The DUTCH Podcast

Finding Hormonal Balance with PCOS

• Episode 113

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In this conversation, Dr. Danielle Desroche shares her journey into naturopathic medicine, influenced by her personal health challenges. She discusses the impact of seasonal changes on women with PCOS, emphasizing the importance of maintaining routines and finding hormonal balance.  

This episode also explores: 

  • How understanding androgens can provide clarity with PCOS symptoms 
  • Finding balance between exercise and nutrition and common misconceptions about weight loss 
  • The importance of self-compassion in dietary choices  
  • How sleep and lifestyle changes can impact PCOS symptoms 
  • The significance of comprehensive hormone testing, especially for conditions like PCOS, and how to translate test results into actionable health plans   

Show Notes 

Check out Dr. Danielle's podcast, The Heal Your Hormones Podcast, and follow her on Instagram @drdanielle.nd! 

To learn more about how the DUTCH Test can profoundly change the lives of your patients, become a DUTCH Provider today. 

Dr. Jaclyn Smeaton, ND (00:01.774)
Welcome to the Dutch podcast, where we dive deep into the science of hormones, wellness, and personalized health care. I'm Dr. Jacqueline Smeeten, Chief Medical Officer at Dutch. Join us every Tuesday as we bring you expert insights, cutting edge research, and practical tips to help you take control of your health from the inside out. Whether you're a healthcare professional or simply looking to optimize your own wellbeing, we've got you covered.

The contents of this podcast are for educational and informational purposes only. The information is not to be interpreted as or mistaken for medical advice. Consult your healthcare provider for medical advice, diagnosis or treatment. Welcome to today's episode of the Dutch podcast. Today, we're going to be talking about a condition that affects a large number of women, which is PCOS. And we're going to be talking about all the things that can get really kind of complicated, especially when you think about the combination of conditions like PCOS with thyroid dysfunction.

But really when it comes down to treating PCOS and helping women achieve hormonal balance, there's a lot of really important factors that come into play and those can really be extra challenging during the summer. In fact, a lot of women with PCOS can experience a more difficult time during the summer managing their symptoms. Today's guest is an absolute expert in this area. We have Dr. Danielle DeRoche. So after an eating disorder brought an end to her career as a professional ballet dancer,

Dr. Danielle began experiencing severe hormonal imbalances, including irregular periods, hair loss, and persistent bloating, but lab tests kept coming back as normal. This is a story probably many of you have seen or heard yourselves. She was very disappointed by the lack of meaningful support, and in the end, pursued a Bachelor of Science in Nutrition, followed by a Doctorate in Naturopathic Medicine, and then a residency in primary care in women's health.

Along the way, she was diagnosed with Hashimoto's thyroiditis, an autoimmune condition that's commonly mistaken for PCOS, which provided long-awaited clarity and allowed her to address the root cause of her symptoms. Through a really holistic and evidence-based approach, she's regained her health and achieved a level of wellness she'd previously never experienced, and now she applies both that personal experience and her training to help women with PCOS, Hashimoto's, and a wide variety of other hormonal imbalances.

Dr. Jaclyn Smeaton, ND (02:19.82)
So welcome Dr. DeRose, we're so happy to have you here with us today. So I wanna start with your background and one I love to ask providers this question because we all find naturopathic medicine or integrative medicine, functional medicine in ways that are oftentimes very personal to us and I know your story is one like that as well. So can you just start by introducing how you got interested in this field?

Yeah, thank you for having me.

Dr. Danielle Desroche (02:44.364)
Yeah. So it kind of goes back to, was a professional ballet dancer when I was younger. I went to ballet boarding school, and trained pretty intensely and through that developed an eating disorder that led to hormone challenges. I was diagnosed with Hashimoto's when I was 19. So I faced health challenges pretty early on. Didn't really get many answers from my doctors. and as a result ended up studying nutrition and undergrad. While I was studying nutrition, I was also

doing my Pilates teacher certification and my mentor at the time, her husband was a naturopathic doctor. So I had never heard of it before. I was going to school in Vermont, which is very naturopathic. It's a great space for now.

I grew up in New Hampshire so I knew it. Oh, did too. Oh, you did. Where did you grow up? Oh, okay. I grew up in London Dairy but my practice was in bed.

Yeah, I grew up in Bedford.

amazing. That's so funny. A very small world.

Dr. Jaclyn Smeaton, ND (03:39.874)
These towns are like next to each other for people who don't know. Sorry, finish your story.

So my mentor, I was debating between traditional medical school, becoming a dietician, going to PT school. I was kind of all over the place. And she was like, you should look into this kind of medicine. It kind of encompasses a little of everything that you're looking for. So I had shadowed a doctor in Burlington, Vermont, where ironically I ended up doing my residency later on. But I instantly fell in love with.

really everything about naturopathic medicine, but really the focus on the root cause and just how many tools there are in our toolbox versus just jumping straight to prescriptions. So yeah, so then I went out to school in Portland, Oregon, completed my residency in primary care back in Burlington, Vermont, and then started my own private practice during 2020 during COVID.

my gosh, I can't even imagine what that must have been like.

Yeah, it kind of forced me into it in a good way, but it was very kind of unexpected.

Dr. Jaclyn Smeaton, ND (04:43.32)
So now in your practice, you focus a lot on like women's health hormones and PCOS. And we're going to talk today a little bit about PCOS and a very timely episode to talk a little bit about some of the kind of changes that can happen seasonally for women with PCOS as well. So I want to start by asking, like when women are traveling or they're dealing with the heat of the summer, how does that affect women with PCOS, like cravings, fatigue, inflammation? Do those things tend to change?

Yeah, absolutely. I mean, travel can make it much more difficult to stick to routine and kind of stick to the habits that we know help us feel our best. We tend to maybe indulge a little bit more. know, maybe we're going to backyard barbecues, eating foods we wouldn't normally. Maybe we're being more social with friends and we're drinking more. So that's something going to impact things like our sugar cravings, you know, maybe our insulin levels, which can then impact our hormones. We can also see travel and just a

in our routine in general also impacts sleep, which can impact energy levels, brain fog. So I definitely see, know, depending on the person, we can see different seasons affect them, but I think summer can be a really hard one for a lot of people because your routine can be really thrown out of balance.

Yeah, I think too about the way, I just noticed it's like being a mom with my children. Normally they go to bed at 7, 38 o'clock, but at eight o'clock it's daylight still outside in the summertime. And I think with sleep being such an important piece and circadian rhythm being so important for hormone balance, it can get a little tricky sometimes in the summer because you have so much less darkness.

Yep, absolutely. And I think that there's ways too, and we can talk about this, to use a sunlight to your advantage in some ways, but it definitely can be challenging in other ways.

Dr. Jaclyn Smeaton, ND (06:28.91)
Let's talk about that, that's super interesting.

Yeah. So I think, you know, the longer daylight hours, you know, one thing I like to get my patients into the habit of during the summer, if they do struggle during the rest of the year is maybe getting outside for a walk first thing in the morning because it is lighter earlier. So, especially if they struggle with waking up in the morning, you know, they're dragging themselves out of bed. Summer is a great time to get that sunlight in your eyes first thing in the morning and kind of start to reset your circadian rhythm. even if it's just for five minutes, like it doesn't have to be a huge time.

commitment, or maybe it's just a little bit more motivation to get up in the morning and work out because you're not dragging yourself out of bed when it's pitch dark. And on the opposite end of that, with it being lighter later, maybe you are a little bit more motivated to go on a walk after dinner or be playing outside with your kids after dinner because it's not dark at 4.30 PM.

love those suggestions. And I think like, even just taking a cup of coffee or tea outside, whatever you drink in the morning is feasible in the summertime. I mean, it is a lot of places, other times of year, but in New England, not so much because it's frigid and it's dark, right? When you wake up in the morning. I think even just being able to get that morning light and enjoying it and making it part of your routine. And I know for us, like, I'm, you know, we have children, including young children. And so our mornings in the winter,

It's like you get up and you hit the ground running because you, everyone's in a hurry to like get packed lunches, get ready, get the kids ready, get them off to school. And I've noticed, you know, I was talking with another mom about this, that, you know, normally school starts at eight 15 camps starts at nine. And even that 45 minute difference in time makes our mornings feel so much more relaxed and you could actually fit in something like a quick workout or a little walk or something like that, which is so nice. So I know some of the things that are.

Dr. Jaclyn Smeaton, ND (08:24.288)
Interesting, we talked about summer, we talked about travel. Are there any other things that can kind of make PCOS symptoms worse that women don't really even think about or know about, but they might be making those mistakes?

like in some way specifically or just.

generally.

Yeah, think over-exercising is one that I see a lot. And I think that more and more we're getting away from it and kind of understanding the difference of how like cardio and high intensity exercise impacts our bodies compared to low impact exercise like Pilates, yoga, walking. But I definitely still will see some women who are in the mindset of, okay, the harder I work out, the more benefit I'm going to get. And sometimes we can see that really stressing cortisol levels.

We can also see a crossover between PCS and Hashimoto's, which is an autoimmune condition that impacts the thyroid. And so those higher intensity exercises are not always going to leave women feeling the best. So that's one.

Dr. Danielle Desroche (09:23.182)
Kind of misunderstanding. see a lot among women and they'll be thinking like, okay, I'm doing what I'm supposed to for my body yet I'm feeling worse. The more and more I do this. Um, I actually see a lot of women have more energy. They actually finally lose weight. Um, you know, they just feel less inflamed in their body overall when they do transition to more of that low impact exercise, which I think from a, like mentally can be a little challenging sometimes when you're wired to think, you know, the, hard, workout is the best.

it is.

I want to talk about that a little bit more because I think many women when they go in, especially to their conventional provider, they're pushed to experience weight loss, like to benefit their PCOS. And there is benefit, we know, for women to get into a healthy weight if they're overweight or obese when they have PCOS and otherwise, but it's particularly tougher for women with PCOS. So I can see that there could be a natural push to be overdoing it on cardio or trying to...

you know, just focus more on exercise as a means to weight loss. Tell me a little bit more about that because I think that's such an important thing. Like what are you seeing women doing or what were they doing? Was it predominantly cardio or was it HIIT workouts or?

Yep.

Dr. Danielle Desroche (10:36.526)
kind of combination of the two. Definitely some were doing more like the long distance running, but a lot of like the orange theory at 45, higher intensity workouts, and they were like, I'm doing these four or five days a week, and yet I'm still gaining weight. And so maybe we switched, instead of running during these workouts, you're walking on the treadmill. Or maybe instead of doing them four to five days a week, you do them two days a week, and we're supplementing with other

forms of exercise. So I try to kind of gauge like, are they doing these workouts? If it's something that they really enjoy and they're like, I just love it, then I'm not going to completely take it out of their life. You know, I don't want to be like, you know, negative Nancy completely. So I say, okay, how can we work still keep this in your routine, but also supplement something that's going to be more beneficial for you. verse sometimes people say, you know, I'm doing this because I'm trying to lose weight. Then it's like, okay, maybe we can

completely ditch this and go to completely different forms of exercise and see how you feel and see if we can move the needle that way because you're not seeing progress with what you've been doing. So obviously we need to do something different.

Yeah, it's interesting. And I think the focus on recovery is really important as well, where when you're doing the more restorative exercise, Pilates, yoga, walking, et cetera, that also gives you like a rest day to allow your body to kind of recover from the more intense exercise. I think people underestimate the need to post exercise to recover because you're right, it can stack on itself if you're doing too much and end up causing, you know, less progress than you'd really want.

Yeah, I think kind of what ties into that can also be under eating, which I'll also see a lot, especially with women who are told, you just have to lose weight and they're not really being given any guidance on how to actually do that. or why it's a struggle for them to gain weight. Like, is it more hormonal? Is it more insulin resistance? So I'll see a lot of women who are skipping breakfast, you know, maybe they're having a few snacks throughout the day around lunchtime or the afternoon, and then they're eating dinner and that's pretty much it.

Dr. Danielle Desroche (12:45.392)
I do find, you know, when we start to educate women on how to eat for balanced blood sugar and we do start incorporating breakfast, a lot of women will say, you know, I'm eating more than I have in years and I'm actually finally losing weight. So again, it's kind of about like reprogramming, you know, everything that they've kind of been taught. And I think, you know, a lot of us as women have been taught of eat less, exercise more, that's going to lead to weight loss, especially when it comes to PCOS. I just do not see that.

being successful with 99.9 % of my patients.

And that's just because, well, it would really end up slowing down your metabolism. When you talk about the tie-in with thyroid as well, that could probably compound and make it even worse if someone's hypothyroid. They're already at a metabolic disadvantage.

Yep, exactly. And then also that's the stress in the body. The body kind of goes into, always explain it as like going back to our caveman days. Like if the body thinks it's under a threat and it doesn't have access to food consistently, then it's going to start to hold onto that. and then one of the first things that kind of shuts down when our body thinks it's under a state of threat is our reproductive system. So for women who are trying to get their cycle back and trying to get pregnant, you know, skipping breakfast and waiting until one o'clock to eat and then over

is really the opposite of what we want to be doing.

Dr. Jaclyn Smeaton, ND (14:02.67)
Now you mentioned like the summer change in schedule where you have like more parties, more backyard barbecues. And I think that leads into another challenge for anyone trying to maintain their health in summer. You kind of said that there's like more alcohol, more snack foods. We're going into like holiday time. And so people are eating or are exposed to a lot of other junky foods as well. And I think it can be very challenging, especially because like if people are getting a lot of food cravings, it can be so hard to not.

then stack upon guilt or stack upon negative thoughts around splurging or cravings, how to satisfy cravings. Is there a way that you work with your patients to help them be more self-compassionate in those situations and not let things completely spiral out of control?

Yeah, I usually try to focus on one or two things that I know is going to allow them to feel good that day. So that way they don't feel like, okay, I just threw everything out the window all day. You know, there's no point in doing anything good for my body. So usually a really easy place is to start with breakfast because they're waking up. Usually their social events haven't started yet. They kind of have control over breakfast. So I usually say like, let's try and get a really protein rich breakfast in. So that way we're starting the day off with stable blood sugar. We're getting in good nutrition first thing in the

And then whatever happens the rest of the day, whatever, like you can, you can enjoy the holiday. You can enjoy family time. Maybe you are eating things that are outside of your routine and that's okay. It's not about being restrictive, you know, a hundred percent of the time, but let's at least.

You know, do something good for your body at the beginning part of day so that you can feel good going to these events and you're not skipping breakfast, going to these events, starving, or you're not, you know, eating something in the morning that is going to spike your blood sugar. That's going to worsen your sugar cravings later on in the day. Um, so that's kind of one place that I'll focus on with them.

Dr. Danielle Desroche (15:53.494)
And then getting in some movement. I think can also be really helpful. So whether that is, okay, can we squeeze in some movement in the morning before you go to your event? Or, you know, if you're going to be say like at the beach, can you go on a beach walk with your partner or your kids?

to get in some movement. So I think finding like little wins can help offset some of the focus of like, oh, I'm just like, I'm just making all the mistakes. I'm not doing anything good for my body. And then explaining to them that, you know, one or two days of indulging in foods you might not normally eat is not going to undo all of the work and the changes and the progress you've made over the past three, six, 12 months.

Yeah, that's worth an exclamation point because I think we really are, I mean, we've all tried like a crash diet where for two or three days you like try to lose a couple pounds and nothing happens, right? Because you can be consistent for a short period of time and see no benefit. It's exactly the same on the other side where you can have a couple days of junk.

or go on a vacation and eat food you don't normally eat, have more to drink, whatever, it's not gonna derail your long-term progress. It might temporarily, but not in the way that we all worry it will. So I wanna put an exclamation point on what you said because I think that mindset, it's easy. What the problem comes is when we have one bad day and then we're like, forget it. Look at all the stuff I did today. This is terrible. There's no point in me even working out tomorrow or getting back on my plan.

You know, we kind of beat ourselves up and then it becomes this downward spiral where it's not a day of, you know, treat eating. It's like weeks of it.

Dr. Danielle Desroche (17:31.468)
Yeah. And I think sometimes, you know, I'll see my patients really get upset because maybe they'll eat something that they kind of know bothers them. And then they'll say like, I was super bloated or I was constipated for two days later, or I felt inflamed. And it's like, okay, yes, but we knew, we knew this about your body. And this is just kind of.

like reassuring you that there's a reason why you most of the time are eating the way that you're eating or doing the things that you're doing, because, know, that does allow you to feel your best. So sometimes it almost can be helpful to kind of like, quote unquote, get off track a little bit, because then you're reminded like, this is how I feel if I were to eat in this way all the time. So it's just like good information that you're continuing to learn about your body and say, okay, yeah, I know for me, dairy really upset my digestive tract.

and that's why I don't typically eat dairy at home. And yeah, maybe you have those symptoms for a day or two after, but it's not gonna last forever, you know, if you're kind of getting back into your routine.

Yeah, it is a good reflection, that feedback of, okay, this is why I don't have ice cream all the time because I feel terrible for days afterward. You gave another suggestion, which is eat before you go, and I think that's another really good one. I would just add, drink a lot of water as well, even if it's before you go, because that can really help with fullness and with just staying hydrated, especially if you're outside in the hot sun. And I'll give one more recommendation for that, if you're dealing with summer parties, that I found because I

have celiac disease so I don't eat gluten and so you never know what you're gonna show up. Like if you're gonna go somewhere else, I mean you work with us all the time as an ND. If you're allergic to dairy, allergic to gluten, allergic to eggs, whatever it is, it can be hard to go to other places and find food you can eat. So I always bring a dish that I can eat or that I would like to eat. So in the summertime I'm normally the one to bring something healthier like a veggie tray or a watermelon or something like that that allows you to have something healthy to snack on.

Dr. Jaclyn Smeaton, ND (19:27.574)
it just gives you more options. So I would just add that to your suggestions there as well.

Yeah, I love that. think something else you can do kind of in the moment when it comes to alcohol. think a lot of people feel pressure to drink because they're like, well, if I am not drinking, I'm going to get asked all these questions on like, why not? Cause that's just our society. It's kind of crazy, but a lot of times, you know, as long as you like have a drink in your hand, one people aren't going to be really asking you because you have a drink in your hand, but two, it's going to make you feel like you're still socializing in a way that you normally would. So making a mock

with like soda water and some fruit or like some, know, kombucha, some soda water, that can be an easy way. You like put it in a glass and like nobody's really gonna care what's in your cup. Nobody should care what's in your cup regardless. But especially if you're like, I know I feel terrible after I drink and I'm really only doing it because I'm in this social situation. A mocktail really, it feels kind of like that.

the awkwardness that some people might feel if you're used to always having a drink in your hand in those social situations.

Totally, and there's a lot of really great non-alcoholic drinks now that look like alcoholic drinks. A lot of them have adaptogenic herbs in them, and I have to just say, most of them, they're like...

Dr. Jaclyn Smeaton, ND (20:45.516)
have one or have two and feel the float. I'm like, there's so little ashwagandha in these drinks. You will feel absolutely nothing when you drink it. Or the mushrooms or functional mushrooms. I've not seen one where I'm like, you could drink three or four and have less than one capsule of the functional ingredient that's in there. So I will just say that if you guys are listening and you make these drinks, make them with more herbs in them. That'd be amazing. But there's a lot of great options that look like a can of high noon or a seltzer.

And the branding looks just like a lot of the alcoholic drinks as well. So there are great options and it's like you could pick it up and take it to a party. We always have those at our house now because we host a lot and it's, I love it. And oftentimes I drink that and it's, right. It just gets people to stop asking questions or like for me, it's always like, Oh, are you pregnant? Cause we have so many kids already. Like, no, not pregnant. just like don't want to drink today, but you're right. It gives you that chance to like have the privacy of not having to answer intrusive questions.

There's so many great choices. And the other thing that I love on that tip is they make like Yeti and like all those brands make a like a cooler sleeve that you can slide a drink into. And that's another way, like the shape of the can is going to look like a beer or a seltzer, but you can be drinking whatever you want. there's so many good options there to not feel like left out of the experience in any way or have any kind of awkwardness and just do what you want to do, which you should do anyway.

Yeah, absolutely. One of my go-to's, isn't really a non-alcoholic replacement, but I love Ollie Pops. are like, I have one almost every night. That's also an easy one where like, I'll pour that into a wine glass at the of the night. And like, I that's like my treat.

I do kombucha a lot too, like kombucha and soda water. love that suggestion. Olypop is so good. That's another great suggestion. There's just so much, and Spindrift is another one that is like a seltzer, but it's a little bit more flavorful. That really, like you throw a lime in the glass and it looks like some kind of fancy mocktail that you pay too much money for. don't know. Definitely. Well, I want to talk a little bit about hormone testing because I know you have a lot of experience using Dutch testing as well.

Dr. Jaclyn Smeaton, ND (22:49.964)
So when you are looking at testing someone with Dutch, tell me a little bit first about like what you typically see in patients with PCOS.

Yeah, so definitely one of the first things we're looking at is androgen hormones. So those are hormones we typically think of as like male hormones like testosterone and DHEAS. They are important for female health as well. But with PCOS in particular, we tend to see at least one, if not potentially all of these hormones be elevated. So by testing them, we can kind of get an idea of, okay, is the androgen excess coming from the ovaries? Is it coming from the adrenals? And that's going to really dictate

what we focus on in terms of how do we treat this. But identifying those hormone imbalances can explain why somebody with PCOS might experience facial hair growth, hair loss, acne, or regular cycles. So that piece of the test I think is like one of the most helpful when it comes to PCOS. Another section of the test is the estrogen levels. So with PCOS, I really see the range of, you

So I might have high estrogen, normal estrogen, a little bit less common tableau estrogen, but I do see it. So it's really important to not just assume.

that we know somebody's estrogen status, especially when somebody has irregular cycles, it can be related to very low estrogen, but they could have adequate estrogen or even potentially high estrogen, but they're just not ovulating, so they're not getting that consistent cycle. And I do see a lot of women who will come to me and they're kind of self-supplementing, and sometimes they're on just the completely wrong supplements for where their hormone levels are at, and they're actually just driving the imbalance

Dr. Danielle Desroche (24:33.136)
even further. And that's where the testing can be really helpful to show them on paper, OK, this is where your hormones are at and what you're currently taking is making this worse. So those are two of the primary things I look at.

It also looks at progesterone, which can be helpful if we're trying to confirm whether somebody is ovulating with PCOS. With PCOS, because a lot of women do have really irregular cycles, sometimes timing the Dutch test can be a little bit difficult. a point. So, you know, sometimes when progesterone comes back super low, I always explain to them, it doesn't necessarily mean that you're not ovulating. It just means that, you know, potentially we collected this test before you ovulated, you know, because your cycles are so irregular or

so long that it was hard for us to determine exactly when. And then cortisol can be a really helpful one as well, because a lot of times women with PCOS, especially if their stress is driving a lot of their PCOS, cortisol is going to impact things like their energy, their sleep, their brain fog, their weight gain. So those are really like the kind of the four main categories that I'm looking at and some of like the imbalances that we might expect to see with PCOS.

Yeah, there's a couple things I want to just call out. One of them is actually kind of newer to the test. When you talk about androgens, for all the providers that listening, I want to just repeat this as many times as I can, because we just in April launched a new version of our test, which looks a little bit different. And one of the things we did was we pulled an androgen metabolite to the summary page for female patients. I don't know if you've seen any reports come back, Danielle, that have that. It's 5-alpha-androstain-diol. We call it 5-alpha-androstain-diol.

internally. And one of the reasons why we did that is that that particular metabolite, androgen metabolite, is incredibly distinctive in women who have PCOS versus not. And also most other androgen related symptoms like hirsutism, hair loss, androgenic alopecia, hair loss, acne, etc. It's really interesting. We published a white paper on it, which is available at defchess.com if anyone wants to check that out.

Dr. Jaclyn Smeaton, ND (26:44.112)
summarizes all the data on 5-alpha-andro. We've always had it on both reports, and the women's report, the female report, it was on the table, but we didn't make a dial for it on the infographic pages, but we've really realized how important it is as the research is developed in that area. just want to call that out because it's really particularly great for any androgen-related symptoms, and I know a lot of listeners might not be aware of that. I'm sure you're looking at it already, but other people think it's a newer concept.

I think with the androgens, something I like to share with patients too, is typically when they're getting blood testing done with their conventional doctor, you know, they're getting testosterone. Hopefully if they have PCOS, sometimes I would say like 50 % of the time I'm seeing that they are getting DHEIS, but they're not getting that more in depth look at androgens is because we can't really do that on a serum test. So I see plenty of women who have those classic androgen symptoms and they're like, but my testosterone DHEIS is completely normal on my blood tests. And that's where I kind of break down.

okay, well the Dutch test is going to be able to look at your androgens in a much more in-depth way that might give us some insight in terms of like why you're experiencing these symptoms. And I don't think it ever has not given us more information or insight in terms of like why it's happening.

Yeah, absolutely. It's so interesting because with androgens, well with serum versus urine, Serum, you're looking at how much of a hormone is available to the tissues. When you look at urine, you're looking at it after it leaves the tissue. So when you look at metabolites, you're looking at after the cells use the hormone. And so that's one thing that's interesting about 5-alpha-andro. And this is the case with...

with many metabolites, we see estrogen metabolites also can bind to estrogen receptors and stimulate it and have an estrogen-like effect. It's the same with androgens. In fact, most docs are familiar with DHT, because they talk about it a lot for men, but it's three times as potent as testosterone. It's a metabolite, but it's three times as potent as the parent hormone. 5-alpha-andro is similar, where 5-alpha-andro actually is a great marker for...

Dr. Jaclyn Smeaton, ND (28:47.042)
DHT's activity inside the cell, because DHT doesn't leave a cell very readily. It has to be metabolized into 5-alpha-androids to leave. So that's what we're measuring is actually the intracellular androgen activity when you look at 5-alpha-androids, which is why it's so interesting, because you're totally right. A lot of women and men too, you might see testosterone looking normal, DHGA sulfate looking normal, but then have that really potent metabolite high.

And that's why you're symptomatic, even in the quote unquote normal blood work. Yeah, super fascinating, the whole androgen metabolism. We're spending a lot of time on that because we've been doing a lot of research on 5-alpha-andro and developing some education that's gonna go out in December. We're doing an A4M pre-conference and we'll be talking about androgens quite a lot there. So definitely interesting science going on there. So tell me a little bit about, you mentioned like cortisol as well and I imagine

This is another area that you probably monitor because a lot of the things we talked about earlier with like stress, travel, sleep, we typically see changes in HPA axis pretty readily with that. Can you talk a little bit about that?

Yeah, so with my PCOS patients in particular, I see kind of both ends of the spectrum. So people who might be, we'll call like newly stressed or in like an acute phase of stress, we might see their cortisol be really high as opposed to patients who have been in this like chronic state of stress. I see a lot of people who have gone through like dental school or medical school. Maybe they're like three or four years out and they're like, I've never quite recovered from that. Then I see their cortisol really just bottomed.

out like they've got kind of nothing left. So you can definitely see either end of the spectrum with PCOS. I don't necessarily expect to see like it always be higher, always be.

Dr. Danielle Desroche (30:37.118)
you know, nothing at all. But I think the lifestyle changes are huge when it comes to supporting cortisol levels. One of the first things I focus on is caffeine intake. You know, I see a lot of women who are drinking anywhere from like one to four cups of coffee a day. And that's when we start to discuss, okay, is your driving reason for drinking the coffee for energy? Is it for the morning ritual? Is it for the flavor? Because that can give me some insight into

terms of like, one, how easy is it going to be to remove some of these cups and start to kind of pare down a little bit. but two, if it's like they're needing that coffee throughout the entire day to kind of keep them going energy wise, then just having, some conversations and education that, you know, while yes, this might give you a temporary, very short-term energy spike in a way, it's almost like stealing from your energy later in the day. So we're kind of just like compounding the problem.

And if we can maybe start to remove one cup of coffee and replace that with some adrenal support or some electrolytes, over time we can get you to a place where maybe you're not relying on coffee at all. That's the goal, of course, for energy. if it comes down to just like a, love the flavor, I love the taste, then, OK, drink it as a treat here and there. Totally fine. Some people will say that decaf tastes absolutely different. I don't understand it, but I'm also not a huge coffee drinker.

Um, so, know, there are some people where I'm like, okay, you know, maybe like Saturdays that's your treat is to have a cup of caffeinated coffee. Um, but that's usually one of the first places I focus on. And then the second place is definitely sleep. So, um, really looking at sleep hygiene, making sure people are staying off screens for at least an hour, ideally two hours before bed. Um, ideally avoiding caffeine, you know, afternoon would be ideal. Um, definitely not later than 2 PM.

you know, considering some support like magnesium can be great for sleep at night. but when it comes to regulating cortisol, if you're not sleeping and then you're just kind of living off caffeine all day, we can pretty much guarantee that your cortisol levels are not going to be optimal.

Dr. Jaclyn Smeaton, ND (32:51.084)
Yeah, that's another, thinking of mocktails, there's a lot of great magnesium drinks that you could mix up at night and if you are liking that ritual of a glass of wine or something like that and want to turn this into something healthier, just kind of putting it all together, because what we talked about earlier, there's a lot of powdered magnesium supplements that are quite delicious to do in the evening too. But those are really fabulous suggestions and you're right, all of those things can impact.

our HPA axis function, you know, and our ability to sleep and our ability to mount a stress response appropriately and not too much.

And a lot of times, you when we talk about exercise, sometimes when I first meet with like a new patient, if they're not sleeping well and they're exhausted and they're relying on coffee all day to get them through, then I don't mean focus on exercise that first month or two, because we really want to get them sleeping, get their energy to a place where they feel like they can get through a workout. And those things I consider much more important than if they're getting to the gym, you know, four or five days a week. So I think also that comes into play with like the reeducation.

of, you know, we think that exercise is like the most important for health and it definitely is a component, but I really think that sleep is probably top my list.

Yeah, I completely align with that. think it's like something you just can't do without it. And there's so much knowledge around the importance of getting adequate sleep for rest and recovery. I'm glad that sleep is now kind of at the forefront of health discussions because for so long we had this hustle culture, this hustle mentality, which was like, I get up so early and then I do all these things and it's okay to not do that. It's okay to rest instead when you need to rest.

Dr. Danielle Desroche (34:31.936)
Yep, absolutely.

So when you use Dutch testing and you get patients results in, how do you help the patient kind of translate the data that you get into a plan? Like how to know what lifestyle tweaks or what supplements to utilize?

Yeah. So first, when I go over the test with them, I'm always sharing my screen with them just so that they can visually see it too. I think that can be more helpful than me just like being on the call because I'm virtual. So just being on the call and kind of talking them through it. think when they can actually see it on paper, they can kind of, one, they feel more validated and like, okay, there's a reason why I feel this way. But also I think they remember it a little bit more and they can see, okay, I can see the dials are here. This is where I want to be. Like this is the change that has to happen. So I feel the way, you know, that I hope to feel.

One of the first things I focus on is diet and nutrition that for me is foundational. I take more of an approach of what food should you be adding to your plate in order to support your hormones. So an easy example would be

If somebody came back on their Dutch test and they had high estrogen levels, we might be focusing on incorporating ground flax seeds, cruciferous vegetables, other foods to support the liver. know, yes, we'll have a discussion on like, processed foods or alcohol might contribute to higher levels, but my focus is more so going to be on what foods do we need to be eating more of and adding to your plate less so on eliminate all these different foods. Personally, I just found that with my patients that allows them to make sustainable changes.

Dr. Danielle Desroche (35:59.428)
and want to stick to it and make them feel like, okay, yeah, I can do this. I can add a cup or two of broccoli to dinner every night, or I can add a tablespoon of ground flax seeds to my smoothie most mornings. And just kind of starting off with small changes like that. And then kind of each time we meet, we continue to add on to those dietary changes as they're ready for them.

And the second piece would be looking at supplementation. so especially, you know, if hormones are really out of balance, if androgens come back super high, estrogen comes back, you know, across the board, very high, then we might use things like herbal supplements, nutritional supplements, more short term to kind of correct those imbalances while we work on the diet and lifestyle and get the diet and lifestyle in a place where it can maintain that change without being reliant on supplements. and then the third piece is the lifestyle.

So again, focusing on are they exercising in a way that's right for their hormones? So if their cortisol comes back completely bottomed out and they are, you know,

training for a marathon, I might say, okay, after this marathon, let's rest for a little bit. Let's do some yoga. Let's do some walking. Let's help you actually recover. You know, really focusing on sleep. If their melatonin is low or again, their cortisol is out of balance. Focusing on alcohol consumption. If their estrogen comes back high. So more so the diet and lifestyle, I think is what allows us to maintain the change and the supplements I use more short-term to get them feeling good.

correct those imbalances with the goal being to get them off eventually.

Dr. Jaclyn Smeaton, ND (37:34.872)
Yeah, I love that. And oftentimes, when patients don't feel good, it's really hard to make good choices lifestyle-wise. I love that. And I think about supplements the same way. It's like supplementing the great things you're doing. But sometimes it can be a bit of a kickstart to have you feeling better so that you can start to make better choices and then not need them long term. I love that approach.

Yeah, think people will often ask, like, do I have to be down on these forever? And I'm like, the goal is absolutely not. And that's why we're not, I'm not just giving you a supplement protocol and saying, okay, just follow this. this. Yeah. See you next year. Yeah. Um, that's why we're doing all these other changes along the way.

See you year.

Dr. Jaclyn Smeaton, ND (38:13.708)
Are there any particular lifestyle changes that your patients tend to have more difficulty with?

That's a great question. I would say probably honestly the sleep, depending on, you know, for people who have kids and it's like by the time the kids go to bed and I finish my work or clean up the house, you know, a lot of times they'll say, like, I just want an hour or two to be by myself, be with my partner before I get into bed. So I find like getting into bed early enough to get the amount of sleep they need sometimes can be a challenge.

I would say that's probably number one and number two is probably.

the coffee for some people, some people who are like die hard, like I love my coffee. it can be really difficult for them to give up. And that's why, you know, we do it slowly. Like if they're having three cups, I'll say, okay, this month, let's go to two cups. Let's be there for a little bit. But I do have some people who say I a hundred percent will not give up coffee entirely. And that, and that point I'd say, okay, well we'll do it. can, we'll, you know, limit you as much as possible, to what you feel comfortable with. But some people are like, my latte is like my joy in the morning. And I'm like,

can't take away your joy.

Dr. Jaclyn Smeaton, ND (39:25.238)
Yeah, no one wants to take away their joy. I'm probably one of those people. Yeah. I like just playing coffee, but I do love it.

Yeah.

Yeah, it can be tough and the sleep one is so interesting and it doesn't get any easier when your kids get bigger because then they're teenagers and they want to stay out late and I'm honestly like my conversation with my older kids is like you have to be home by 10 because I have to be asleep by 10, you know. Like I want to be, I want to go to bed. You can't be out that late. So it is a really funny conundrum the way that parenting can impact your sleep and but you're right even just trying to get some time alone to relax.

It can be a super challenge to get to bed early.

Yeah. Or I'll see, like maybe somebody doesn't have kids, but they're a business owner. can be really hard for them to turn it off. And so they're just, they're just on all the time. And that's where we have to kind of put boundaries into place, or even if they're not a business owner, but they're, you know, they do take their work home. Then we have to say, okay, by ideally like 8 PM at the latest, sometimes, you know, if people are working until midnight, then you know, more like 10 PM is the goal. We, kind of consider like, what are they doing now and how do we pair it back?

Dr. Danielle Desroche (40:31.888)
But that can be a really difficult one too if they're like, just have so much work to do and these are the hours where no one's bothering me because the rest of my team isn't working. Or I'll see some people who are waking up at four in the morning and they're like, I have to get in three hours of uninterrupted work before my team wakes up and they're pinging me all day asking me questions. So that can be another layer to it in terms of work kind of getting in the way of sleep.

Yeah, absolutely. Well, we've covered a lot of ground today. I really appreciate you being on with me, Danielle, and sharing a little bit more about PCOS and some of the challenges that can come up for women, particularly in the summer when they're trying to kind of keep their hormones balanced. Thank you so much for joining us. If people wanted to learn more about you, what are the best places for them to find you?

Yeah, so I'm on Instagram at Dr. Dr. Danielle period ND. and then I also have a podcast called heal your hormones with Dr. Danielle, where I really dive into more PCOS and fertility topics.

Fabulous and we'll make sure we put those in the show notes and thank you guys all for listening to us today here at the Dutch podcast if you Really like what you learned today and you want to listen to other episodes We do release a podcast every Tuesday. You can follow us and stream anywhere that you Listen to podcasts today and we also encourage you to follow us at touch test on all of our socials We will see you next Tuesday

If you're wanting to learn and really expand your expertise in hormones, you're not going to want to miss our podcast. So make sure you tune in each and every week for our new content.


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Dr. Jaclyn Smeaton

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