The Mitochondria and Your PCOS- The True Root of Health with Dr. Kalea Wattles of Functional Fertility, Season 4 Episode 2

This was a really good one, guys!  Today we are talking with my good friend Kalea about mitochondria and specifically how they impact PCOS.  Now, I know it sounds a bit science-forward but trust me, Dr. Wattles and I love the mitochondria for a reason.  Hope you love it as much as I did!

Mentioned in the episode:

Follow Dr. Wattles on ig @functionalfertility or visit her website www.drkaleawattles.com for more on her Functional Fertility Blueprint program!

Try N-acetyl cysteine (NAC) mentioned in the episode here: https://s.thorne.com/NRI4c

Transcript

Speaker 1: 0:38

Hello everyone, welcome back to an Amber a day, the functional nutrition podcast. I'm your host, amber Fisher, and today I am here with a fabulous guest. She has been a guest on our podcast before. This is Dr Kalia Waddles, who runs functional fertility and, as I was just telling her, I have long admired her work. Just look up to her, think she's a fantastic, fabulous person and it's incredibly intelligent. Love to learn from her. So today, her and I are going to be discussing mitochondrial health, pcos and a little bit about fertility, since that is her specialty. So, yeah, thank you for being here, kalia.

Speaker 2: 1:14

Thank you so much for having me. We're reunited and it feels so good.

Speaker 1: 1:18

And, yes, we, we have known each other virtually for a few years now.

Speaker 2: 1:24

And a few years we've had a virtual friendship.

Speaker 1: 1:26

Yes, a lot, a lot has happened in those years, so it's wonderful, okay, so what I want to do first is I'd love for you to just introduce yourself to everybody. Tell us what you do, you know.

Speaker 2: 1:38

Yeah, great. So I am Kalia Waddles. I'm a naturopathic doctor by training and then I have some post doctoral certification through the Institute for Functional Medicine. So I'm also an IFM certified practitioner. I am the founder of my practice, functional fertility where I really take a root cause, evidence based, patient centered approach to fertility using a body systems approach, which is what IFM teaches us. So I'm looking at all the aspects of someone's health to really identify the underlying drivers of their fertility struggles, and we're cultivating resilient health that sets them up for a healthy pregnancy, a healthy baby and longevity in their health so that they can enjoy this family they work so hard for we love it.

Speaker 1: 2:16

We love to see it. Is she not so well spoken? Everyone, just I, just she is. So what we're going to kind of talk about today is a topic that you and I are both very passionate about, and that is mitochondrial health. And when I say mitochondria, people sometimes when I look like a deer in headlights are like okay, this is over my head, Like we're talking about something like really you know intense here what the heck is a mitochondria? So for those of us who have forgotten our biology, can you explain to us what the mitochondria are and why they are important, just for our health in general, but also for our hormones specifically?

Speaker 2: 2:50

Yes, I would love to. Mitochondria are a beloved to me and if anyone's been on my social media, you'll see like 30% of the posts are about mitochondrial health, because it's so important. Mitochondria are tiny structures that are found in both cells of the body and I think the mitochondria have an excellent PR team, because everybody knows their catchphrase. People always tell me I can still hear my 10th grade biology teacher say mitochondria are the powerhouse of the cell, like that's their thing, and people remember that. What that means is that mitochondria are responsible for generating energy, and I say we can think of them like cellular batteries, because they essentially convert energy from things like the food we eat into a form that our cells can use. And this comes up in my fertility practice all the time because I say ovulation, fertilization, implantation these are energetically expensive processes. So we need really healthy mitochondria to power those.

Speaker 2: 3:42

And when we look at hormones, a fun fact is when we make hormones, the backbone actually begins with cholesterol. So cholesterol is shuttled into our mitochondria and then that cholesterol goes through a series of very fancy enzymatic reactions until it turns into hormones like estrogen and progesterone. And so sometimes when I have patients that have a short luteal phase or they have low progesterone so they might have things like recurrent pregnancy loss. I always want to support their mitochondria as we work on that hormone imbalance pattern, because inside the mitochondria that cholesterol will turn into pregnant alone and then pregnant alone is transformed by this very fancy enzyme called 3-beta hydroxystero dehydrogenase into progesterone. So if we're going to really work on helping our body make progesterone on its own, we got to get those mitochondria healthy.

Speaker 1: 4:31

Yeah, so a lot of our creation of hormones actually happens in the mitochondria, so it's super key. If we want hormones at all, we've got to have our mitochondria.

Speaker 2: 4:41

That's exactly right. It's the rate limiting factor in hormone production, which means we're only able to make hormones at a rate that our mitochondria can sustain. It's kind of a big deal.

Speaker 1: 4:51

Yeah, and so if well, I'm maybe jumping ahead. But if our mitochondria are like overtaxed, then that can be really difficult on our hormonal health.

Speaker 1: 4:59

I often talk about hormones in like a pyramid structure because, just for a visual illustration, because people often associate something like PCOS with like being just a purely hormonal issue. They're like well, I was just born with too much testosterone, like, this is just how I am, and the reality is that hormone processes are kind of like one of the last sort of things that the body is going to work on. It's almost like your hair and your nails right. Like if you're unhealthy, those things are going to suffer. Like if you're not healthy underneath your mitochondria, not healthy, your hormones are going to suffer. So it's not something that well, I guess, am I making sense?

Speaker 2: 5:38

Yeah, yeah, You're making sense to me and I'll bring up. There's a hormone called the hormone conference that the IFM offers. That you have attended and have worked on for years, and one of the kind of hallmark takeaways from that program is that a hormone imbalance is often an appropriate response to something going on elsewhere in the body. Right Like our hormones are constantly trying to compensate for other things. So it makes perfect sense what you were saying. It's like the last step in. Our hormones are just trying to keep us healthy in the context of everything else going on in our body.

Speaker 1: 6:09

Yeah. So if we've got an imbalance or signaling issue or whatever going on with our hormones, we have to look deeper. We can't just say, okay, let me take the supplement that's going to make me make more I don't know, estrogen or whatever. It's not that simple. It's like well, why are things out of balance in the first place? And oftentimes it goes back directly to the mitochondrial health and the function of our energy makers of ourselves.

Speaker 2: 6:31

The powerhouse of ourselves.

Speaker 1: 6:33

Yeah, it's like a magic school bus in here. Okay, so what kinds of things might happen when our mitochondria are working well? You give us some examples.

Speaker 2: 6:44

Yeah, I would love to give some examples, and what I am about to say I'm going to preface this is that it's going to be annoying. But I would not say it's going to be annoying and so I'll just get out. I'll just get out with it that A mitochondrial dysfunction, mitochondrial disease. It can be hard to notice or to diagnose, because people actually call mitochondrial dysfunction like the great masquerader or the notorious masquerader, because, if you think about it, our mitochondria, like I said, are found in most cells of the body and so when we have dysfunction it can present, like with any symptom in any organ at any age. So how frustrating, right.

Speaker 2: 7:22

But this is actually an opportunity for us to say okay, then what type of patient do I want to consider mitochondrial dysfunction in? And so I think about if someone has an atypical presentation of a common disease, like when we see all the time that's a comorbidity with PCOS, is Hashimoto's right or autoimmune thyroiditis, and it's like if I have an autoimmune patient and they're not responding to my normal stuff, I'm doing everything I can to tone their immune system, I've got them on thyroid hormone and they're just not feeling better. I'm really wondering what's going on in the mitochondria. So atypical presentations of common disorders. If someone has a lot of recurrent setbacks or flare ups in their health, like we think we're on a good trajectory, and then something happens, they get an illness, some big stressor happens, or even something like fasting that the body might perceive as stressful, and now their symptoms are in full flare mode, I'm kind of wondering if something is going on with their mitochondria.

Speaker 1: 8:19

Well, speaking of fasting, I want to pick your brain a little bit about that, because what I recall from some of my IFM conferences is a lot of us, different practitioners, have sort of different opinions about fasting. Right, because there can be some huge benefits to fasting, but then there can also be some difficulties to fasting, depending on the person.

Speaker 1: 8:38

I've heard that a certain amount of fasting is really helpful for the mitochondrial health, because if you go a certain length of time it helps them to sort of clean up, right? Is that true, and what should we take away from that?

Speaker 2: 8:53

Yeah, intermittent fasting can be helpful for mitochondria, but I think we have to look at this person as a whole. So, like you and I have talked about fasting before in the context of cortisol If someone is really having HPA axis dysfunction meaning their body is already under such a source of stress that it can't really tolerate any more stressors I'm going to be really cautious about using fasting Now. We know that, in fact, for PCOS, the bulk of the research on fasting is in people who are insulin resistant specifically, and we know that not everyone with PCOS has a lot of trouble with insulin.

Speaker 2: 9:25

It's common, but not everyone. So I think we have to look at, like their whole hormonal health, their HPA axis. We should experiment. If we think fasting is going to be helpful and they feel a lot worse, we should probably back off and do some mitochondrial support, not to say we can never do fasting, but let's get their mitochondria a little bit more resilient and then try again.

Speaker 1: 9:44

Yes, I love that because you know, personally I tend to recommend fasting more in my post-menopausal patients and stuff and I myself in post-menopausal I do intermittent fasting. Now I feel good when I do it. But I've also had clients who felt horrible and it almost reminds me of treating other things like candida overgrowth or something like that, where if you do too much, too soon and too fast it's so overwhelming for the body you can almost get this cascade reaction of inflammation from actually trying to do something positive. So healing sometimes is kind of a slow process and I always think about the body as, like you know, it can't. You can't push it too hard, too fast. You have to let it heal in its own time and each one of us is like on a different timeline with it. I think fasting is kind of one of those things that gets thrown in there. A lot is like well, just fast and it'll help, everything you know, but for some people now it's not helpful.

Speaker 2: 10:40

Yeah, I was actually just listening to a lecture, like kind of a tangent, but it's adjacent, you'll see where I'm going. I was talking about fasting and how. Yeah, fasting can be great for a lot of people, but the lecture was specific to people who have genetic variations in the way that they glucuronidate things. So Gilbert syndrome was the big example. It's like how you engage with environmental toxicants, right, and like most of us don't walk around knowing our genetic status for things like this, and then when we fast, we feel terrible. So what I'm trying to say is let's normalize a little bit of trial and error. You know, it's okay to try something that you think is going to be helpful and then, if it doesn't feel good, to go back to the drawing board. I think in medicine we do ourselves a disservice when we're like, well, this should work, so we're just going to stick with it. You know what I'm saying. It's like it's okay if it's a bit of an experiment.

Speaker 1: 11:30

I totally agree, and I think in the case of PCOS that's really important, because so often in the sort of medical community at large, pcos gets kind of lumped in as like this one type of issue. It's like it's an insulin resistant thing, like limit your carbs, fast, do that kind of stuff. It'll help whatever. But then when you get into the PCOS sort of healthcare community, those of us who've spent a little bit more time sort of thinking more deeply about the disorder, we've all come up with our own sort of ways of dealing with this.

Speaker 1: 11:58

But there's this pervasive theme on the other side that like fasting is horrible for you and it's terrible for your hormones. That will never help you at all and you should never, ever try it. And I really think the truth lies somewhere in the middle that for some people something like fasting could be really beneficial. For other people it's not going to be helpful, and for a lot of people it might not be helpful at first but might be helpful later or vice versa. But, like you said, a little bit of experimentation, trial and error, I think is so important to view your body as almost a little bit of a science experiment. That's how I do it, you know, because you won't everyone's biochemically unique right.

Speaker 2: 12:35

So we all have different needs Individual Yep, that's right, and I think that kind of like oh, I think the truth is somewhere in the middle probably applies to a lot of the things that we do. There is life and general right and general right on a lot of things. So I think that's true for so many different areas.

Speaker 1: 12:51

I think the struggle comes when you know just as, like practitioners, we're always trying to find like a protocol, right, like we want, like a set of steps that we can like put everyone through, but we just that's the beauty of functional medicine and functional nutrition is that the whole point is we don't put people through a set of specific steps. We, you know, take them as a unique person, exactly, and that means that things may change.

Speaker 2: 13:14

So anyway, we're not with it. We don't treat diagnosis codes, we treat people, and that's the beauty of it.

Speaker 1: 13:19

Yes, love it. Okay. So let's talk a little bit more specifically about mitochondria and PCOS. Where, like, where's the connection there? How might it impact PCOS?

Speaker 2: 13:31

This is a fun question and in order to answer this, I feel like I'm going to have to do a little bit of anatomy and physiology review. So everyone, focus back. We got to get into the A and P. So I there's a few different ways that I can connect mitochondria specifically for PCOS. The first is that there's an effect at the level of the ovary, which I'll describe, and then there also is a connection to insulin resistance. So I'll talk about the ovary first and then can I put you responsible for not letting me forget about the insulin resistance part If I get so excited about the ovary Right here. Okay, so I love granulosa cells and I just need to own how much I love granulosa cells.

Speaker 2: 14:08

Granulosa cells are these. They actually represent the largest cell population in the ovary and they're so important for fertility. There's their specialized cells. They're located in the ovarian follicle, which is basically our egg sac that surrounds our little oocyte or egg cell. People call them, like the egg cell, helper cells or nourishing cells. So they're really, really important and I love them. They provide nourishment. They support the developing egg by producing hormones like estrogen, which is a big deal. So during ovulation, a mature egg is released from the follicle, it bursts from the follicle and then the remaining granulosa cells that were in the egg sac, they form a structure called the corpus luteum and that produces progesterone to sustain the endometrium during the luteal phase or during early pregnancy. So that part's really important.

Speaker 2: 14:57

And I think I am happy to say that the growth and the proliferation and the division of the granulosa cells require abundant and stable mitochondria to supply appropriate levels of energy. And the granulosa cells are really dependent upon healthy mitochondria. And when we have mitochondrial dysfunction it disrupts that bi-directional communication between the egg cell and the granulosa cells, which can lead to stagnant growth and development. And if we think about PCOS and the cystic part of PCOS, they're not really cysts, right? They're all of these follicles, all of these little egg sacs that grew a little bit but didn't get big enough to ovulate. That's why we see this anovulation happening.

Speaker 2: 15:38

So when you look to the studies, we see that when they have been in the IVF setting and they'll extract some fluid from the follicles of women with PCOS, we see increased levels of reactive oxidant species and what that means it's oxidative stress. So it essentially means we have more compounds that can damage DNA than we have antioxidants that can kind of fight those compounds. So we see an increased level of reactive oxidant species in that follicular fluid which can impair the function of the mitochondria. It can lead to an abnormal shape of the granulosa cells and then we have inadequate energy supplied to do all these things that we need to do, like ovulate and mature an egg. It's also interesting that we see that mitochondrial dysfunction in the follicular fluid of women with PCOS, so we can actually make our egg cells less effective at utilizing energy from glucose. So there's all of these metabolic components. It's really interesting. In in turn, as a result of all of that, we see altered egg quality and this is thought to be one of the contributors to why we sometimes see poor pregnancy outcomes through IVF when women with PCOS are going through treatment.

Speaker 2: 16:54

And I'm bringing that up because I think that that can be Scary to hear sometimes. But the good news is we have a lot of control Over those changes. So they're largely influenced by epigenetics and I talk about so genetics are like the part of your story that's written in pen, but epigenetics are the part that's written in pencil. We can do some editing, we can erase, we can write new things in. So While we do see these connections. There's so much that we can do and we'll talk about this, I'm sure nutritionally, lifestyle supplements, all of that to power up those mitochondria and really support that process, no matter where you are on your fertility journey, if you're just trying to ovulate regularly, if you're ready to do IVF. There's just so much that we can offer.

Speaker 1: 17:35

Well, and I think it's important to remember too that Fertility is not just about getting pregnant.

Speaker 1: 17:41

Your fertility health, your hormonal health, your ability to ovulate, your ability to make enough Progesterone, is important for your physical health and can be a great indicator of how healthy you are underneath.

Speaker 1: 17:52

As someone with PCOS, you know if you're ovulating more regularly, and Especially if you've done lifestyle changes and that's shortening your cycles in a positive way, like that's a good underlying sign that you are in a more healthy state. You know, so often we're told with PCOS like, oh, go away, come back when you want to get pregnant, and so we just sort of assume that these sort of fertility or period related issues with PCOS aren't really that important Until they affect our ability to conceive. But it's all connected, right. So yeah, our fertility health is our health, like it's our. It's our personal health too. But to kind of piggyback on what you were saying about, you know, oxidative stress, I got a question just yesterday because I'm always telling people that my favorite supplement for PCOS is NAC. Right, and there was a new study that came out this year that sort of validated me, which I was like yes, because, because, what's that oh?

Speaker 1: 18:48

long, everybody's like oh you know, a nozzetals and great, I love them. I love a nozzetals, but I am a NAC fan because of that oxidative stress and that NAC it, for those who don't know, is a. It's a precursor to a and a powerful antioxidant called glutathione, and so this stuff that that we're talking about here is one mechanism for how NAC might be supportive of your PCOS health. It doesn't just help your egg quality, but also, you know, potentially, your insulin sensitivity or your glucose management and stuff like that. Tell us a little bit about the mitochondria insulin resistance connection.

Speaker 2: 19:23

Oh, thank you for reminding me because I definitely was, like, so excited about these granulosis. Yeah, so remember how I said, there are mitochondria in all over, in all of your different tissue types in the body, and it's interesting because there have been studies that are showing that when we see I Don't I really despise the word defect, but that's what they call it in the in the research right, variation, we could say variation Variations in mitochondrial protein synthesis that affect energy production in our granulosa cells can also affect energy production in our pancreas, which is where we make insulin, and that can Contribute to what they call the, the clinical phenotype of the insulin resistance PCOS. And so to your point earlier about, like this isn't just about fertility, right, when we start supporting our mitochondria. Some of the biggest users of mitochondrial energy are our brain like that one's pretty important our art, our Skeletal muscle. So it's not just about the ovulatory piece and even the metabolic piece, it's about supporting these crucial organs that are keeping us alive, right and that's a look.

Speaker 1: 20:26

When we talk about like root cause medicine or root cause nutrition, I mean, the mitochondria are like the root, you know, of everything. So it's it's just cool how, when there are different things, that strategies and things that we can do that are supportive, that it doesn't just help one thing in the body. It, whenever we work on the mitochondria, we're helping everywhere, right?

Speaker 2: 20:45

So, because the my computer everywhere, Can I put a visual out really quick? Because you just reminded me, we learn this in functional medicine. That's like you, if you think of all of your body systems as a web. So the way that we do this in Functional medicine is we have this tool that's called the functional medicine matrix, which I'm obsessed with, and it is a kind of a map of all of our different body systems. It's our Gut health, our immune system, inflammation, mitochondrial energy production, our environmental toxicin exposure, our transport mechanisms, which is like our blood supply, our lymphatic system. It's our hormones, our neurotransmitters and then the structural integrity of our skeleton and our cell membranes. And if you think about that as a spider web, like all of those systems are connected. Imagine a spider web in your mind. If you pull on any part of that web, it's gonna change all of the other areas, and so when we start working on our mitochondrial health, there are implications in our hormones, in our gut health, in Every other part of our body.

Speaker 1: 21:40

So we're really building resiliency in our whole and our self as a system if you had to, to make a definitive determination between what, like, the true root cause of a A lot of issues is. You know how, in functional medicine, we're always like everything goes back to the gut, right? Yeah, what's more important? The gut and mitochondria, what's more?

Speaker 2: 22:04

This is like asking someone to choose between french fries and mashed potatoes. Like what an excruciating decision. But I'm gonna go mitochondria, I'm gonna go my the hard questions, because mitochondria can also affect Our intestinal barrier function and so really I could make a case that it's like the root of the root.

Speaker 1: 22:22

So I'm gonna go my dream actually I agree with you because, yeah, I mean I do a lot of my work with clients involves working on the gut, because I'm a nutrition professional and Nutrition is digestion. Digestion is food, like the gut is right there, right, but but you know the mitochondria really where it's at. I mean, that's that's the ultimate goal of, like, getting somebody's digestion Better is so that they can eat more antioxidant rich foods, more polyphenols, more of all this stuff, and then eventually get to the cell right. So that's right, okay, well, we're gonna talk about some things that you guys can do to be supportive of your mitochondria, but before we do that, what are some things that might damage mitochondrial health? I'm also going to ask you a little bit about genetic influences on mitochondrial health. This is personal, but I've had a genetic test done and I have some issues with my mitochondria from that perspective. So I'm interested in the connection there and I want to hear more about it.

Speaker 2: 23:21

Yeah, so what are some of the things that can affect the health of our mitochondria? I think there's two different pillars, two different ways. That I think about this is things that you have too much of and things that you don't have enough of. We got to unpack that and figure that out. So, in the too much category, when we have too much oxidative stress we've talked about that when we have chronic inflammation, which that we could probably do a whole other episode just on inflammation. But inflammation might come from autoimmune disease or a gut infection, periodontal disease, which people forget about all the time food sensitivities there's a whole spectrum of inflammatory triggers that we could talk about, but too much of it is going to damage the mitochondria. When our blood sugar is chronically high, exposure to environmental toxicants all of that can lead to mitochondrial dysfunction. Then we don't have enough of mostly nutrients. We don't have enough vitamin C or CoQ10 or glutathione, which you talked about, which is why we're going to use enocidal cysteine to give our glutathione a boost.

Speaker 2: 24:23

When we don't have enough B vitamins or mineral co-factors like iron and this is a big link between our assimilation in our gut and our mitochondrial health, because iron is one of the most important mitochondrial support nutrients. I have patients all the time. I just saw someone recently and she has really heavy periods like so much blood loss, so she's iron deficient. Then she's also super fatigued because her mitochondria need the iron. There's all these connections between if we're bleeding super heavy or if we have hypochlorhydria, which is low stomach acid, we can't pull the iron from our food. We're going to start to see an impact on the mitochondria and then we might see fatigue, depression, anxiety, migraines, muscle pain, like all of these things that are related to the health of our mitochondria.

Speaker 1: 25:09

Right. So many women struggle with those subtle, sneaky symptoms that are very hard to definitively put in a diagnosis category. They get pushed around to different places. I guess it's iron deficiency, andemia, that's all. But I see this so much in my clients that when we look at their blood work they're struggling with all this other stuff autoimmunity, gut health issues, whatever. They're also struggling to bring that iron in, even when they're on iron support. So when there's trouble getting the iron into the body, yeah, there's something going on there. So it's interesting that you mention inflammation and insulin resistance and all of these things, because I always talk about the PCOS vortex. These are really the issues that make up the core of PCOS. It's an inflammatory condition, it's an insulin resistance condition. Typically, there's usually some adrenal dysfunction going on. All of those things. Like you said, they tend to affect each other, but they also affect the mitochondria and vice versa.

Speaker 2: 26:10

It sets the scene. Isn't this a reason why, like you mentioned earlier, it's really tempting for a lot of people to file PCOS under a hormonal condition? But if we broaden that lens and look at it as hormones, inflammation, the metabolic component, now we have all of these other tools in our toolbox that we can call upon, and so it's shattering these limiting belief systems that allow us to look at the root cause, like if we open up our minds to the fact that mitochondria could be at the root of these symptoms. Now we have a whole spectrum of tools we could use that we didn't even consider before.

Speaker 1: 26:46

Yeah, the cool thing about them is so many of them are lifestyle based. They're nutrition based tools, so we're going to talk about that. So how might someone with PCOS support their mitochondrial health?

Speaker 2: 26:59

There's all kinds of things, and I think this is like every practitioner has their favorites, and so what? I have my favorites, what are your favorites? You have your favorite, so we'll talk about it and compare notes. But I think, from a lifestyle perspective, another piece that helps on so many levels is keeping your blood sugar stable, because we talked about how, when you have chronically elevated blood sugar, that that can cause some dysfunction in the mitochondria. So, keeping blood sugar stable with all the nutrition stuff that you talk about all the time, combining your carbohydrates with that fiber protein to slow that release of glucose into your body, and no naked carbs, no naked carbs. And eating your soluble fibers and all of the things that you're always educating about. And then with our regular moderate exercise I love this idea. Like so many of my PCOS patients, they're taking their 15, 20 minute walk. I see you on Instagram, even in the dark, like so committed doing your glucose walk.

Speaker 1: 27:54

Do you think it's so important? I got it under desk treadmill so I don't have to do that anymore. Got to do what you got to do.

Speaker 2: 28:00

I think that's all really important. Meditation, even because of the way that it lowers our stress hormones, can be super helpful for our mitochondria.

Speaker 1: 28:07

Yeah, a lot of people don't realize that when you're stressed you get like an acute stressor during the day. It raises your blood sugar Because you store a little sugar in your liver and your muscles and it's there for that emergency of when you're under attack, but like when you get a text or a mean message on your inner DMs, like that's going to raise your blood sugar.

Speaker 2: 28:26

So you're activated. Yes, so having those stress transformation strategies is super important, minimizing environmental toxicants, which I say that and people I think are like. What does that even mean? I always say we have to live in the world where there are toxic exposures. It's just you go outside and breathe the air. If you live in a city, even out, I live in the country and even out here, you know, anywhere you are there's going to be toxicants, but it's fine.

Speaker 2: 28:49

Our body is inherently wise and we have the tools that we need to transform those. But we can do ourselves a favor by minimizing exposures where we can. So I always start with personal care products, just because it's like what we're bathing our skin in all the time, and I say let's do a little product inventory. I go to the skin deep database from environmental working group and just type in the little products and gives you a toxicity rating from one to 10. I try to stick in the green, which is zero to two. So just trying to clean up those things like where are the greatest sources of exposure in our cleaning products and our personal care products and starting there. So that's like.

Speaker 1: 29:22

Glass and plastics too I'm always with PCOS has a particular connection to high levels of BPA and difficulty in metabolizing, I think, plastics and stuff, when they get ingested. So just trying to switch over to glass and you know that kind of thing, I mean, like you said, this is the world that we live in, right, and I think oftentimes those of us who have chronic health conditions or autoimmune conditions or things like that we're just like almost like canaries in the coal mine, right, like our bodies are not adjusting to this new modern sort of context that we're in, as well as maybe some other people's bodies are. But this is the reality that we're all living in. I mean, it goes far beyond what you can do as an individual, but, like you said, you do your part.

Speaker 2: 30:11

Do what you can. You do what we can. And thank you for calling out glass, because people always ask me what do you want me to cut my raw chicken on if you don't want me to use a plastic cutting board, glass, glass?

Speaker 1: 30:23

I actually saw, and I don't actually know that this is true, but I did see somebody really talking intensely about how wood is actually a pretty decent anti-microbial environment for cutting meat. It's more antimicrobial than plastic or something.

Speaker 2: 30:41

Don't quote me on that, but I heard that.

Speaker 1: 30:42

Well, let's all Google that, because that's super interesting, because I love a black cutting board. I would just love that to be true, but we are not. Yeah, I'm not an expert on the microbial properties of bamboo or wood, nor am I, but environmental toxicants.

Speaker 2: 30:55

We'll tie that one up with a bow. We're going to do our best. Lower inflammation which we talked a little bit about this and work with a practitioner if you can, with a functional medicine practitioner. Shout out if you want to go to ifmorg and find someone near you and find a practitioner tool. There's people, there's thousands of certified practitioners over the whole world, so the likelihood that someone is going to be near you enough to do telemed is likely. So anyway, that's an aside.

Speaker 2: 31:18

But when you go looking for chronic inflammation, we can go inflammation hunting. Do you go to the dentist and what's going on in your gut and do you have insulin resistance, and it's a bit of an investigation. So just work with someone who's comfortable doing that. We talked a little bit about no-naked carbs, but I think a nutrient-dense diet in general is really important and the easiest way to conceptualize that is to eat the rainbow. I know that sounds super simple, but that's actually the best way that we can guarantee broad spectrum antioxidant coverage is like did you actually eat red, orange, yellow, green, purple foods today? So just give a checklist.

Speaker 1: 31:53

A lot of health stuff. I mean, we've got this whole podcast about it right, but at the end of the day, a lot of the stuff that we're talking about it's the simple stuff, and somewhere along the way we have disconnected ourselves so much from our own health and intuition that we've forgotten that health is actually simple. It's eating your veggies and taking a walk.

Speaker 2: 32:17

I don't know Work on the trauma, the implementation part. That's hard right. It's like, yeah, I know that going to bed before 11 PM in a totally dark room is what I should be doing, but also, how am I supposed to read my romantic novels on my Kindle at 11.30? If that's the case, Exactly, or?

Speaker 1: 32:34

I know that I'm supposed to eat the rainbow, but how am I going to actually overcome my food sensory issues, or how am I going to shop for all those and how am I going to put them together? You have a recipe that I think I'm going to link to on this podcast.

Speaker 2: 32:50

I'm so excited.

Speaker 1: 32:51

What is it? Isn't it like a glutathione salad? Glutathione salad so good. Every time you share that, I share it right back because I love the glutathione salad, but something like that. One of the things that I do that I think is really supportive of mitochondrial health is I just have a matcha latte every day. It's like my little thing. It's a great source of antioxidants If you get a high quality one that's not contaminated with lead, and so, if you can make little things into habits, you have a salad every day for lunch.

Speaker 2: 33:23

Yeah, because you're matcha latte.

Speaker 1: 33:24

It doesn't have to be that complicated. You can do one thing at a time.

Speaker 2: 33:28

OK, you've kind of opened a door to talk a little bit about sups. Is that OK? Can?

Speaker 1: 33:31

we go there the supplements, because I am a supplement fan.

Speaker 2: 33:36

You know, yeah, it's easy to get supplement fatigue. I think it's like, immediately, I'm a supplement, yeah, too, school. But I'm also defensive because I think there's a perception, which can be true at times, that functional medicine is just like a supplement for everything, right, right, because we know what to use. And so I'm always like, yes, I'm so happy that we have supplements and I know about so many of them and I have so many to offer. And I think the distinction is I'm never just going to give someone supplement recommendations Right, it's always in combination with the lifestyle, with all the things. But in this case there's some rock star mitochondrial support, of course.

Speaker 1: 34:15

Supplements and you mentioned OK, so I thought about what are your?

Speaker 2: 34:18

favorites. Ok, so this one is actually. I've long been a lover of vitamin D for a variety of reasons, but I was underappreciating the mitochondrial aspect of vitamin D. I was like it's great, you know our immune system and hormones and all that, but vitamin D can actually directly act on mitochondria and upregulate antioxidant enzymes. So just another reason for us to get our vitamin D tested and to supplement accordingly. You already mentioned NAC, which is we love it for so many reasons. It's a mitochondrial support, it's an antioxidant, it helps with our glucose control. It's a mucolitic meaning it helps to thin mucus. So when I have patients that are like I'm not seeing that egg white cervical fluid or I'm taking Clomid and my cervical fluid is gone, nac to the rescue.

Speaker 1: 35:03

Yep and, as an aside, with NAC and vitamin D both of those if you've ever had COVID or dealing with some like longer term symptoms from COVID, it would be very helpful.

Speaker 2: 35:13

We love, probably because they help the mitochondria so much and my function is one of the drivers of long COVID, but that's a whole thing. But, yeah, a lot of these supplements are going to work. You mentioned matcha. That's an excellent thing to add. I'm also going to give a shout out to melatonin, and I'm going to talk about this because people are always like what Melatonin? I'm like there's a lot of fear around melatonin and so I think people aren't using it. But melatonin in people with PCOS significantly improves mitochondrial function in our granulosa cells and people are always really worried about, I think, dependency on melatonin. But I feel really comfortable with low doses of melatonin at night, so I use a 0.3 dose, which is very low, some interesting stuff about high dose melatonin in PCOS.

Speaker 1: 36:02

But it's newer, right, I don't know a ton about it yet.

Speaker 2: 36:05

Yeah, and we've historically been using high doses for things like lupus. People use high doses like an autoimmune picture in general, but I'm using like 0.3 milligrams for the most part, and people always say I'm worried about inhibiting ovulation and I've looked into these studies and I'm happy to be proven wrong if someone wants to forward me an article. But it seems like this whole idea is derived from these studies that were done in the 90s where people were given melatonin at incredibly high doses, like 300 milligrams, which is so I just said. I give 0.3 milligrams. It's so high, and so I haven't personally seen any issues with ovulation at low doses and I think that the antioxidant protection of melatonin, the mitochondrial support aspect of melatonin, is like if we do a cost-benefit analysis, I think that the benefit outweighs any potential costs that I haven't seen at that dose. That being said, of course, always talk to your doctor and make sure melatonin's right for you. Sometimes it causes people to be more awake at night and if you're that person, then melatonin is not for you.

Speaker 1: 37:16

But I just wanna like give a shout out to melatonin because it is a great option, and those people that I've worked with before who have like a lot of the people I work with have sleep issues right. It's just a common thing when you've got other stuff going on, and so I cannot count how many people have been like, yeah, I tried melatonin. It doesn't really make me tired. It doesn't do anything for me, though. So if it's not, you know, it's not one of those things that, for a lot of people, that much every night is gonna be something you get like sleep dependency on.

Speaker 2: 37:41

But Exactly, but it does give that little mitochondrial boost. And then some of my other favorites are CoQ10 is a big one. This is super important part of the electron transport chain, which is how we produce energy. So CoQ10, l-carnitine is another one that's super important. Alpha lipoic acid is a good one. And then resveratrol.

Speaker 2: 38:04

I love resveratrol but I always give a caveat that I only dose resveratrol in the follicular phase. So maybe, like the first 10 or so days of the cycle, I'll use resveratrol and the studies we see that there's a benefit, even if it's just used for a week, a week at a time, and then take a break. So I'm a fan of resveratrol. In that context, is it reasoning for only using it during the follicular phase? Yeah, there's some evidence to show that it affects the way that the uterine tissue, the endometrium, changes following implantation Interesting. And so there's some research from the IVF setting saying that people who took resveratrol throughout their whole cycle had problems with the development after implantation. That did not result in a pregnancy. So I'm just within abundance of caution, I'll use it in the first half of the cycle for the mitochondrial benefits and then we discontinue.

Speaker 1: 38:53

No big sense. Yeah, well, that's a really good one. I mean there is I could add to this list. How about fish oil?

Speaker 2: 39:01

Fish oil Love a fish oil. Fatty acids Love a good fish oil.

Speaker 1: 39:04

You can see what else I don't know.

Speaker 2: 39:06

You've covered all the ones that I was probably going to say, but then also going back to B vitamins, like those foundational things, yeah, so important for that electron transport chain, and I'm glad you mentioned fatty acids. So our mitochondria have a cell membrane that is largely it's called the lipid bilayer and it really incorporates a lot of omega-3 fatty acids. So if we want that cell membrane to remain flexible and healthy and prepare itself from damage, it needs to have fatty acids.

Speaker 1: 39:36

So from a PCOS perspective, what I have seen is a lot of great evidence on using vitamin D, on using NAC. I've seen some stuff on melatonin especially recently I feel like I've been seeing more stuff about that CoQ10, alpha lipoic acid and L-carnitine. I've seen stuff there, fish oil, of course, zinc. So all of these things. If you want to go on PubMed and just do a little searchy search you can find a fair amount of evidence that they're supportive. Of course there's differences in quality of research and all that, but not just for what we're talking about here with mitochondria, but directly for PCOS symptoms. So I highly recommend you don't need to do all of them all at once, unless you're a super overachiever, but you can start with one and give supplements a little time, see if you notice any differences.

Speaker 1: 40:30

I know for me NAC was probably the biggest thing for me. Just regularly using NAC for a few months I noticed a big difference. And just having a matcha too, I mean that really changed my skin. It changed a lot of things for me. And it's not necessarily a you don't think of it as a supplement, it's a food but it kind of acts in the same way that maybe a supplement would I love foods like that, like a medicinal quality, but I'm also enjoying myself and it's delicious and luxurious.

Speaker 2: 40:55

It helps me romanticize my life.

Speaker 1: 40:57

Exactly, it's all of those things Kind of just love matcha, I'm just obsessed with it. I think it's because I never got into drinking coffee, so I had this gap where I needed, like everyone every girl likes their little. I'm a beverage girl.

Speaker 2: 41:11

A little drink yeah.

Speaker 1: 41:12

Every little drink right and I had. There was just such a gap there. Now it's filled with joy.

Speaker 2: 41:18

Well, as a Seattleite, I'm drinking my coffee, girl, yeah.

Speaker 1: 41:22

I know you are, and no, no hate. Well, I mean, you were just talking today about bitters, right?

Speaker 2: 41:27

Yes, so is coffee a bitter, or I mean coffee is a bitter, coffee is a bitter. Matcha is a bitter, I believe. I think matcha definitely could qualify as a bitter.

Speaker 1: 41:36

It's when you first drink it. Definitely, yes, it's bitter. It's those bitter receptors. Yeah, but the cool thing about bitter foods is the more you eat of them, the more you taste the subtle flavors that come out. They're really quite delicious and tell everybody about the bitters thing that you shared today about how there's receptors.

Speaker 2: 41:56

There's actually a PCOS connection, so I'm so excited to talk about this, so this sounds funny and people commented when I shared about this on Instagram. They were like wait, am I reading this correctly? Yes, and let me explain. You have bitter taste receptors. They're on your tongue, right? So I see you have that bitter sensation. When you eat bitter greens like arugula or Brussels sprouts, or coffee or grapefruit, it tastes bitter and I know everybody knows that feeling that I'm talking about Makes you salivate, it makes your stomach growl.

Speaker 2: 42:21

Well, emerging research over the last five years or so has shown us that we have bitter taste receptors in our ovaries, in our uterus, on sperm, in our kidneys, in our genitourinary tract. I mean, they're everywhere and it's so, so, so interesting. And it's still a little bit unclear about the mechanism behind why we'd have all these receptors outside the oral cavity. But what's really strange and cool and exciting is that I'll give PCOS as an example. They found that this was a mouse study. So let me just say that when they gave mice who had PCOS a hops-derived bitter compound, they started ovulating regularly. Their levels of progesterone improved and this was all started because they were trying to do these experiments on mice where they removed or blocked the action of their bitter receptors and then the mice could no longer reproduce and they were like, oh wait, maybe the bitter receptors were doing something.

Speaker 2: 43:23

So it's like prompted this whole line of research and now they're looking at the bitter taste receptors in the granulosa cells. We know how much I love those and how it seems like when you're younger than 36, you have more bitter taste receptors in your granulosa cells and then over 36, you have a little bit less. And when they look at studies of people who had UTIs, they found that bitter receptors in the genitourinary system would detect the chemicals that were produced by pathogenic bacteria that caused the UTI and that activated this whole immune response which causes some of the pain in the urinary tract. But it's like why your immune system, like, responds and clears that bacteria. So who knew that UTIs and bitter taste receptors were related? But there you have it and people saying nutrition doesn't matter, it's everything.

Speaker 1: 44:15

Come on, that's incredible and actually I'm going to take that tip and I'm going to use that with clients, because I have some clients with chronic UTIs that are really hard to get a handle on and maybe some more bitter foods in the diet might be helpful.

Speaker 2: 44:28

Maybe some bitters will have to have a whole other conversation about the vaginal microbiome. Have your coffee. Yes, have your coffee. I'll never take them away.

Speaker 1: 44:36

Yeah, I don't know I never I get the. I actually did that question a ton where it was, especially when I'm sharing about Mojah, Because there's this assumption that with PCOS you can't have any caffeine. No, caffeine at all, Never. And like sure. I mean, if you've got a major adrenal component you might want to limit your caffeine. But I really think we have this weird sort of thing about caffeine that I'm not sure is actually played out in the research. I mean, do you have thoughts on caffeine?

Speaker 2: 45:00

I always tell people well, my patients are all trying to get pregnant. And so they're like, is this OK? And then what if I get pregnant? And for years we were told that up to 200 milligrams of caffeine is probably fine. And then there were some research that came under like maybe that's a bit much. So I say 100 milligrams of caffeine, which is like eight ounces of coffee, or it's a latte, a tall latte, and I feel pretty good about that. Yeah.

Speaker 1: 45:21

I feel fine too. I mean so from the pregnancy perspective. I know there's a great book that I loved called what is it Expecting Better?

Speaker 1: 45:31

I don't know, it's by the statistician who wrote a pregnancy book and she basically went into the statistics of all the different studies that have been done on things like deli meat consumption, you know Right, like all that kind of stuff. And she did a lot of the studies on caffeine and found that really kind of her conclusion was if you are used to drinking a certain amount of caffeine, then you could probably cut back slightly from what you're used to drinking and be fine. Now I don't want to talk to your doctor before, yeah, of course, but that rings sort of true for me. I just feel like there's a certain level of caffeine that we probably can tolerate, and a lot of people think caffeine is responsible for a lot of the intellectual developments of the last 300, 400 years. So you know.

Speaker 2: 46:19

I believe it's responsible for my doctoral.

Speaker 2: 46:23

There's some benefit. And let me just I have to talk about CYP1A2 just for two seconds. Oh yeah, it's a genetic variation, it's a single nucleotide polymorphism. It's the way that you metabolize caffeine is your CYP1A2. And so that variation can make you metabolize caffeine quickly or more slowly, right, and so if you're that person, like I am, that can have a coffee at 6 pm and then still go to sleep, perfectly, you're probably a fast metabolizer. Where we know we have our friends and they take a sip of caffeine and they are wired, you're probably kind of a slow metabolizer. So, just to tie it all up, every human has the biochemical individuality that makes these things more or less appropriate for them.

Speaker 1: 47:04

Yes, exactly, and I am a slow metabolizer and you know, what's funny is that I've always sort of known that, because you know I have to stop by 2 pm or I won't be sleeping. And then I did my genetic test and what do you know, there it came up and I'm like, yes, confirmation. So, okay, let's talk about before, because I know we're running short on time. So if anyone is trying to conceive with PCOS, are there some specific reasons why we want to? Oh, you know what we talked about that already. I'm gonna.

Speaker 2: 47:33

I think we've made the case.

Speaker 1: 47:34

Like there's so many reasons I did that Okay so, before we close up for the day, tell us where we can find you, tell us if you have anything that you want to let us know about.

Speaker 2: 47:44

Yes, the best place to find me is on Instagram at Functional Fertility, because I'm there most days having fun and just doing my thing. You can head to my website, drcaliawattlescom, to learn about my clinical services, including my upcoming online program, which I'm super excited about. It's called the Functional Fertility Blueprint and it walks through all of the steps that I normally take with my patients. There's a lab testing involved. It's all of your supplements, your modifiable lifestyle factors. We create your own functional medicine matrix together so that you can identify your unique area of clinical imbalances. I'm super proud of it and I think it's gonna be really helpful and just allows me to reach this audience that is larger than the people who live in Washington, which is who I normally work with. So very excited for the Functional Fertility Blueprint to come out. The kind of page describing all of the curriculum is open at Dr Caliawattles If anyone wants to go check it out and join the list. 20 people are invited to be my founders round, so spots are limited, that's gonna be so cool.

Speaker 1: 48:42

That would be such an incredible opportunity. Hopefully, yeah, when this podcast comes out, we can send people that way and I think it is gonna be great. I can already tell I know, if I know Calia, there would be a lot in there. She jam. She's like me in that way. I think we're both very similar in that we love to jam pack our courses with lots of information Once you get your money's worth.

Speaker 1: 49:06

So I know it's gonna be great, so I will link to that and then follow her on Instagram. While you're at it, follow me on Instagram if you're not already, and thank you for listening today. Calia, thank you for being on the show. I really appreciate it. Thank you so much. All right, talk to y'all later. Bye.