Balance Hormones & Blood Sugar: Women’s Wellness Guide

Tabatha Barber, DO, FACOOG, NCMP, IFMCP

Thank you, Dr. Yates. I’m so excited to be here. This is such a passion of mine, because honestly, coming through conventional medicine, training, and trying to practice as an OB-GYN for a long time, I was frustrated that I could never make my patients well. I was able to control their symptoms and sometimes give them some reprieve from their complaints. But nobody ever felt well, including myself. It wasn’t until I went on this healing journey of my own and found the world of functional medicine and went on to become certified, then anti-aging medicine, and all the things that I realized, like there’s a whole world of health and wellness that’s ours for the taking, but we just don’t know about it. So it’s so exciting that you’re bringing this truth to people because otherwise it’s just not available from their doctors,? Here I’m the first to admit, like I was a doctor, I just didn’t know. Once you get better, you get to do better.

Beverly Yates, ND

Know better? We do better. Those will be like the words for humanity going forward forever.

Tabatha Barber, DO, FACOOG, NCMP, IFMCP

I want to say that was Maya Angelou. That was not me.

Beverly Yates, ND

That’s how we learn. I’m sure she’s smiling. With that in mind, will you kick us off with this discussion? Because it’s a rich, nuanced discussion. When it comes to women’s health as we go through our various life cycles, we go through puberty, our young adult years fully formed, fully formed adult years, and then into midlife transition, menopause, and then beyond approaching our elder years, what are three myths that you might have? Let’s start with one myth that women may have around, let’s say, blood sugar and diabetes and their health specifically as a woman, because I feel like there’s a lot of missed opportunity to make sure that we can stay well during those times.

Tabatha Barber, DO, FACOOG, NCMP, IFMCP

Unfortunately, we were sold the lie that we should eat every couple of hours to maintain stable blood sugar. This was pushed. This narrative was pushed by the American Dream Association and the American College of OB-GYNs, and it set us up for metabolic dysfunction. Unfortunately, it took a good 10 to 15 years to see the effects of eating every couple of hours. Make sure you’re snacking in between your meals. There are a lot of women still out there being told this lie and that they’re trying to be, quote-unquote, healthy, and live this way because they don’t realize that is a myth. What is happening is that when you eat every couple of hours, your pancreas is working overtime. Every time you put something in your mouth, your body has to produce insulin to go out and regulate that sugar in the bloodstream—that glucose that you’re breaking down and absorbing. It’s exhausting for the pancreas; it’s exhausting for the gut and the liver. So we’re diverting resources, and we’re constantly in this digestion mode, which requires energy. so it’s not a healthy state of being. This is one of the biggest things that prompted me to study fasting. As a surgeon, the first thing I was taught in residency was that you write NPO orders after surgery, and that is telling the nurse, Do not feed my patient; my patient is not allowed to eat because they are in a healing process, and we don’t want the digestive system to be active and using all of our resources.

I had that training. It was in the back of my mind. But then this new trend of eating all the time to regulate your blood sugar came out, and we forgot about that. But when I go back and do the research, and I go back 2000 years and read the Bible because that’s where I stem from, God created our body with this incredible innate intelligence to be able to fast. Fasting is a tool that helps us heal and helps us get back into a balanced homeostasis. It clears our minds mentally so that we can reconnect and nourish our souls. But I want women to realize that our physiology was not created to eat regularly. There were no grocery stores on every corner thousands of years ago, millions of years ago, when man started to walk this earth. We were created to have feast-famine cycles. We should be able to go periods without eating, have a nice meal, and then go without again. That is how our body is designed. But because we got into this society of eating every couple hours, we lost our metabolic flexibility, our ability to get into ketosis, and our ability to regulate our energy production from other foods like fats and proteins. We’ve become dependent on carbohydrate foods. So that is why we have fatty liver insulin resistance, polycystic ovarian syndrome, diabetes, all the problems, and infertility are at an all-time high, and this is one of the drivers of that. Women need to pay attention, and that’s an important thing for them to understand.

Beverly Yates, ND

That’s a great way to phrase it. I’m glad you shared this because I’ve always thought that it’s so interesting. You look around the world and at the different cultures; you look at people, their spiritual beliefs, their religions, and the things that they do. What is one of the things that pops out, if you would pay any attention? It’s fasting.

Tabatha Barber, DO, FACOOG, NCMP, IFMCP

It’s a religion. It is part of every religion because it is part of how we stay healthy in our physical bodies. 

Beverly Yates, ND

That physical body and its interaction with the spiritual body, nourishing one and then also giving a chance as you talk about with this metabolic flexibility concept, it makes sense. I feel like it gives us more spiritual dynamism and the ability to be dynamic in our spiritual life as well as our physical life. I agree with you 100%. We’ve lost that ability because of this 24-hour access to food. We haven’t yet adapted to that. 

Tabatha Barber, DO, FACOOG, NCMP, IFMCP

We have it. When we are eating, we are creating more cravings, and we’re responding every time we feel a little twinge from our ghrelin, our hunger hormone. We’re like giving in to that urge. We get overly indulgent in feeding all of our cravings and all of our urges. We should not be living that way. We need to have some discernment, and we need to tell our body no sometimes and go through that feeling of, okay, this is a little uncomfortable, but I don’t need to give in to every craving and every whim. That’s what people who end up with major problems like addictions and things have: they’re not stopping themselves. They just give in to every feeling. This is part of why we have so much emotional eating and dysregulated eating because we are listening to our urges as opposed to eating for nourishment and for the reason of eating right.

Beverly Yates, ND

With that lens from functional medicine and with your original training in conventional Western medicine, what are your thoughts about that transition that leads into menopause and the post-menopausal years? Because for a lot of women, this is where issues with insulin resistance pop up. Maybe if they didn’t historically have weight struggles, they might now suddenly, it seems like it happens. They might start having problems with their sleep. Their ability to handle stress may change. They may have more feelings of anxiety and panic attacks, and there’s a lot of dust-up that can happen for some people during this time, all of which is a set-up, an absolute setup for Type 2 diabetes and pre-diabetes.

Tabatha Barber, DO, FACOOG, NCMP, IFMCP

Here’s something I did not learn as a conventional OB-GYN, but it’s key, estrogen protects our body and keeps it healthy. We have hormone receptors throughout our body for estrogen, progesterone, and testosterone. When we are in a balanced state of estrogen during our reproductive years, our immune system behaves; it usually acts appropriately, protects us, and protects our cardiovascular system. Our blood pressure can stay regulated. It keeps everything healthy. When we go through this menopausal transition and we go into a state of estrogen deficiency or decline that’s permanently low, we’re just not going to make that much estrogen as we did ever before. 

Everything shifts, not only in your uterus and in your ovaries, but in your entire body—the way your brain functions, the way your cardiovascular system functions, and the way your liver functions. So what we know is that estrogen deficiency, or menopause, is a state of increased inflammation. so we see those diseases come about. We see the increased risk of developing pre-diabetes and diabetes, insulin resistance, heart disease, etc., and this is what I see in my practice every single day when a woman goes into that transition. Her blood pressure increases by an average of 10 to 20 points because the arteries that pump your blood throughout your body and your heart are relying on estrogen to stay elastic, pliable, and mobile. So when you no longer have that estrogen supporting those cells, your arteries get stiff. They turn more into pipes. so you have to pump your pressure harder to get the blood out throughout your body. so I see it every single day. Women are like up. I just got told I have elevated blood pressure. Well, you went into menopause six months ago. 

The same thing happens with cholesterol. You’re going about your life. Your liver is making a certain amount of cholesterol. Here’s the thing. Cholesterol is the main ingredient in making your sex hormones. We use cholesterol to make testosterone, estrogen, progesterone, DHEA, and even cortisol, our stress hormone. When we stop making all these sex hormones because we’re no longer reproductive, that cholesterol sits in our liver and it’s not being utilized; it takes a minute for your liver to go. I don’t need all of this cortisol or cholesterol production anymore. Let me down-regulate. Women get told, you have elevated cholesterol; here’s your statin; and here’s your blood pressure medication. When those are honestly normal changes that your body is going through because it’s transitioning into a hormone-deficient state, We just got it all wrong. 

We’re just not understanding that the body is incredibly smart like it knows exactly what it’s doing. Here’s the other thing that women are surprised about weight gain is inevitable with menopause—at least five, maybe ten. Again, it’s your body’s innate intelligence. We make estrogen in our fat cells. When we go into an estrogen-deficient state, our body says we want enough estrogen to keep protecting the bones in our brain. It makes your fat cells more metabolically active to make more estrogen. That is a normal process, unfortunately, of going into menopause. We don’t like it because we don’t like how it feels or looks.  But your body is not betraying you. Your body’s not failing you. Your body knows exactly what it’s doing. If you want to combat that, you can get on bioidentical hormone replacement and stop your body from trying to do that. But I love explaining to women that you have to work with your body. It’s not failing you. It’s not betraying you. Honestly. As soon as you shift your mindset around that, everything can change going forward.

Beverly Yates, ND

Beautifully said. These are normal physiological shifts. Here’s what was true before. And now here’s what’s true in this stage of your life. Your season has changed. Now the reason for these things has changed. Thank you for that. That was a clear explanation. A great job here. So that’s another myth that goes on around the idea of blood sugar regulation and risks for Type 2 diabetes, pre-diabetes as a woman’s life unfolds, whether she’s in her reproductive years, that window, or she’s transitioned to menopause, and now the reproductive window has closed. That energy, a life energy, is available for other things. That’s a tremendous shift. That’s a lot of energy there.

Tabatha Barber, DO, FACOOG, NCMP, IFMCP

Let’s take that in two parts. Or the reproductive-age woman who’s trying to get pregnant or be healthy in that stage of her life. There’s a new myth going around that you should not fast; you should be eating all of the time, essentially because it’s not good for your hormones. Again, I’m going to say that is a myth. That is not true at all. Our bodies do not want that food. As I mentioned, 24/7, because the more that you are relying on insulin to come into the picture, the more your hormones get dysregulated, and polycystic ovarian syndrome is probably the number one cause of infertility in this country. What’s happening is that it’s not an ovary problem. It’s a metabolic dysfunction problem; it’s an insulin resistance problem, and we’re trying to tackle it with hormones when we have to regulate our blood sugar and stop all that insulin production. That’s how you reverse PCOS. When I run my fasting programs, I don’t fast with all my one-on-one patients. People get pregnant every time they start getting back to this healthy lifestyle; fasting is not a fad. It’s how you were created to function. It’s a lifestyle. So once you get back into using fasting in your life, your ovaries will finally feel safe and comfortable producing the hormones when they’re supposed to. You’ll get into a regular cycle. Remember, you know this is Dr. Beverly, that your body does not want to procreate and be reproductive and grow another human being if it’s in survival mode, if it’s struggling if there are infections to kill off, if there’s stress, they think they have to run from a tiger or any of these stressors externally or internally. They will signal to the brain, and the brain will shut down that hormone production with the ovaries. That communication will go offline because it’s a protective mechanism yet again. It’s not that your body does not know what it is doing. It’s protecting your unborn baby by not allowing you to get pregnant at this time. We don’t talk about that enough. The cool thing is that I find that very empowering because women can be like, I have so much input and say, whether I’m reproductive or not. I can affect my fertility with my lifestyle choices and my diet choices. That feels empowering as opposed to going to an REI, like a reproductive endocrinologist, and being told that, well, you just need IVF because there’s no bringing your ovaries back to life. I promise you, that’s a lie. It just is.

Beverly Yates, ND

That’s a great point that you’re bringing up here. When we talk about rejuvenation, letting the body restore and repair itself, doing what it’s supposed to do, and removing those obstacles to cure, that’s how we would say it. Naturopathic medicine, where we completely overlap with our functional medicine colleagues,  root cause issues. You think about today’s world in terms of constant snacking and the advertising of food, and it just looks so glimmering, and it’s like this food never looks like that. But are you all even showing our dopamine and serotonin, and the next thing people feel compelled to do is to do things that their rational selves know don’t even make sense? But here we are. then in this moment for women’s health care, as we go to look at healthy aging and having our health span equal our life span, because people on average are living longer, and in part because we don’t have the same high rates of infant mortality. If you look at the numbers, there’s a way in which it gets put out that’s not quite accurate. But the bottom line is that you want to be healthy for however many years you are blessed to be on this earth. If we’re looking at doing that and we’re thinking about women’s healthy journey and going through menopause, the reproductive window, preserving that fertility, For those of you listening to the summit, if you’re a younger woman, please listen carefully. Rewind if you need to, and take notes. Because what Dr. Barber is saying right now is true—that Dr. Tabatha has given you the goods here. If you are an older woman, share this with younger women. Now we’re going to talk about the fact that older women are going through menopause. We’ve hit that transition. We will probably realistically gain about five or 10 pounds. You’ve done a great job of explaining that. I’ve always thought that as we enter what is sometimes called our crone years, our elder years, our wisdom years, and our give-back years. My mother said one of the most beautiful things she ever shared with me before she passed away was to make sure, Beverly, that you make friends with women of all ages, especially younger women. It wasn’t necessarily because the expectation was that women my age or older would die around me, but rather to pass back information nuggets so that they could be well too, like she was very much a community-minded person. So in that, what will we want to tell ourselves or our older sisters, women who are older than us, to let them know, Here’s how you keep this precious vessel of you put together, like, what do we offer these women?

Tabatha Barber, DO, FACOOG, NCMP, IFMCP

I would say that for the majority of women who go through the menopausal transition—women north of 40 and north of 50—the biggest hiccup they have is not managing their stress appropriately. We hear it all the time. The idea gets diluted, and we’re like, Well, I can handle my stress. That’s not a big deal. We’re running around trying to do all the things like have an amazing job, be the supermom, be a great partner, be an awesome girlfriend, go out for cocktails, and do all these things right and still look good. But even though those might be good stressors, and then we have our other bad stressors, they still cause your body to make excess cortisol, which is our stress hormone, excess adrenaline, and all of these inflammatory chemicals. So it can compound and make it difficult for the body to stay healthy. Here’s the kicker. When you go into menopause and your ovaries are no longer making your sex hormones, the body goes to your adrenal glands. They are your backup ovaries. They say “We need some sex hormones to get us through this next half of our lives. Kick it up a notch. Let’s get some more production from your adrenals.” But I see so many women going into menopause with tanked adrenals, like hard-core adrenal dysfunction. They have, like, created such a cortisol excess that their body gets to a point where it says, “Nope, we’re done doing that. We’re not going to do that anymore.” It downregulates your cortisol production, and some women are even going into menopause, like flatline cortisol. We’ll do a 24-hour saliva cortisol test, and they’re just not producing. Their DHEA is in the tank, so there’s nothing to pull from. There are no backup ovaries to make any little residual amounts of testosterone and estrogen. These women are struggling to continue exercising.

They used to struggle in their jobs to have mental clarity, even finish a thought, or get through Project X. They’re feeling exhausted from all of those things. So this is just the picture I see every single day. I’m stressed, but I can handle it. But I’m here to tell you it’s not how you can handle it mentally. Your physiology cannot handle it. It is done with you being overly stressed and going on the go from dusk until dawn. So we have to shift how we’re doing a lot of things. A lot of women have to shift from high-intensity interval training and heavy cardio to more restorative practice, pilates, yoga, adding in walking, strength training, and those types of things. We want to strengthen and train our muscles, but we have to change, set boundaries, and get rid of a lot of those external stressors. But in addition, you’re experiencing internal stressors. I’m seeing more and more women with chronic gut dysbiosis, they have bacterial overgrowth where they have tooth issues and undiagnosed thyroid issues, and all those stressors are hard on the adrenals. Then you go into menopause, and you don’t have any sex hormones to pull from at all. That is where menopause is like a make-it-or-break-it for women. Either you’re going to take back control of your health and you’re going to make the next half amazing, or you’re going to give in and believe that the white coats are the only ones that can fix you, and you’re just going to lay down and die, and I don’t want any woman to do that.

It’s not necessary. You don’t need to be on all these medications. You don’t have to look to doctors to heal yourself. It is in your hands to set boundaries and get into parasympathetic activity. Hopefully, you guys are talking about that, like laughing more, hugging more, doing things to get you in a calming state, breathwork, tapping, meditation, reading the Bible—all of these things shift how your body functions so that it can thrive in the second half of life. Let me just throw in that fasting is like a superpower for menopausal women because it’s the quickest way to reset everything. If you are fasting along with regulating your nervous system and shifting how your adrenals are functioning, your second half can be better than the first half of your life. Without a doubt, I’m living proof. My patients are living proof. It’s a game-changer. 

Beverly Yates, ND

I agree. Fasting is an invitation for a massive reset button. It is, and the word no is a complete sentence. I write. Amen. I invite everyone to consider. That’s one of the things I’ve observed in my patients. It’s been interesting with the female and male patients; caregiving has become a real thing for some of us, particularly in that window where we’re in our forties, fifties, sixties, or seventies, and we may be caring sometimes for two generations in our family, people who are older than us, perhaps parents that have ailing health, children, or other people that we are close to either in our household or close relationships. The other thing that can happen then is that sometimes there’s just not enough resources, enough help, enough capacity to go around. When people are in those deeply intense and sometimes prolonged caregiving moments, they wind up so tapped that they start to tip over. One of the things that can show up is Type 2 diabetes. Sometimes people are shocked at that diagnosis because they were otherwise doing all the things you shared, and yet they don’t have the result. They’re like, How did I get here? What happened? They aren’t the stereotype of, let’s say, partying their way to Type 2, eating ice cream and chips, and all these other things all the time, they’re exercising, they’re trying to pay attention to the things that they know about, but yet it still happens to them. rather than do the blaming, shaming, and disparagement that goes on, because we all know that’s not helpful or curative right now. What do you do right now?

Tabatha Barber, DO, FACOOG, NCMP, IFMCP

I see this a lot in my programs. Women, a few years back in my programs, I would use a Keto-Mojo where we would measure your glucose with a finger poke and then your ketone production because we were trying to shift into ketosis and get away from all that carbohydrate use. Inevitably these women would say, I woke up with a good fasting blood sugar, and then an hour later it spiked up. I’m not eating; I’m not drinking. What is wrong with my body? It’s because they were having crazy mornings. They were stressed out. We need to realize that every time we make cortisol to handle something, we also make glucose in our liver to put in our bloodstream because our body thinks we’re going to go fight or we’re going to go run and handle that stress. so you don’t even have to eat glucose, sugar, or carbohydrates. Your body will make it from your liver if you are stressed out, and you have a normal little rise in cortisol first thing in the morning. It’s our body’s natural way of getting us going for the day. It’s our natural cup of coffee, but we can get that thing shot up way too high if we’re running around like a chicken with our head cut off, if we’re fighting with our kids to get out the door, if we’re not giving ourselves enough time to get ready and answer all the emails for the boss we hate, to do all this stuff, or we’re like, do intense cardio for an hour before we get out the door. That pushes in some excess cortisol and excess glucose production. You could have elevated blood sugar without even eating. I was a living example of that as an OB-GYN, and I didn’t eat very often, but when I did, it was a poor choice, whatever was available to me at the moment.

But I was pre-diabetic, and I only weighed 160 at that point. I was a little bit overweight, back down to where I should be, but it was from the stress of my job, like having babies in my hands. It doesn’t have to be that extreme. I see this in my patients, who are like CPAs, around tax time. Their hemoglobin A1C just shoots through the roof. Or young moms who have multiple little kids and feel like their mornings are so crazy and they just can’t get control of anything. I find it important for women to get centered before anybody else wakes up so that you are starting your day on the right foot. I want you to think about, like, here’s a teacup sitting on a little saucer, like Ode to My Grandma. You want your teacup to be overflowing and filled so that the saucer is full of tea as well. That is what is feeding everyone in your life. You should not be pouring from your cup. You should not be waiting for the last drop to come out of your cup to give to somebody else like you.

Your cup should be overflowing, and the saucer should be like pouring into their teacup. That is how I feel about it now. I had to learn the hard way, like most of us. But if you are not filling your cup first, you can. It’s not sustainable. You can’t keep pouring into other people. You will get depleted, you will turn on autoimmune conditions, you will destroy your gut, you will tank your adrenals, you will go into premature menopause, and you will end up with blood sugar, dysregulation, and all the stuff we talked about. I just see it every single day. It’s in your hands, like how you’re living your daily life and the little choices you’re making. Am I going to get up an hour before everybody else? Am I going to sit in the world and, like, feed myself and my soul? Am I going to journal and get my thoughts out on paper, or am I going to prepare the night before and know what my day looks like before I even wake up? Like so many things, they can set you up for success, and they’re free. They’re easy to do, but it takes intention. It takes getting mindful and shifting how you’re living your life. But it’s so powerful.

Beverly Yates, ND

What a great way to wrap up our episode. Dr. Tabatha Barber, I so appreciate you being here with us. Would you kindly let our audience know where they can connect with you? Where can they find more information?

Tabatha Barber, DO, FACOOG, NCMP, IFMCP

We would love to help you if you’re struggling on your health journey. We love figuring out hormones, thyroid and gut health, blood sugar, and all the stuff. I have a virtual medical practice, it said drtabatha.com, DRTABATHA.com. That is the best place to find me or follow me on Instagram @thegutsygynecologist. There is tons of free content on The Gutsy Gynecologist Show podcast, and I just talk about this stuff all day long.

Beverly Yates, ND

Always with grace, humility, and clarity. I also appreciate you. Thank you so much for being here.

Tabatha Barber, DO, FACOOG, NCMP, IFMCP

My pleasure. Thank you.