Season 3, Episode 6: The Overlap Between PCOS & Digestion

This episode is one I'm so excited about because we have PCOS expert Cory Ruth! Cory Ruth is a registered dietician nutritionist and women's health expert. She's the founder and the principal owner of The Women's Dietitian and the Instagram account @thewomensdietitian. This is a private practice in digital platform for women seeking nutrition support for hormone balance, PCOS, fertility and weight management. She specializes in PCOS and nutrition therapy for infertility and associated reproductive technology.

She's also the creator of successful online programs Get Pregnant With PCOS and The PCOS Boss Academy. Through these programs, she's been able to help countless women on their journey to weight loss and fertility with PCOS. Recently, Cory has also launched a supplement company and protein powder line called Vita-PCOS to further support women who are dealing with PCOS symptom management.

In this episode, Cory and I talk about how PCOS and hormone imbalances may be connected to digestive issues and conditions like IBS, and how there are actual solutions out there for those who are struggling with this condition. So enjoy her perspective, enjoy the episode and then let us know what you think by leaving a review or coming into The GUT Community to let us know what you thought!

This episode is brought to you by Nerva - a non-invasive, evidence-based, at-home IBS management tool. Nerva is an app that provides gut-directed hypnotherapy through a structured six-week program, followed by a maintenance plan.

Use this link to try Nerva today at 30% off!

Erin Judge: Hi, Cory, I'm so excited to have you on and I want to just jump right in by going into your story! So why in the world would you specialize in PCOS? How did that come together and what's the background behind that?

Cory Ruth: Yeah, good question! I don't know why either? No, just kidding. When I first started my practice, my number one thing was, so I have PCOS, number one, backstory. And my number one thing was, I never want to work in PCOS because it is so complicated and there's so many moving parts, it looks so different on everyone who has this condition and I was like, I don't want to touch that with a 30 foot pole! But as I went along my own health journey with PCOS, I realized what a lack of care there is out there for us. And when we go to the doctor's office we're told to lose weight, we're offered the birth control pill or Metformin, and then we're sent on our merry way. And that wasn't enough for me, and it's not enough for all of the women who come knocking on my doorstep, so I decided to specialize in it because there is such a need for it. And there's such a huge connection between diet and nutrition. And I am a dietitian, and have PCOS, so I thought, why not be the person to bridge that gap and provide real, you know, affordable care that's specialized in this condition, so that's, that's how I got into it.

Erin Judge: That's awesome. And I love that you mentioned that with your own personal stories. I also have IBS, I’ve had IBS since I was a kid and I actually had the same thought at first whenever I was like, okay, what am I gonna specialize in? I love the gut, it's also so hard. It's so challenging. And I think there's that empathy you get personally, but I think that something people don't understand is that some of these conditions are so complex, that it's fun, it's also hard. It would be easier at times to focus on something more straightforward, but we're not here to do that, obviously.

And on that note, IBS and PCOS go hand in hand, we see it in our practice, I think it's something that as these two conditions that haven't gotten enough attention and research and even media and all of these different places, as they get more attention, I think we're gonna probably see even more of an overlap. Why do you think that that is in your work with PCOS? Why do you feel like there's a connection with digestion? Where have you seen that show up?

Cory Ruth: So PCOS is an endocrine and it's also a metabolic condition. Basically, the endocrine system has to do with hormones. So hormones and our gut are so intricately connected, and we have so much research coming out, you know, kind of more and more, especially with gut health and PCOS, kind of how these two are tied together. So women with PCOS are kind of in this constant state of mild inflammation, we have higher levels of different inflammatory markers, like CRP. And so that is, you know, kind of we know that inflammation plays a key role in gut health issues.

In a healthy individual, your intestinal walls and your gut bacteria kind of work harmoniously to form this physical barrier between, I'm sure you know this, between the body and the outside world. And it only allows these really tiny, little nutrient molecules into the bloodstream. So when our gut becomes unhealthy and unbalanced, like this picture of dysbiosis, we have this imbalance of good to bad bacteria, that visible barrier, that wall becomes sort of leaky, and it lets these big molecules which are normally kept outside the body pass through into our bloodstream. And these molecules can activate our immune system and cause chronic systemic inflammation. So this chronic inflammation can lead to insulin resistance and that is a classic hallmark of PCOS. So going back to kind of the complexities of that condition, not all women with PCOS have insulin resistance, like classically defined, but all of us in some capacity are sensitive to blood sugar issues. So because of that insulin piece in PCOS as well as we have higher levels of sugars and fats in the blood, this inflammation piece is huge. We're talking about gut health and IBS.

So I talked about those big molecules that can kind of pass through and up in our bloodstream due to this sort of leaky gut, women with PCOS have higher levels of what we call advanced glycation end products or AGEs. And these are made by cross reactions formed when plants or animal tissues are heated to really high temperatures like when deep frying. When examined closely, researchers found that AGEs both activate the immune system, trigger inflammation and promote the production of pro inflammatory hormones. So in addition they found that these high numbers of receptors, basically, they're inside of our ovaries, so when they're activated, these receptors were shown to induce ovarian inflammation and reduce response from ovarian cells to female sex hormones like LH luteinizing hormone, which is essential to ovulation. Lots of women in PCOS have ovulation issues. So because of all those period problems when we have PCOS, these findings are super, super relevant for us. So there's other groups of molecules that pass through, but it's all you know, like I talked about with PCOS, hormones, digestion, and then we bring in stress, sleep, you know, all these things for IBS, they're all connected. And it's so important to take a look at the whole body systematically, you know, when we're looking at PCOS, and IBS.

Erin Judge: Absolutely, I love explaining it sort of like this complex web. It's not just this and this, it's not just that they're synergistic, it's like this complex web. But the value of that is as you piece it apart, a lot of that can have multiple effects, which is such a good thing and that benefit is so big. When we hear hormones, and I know I have clients come to me, if anyone has followed you for a moment on Instagram, they're gonna know this is a common misconception, but what we tend to hear with PCOS specifically, or anything that has to do with hormones, is that birth control is the answer, right? Hormonal therapies, birth control is the solution that's available. Is that true? Or is that not?

Cory Ruth: So birth control is a totally personal choice. And just like any medication, you know, I get asked a lot in my DMs or, you know, from clients, should I take birth control? Totally up to you. You know, we have research about birth control causing certain side effects that are not so pleasant for some women, and also certain birth controls may deplete certain nutrients that are important for hormonal processes and all kinds of stuff. So it's really a personal choice. What I will say about hormonal contraceptives, are that they are kind of a band-aid solution, they’re something that's easy to give, you know, very easy to just write a prescription, and they can cover up a lot of our PCOS symptoms, they give us a regular bleed, I won’t say period, because what the birth control pill does is it basically prevents ovulation from happening and a true period always follows ovulation. So you're getting a regular bleed, which for those of us who have PCOS who have really irregular periods, that feels really nice, we feel normal. For some of us it can help with lower androgen levels, which can cause things like acne, so it can clear up acne.

But the problem with birth control is that because we're not doing anything to actually take care of our symptoms and get to the root cause, once we get off birth control, all of our symptoms can come back with a vengeance. So it's really just kind of like this solution that's out there, but it's not a long-term solution and it's not doing anything to actually help our PCOS and why we have it to begin with.

Erin Judge: Yeah, yeah, I like that answer. I like that you mentioned how it is so personal and the value of knowing what something does so you can make that choice yourself as a patient coming in. And I think what could be good to hear too, because there is, and I wanted to ask you specifics because I know your voice on this, and it is that middle ground of let's educate, let's talk about the reason why that can be beneficial or not and what we need to think about, because there is this conversation of it's not bad, just take it or this is bad, don't take it and you should take it off of it immediately. What I'm hearing is that there could almost be the side of it of, if you do choose to use it as that band-aid, which nothing's wrong with a band-aid every now and then and you still have the ability to get to that deep root, you still have the ability to deal with the systemic issue, then you can come up and choose to make that transition if you want. Is that correct? Like is that a way that some people approach it?

Cory Ruth: Yes, definitely. So when we're on birth control because we're kind of shutting down our a lot of our sex hormones and replacing them with synthetics, there's not a whole lot we can do to kind of take care of hormone balance while we're on birth control, something that's hormonal birth control, but there are still other steps we can take from a nutrition standpoint, which impacts our hormones, from a digestion standpoint, which impacts our hormones, from a movement, stress, you know, all kinds of stuff. So there's lots of things that we can do to optimize, you know, how your body's functioning while you're on birth control and also supporting the transition off of it. Because that can be really scary for a lot of women who've been on it for, you know, 10-15 years. And all, you know, they're scared of all these symptoms coming back. It can feel really scary and overwhelming, but there are lots that we can do to kind of mitigate some of that, some of those effects.

Erin Judge: That's great, that's really helpful to know. Sometimes there's that mix as a patient coming in, and most of those listening are patients, they're thinking about, you know, what steps do I take, and sometimes it can feel like, it's such a big jump to make of, oh, well, I have all this to do and sort of seeing those small steps that you can start with are so helpful because it makes it feel less scary, less overwhelming. And I think also that web in your mind, it helps you picture how that can start to get unraveled.

What are some of the things that someone could do right now to support their hormones? So you mentioned, you know, there are some pieces that we can put into place. And I know we can't get into all the personalization involved in that, but what are some of the few things that someone could start doing right away?

Cory Ruth: So from a nutrition and dietary standpoint, we don't always think about what we're eating and how it's impacting our hormones. We think about things impacting our hormones like medication, you know, birth control, but dietary wise, there's lots that we can do and the bulk of it comes down to blood sugar balance, you know, we don't talk about it enough, we talk about it mostly in the context of diabetes, but that's really the end point, there's a lot that can go you know, kind of leading up to that, that we can work on from a preventative side of things. And there's a huge connection PCOS or not between blood sugar balance and our hormones and what we're eating.

So basically with, you know, the way that our food system is set up, at least here in the US or the way that it's moved to is really very carbohydrate centric, and I don't pretend to you know, want to demonize this, it's a healthy nutrient potentially. But we can also really easily go overboard. You know, I talk about my dinner example, when we go out to eat, say we go to an Italian restaurant, we sit down for dinner, we get breadsticks, we get croutons in our salad, carb, carb, we get pasta, we get a glass of wine carb, carb, and then after dinner, we have you know, piece of tiramisu cake, carb. So we can really overdo it without really thinking much about it and that sends our blood sugar on a rollercoaster ride, which can lead to worse PMS, mood swings up the wazoo, which women deal with all the time, so especially around our period, and especially with PCOS, and we're already in this kind of state of hormonal imbalance. Really focusing on protein and fiber intake, fiber is huge, we do not get enough fiber just as a society overall, every time you know, consistently, you'll find if you go out to eat, or if you cook a recipe, vegetables are kind of like the afterthought. They are kind of like the garnish. I always laugh with those little sprigs of parsley that make their way onto the plate. I know that's their aesthetics, but I'm like is that the vegetable, we are so we undervalue and we don't eat enough.

I really teach practicing adding in more protein, fats and fiber and just kind of scaling back on the amount of carbs that we're doing. And also, when we are doing a carb, try to pick a complex carbs. So that would be the difference between white rice versus brown rice. And also making sure you're pairing that carb with something that's going to negate a blood sugar spike, like instead of just doing an apple for a snack, half an apple with peanut butter, that's going to be more even for you, it's gonna kind of help balance your blood sugar better. So blood sugar, nutrition, hormone connection is huge, not to be overstated.

When we're talking about movement, exercise, a lot of us, we go through, you know, periods of time where we exercise a lot, and then we kind of fall off the wagon, we see that a lot. And, you know, we kind of again, like shifted into society that we don't really, a lot of us don't really walk a lot. You know, if you go to Europe, or you know, when I was in Africa, just walking all the time, everywhere, and here, we drive everywhere. So we're really sedentary and our hormones don't appreciate that either, we need some daily movement in there. It's also great from a mood standpoint too. Stress is another big one, especially since the pandemic I've seen so many more issues coming about cortisol imbalance and stress and adrenal burnout. So that's another huge one, I don't feel like any of us really take enough time to dig deep and figure out a really solid self care plan and some strategies that work to kind of, you know, take care of our adrenals that can really impact our hormones. So those are just a few things that, you know, you can look into.

Erin Judge: Yeah, thank you for sharing those. That's awesome, those are great places to start. And it's funny because or not funny, it's life, those are also some of the basics that you would start with if you're dealing with digestive issues, like, hormones love that balance, your gut loves that balance because of their connections. And I also like that you brought up the blood sugar balance piece, I think, if we all started there, before we start on what do I eat, what don't I eat, like, we all just think about the balance and how we pair things together and how those work in the body and start with that consistency, you know, there might be less things to take out and all of those different pieces and with the gut too, like the gut loves a stable blood sugar. And so when we're able to keep the blood sugar stabilized, like digestion improves, and it's just a win win without having to cut things out or get too in the weeds with it. And there are I think, steps where then you do get into the weeds of things and it requires a bit more personalization. When do you typically see someone going from you know, doing some of those basics on their own to really needing help specifically around helping with their hormones, whether it be PCOS or even just some signs of hormonal imbalance?

Cory Ruth: Yeah, so most clients will come to me and I mean, I only work with women with PCOS, like pretty much exclusively now, so they'll come to me and PCOS is also the leading cause of infertility. Lots of women who are dealing with ovulatory dysfunction so they're not getting regular ovulation, which means they're not getting a regular period. That can be so frustrating, you know, what's driving that? Why is this happening to me and really looking into, I like to use the Dutch hormone test, we've kind of take a deep dive into the current state of affairs, hormone wise, what's going on with your androgens, which are male sex hormones, what's going on with your estrogen or progesterone, your adrenals, certain vitamins and minerals. So I love to look at that test and kind of address any imbalances there, I do sometimes do GI map gut health tests, so I take a look at bacterial balance, you know, pathogens, and parasites. I like to take a look at that and see what we can do to optimize digestion and gut health.

But I would say period issues. I also work quite a bit now in weight management, because we see lots of issues with PCOS, especially when it's linked to insulin resistance, issues with weight, you know, and it's so frustrating when we get told just lose weight, but it's harder for certain women with PCOS to lose weight because first we have to take care of the hormone piece before we can even go there. And so I do work a lot there. A lot of women come to me saying you know, I'm eating less and moving more, I'm taking all the advice that you know, so and so's giving me and my friends lost 30 pounds, and I lost three, what's going on? So at that point, it's worth it to look into what kind of hormonal imbalance might be driving that and see what we can do to optimize that to get you the results that you need.

So period stuff, fertility stuff, weight management, those are some biggies of why people why women come to work with me, but also just PCOS symptoms in general, and acne, hair loss on the head, facial and body hair growth. All of those are so frustrating. I mean, it's hard enough in this world to be a woman and then add that on there. It's tough. So some of that’s a big sign of PCOS as well.

Erin Judge: Yeah, I like that you call those signs out. And so if someone had some of those signs, you know, when they didn't have a PCOS diagnosis yet, is there a good first step to getting one and can it be a little hard to fully diagnose sometimes?

Cory Ruth: Yeah, that's a great question. I get asked that question almost every day in my DMs! So you want to ask your doctor for a full hormone panel. Don't ask me what that is, your doctor will know, they should know if they're a medical doctor. For the hormone panel, that's gonna include testosterone, estrogen, progesterone, sometimes, TSH, so that you're looking at the thyroid. You want to ask for your fasting insulin or glucose and your A1C because that's going to take a look at any blood sugar issues. You're also going to want to ask for a pelvic ultrasound so they take a look at your ovaries and see if there's what we call cysts, multiple cysts and what those are. Polycystic ovary syndrome is kind of a misnomer because they're not the type of cysts that rupture and cause pain. Now a lot of us think of system we hear those horror stories “I had a grapefruit cyst” it's not the same thing. We have these little what they are basically tiny, immature follicles and they're all competing to ovulate and no one's winning. So that's what they are. So it's a big scary word, but that pelvic ultrasound, we'll take a look at that, too. And that's how you can get a diagnosis.

Erin Judge: Great. And that would be through maybe a primary care or does that have to be through a gynecologist?

Cory Ruth: You know, you could go through primary or an OBGYN to diagnose.

Erin Judge: Yeah, that's awesome. Thank you for that. And sort of diverting a little bit, not really, this kind of goes into specialized care, but you recently released a supplement line, you created your own supplements, which is, I know no small feat and no small task. But the big question is, why would you create your own when there's so many out there. So I want to talk a little bit about what got you to where you created your own, why that matters and what came out of that?

Cory Ruth: Totally. So there are a million jillion bajillion jillian supplements out there, but actually, there's not a lot of PCOS specific supplements, so that was my number one, right? Like, there's definitely a need. Supplements are only, you know, one piece of the puzzle, there are lots of other things we're you know, optimizing, but it can be super helpful. So I wanted to create something to kind of fill that gap, and also, there are so many supplements out there that are just…..can I curse on this show? There are just shit. You see these like a hormone balance, my favorite one, or that is like a hormone balance blend and it's like this random stuff. The thing about the term hormone balance is that it can encompass so much, right? There's so many different imbalances, there's so many different hormones. So these blends are marketed and they're expensive as hell and they're marketed to women and it really just fires me up because these poor women are struggling, they don't know why, they buy these expensive, you know, supplement blends and they're really not doing anything for them because they're not unique to their needs. So I wanted to get away from that and I wanted to create a line that was affordable. There's a PCOS colleague that I saw has a $70 prenatal and I'm just up like, I feel like PCOS care should be affordable. It's expensive enough to deal with this condition as it is and my goal has never been to go make a million dollars off my supplements, I really don't make much at all because I want to keep I want to keep them affordable for women, that's like my number one thing. So high quality ingredients that matter, that are going to be helpful for women with a specific condition and their unique needs and keeping my line affordable for them. So that's why I created the vitae PCOS line.

Erin Judge: That's amazing. I love that. And that's it's such a good resource. I think having the knowledge of exactly what you're trying to target and having the underlying product and being able to use that is so helpful. I see that in IBS side, too. It's just, there's so many things out there and I've never created a supplement so like I haven't gotten behind the curtain like you have. Is there anything regardless of PCOS or whatever people are looking at, they're thinking about supplementation, did you learn anything, as you were kind of behind the curtain and creating your own that people can like look for?

Cory Ruth: You know, there's lots of talk about. I get asked a lot are your supplements, you know, FDA approved. Actually, no supplements are FDA approved, that's not a thing so you can't guide anything off of that, so that's something I see a lot of. I see a lot of like, you must have supplements that are third party tested, mine aren't third party tested, because I can't even get them yet because they're newer. So not to say they're not tested, but they're not officially stamped that way. So I feel like sometimes, I totally understand the idea behind that, but it's not always feasible with smaller companies like myself, like I'm just, it's just me, like woman, female on brand, that's it. So I don't have you know, $3 million to go through a separate facility, but my facility is, it's all certified by the FDA. You can't get your supplement itself certified, but this facility where they're made are. So that's something to look into.

Erin Judge: When you say that you mean like that they're going to follow the protocols needed to make the formulation that you so that's where we go into like, knowing that you can trust that what you're getting is what it is, like knowing that someone's utilizing a really trusted facility can be part of that, because then you know that what is on the bottle should be there, according to like their protocols in place.

Cory Ruth: Yes, thank you, you summarized that much better than my I said, right? Yes, exactly. So that's super important and something to look into. But honestly, I think it's finding providers that are credentialed, you know, it would be one thing if there was some, you know, someone else there who was claiming to be a PCOS, I see this all the time PCOS expert, you know, maybe they have PCOS and they've been coaching women for three months and then they created their own supplement line, you want to make sure the person who's behind your supplement has credentials as a licensed professional because they know what to put in there. They know what's going to be helpful and they're going off research. They're not using, you know, anecdotal evidence, like this works for me so it's gonna work for everybody else. So I think that's important too. But with supplements, it's a big, wild world, and we just kind of really have to do the best we can with vetting, you know, what's helpful. I post all the reviews on my social media, so you know, if anyone's interested in a particular one, they could check out and see what other women who actually experienced the supplement have to say about it. So transparency is really key as well.

Erin Judge: Yeah, I love that. And then, you know, we talked about the beginning about personalization, I think with anything, it's knowing what works for you, I think that's the value of having a guide. I'm a dietitian, so I'm biased towards us as dietitians, but having some sort of guide that's right by your side that knows the background, that knows their stuff, walking with you, as you're kind of trialing things like that can be so helpful to make sure that the result you're wanting. I see this with probiotics all the time, it's like, you know, a probiotic taken for a year with no noticeable benefit and it's like, well, if it doesn't have a benefit, like let's switch it up or remove it, what's the point it's not actually working? And we won't always see those noticeable benefits but sometimes we can, especially if we know what we're looking for. And I know, with your products, you likely know exactly what you're looking for, because you created them with that in mind, which to me makes it almost even more valuable knowing that there was a problem, this is trying to solve that exact problem and so we know what we're trying to monitor. And that's so valuable. Well it's Vita PCOS and I'll make sure that we link all of that information in our show notes, if anyone's interested in going directly to the supplement line. But what if they want to work with you? So you work with women with PCOS, so that's number one. What does it actually looked like? Like what would be the best step for someone to work with you?

Cory Ruth: Yeah, so I still do one on one work, I just love it. I love the one on one stuff. It is a lot of time, and I'm also running online programs and I don't know after I get back from maternity leave if I'm going to keep doing one on one stuff, but we'll see. So you can book me directly on my website. If you want to go that one on one route obviously, that's, you know, a higher price tag because it's so individualized. it's very time intense for both people, it's a whole experience. So there's that but also what I kind of have created in the last couple years was kind of taking my one on one work and distilling it down to DIY and go your own pace programs. So I have to I have get pregnant with PCOS, which is my baby, I created it in 2019, it's been running ever since, we've had hundreds and hundreds of babies come from those programs. So I run these a couple times a year and so get pregnant with PCOS is one, if you have PCOS, and you're looking into fertility, you have had struggles in the past and you're looking to try again without all those issues. So it's really about optimizing your fertility, getting ovulation back on track, managing your PCOS, and it's great because you can use it when you're pregnant, and postpartum because there's a weight loss option too. So if you're like, okay, once, I’m postpartum I want to kind of get back into my groove, lose weight, it's all there for you so it's a really cool program.

And then I have my PCOS Boss Academy, which is a little bit newer, but that is all focused on PCOS on weight loss. So that really dives into again, PCOS, symptom management, but non restrictive weight loss and not you know, approaching weight loss in a way that doesn't just say, exclude you know, gluten, dairy, soy, sugar, fun, joy, have a nice day. It's so much more complicated than that PCOS, and that's not a solution. So the Boss Academy is really about building the strategies that you need for sustainable permanent weight loss that's, you know, going to be achieved in a way that doesn't like restrictions.

Erin Judge: So yeah, lots of good options.

Cory Ruth: Yeah, those two programs are my two flagship signature programs and they run like I said, like a couple times a year, so my next kind of round will open in April. So that's an option too. I only have limited spots for both though and they do typically sell out same day. So um, yeah, they're wildly popular and very successful, I love those two.

Erin Judge: That's amazing, I’ll make sure to link all of that so anyone's interested in, check that out! And then Cory is online at www.thewomensdietitian.com. Anything else you want to share Cory?

Cory Ruth: Well, my question for you is, okay, so we talked a little about IBS and PCOS, how does that show up in your practice? How did the two coincide for you? I'm so curious!

Erin Judge: Sometimes it's something that comes out right away, where someone will say, you know, oh, I got diagnosed with PCOS. It's either before or after, sometimes right around the same time, and no one has ever communicated to them that they could be connected so I usually ask, well, what came first? Or, you know, how did that come about? Who discovered those symptoms? And usually, it's, uh, oh, well, yeah, it was just diagnosed and left alone and so that's where we start to dig into well, what are your labs like? Are those up to date? So we usually have to ask for those.

More often than not, we see PCOS come up as a second thought. And we typically don't look for it in diagnosing, that's something that our practice could even improve on is looking for maybe some other signs, we see hormonal imbalances, often we track cycles. And we look at, you know, how symptoms are changing around cycles, because we do see that that change. And, you know, we can see some red flags of really painful periods, irregular cycles. We don't track ovulation as detailed as we could. But you can typically see like, there's zero signs of ovulation happening, like that could be a problem. And we deal with some clients who are dealing with infertility issues as well, or going through that process. Not the reason they come to us, but it does seem to go hand in hand, and a lot of the work that we do to support their gut because we also take some of that holistic lens, like we don't do low FODMAP on day one, like we want to focus on are you eating enough, are you balancing things out, are we incorporating mindfulness and stress management and movement and you know, all these pieces we look at, you know, what could be driving more cortisol? And so we're doing a lot of those things. So we tend to see the benefit, but what does come up sometimes is when we start seeing those red flags, we might bring them up with patients and then it's oh, yeah, yeah, once in my life, I had PCOS. And I think we see that big, just missing whole of well, no one ever talked to you about it, and no one ever, like worked with you on it. So that's typically where we'll refer like, hey, let's find you a provider that can do some of that testing for you and get into that more as we typically don't address it right away.

So we do see it often. And we work primarily with women. And I will say 90%, I mean, it's not even exaggerating of the women we work with, like hormones are a big piece of it and it's something that we have to look at and think about. And even if it is just, oh, yeah, I've really bad PMS, or I've really big mood swings and energy. I mean, we look at blood sugar balance consistently, like energy and fatigue, and just those swings and poor sleep. And, you know, all of those different signs come out. And one of our goals of 2022 is to be able to have an even deeper understanding of the hormone component, because we are noticing that it's way too connected, that you know, there could be some missing pieces that could benefit a lot of our patients.

Cory Ruth: Definitely, yeah, like we said, you know, everything's connected!

Erin Judge: Yeah, yeah. And we always watch out for all the supplements people are on because there's just so many. And you know, it's like is it helping or not? It's like people are grasping. And I know that the basics of those foundations that we you talked about even, when those are really honored and like put into place well, we see so much benefit, and we always monitor cycles, like how's this period compared to last month's period. And then how's the next period, those are always big celebrations, regardless of how the guts acting. But we notice that those symptoms that come up because you know, prior to menstruation, that shift of hormones, and then around ovulation that shift in hormones, those with IBS have symptoms during those times and it's pretty obvious when we start really looking at it. And we'll notice that as we're doing some of these things, regardless of where their IBS is outside of their cycle, like those drastic shifts in hormones, maybe we're changing the way that those are shifting, I don't know, but the symptoms associated with those change. And so we start to see that the symptoms leading up to mensuration, like they start to go away where they're not that dramatically different and so those are always big celebrations, where it's like, okay, we're doing something that your hormones are really enjoying. We just don't test for it yet, so we'll be adding that on this year as well.

Cory Ruth: Awesome. Well, that'll be great!

Erin Judge: Yeah, and if PCOS is a big marker we refer! We always try to figure out, okay, who is better to, to work on this and infertility is not something we ever tackle, like for ourselves. It's not our wheelhouse. Typically, someone's already in that process of figuring that out. But if that's ever the first goal, it's like, okay, we need to get you to a specialist for that. Our specialty is the gut itself.

Cory Ruth: Yeah, stay within our lane. I refer out all the time.

Erin Judge: Yeah, it's so, I think some people miss that. And I get this question a lot. It's like, can you tell me about this? Can you tell me about that? It's like, I can as a person, there's no way I can know everything. And you know, as I get more and more experience, yes, we'll learn more. But like focusing on the gut is so complex in and of itself, that thinking about all these conditions, and then the new research changes every year. And you know, all of these pieces, it's like, there's no way! Hormones, yes, we can learn more about that, because that's needed, but I'm not going to go learn about everything about diabetes, like I'm not going to go learn about everything around heart disease, because that's not, that's just not what I can do as a person. And so finding those good resources and referrals and figuring out and I think you kind of mentioned this too, like what's the primary issue here, like, what's the thing that we need to focus on the most, and we try to do that well with new clients. And if it's not the gut, we may not be the first step. So that's something that we always have to kind of determine if like, if it's not this, like, we may not be there. It might be something else and then we might come into play. And that's something that as a patient, sometimes it's hard to wrap your head around, like, well, why can't you do it all? It's like, well, you want to find the person that's going to help you with that primary concern and then some of the other concerns typically resolve, you know, with that, and sometimes they don't, and then you address the secondary concern. That's a skill.

Cory Ruth: Definitely!

Erin Judge: Well, thank you so much, Cory. I appreciate your time. I appreciate you coming on educating and spending time with our audience and look forward to continue learning from you.

Cory Ruth: Thank you so much for having me. This is great. I know this is going to be a great episode. So I appreciate your time as well, thank you!

Erin Judge: Yes, me too.