Welcome to Hotness, the podcast that brings you practical tools to balance your hormones and rekindle connection, confidence, and desire in midlife and beyond.

I'm your host, Dr. Liz Lister. Hotiness is a safe space for honest conversations about menopause, sex, identity, love, loss, reinvention, and desire, because you can embrace your hotness at every age.

My conversation today is with Amber Ross, certified physician assistant in the San Francisco Bay Area, specifically in Pleasanton. Amber has a functional medicine practice with a lot of overlap.

She's also certified by the A4M American Academy of Anti-Aging Medicine as a Functional Medicine Provider. So she has great breadth of knowledge, a lots in common with what I do with hormones.

However, she also brings a lot to the table. We had a very wonderful discussion about the gut in particular. She's one of my go-to colleagues for questions that are gut related.

What testing? What remedies? what ways to help the guts? So you'll learn about the four Rs to help the gut health, the estrobalome, a new up and coming word.

And so please enjoy my conversation with Amber Ross. Hi, Amber. Thank you so much for joining me on Hot Nose. I'm very excited about the tools that you have that I know that implement in your practice.

So let me let you start us off. And I'd love to hear your own story of how your practices evolved. Then I'll ask you more specific questions related to women in midlife and gut health.

We'll go down that road, but tell us a little bit about your story, please. So Dr. Liz, thank you so much for having me online. This is so fun to get to chat with you.

So yeah, I am a physician assistant and I worked in family practice for about 18 years. And when I had my second child, after I heard her, had a little bit of baby blues and her menopause because I was older, but nobody told me that.

Then I tried to go back to work. And I just wasn't feeling it. It wasn' a friendly environment. I was just completely burned out on mainstream medicine, and I didn't feel like I helping people as much as I would like.

And so I ended up just going home and being a mom for a while, which brought me to my next stage of functional medicine because then I had time to go back to school.

That's led me here. Beautiful. And then you were saying to me about there was a point in your own practice where you felt burned out. Were you already what we would call midlife?

I usually say mid-life starts at 40. I mean, hormonal changes are happening younger and younger. Can you share a little bit about what you pursued in your functional medicine training?

What caught your interest? I know you deal with hormone balance, which people who listen and follow my stuff hear and learn and already know a lot about that.

So we can work that into our conversation, but I that you have other tools in you toolbox. Yeah, so I mean, I love functional medicine. I loved looking at the body as an entire organism where everything's connected, right?

Like, yeah, our gut has a lot to do with processing our hormones. And I know in functional and hormone practice, most of us feel this way, but we don't just want to sort of introduce hormones into a system that might have inflammation or gut problems because then they're not going to be getting the best use out of their hormones.

So we want to optimize things. We don't want just to have band-aids on anything. And so I feel like once we start working with people and their issues start coming up, it's not necessarily hormones, like hormones is the starting point, which leads into everything else.

And so a big part of overall health, though, I would say is the gut health because that's where most of our immune system lives, like 80% of are immune.

And then if people are not really seeing what comes in and things adopt up, then things can become toxic. that's not good for us overall, so we want to be mindful of the gut health with movement, with balance, and we really like to get into that here at my clinic.

Are you talking about overall movement like exercise and that type of movement or like the bowels moving because that is important too? All of it. Okay.

We want everything moving. And release. Release what's not serving us, release our bowels, move our bodies. It's a whole body that we look at. With hormones in particular, They are so powerful.

I mean, they have such amazing effect on everybody, but that I think is the difference between the functional versus what we do as functional rather than conventional is we're not just kind of like writing a prescription, like, here you go, good luck.

We're sort of managing all of the different areas that the hormones might touch. Yeah, absolutely, which of course is the entire body. There's no part of the body not touched by hormones.

And as I always like to say, being a woman in midlife is a whole body experience. Yeah. So there you have that. First of all, what do your patients usually present to you with?

What are they complaining over? what symptoms are They having when they arrive at your practice? And then I want to talk and ask you more specifically related to the gut.

But what types of symptoms are we talking about? So usually when women show up to us, they're just exhausted, They can't get through the day. They're having hot flashes.

they feel terrible. And they also feel like no one's listening to them. and they've been told that they are making up things in their head. this is just normal for this time of life.

And it's emotional for them. They feel like there's nothing left for then and this just how it gonna have to be. Right. Yeah, they feel, you know, They've been told this as normal and so when we tell them it is not normal, and there is something you can do about it.

The relief that just washes over their face. Yeah, that's amazing. And then just to see them change, I mean, it only takes three or four months until they're kind of like a new person.

Beautiful. Let's do a little more specifics of the gut and inflammation, whichever order you want to tackle those in. Okay, so I feel like inflammation is just part of being alive these days because we get so much.

We live in an industrial civilization. I mean, we're exposed to microplastics, pesticides, and this was just a fact. you know, say that wasn't true. But what becomes an issue with hormones in particular is that it creates a barrier from the hormone to get to the receptor.

So the hormones is like a key in a law. And if the receptor has a bunch of junk in front of it, the hormone can't push through, it's really going to impair the body's ability to accept that hormone.

So I know for us, we do detox with our hormone patients to try to like clean that up so that the hormones can do their job. Yep. And then gut health is a similar issue, but then we're dealing more with microbes and cleaning that up.

I hear a lot of women sometimes, even in my practice as well as otherwise, women talk to me about these things all the time. that they feel inflamed, like they're having joint pain, that type of thing.

So is that what you're talking about when you talk about inflammation with your patients? Because I don't necessarily see it as exactly the same thing, sometimes their inflammation markers will be okay, but they are still having the sensation of inflammation.

Anything else that you talked about with women when they come into your practice, midlife women, when your assessing them for inflammation, and what other types of questions?

I would say insulin is really high on the list because if that insulin has dysregulated and people are spiking their glucose, which is very common with our American diet.

Yes, the standard American sad diet Very sad, it is sad. I explain to people that insulin is kind of like the tip of the iceberg. Until that insuline gets regulated, nothing can really stack below it properly.

And so we spend a lot of time talking about nutrition and not that carbs are evil, but we like people to eat their vegetables and then their protein and fats and the carbs at the end to kind sneak it in so it doesn't spike that And people taking control of keeping their insulin balance is a huge part of hormones, right?

Because that insulin's dysregulated, it can also make your cortisol, your stress hormone go up as well. Yeah. All this chicken and egg, right? We don't know which is causing which.

Okay. And what questions do you ask to assess their gut and testing? Do stool testing particularly, do that on everyone? What do do initially to asses the gut?

We have a very basic program that does not include testing, and probably 80% of people will feel better with it. We do a 4R program, which is remove, reinoculate, replace, rebuild.

And it's basically… Say a little more about that, because I've heard those 4 R's, but say them again and what each of them means. Yeah, so the first one, and honestly, as we get into more sick people, we almost need to reverse the order that we're doing it because…

The rebuilding, yeah, the rebuilding is so important. It's not a one size fits all. That's good. Kind of three to four are, is going to be removed the pathogens.

So most people do have overgrowth of yeast in their bodies from eating sugar and most packaged foods do you have a little sugar. And so most people do have a candida overgrowth.

They can have bacterial over growth. they can Have parasite overgrow, which is really common. Like you would think that's so weird, but it's really not.

And, so we have an herbal blend that works really well. I've tried all of them and this one seems to be the best one. A supplement or a power. Yeah. It's a supplement.

The very first thing that we do is we an elimination diet and a liver cleanse to make the path clean so that when we the killing phase, they have somewhere to go.

And so we have to makes sure people are able to to the bathroom. That's really fundamental and shockingly common that people can't. Yes, I want to ask you more about that, but keep going with the Rs.

Let's do the R's and then let's talk about I think it's even more common for women in midlife. Of course, we go through different phases. Pregnancy can be a difficult time for keeping the gut moving.

Also, a lot of people on GLP-1 receptor agonists now, so it is really important. We'll talk about the good moving, but okay. So we've got the four R's.

The first was remove. That's awesome. Removing, offending things that we take into the body, But also making sure the elimination is working. Okay. Yeah.

So we remove, eliminate, get rid of the bad stuff, and then we re-inoculate. Then we're putting the good stuff back in. Okay. And then, we basically need to rebuild the lining because the rebuild, that is like a butyrate, like an immunoglobulins.

That is going to strengthen that gut wall because, the gutwall is only one cell thick. And so it's really easy to make it porous and things can go in and out.

And it was really supposed to be the pipe, like inside and outside are separate. So it is really important to keep it that way. I would say in our practice, we don't even check food allergies until after the gut program.

If we check it the first week, it's going to be lit up like Las Vegas and then people cry because they can't eat anything. I got it. That's great. Okay.

And then if they don't get better, that's when we do the gut test and we can send it out and have it looked at. Got it, yeah. Pathology. Yeah. Then we dig deeper into medications.

Cool. Did we the 4Rs remove, re-inoculate? Replace. Re-place and rebuild. and rebuild. Beautiful, I love that. Okay, tell me if kombucha is actually good for people or not.

People ask me this question. I'm not a fan, i just don't like how it tastes and I know I've seen patients who just absolutely love it and then they have so much of it that their blood sugar goes out of whack.

So And when I heard you say re-inoculate, I'm like, okay, because that's where people think about certain foods that some people can't tolerate. Certain dairy products, yogurt has certain organisms, strains, et cetera.

So start with the hoochah and then other… Dr. Jill Carnahan, and I've seen her speak before and she is not like Kamlocha. Okay. She thinks it's some wild thing that just grows and people don't know anything about it.

And like, why would they introduce that to their bodies? I personally don' like it, like I don''t have a flavor for it but I know people like and if that's the one thing they do that''s healthy, I'm probably not going to tell them to stop.

Right. Got it. I totally agree. All right. We both feel the same way about that. So I'll find somebody that I talk with on the puck at some point who's a big in favor of it, and then we can say it and we'll learn more about it We have sauerkraut, we have kimchi, in Latin countries, there's the pickled carrots and peppers.

Every culture has some kind of fermented food, really. So that's what we're talking about with re-inoculate is fermented foods that we- Fermented foods.

We also have specialized medical strength specific probiotics that targeted probiotic- Got you. That's a whole topic. Maybe we'll do an entire recording another time talking all about that because they're so specialized.

There's so much to talk about. Let's talk about constipation because I really think that with the hormonal changes that women and midlife go through and I've experienced this myself.

Me too. The slowing down of the gut and also I know this is more common in women than in men because when I have gone for my colonoscopies when i turned 50 and when turned 60 and the GI doctor talked about this with me that the colon is just more relaxed and it doesn't move as well.

So say a little bit about that. What do you see about and what do have women do to get things moving? So a lot of products out there. Yeah. So with constipation, there's so many factors.

A hydration level, fiber level. Is your gallbladder working? That bile is so important to have enough and Oftentimes that will be the answer is giving them something with like a bitter, like an artichoke kind of a base to stimulate that contraction.

It is a tough thing to tackle because it does slow down and people think, oh, this is normal, but it's really not. I mean, they've done studies showing women who are more constipated or more prone to cancer.

So it is really so important to relieve that. And that makes sense because the, like you said at the very beginning, when we're not eliminating, we are not limiting waste products.

Our bodies, our cells are metabolizing all the time and the waste has to go out either in the urine or the gut. For hormones, the got is the main route of eliminating those waste product, those byproducts.

Oh, yeah, you don't want estrogen just cycling and cycling, cycling around your body. Yeah. You took me right where I wanted to go, which is a word that is relatively new word.

Of course, it wasn't around when I was in medical school, but that was when dinosaurs roamed the Earth. So the word estrobalome, most people have heard the world microbiome.

We have microbiomes everywhere in the gut, on our skin, in lots of places. But now people are using the words estrobolome So say a little bit about that and how that connects to what we're talking about in the gut health.

So this is a word that will come back on a stool test. So if you were to do like a functional stool tests, you would get a special little paragraph about how someone, how their astroblom is functioning.

And what it means is there is family of bacteria that it's their whole job to decide whether to keep that estrogen cycling in your body or to get rid of it.

And so you don't want it to be too high or too low. You want to it be just the Goldilocks in the middle. And the best way to do that is to have good gut health.

It's really interesting how the two things, the gut and the estrogen and hormones do all this crosstalk really. Yeah. Wonderful. Yes, and you and I met through the Biodentical Hormone Provider Training Academy and so we have learned so much, right?

We have volumes of materials related to hormones and we're just doing this short tip of the iceberg conversation today, so I'll look forward to more. What else are you really passionate about exploring?

In addition, you got a woman in midlife. I know you take care of people of lots of different ages, but for women in Midlife, this podcast is for feeling great, feeling hotness as in not just hot like the hot flash, which is can happen, but we like to help people not feel those.

But we want to feel hotness like from a libido standpoint, and we have to have good energy for that to happen. There's a lot that goes into that. So what else do you talk about that brings us back to that and other topics that you're passionate about, that we can just bring up?

Oh my goodness. Well, reading someone's hormones and diet really, I feel like in your 50s, maybe like late 40s 50's, all the chronic stuff kind of starts coming up.

And if you can tackle that. in that decade, you can really prevent things from becoming chronic and then you actually start to reverse it a little bit.

And so I love seeing people, they come in and they have dry skin and wrinkles and that tire around their belly and just feel horrible and not feeling like they look very good.

Then after about a year of being on hormones, I mean they get their waistline back their skin looks better they're glowing they have energy they, have a libido they get their little sparkle back and they rekindle their relationships with their husbands and like they just get there zest for life back.

And it's so wonderful to see that. Yeah. Beautiful. I love that. Yeah, because libido isn't only about sex. It is zest for life. That's one of my favorite definitions.

And I know, just to touch on this just a little bit, getting a bit more personal. You've been through things. Your daughters are now old. Are they both older teens?

I have a 15-year-old and a 19- year- old. So yeah. All right. That's what I thought. Yeah. There's a lot involved in being in midlife and being a mom and be a wife, being the partner.

What would you share that's made a big difference for you? I like to share tools with women. I know you've used lots of different tools, including hormone replenishment and gut health and all those things that we do that, we talk about with other people.

anything else that has been helpful to you in terms of keeping your own spark alive while you're doing everything that you do. Oh my gosh. Well, I would say doing my pellets with you has been a life changer because that little bit of testosterone gives me so much a drive and I can manage my life.

Whereas before I was kind of a mess and it just felt like I just was all over the place and couldn't see things through to the end. And now I have, like, can do it all.

And that's a huge gift, but I mean, it also gives me the energy to do the self care that is needed. I'm able to finish my tasks so that I can go to my yoga class and I walk the dogs and go outside and just like take in the sun for a little while.

And like I have bandwidth to get to that. Whereas before I might not have all my bandwidth would have been used up just on the day-to-day tasks. I love it.

I Love that. Right. We love testosterone. It really helps women draw boundaries. That's what I'm hearing when you're like having a boundary around work, right?

You own your own practice. And we have to be able to draw a boundaries so that we can go and like you said, do those self-care things. So that's really fantastic.

As I always say, you and I could really talk for a very long time, but what I want to also leave our listeners with is how can they reach you? If they want learn more about your practice, I'll put the link in the show notes.

But what is the best way for people to reach? I would go to my website, which is timelesswellnessclinic.com, and you can call our clinic, the number's on there, or you fill out a little form, a contact form and we'll get right back to you.

And you're in the San Francisco Bay Area. Uh huh. We're in the Bay Area, East Bay specifically. Beautiful. I love it. In person, telehealth, both. Mostly through in person.

Nice. Um, I can do tele-health. It would be nice to at least meet in-person once, but I have a few people that live too far for that and I've been able to help them for sure.

Wonderful. That is so great. Well, I wish you the very best with your own hotness and your work that you do, which is wonderful and important in the world.

And I am giving you a hug across the video waves, and I will look forward to getting to speak with you again soon. Thank you so much for having me, Dr.

Luz, that was super fun. You're welcome. Thanks for listening to Hotness. Help more women find these practical tools by liking, sharing, and following the show, as well as leaving a review.

As a gift for listing, go to drlizmd.com forward slash hotness for your free midlife guide filled with powerful support for you mind, body, soul, because you can embrace your hotnes at every age.

Amber Ross, PA-C

Is Your Gut Getting in the Way of Your Hormones? — with Amber Ross