver health.
So I, I talk about in the book how to help your liver by
detoxifying your environment. So when we look at our liver,
(14:24):
everything comes through that right?
So if we have estrogen mimickersor endocrine disruptors, our
liver has to process that alcohol.
Our liver has to process that. And what happens when our body
is processing alcohol? Well, it's like, yeah, like this
is toxic. I need to deal with this.
I'll deal with detoxifying your estrogens later.
(14:46):
You know, it's like. That's shifted into a different
mode, basically, yeah. And mold can do this.
Mold is another thing that I have seen with patients that are
in perimenopause and their symptoms are multiplied because
they're dealing with mold and mold is detoxified through the
liver also, like if they're living in mold, it's really
evident. So we need to clean up the
(15:08):
liver, clean up our environment,our gut needs to be tip top too,
because we, we also get rid of estrogen in our gut.
And if our gut is not working properly, sometimes we can
recycle toxic metabolites and estrogen.
So then that would make that estrogen progesterone imbalance
even worse. So we, we start with that and
(15:31):
you know, low hanging fruit withthat.
And then also we want to just supplement, you know, B
vitamins, magnesium, things thatsupport the liver.
When women are younger and they're starting like early
perimenopause, sometimes I will have them just go on Chase Tree
Berry or Vitex and, and that will.
And that they take every day. We at least try it for three
(15:52):
months and we'll check their labs and their symptoms and see
how they're doing. And that encourages your body to
make its own progesterone. It works through the pituitary
access. Yeah.
So that's really nice. But then if a woman comes to me
and they're like in their late 40s, their parents went through
menopause or their mother and their early 50s, then I'm like,
yeah, like it's time. We're just going to do
(16:13):
progesterone. And they would just take it
during that second-half of the cycle, the luteal phase.
Cause most of these women are still cycling normally, but they
might have had like a shortened cycle where they were 28 days
and now they're 26, now they're 25.
So that will lengthen it out. And then depending on how close
(16:34):
they get to menopause will will do different things too.
But those are really helpful. And then another low hanging
fruit is controlling stress because if we have high stress,
that is going to increase cortisol, that is going to
deplete your progesterone too. If you're stressed all the time
or say you know, you're fasting in the wrong part of your cycle,
(16:57):
which we'll talk about cycle thinking later.
So there's a lot of these things.
And honestly, women in perimenopause, it's that age
where, you know, they might havea career that they're working
on. They have kids, they have a
husband, they have aging parents.
Yeah. Everything is coming at them,
right? It's, it's a lot.
(17:18):
Yes, absolutely. I wanted to go back to ask to
the topic of migraine because a lot of my patients have
migraine, whether it's with or without aura, all kinds of other
symptoms, light sensitivity, nausea, vomiting, etcetera.
And when it comes to what we call menstrual migraine, where
women tend to get migraines as soon as their cycle, you know,
(17:39):
as soon as they start menstruating, that's usually
those two or three days. They're very, very, their
threshold for migraine is very low.
That's typically when it happens.
So the traditional teaching is that it happens, migraine
happens in that time because there is a very sharp drop in
estrogen levels and that's what the brain is not used to and
(18:00):
then it can trigger a migraine. So in terms of your approach
with looking at also progesterone levels in
relationship to estrogen, what are your thoughts about that?
And do you think that's really true?
It's that sudden fall in estrogen and what can people do
from an integrative standpoint to balance that out?
Yes, I definitely think it's thefluctuations right and imperi
(18:23):
menopause when, you know, sometimes that flares their
their migraines and I don't think that migraines are normal.
I think they're root cause. I don't think that women should
suffer from migraines. They need to keep digging.
I've had a lot of patients with migraines that have had mold
toxicity and once we treat that mold and you know, and that's
(18:43):
going to like I spoke about how estrogen and mold it.
You know, there are some molds that actually mimic estrogen, so
definitely that could be a root cause.
I have found that giving progesterone during that luteal
phase, that second-half, so these 15 through 28 of cycle,
they'll get less migraine triggers because they're really
(19:06):
supporting that progesterone andthat's balancing out that
estrogen and then also working on that estrogen detoxification.
So they're not dropping so much that it's more balanced.
So that will really help a lot of women just balancing out
their migraines. And then when they go through
perimenopause to menopause, thenwe just want to have them on
(19:29):
balanced estradiol and a little estrol and make sure that
they're not overmedicated. I get a lot of patients that
come to me and they are overmedicated on estrogens.
And a lot of the time it's because the doctors aren't
testing them, right? If they're on topical estrogen,
they're doing serum or blood testing and not looking at the
(19:50):
tissue levels. So then, you know, we know if we
have way too much estrogen, thatcan increase migraines.
And once again it goes back to. How women that have migraines,
migraines with aura, they are not supposed to be on oral birth
control. You know that that is a no, no
'cause it's gonna increase risk of stroke.
(20:11):
So if we have to look at that, that balance of estrogen,
progesterone, cause progesteroneis gonna modulate blood vessels
too and, and the vasodilation. So if we balance that more, I
have found that patients get wayless migraines and I've had I've
had patients get like migraines mid cycle too and.
It can happen at any time and I'm in a migraine for myself, so
(20:33):
I've definitely been through that, yeah.
But but it takes them out for for days.
So we definitely don't want that.
Yeah, I've had, I had a patient that would like get a horrible
migraine. She would just like drop like
she couldn't do anything. She would be out for three days
for work every month. And she also had cysts.
So we worked on that estrogen metabolism, making the liver
(20:56):
healthy again because so many ofus just have bogged down livers.
I mean like. With the amount of toxins we're
exposed to in our daily lives, yes, absolutely, yeah.
And and EMF now too, I mean our cells are just very stressed.
So that that can be really helpful to to get the liver just
(21:18):
functioning well again. Our liver is very, you know,
resilient, but still like we need to give it a break and, you
know, get the right herbs and cofactors to, to really help
with detoxification, things likeNAC, glutathione, all of that.
And, and The thing is, if you'retaking medications for any of
these signs and symptoms, you know, these diseases that you're
(21:39):
having, most of them are broken down in the liver.
So then you're even putting moreof a burden on your liver.
So this polypharmacy and being on multiple medications can also
just add to that toxic burden. Yeah, no, I love your approach
is looking at it very holistically.
What are the underlying causes, liver issues, detoxification
(22:02):
issues, whether it's mole toxicity, stressors, etcetera.
This has been amazing. You know, I've learned a lot
from you already, Doctor Jen, we're going to take a very short
break to hear from one of our sponsors and then we'll be right
back with more. And I'm going to be asking you
about the cycle sinking that youmentioned.
So stay tuned everyone, we'll beright back.
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Welcome back everyone to the IQ Podcast.
Today we're chatting with DoctorJen Pfleger and we're talking
about hormones. And Dr. Jen, in your newest
(23:28):
book, The Perimenopause Reset, one of the themes you cover is
cycle stinking. Can you explain to us what that
is and when you use it, or when it's appropriate to include in
someone's care? Yes, I love cycle syncing for
teenagers, you know, all the waythrough menopause.
I think it is so great, but it'sreally important in
(23:49):
perimenopause because this is when things are starting to
shift and we really need to optimize the hormones at the
certain parts of the cycles. And the big mistake I've seen
the past like couple years of patients, we know that fasting
has gotten really, really popular.
Everyone is just like, oh, I do intermittent fasting.
(24:10):
I've lost 50, you know, I mean, you just see it everywhere.
Well, what I noticed in my patients is if they were fasting
in the wrong part of their cycle, they were actually
increasing blood glucose becausethey were having a cortisol
spike and they were stressing out their bodies.
So I'm like, OK, that's one thing that we need to fix.
So fasting, we need to fast for our cycle.
(24:33):
We need to fast in the luteal phase, that first half of the
cycle, that first half of the cycle we are more estrogen
dominant compared to the second-half of the luteal phase
where we're more progesterone dominant.
So in the first half of the cycle we are more insulin
sensitive. So it's easier for women to
fast. It's not stressing out their
body. I've looked at hundreds and
(24:54):
hundreds of continuous glucose monitor data and they they do
great there. This is also when if I'm having
someone try carnivore diet to help with their insulin
resistance or to help with gut health, I'm like, OK, try it
there. Do it then or do strict keto
then. So a couple things, like
mentally you're going to be morelikely to succeed and do it
(25:17):
because you're not fighting yourbody and fighting the hormones
and then they're just going to be more successful and their
body is going to do really well with it can.
I ask you about the the fasting.What type of fasting do you
typically recommend for women inthe first phase of their cycle?
Is it like an 8, you know the different hours?
Like how much time should they be fasting?
(25:39):
Or is it is it like 5 days out of the week you do a fast and
then two days you do a differenttype of eating pattern?
It depends on the patient. I mean obviously everyone is
different for gut health and a little autophagy.
I will recommend them once a month to do a 24 hour fast in
their follicular phase. I'm like look at your calendar.
Here's the thing, like you look on social media and all these
(26:02):
influencers can do three day water fast and all this stuff.
I don't know, they probably somenannies and stuff.
I was asked if I had a nanny at this conference I was at last
week and I just kind of chuckled.
I'm like no, like I want to be hands on with my kid.
And if someone has a nanny that's amazing too.
But what I'm saying is most women I work with don't have
nannies and they have to drive their kids to their activities.
(26:23):
They have to drop them off at school, pick them up, they're
home schooling. They just can't lay on the couch
and do a three day water fast. So I will tell them to do, you
know, a 24 hour fast, make sure they're having electrolytes,
they can have black coffee, you know, just different things.
And that is like a good, you know, you eat an early dinner on
a Sunday and then you eat dinneron Monday with your family.
(26:45):
For women also, it's just hard to not eat dinner with your
family where you know it's better to eat more of your food
in the morning, but that's not as social with family.
So we need to look at like be realistic with patients and
that's going to cause them less stress.
So for weight loss, if a patienthas had it like a stall, like a
(27:07):
weight loss stall, I'll have them do a 36 hour fast.
And that's doable also, especially with how busy women
are at this time of their life. So that for three days will also
kind of like reset the body, help autophagy, get in that
therapeutic ketosis. So those are some examples of
what I think is doable for women.
If you could do a three day water fast and you're not going
(27:28):
to, you know, just struggle withthat, like being a mother, you
can do that too. I know the hardest part for me
is just cooking for your kids. So once again, you could look at
that two week calendar and be like, OK, where are we going to
be like out and about like with sports or something?
And I'm not going to be like cooking them this food and like
not get to eat it. So.
(27:50):
So there's a balance. So a lot of my audience happens
to be plant based or vegetarian,myself including I'm vegetarian.
So for people who don't eat meator fish, what are some options
in terms of like getting that protein, getting into ketosis,
What are some recommendations? So ketosis is gonna be, you
(28:11):
know, you could do more fats like MCT oils.
So that's gonna get you into ketosis faster.
Yeah. If you can't have sardines,
that's a little bit different. But you could just just really
high fat. If you do butter, that would be
good. If you do eggs, that would be
really good and you know, tofu would be helpful.
You could do pea protein with like nut butters and really put
(28:35):
on the the nuts. I know the fasting mimicking
diet, like the prolong therapy that is plant based.
So you can do that and that willlike mimic the fasting.
So those are options too. Yeah.
So there's definitely ways to get that.
And then you just have to, well,we could talk about, you know,
luteal phase, then you're addingback in more of the
(28:56):
carbohydrates. So then you can get hit those
leucine triggers a little bit better.
So and that's the thing in the follicular phase, you're not
going to be doing it the whole time, you know, you're not going
to be fasting the whole time. So then you can incorporate, you
know, more things that would activate that leucine trigger
because that's the thing we really want to build muscle and
perimenopause to help with insulin sensitivity and we lose
(29:19):
muscle as we age. So for vegans and vegetarians,
it's that leucine trigger, whichis an amino acid that we have to
eat like hit a threshold to to get muscle, you know, say hey,
yeah, we're growing. So that's the hardest thing that
I find with my vegan and vegetarian patients.
And then the luteal phase. Yeah, of course, the luteal
(29:40):
phase. So I do have patients that want
to be keto, you know, all the time and their body does OK with
that and that's OK. So I just have them increase
their fats during in their calories during the luteal
phase. So the luteal phase we are more
insulin resistant here, but our body also requires more calories
because that progesterones coming in and post ovulation.
(30:02):
Our body is trying to be a greatplace for for it to make a baby
and we need to lean into that a little more.
I feel like with women, it is emotional too.
If we restrict to continue to like restrict during that ludial
phase, we're just going to fail.We're just going to binge.
We're just going to be like, OK,I'm just going to eat a
chocolate bar. Like I've been good all day and
(30:24):
now I'm done. So if we lean into that and say
it's OK to eat more here, it's OK to have more carbs, you know,
and be smart about it. And really, you know, if we're
craving chocolate, well then we need some more magnesium either
in our diet, like with pumpkin seeds or dark chocolate or
supplement with that. So we need to lean in more here.
And it's nice because then there's no guilt, right?
(30:46):
We're going to increase our calories.
We're not going to fast or restrict.
And then when we go to follicular phase, we know that
we're going to be in control there.
We're going to be more ketogenic.
We can throw in a fast, we're going to be more balanced.
So I, I feel like especially women, if they're like, OK, I'm
going to start intermittent fasting.
They start it in the wrong part of their cycle.
(31:07):
They're usually frustrated and unsuccessful.
So that's fantastic insights. I mean, things that I've never
thought about and I'm sure many of my listeners who are trying
to manage this stage of life have not really, you know, given
much thought to. So thank you for sharing that.
If you could, could you share another, I know you shared a few
stories earlier, maybe another success story of someone that
(31:30):
you've kind of worked with to get through this phase of their
life and what what they ended updoing and how they're doing now.
Yeah, yeah. Well, first I wanted to talk
about GLP 1. So if you have any patients on
GLP 1, So in perimenopause, something I've been doing with
my patients, cause one of my patients actually was doing and
I'm like, yeah, that makes sense, was dosing the GLP ones
(31:52):
during that luteal phase, like asmall dose, 'cause you're more
insulin resistant. That is where everyone is just
cravings, you know, cause a lot of these women have this food
noise. So dosing it with your cycle is,
is pretty cool too. So you would just dose it during
that luteal phase, cause the follicular phase, you're fine.
So I'm gonna wait for some more continuous glucose data for
(32:13):
that. But another thing, you know, I
have a lot of women that oh man,that are addicted to hit
workouts, high intensity interval training and they go to
Orangetheory and they get all the splat points and they're
gaining weight, right? I had a patient that actually
had a patient that trained for amarathon she didn't tell me
(32:33):
about until after she was done and she gained 20 lbs while
training and. Consuming that wasn't muscle
mass that she's gaining muscle weight, it was more right.
Cortisol belly, cortisol belly fat.
Yep, 'cause she was doing all this training and, and we see
this a lot all of a sudden, likeI, I just saw someone like last
(32:54):
week on my Facebook like so whenI went to high school or with
her something they're like I'm training for a marathon and I'm
like, you are in perimenopause stop.
So if if your training and stressing your body out.
So it's the same with working out.
So during that first half the follicular phase, go for your
PRS. This is where I do my Sprint
training. So I keep my VO2 Max at a
(33:15):
healthy, you know, or aerobic capacity, which is important as
we age. I lift heavy, you know, that
that is where I push myself. The luteal phase is where I'm
not doing sprints or hip workouts.
I'm doing mobility stretching. You can do your weighted vest,
walking, walking at an incline. I'm still lifting because we
need to have muscle, but I'm doing more reps and lighter
(33:36):
weights. I'm not going to squat my
personal record because I did that once during luteal phase,
like not paying attention and I like tweaked my back because we
first of all, were more likely to get injured.
They've done studies on this on soccer players in Europe, more
likely to get injured. They had more ACL tears of the
knee and a ligament in the knee tears during that luteal phase
(33:59):
because of how progesterone and relax and work with our
ligaments and making them more unstable, so more likely to get
hurt. And then what else we talked
about cortisol and progesterone,how they interact.
If we have really high cortisol,it's going to lower our
progesterone or affect that. So you don't want to push
yourself and Sprint and do all these high intensity interval
(34:22):
trainings during that second-half of the cycle.
So that woman that I saw and sheknew she's like, oh, she's like,
I know it's my hormone. She's like, this was a goal I
wanted to do. And I'm like, that's OK, we're
going to get it back on track. We're going to regular get your
cortisol regulated. We worked on a, a bunch of
things. And yeah, her hormones, we
checked them. They were wrecked and it
(34:43):
affected her thyroid too, because our adrenals and
cortisol and thyroid are related.
So we we worked on her HPA access and hypopituitary adrenal
access help balance her hormones.
Again, just got everything back and she is doing better.
It took a couple months, but butwe have to be mindful of this.
Like, you know, what is that doing on your body?
(35:04):
That's stress. I mean, I think if yes, if
someone wanted to run a half marathon or a marathon, yes, but
let's train for your cycle, you know, do your long runs when
you're in your follicular phase,like do more recovery runs in
your luteal phase. Like let's not stress out.
And we mess with our hormones because when we're younger, we
(35:25):
have a little bit more play, right?
With anything, we could stay outlate.
We could, you know, eat bad like.
These are more resilient, right,When we're younger and as we get
older, they require a little bitmore nurturing care, I think.
Yeah, yeah. So we have more like Will,
we're, you know, we're going to push ourselves more because
we're older. But, you know, I'm seeing this
(35:47):
lack of wisdom and wisdom aroundour cycle and we just don't want
to run into trouble. Well, we don't want to
complicate things. So yeah.
So that was one, one example of a patient that, you know, I was
like, well, we need to get back to training and stuff around
your cycle and think about how cool if and, and some are doing
(36:08):
this. Some colleges are actually
paying attention to the menstrual cycle and training
their women athletes around it. Because what most women tend to
sync their cycles with each other.
My daughter and I are, you know,we sync our cycles to each
other, which is nice 'cause we can, you know, be more aware of
our feelings. Now we live with my husband and
three, she has three brothers. So that's pretty funny.
(36:31):
But we're teaching them, I'm teaching my, my boys about
ludial phase about like, you know, we got last week after
their cross country, my son wanted to go to this new custard
place. And I was like, we don't have
time. But then, then I was like, Oh
yeah, I do want some custard. I'm in my ludial phase.
And he was like, yeah, my, my 5 year old's like you said, you
(36:51):
don't eat sugar. And I'm like, tonight I'm going
to. But I told them I'm like, if you
want to get a sweet treat or if you want to stop for ice cream,
ask me in my ludial phase. Like pay attention 'cause I'm
more likely just. Say yes, I love that teaching
your kids hormone literacy so. Important.
Their wives will appreciate it, right?
Yeah, you're teaching them good,good, good habits early.
(37:15):
Well, this has been a fascinating discussion, Doctor
Jen, you know, you've shared so many insights I never even knew
about, never thought about fasting and cycles and even
exercise and cycle. So it's been really, really
great to get these, these tips from you.
If anyone wanted to learn more learn more about your book, how
could they find out about you and your work?
(37:36):
Yes, so, so the best thing rightnow, I would love if you went on
Amazon and grab my book The Perimenopause Reset and just
type in Jen Flegar 28 days. Or you could just get the link
at doctor jenbook.com and Jen book, DRJEN book and just buy
that. Leave a review.
(37:56):
Help me reach these women that need help.
And the book is just basically ablueprint for hormone health and
over a decade of practicing integrative medicine.
Most of my patients were in perimenopause and those were the
women that needed the most help.And then I am on social media
and YouTube and Instagram at integrative Dr. mom and that's
(38:18):
integrative Dr. mom and you can see like I'm very silly on
there. Sometimes.
I will get, you know, just very motivated by conventional
medicine and what's going on with it and, and share insights
with that. But also I share a lot about my
mini farm on Tennessee. So we have some chickens and
turkeys and we're going to be getting some cows.
(38:40):
My husband gave me the green light on that so that will.
Be that you know, I love that you're sharing your authentic
self and life. That's fantastic.
So we will definitely include those links in the show notes,
the link to your book as well asto your website.
And I believe you have a course at some point in the future.
So we will update the show noteswith your course link once we
(39:02):
have that as well. Well, again, Doctor Jen, it's
been a pleasure having you on the IQ Podcast.
I really appreciate your time. Any last words you'd like to
leave the audience with? One last thought.
Well, thank you so much for having me Doctor Ronnie and just
women listening out there like you are not broken.
Your body can heal and wants to be in homeostasis.
(39:23):
So just you can get through it and have faith and get get
knowledge. Well, thank you for that.
Thank you for that inspiring message and thank you all for
listening to this episode of theIQ podcast.
I hope you enjoyed what Doctor Jen shared and and what insights
she really instilled into well into her patients, but then it
(39:45):
also into her book. And if you enjoyed the podcast,
remember to subscribe and also leave a review.
Would really appreciate that andI hope to see you all next time
on the IQ Podcast. Stay tuned.
Thank you for tuning in to the IQ Podcast.
I hope you enjoyed today's episode and learn something new
to help you boost your IQ. Leave us a review and share the
(40:08):
podcast with your family and friends.
Stay connected with me for more eye opening insights on ihealth,
nutrition and lifestyle. Until next time, keep your
vision clear and your IQ sharp.
Another low hanging fruit is controlling stress because if we
have high stress that is going to increase cortisol, that is
going to deplete your progesterone too.
If you're stressed all the time or say you know, you're fasting
in the wrong part of your cycle.So there's a lot of these things
(00:21):
and honestly, women and perimenopause, it's that age
where, you know, they might havea career that they're working
on, they have kids, they have a husband, they have aging.
Parents, welcome to the IQ Podcast.
I'm Doctor Ronnie Bannock here to help you boost your IQ with
powerful insights that connect your eyes, your brain and your
(00:44):
whole body Wellness. Hello everyone, and welcome to
the IQ podcast where you can gain insights into your vision
health, your brain health and your overall Wellness and raise
your IQ. I'm your host doctor Ronnie
Banik, America's integrative ophthalmologist and today I'm
honored to share the stage with Doctor Jen Flagar, who is a
(01:07):
double board certified physician.
She is trained in emergency and integrative medicine and Doctor
Flagar her was diagnosed with Hashimoto's after which she
became passionate about autoimmune healing, hormone
balance and root cause medicine.Doctor Jenna is Olson author.
(01:27):
She's co-authored Eat, Sleep, Move, Breathe, and her newest
book, the Perimenopause Reset was just released a few weeks
ago. And she hopes that this book
would lead to a mission or guidepeople on a mission to change
their health. And she hopes to reach at least
500,000 women, helping them navigate perimenopause and
(01:49):
empowering them with faith-basedscience back strategies to
reclaim their energy, clarity and joy.
Welcome to the IQ podcast. Doctor Jen, it's a pleasure to
have you here. Hi, thank you, Doctor.
Ronnie. Well, I wanted to start off with
a question that I asked most of my guests, which is you are
trained in traditional medicine,right?
(02:11):
You are an emergency room physician.
So how is it that you found thispath where now you incorporate
integrative strategies and functional medicine as well and
faith-based strategies into yourtreatment protocols and
diagnosis strategies? We all go through the
traditional medical school, right?
And we are kind of groomed plus train to take these tests and
(02:36):
these tests are basically match diagnosis with treatment which
is a pharmaceutical usually. And even though I went to DO
school, which AT still, who was an MD, created doctor of
osteopathic medicine to look at the body more of a whole, but we
really got away from that. And in the ER I just came very
disillusioned with conventional medicine.
(02:58):
And what I was treating in the ER was chronic things that could
have been prevented. Not only that, I mean, I would
have patients coming in with chronic belly pain and they were
going to GI, they were going to their family doctor, They were
taking the medicine, right. And still not getting better.
So I was like doing diet plans. I was seeing more and more sick
kids. So I was reading about lime and
(03:20):
mold. And I remember when I think I
was pregnant with my, my second boy and I looked at my husband
and here we are. I like just, you know, a couple
years out of starting an emergency medicine and I'm like,
yeah, I need to go back and do an integrative medicine
fellowship because I was readingall this on my own.
I wanted to get board certified because I knew if I didn't have
(03:44):
the actual training, first of all, I wouldn't read the stuff I
didn't want to read, right? And and then also I wanted that
board certification. So when I communicated with
conventional doctors, I could say, look like this isn't woo
woo. This is real science evidence
base back to medicine. Supplements are OK.
They work with our body and it just was really important to me.
(04:07):
So from that just kept, you know, learning about hormones
and now that's my main passion cause so many women are
suffering, actually 8 million women in perimenopause right now
in the US So that's why my mission of 500,000 seems like a
lot, but it's really, it's really not 'cause there's so
many women. Yeah.
And then hormones, peptides, youknow, all of these things just
(04:31):
it's kind of like drinking from a fire hose, right?
When you touched into integrative medicine, there's so
much to learn and it's beautifulbecause like you and I, we will
never stop learning. In the integrative world.
There's no ceiling, you know? We just keep learning and
expanding and collaborating witheach other.
And who benefits the patients? And it's beautiful.
(04:52):
Yeah, Now I love hearing your story.
And I have to say, Doctor Jen, you're truly a Unicorn.
I would say as an emergency roomphysician, because in my
experience, my my father is actually an emergency room
physician who's now retired. But, you know, in my experience,
most patients come in and out ofthe Ed, But to have a doctor
provider who actually sits with them and tries to figure out,
(05:14):
OK, why is this happening? And let's talk a little bit
about other things. The root cause of it, diet,
hormone, stress, lifestyle, you know, all of those other things.
Were you able to do that in an emergency department setting or
is that kind of why you have established your practice
outside of that type of care? Well, we just moved to Tennessee
this year, so I still need to get into AER here.
(05:37):
But when I was practicing in theemergency room still, I had my
private practice and I still work shifts in the ER.
I would have that time. I worked in a lot of critical
access ER. So it was very nice because I
had more time and I was working a lot of night shift, which
isn't good for my health, but I would be able to sit down and,
and talk with these patients. I remember this one patient, he
(06:01):
was a, a vet, he was in the Armyand he got injured so was
discharged, had a lot of PTSD, kept coming to the ER young
healthy guy for chest pain. And every time it was ruled out
normal. So I sat down with him and his
mother because everything was normal again.
And I'm like, well, what's goingon?
Like are you sleeping well and are you eating well?
(06:21):
Just through the basics. And he broke down and was like,
actually his dog, his support dog passed away.
So, so that was a whole thing. And then he got a new dog and
the dog was keeping him up all night.
Then he injured his back probably because of lack of
sleep. And, and you know, I, I really
spoke with him. I actually gave him a copy of
the Eat, Sleep Move, breathe book because I would carry that
(06:44):
those in the ER and I would givethem to people as a, a resource
to these patients because they are going to their primary care
doctor, but they only have a 10 minute appointment.
They can't talk to them about the pillars of health.
And you could be on 100 medications, the best
pharmaceuticals, you know, and if you're not sleeping or not
(07:04):
getting good restorative sleep, your body is not going to heal.
Your brain is not going to clearout, you know, through the
lymphatics. It's not going to detox.
You're going to have brain fog. It's just this ripple effect.
So in another example, like a woman that was, came in and she
had ovarian cysts. So we ruled out ovarian torsion,
made sure there was no infection, all those things
we're doing the conventional medicine.
(07:26):
But then I, I sat down with her.I'm like, tell me about your
family history. And she's like, oh, my mother
had to have a hysterectomy when she was 30 because she was
bleeding so much. And I'm like, OK, you have an
estrogen metabolism problem, which could be coming from liver
health or it could be coming from gut health.
And, and I talk about all of this in my book, The
Perimenopause Reset because we have to start now and pay
(07:50):
attention to these things because I, you know, I truly
believe God designed our bodies beautifully.
But because of all the environmental toxins stress, the
environment we live in now, things get mismatched,
miscommunicated. So the goal is to bring things
back into homeostasis. And, you know, I just sprinkle
(08:10):
integrative medicine in during those ER visits as just an extra
service. And some patients are open to
it, but some aren't. You know, like I'm sure you've
noticed, not everyone wants an integrative ophthalmologist.
Some people are just they they can't even fathom it.
Yeah, no. Well, I really applaud you for
taking that extra time and really trying to dig deep and
(08:33):
figure out what's going on. I often find myself in the same
situation where patients are coming in just for a routine eye
exam and just things are not going well.
You know, their eyes are inflamed, they're very
uncomfortable, their quality of the vision is not good.
So I sit down and I ask them what's really going on.
And inevitably it'll be one of those pillars of health, as you
mentioned, is not ideal or it's not optimized, whether it's
(08:56):
their sleep, their diet, they'renot able to manage their stress
level. So I think as providers, we do
owe it to our patients, even if it's a short amount of time in
maybe one or two minutes, talking about some of these
things and then guiding our patients to the right Ave. so
that they can get help. It's really, really important to
have those conversations. Well, I wanted to switch over to
(09:16):
talking about something that really is in your area of
expertise, Dr. Jen, which is hormones, especially hormone
fluctuations during this time inmany women's lives with that we
call perimenopause as they're transitioning into menopause.
Can you just explain, first of all, to give our audience, like,
what is the overall pattern that's happening during this
(09:39):
time? What's happening to our hormones
and what can people expect during this period?
Yes, perimenopause is kind of a weird phase, right?
It's, it's before menopause where menopause is a year
without a menstrual cycle. And this is where your estradiol
levels eventually go to to zero.Well, some women, they'll still
(10:02):
have conversion of estrogens in their fat cells to estrone, but
basically estradiol, which is protective for the heart, for
the eyes, for the bones, for everything.
Estradiol is very important. That is going to plummet.
So what happens before that? Well, in perimenopause, which
could be 5 to 10 years before menopause.
(10:23):
I mean, I am seeing this earlierand earlier in women and I think
from stress, I think the pandemic, a lot of reasons.
But when we start to age, when we go through aging, our
progesterone is just on a decline.
So progesterone is the hormone that is most prominent during
(10:43):
that luteal phase or that second-half of the cycle.
Progesterone is what when the egg is implanted, it is going to
maintain the endometrium into that nice fluffy space for that
egg to sit. And then our body produces more
progesterone until the placenta takes over.
So what happens is we're having that progesterone decline.
(11:04):
Well, we know that there are some women that are more
estrogen dominant or they don't detoxify their estrogens as well
or their progesterone is low compared to their estrogen.
And then these are the women that are getting symptoms such
as irritability before their cycle, heavy cycles.
And and this is what we see in perimenopause because that
(11:25):
progesterone is declining and then we will get a little bit of
erratic estradiol levels, so. It's really about the balance
between the two. That's what you're.
That's what you're saying. Yes, yeah.
And sometimes we have like an extra ovulatory cycle because
the follicles aren't as robust. So the body's like did did she
(11:47):
ovulate or no, was that a follicle or not?
So, so then sometimes there's another surge of SSH follicle
stimulating hormone and in another, you know, burst of
estradiol. So we so then we have an even
even bigger unbalance and what is that going to lead to more
symptoms? So sometimes these women that
have been regular every 28 day cycle, you know, every month all
(12:10):
the same, not so heavy cycle, they'll be like, I'm getting
heavy cycles now out of nowhere because their progesterone is
declining, right? And then one symptom that
happens a lot is like anxiety orpalpitations.
We see poor sleep, all of this. So these women in perimenopause,
they don't know what it is. So that's why awareness is good.
(12:32):
They're like, I don't feel like myself.
My body's changing, but I've changed nothing.
And they go to their doctor and this is like their recipe for
perimenopause is to put these women on birth control and an
antidepressant all the time. I've seen that so many times,
yes. Yes, yes, and for and for you
for eye health like or migraineswith or without aura, you know,
(12:56):
dry eyes, well-being on an oral birth control can make those
worse and make the eye worse. So I, I'm sure they come to you
and you're like, oh, they put you on that like, great.
So there's easy solutions to this.
Well, it's very emotional for women too, because they go to
their doctor and they're basically told they're depressed
(13:17):
and something's wrong with them and they're put on these.
And then the other crazy thing, I'm sure you've seen this, some
of these women, they are put on oral birth control at age 40 and
they stay on them 15 years. So you don't even know if
they're in menopause. You can check, you know, FSH and
stuff, but we know that oral birth control is pretty toxic.
(13:39):
It's going to increase risk whenyou're taking oral estrogen of
stroke of cardiovascular factors.
It's going to increase your riskof migraines.
If you have migraines, you're actually not supposed to be on
oral birth control, but still happens and they're using it off
label. Birth control is not, you know,
labeled for for perimenopause orcontrol symptoms.
So. What is a good alternative then,
(14:01):
like from an integrative standpoint for these, you know,
with these women who are going through these changes?
What do you typically recommend?What can they do or maybe
something that they can do with the provider?
Yeah. So it can be complicated, right?
So sometimes it could be liver health.
So I, I talk about in the book how to help your liver by
detoxifying your environment. So when we look at our liver,
(14:24):
everything comes through that right?
So if we have estrogen mimickersor endocrine disruptors, our
liver has to process that alcohol.
Our liver has to process that. And what happens when our body
is processing alcohol? Well, it's like, yeah, like this
is toxic. I need to deal with this.
I'll deal with detoxifying your estrogens later.
(14:46):
You know, it's like. That's shifted into a different
mode, basically, yeah. And mold can do this.
Mold is another thing that I have seen with patients that are
in perimenopause and their symptoms are multiplied because
they're dealing with mold and mold is detoxified through the
liver also, like if they're living in mold, it's really
evident. So we need to clean up the
(15:08):
liver, clean up our environment,our gut needs to be tip top too,
because we, we also get rid of estrogen in our gut.
And if our gut is not working properly, sometimes we can
recycle toxic metabolites and estrogen.
So then that would make that estrogen progesterone imbalance
even worse. So we, we start with that and
(15:31):
you know, low hanging fruit withthat.
And then also we want to just supplement, you know, B
vitamins, magnesium, things thatsupport the liver.
When women are younger and they're starting like early
perimenopause, sometimes I will have them just go on Chase Tree
Berry or Vitex and, and that will.
And that they take every day. We at least try it for three
(15:52):
months and we'll check their labs and their symptoms and see
how they're doing. And that encourages your body to
make its own progesterone. It works through the pituitary
access. Yeah.
So that's really nice. But then if a woman comes to me
and they're like in their late 40s, their parents went through
menopause or their mother and their early 50s, then I'm like,
yeah, like it's time. We're just going to do
(16:13):
progesterone. And they would just take it
during that second-half of the cycle, the luteal phase.
Cause most of these women are still cycling normally, but they
might have had like a shortened cycle where they were 28 days
and now they're 26, now they're 25.
So that will lengthen it out. And then depending on how close
(16:34):
they get to menopause will will do different things too.
But those are really helpful. And then another low hanging
fruit is controlling stress because if we have high stress,
that is going to increase cortisol, that is going to
deplete your progesterone too. If you're stressed all the time
or say you know, you're fasting in the wrong part of your cycle,
(16:57):
which we'll talk about cycle thinking later.
So there's a lot of these things.
And honestly, women in perimenopause, it's that age
where, you know, they might havea career that they're working
on. They have kids, they have a
husband, they have aging parents.
Yeah. Everything is coming at them,
right? It's, it's a lot.
(17:18):
Yes, absolutely. I wanted to go back to ask to
the topic of migraine because a lot of my patients have
migraine, whether it's with or without aura, all kinds of other
symptoms, light sensitivity, nausea, vomiting, etcetera.
And when it comes to what we call menstrual migraine, where
women tend to get migraines as soon as their cycle, you know,
(17:39):
as soon as they start menstruating, that's usually
those two or three days. They're very, very, their
threshold for migraine is very low.
That's typically when it happens.
So the traditional teaching is that it happens, migraine
happens in that time because there is a very sharp drop in
estrogen levels and that's what the brain is not used to and
(18:00):
then it can trigger a migraine. So in terms of your approach
with looking at also progesterone levels in
relationship to estrogen, what are your thoughts about that?
And do you think that's really true?
It's that sudden fall in estrogen and what can people do
from an integrative standpoint to balance that out?
Yes, I definitely think it's thefluctuations right and imperi
(18:23):
menopause when, you know, sometimes that flares their
their migraines and I don't think that migraines are normal.
I think they're root cause. I don't think that women should
suffer from migraines. They need to keep digging.
I've had a lot of patients with migraines that have had mold
toxicity and once we treat that mold and you know, and that's
(18:43):
going to like I spoke about how estrogen and mold it.
You know, there are some molds that actually mimic estrogen, so
definitely that could be a root cause.
I have found that giving progesterone during that luteal
phase, that second-half, so these 15 through 28 of cycle,
they'll get less migraine triggers because they're really
(19:06):
supporting that progesterone andthat's balancing out that
estrogen and then also working on that estrogen detoxification.
So they're not dropping so much that it's more balanced.
So that will really help a lot of women just balancing out
their migraines. And then when they go through
perimenopause to menopause, thenwe just want to have them on
(19:29):
balanced estradiol and a little estrol and make sure that
they're not overmedicated. I get a lot of patients that
come to me and they are overmedicated on estrogens.
And a lot of the time it's because the doctors aren't
testing them, right? If they're on topical estrogen,
they're doing serum or blood testing and not looking at the
(19:50):
tissue levels. So then, you know, we know if we
have way too much estrogen, thatcan increase migraines.
And once again it goes back to. How women that have migraines,
migraines with aura, they are not supposed to be on oral birth
control. You know that that is a no, no
'cause it's gonna increase risk of stroke.
(20:11):
So if we have to look at that, that balance of estrogen,
progesterone, cause progesteroneis gonna modulate blood vessels
too and, and the vasodilation. So if we balance that more, I
have found that patients get wayless migraines and I've had I've
had patients get like migraines mid cycle too and.
It can happen at any time and I'm in a migraine for myself, so
(20:33):
I've definitely been through that, yeah.
But but it takes them out for for days.
So we definitely don't want that.
Yeah, I've had, I had a patient that would like get a horrible
migraine. She would just like drop like
she couldn't do anything. She would be out for three days
for work every month. And she also had cysts.
So we worked on that estrogen metabolism, making the liver
(20:56):
healthy again because so many ofus just have bogged down livers.
I mean like. With the amount of toxins we're
exposed to in our daily lives, yes, absolutely, yeah.
And and EMF now too, I mean our cells are just very stressed.
So that that can be really helpful to to get the liver just
(21:18):
functioning well again. Our liver is very, you know,
resilient, but still like we need to give it a break and, you
know, get the right herbs and cofactors to, to really help
with detoxification, things likeNAC, glutathione, all of that.
And, and The thing is, if you'retaking medications for any of
these signs and symptoms, you know, these diseases that you're
(21:39):
having, most of them are broken down in the liver.
So then you're even putting moreof a burden on your liver.
So this polypharmacy and being on multiple medications can also
just add to that toxic burden. Yeah, no, I love your approach
is looking at it very holistically.
What are the underlying causes, liver issues, detoxification
(22:02):
issues, whether it's mole toxicity, stressors, etcetera.
This has been amazing. You know, I've learned a lot
from you already, Doctor Jen, we're going to take a very short
break to hear from one of our sponsors and then we'll be right
back with more. And I'm going to be asking you
about the cycle sinking that youmentioned.
So stay tuned everyone, we'll beright back.
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(22:22):
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Welcome back everyone to the IQ Podcast.
Today we're chatting with DoctorJen Pfleger and we're talking
about hormones. And Dr. Jen, in your newest
(23:28):
book, The Perimenopause Reset, one of the themes you cover is
cycle stinking. Can you explain to us what that
is and when you use it, or when it's appropriate to include in
someone's care? Yes, I love cycle syncing for
teenagers, you know, all the waythrough menopause.
I think it is so great, but it'sreally important in
(23:49):
perimenopause because this is when things are starting to
shift and we really need to optimize the hormones at the
certain parts of the cycles. And the big mistake I've seen
the past like couple years of patients, we know that fasting
has gotten really, really popular.
Everyone is just like, oh, I do intermittent fasting.
(24:10):
I've lost 50, you know, I mean, you just see it everywhere.
Well, what I noticed in my patients is if they were fasting
in the wrong part of their cycle, they were actually
increasing blood glucose becausethey were having a cortisol
spike and they were stressing out their bodies.
So I'm like, OK, that's one thing that we need to fix.
So fasting, we need to fast for our cycle.
(24:33):
We need to fast in the luteal phase, that first half of the
cycle, that first half of the cycle we are more estrogen
dominant compared to the second-half of the luteal phase
where we're more progesterone dominant.
So in the first half of the cycle we are more insulin
sensitive. So it's easier for women to
fast. It's not stressing out their
body. I've looked at hundreds and
(24:54):
hundreds of continuous glucose monitor data and they they do
great there. This is also when if I'm having
someone try carnivore diet to help with their insulin
resistance or to help with gut health, I'm like, OK, try it
there. Do it then or do strict keto
then. So a couple things, like
mentally you're going to be morelikely to succeed and do it
(25:17):
because you're not fighting yourbody and fighting the hormones
and then they're just going to be more successful and their
body is going to do really well with it can.
I ask you about the the fasting.What type of fasting do you
typically recommend for women inthe first phase of their cycle?
Is it like an 8, you know the different hours?
Like how much time should they be fasting?
(25:39):
Or is it is it like 5 days out of the week you do a fast and
then two days you do a differenttype of eating pattern?
It depends on the patient. I mean obviously everyone is
different for gut health and a little autophagy.
I will recommend them once a month to do a 24 hour fast in
their follicular phase. I'm like look at your calendar.
Here's the thing, like you look on social media and all these
(26:02):
influencers can do three day water fast and all this stuff.
I don't know, they probably somenannies and stuff.
I was asked if I had a nanny at this conference I was at last
week and I just kind of chuckled.
I'm like no, like I want to be hands on with my kid.
And if someone has a nanny that's amazing too.
But what I'm saying is most women I work with don't have
nannies and they have to drive their kids to their activities.
(26:23):
They have to drop them off at school, pick them up, they're
home schooling. They just can't lay on the couch
and do a three day water fast. So I will tell them to do, you
know, a 24 hour fast, make sure they're having electrolytes,
they can have black coffee, you know, just different things.
And that is like a good, you know, you eat an early dinner on
a Sunday and then you eat dinneron Monday with your family.
(26:45):
For women also, it's just hard to not eat dinner with your
family where you know it's better to eat more of your food
in the morning, but that's not as social with family.
So we need to look at like be realistic with patients and
that's going to cause them less stress.
So for weight loss, if a patienthas had it like a stall, like a
(27:07):
weight loss stall, I'll have them do a 36 hour fast.
And that's doable also, especially with how busy women
are at this time of their life. So that for three days will also
kind of like reset the body, help autophagy, get in that
therapeutic ketosis. So those are some examples of
what I think is doable for women.
If you could do a three day water fast and you're not going
(27:28):
to, you know, just struggle withthat, like being a mother, you
can do that too. I know the hardest part for me
is just cooking for your kids. So once again, you could look at
that two week calendar and be like, OK, where are we going to
be like out and about like with sports or something?
And I'm not going to be like cooking them this food and like
not get to eat it. So.
(27:50):
So there's a balance. So a lot of my audience happens
to be plant based or vegetarian,myself including I'm vegetarian.
So for people who don't eat meator fish, what are some options
in terms of like getting that protein, getting into ketosis,
What are some recommendations? So ketosis is gonna be, you
(28:11):
know, you could do more fats like MCT oils.
So that's gonna get you into ketosis faster.
Yeah. If you can't have sardines,
that's a little bit different. But you could just just really
high fat. If you do butter, that would be
good. If you do eggs, that would be
really good and you know, tofu would be helpful.
You could do pea protein with like nut butters and really put
(28:35):
on the the nuts. I know the fasting mimicking
diet, like the prolong therapy that is plant based.
So you can do that and that willlike mimic the fasting.
So those are options too. Yeah.
So there's definitely ways to get that.
And then you just have to, well,we could talk about, you know,
luteal phase, then you're addingback in more of the
(28:56):
carbohydrates. So then you can get hit those
leucine triggers a little bit better.
So and that's the thing in the follicular phase, you're not
going to be doing it the whole time, you know, you're not going
to be fasting the whole time. So then you can incorporate, you
know, more things that would activate that leucine trigger
because that's the thing we really want to build muscle and
perimenopause to help with insulin sensitivity and we lose
(29:19):
muscle as we age. So for vegans and vegetarians,
it's that leucine trigger, whichis an amino acid that we have to
eat like hit a threshold to to get muscle, you know, say hey,
yeah, we're growing. So that's the hardest thing that
I find with my vegan and vegetarian patients.
And then the luteal phase. Yeah, of course, the luteal
(29:40):
phase. So I do have patients that want
to be keto, you know, all the time and their body does OK with
that and that's OK. So I just have them increase
their fats during in their calories during the luteal
phase. So the luteal phase we are more
insulin resistant here, but our body also requires more calories
because that progesterones coming in and post ovulation.
(30:02):
Our body is trying to be a greatplace for for it to make a baby
and we need to lean into that a little more.
I feel like with women, it is emotional too.
If we restrict to continue to like restrict during that ludial
phase, we're just going to fail.We're just going to binge.
We're just going to be like, OK,I'm just going to eat a
chocolate bar. Like I've been good all day and
(30:24):
now I'm done. So if we lean into that and say
it's OK to eat more here, it's OK to have more carbs, you know,
and be smart about it. And really, you know, if we're
craving chocolate, well then we need some more magnesium either
in our diet, like with pumpkin seeds or dark chocolate or
supplement with that. So we need to lean in more here.
And it's nice because then there's no guilt, right?
(30:46):
We're going to increase our calories.
We're not going to fast or restrict.
And then when we go to follicular phase, we know that
we're going to be in control there.
We're going to be more ketogenic.
We can throw in a fast, we're going to be more balanced.
So I, I feel like especially women, if they're like, OK, I'm
going to start intermittent fasting.
They start it in the wrong part of their cycle.
(31:07):
They're usually frustrated and unsuccessful.
So that's fantastic insights. I mean, things that I've never
thought about and I'm sure many of my listeners who are trying
to manage this stage of life have not really, you know, given
much thought to. So thank you for sharing that.
If you could, could you share another, I know you shared a few
stories earlier, maybe another success story of someone that
(31:30):
you've kind of worked with to get through this phase of their
life and what what they ended updoing and how they're doing now.
Yeah, yeah. Well, first I wanted to talk
about GLP 1. So if you have any patients on
GLP 1, So in perimenopause, something I've been doing with
my patients, cause one of my patients actually was doing and
I'm like, yeah, that makes sense, was dosing the GLP ones
(31:52):
during that luteal phase, like asmall dose, 'cause you're more
insulin resistant. That is where everyone is just
cravings, you know, cause a lot of these women have this food
noise. So dosing it with your cycle is,
is pretty cool too. So you would just dose it during
that luteal phase, cause the follicular phase, you're fine.
So I'm gonna wait for some more continuous glucose data for
(32:13):
that. But another thing, you know, I
have a lot of women that oh man,that are addicted to hit
workouts, high intensity interval training and they go to
Orangetheory and they get all the splat points and they're
gaining weight, right? I had a patient that actually
had a patient that trained for amarathon she didn't tell me
(32:33):
about until after she was done and she gained 20 lbs while
training and. Consuming that wasn't muscle
mass that she's gaining muscle weight, it was more right.
Cortisol belly, cortisol belly fat.
Yep, 'cause she was doing all this training and, and we see
this a lot all of a sudden, likeI, I just saw someone like last
(32:54):
week on my Facebook like so whenI went to high school or with
her something they're like I'm training for a marathon and I'm
like, you are in perimenopause stop.
So if if your training and stressing your body out.
So it's the same with working out.
So during that first half the follicular phase, go for your
PRS. This is where I do my Sprint
training. So I keep my VO2 Max at a
(33:15):
healthy, you know, or aerobic capacity, which is important as
we age. I lift heavy, you know, that
that is where I push myself. The luteal phase is where I'm
not doing sprints or hip workouts.
I'm doing mobility stretching. You can do your weighted vest,
walking, walking at an incline. I'm still lifting because we
need to have muscle, but I'm doing more reps and lighter
(33:36):
weights. I'm not going to squat my
personal record because I did that once during luteal phase,
like not paying attention and I like tweaked my back because we
first of all, were more likely to get injured.
They've done studies on this on soccer players in Europe, more
likely to get injured. They had more ACL tears of the
knee and a ligament in the knee tears during that luteal phase
(33:59):
because of how progesterone and relax and work with our
ligaments and making them more unstable, so more likely to get
hurt. And then what else we talked
about cortisol and progesterone,how they interact.
If we have really high cortisol,it's going to lower our
progesterone or affect that. So you don't want to push
yourself and Sprint and do all these high intensity interval
(34:22):
trainings during that second-half of the cycle.
So that woman that I saw and sheknew she's like, oh, she's like,
I know it's my hormone. She's like, this was a goal I
wanted to do. And I'm like, that's OK, we're
going to get it back on track. We're going to regular get your
cortisol regulated. We worked on a, a bunch of
things. And yeah, her hormones, we
checked them. They were wrecked and it
(34:43):
affected her thyroid too, because our adrenals and
cortisol and thyroid are related.
So we we worked on her HPA access and hypopituitary adrenal
access help balance her hormones.
Again, just got everything back and she is doing better.
It took a couple months, but butwe have to be mindful of this.
Like, you know, what is that doing on your body?
(35:04):
That's stress. I mean, I think if yes, if
someone wanted to run a half marathon or a marathon, yes, but
let's train for your cycle, you know, do your long runs when
you're in your follicular phase,like do more recovery runs in
your luteal phase. Like let's not stress out.
And we mess with our hormones because when we're younger, we
(35:25):
have a little bit more play, right?
With anything, we could stay outlate.
We could, you know, eat bad like.
These are more resilient, right,When we're younger and as we get
older, they require a little bitmore nurturing care, I think.
Yeah, yeah. So we have more like Will,
we're, you know, we're going to push ourselves more because
we're older. But, you know, I'm seeing this
(35:47):
lack of wisdom and wisdom aroundour cycle and we just don't want
to run into trouble. Well, we don't want to
complicate things. So yeah.
So that was one, one example of a patient that, you know, I was
like, well, we need to get back to training and stuff around
your cycle and think about how cool if and, and some are doing
(36:08):
this. Some colleges are actually
paying attention to the menstrual cycle and training
their women athletes around it. Because what most women tend to
sync their cycles with each other.
My daughter and I are, you know,we sync our cycles to each
other, which is nice 'cause we can, you know, be more aware of
our feelings. Now we live with my husband and
three, she has three brothers. So that's pretty funny.
(36:31):
But we're teaching them, I'm teaching my, my boys about
ludial phase about like, you know, we got last week after
their cross country, my son wanted to go to this new custard
place. And I was like, we don't have
time. But then, then I was like, Oh
yeah, I do want some custard. I'm in my ludial phase.
And he was like, yeah, my, my 5 year old's like you said, you
(36:51):
don't eat sugar. And I'm like, tonight I'm going
to. But I told them I'm like, if you
want to get a sweet treat or if you want to stop for ice cream,
ask me in my ludial phase. Like pay attention 'cause I'm
more likely just. Say yes, I love that teaching
your kids hormone literacy so. Important.
Their wives will appreciate it, right?
Yeah, you're teaching them good,good, good habits early.
(37:15):
Well, this has been a fascinating discussion, Doctor
Jen, you know, you've shared so many insights I never even knew
about, never thought about fasting and cycles and even
exercise and cycle. So it's been really, really
great to get these, these tips from you.
If anyone wanted to learn more learn more about your book, how
could they find out about you and your work?
(37:36):
Yes, so, so the best thing rightnow, I would love if you went on
Amazon and grab my book The Perimenopause Reset and just
type in Jen Flegar 28 days. Or you could just get the link
at doctor jenbook.com and Jen book, DRJEN book and just buy
that. Leave a review.
(37:56):
Help me reach these women that need help.
And the book is just basically ablueprint for hormone health and
over a decade of practicing integrative medicine.
Most of my patients were in perimenopause and those were the
women that needed the most help.And then I am on social media
and YouTube and Instagram at integrative Dr. mom and that's
(38:18):
integrative Dr. mom and you can see like I'm very silly on
there. Sometimes.
I will get, you know, just very motivated by conventional
medicine and what's going on with it and, and share insights
with that. But also I share a lot about my
mini farm on Tennessee. So we have some chickens and
turkeys and we're going to be getting some cows.
(38:40):
My husband gave me the green light on that so that will.
Be that you know, I love that you're sharing your authentic
self and life. That's fantastic.
So we will definitely include those links in the show notes,
the link to your book as well asto your website.
And I believe you have a course at some point in the future.
So we will update the show noteswith your course link once we
(39:02):
have that as well. Well, again, Doctor Jen, it's
been a pleasure having you on the IQ Podcast.
I really appreciate your time. Any last words you'd like to
leave the audience with? One last thought.
Well, thank you so much for having me Doctor Ronnie and just
women listening out there like you are not broken.
Your body can heal and wants to be in homeostasis.
(39:23):
So just you can get through it and have faith and get get
knowledge. Well, thank you for that.
Thank you for that inspiring message and thank you all for
listening to this episode of theIQ podcast.
I hope you enjoyed what Doctor Jen shared and and what insights
she really instilled into well into her patients, but then it
(39:45):
also into her book. And if you enjoyed the podcast,
remember to subscribe and also leave a review.
Would really appreciate that andI hope to see you all next time
on the IQ Podcast. Stay tuned.
Thank you for tuning in to the IQ Podcast.
I hope you enjoyed today's episode and learn something new
to help you boost your IQ. Leave us a review and share the
(40:08):
podcast with your family and friends.
Stay connected with me for more eye opening insights on ihealth,
nutrition and lifestyle. Until next time, keep your
vision clear and your IQ sharp.
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