What Can At-Home Hormone Testing Tell Women Over 40?

Nikkiey: Real quick, the only ask I could ever have of you guys is to help spread the word so we can help more women lose body fat, build muscle, reach their goals and feel insanely confident. And the only way we can do that is if you rate, review and share this podcast. So the single thing I ask you to do is leave a review. It will take you 10 seconds, and it will mean the absolute world to me and may change the world of someone else.

Stephen: Now, I want to say that I've run thousands of these labs. This is one of the best estrogen to progesterone ratios that I've ever seen. Not just saying that because, obviously, we're on the show right now.

Nikkiey: No way.

Hey, everyone. Welcome back to the show. Today's guest, who I'm very excited to have on the podcast, is Dr. Stephen Cabral, a renowned board-certified doctor of naturopathy, founder of Equi.life and the Integrative Health Practitioner Institute. He was diagnosed with a serious illness at age 17 and, finding no hope in traditional treatments, Dr. Cabral turned to a blend of ancient Ayurvedic methods and modern naturopathic and functional medicine. This journey not only led to his recovery, but also shaped his approach to wellness and what he preaches today. He now leads a successful online practice with over 250,000 client appointments. He specializes in functional medicine and personalized wellness plans, tackling a range of complex health issues.

And today I'm very excited for him to be here. I'm going to pick his brain on functional medicine and his book, The Rain Barrel Effect. And he is also going to read my at-home stress, mood and metabolism results. If you guys are interested in taking this test at home, you can do so by going to stephencabral.com/macros. That link will be in the description below. But welcome, Dr. Cabral. I'm super excited for you to be here. It's a pleasure to have you on the show.

Stephen: Thanks so much for having me. It's great to be here.

Nikkiey: Awesome. So I just want to dive right into it. I want your take. Can you explain what functional medicine is first and foremost, and then how it differs from traditional medicine?

Stephen: For sure. So functional medicine, or what we like to call it more, integrative health, is a divergence from conventional medicine, but not in the way that we actually know about the human body and science. A lot of people think, oh, either you go with conventional medicine if you want to follow the science, or you go over to integrative health or functional medicine if you want to follow something else that's not really based on science. But it's actually not that way.

With your nursing background, and with medical school, whatever you're studying, the first couple of years you take all of the same courses: toxicology, kinesiology, anatomy, physiology, oncology. I always call it all of your ologies. It's the study of all the different parts of your body. So we take that, but then conventional medicine for the next couple of years studies pharmaceuticals, and they study the disease pathology and how pharmaceuticals can intervene to essentially mask or block all of those symptoms.

As a doctor of naturopathy, what we do is move on to say, instead of using drugs the last two years, what if we used herbs? What if we used diet? What if we used exercise? What if we used nutritional supplements? What if we used all these other modalities we have that we wouldn't use if we had pharmaceuticals? So that's the major difference. We look at the human body and health, and we understand the body in the same way. We go about fixing it in two different ways.

In my opinion, conventional medicine is needed for acute-based care and emergency medicine. I know your background, you worked in emergency, right? You need that. If I lose a finger or I'm having a heart attack, I need emergency care, not naturopathic medicine. That's just the truth. Now, ideally, I get that person a year earlier or a few months earlier, right? And so what I'm working on is never having that heart attack in the first place. An injury, I can't help. We all get injured, and that's when we need emergency care.

But honestly, everything is being treated right now as chronic-based conditions by masking the symptoms, when all of them have an underlying root cause and can be fixed. And if all you do is continue to take the pharmaceutical, you'll always have the disease. You're just masking the outward symptoms. With naturopathic medicine or integrative health, you don't use pharmaceuticals. You don't mask the symptoms. You get to the underlying root causes, where a healthy person can't be sick.

Nikkiey: Okay. Thank you for the answer, I love it. To dive a little bit deeper on that, why do you think functional medicine is not more widely practiced in hospital settings, outside of the ER? When you go to the floor, why isn't more of what you're saying here taught and practiced outside of the ER in other departments?

Stephen: Yeah. So the ER will always have to be conventional medicine. That's an acute circumstance. If it's lifesaving, we have the best doctors and nurses in the world, a lot of them in the United States, and I'm very happy that we have emergency medicine. We need that. We also need all the advanced testing. So I'm not saying we don't. There's a time and place for both conventional medicine and integrative health or functional medicine. There really is.

Why aren't more people doing functional medicine? Well, it's not taught in medical school. And the reason it's not taught is that medical school is driven by insurance. And insurance says we need to get the most patients in a day with a very simple formula: run blood work. If it's high, out of range, give X, Y or Z pharmaceutical. If that pharmaceutical does not do what it's supposed to, use the next pharmaceutical. That's the entire system.

I find this so hard to believe, because we have some of the most brilliant people in the world in the medical industry as medical doctors, general practitioners, specialists and nurses. And they are like robots running labs and giving out pharmaceuticals, giving out drugs. They're using all their brilliance for that. That's why they're going to be replaced by AI really quickly, because there's no real art to that whatsoever. It's come in with A and leave with B.

Whereas functional medicine is, oh, you have high cholesterol, you have high blood pressure, you have low thyroid. Let's just say you have low thyroid. I bet one out of five women have functionally low thyroid. So their TSH, instead of being a 0.5 to a 2, might be a 2.5 or 3. And their endocrinologist or their doctor says everything looks good, no problem. And you might say, but I'm dealing with thinning hair, dry skin, cold hands and feet, low mood, low libido, brain fog, all symptoms of low thyroid. Yet conventional medicine says you're fine until you move out of the 5.0 range. Instead of it being 0.5 to 2.5 or 2, they go from 0.5 all the way up to 5.

And even if you're out of range, they just give you levothyroxine or some type of medication. But the truth is, you might have high levels of cortisol. There are about 12 different reasons why women may have low thyroid. It might be high cortisol, low vitamin D, high levels of aluminum or mercury or arsenic or cadmium, or low selenium, zinc, iodine, B6. So what we do in functional medicine or integrative health is look for the reasons why a woman or a man might have low thyroid instead of just giving them the pharmaceutical.

But that is not covered by health insurance. It takes a little bit of extra time, and it takes me getting to know you a little bit better. It's a much deeper relationship between patient or wellness client and practitioner, rather than just, hey, how's it going, here's your blood work. Conventional medicine is very transactional. There's no real relationship.

Nikkiey: Yeah, I love it. Spot on. Especially the point about addressing the symptoms rather than the root cause, and just one pharmaceutical after the next. I'm interested to hear your take on this, and I think you mentioned it in your book too: the future of functional medicine. Let's transition into talking about your book. How does The Rain Barrel Effect contribute to this vision? Where do you see functional medicine going?

Stephen: So it's funny. I wrote that book, which is still as viable today as it was a few years back, but it's progressing even faster. With machine learning and artificial intelligence, we're going to be able to use that for good, not for evil.

Right now, functional medicine has the ability to use precision-based health. Your blood work is great. You should run your blood work every six months if possible, if not, every 12 months. But it doesn't cover everything. It doesn't look at gut health. It's not looking at heavy metals. It's not looking at cortisol throughout the day. It's not looking at food sensitivities. It's very rarely looking at omega-3s to omega-6s. It's not looking at inflammation. So there's a lot that you're missing. What conventional medicine doesn't tell you is that you're missing all of the things that point to the underlying root causes.

So what we now have the ability to do is ship a lab to anyone in 27 countries around the world for you to take right at home with a urine sample, hair sample or blood spot from the finger, so not a blood draw, because nobody likes to have their blood drawn, or with saliva. Then you ship that back to the lab. You get your results. The results are sent to you with an easy-to-understand plan. You get a coaching call along with that and a personalized plan.

That's real integrative health and functional medicine. That means you're not getting a plan that your sister or brother had, your parents had, your friends had, your gym buddy had. You're getting one that's built for you. That's your nutrition, everything that you need. So that's what you can get right now.

Now, with machine learning and artificial intelligence, well, we are one of the largest, if not the largest, at-home lab provider in the world with Equi.life. We have well over half a million labs, and we use a HIPAA-compliant, totally anonymized system. So when we get it into our system, it just looks like ones and zeros. It's just data. That's it. Not attached to anybody. But we can actually see all the precursors ahead of time to what leads to autoimmune issues, what leads to poor longevity factors down the road. So we're going to be able to do predictive analytics as to what may come in your future if we don't rebalance X, Y and Z. And we'll be able to tell people 10, 20 years out, before it's even a worry.

So I find that to be dramatic. I mean, amazing. And you can only do that with a supercomputer. For example, one of our labs, the Candida, Metabolic and Vitamins test, has 77 biomarkers. I don't want to do the math here, but what's 77 biomarkers times the 100,000 labs that we have of that? That's a lot of data, right? A lot of numbers that it's able to crunch within seconds. So I'm excited for that and what it means for all of us.

Nikkiey: Yeah, that's incredible. I'm excited for that too. The future just seems so bright for, one, the personalization, how nitty-gritty you can get with a client that you work with. But also getting down to the root, getting down to what the actual cause is and how it can be addressed and fixed through eating right and moving your body, not just taking medicine to fix the problem. So I love it.

In your book, you also address the impact of stress and lifestyle on health. Can you talk a little bit about how you address that in the book?

Stephen: Yeah. So the first half of the book, The Rain Barrel Effect, is how we get sick and why. Because it's important to know why you got sick in the first place, or even just why you feel lower energy, lower mood, lower ambition, lower drive, lower libido, all the lowers, right? Why do you feel that way? Because it doesn't happen just because of age.

I got sick at 17 years old. It took until 27 to get well, and that's because I didn't have the information that we have today. But now I'm in my mid-40s, and I have way more energy and feel way better than I did even as a teenager before I got sick. So why is that? Well, as a teenager, I still had allergies, digestive issues, food sensitivities. I had heavy metals. I had all these issues that I didn't know about. So we figure out what those things are that are keeping us from becoming well. And of course, we can find those in an at-home lab test as well.

The second half of the book is how to get well. That's the DESTRESS protocol we use in my practice. It's diet, exercise, stress reduction, toxin removal, rest and sleep protocols. It's emotional balance. It's scientifically backed supplement protocols. And it's a success mindset. So if we look at stress, emotional balance and mindset, that's three out of the eight that are all dedicated to essentially reducing stress and balancing overall healthy emotion in our life.

That's because it's so important. You can weaken your immune system, throw off your stress response, increase stress hormones like cortisol, lower progesterone, especially in women, lower testosterone in men if they get more stressed, and lower thyroid in both men and women, just from stress alone. Plus, it can cause gut-based issues and slow digestion, which can potentially lead to SIBO, small intestinal bacterial overgrowth, with ileocecal valve dysfunction, all these different things. And it all comes from stress.

There's actually a name for it: the neuro-endo-immune system, or function. So the nervous system, that's stress on the body, fight or flight, can cause a disruption in hormones, that's the endocrine system, the endo, which then affects our immune system, and that can lead to autoimmune or other factors. So it's pretty profound. And again, conventional medicine will never talk about stress being implicated in real dis-ease in the body.

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Okay, so a question for you based on the women that we serve. Inside of WarriorBabe we have women who are 45 to 65 years old, and we have a coaching team where each coach has a roster of upwards of 50 to 60 clients. A lot of women come to us with hormonal problems, thyroid being off, stress, cortisol being high and elevated. And a lot of them are coming in not eating enough food. The big one too is that they want to be on low carb and/or they want to be intermittent fasting. Can you talk a little bit about your take on that, especially for women with those precursors going on? Then you throw this diet at them to follow. How is that going to help them?

Stephen: I agree. The problem is that we have to look at the body as a very finely tuned machine and organism that, especially in women, responds to stress in a very systematic fashion. For example, let's say a woman is experiencing a higher level of stress. We know that in a woman's body, she will most likely begin to increase cortisol. She'll most likely begin to decrease progesterone, because more of that will be shunted towards cortisol. And she'll end up with something called estrogen dominance.

Now, that'll never be seen on regular blood work, because it's about the ratio. They'll still be within okay ranges of estrogen and progesterone, but they'll have all the symptoms of high estrogen and low progesterone. It will look like increased water retention, lower mood, overwhelm, anxiety, adult-based acne, oilier skin and hair, colder hands and feet. We'll start to see that. And we may also start to see disrupted sleep and lower thyroid over time. Lower thyroid will be the creeping up of the TSH, the thinning of the hair, the drier skin, the lower mood, the brain fog, even weaker digestion.

So what we want to understand is that everything is a stressor. Lack of sleep, that's a stressor. We're trying to work more and more, more output, less sleep. That's a stressor. We're trying to fast more than ever. That's a stressor. We're trying to do cold plunges and saunas. That's a stressor. We're trying to do hard workouts, HIIT, Metcon, boot camps, et cetera. That's a stressor. And now we're taking down our diets as well. Our calories are becoming hypocaloric. Now the body's like, oh, and you're not giving me enough food. Now it's a greater stressor.

So how can we be surprised when women's hormones become dysfunctional and they end up with fertility issues or even PCOS, et cetera? The stress load is too great, and the body is responding exactly with what it knows to do.

Nikkiey: So then how can food help that? How can eating right help that?

Stephen: Yes, I'm sorry if I missed that the first time. Eating right tells the body that even though we have a lot of stress, we have the fuel to be able to combat it. And so if you tell me, okay, I'm getting enough calories, but I'm missing a whole macro group, I'm missing all my carbs, well, the body knows that in fight or flight it needs glucose. There's this misnomer that it's fine using ketones. It's not. That is not it at all.

I would actually say being on a long-term keto-based diet is very detrimental for women. I don't think women's bodies were meant for it, and neither were men's. But women's bodies are far more finely tuned. The reason is that they need to carry on life, not just their own life, but be able to reproduce the human species as well. And so if their body believes it's starving at all, it won't get pregnant. That's what we've seen in our practice for many, many years now.

Now, I'm not saying everybody needs 150 carbs a day, but finding the right amount of carbs to protein to fat, keeping that balanced and being well nourished, not just with macros but also with micros, which I'm happy to talk about, is really how we keep a person's body safe.

Nikkiey: Amazing. You're becoming my best friend, Dr. Cabral. I love that you're on this podcast right now sharing this insight, because I totally preach all the things that you're saying. Macronutrients, follow a balanced diet. We want to heal from the inside out. Aesthetics are beautiful, great. We all get into this wanting to see a better image of our body. However, how you're functioning on the inside is what's going to create the longevity for your life, and the muscle that you build, the organ of longevity, as Dr. Gabrielle Lyon says. So I love that you're saying all this stuff, because I can say it, but having somebody else share this insight is just beautiful too.

I know we're going to dive into my lab results, and I'm very excited and nervous to hear the outcome. But you mentioned a little earlier that there are different types of hormone testing available, such as urine, saliva and blood tests. How do they differ, and which is better for accurate results?

Stephen: That's a great question as well. So I still love blood work. It's really not that I don't. I use blood work to look at a complete blood count, which looks at your red blood cells, white blood cells, et cetera, and cholesterol and lipid panels, so good cholesterol and bad cholesterol, and I'm using that in air quotes just for today's show. And we look at all the major functions of the body, because you want to make sure there isn't actually a disease state. So that's very important.

But when we look at functional medicine lab testing, so at-home lab testing, we have to understand that regardless of what some labs say, you can't use a hair mineral analysis, that minerals and metals test, to find parasites. No matter what, that data is not accurate. So even in the natural health field, we need to be realistic about what's actually possible.

In your hair, we're going to look for minerals and heavy metals. We know that for decades now they've been using it in clinical-based research, believe it or not, in pregnancy, to look for heavy metal excretion through the hair. It's a very safe way to look for it. They also use it for FBI testing, drug testing, so much more, because we know that hair is a protein that catches what's excreted by the body. So we look specifically for minerals and heavy metals.

Saliva is one of the very best ways, if not the best way, to look at free levels of hormones. So not what's bound up within the blood, but actual free levels of estrogen, progesterone, testosterone, DHEA and cortisol. It's also one of the best ways to test cortisol throughout the day. Unless you're going to go in and get your blood drawn four times in one day, you can't measure your cortisol curve throughout the day. Cortisol should be high in the morning, between 6 and 8 a.m., and then start to lower as the day goes on. And probably the most important time to know your cortisol is before bed. We're going to review yours today as well. That's the most important number, even more important than the morning.

Then thyroid. Thyroid is best tested with blood, so we can use capillary blood. And that's the difference. You can't use capillary blood quite yet for a lot of other blood tests like a CBC, or complete blood count, but you can use it for thyroid hormone. Very accurate. We use, again, FDA-rated facilities. These are CLIA-certified labs, all third-party tested, so it's at the highest level possible. And then for gut testing, you want to use either urine or stool testing to look for fungus, mold, candida, bacteria, parasites and H. pylori, which is a bacteria as well.

Nikkiey: Beautiful. Thank you for explaining that. I was very intrigued to know the difference, because when you go to a doctor, they just test your blood. That's just one marker at a given time and day. Whereas with saliva, like you were sharing, the results show up as you go throughout the day, especially for cortisol.

Stephen: Blood is also the last place for anything to go wrong. I think that's important to know too. Blood is a homeostatic fluid. If your body's low in calcium, it just pulls more calcium from your bones, or whatever it needs from the food. If your body's low on anything, it will usually rob it from other areas in order to maintain a level of consistency. That's why it's not the best first place to go. That's why it diagnoses disease. And that's why things can be found five or 10 years earlier with at-home labs that don't necessarily look for the disease state, but for the underlying mechanisms of it.

Nikkiey: Interesting. Okay. Can you give us an overview of what you're going to be reading with this at-home lab, what it entails? The specific aspects of the stress, the mood, the metabolism, what does it examine? And then we can get into these results.

Stephen: Yeah. So we're going over the first part, where we're looking at estrogen, progesterone and the estrogen to progesterone ratio, which I'd love to explain a little bit more. That goes back to estrogen dominance. Believe it or not, in our practice, we see about eight out of 10 women with some level of estrogen dominance. Now, that could be because they're coming into our practice already out of balance. There's no doubt about that. But it's probably the biggest thing that isn't being talked about. Those are the symptoms I just spoke about: lower mood, lower energy, disrupted sleep, oilier skin or adult-based acne, potentially thinning of the skin, and bloating around the last seven to 10 days of the menstrual cycle. That's essentially the symptoms of estrogen dominance, and a lot of what might be referred to as PMS or something like that. So that's a really important factor.

We look at DHEA and testosterone. These are for both men and women. Men and women have different levels, but that doesn't mean they don't both have some of these. And then we look at cortisol. Your morning sample from when you wake up, cortisol is that energy and stress-based hormone. Then we look at it at noon, around dinnertime, and then before bed. So that's what we're going to look at on your lab today.

The lab that I know we're going to offer to your community also tests thyroid. It usually goes over free T3, free T4, TSH and TPO antibodies. Then it looks at vitamin D, and it looks at your insulin and hemoglobin A1C for blood sugar. So those are all usually part of the overall test. That's the second half. I'd actually love to upgrade your lab to that, so I'm going to make sure you get all of those numbers, but I can explain it here today. And we're going to go through all of your hormones and stress hormones right now.

Nikkiey: Okay. Amazing. Well, the floor is yours for reading these results, Dr. Cabral.

Stephen: All right. So this is really straightforward. Obviously, all of this is completely private. I want to mention that as well. I operated two wellness centers in Boston, Massachusetts. We typically had 20,000 appointments a year, and we're now over 250,000. And we said, a lot of people want to get access to this, how can we bring it globally? So that's what we did. I hired a medical director in all 50 states, and we have them overseas as well. I'm sharing this with you because everything is kept private. People are always worried about privacy, and I agree, I think you should worry about that. This is not shared with your medical doctor. It's not shared with your insurance. It's not shared with anybody else. So Equi.life, the lab running your results, and you. That's it. It's like a triangle of only those specific parties.

So how it comes in is a graph, and the graph isn't even that hard to read. It basically shows red for out of range, yellow for not optimal, and green for optimal. Then we start to look at the overall health of the individual and the ratios. So for you, I'd love to take you top to bottom, if that works, from estrogen all the way down to cortisol.

Nikkiey: Yeah.

Stephen: All right. Perfect. So we'll go over the first couple. This actually matters: for women, if you do have a menstrual cycle, you want to run the lab around day 19, 20 or 21. Did you run it at the peak of your luteal phase?

Nikkiey: Yes, I did. I marked it on my calendar.

Stephen: Perfect. That's going to give you the most accurate reading. If you're ever feeling any of those symptoms that I spoke about before, your symptoms will probably be greatest during that period of time. So we're going to look at what your estrogen to progesterone ratio looked like.

I do a lot of these readings. Again, we run hundreds of thousands of labs. Your estradiol should be between a 0.5 and a 1.2 during the luteal phase. And your progesterone, they say should be between 75 and 270, but really you want it above 150. Yours was 179. So you have a 0.9 for estradiol and a 179 for progesterone, with a progesterone to estrogen ratio of 199. And you want it above 100.

Now, I want to say that I've run thousands of these labs. This is one of the best estrogen to progesterone ratios I've ever seen. And I'm not just saying that because we're on a show right now.

Nikkiey: No way.

Stephen: Yeah. We're going to get to the rest of your hormones, but besides DHEA, which we're going to talk about, all of your hormones are very balanced. And it could be because you're getting adequate sleep, the right food, the right exercise. I wish I had your thyroid. I'm a little upset I don't, but we're going to get that. From what I can see right now, there's one marker off, so I want to talk about that. But your hormones are very dialed in. So obviously, kudos to you for doing a lot of the right things in life. There's no doubt about that. It has to be.

Nikkiey: Amazing. I sleep like a baby. My HRV is like 145 to 150, max 200. And my heart rate gets down to like 35 to 40 when I sleep.

Stephen: There are a lot of jealous people out there right now, including me. Those are incredible numbers.

Nikkiey: Thank you.

Stephen: Even when I was six years old, I have no doubt my HRV was not 140. Good for you.

Nikkiey: Thank you.

Stephen: All right. So now we know your estrogen and progesterone are dialed in. And again, most women's won't be, so you're not the average case study here. Your testosterone, we want between 16 and 40, and yours is 29. So I think that's excellent. The higher we go above 40, the more we get into the territory of PCOS or higher androgenic-based effects. So yours is natural, perfectly healthy at 29.

Your DHEA, though, is 1.6. We want that between 6 and 18, so obviously 1.6 is very low. Now, we have to look at this as part of the overall cumulative picture of the test. DHEA is basically a prohormone, or precursor, to testosterone, to estrogen, and to balancing cortisol and progesterone. DHEA is dehydroepiandrosterone. So in this snapshot in time, DHEA may have just lent itself to the others.

It's kind of like this. Let's say you've got a jug of water and six glasses that you want to fill up. The jug of water is like pregnenolone or DHEA, and DHEA pours itself out for the other hormones. So at that moment, you may just not have refilled. That's literally possible. Your hormone cascade goes from cholesterol down to pregnenolone, down to DHEA. And DHEA essentially balances testosterone and estrogen below it and, to the other side, progesterone and cortisol.

So I don't know that I have a big issue with this, because if there was an issue downstream, you would see low testosterone, or you would have seen low progesterone and/or estrogen. And I don't see that. So I don't see it as an issue, and therefore I wouldn't supplement with it. But I would put a little pin in it and have you rerun this in four to six months.

Nikkiey: Okay.

Stephen: All right. Now, your cortisol in the morning should be between 6 and 9, and yours is 6.4. There's nothing wrong with that number, it's not bad, but it's on the low end. So I would ask you, do you wake up a little groggy, a little sleepy? Or do you feel pretty much ready to go without caffeine?

Nikkiey: Yeah, a little groggy, a little sleepy. And I need the caffeine to wake me up.

Stephen: Okay. That's probably that slightly lower cortisol in the morning. You'd feel much more awake if it was a 7.5 or an 8. Not necessarily pinned to the top at 9 or 10 or even greater, but just a little bit more. We use a product called Adrenal Energy Support, just like it says. It has rhodiola, eleuthero, licorice root, a lot of great herbs. Now, you don't need to use this, but it's something to just know: oh, I might need a little bit of a boost. But I'm going to share with you why I wouldn't even start there yet.

Your lunchtime cortisol should be between 1 and 2, and it's 1.9. So it's great. Your dinnertime cortisol should be between basically 0.6 and, let's say, 1.6, and you're at 1.3. So good, but starting to come up a little bit at night, which we don't necessarily want. And then before bed, it's 0.9. It should be 0.5 or less, and that actually matters.

Again, functional medicine or integrative health is different from conventional medicine. If you were out of range there, they would just give you Ambien or Lunesta or a sleeping pill, right? But that's not what we want to do. So I would listen to you. I'd listen to your story and say, oh, amazing HRV, amazing drop in heart rate. Great. You probably get great deep sleep and REM sleep, if you're tracking those. Do you get about an hour and a half of deep and about two hours of REM?

Nikkiey: Sometimes I can get three hours of deep. Usually I get more deep than I do REM.

Stephen: Okay. Do you get two hours of REM, though?

Nikkiey: Give or take. I would have to look back at my Oura, but usually an hour and a half to two, maybe.

Stephen: Okay. Well, two hours is okay. So basically, think of it this way. Deep sleep repairs the body and REM sleep repairs the mind. Deep sleep is usually in the first half of the night and REM sleep in the second half, though of course they do occur at different levels. That's just what we typically see in practice.

Usually when someone's bedtime cortisol is above 0.5, they have wakes throughout the night, not enough deep sleep, not enough drop in body temperature, all of those things. So usually we would recommend something called the Sleep Help Support protocol. We would do journaling before bed, or meditation, or resonance breathing, or something to calm that fight or flight and move them into the parasympathetic nervous system.

For you, I would say that even though it shows 0.9, which is accurate, you still switch that off very quickly when you get into bed. What that might mean is that you've got a lot on your mind right up until bedtime, but then your body's really good at shutting off. Most people's bodies and minds are not good at shutting off. Yours just seems to be very good. The reason I make that assumption is that at dinnertime your cortisol is starting to come up a little bit, and at bedtime it's definitely up. So am I right? Again, I don't need to be right, but is it a factor that you might have a lot of to-dos and things to get done before getting to bed?

Nikkiey: Yes, 100%. Oh, yeah. That list doesn't stop. I have tons of it, but somehow I don't worry or stress about it when I fall asleep.

Stephen: Yeah. And that's great to see. It really is. So usually my recommendation would be something called the 3-2-1 bedtime routine. Three hours before bed, no eating. So we're not turning off digestion, but we allow the food to be digested. Two hours before bed, no more water, so we don't wake up during the night having to urinate. And one hour before bed, no more blue light, no more screens, and we try to just relax more. If you are watching TV, you put on blue light blocking glasses so you start to shift more into the parasympathetic. And if people can't make it happen one hour before bed, then 30 minutes before bed: again, journaling, meditation, resonance breathing, reading a good book, maybe not a fiction-based book, to put their mind more into slumber mode.

You're already doing great, so I don't necessarily know that I need to recommend some magnesium before bed. We use full-spectrum magnesium or calming magnesium. We use a product called Sleep Help Support. We use Adrenal Soothe to calm cortisol levels. But with you, again, I would look at whether we can do something lifestyle-wise, like the 3-2-1 bedtime formula, to help you get into a better range.

Nikkiey: Okay. Amazing. That's awesome. These are good to read. Is that the last one?

Stephen: Yeah, cortisol was the last one. So then the add-ons we usually include are free T4, free T3, TSH and TPO antibodies. When you go to your conventional medicine doctor, they usually run TSH. But TSH just means thyroid-stimulating hormone. It does not tell you in any way, shape or form how much thyroid hormone you're producing. And that's why, in my opinion, it's a huge issue with endocrinology. If you're not running free T4 or free T3, how do you know how much thyroid hormone you're actually producing?

What we see in our practice is that sometimes people are higher on TSH and they look good on T4, but they're not making enough T3, which is why the body keeps calling for more thyroid hormone. And free T3 is actually 70% of all usable thyroid in the body. Thyroid helps boost metabolism and metabolic rate and improve circulation. It helps all of the homeostatic thermostat regulators in the body. So it's really important. It also works with what are called leptin and ghrelin to make you feel satiated and to tap into more body fat rather than store body fat. We know that if you're lower in thyroid, you start to gain more weight around the waist and the hips, especially if cortisol is elevated in the evening.

That would be the only other thing I'd mention for you. If you see yourself retaining a little bit more water, it can also be from the elevated cortisol later in the day. Now remember, retaining water is not the same as body fat. That's really important. I'm sure you teach this as well, but that is stress-based water retention, or estrogen dominance, or even low thyroid. It's important to point out because sometimes women and men try to deplete themselves too much, and they'll never lose that inflammatory water weight. You don't lose it until you actually decrease the inflammation and the hormone imbalance.

So the lab shows thyroid. It shows vitamin D, which is crucial any time of the year. And it shows your insulin levels, which are important for fat burning. If you have high insulin and high hemoglobin A1C, you're not going to tap into body fat as well and be able to transform the body.

Nikkiey: Yeah. I love that you added that. It's so important to distinguish between all of those, especially when women step on the scale, right? They see the number going up, but it could be related to water retention, something different going on internally that needs more addressing. So I love that you added that plug. All great stuff here.

I know you recommended redoing this in four to six months. How often should someone take this test and monitor their stress, mood and metabolism?

Stephen: So let's say you were the average individual and you came in with a couple of things imbalanced. You had maybe low DHEA, but you also had low testosterone and low progesterone. We see that quite often. So I would say, okay, we're going to put you on a 12 to 16 week protocol. It's the whole diet, exercise, stress reduction, toxin removal, rest, science-backed supplements, all that good stuff. And then we're going to retest after you've been on it for 12 weeks.

What that allows us to do is say, oh, okay, we've got you back in range. Perfect. Now let's wean down on some of those nutritional supplements so we can get back to a baseline. Or we retest in 12 weeks and say, everything looks good except that DHEA, which still isn't rebounding. That's interesting. Here's what we're going to do: we're going to wean down on these and bump this up a little bit. So we can continue to custom-tailor a person's protocol based on their unique needs and where they're at.

Most people run these labs twice a year. So if you're just looking at generalities, every six months is a great time to run them, because remember, our bodies aren't static. Our needs change based on the non-static environment we live in. If your exercise changes, your stress changes, your sleep changes, your diet changes, then the way you support your body may need to change as well.

Nikkiey: Amazing. Well, thank you so much for reading those and sharing that awesome information. I appreciate it. I'm excited to test the 3-2-1. I'm definitely going to give it a go and see if it helps my cortisol at night. And guys, if you're listening to this and you're interested, definitely go to stephencabral.com/macros and check out this test. Dr. Cabral, I appreciate you being here on this podcast today so much, and your insight and your knowledge. Thank you so much.

Stephen: It was my pleasure. Thanks so much for having me on.

Nikkiey: Real quick, the only ask I could ever have of you guys is to help spread the word so we can help more women lose body fat, build muscle, reach their goals and feel insanely confident. And the only way we can do that is if you rate, review and share this podcast. So the single thing I ask you to do is leave a review. It will take you 10 seconds, and it will mean the absolute world to me and may change the world of someone else. Thank you.