Podcast Episode: Dr. Janelle Sinclair *Unpublished* ~ What is PMDD?

Do you suspect you have PMDD?

Join Mandy & Dr. Janelle on this unpublished podcast episode. Dr. Janelle & Mandy explore what PMDD is, a bit of Mandy's story & what initial steps you can take to tackle it!

Do you suspect you have PMDD or recently diagnosed with PMDD?? This episode is for you!

We cover:

• Mandy's personal story with PMDD & PME
• Foundational nutrient needs for supporting PMDD
•  Do hormonal imbalances cause PMDD?
•  What hormone testing can be helpful with PMDD & how should they be interpreted?

Catch the episode below!

Interested in a functional approach to PMDD? Schedule a chat here. 

Transcript:

00:00:02 Dr. Janelle

Awesome. So hormones can play heaven with our mental health and many women know this and experience this just a few days every single month. You know, I'm talking about PMDD or Premenstrual syndrome, but did you know that for some women, this period is very severe and it lasts much longer than just a couple of days?

00:00:23 Dr. Janelle

And it can be debilitating. And so I'm pleased to say that we've got Mandy Rother here, a functional nutritionist to speak with us about this topic and that's PMDD.

00:00:37 Dr. Janelle

So Mandy, can you tell us what PMDD stands for and what it is?

00:00:43 Mandy Rother

Certainly. And so happy to be here. PMDD stands for premenstrual dysphoric disorder and a lot of times people will call it PMS on steroids. And that's an easy way to think of it, but not always quite accurate because like the actual underlying cause is the. The Physiology is quite different.  And the impact is more severe. So as you started to talk. PMDD can impact for some, you know, up to half or even a little bit more than the month half of those days a lot of times symptoms can range from you know a week before the period to two weeks before that you know initial start of the menstrual cycle and really can have a debilitating impact on someone's life.

00:01:27 Dr. Janelle

Hmm, So what sort of symptoms that a woman with PMDD experience?

00:01:34 Mandy Rother

Yeah, it can be both. Like psychological symptoms, mental health type symptoms, and physical. So the physical ones, you would think of as more classic of PMS but can also be more intense, you know, bloating, breast tenderness, headaches, joint pain, insomnia can be very, very prevalent as well. On the mental health side, it can be severe depression, anxiety, even what people describe as rage intense irritability, and sometimes even severe brain fog. And just like confusion just changes in cognitive function. That impacts how someone can perform that work essentially at home too.

00:02:22 Dr. Janelle

And it can't be easy sort of being knowing that you're well two weeks one, you know, two weeks of the month and two weeks of the month, you're just, you know, someone different, isn't it? And with different capacities. And. Yeah. So it must be from a psychological perspective, that must be it. Must be very difficult to deal with.

00:02:43 Mandy Rother

Yeah. And a lot of people describe it as they feel like they're living a 1/2 life. Half of the time they feel like themselves, and then the other half it's just like a very sudden and intense change. Sometimes people describe like, I don't know who that person is or I feel like two different people and. And we can talk about this a bit further, but sometimes it's even misdiagnosis, bipolar. Which can be quite common. So. Yeah, can have a a significant impact for a pretty big portion Of the month.

00:03:18 Dr. Janelle

And a lot of women find it very difficult to get a diagnosis of PPDD, isn't it? And. And so you've mentioned bipolar disorder. Is there any other diagnosis that women can be given that has PMD?

00:03:34 Mandy Rother

Yeah, it's it can be. Well, there can be two different things that happen, either a misdiagnosis or someone can have what's called PME or premenstrual exacerbation of another underlying mental health condition. So there can be a lot of it. You know, it's called trans diagnostics. So it can overlap, so major depressive disorder, anxiety, bipolar, which we've said even borderline personality disorder. Anything that's driving even, you know, suicidal ideation or suicidal behavior. Others and eating disorders addiction, ADHD you know it's a long list, right? It's really common that there can either be a crossover between PMDD and those diagnoses making it the PME or that it can be misdiagnosed and show up as one of those things. So it's it's it's pretty common and can be hard to get diagnosed, I think because of that crossover and also just due to awareness, oftentimes you know I describe it. Because doctors may bark up like every other tree before they land on the diagnosis of PMDD, and sometimes it's even a family member who has maybe experienced similar symptoms or a loved one, or anything else, or someone reading online of like, oh, that sounds like me. And then they start asking the questions of their physician. But there are people hard at work spreading the awareness so more health professionals are aware of the condition and know how to accurately get to the right diagnosis.

00:05:05 Dr. Janelle

So it's key for people to actually record, like, keep a diary, right? And I mean, there are specific tools that people can use, but tracking their symptoms across the month, say, and so people need to. I mean, I'm not the expert on this at all, but I know that people need to be tracking it for at least two to three months. Right to actually get a Diagnosis. Is that right?

00:05:30 Mandy Rother

Yes. So I think they will require at least two months, but I think it's very helpful to track at least that two to three and then continue tracking even as someone seeks out treatment and support to track how things are working and then the diagnosis will be made if there's at least five symptoms present, there's a whole diagnostic list. With at least one psychological symptom, and so typically they look at like if you have your whole menstrual cycle day, one being the first day of the bleed all the way through, let's just use a classic 28-day cycle that. You know, symptoms may present anywhere between, let's say, around day fourteen in the middle or sometimes just the week before. Day 21 is through the end and then it lifts the symptoms lift either at the very start of the bleed. Some people get relief right away when there is underlying depression. Especially or other conditions, sometimes it lifts a little bit slower, maybe days 2-3-4-5. There there's a lot of different presentations of it, but the key diagnostic criteria for the practitioner would be the symptoms. Have is a really stark contrast when that menstrual cycle starts and that person gets relief.

00:06:46 Dr. Janelle

Yeah. So what lead you may need to become interested in in this area?

00:06:51 Mandy Rother

Yeah, as with many things, it's my lived experience, my own experience, and my journey with PMDD. And I would say for me, more accurately, it was at different times, more PME. I had underlying depression and anxiety that just significantly worsened. And either times of like heightened, like psychological stress, a big time for me when I actually realized I had the condition was during college, and I was your classic type, a student having 3 degrees at once and playing violin and playing sports and doing all the things, right? Just that intense stress and pressure.  But I think, yeah, so my my lived. Experience in going kind of through it.  And essentially how long it took me to find answers, you know, it came to this, you know, a determined place to, you know, help others. So it doesn't have to take them that long that we can expedite that journey and find relief a bit faster.

00:07:37 Dr. Janelle

Yeah, and yeah, how long did it take you to find answers? And then you go through conventional treatments first or what was your journey?

00:07:58 Mandy Rother

Yeah, it's. It's hard to put like a time stamp on it because I feel like it was like a slow peeling back of the layers of the onion, like as you know, was becoming a dietitian nutritionist and then, you know, expanding my training and you know, functional medicine, nutrition therapy and all these things. But yeah, my journey. At the beginning was, I would say, very traditional. You know, tried all the different types of SSRIs, different types of birth control, and I think you know, when I look at that starting point, I would say that's the biggest thing that fuels my passion today is because, with each thing I tried, it was, you know, just like a dent in my armor. The more I felt, you know, broken, the more I felt like I was beyond fixing.  Because it was like, OK, these are the standard treatments. These are research and they didn't work for me. In fact, many of them felt significantly Worse, and that is the case for many that even though there is, you know, there's research out there, there's data on there. In these treatments, there are various reasons why they may not work or someone could have adverse reactions. That doesn't mean that something's wrong with that person. It means that we have not found a comprehensive enough treatment approach for them.

00:09:11 Dr. Janelle

Yeah, I agree. I mean, there's not heaps of research into PMDD. Yeah. I mean, it's only more recently that they've actually started To do the research so You know what so were you studying to be a dietitian before and nutritionist before you got interested in PMDD? Or did you sort of start to train in that area because of your health conditions?

00:09:37 Mandy Rother

Yeah, I was already doing that training and on my way. And it was studying, you know, psychology at the same time. My passion originally was in the psychology of Behavioral change around health, so why do people make certain decisions regarding their health, and then what decisions do they need to make based on their Physiology, biochemistry, and unique makeup? And I think for me that stemmed from, you know, I think as a child, I and even as a teenager I probably had some degree of PMDD but didn't know or have an understanding of it. I just knew that when I took care of my health, especially as a teenager when I took care of my health. When I ate a certain way, when I moved my body, I felt better. You know, some of this duality that I felt emotionally inside me, even I found journals from childhood where I had doodled pictures of this dark, mysterious side. And then my happy, goofy, socially outgoing side and feeling confused that like why do I feel this way but I, you know, even before I knew what PMDD was. But I knew as a child that when I would go and and and bike or rollerblade or lift weights I would feel better that when I ate in a certain way I felt better. And so I just became fascinated with the connection between the body and the mind. It was later that I started to specialize in PMDD after working as a dietitian for over 10 years at that time, and now my practice is, I would say almost exclusively with with people who have PMDD. So it's it's evolved to be my primary passion.

00:11:28 Dr. Janelle

Yeah. OK. So what were some of the keys to finding healing for yourself? Cause I mean you've mentioned that when you did exercise, you felt better when you ate a certain way that you felt better. So what were the keys for you interested to find out?

00:11:46 Mandy Rother

Yeah. So for me, I had a mixed bag. I would say one of the primary things I would say was addressing digestion. I had some, I would say, assaults against my digestion growing up in pretty severe irritable bowel. Different digestive issues landed me in the hospital and then Fast forward, you know, about a decade from childhood. I had been on a PPI medication like an antacid, like common Prilosec for 10 years. And yeah, it wasn't until I studied nutrition that I knew that that was.

00:12:17 Dr. Janelle

Ohh really?

00:12:23 Mandy Rother

It negatively impacted me and how I was absorbing nutrients. Yeah. And so that's where I started was OK,  I have these symptoms. I can tell that my digestion is still off. And so I was able to, you know, safely get off that medication.  And address some of the root issues with my digestion, which for me I think was a combination of kind of bacterial imbalances, pretty significant like gluten and dairy intolerance, and then really supporting the absorption of nutrients to make sure that I had as you know as biochemists. The necessary nutrients to make all those brain chemicals. Yeah. So I would say it started there and then. You know, also uncovered some pretty significant hormonal imbalances and I should add or clarify that hormone imbalances do not cause PMDD. We can have a response in the brain, there are structural differences in the brain. You know, that can impact how someone responds to even normal hormonal fluctuations. But when a hormonal imbalance is there that can exacerbate PMDD symptoms. So in my case, I was diagnosed with PCOS, or Polycystic Ovarian syndrome, which in my humble opinion was triggered by the birth control I was on and intense amounts of stress.  And then a hint of genetics was thrown in there as far as how my profile was showing up, but that was leading to, I would say heightening of the kind of rage and anxiety-type symptoms that would present before my cycle. So figured that all out and then and then you know as even recently I would say in the past you know 5 to 8 years. As I've learned more on the genetics side like nutrigenomics and stuff kind of learning about my unique set of genetics that impacted how serotonin functions in my brain and even components of inflammation and histamine intolerance. Well, those kinds are parts of my PMDD puzzle that I've started to solve over time.

00:14:34 Dr. Janelle

Root cause? So would you agree? You know, as functional medicine practitioners, we don't always just look at symptoms. We try to look at the underlying drivers. So you know and I think there'll be very similar underlying drivers when it comes to depression or anxiety or chronic fatigue, but often it just presents differently for people and probably the same with PMDD. So what are the the sort of underlying drivers that you look for with with your client?

00:15:07 Mandy Rother

Yeah. And I think it's, you know it is unique to the person. There are unique root factors, but what I've started to do is look at what I like to call the low-hanging fruit. What are the most common root factors that impact almost everyone with PMDD you know, I think one of the biggest things is inflammation. There's research that there's or there's inflammatory markers that are increased in people who have inflammation and looking at how that inflammation impacts the brain and so sometimes that can be just related to the foods that are coming in and creating inflammation or not enough of the foods coming in that are anti-inflammatory and genetics can play a role in that as well. If someone has a bit of an uphill battle combating inflammation in the body and in the brain, so inflammation and I would say nutrients.  Of course, absorption of those nutrients related to digestion is also key and even blood sugar regulation or glucose regulation impacts nearly every mental health condition in every hormonal condition. That's why All of us always talk about it. There are increased glucose needs and the cerebellum of the brain in people with severe PMS and PMDD. And so I like to kind of geek out and look at, you know, all the root factors that impact glucose regulation as well.  And those, I would say are like the three most common factors, to begin with, and then?

00:16:42 Dr. Janelle OK so. And that was the second one you said. Nutrients, nutrients, and digestion, and the third one. Blood sugars, OK.

00:16:54 Mandy Rother Yeah, yeah. So I would say those are foundational for for everyone. And then from there, we can bring in the fancy stuff and look at other common factors like the histamine intolerance I mentioned. Sometimes they're, you know, the factors that impact someone's brain chemistry, their balance of serotonin and GABA.

00:17:14 Mandy Rother Dopamine and those sorts of things. So. But yeah, those foundational layers are super key.

00:17:19 Dr. Janelle Yeah, that's the thing you've. You have to get the foundations right, right? Yeah. Yeah, I think blood sugar is a big one too. When I see anyone with anxiety or panic attacks, you know, it's always blood sugars that we want to look at first because when the blood sugars drop too much, that's when the brain gives me some glucose. Give me some fuel. I'm starving here and so.  Then the adrenaline Comes in and that's when either people may experience that panic attack or probably that rage right and the pain did. It's that rage when that adrenaline come comes in and, you know, have those mood swings as you go through the blood sugars going up and. Well, yeah, So what sort of dietary advice would you give people with PMDD?

00:18:12 Mandy Rother

Yeah, I think even just big picture to zoom out a lot of times, what I see is someone will try to go all in with nutrition and eat this clean, pristine diet.  And that only lasts typically until the symptoms start again, and then they might feel. And if anyone's listening identifying like, yes, that's me. It's normal. Everyone I talk to experiences like I'm doing my best. I swear I'm trying, but then it is all. I just fell off the bandwagon. As soon as that.

00:18:28 Dr. Janelle

Yes. Yeah.

00:18:44 Mandy Rother

The luteal phase starts the two weeks before the cycle, so just for anyone listening, that's normal and so it's important with nutrition to start with what to add in in a flexible approach. Even though there may be inflammatory foods like say, adding to the inflammatory fire. Yeah, starting with that is overwhelming to just start taking out food. So building, you know, the foundation with this, I call it the peaceful period's plate. So making sure and these are things that are.  Helpful for any mental health condition, but Having half of your plate, even if you do anything, gradually working up to your digestion can get used to all the fiber, but gradually working up to half of your plate filled with vegetables and a colorful variety is one of the best things. And of course quality source proteins. About 1/4 of the plate for most people. And then gentle carbohydrates that other quarter and lots and lots of healthy anti-inflammatory fats. So even it's easier said than done, right? So with with nutrition, it's and and PDF.

00:19:56 Dr. Janelle

I think especially in America, in America, my sister just coming back from America and she's just like the food is is rubbish over there. There are so many preservatives compared to here in New Zealand. So yeah, maybe it is even harder over in America, but it's starting with real food, right? Actually. Thing around the edge of the supermarket and going to the fruit and veggies section and you know in your good in your good carbs and what kind of good carbs would you suggest like sweet potato and yams and what sort of other.

00:20:32 Mandy Rother

Yeah. So the whole hole in processed carbs. So yeah, root vegetables like that are great. You know, your sweet potatoes, regular potatoes are great too that we can't leave them out. Root root vegetables like, you know, parsnips and turnips and rutabaga, squash.

00:20:36 Dr. Janelle

1. Yes.

00:20:47 Mandy Rother

Josh is awesome, and then even you know, whole unprocessed grain. So you know, quinoa, Americans, rice, those sorts of things, and then.

00:20:58 Dr. Janelle

I think predominantly gluten-free.

00:21:01 Mandy Rother

A lot of people do benefit from eating gluten-free, but I would not say that's a hard and fast rule. That's something I would explore with individuals but worth worth having curiosity around. And then if someone does tolerate wheat and gluten, if you're in the United States especially.  Choosing organic wheat products just because of we won't we won't go down that rabbit hole, but organic wheat products.  Here. Yeah. And then, you know, sprout, it is is a bonus just to increase the nutrient availability.

00:21:34 Dr. Janelle

And like you know, I haven't had a truckload of clients with PMDD, but you know some of my observation was a lot of my my clients and clients with anxiety, depression kind of fatigue as they're not eating enough protein, good quality protein. Is that an observation?

00:21:55 Mandy Rother

Absolutely. Yeah. And maybe you're.

00:21:59 Dr. Janelle

Erring on the side of being a vegan or a vegetarian, have you seen that too or not?

00:22:06 Mandy Rother

Yeah. And I think it's, I see it in everyone, I would say, I can't even think of a client in the last year who I.  I felt I was eating adequate protein. Yeah. So it's, I would say it's so common and sometimes even, you know I mentioned the half plate vegetables adding protein makes I would say the fastest difference even within a given day of how someone feels and so and.

00:22:19 Dr. Janelle

Yeah, right.

00:22:36 Mandy Rother

And I do believe, you know, it's, I would say.  A little bit harder with, you know, vegetarians and vegans, but possible. So we just have to, we have to work with that and people who eat animal protein Even so, it's making sure that when we look at the individual meals and how they're spaced out we're not hopping on that blood sugar roller coaster we were talking about. And that's, you know, that's the foundation. If we don't have those, you know, the protein breaks down into amino acids, you've you've likely talked about that in the podcast before. Those are needed to make those brain chemicals that are so, you know, sensitive in folks with PND because of how the hormonal shifts impact that, that, that protein has to be there.

00:23:20 Dr. Janelle

Yeah. And a lot of people think that protein, it's just there for building muscle or maybe hair in your skin. But no, it's for your amino acids, for your neurotransmitters, for the brain in the double. The second thing is that it does help stabilize your blood sugars too, doesn't it? Umm, so as well as putting your fat.  So, you know, do you also advocate for, supplements, for PMDD? And are there any sort of general supplements that you would recommend to a woman that just like like give me something now that might make a bit of a bit of a difference? Food might be just too overwhelming. But you know what?  I want something could I take to improve my mood. Yeah.

00:24:02 Mandy Rother

Yeah. And I do consider I call it strategic supplementation. You know, part part of that foundation.  OK. Because, you know, like, like you said, even making a single change, sometimes even brushing your teeth, feels like, you know, climbing a mountain when you have those severe symptoms. And so I think, you know, supplements help provide a little bit of momentum. Sometimes they're that first domino that gets things going. And so and, of course. Food matters. We need to use food as medicine, but supplements, when used wisely, are highly effective. And So what I often see is someone will come sometimes with a whole bag. They'll show me via Zoom of like a whole bag of, you know, bottles tossed aside supplements. I've tried supplements, haven't worked and it comes down to either crap supplements. I'll frankly call them so low quality, poor quality nutrients, or sometimes just not like therapeutic amounts of whatever is in there.  Or it's not targeted to them or they haven't built that foundation. Yeah. And so I think, you know nutrients. Are are at.  That foundation. So if someone's take. You know, an herbal blend or a hormone support supplement, so some common ones like calcium glucarate and dim people will take like Vitex or chaste Berry. For PMD, those sorts of things can be helpful when it's right for that person and when the time is right. But they won't do much without the foundation of nutrients. Amino acids and fatty acids like Omega threes or fish oil supplementation. So I find that a high-quality multivitamin. I know it sounds boring, but a high-quality multivitamin and. A high-quality fish oil with enough of that EPA, maybe you've talked about that on here before, can go a long way go a long way.

00:25:55 Dr. Janelle

Yeah. So the EPA component is anti-inflammatory and is, yeah. And most people think DHA is another omega-3. That it's it's. The one that's highest in the brain and they say they think ohh I need DHA for mental health, but it's not. It's not the case. It's the EPA that makes a difference though. So what do you think about minerals, calcium, magnesium, and zinc?  They're they're quite key for PMD 2, isn't it?

00:26:21 Mandy Rother

Yes. Yep. So I'll so the most common trio that I'll do is the high-quality multivitamin which has, your vitamins and minerals. Then I typically add extra magnesium and then the fatty acids through fish oil or if needed, a. Vegetarian or vegan fatty acid supplement but with the magnesium. I find that a lot of people have heard of that. They're already taking it, and if anyone's listening, they can check their supplement bottle. They're often taking a lower quality form that doesn't absorb very well where it's hard to take enough before.  Letting you before your digestion sends you a little message that you took.  Too much so. You want to make sure that you're taking magnesium oxide.  Right, not so great. You want to look for the most I. Would say the.

00:27:14 Dr. Janelle

Could have been Constipation perhaps?

00:27:14 Mandy Rother

One to start. Yes, you are constipated, perhaps magnesium oxide. But even then I would probably choose magnesium citrate. Yes, but yeah, magnesium glycinate is my go-to.  And then sometimes we'll do magnesium malate or three and eight. There's there's lots of different forms. But is that where you normally start? So it's fun to see how practitioners.

00:27:39 Dr. Janelle

Yeah, yeah. Three nights. Not very available in in New Zealand. So yeah. So glycinate, the one that I've always used, it's it's it's nice and calming. So yeah, so it's it's it's good. Yeah, so.  Oh, OK.  I've found it interesting that your comment about PMDD is not being caused by a hormonal imbalance as I said, I'm not the expert on PMDD, but I've always wondered like and I haven't delved into the research about hormonal imbalances and the.  And was PMDD being caused by a sensitivity to hormones? You know, do you do hormone testing with the majority of your private clients and what sort of imbalances have you seen I mean I think one one of the thoughts is you know it's a producer-owned efficiency but the problem is that not everybody with PMDD.  Does have a producer's own deficiency? And I think maybe the research has shown that and that has been the common thinking, but it hasn't been. Well one, but I've I've had, you know. And as I said, a number of PMDD clients and most of them had hormonal imbalances, but they were all different. They were a combination of estrogen dominant. Some of them were actually estrogen deficient, which is not what you would expect. Others are produced around efficiency. Others are cortisol deficient. 0Others are called as are through the roof, you know, and it's like I have this gut feeling that probably it is a lot of it, a big component of it is hormonal, and but it's just we just can't define it to one type.  Would you agree with that or disagree? With me or.

00:29:31 Mandy Rother

Both I get fired up about this topic because well and there's there's new research that they're looking at they're they're calling them the temporal subtypes of PMDD. So depending on how it the.

00:29:38 Dr. Janelle

OK.

00:29:46 Mandy Rother

They call it onset and offset, so the onset is when symptoms start the offset of when they stop. OK, there's there's distinct types. And from what they've shared so far about the research, hopefully, the next step will be OK. So if there are different types, are there different underlying pathophysiologies to that? And so I think, you know, in the functional medicine space, we already know you can have one umbrella diagnosis and many different root causes. And so when I work with PMD, I approach it from that mindset of we know things of commonalities across the diagnosis of what's happening in the brain, what are common root factors, and then from there, we got to piece together the rest of the puzzle. And so with hormones, I do feel like there can be an.  imbalance. But I do see it all over the board too because I've done quite a bit of I'm here. We have Dutch testing or have done blood hormone testing and so I have kind of a way that I prioritize testing because it can get.  Cost prohibitive to do everything at once, or just even downright overwhelming. To test everything all at once. But I like to, depending on their symptoms, rule out high androgens. But you know that sometimes it's, you know, whether you call it PCOS or not. But the high testosterone. Or DHEA. 00:31:15 Mandy Rother Even DHT, I see that quite a bit and then even high prolactin prolactin is something to test and preferably during the early part of the the cycle you know within you know the first week or so of that follicular phase of the cycle that can be quite common. As well as all the things you listed. Sometimes they'll see estrogen excess. Or low estrogen, or all the cortisol things I've seen across the board. So that's why that's why testing is important. And then even if there is a hormonal imbalance, we have to ask why. And that's where often we come back to the common root causes of issues with digestion and detox and inflammation and the way the body is responding to stress and all those.

00:32:01 Dr. Janelle

Yeah. And umm, so you know, I can think of a few clients of mine with PMDD and quite a number of them had Constipation. Is that something that you see reasonably regularly with women with PND?

00:32:17 Mandy Rother

Yeah, both. I would say I have a lot of PMD clients who have tried everything like many, you know, medications, and types of birth control, a lot of them have even seen multiple nutritionists or naturopaths or functional medicine doctors, like people in. In the space that you and I operate in and and then we still. Uncover more digestive issues, and once we address those like, I cannot believe the relief experience and so whether it's presenting as Constipation or other, you know, bloating, diarrhea or any symptoms, you know, underlying bacterial imbalances can be a factor in. In the Constipation, you know? Hope if hopefully there's an easy remedy to that. Like you know adding in that magnesium more fiber, more water, and but if it's still being very, very.  Learn that can especially long term have an impact on hormone detoxification and lead to excess hormones being stored and recycled and wreaking havoc. Yeah. And I thought I don't think people realize that's, oh, it's just me, you know, only go every two or three days or twice.

00:33:29 Dr. Janelle

A week and. I'm like you don't. Realize you're holding on to all the junk you're holding on. To all the toxic.  Things and that overload. You know, there's different chemical reasons for that, but in the.  The liver.  Then people can't get rid of the estrogen and they don't realize that the gut this the just just the Constipation itself can be one of those reasons that they're not getting rid of their excess estrogen. And that can be triggering some of the PMDD or mood mood conditions here.

00:34:02 Mandy Rother

Well, and let's let's make a big announcement so everyone knows what is normal. So. Not normal to have a ball movement every other day or every 2-3 days if you want.  A minimum, I say one a day, preferably at least two or even 3A days.  Formed healthy soft stools are what you want for everyone.

00:34:25 Dr. Janelle

I always say, do you have a nice formed sausage or is it more like soft surf or sheets, pellets so soft?  The person she pellets is not what you want. Well, well-formed sausage once or twice or three three times a day. So thank you, Mandy.

00:34:42 Mandy Rother

There's your your poop report card. 

00:34:44 Dr. Janelle 

Yeah, exactly. So all has an impact, so.  When when you said before that you sort of have a priority kind of order, you know it sounds to me like initially you're making sure that people are feeling their bodies properly eating, eating well, and then what? What other sort of priorities do you work with, with, with?  People. Is it testing or is it stress management or what? What's what do you think's important?

00:35:16 Mandy Rother

Yeah. So maybe let's cover the testing piece 1st and so you know that's you know the world I live in, I can be guilty of being a data junkie because I love to get that data and really use that to get the most targeted approach possible. But it really needs to start with the cycle tracking and symptoms. OK. Yeah.

00:35:28 Dr. Janelle

Me too.

00:35:36 Mandy Rother

Charting that is your first line of data really, even if you know you don't have access to blood work or or hormone testing or any of these things yet, and even from there, I encourage people to look at even beyond the. Symptoms. What are their more innate needs during certain parts of their cycle? Like what? What is it they like want and need and desire to do? What are their natural strengths where you know those sorts of things? We get more of a look at the whole person versus just honing in and only focusing on symptoms. Plus that can be quite depressing and discouraging. And you kind of lose. Can lose yourself in that. But from there, as we bring in more information, I'd like to start with a pretty comprehensive blood panel before doing anything else. And that's important to us.  You know the nutrient markers, vitamin D, you know, even like a basic red blood cell pattern panel and a comprehensive metabolic panel, which here are standard labs that are drawn at most annual physicals and then adding in some more in-depth markers on, you know, to look at iron status and such can give a lot of information. And looked at it with the functional medicine lens and then the other thing that we didn't mention when looking at hormones is ruling out thyroid issues. I don't know about you, but I have often found.  Underlying, like hypothyroidism, I would say, especially your Hashimoto's. Yeah, you know, either causing the symptoms altogether or coexisting with PMDD. And that, as you know, as you talk about is a huge impact on mood. So ruling out thyroid or if it's not optimal optimizing that. Along with ruling out the androgens and prolactin stuff. We talked about it.

00:37:24 Dr. Janelle

Right. Yeah. OK, great. And the zinc one of yours. Favorite tests as well.

00:37:31 Mandy Rother

Yes, it can be, yeah. So zinc can be well and you can. I know you talk a lot about zinc, but yeah, look at that and then you know zinc tally test can help look at zinc status, what is your favorite way to test it sometimes it can even if it's like appears normal in labs, it's not always optimal.

00:37:31 Dr. Janelle

Is that something you? Look at. Why always teach people as well that you don't just take the standard reference ranges? Yes, like in the same with. Same with iron, you know, ferret ferritin, iron stores. Even if you are within the reference range. If you're in that.  The bottom is probably a quarter of that reference range it it's it's too low. So you know I just do the zinc standing zinc testing and just just kind of aim for optimal OK and and. It will depend on. What units do you use and everything you do in America? I'm in.  It'll be different, but you don't aim for the bottom of the reference range. It's not optimal, so yeah.  And yeah, and.

00:38:32 Mandy Rother

Oh, I was just going to I we have to use the optimal ranges and we have to look at the markers in relation to one another. They don't mean anything just by themselves. We have to look at the groups and connect the dots.

00:38:45 Dr. Janelle

Yeah, yeah. True. And you were saying earlier that genetics is an area?  That you've.  Become more interested in. Yeah. And so. So what sort of results have you found or what sort of genes have? Rather than calling them genetic mutations, I like to call them genetic weaknesses or vulnerabilities because we can compensate for these vulnerabilities. It's not. It's not. Your DNA is not, you know, written in stone. It's like we can compensate if there's. If you've got a weakness in methylation, we can give methylating.  Janelle Supplements. If we've got a weakness and you know vitamin D receptors, we can make sure our vitamin D is at a good level and sulforaphane. So yeah, what? What sort of genetic weaknesses or vulnerabilities do you look for or have you found in your client?

00:39:36 Mandy Rother

Yeah. So I'll run like a nutrigenomic test and what that means is we're it's looking at many, many different snips or the different kind of genetic profiles. And I would say, you know there there's some research on the genetics behind PMD, but a lot of what they're researching, it's like SR1.  And the stuff they're not as easily tested on like a test that serves to function to, like, support your lifestyle and nutrition, but one that I have a lot of curiosity around that I see a lot is around like serotonin transmission, like how serotonin functions in the brain HTR 1.  OK. And so I wrote a note here actually it's.

It can increase the risk of community by 2.5 having one copy of that and so like looking at the report I use looks at a bunch of different of the snips or genes related to dopamine, some related to serotonin.   And GABA. And so I see a lot of shifts in there and even comped, which can impact neurotransmitters and estrogen detoxification and such. So I'd say those are common. So all the everything. Having to. Do with brain chemistry and methylation, of course, which is not just MTHFR, it's there are so many different things that impact methylation. So I'll see common things there. And then even related to the histamine, sometimes people just genetically don't make the. You know the two enzymes that break down histamine, the DA O&H NMT. So. Those are and then. You know.

00:41:24 Dr. Janelle

A lot of people don't realize that histamine is a neurotransmitter anyway. You know, people talk, and think about histamine and allergies and maybe maybe if they know a little bit more, they might think about histamine intolerance and gut house, but then they don't realize histamines and neurotransmitters. It's a little bit like dopamine and it is, in the way that it's. Military serotonin's inhibitory histamine is stimulatory so that can probably give rise to anxiety. Type of thing I think. Yeah. So interesting. So I mean, we probably shouldn't spend too much time on tuning that's cause it's that gobbledygook has and that with all these names. But HTR 1A I mean it. Yeah. Interesting. But definitely for something I think for people that have been. Very treatment-resistant and have felt like they've done everything before. I think genetics could be a game-changer though.  Would you agree? Yeah.

00:42:21 Mandy Rother

Yeah, I would agree. And, it was, it was a turning point in my journey actually in a slightly different way. And so I just want to put out there too, like if anyone is experiencing like crisis and severe symptoms and it, it can feel overwhelming to start you know.  A healing journey. If you're feeling like. Yes, I need medication and my doctor's having a hard time finding the right one. There are psychotropic genetic tests at least available in the US. I'm not sure if you have them there, but they'll look at how you specifically or you know, based on your genes, metabolize certain medications. And you know, so there's, you know that sort of testing and you know in my line of work, we prioritize and focus on. What are the genes that we can impact I think of it as you know, if you have certain genes that put construction cones and roadblocks in your way, how do we circumnavigate around those and and find a new path to get your body back to Wellness? So, but yeah, big, big game changer and helps to answer a lot of questions.

00:43:29 Dr. Janelle

Yeah, well, maybe you could just share with us a success story of one of your clients or I know that you've got a course as well. I think it's a PMDD reset. So maybe you could just, yeah, share a little bit of their experience and what type of interventions have helped them. Along the way.

00:43:49 Mandy Rother

Yeah. So, gosh, it's hard. It's like trying to choose your favorite, you know, and the thing that I'm floored by is I'll say this first is, you know, with.  Is anyone you know struggling with PMDD? It's really from all walks of life, you know, I'll work with. You know perimenopausal women, you know versus, you know, even new moms or moms in the thick of it or, you know, just people from all walks of life. Even I've had. A lot of.  College students have had to leave college and pause their education because of the severity of PD. And so. You know, whoever you are like, wherever you are, like whatever stage of life you know, you're not alone. So anyone listening and so, you know, it doesn't discriminate, you know, as far as you know who it impacts. And so.  I'm just thinking of one of my very first PMDD clients who was a college student and had to stop her education at that time. And was, you know, had tried all the antidepressants, you know, all the all the conventional treatments and, you know, really struggling with severe, you know, suicidal ideation. A more recent client that she reminds me of has very similar stories but with both of them, we started that kind of from the bottom up at the foundation. Just big gaps in the diet impacting blood sugar nutrient gaps and then looking at more of the specifics between their hormones and what was impacting their brain chemistry. So for for one of them, it was that the thyroid was not functioning optimally impacting everything and then.  For another one, it was she had both androgen S and estrogen excess. So everyone you know has their unique puzzle. But starting from the ground up. And you know, so. So those two college students come to mind, and then even more recently just thinking about two mothers who, you know, was impacting their professional identity as well, one having to stop work and one feeling like she just was not, you know, being the mother she always imagined she would be.  Like she could kind of white knuckle it through work, make it through the day. But then when she got home, her family got the brunt of it. And yeah, and it's and it's so and it's, it can feel so isolating. Like, even if you feel like you're never alone because life is chaotic and you have people around you like it. It feels very lonely and.  Isolating and both of those, these are clients that like are one is graduating this month and one graduated last month. I think one had like 87% symptom reduction and one had like 97 or 98% symptom reduction. And this is you know one of them went from like. 14 days impacted with moderate to severe severe symptoms down to 0 and so you know these are these are the stories that keep me reading and researching and like going to work. Every day just to see that come to life. So I couldn't ask for a better job to have.

00:47:07 Dr. Janelle

Lives change. Yeah. And it's not just the women's lives, it's the family's lives say that you're impacting Mandy, that that's fabulous. And I know that you know, Pindi can be very severe. So what helpful advice have you got for women in their worst? Days or weeks and is there, you know one. You know, if you could just give one tip of on your difficult days. The one thing that you could say please do this. This is your essential.

00:47:41 Mandy Rother

Yeah. Ah, yeah. And  I think you know the first thing and I'll just put a resource out there like again if anyone if someone's experiencing a crisis, depending on where you live in the world, there's always crisis support available. So the IAP MD.

00:47:42 Dr. Janelle

That one was it. Tough, tough question.

00:48:00 Mandy Rother

The International Association of Premenstrual Disorders. They have a whole, you know, link on their site for crisis support. So and then you can search by country and everything. So just put that out there and then next to know like it's valid and it's real. Sometimes we can gaslight ourselves or feel gaslit by the medical community or even by loved ones. So just to know that. You're not alone, it's. Real and there's a community of people going through it and working towards healing. Even, you know, beyond my group, just all around the world, there's a global community and.

I think at the moment at the moment this may sound like strange or backward advice, but it would be to stop trying to fix it, to stop trying to fix your broken cycle or your broken body and call a truce with PMD. Call a truce with your cycle and stop seeing it as the enemy.  And to in that moment, you know, just sit and be with yourself and even ask yourself like, what? What do I need? What is my body telling me? And to start to see it, you know, those symptoms is not who you are, it's it's information, it's information and.  That's the starting point. You know, we stopped fighting.  It and fighting against it.  We can lean in a little bit and listen, and that is the first step to actually uncovering some of these things we're talking about today. And it's, I think the the biggest barrier is that it's hard to believe that's possible when symptoms are so severe and you know, especially if you've had family members who have suffered from it, so.  Yeah, it would be to stop and listen. Listen to what your body's telling you. I know that sounds like strange advice, but just trusting in that and trusting in the process.

00:49:49 Dr. Janelle

Yeah. And knowing that there are.  There is help out there and continuing in the journey, not giving up hope, realizing that there is hope and there are solutions and people such as Mandy and well, thanks for joining us today, and yeah. For all your. Support and you know. Yeah and. Your fight. You're not fighting with PMD, but fighting for PMDD and women who need answers. And I know you run your own business. It's called real reveal functional nutrition. So how can people find out about you and you're consulting yours?

00:50:30 Mandy Rother

Yeah. So they can go to my website if you want to link to that occasionally I'm on Instagram. Can connect with me there and I.

00:50:40 Dr. Janelle

For your website. Reveal functional nutrition.com. Is that right?

00:50:44 Mandy Rother

Yep, Yep. Yeah. And there's information about the group program. I just launched the first one, but we'll be launching another, you know, Community Group for group coaching, likely in the fall. And then I do. Often a lot of hybrid work, so group and one-on-one, or sometimes just one-on-one with like the data-driven and lab testing approach, yeah.

00:51:10 Dr. Janelle

1. Well, if you're listening and you've found today's information helpful or if you know someone else with bad, I'll, I'll call it bad PMS and it's not to degrade. The only one who's experiencing this, but I just to simplify it so people. Sort of have some so rather than using a term that people don't understand, but if you know someone that you know suffers badly every month, or you know that they have poor mood, which seems to be cyclical and it's up and down, then I would just ask you to share this podcast. And if you're interested to learn more about mental health. And if that's the body's soul and spirit, please subscribe. So thanks again Mandy, for joining us. It's been so great to have you.

00:51:53 Mandy Rother

Yes, thanks for having me. Bye.

00:51:54 Dr. Janelle

Yeah. And we'll see you again, I'm sure.

00:51:58 Mandy Rother

I hope so.

 *All information on this site is general information and education only and is not meant to be personal medical advice or a substitute for a medical evaluation.