Why Younger Women Are Getting Breast Cancer at Record Rates (And How to Reduce Your Risk) with Dr. Thaïs Aliabadi

Mark Hyman, MD

Full Transcript

Automatically generated. Please forgive any typos or errors in the following transcript. It was generated by a third party and has not been subsequently reviewed by our team.

Dr. Thaïs Aliabadi
You know mammograms pick up seventy five to eighty five percent of breast cancers. More than half of women above age 40 who had mammogram had dense breast tissue. The more dense the breast tissue is, the harder it is to catch that cancer on breast imaging. Dense breast tissue is white. Cancer lights up as white under when you look at mammograms.

That that little lesion, white lesion gets lost in this, in the background. Women, if you have dense breast tissue, you need to ask for three d mammogram because two d mammogram is a two d X-ray of the breast, and the radiologist will just say on the report, well, we didn't see anything. That doesn't mean there's no cancer.

Dr. Mark Hyman
Hey, everybody. I got some really exciting news. The doctor Hyman show is a finalist for two SIGNAL awards this year. Now first nomination is for the best live podcast for my conversation with Halle Berry at Eudaimonia where we had an incredible discussion about menopause, women's health, and why we completely need to rethink how to support women through this stage of life. We're also nominated for my thought leadership for my conversation with doctors Michael O'Koon and Ray Dorsey about the alarming rise of Parkinson's disease and what the latest science is teaching us about the connection between the gut and the brain, environmental toxins, and a whole bunch more.

And I'm really proud of both these conversations, and now we need your help. Please help me. Voting is open through October 15. Just head to vote.signalaward.com and vote for the doctor Hyman show. And as always, thank you for listening, for watching, for sharing these conversations, and being part of this community.

We couldn't do it without you.

Dr. Mark Hyman
Welcome doctor A to the doctor Hyman show. It's so good to have you.

Speaker 4
Thank for you having me.

Dr. Mark Hyman
Well, we're gonna talk about a topic today that is... Terrifies most women that you unfortunately experience, which is breast cancer. And unfortunately, it seems to be increasing and particularly in younger women who are actually having worse outcomes and higher mortality, meaning they're dying from it. This is kinda scary. And personally, I've had some very close friends who've had this and died from it, you know, young, in their thirties, forties.

And the question is why and why are we missing it and why are these cancers being caught late? You know, there's a screening protocol. It's now 40 years old every two years, but still

Dr. Thaïs Aliabadi
And I'm here to debate that.

Dr. Mark Hyman
Okay.

Dr. Thaïs Aliabadi
I wanna start by talking about access. Right? 50% of counties in this country don't have an OBGYN. Five zero. 50%.

So that's the first problem. Patients, they find lumps. They don't even they can't even go see an OBGYN, that's number one. When women get to that medical office, whether it's their primary care or gynecologist, they're more likely to be dismissed. Their pain is minimized, their symptoms are completely ignored, and that's a fact.

So I think a lot of this, that's the first... That's where we start. That's the baseline. Standard of care, I always say in women's health is underground.

Dr. Mark Hyman
Mhmm.

Dr. Thaïs Aliabadi
We're not... Really, we're not doing any favor to any of our patients. Right now the, you know, women think that they don't need to have a mammogram until age 40. That is so misleading. In my opinion, every single woman...

And let's go back to incidents. Breast cancer affects one in eight women, right? So an average American woman has a twelve point five percent chance of getting breast cancer. If I told you you're about to board the plane with your family members that has a twelve point five percent chance of crashing, what would you say?

Dr. Mark Hyman
I'd say don't get on that plane.

Dr. Thaïs Aliabadi
Don't get on that plane. But when I say an average American has a twelve point five percent chance of getting breast cancer, what I hear is it's okay. I don't have it in my family. I'm not gonna get breast cancer. And that's the misinformation, and that's why I love talking about this topic.

Dr. Mark Hyman
Yeah. People are oh, so I have a BRCA gene or family history, then I have to worry about it, but you're saying no.

Dr. Thaïs Aliabadi
No. Eighty five percent of women who get breast cancer don't have it in their family. I had no family history of any cancers, I didn't have a genetic mutation, I was very healthy, I never smoked, I've never done drugs, I've had maybe... I've had 20 alcoholic drinks all my life, I've always been thin, I used to exercise a ton when I was diagnosed with breast cancer. You can't really say, you know, I don't have it in my family so I'm not at risk.

So that's the first misconception that we need to address. The most important thing is obviously if you have family history, if you have dense breast tissue, if you have a genetic mutation, if you've had a biopsy that shows atypia, if you had radiation to your chest, at a young age, if you're overweight, if you're drinking a lot of alcohol, those are all risk factors that can increase your lifetime risk of breast cancer beyond that twelve point five percent.

Dr. Mark Hyman
So is not breastfeeding?

Dr. Thaïs Aliabadi
Absolutely.

Dr. Mark Hyman
So is having babies late?

Speaker 4
So is not having a lot of babies?

Dr. Mark Hyman
Right. Exactly. Because I don't have a lot of babies and breastfed a lot, don't seem to get as much breast cancer.

Speaker 4
Right. So there's so many risk factors and that's why one of

Dr. Thaïs Aliabadi
my missions in life is I always say, if you know your first name, if you know your last name and your date of birth, you need to know your lifetime risk of breast cancer. Literally, I go to a party and I see... I always wanna see a number above everyone's

Dr. Mark Hyman
How do you how do you calculate that?

Dr. Thaïs Aliabadi
So I recommend using the Tyre Cusick risk assessment tool, it's a tool we use that calculates... You basically enter your age, your height, your weight, the density of your breasts, your family history, age at menarche, age at menopause, whether you've had any abnormal breast biopsies like atypical lobular hyperplasia, Some basic questions. And at the end, it calculates your lifetime risk of breast cancer. If that number is twenty percent or more, I wanna change that in function health for you. I want every woman to have their lifetime risk calculated.

Dr. Mark Hyman
I

Dr. Thaïs Aliabadi
would love to help you do that because anyone that has any platforms that wanna grab those women and say calculate your lifetime risk of breast cancer. If that number is twenty percent or more, you do not start your imaging at age 40, you actually start it as early as age 30 and you get a mammogram, if you have dense breast tissue, you do an ultrasound, and for high risk patients that fall above this twenty, twenty five percent, we also add a breast MRI annually. So these are women who at 38, they show up with stage three, four breast cancer because no one really calculated their lifetime risk of breast cancer. I had no family history of cancer. I had no genetic mutation, but my lifetime risk was high based on this biopsy they did in my breast that showed atypical lobular hyperplasia that pushed my lifetime risk to thirty seven percent.

But if you look... My doctor would look at me and say, you're gonna be okay. Look at you. You have no family history. You have no genetic mutation.

Don't worry about this atypical lobular hyperplasia. Yes. I worry about it, and I don't wanna come back in six months.

Dr. Mark Hyman
So what happened? You were 48, you had atypical cells in your breast, but your imaging didn't show it?

Dr. Thaïs Aliabadi
I had a negative mammogram, I had negative ultrasound, and my MRI was read as benign. Well, looking back, my lesion was sitting in my MRI, and it's okay. People can... Radiologists can miss, know, can... You know, we're not robots.

We can make

Dr. Mark Hyman
this

Dr. Thaïs Aliabadi
But

Dr. Mark Hyman
you insisted to have a biopsy, that's why you found you?

Dr. Thaïs Aliabadi
No. I went for my mammogram and they said you need a biopsy, so they biopsied it. They biopsied my left breast, they called me, they said it's atypical lobular hyperplasia, they did an excisional biopsy, removed that lump, and they told me to come back in six months. I always calculate everyone's lifetime risk of breast cancer in my office. So at that point, I had no reason calculating mine because I had no risk factors.

But as soon as that atypia showed up, I went back to my office and I calculated my lifetime risk. And, Mark, I almost fell off my chair when I saw that number. It popped out 37. And I'm like, wait. What?

That's a mistake. Me? No. Like, look at me, I'm not gonna get breast cancer. And I recalculated it and it was thirty seven percent.

And that's when I called my breast surgeon and I said, you told me to come back in six months. I have three little kids at home. I'm... I have a busy practice. I love my husband.

I love my life. I don't have time for breast cancer. I already have implants. Take my breasts off, put bigger implants in, let me go on with my life. That's when they started telling me I'm being anxious, I'm being too nervous, why I'm so paranoid, you know, everything that women hear again and for me...

Dr. Mark Hyman
Women are dismissed typically by medicine.

Dr. Thaïs Aliabadi
I mean, if I get dismissed, if I'm told I'm crazy, I literally have had colleagues who called me crazy, anxious, paranoid, I heard it all, but it didn't matter. I was so laser focused. I finally found a doctor who was willing to do my double mastectomy, and the day before surgery she's like, you know I'm doing this, but it's against my wish. And I'm like, why? Why so much resistance?

It's my body. Why do you care so much? You know what she said? We have really good chemo for breast cancer.

Dr. Mark Hyman
Wow.

Dr. Thaïs Aliabadi
Do you understand that?

Dr. Mark Hyman
Wow.

Dr. Thaïs Aliabadi
I don't want chemo, you go get chemo. I don't have... I don't wanna get chemo, I don't wanna put that poison in my body. So she did it, I almost died because the surgery was ten hours. I bled out.

You would appreciate this. My hemoglobin the day after surgery was five, and my blood pressure was 60 over 20. It took them two three... Two days to transfuse me with blood. I don't even have a memory of that.

But one thing I remember, the minute they woke me up from anesthesia and I... My husband came to hug me, the first thing I told him is go home, tell our girls mommy will never come home telling them she has breast cancer. Go tell the kids that I did this. Of course, a week later, I'm in the car back to school shopping with my husband and I get a call. Report.

Yep. And, you know, when your doctor calls you, it's never good. When the doctor says, I got off the phone from pathology, my brain shut down because I knew what he was gonna say.

Dr. Mark Hyman
Yeah.

Dr. Thaïs Aliabadi
And all this time they were digging in my left breast. My cancer was actually invasive stage one in my right breast. People say, why did you pick a double mastectomy? It's so aggressive, it's this, it's that, you've obviously never had a mammogram and you've never had a breast MRI, but you go, you have to take, like, literally half a day off. You go sit, they put you in these machines, they squeeze your breast, they put you in an MRI, they give you contrast, and then you have to wait four or five days for one phone call and you still don't know, and in my case I was right, whether or not they can read it correctly, right?

Because it's human error anyways involved in it. So I felt like my life was in the hands of these radiologists reading these and I didn't wanna put myself every six months through these imaging. And that's why I decided to do the double mastectomy, but it doesn't end there. Like two weeks later and I was I was still... Even though I was upset and, you know, my doctor who didn't wanna do this for me and kept calling me, you know, told me it's a...

You know, don't do it. You're paranoid. She called me and... You know, because these hospitals turned upside down when my path report came back. And she told me, Taiz, you're so lucky.

I never forget where I was standing in my room when she called me. She's like, you're so lucky. We caught this early.

Dr. Mark Hyman
You caught early.

Dr. Thaïs Aliabadi
I'm like

Dr. Mark Hyman
Not day.

Dr. Thaïs Aliabadi
I'm like, lucky? What? I'm not lucky. No one with cancer thinks they're lucky. Do you know what I'm saying?

Because it's always in the back of your head. When someone tells you you have cancer, you go to the

Dr. Mark Hyman
worst

Dr. Thaïs Aliabadi
case scenario.

Dr. Mark Hyman
And this is such an important lesson for people. You know, you were a doctor. You were a woman's health advocate. You were woman's health advocate. You had a funny little thing in your one breast.

You had a biopsy. You made you calculate your risk. You made a pretty radical decision, you know, like Angelina Jolie had a breast cancer gene. So she took off both her breasts and that was a big public event that got people's attention. But you didn't have that.

You were like, I just don't wanna take the risk, which is a pretty aggressive decision for most women. But it turns out that you were right and that there was there was something there. And I think, you know, for women listening, you know, women are gonna have a completely normal mammogram. You had a quote normal MRI. Like, know, what are the limitations of mammograms particularly for younger women who have denser breasts?

Like, what were the problems with this? Because people think I have a mammogram, it's normal, I'm okay, not necessarily. No.

Dr. Thaïs Aliabadi
And, you know, mammograms pick up seventy five to eighty five percent of breast cancers, right? Let's start there. So we're still missing a lot of cancers screening women, like fifteen to twenty five percent of women with cancer will still go out, like just like myself, and they're told they have a negative mammogram. More than half of women above age 40 who had mammogram had dense breast tissue. What does dense breast tissue mean?

The more dense the breast tissue is, the harder it is to catch that cancer on breast imaging. Dense breast tissue is white. Cancer lights up as white when you look at mammograms. So when someone has fatty breasts, right, and they don't have any dense breast tissue, which ten percent of women have fatty breasts, in this group of women, cancer is picked up easily on mammogram. I had extremely dense breasts, extremely dense breasts, there's so much background noise that that little lesion, white lesion gets lost in the

Speaker 4
background

Dr. Thaïs Aliabadi
of dense breast tissue. So for patients like myself, A, women, if you have dense breast tissue, you need to ask for three d mammogram because two d mammogram is a two d x-ray of the breast and the radiologist will just say on the report, well, we didn't see anything. That doesn't mean there's no cancer. If you can't see something, if this window was muddy and you told me to describe the view, I wouldn't be able to describe it. Right?

But if you took a Windex and cleared it, I could see I could see better. So as AI is improving and with three d imaging, with adding breast ultrasound, it's that Windex that we can clear some of this and be able to see outside.

Dr. Mark Hyman
And the three d mammograms is a better technology.

Dr. Thaïs Aliabadi
Yes.

Dr. Mark Hyman
But it's not something that's standard or people get It

Dr. Thaïs Aliabadi
is pretty much standard right now. And I would tell your listeners if you, you know, and as of a few years ago, radiologists need to report on the density of the breast on the mammogram and recommend maybe a follow-up with additional breast imaging or a breast ultrasound and for high risk patients with a breast MRI afterwards. But if you look at your mammogram and it says dense breast, and on top it says a two d mammogram, year, go ask your doctor for a three d. If you have dense breast tissue, ask for bilateral breast ultrasound. Calculate your lifetime risk by age 30.

If that lifetime risk is twenty percent or more, ask your doctor for a breast MRI. Unfortunately, a lot of doctors will give a pushback.

Dr. Mark Hyman
Can people calculate their risk on a website or how do people calculate that?

Dr. Thaïs Aliabadi
I have it on SheMD, on our podcast. It's free. They can literally go there, but before they That's gmd.com?

Speaker 4
Yeah. Yeah. Shemdpodcast.com.

Dr. Thaïs Aliabadi
Podcast.com. Right. Because people are gonna say, how do I find that out? They wanna know.

Speaker 4
They wanna know and they should.

Dr. Thaïs Aliabadi
And that's why literally want Function Health to do that for every woman, every single woman that you're

Speaker 4
We're

Dr. Thaïs Aliabadi
working on it.

Speaker 4
Sending last.

Dr. Thaïs Aliabadi
I love that. I'll help you with it. I mean, you should do it. It's a... You will see, you will save millions of lives

Dr. Mark Hyman
Yeah.

Dr. Thaïs Aliabadi
Doing this because, you know, someone like me with no family history, no risk factors, my risk was still thirty seven percent. And, you know, people say it's so aggressive to remove your breasts, but thirty seven percent chance of boarding a plane

Dr. Mark Hyman
It's gonna crash.

Dr. Thaïs Aliabadi
That's gonna crash? That's not crazy. If I say I don't wanna board this plane and someone's calling me crazy, how would that make you feel? If you're about to board a plane and I say you have a thirty seven percent chance of crashing and you say I don't wanna board, it's... I don't wanna go, I don't wanna take my kids on that plane and people called you crazy, how would you feel?

Dr. Mark Hyman
Would think

Dr. Thaïs Aliabadi
they're crazy. It's like you're crazy, I'm not crazy. You're crazy, you're the crazy one.

Dr. Mark Hyman
Yeah. Exactly. Exactly.

Dr. Thaïs Aliabadi
Wow.

Dr. Mark Hyman
And and I don't think people have heard about this lifetime risk calculator. There are there are calculators for heart disease and other things, but this is relatively unknown thing, and I don't think most doctors know about it. And I think it's a useful tool. So I think I think, you know, I don't think you're saying everybody with a high risk should go get their breast lopped off.

Dr. Thaïs Aliabadi
But Oh, god. No.

Dr. Mark Hyman
You know, but I think it's important to really be careful about screening, understanding what's happening. And there's new diagnostics. At Function Health, we use the gallery test, is a multi cancer early detection test. It's not perfect, but it picks things up. There's new tests.

MD Anderson is providing proteomic tests that are looking at at risk including breast cancer to help get ahead of this. And I think, you know, better early... You know, I I always say the cancer's worst enemy is early detection. And there's still some emerging cancer therapies that are really optimistic and improving, but still cancer's not a great diagnosis and it's not well treated by traditional medicine and we're getting more and more of it.

Dr. Thaïs Aliabadi
I wanna talk to you before we leave this topic of genetic testing.

Dr. Mark Hyman
Yeah, was gonna bring that up. Because That

Dr. Thaïs Aliabadi
was your next question, I love that. Because I feel like at the latest, by '25, every single woman with family history of not just breast cancer and ovarian cancer, pancreatic cancer, prostate cancer, ask your doctor for genetic cancer testing. When we do genetic cancer testing, they look at maybe 48 to 80, 90 cancer causing genes. When it comes to breast cancer, there's about 11 single gene mutations that are pathogenic like the BRCA, PALB2, CHK2, ATM gene, and the list goes on and on. And these are gene mutations that will increase someone's lifetime risk of breast cancer.

It doesn't mean they're gonna get breast cancer, but it can significantly increase that risk from like twenty five percent to thirty five percent to fifty percent to eighty percent. So it's very important by '25, in my office, I used to do it at twenty five but because of all this cancer that we're seeing, I've dropped it to about twenty with the patient consent obviously. I do genetic cancer testing because I don't wanna miss anything.

Dr. Mark Hyman
And just so people understand, everybody out there has heard about the BRCA gene or most people have heard of it, which is the most common thing discussed around breast cancer. And and and it was interesting. If you look at the data, like, in the thirties and forties that we were able to track some of this, the... If you had that gene, your risk of cancer wasn't as high as it is now. And now it's about seventy five percent if you have that.

And so that that is... That speaks to the fact, one, that there's environmental factors that play a role. And two, what you were speaking about was what we call polygenic risk score

Dr. Thaïs Aliabadi
That's really gonna get

Dr. Mark Hyman
important concept that means that it's not just one gene that matters, it's the cocktail of genes that all influence your risk. And we're able to do these around heart disease, around cancer now, and they're very helpful.

Dr. Thaïs Aliabadi
And they're very helpful for breast cancer. So you can do your genetic cancer test and look for these gene mutations like the ones I listed, but that's less than ten percent of women with breast cancer will have that. A lot of us are walking around with this high polygenic risk score, meaning we have these variants in our genes that individually, these are markers that by themselves, they don't have much power, but someone like me can walk around with a lot of these markers. And if I'm not mistaken, right now they're checking anywhere from 86 to three zero five markers, variants for the polygenic risk score and they report on that and breast cancer is one of it. If you fall in that bell curve above ninetieth percentile for the polygenic risk score, that can increase your risk.

So someone like me actually, I didn't have any genetic mutations, I didn't have any family history, I really didn't have any obvious risk factors, but if you look at my polygenic risk score, it flags at high risk for breast cancer, which means I had a lot of these variants in my DNA.

Dr. Mark Hyman
And there are also a lot of labs that can be really helpful besides just the genetic screening. Can you can you maybe touch on some of the things that play a role in the rest

Dr. Thaïs Aliabadi
of You know what? I wanna clarify one thing. There's no blood test that will tell you if you're gonna get breast cancer or if you have breast cancer right now.

Speaker 4
But there are things in your body that increase

Dr. Mark Hyman
your risk. Right?

Dr. Thaïs Aliabadi
Right. But, you know, I think we talked about this. Your metabolic dysfunction is huge, inflammation. I always tell my patients, if you wanna reduce your risk of any cancers, not just breast cancer, there are certain lifestyle changes you need to do. The basics, sleep seven hours, exercise every day, optimize your metabolic health.

You know, we we talked about this, majority of people on this planet will go through life and will have metabolic dysfunction. I'm sitting here, you know, my entire mom's side of the family, they're pre diabetic and diabetic. So we are... We have some, you know, your genetics load the gun, but your environment

Dr. Mark Hyman
Pulls the trigger.

Dr. Thaïs Aliabadi
Pulls the trigger. So optimizing your metabolic dysfunction, lowering inflammation I think is huge.

Dr. Mark Hyman
And you can measure these things like insulin, CRP.

Dr. Thaïs Aliabadi
Yeah, I do that every single patient literally besides the hormone panels that I run, I check their hemoglobin a one c. I check their lipid panels. We talked about this. I check apo b lipoprotein, little a high sensitivity CRP, homocysteine, and their vitamins, vitamin b twelve, vitamin d, ferritin, iron.

Dr. Mark Hyman
Play a role

Dr. Thaïs Aliabadi
in your lifestyle. So it's not just one thing, it's a combination of everything.

Dr. Mark Hyman
And we test all that at function health. You're really gonna get a comprehensive screening.

Dr. Thaïs Aliabadi
Of you guys, honestly, for provide... You know, I do it for my little office. Yeah. You're doing it Perfect. Yeah.

For people Hundreds of thousands which is unbelievable and I'm so proud of you guys for doing that. And honestly, I will tell you I've practiced... I've been in private practice in my own little world for twenty five years. I've never lost a patient under my care to cancer who did what I told them to.

Dr. Mark Hyman
That's amazing.

Dr. Thaïs Aliabadi
I... But I do everything. I do genetic testing. I do this liquid biopsy that we talked about. I ordered the total body MRI on my patients, you know, after forty five, I always recommend it obviously.

Dr. Mark Hyman
And we do that with function too, we can do it through as a full body

Dr. Thaïs Aliabadi
MRI. I love that.

Speaker 4
It's very affordable.

Dr. Thaïs Aliabadi
Yes, every single patient of mine has had their lifetime risk calculated. Every single patient of mine, if they need genetic testing, it's already done in their chart. If they... If they're at high risk, they have an order for ultrasound three d mammogram. I fight with insurance companies if they have a high lifetime risk to get their MRIs approved.

I optimize their metabolic dysfunction. I mean, I'm a gynecologist and I'm running APOB and lipoprotein. Don't have time to do that. And my physician assistants who work for me, they're frustrated because I do so many labs on every single patient, but I do it because nobody else is doing it.

Dr. Mark Hyman
Yeah. It's like you wouldn't be, like, driving your car with blinders on. You wanna see what's going on. Like, you need to see the spectrum. I wanna sort of dive into a little bit of of this kind of science around why this is happening because, you know, I'm I'm in medicine forty years and I don't remember this level of breast cancer in the younger population.

And what really seems to be interesting is that these are these are estrogen related cancers primarily cause there's many different kinds of breast cancer, these are estrogen receptor positive driven cancers. And what we learn in functional medicine is this concept of estrogen dominance or excess. And it's it's either relative or absolute. And a lot of things affect your lifetime exposure to estrogen which is when you had your puberty and women are getting it earlier than ever. Some girls get it at eight now.

When they give birth, the first... At what age?

Dr. Thaïs Aliabadi
Right.

Dr. Mark Hyman
Breast. They're having less pregnancies, they may not be breastfeeding. All these increase your risk of breast cancer. And this is not to shame women or to make them feel bad, these are just the facts. And then and then there's obesity on top of that which Huge.

Is a huge driver of cancer in general, particularly breast cancer because of insulin resistance. And we have lack of exercise which increases your risk of breast cancer and we have alcohol consumption which increases your risk. Mean, was shocked when I remember reading in JAMA that was like a woman had one glass of wine a day, their risk of breast cancer was increased by

Dr. Thaïs Aliabadi
forty percent. Right.

Dr. Mark Hyman
That's just one glass a day.

Dr. Thaïs Aliabadi
Yep.

Dr. Mark Hyman
Then on top of that, we have all these environmental chemicals that are what we call xenoestrogens or foreign estrogens that are very powerful estrogen mimicking compounds that bind estrogen receptors, whether they're PCBs or phthalates, they're in they're in makeup, they're in sunblock, their face creams are in Right. They're in plastic, they're pretty much everywhere. And these are petrochemical derived products. These are huge toxic burden. PCBs, BPA, phthalates, parabens, all this stuff.

And then obviously there's heavy metals. So all this stuff is going on at the

Dr. Thaïs Aliabadi
same time. All day long we're exposed to this.

Dr. Mark Hyman
And then our microbiome plays a huge role in cancer. You know, again, there's another big factor. Our microbiomes because of our ultra processed diet have changed, our guts aren't healthy, and there's a whole estrogen processing system in your gut with bacteria. If they're the right bacteria, it works. If they're not, it doesn't.

And you recirculate the estrogens and increase your estrogen. And this is called the estrogolome. It's a whole Yes. Field of medicine. Just understanding the the way the microbiome is related to your estrogen metabolism.

And all in all, we see these is really increasing numbers of estrogen. Some of the even things like PMS or fibroids or

Speaker 4
It's PMDD.

Dr. Mark Hyman
PMDD or PM... All these things are related to imbalances in estrogen and there's ways to treat it and diagnose it that I think most people aren't

Dr. Thaïs Aliabadi
I want you to open an office right next to me. I found my twin.

Dr. Mark Hyman
Yeah.

Dr. Thaïs Aliabadi
Well It's really... You know, I always call my office the office of dismissed women. If you spend a day with me in my office, you will go home with a broken heart. These are women who travel from everywhere, and they only come... They already know.

They know they have endometriosis. They know they have PMOS. They know they're at risk for breast cancer and someone's not writing an MRI order for them. They want genetic testing. The dismissal...

So when I started this podcast and I said access is one issue, but once they... Even when they have access and they end up in the medical office, their symptoms are dismissed and the right tests are not ordered for them. Let's start with even you were talking about other cancers, pelvic ultrasound. Do you know how long it takes to do a vaginal ultrasound?

Dr. Mark Hyman
Five minutes?

Dr. Thaïs Aliabadi
No.

Dr. Mark Hyman
One minute?

Dr. Thaïs Aliabadi
One minute. Yeah. One minute if you've done it for twenty five years or thirty years. It takes me one minute.

Speaker 4
Right? Yeah.

Dr. Thaïs Aliabadi
It's an uphill battle for women to get a pelvic ultrasound.

Dr. Mark Hyman
Yeah. Just just so people are listening, we learned in medical school that in order to check a woman's reproductive health, you do a pelvic exam, which is where you use your one finger in the vagina, one hand in the vagina, one on the abdomen, you feel around, you try to feel the ovaries, you try to feel the uterus, you try to... It's like, you know, it's like kind of braille. You know? Instead of sticking an ultrasound in the vagina and actually being able to see everything in three d, clearly, what's going on?

It's... What's going on? Yeah. And it's and it's it's a it's a device that most gynecologists have in their office. It takes, like you said, I thought it was five minutes, takes one minute.

And it's very inexpensive, it's very easy, it's very fast, and there's no reason it shouldn't be part of an annual screening exam.

Dr. Thaïs Aliabadi
But you know what? It's not in every gynecologist's office. That's the problem. These people still get a prescription if the doctor writes for it. Women, I think women should get a pelvic ultrasound every single year.

As soon as you become sexually active, get that transvaginal ultrasound. If I don't do an ultrasound, you if decline an ultrasound in my office, it's like you're covering my eyes and tell me to drive. I need to see, do you have a polyp? Do you have fibroids? Do have a septum?

Do you have... Do I see endometriomas on your ovaries? Do you have ovarian cysts? What is going on? I need to see, do you have polycystic ovaries on ultrasound?

There's so much I can tell.

Dr. Mark Hyman
And there's no radiation.

Dr. Thaïs Aliabadi
Nothing.

Dr. Mark Hyman
Safe to do.

Dr. Thaïs Aliabadi
And bimanual exam is very invasive.

Dr. Mark Hyman
Yeah.

Dr. Thaïs Aliabadi
To have a guy gynecologist to put their fingers inside... Like, it's uncomfortable. I don't want anyone doing that to my daughters.

Dr. Mark Hyman
Yeah.

Dr. Thaïs Aliabadi
So why not just be more civilized and put an ultrasound you're gonna get? What is bimanual exam gonna tell you? You can miss ovarian cancer. Wasn't it terrible? Yeah.

It's uncomfortable for the doctor doing it, it's uncomfortable for the patient, and you really don't get that much information from it. So it's it's it's really sad. So I I would say start with a... Start with basics when it comes to women. A, listen to them.

B, don't dismiss what they're telling you. Women are very in tune with their bodies. If they tell you... If a woman comes to my office and says something's wrong, almost always something's wrong. Women are not crazy.

We're far from crazy.

Dr. Mark Hyman
Well, it actually harkens back to the '9... Early nineteen hundreds when women were diagnosed with hysteria. It was a medical diagnosis in their diagnostic code book. Hysteria derives from the word hysterectomy or So it's like what? Women are hysterical.

That's actually a pejorative against women that people are talking about all the day. No, no, no. I've gotta

Dr. Thaïs Aliabadi
change that. That's gotta change. It's like, it's unacceptable.

Dr. Mark Hyman
Yeah. No. I think as a doctor who's been practicing medicine for forty years, I'm old, it's shocking to me how doctors don't often listen carefully to their patients because they will they will usually tell you what's wrong with them or they'll tell you the clues that will help you figure out what's wrong with them if you ask enough questions. And I think it's easy to say, oh, we know better. We're dismissing this because it's nothing.

And I I always said to my my my talks, would say, you go to your doctor, you know something's wrong, you feel bad, something's off. The doctor says, well, I've done your labs, I've examined you, which means he's done like 20 different lab tests, not a 150. And everything seems fine, so maybe take some Prozac. And I said, there's only one of two possibilities in that situation. One, your doctor's missing something or you're crazy.

And I don't think most people are crazy. It's usually... Women, we're not crazy. It's usually doctors missing something and I think it's it's so important. I would love you to sort of talk a little bit more about how to reduce your risk because you know, we've talked about this early screening, we talked about your lifetime risk for breast cancer, we're talking about mammograms, three d mammograms, best MRIs, ultrasounds, all this is really important.

And this is about detection. But I wanna talk about addressing the factors that are increased risk because it's not because we don't have good detection that women are getting cancers earlier and dying of them at a higher rate. It's because of something else. So I wanna get into something else. I touched on a lot of these issues.

I'd love you to sort of dive into how do women address these these fundamental drivers of breast cancer because people who's dealing with cancer is just think, I got cancer, like I got a I got a virus. No. It's something that develops from a foundation of disturbances in your biology that can be modified if you know what they are and if you look for them. So can you talk to us about that?

Dr. Thaïs Aliabadi
I think environmental factors are huge. When it comes to breast cancer, obviously, you know, there are certain factors like your genetics, your density of your breasts, are certain things you can't really change. But there are other factors that you can address that will lower your chances of getting breast cancer. If you're overweight, drop your weight. If you're not exercising, exercise.

If you're stressed and not sleeping, address that. If you're not eating healthy food, if you're eating a lot of processed food, deal with that. Toxins, we talked about how we're all exposed to toxins from the air we breathe to the water we drink in plastic bottles to the, you know, to the processed foods we eat to all the products that we put on our skin. So this is just four ways of getting toxins in your body. It's hard to live in a world where you have zero

Dr. Mark Hyman
exposure,

Dr. Thaïs Aliabadi
but I feel like if you address all of it a little bit from your sleep to your exercise, to your diet, to your hydration, to your stress level, to your sleep, to your metabolic health, lowering your inflammatory markers, you know And your

Dr. Mark Hyman
toxic levels.

Dr. Thaïs Aliabadi
And your toxic levels, all of it, all of it. And you know, for example

Dr. Mark Hyman
Alcohol, alcohol,

Dr. Thaïs Aliabadi
alcohol, oh my god, huge. Alcohol, smoking, and you know, like I treat a lot of PMOS patients and these, you know, PMOS is the leading cause of infertility on the is? It's a new name for the old PCOS. You know, it took us years to bring awareness to PCOS, and then they changed the name to PMOS, is better because polycystic ovary syndrome does not describe the condition.

Speaker 4
It's

Dr. Thaïs Aliabadi
actually polyendocrine metabolic ovarian syndrome. What does that mean? PMOS, you know, it's the leading cause of infertility, one of the leading with It's endometriosis ten to thirteen percent of women. Majority of these women go through life, they're never diagnosed. These are women, in order to diagnose it, need to meet two out of the three criteria, irregular period, PCOS looking ovaries on ultrasound or elevated AMH, and the third criteria is symptoms of high testosterone.

It could be facial hair, body hair, acne, hair thinning. So you need to meet two out of the three criteria. But PMOS patients are anxious, they're depressed, they have PMS, they have PMDD, they have mood disorder. Seventy five percent of them gain weight, they can't lose it, they have a really hard time losing it. They're at a high risk for eating disorder.

You know what I always say, you wanna find PMOS patients? Go knock on the doors of eating disorder centers. They're all sitting back there. That's Instead of someone saying, let me address your metabolic dysfunction, what do they do? They they bring him a psychiatrist Right.

And they get treated for... With Zoloft and Lexapro and this and that, but no one's addressing their underlying It's really, really sad and it's the leading cause of infertility. If men had a leading cause of infertility and majority of them would go through life not diagnosed

Dr. Mark Hyman
That's crazy to think about.

Dr. Thaïs Aliabadi
Never happen.

Dr. Mark Hyman
No.

Dr. Thaïs Aliabadi
Right?

Dr. Mark Hyman
No. You're right. I mean, I think I think this is important. I I've been saying for literally decades, probably thirty years that PCOS is non ovarian problem. It's a metabolic problem.

Dr. Thaïs Aliabadi
Yes.

Dr. Mark Hyman
And and it's really a nutritional problem Yes. Primarily and and it shouldn't be treated as if it's an ovarian problem. They give people metformin or spironolactone or they give them the birth control pill or all these things that actually just may mask the symptoms instead of actually dealing with the real issue and helping women get pregnant.

Dr. Thaïs Aliabadi
I actually listened, I was listening to this huge podcast and they had a gynecologist and the host asked the gynecologist, so what is the treatment for PMOS? She said birth control. I wanted to fall off my chair, like what? No. The underlying condition is metabolic dysfunction.

Did you know that

Dr. Mark Hyman
And what do mean by that is insulin resistance.

Dr. Thaïs Aliabadi
Insulin resistance. This whole spectrum of insulin resistance, prediabetes, type two diabetes, that's the whole spectrum.

Speaker 4
Because what happens with these patients because of that insulin

Dr. Thaïs Aliabadi
resistance resistance, when they they eat carbohydrates and their body releases insulin, their cells are insulin resistant. So instead of the sugar going into the cell and turning into energy, it bounces in the blood, pushes their insulin to go up in simple terms. This spike in insulin causes these symptoms or the cascade of events in their body. This high insulin tells their liver, take the sugar and store it as fat, but the fat that they store is visceral fat. It's highly inflammatory.

It causes more insulin resistance, brain fog, fatigue, all of it. The high insulin stimulates their theca cells in the ovary to pump out testosterone. Testosterone is toxic to these little follicles. So these follicles, these antral follicles that come to the surface every month and one of them becomes dominant and ovulates, that whole thing with testosterone around, these follicles freeze. That's why you get that polycystic look.

These are not cysts, these are sac of pearls inside the ovary. And what happens, this testosterone not only is toxic to these follicles, ovulation goes away, the periods become irregular.

Dr. Mark Hyman
And heavier and they get more bleeding and they get more iron deficiency.

Dr. Thaïs Aliabadi
Exactly. But they also get facial hair, body hair and acne. Why would a 30 year old have acne?

Dr. Mark Hyman
They get... They go bald, get pimples, and get facial hair.

Speaker 4
Yes. So...

Dr. Mark Hyman
Not good.

Dr. Thaïs Aliabadi
So... And then you have you have a condition, we already know inflammation's high, we already know androgen is high, we already know there's no ovulation, so progesterone are down and we know these follicles are secreting erratic estrogen. So of course all of it affects your limbic system. Your limbic system, which is your emotional headquarter, in order to be calm, it needs high progesterone, normal amount of estrogen, testosterone, and low inflammation. All of it is the opposite in a PMOS patient.

But instead of someone addressing their metabolic dysfunction, that first domino that dropped was their metabolic dysfunction and insulin resistance. No one addresses that. They get the Zoloft, they get the spironolactone from the dermatologist, Zoloft from the psychiatrist, birth control from the OBGYN, but no one looks at these patients holistically, say, wait a minute, these are not separate, these are all part of one condition. Address their metabolic, address their, look at their lipid panel, look at their high sensitivity CRP, these patients have so much inflammation and from my studies, sixty one percent of PMOS patients have endometriosis. Yeah.

And another leading cause of infertility takes doctors nine to eleven years to diagnose these And so think of this one woman who's gaining weight, who has irregular period, who has all these symptoms, painful periods, a, doesn't have access to an OBGYN, and then when she gets to that office, the doctor says there's nothing wrong with you.

Dr. Mark Hyman
I I just I just had a patient like this. It was quite amazing. She was 28. She had high in... Very high insulin of like I think 30 fasting.

She had very high testosterone. She was quite anemic. Her iron stores were ferrin was three. Should be 45 because she'd been having heavy periods because she wasn't ovulating and making progesterone, progesterone so she wasn't regulating her cycles. She had anxiety, she had depression because progesterone is a relaxation hormone and when you don't ovulate, don't make progesterone because you were talking pretty fast.

I'm just gonna slow it down a little bit. So people... Women who have low progesterone, too much estrogen, it creates emotional dysregulation, not to mention all the other factors. And you know, obviously she had you know, lots of inflammation, high CRP, you know, all these things going on. They were all indicative of of this metabolic syndrome.

And I basically treated her with just diet and a few simple supplements and exercise. And her testosterone went back to normal. Her insulin went back to normal. Her l h... FSH ratio went back to normal.

Her progesterone started coming up. She started ovulating again. It didn't give her any drug. It didn't give her any drugs. And and the problem is most doctors don't know how to prescribe food or prescribe exercise.

It's not like eat better, exercise more. Like that's not helpful. Have three balanced meals a day. What's that? Like how do you do it?

What do you eat? Like, I I think there's just such a lack of of nutrition training for physicians, and it's... These are nutritional diseases.

Dr. Thaïs Aliabadi
For anyone listening, I would say I have a platform with an easy test. Obviously, I can't diagnose people online, but it's free. If you're listening to this podcast and you have irregular period, you're gaining weight, you have acne, hair loss, facial hair, body hair, you have disordered eating, eating disorder, fertility issues, take the quiz. I can tell them whether or not by answering a few questions whether or not they have the likelihood of having PMOS. And if they do, I've created this amazing supplement with vitamin d, with an acetal blend, with Yeah.

Wild mob, all this stuff that will address their underlying metabolic dysfunction, inflammation. One of the most important things for PMOS patients, walk after each meal. Yeah. Go for a walk,

Dr. Mark Hyman
simple things. And and and it's true because I think there's all the history that'll help you and it's really important to start there. But lab testing is now so affordable through Function Health and we test all these things. We test your LH, your FSH ratio, your estrogen. We check for inflammation.

We check for insulin levels. We check for a one c. We check for your lipid particle size and number which reflects all that. We check for your vitamin d. We check for your iron.

We check for b vitamin status. We check for all the things that regulate all these pathways and we can actually fix them if we find out what's going on and you'll get a clear plan of what to do and what's going on. And and it's... These are things that even if your doctor's not helping you because by the way, the doctor's not gonna give you anything except drugs. So the rest of the stuff you do on your own, what you eat, exercise, your lifestyle, supplements, these are things you don't need a doctor for if you actually So know what to

Dr. Thaïs Aliabadi
here's I wanna add another thing to function health.

Dr. Mark Hyman
What? When you have a PMOS patient, please screen them for endometriosis

Dr. Thaïs Aliabadi
because the gynecologists are not doing it. So function...

Dr. Mark Hyman
That's not blood test.

Dr. Thaïs Aliabadi
It's not. Well, there is a blood test now. It's called HER

Speaker 4
Resolve

Dr. Thaïs Aliabadi
and it was just released. It's not public. I mean, not Not available doctors don't have access to it yet, but soon they will. It's a blood test. It picks up eight out of ten patients.

Dr. Mark Hyman
And what is it measuring?

Dr. Thaïs Aliabadi
Circulating m r... MRNA, microRNAs. And they look... They add an AI algorithm to it and they tell you the likelihood, like whether or not you have endometriosis or not. So it's actually a good test when it's positive.

If it's negative, it doesn't mean you don't have it. My... You know, by listening to women, you can get as accurate as ninety nine percent in diagnosing them with endometriosis, but this test is eighty percent. I'll take it. There is a saliva test right now, you know, hopefully it'll be available soon, it's ninety seven percent accurate.

Dr. Mark Hyman
So essentially what you're saying doctor A is that the same things that help you prevent breast cancer will also address PCOS or PMOS now.

Dr. Thaïs Aliabadi
Endometriosis...

Dr. Mark Hyman
It's basically eating a whole foods diet, getting off of your processed food, start dialing way back on the starch and sugar, alcohol is occasional treat like rarely, exercising regularly which really helps metabolic health and hormonal health, managing your stress levels which affects your hormones, managing sleep which affects your hormones, getting your lifestyle, reducing the toxic load by filtering your water, maybe an air filter, not using plastics, basic stuff. You know, I'm in the board of the environmental working group. There's a whole guides on how to reduce your exposures from household cleaning products, from food, from skincare and so forth. And I get obsessive about it, but if you just focus on these basic things, you can dramatically reduce

Dr. Thaïs Aliabadi
the interest. If that's the right way to say it, you can dramatically reduce your risk, but it doesn't take your risk to zero.

Speaker 4
No.

Dr. Thaïs Aliabadi
Endometriosis can still show up. PMOS can still show up. Breast cancer can still show up, but you can do something about it to reduce this risk.

Dr. Mark Hyman
Yeah. It's really important. And I think your your story in particular as a doctor facing breast cancer yourself, identifying this when no one else was looking at it, being your own advocate, It sort of speaks to a really important point which is you have to be the CEO of your own health. That's why we've created Functional Health. So people could be the CEO of their own health.

You know, had a friend who who developed rare cancer and she's... Was going to doctor after doctor and she says she started a new company which is Save My Ass Technologies Inc. Basically, she realized she had to take ownership of the... Her own health and and and now she's still alive, you know, decades later. Oh, good for her.

And she wasn't supposed to be. So I think people people can have a lot of power in in understanding how their health works, what's going on underneath the hood, using tools like your breast cancer risk stratification questionnaire or function health lab testing to really understand what's happening in their bodies and not just sort of wait around for something to happen.

Dr. Thaïs Aliabadi
Absolutely.

Dr. Mark Hyman
In terms of, like, metabolic markers that that that are really hormone markers that people should be testing, we kinda touched on a lot of them, but, just gotta recap. What do think the most important things to look for are?

Speaker 4
So in my

Dr. Thaïs Aliabadi
practice in women in reproductive age, if I could check one thing, I would check their egg count, especially women who want to have children. It's a simple blood test. You can add AMH. We do it we do at function. I love that.

We do it. AMH is very important. Right? There... I just did a podcast with a young girl at 19 who had breast cancer.

She had a check two mutation, no family history of breast cancer. And, basically, her AMH, when they went to freeze her eggs, her egg count was really low. As I was interviewing her, she still didn't know why. And I'm like, did you have painful periods? She's like, well, now I don't because, you know, they're suppressing my ovulation.

But prior to that, yes, very painful periods. And that endometriosis can destroy your egg count and quality. So AMH for reproductive women is very important. I... Every year I check...

Do a full hormone panel on my patients. I check their testosterone because I see a lot of PMOS patients. Even though you don't have to have a high testosterone in the blood to get the diagnosis of PMOS, I still check and total testosterone, DHEAS, to see what their stress level is. If they have irregular period, I check their prolactin. If they're overweight, I get a hemoglobin a one c.

Every woman once a year, twice a year with me is vitamin d, a b twelve, iron, ferritin. I check high sensitivity CRP. I check homocysteine. I check their APO B if they're fasting, they come in, I always do a full blood panel and part of that is their APO B and lipoprotein little a. APO B I always say is a bucket of four particles that can cause plaque, and in that bucket, one of them is genetic, which is lipoprotein little a, twenty percent of women have it.

No, if you have lipoprotein little a, that does increase your risk of stroke, heart attack, it can increase, you know, I check for APOE4 for my perimenopausal women because that increases the risk of a dementia, inflammation, stroke and for those patients actually there's new data that if you give them hormone replacement, you can actually reduce their risk of dementia. So APOE4 positive women and two percent of women have two copies of the That's a genetic risk

Speaker 4
factor

Dr. Thaïs Aliabadi
Alzheimer's. For Alzheimer's, absolutely. So those women actually, if you treat them early in perimenopause and menopause for seven years with hormone replacement, there's new data that you can probably reduce the risk of dementia. Again, it's multifactorial

Dr. Mark Hyman
And not if you start it later, when you start it right after

Speaker 4
Right.

Dr. Mark Hyman
Yeah.

Speaker 4
Right.

Dr. Mark Hyman
Right. So people can find out this information now.

Dr. Thaïs Aliabadi
It can change their lives.

Dr. Mark Hyman
Because if you go to your doctor and you ask for all these tests, their likely answer is gonna be, it's not necessary, It's too expensive. It's gonna chase out things that aren't important and make you scared. I would say nonsense because information and knowledge is power. And if you don't know what's going on, you can't act on it. So I agree, I 100% agree with you.

That's the conclusion I've come to as a doctor which is opposite of what we were trained to do.

Dr. Thaïs Aliabadi
And honestly for for all your clients who are coming on Function Health, the other advantage that I see is that when you do a blood test request, let's say, your APOB of less than 90 is considered normal. It's not. Your AMH of one and above is normal. It's not. It's not normal.

Dr. Mark Hyman
Yep.

Dr. Thaïs Aliabadi
So you have to start looking at these. It can range in different ages.

Dr. Mark Hyman
I wanna I wanna sort of end by kinda doubling down on a bigger topic, which is hormone replacement therapy

Speaker 4
because

Dr. Mark Hyman
essentially what we've been saying for the last almost hour is that excess estrogen stimulation from all the reasons from being overweight to sugar to alcohol to environmental toxins to so forth are increasing your risk of breast cancer. And yet, we're also in a moment where the fear about hormone replacement therapy has reduced. It was was triggered from the Women's Health Initiative, which was a little bit over interpreted for that reason. And now there's a sort of an increasing movement to put more women on hormone replacement therapy around perimenopause and menopause. So how do you reconcile those two and how do you handle that that threading needle on that?

I I I think imagine people are having that question mark in their head.

Dr. Thaïs Aliabadi
And let me tell you, I feel like

Dr. Mark Hyman
And by the way, not just for for the hormone replacement therapy, not just does help your health, it helps reduce osteoporosis. It helps your symptoms. It helps your sexual health. It helps

Speaker 4
Cognitive health. Cardiovascular health.

Dr. Mark Hyman
I mean, there's so many benefits. It's it's kind of like a... How do you thread that needle? I feel as a

Dr. Thaïs Aliabadi
gynecologist, and I've been in women's health for thirty years now, I feel like the pendulum went from all the way from this end, now it's swinging all the way to the other end.

Dr. Mark Hyman
Mhmm.

Dr. Thaïs Aliabadi
And there's a happy medium. Right? I have patients who come to me and they're like, we heard on this podcast, you know, I've had an estrogen receptor breast cancer, but I've been cancer free for, I don't know, seven years, and now I wanna do hormone replacement. I will not start that patient on hormones yet because especially estrogen receptor positive patients, you know, these are patients who twenty years down the line, they can show up with breast cancer again. So I think you have to personalize care.

In my practice, if you come to my office and you want hormone replacement, I already know your lifetime risk of breast cancer, I've already done genetic testing if you have family history. So let's say I have a patient with ATM gene or CHEC2 who has a higher risk of breast cancer, who falls into the high risk category. If that patient wants to have hormone replacement and I understand I couldn't have hormone replacement and I understand all the bad things that can come with it, But then I might have a discussion. If your lifetime risk of breast cancer, let's say it's fifty percent, and with risk reduction, one option is to put these patients on tamoxifen, hormone blockers. If they take tamoxifen every day for five years, then you can reduce their risk by, like, fifty percent for the following ten years.

Dr. Mark Hyman
But that throws them in a menopause.

Dr. Thaïs Aliabadi
It it has side effects. Yeah. Yeah. Hot flashes, vaginal dryness, mood, fatigue, all of it. Right?

But you reduce their risk of breast cancer. So one discussion that I'm having them is here's... Here are your options for risk reduction. Let's say your lifetime risk is really high and it's at fifty percent. I can give you tamoxifen.

But if I give you tamoxifen, I can't give you hormone replacement because they're doing the opposite. They're... Like, I'm trying to block the hormones. I'm not gonna give you hormones. Or the other option is, you know, let's say when I did my double mastectomy, if they didn't find cancer, I would have been on hormone replacement right now.

Do you know, remove your breasts, reduce your risk, and then start hormone replacement. But if someone has a intermediate risk, low risk, they have symptoms, I'm all for hormone replacement. Give them hormone replacement. But I take every patient.

Dr. Mark Hyman
It's individualized.

Dr. Thaïs Aliabadi
It's individualized. It's not a blanket, everyone take hormone, nobody takes hormones. You know, it's the discussion again, like everything else we did, look at their metabolic function, look at their inflammation, look at their family history, look at their genetics, look at their polygenic risk score, look at all of that, their cardiovascular health, and then decide whether or not they're a good candidate. But I love hormone replacement, I think for women who, you know, have the advantage of taking it, they should absolutely take it. The sooner you take it, the better it is.

A lot of people think they have to wait for their periods to end and be menopausal to start hormone replacement. It's not true. Average age of menopause is 51.5, seven to ten years, and the range is 45 to 55. Seven to ten years before menopause, women can go through perimenopause. So if you're someone who at 45, let's say you're gonna be menopausal, you could be perimenopausal in your late thirties and there's nothing wrong with treating that patient with hormone replacement if she's having hot flashes, night sweats, mood swings, sleep disturbances, you know, all these other symptoms, there's like 30 some symptoms that can happen with perimenopause and menopause, vaginal dryness, painful sex, joint pain.

And, but again, individualized care. And that's what I do in my practice, I do a lot of preventative testing a ton, but I also offer hormone replacement to majority of the patients.

Dr. Mark Hyman
Yeah, mean, is really functional medicine approach, which is personalized care, It's looking at deeply at your biology. It's understanding the risk factors and modifying those. It's working to help your overall health. I think we didn't talk a lot about the microbiome here, but I think it's a big factor in hormone metabolism, particularly cancer and overall hormone metabolism for women. So there's a lot of things that can be done if you know what's going on.

And and I think most people don't have that information and your your work, your practice really is is such a gift because you're actually helping people to understand that these are not just things they have to suffer from. And you know, I I wrote this article years ago. It was about PMS and it was like seventy five percent of women have some version of PMS or premenstrual syndrome. And I'm like, is is this just a design flaw or is something else going on here? Like, I...

To me, I... It doesn't make any sense that our biology was designed to make women suffer the way they do. And that these are things that are modifiable risk factors that we can change.

Dr. Thaïs Aliabadi
I mean, my daughter's at Stanford, Delara, she's a senior and she is... Her her project is on PMDD, gut microbiome

Speaker 4
Yeah. Amazing.

Dr. Thaïs Aliabadi
Wearables for PMDD. I mean, these all have underlying risk factors. And PMDD

Dr. Mark Hyman
is like a severe form of PMS, it's premenstrual dysphoric disorder which means you're like, it's get temporarily insane for the last two weeks of your cycle.

Dr. Thaïs Aliabadi
Yeah. So It's so sad for these girls. And, you know, again, it affects three to five percent of women. No one diagnoses them. No one.

And I, you know, I say they destroy every relationship Yeah. During those two weeks, and then they spend the other two weeks going back and cleaning up, and then here comes again. And they start thinking, and it's so traumatic. These ten days before their period is so traumatic to them that eventually it causes chronic anxiety and depression. Yeah.

And no one addresses this. They have a higher suicide rate. They... It affects their work. It affects their relationships.

Yeah. And, again, it's the list goes on. I mean, I can sit here until tomorrow and talk to you about every condition that women get dismissed. That's why, again, I started this podcast by saying women, a, don't have access, but even for women who have access, they're still being dismissed. They're still being told they're crazy.

Well, we

Dr. Mark Hyman
might have access to certain types of doctors, but not other types of doctors. And you have to think out of the box and we didn't learn any of this in medical school.

Dr. Thaïs Aliabadi
No. None of it.

Dr. Mark Hyman
And yet the science is there. And like the science, the data is there. It's it's just hard to change paradigms. It's hard to change the way people think or practice. And it's also hard for doctors to focus on things that they're not trained with, which is lifestyle or prevention.

Dr. Thaïs Aliabadi
But look at all the labs you do with with function health. Right?

Dr. Mark Hyman
Mhmm.

Dr. Thaïs Aliabadi
How much time would that take for a doctor in the office to explain all that to the patient?

Dr. Mark Hyman
Yeah.

Dr. Thaïs Aliabadi
Doctors don't have time. They have ten minutes with the patient. A woman's health exam right now, everything I told you I do and more, because I haven't talked about colonoscopy, bone density, cardiovascular, all of it that I do, it takes forty five minutes.

Dr. Mark Hyman
Yeah. It's a long time.

Speaker 4
You know what patients get? A Pap smear, a

Dr. Thaïs Aliabadi
bimanual exam, maybe a prescription for birth control if the patient's sexually active, maybe an STD check, and maybe a breast exam. And if they're 40, they get a mammogram and off they go. That's not well women. That's dismissal.

Dr. Mark Hyman
Comprehensive care.

Dr. Thaïs Aliabadi
No. This is nothing. It it shouldn't even... I don't even wanna call it standard of care because that shouldn't be standard of care.

Dr. Mark Hyman
Unfortunately, is though.

Dr. Thaïs Aliabadi
It is.

Dr. Mark Hyman
Yeah. Well, thank you so much for your work, what you do. Where can people learn more about you, your work, and and how to calculate your lifetime breast cancer risk?

Dr. Thaïs Aliabadi
You know what? I started my, SheMD podcast with my partner, Mary Alice Haney, about two years ago, and it exploded because we really talk about women's health. We take every topic in women's health. We cover it. We go in details of it.

And, from prescriptions to what they ask, we make women become their own health advocate. The only way to advocate for yourself in this health care system is to be educated about that condition, and that's exactly what we do. So I say go find me on g m d podcast. I have all the information there. I have the

Speaker 4
ovgmdpodcast.com.

Dr. Thaïs Aliabadi
The gmdpodcast.com. I also have ovi.com, ovii.com, for anyone with metabolic dysfunction, anyone struggling, needing hormone balance, metabolic... Struggling with metabolic dysfunction, it's a great platform. It has a calculator for PMOS and we have the most amazing supplement. Thank you for having me.

Dr. Mark Hyman
Thank you, and thank you for your work. Thank you for not dying and helping us learn all about this.

Speaker 4
I

Dr. Thaïs Aliabadi
love that. Make sure you add the lifetime risk calculator for all your patients, and make sure you're screening for endometriosis in We'll all

Dr. Mark Hyman
work on that. We'll work on that. Thank you. Thank you so much.

Dr. Mark Hyman
Hey, everybody. It's Doctor Mark here. I'm so excited to share that my new book is officially available for preorder today. After more than thirty years of practicing medicine and caring for tens of thousands of patients, I've written the book that brings everything together that I've learned about helping people get healthy and stay healthy as they age. It's called a 100, what to do today to live a 100 healthy years.

It's a whole body guide to living a 100 healthy years. It's grounded in a new understanding of how our bodies work. It's the new map of the body. And inside, I walk you through the seven core systems that drive your health from your gut and hormones, diet, your cells make energy, and help you understand the signals your body's been sending you all along. Now a lot of what's in the book, learned the hard way through my own body.

When I got sick, the medicine that I trained in did not have any of the answers I needed. So I had to go looking for them myself, and that search became my life's work. This book brings together decades of my learning from my patients, from the scientific research and scouring that, from the things I got wrong, and the things I had to rethink along the way. I don't want you to have to struggle the way I did to find those answers. So much of our health is shaped by what happens outside your doctor's office.

And I want you to feel confident knowing how to care for yourself every day. I put so much of myself into this book, and I'm really excited to finally share it with you. It's really my life's work. It's my capstone of my career that I put everything I know. It's finally available for order today.

Preorder. Everywhere books are sold, go get a copy. Please support me, and this is my life's work. So I think you're gonna love it.