Improving Fertility with Dr. Jane Levesque: Rational Wellness Podcast 325
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Dr. Jane Levesque discusses How to Improve Fertility with Dr. Ben Weitz.
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Podcast Highlights
0:55 One of the biggest obstacles for couples trying to conceive is that there is so much information that it is difficult to know what is true and what’s not and where you are in your journey. Some couples wonder if the conventional route, whether it’s IVF, IUI, or medications like letrozole or Clomid to stimulate ovulation is the only option.
3:00 When Dr. Levesque sees a new client for the first time, she spends a lot of time going through their history and then she starts by looking at their previous labs, which often their doctors have not looked at very closely. Often their doctors may have told them that their labs are normal because they are busy and skim through them and they also are only looking at the reds and have no sense of what optimal ranges are. For example, when it comes to vitamin D and the normal range is 30 to 100, but if you are at 30 is that good? No, that’s low and vitamin D is important for hormone production, to make our neurotransmitters, and for our immune system function. There’s actual vitamin D receptors on both the egg and the sperm. Dr. Levesque likes to see vitamin D levels in the 60 to 80 ng/mL range.
6:35 For women it is important to figure out if they are ovulating and if the quality of their eggs is good. If the woman is not healthy, then her eggs will likely not be healthy. If they are struggling with fatigue, digestive disorders, anxiety, or skin issues, then they are not going to have healthy eggs either. We need to look at the FSH to LH ratio and estrogen and testosterone on day three and at progesterone on day 21 or 22, if they have a 28 day cycle. We also want to look at electrolytes, at a liver panel, a kidney panel, and then it is helpful to get a Gut Zoomer stool test. Dr. Levesque has seen a number of women in their 20s with an FSH well above 10, which is a strong indication that they are no longer ovulating and this may indicate premature ovarian failure. When testing on day three, we want a FSH/LH ratio to be close to 1:1. If LH is really high, this is a sign of Polycystic Ovarian Syndrome.
10:04 Hormone testing. Dr. Levesque likes to test estrogen on day three of the cycle but she also likes to look at the DUTCH (dried urine) hormone panel to look at the metabolites to see you well you are breaking down your hormones. A lot of symptoms, such as painful periods, heavy periods, fibroids, and even endometriosis are related to the bad estrogen, Estrone, due to endocrine disrupting substances. There are three main forms of estrogen: 1. Estradiol E1, 2. Estrone, E2, and 3. Estriol, E3. Estradiol is the good estrogen, Estrone is the bad estrogen and the one most associated with breast cancer, and Estriol that is in the middle. Estriol is high during pregnancy, but also high in fibroids and endometriosis.
14:09 Birth control. Many women have been taking birth control for years and sometimes for decades and this can make it difficult to become pregnant. Birth control is synthetic hormones and your body has to process it and this takes a lot of nutrients, including N-acetylcysteine and CoQ10, zinc, and selenium. There’s also a connection with the gut microbiome. Imbalanced hormones affect the microbiome balance, which makes it harder for the body to produce neurotransmitters like dopamine and serotonin.
16:01 The microbiome and hormone connection. There’s a connection between the microbiome and our hormones. If you have imbalanced hormones you likely have microbiome issues. We think that our gut is separate from our reproductive system but your uterine lining is only separated from your GI tract by a tiny, little membrane. If you have a bunch of pathogenic bacteria surrounding your reproductive organs, this can make a successful pregnancy more difficult.
Dr. Jane Levesque is a Naturopathic Doctor, who specializes in fertility. Her mission is to help high-achieving couples get pregnant naturally, have complication free pregnancies and give birth to healthy babies. Her website is DrJaneLevesque.com. You can also contact her through her Instagram account @drjanelevesque.
Dr. Ben Weitz is available for Functional Nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure. Dr. Weitz has also successfully helped many patients with managing their weight and improving their athletic performance, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111. Dr. Weitz is also available for video or phone consultations.
Podcast Transcript
Dr. Weitz: Hey, this is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness Podcast for weekly updates and to learn more, check out my website, drweitz.com. Thanks for joining me and let’s jump into the podcast.
Our topic for today is infertility with Dr. Jane Levesque. Dr. Jane Levesque is a naturopathic doctor who specializes in fertility. Her mission is to help high-achieving couples get pregnant naturally, have complication-free pregnancies, and give birth to healthy babies. Thank you so much for joining us, Dr. Levesque.
Dr. Levesque: Thanks so much, Ben, for having me. I’m really excited to chat with you today.
Dr. Weitz: Excellent. So, what are some of the biggest obstacles that couples have when trying to conceive, especially today in 2023?
Dr. Levesque: I think in 2023 the biggest obstacle is that there’s so much information and it’s really hard to decipher what’s true and what’s not. I have a lot of patients coming to me basically just, “I’ve already tried this. I’m taking a handful of supplements. I have no idea what to do, what’s working, what’s not working.” And feeling like the conventional route, whether it’s IVF, IUI, even medications, letrozole, Clomid, to stimulate ovulation is the only option. And so, it’s being able to have a filter on the information and also understanding where you are in your journey that makes it difficult for couples. Because if you’re just starting out your journey and you have no idea what it’s going to be like, your biggest obstacle that I see for couples is that you’re just overwhelmed and you’re fearful of the future and sometimes unnecessarily so, and sometimes there is, of course, a reason to that fear or anxiety. And couples who have been struggling for a long time, it’s like, “I have no idea what to do. I have no idea what’s working. I don’t have any answers, and I’m tired of throwing things at the wall and hoping something that’s going to stick.”
Dr. Weitz: Not to mention that fear, stress and anxiety is a major obstacle to getting pregnant.
Dr. Levesque: Absolutely. Absolutely. Yeah. And it’s this vicious cycle where I follow a lot of people in the infertility community where it’s, “Stop telling me to relax.” Or, “Going on a vacation doesn’t help.” And I know what they’re saying because obviously if you have endometriosis or PCOS or fibroids or other conditions, going on a vacation isn’t going to fix that.
Dr. Weitz: Right.
Dr. Levesque: But relaxation and having a calm and soothed nervous system is absolutely part of being able to conceive.
Dr. Weitz: So, when you’re seeing a new client for the first time and going through their history, what are some of the things that come up most commonly?
Dr. Levesque: Yeah. A lot of the times actually as a general thing is people have no idea what’s going on even though they’ve had all the testing done. So, one of the things that I’ve been really telling my couples and on my channels is, make sure you have copies of your lab tests and your practitioner should be going through them with you. What we’re seeing now is you’re getting this, “Labs look normal, nothing that we know of.” And then you’re left feeling, you’re in this space like, “Okay, well, I guess I still have my painful periods. I can’t get pregnant. I’m still tired. I still have brain fog, but my labs look normal.” Where in reality they’ve never actually even looked at their labs and they haven’t seen if there’s any L’s or any H’s or any just abnormals, reds, because the doctor is just skimming through and a lot of the times they’ll miss information. And so, I have patients who had no idea that they had adhesions on an ultrasound or even little fibroids that were present. They had no idea that their estrogen was out of range for the mark that they were in. And so there’s, of course, the normal range and the optimal range, and that’s the initial consultation when I first see people, it’s like people just have no idea.
Dr. Weitz: Maybe you should explain the difference between the normal range and the optimal range.
Dr. Levesque: Yeah, for sure. So, let’s take vitamin D. Everyone talks about vitamin D now. It depends if you’re in the US or Canada, but the range can be anywhere between 25 to 100 or 120.
Dr. Weitz: Right.
Dr. Levesque: If you’re at 25, are you really at an optimal range? It’s like to me that’s a low … Especially if you’re trying to conceive, because now vitamin D is important for hormone production, it’s important for mood, our neurotransmitters, our immune system. There’s actual receptors on both the egg and the sperm, vitamin D receptors. So, if both male and female are going to be low on that, that reaction isn’t going to be as strong for fertilization. So, if you’re telling me that, “Okay, I’m in the range.” But you see that you’re on the bottom half of the range or on the top half of the range, it’s likely that you’re probably low or there is and imbalance, right? Because everything in the body is about balance. Even too much of a good thing is, it’s too much and obviously not enough isn’t as well.
Dr. Weitz: Yeah, I think in the US the average doctor will say, and I think most of the labs say, “Over 30 is normal, anything more than that is a bad idea.” And yet, I feel for a couple trying to get pregnant that they should get their vitamin D level at least up to 50.
Dr. Levesque: Yeah. And I say 60 to 80 is a good range. I have a couple patients in California, so it’s, if you have access to the sun, you need to be going out to the sun. I live in Calgary, Alberta where we don’t get a lot of sun for a lot of time of the year. So, when we can get access to it, go for it. But when you can’t, that means you need to supplement. And the best way to know how much you need to supplement is just by doing some testing.
Dr. Weitz: Besides low vitamin D and fear and stress, what other sorts of things do you see come up in history?
Dr. Levesque: For sure. So, for females, it’s figuring out if they’re ovulating and if that ovulation is good and the quality of the egg is good. Now, there’s no tests that show quality of the egg, but the way that I look at it is your eggs are your cells. If your cells are healthy, then chances are your eggs are also going to be healthy. Because women who struggle with low quality eggs are also women who are struggling with fatigue, with digestion, anxiety, skin issues, you name it, weight, all that jazz. So, for women, I’m always looking at the FSH/LH ratio, estrogen and testosterone on day three from hormonal perspective. And then day 21, day 22, 7 days post-ovulation ideally you’re looking at progesterone and that’s going to give us a really good idea if number one, you are ovulating and number two, how strong that ovulation is. And then we want to look at your electrolytes, your liver panel, your kidney panel, and then I’ll go deeper into Gut Zoomer and all that. Usually people don’t have that when they come to me. They have just the basic information. And I’ve had women who had their FSH well above 10 in their 20s, which is a strong indication that that woman is no longer ovulating and it’s whether it’s premature ovarian failure-
Dr. Weitz: Maybe you can explain about LH and exactly what that indicates at what range.
Dr. Levesque: Yeah, for sure. So, the LH strips is something that women use to help them detect that ovulation halfway through the cycle, which again is something that I don’t want to say I advise against, but it’s not a super reliable way to tell if you’re ovulating or not, because LH is a pulsatile hormone. So, sometimes it comes before ovulation, sometimes it comes after. And so, it can confuse women. Where when we’re testing it through blood on day three, we’re looking for a FSH and LH ratio to be close one to one. So, if that LH is really high, usually it’s a sign of polycystic ovarian syndrome. Now, that’s not the only thing, but you need to look at that ratio. The FSH, the follicle stimulating hormone, if it’s above 10, let’s say between day three and five, it’s typically a sign that the body is not ovulating or that ovulation is really sluggish.
And the way that I like to describe the relationship between the FSH, if you will, is FSH is a brain hormone and the brain is where ovulation starts. The brain is the one that has to tell the ovaries to start growing the follicle, getting it ready to produce. If FSH is nice and low, it’s like the brain has to just whisper to the ovary, to say, “Hey, it’s time to ovulate.” Versus if that FSH is really high, that means now the brain is screaming. It’s like a parent-child relationship, whether you tell your kid really quietly to put on their shoes and they do it, or you have to yell at them several times and they still don’t do it, then that’s the relationship there. So, when that FSH is high, it’s a sign that the brain and the ovaries are not communicating. And so, we want to address that because obviously if you’re not ovulating, it’s going to be very hard for you to get pregnant.
Dr. Weitz: What are some of the other things you’ll see on a hormone panel besides FSH and LH?
Dr. Levesque: Yeah. So, estrogen, if you test it on day three, for the most part, I find women are in range. So, this is testing it through blood. Now you can test estrogen through blood, through saliva or through urine, and blood is going to be your gold standard diagnostic. Will show you exactly what’s happening in the body this moment in time. Whereas I do a lot of urine analysis, I’ll use the DUTCH hormone panel by Precision Analytical, where we’re looking at the metabolites, so how are you breaking down your hormones? And that breakdown then shows us what’s happening with your progesterone, what’s happening with your estrogen, what’s happening DHEA, testosterone. And so, I like to compare the two because we want to see what’s happening in the body right now versus how is your body breaking it down? And it gives us an idea of some genetics. It also gives us an idea of how your liver is working. So, I’ll typically see really high estrogens or you’re favoring a bad estrogen versus a good estrogen. And a lot of symptoms come with the quote, unquote, “bad estrogen. Whether it’s painful periods, heavy periods, fibroids, and even endometriosis. All those conditions are driven by an endocrine disrupting process. It’s a hormonal imbalance, right? For [inaudible 00:11:29].
Dr. Weitz: Right. Explain what you mean by a bad estrogen.
Dr. Levesque: Yeah. So, there’s three different metabolites, E1, E2 and E3, and so there’s some that are more harmful and some that are better. Right? So, E1 is the good one, if you will, and then there’s E2 that’s more of the bad estrogen. And then E3 is kind of this in the middle where we see it in conditions where there’s a lot of replication, if you will. So, we’ll see that a lot in fibroids. We’ll see it really high in pregnancy because there’s a lot of growth that’s happening during pregnancy. And then you’ll see it in fibroids, endometriosis, and in pregnancy. And then E2, usually we see it in relation to cancers, whether it’s breast cancer, whether it’s cervical cancer.
Dr. Weitz: You’re referring to estrone as the bad one, estradiol as the good one, and estriol as-
Dr. Levesque: This middle where sometimes it’s okay to have it, but other times … It’s more about the ratios than it is anything else.
Dr. Weitz: Right. Some doctors consider estriol a weaker estrogen and estrone a stronger estrogen.
Dr. Levesque: Yeah, for sure. And like I said, in the body, it’s all about balance. Right? So, if I look at, they give you the gauges, and if you’re seeing someone really push towards one side, then you’re asking … Because some of it, it’s like I said, you’re going to see a little bit of genetics too. Right? We have certain enzymes that are upregulated, and so they’re going to push certain pathways, and so you might need to eat more cruciferous vegetables just because that’s what your system needs in order to function at its best. And this is where we can get into more customization and personalization as opposed to this generic advice of, “Yeah, absolutely everybody should be eating vegetables and having good quality protein and clean water and all that jazz.”
But when that’s not enough or when you’re not getting results from that, it doesn’t mean that, “Oh, okay, I guess this isn’t for me.” It’s more like, “Well, what else is missing? And let’s dig deeper and maybe we need a little bit more of something and maybe now we need to tweak your supplement routine and take a look at your environment a little bit deeper.” Because we know those are the basics. We can’t get away from that in terms of as a human, everybody needs to move their body. We can’t not move our body and say that we’re healthy. That’s the same kind of what I see with some of the basics of the protein and eating enough protein, eating enough veggies, water, all that jazz.
Dr. Weitz: Now, when it comes to hormones, one factor that I know is very common is quite a number of women who’ve been taking birth control and often taking birth control for years and years.
Dr. Levesque: Yep.
Dr. Weitz: How do you deal with that?
Dr. Levesque: It’s a huge problem. Yeah, it’s a huge problem. I mean, one of my patients right now, she just conceived, she’s at 10 weeks. She was on birth control for 20 years. Since basically 12 years old, was put on birth control, whether it was PCOS or something, and then just one of those never got off it. Didn’t know enough about it. And so, it took us almost a year to regulate her cycle to a point where instead of it being every 60 days and then 55 days and 42, and it was a lot of work. So, birth control, that relationship that I talked about, the brain and the ovaries, it just shuts down that communication altogether. So, now the brain and the ovaries are not talking. And if they’re not talking for a year, okay, the brain can restore that relationship, and maybe it’s even five years, it’s okay, it might take some time. But if it’s been a decade, if it’s been 15 years, it’s going to be harder and harder for those pathways to come back and to come back in a good strong way, if you will.
Then the next component with birth control is, I mean, it’s a synthetic hormone, so your body has to process it, and it takes a lot of nutrients, so it depletes a bunch of nutrients from your system. And of course, like I said, it’s a synthetic hormone, so it’s strong. Your system has to work through that. And so, we see deficiencies in B vitamins, in a lot of antioxidants that are really important for fertility, like an N-acetylcysteine and CoQ10, zinc, selenium. Things that are of course also important for the thyroid.
And then there’s a connection between the microbiome as well of the gut. We talk about hormones a lot, but it’s like you can’t balance hormones without gut function. If you have poor hormone function, guaranteed you’ll have something in the gut even if you quote, unquote, “Go to the bathroom, have a bowel movement once a day, twice a day, and you don’t have any issues. I have mild bloating.” I find a lot of us are disconnected and have no idea what a good bowel movement actually looks like and feels like. And so, if you have imbalanced hormones, you probably have microbiome issues as well. But the connection there, Ben, is that it’s a huge impact on … It wipes out a lot of the good bacteria, and so then, hey, that’s going to make it really hard for the body to produce neurotransmitters like dopamine and serotonin. And so then there’s anxiety and depression that’s associated with that. So, it can just spiral downwards.
Dr. Weitz: Yeah. Shame on them. They should have the Bristol stool chart on their wall.
Dr. Levesque: That’s it. Exactly. Exactly. But in all honesty, we’re not really taught and I’ll have a lot of women who have shame around even talking about bowel movements because it’s like it’s a private thing, you shouldn’t talk about it. And we’re holding this all the time, and so our pelvic floor is really tight. And we’ll look at the stool analysis and it’s like there’s an insane amount of overgrowth and there’s so many pathogenic bacteria there. And we think that our gut is so separate from our reproductive system, but if you look at the abdominal cavity, it’s like it’s all crammed in there. Your uterine lining in your uterus is separated from your GI tract by a tiny little membrane, and all of that stuff travels back and forth. And so, you might not have a bunch of yeast infections or UTIs or whatever, urinary tract infections, to have pathogenic bacteria that’s all surrounding your reproductive organs, which becomes really vital for a successful pregnancy.
Dr. Weitz: So, how do you like to analyze the stool? What’s your favorite stool test you like to run?
Dr. Levesque: I’ve used the Diagnostic Solutions before and over the last couple of years I’ve switched to Vibrant America and I love it. It’s probably the most comprehensive. The Gut Zoomer is the most comprehensive one I’ve seen to-date. They test up to eight inflammatory markers, and they do all the immune system and the microbiome and the pathogens. Detecting your pancreatic elastase, so how well you’re absorbing, digesting food. Short chain fatty acids. So, I’ve really learned to love the test and I find it gives me so much information to just really look at the gut in depth, so we can start attacking and addressing some of the things that are going to come up. Because there’s no such thing as a normal stool analysis. There’s a little bit of fear, I think, from people like, “Well, I don’t want to invest into lab testing because everything is always normal.” And it’s just like, yeah, it’s not possible.
Dr. Weitz: Well, the other thing is patients, they don’t understand the levels and depths of lab tests that are available.
Dr. Levesque: Exactly.
Dr. Weitz: And they go to their doctor, they get a CBC and a chem screen and maybe a basic lipid profile if they’re lucky, a couple of hormone tests. And each test is put on a separate sheet of paper, so it looks like they had every test that you could possibly get. And actually-
Dr. Levesque: Is that why they do that?
Dr. Weitz: … on the scale of lab tests, they had this much done.
Dr. Levesque: Totally. Yeah. No, I agree. And that’s the point that I made before, it’s like, you want to understand what really got tested. I just took on a couple a month ago and they were like, “Yeah, sperm analysis is fine.” And I put out this freebie to be like, “Hey, if you’re not getting pregnant, make sure you check your partner’s sperm analysis, and these are the parameters.” Turns out he didn’t even have enough volume to run the test. And so they read it as, “Oh, it’s normal, don’t worry about it.” Versus he had to go back in and do it. And so, it’s like there was this six months period that they had no idea that something was wrong, where in reality there was a lot of things wrong. So, infertility and fertility in general, once, especially we as women decide we want to have children, that time is on. You just feel like every month the clock is ticking. And so, from the perspective of not feeling like you’re wasting time, you want to understand what’s going on, both of you because it takes two. And so hopefully whoever is listening is like, “Hey, collect your labs and take a look at them yourself.” And if you have no idea what you’re looking at, your doctor should be showing you that. That’s what a good doctor does is, hey, doctor is teacher, right? “I’m going to show you that these are the things that are wrong. This is how you’re going to fix it.” Instead of waiting for the big red diagnosis, you can do something about things … We all have something to improve on, right? Always.
Dr. Weitz: And I think the health of the man gets overlooked quite a bit. And that’s at least 40%, right, of the potential issue?
Dr. Levesque: Huge. Oh yeah, for sure.
Dr. Weitz: It’s easy for a guy to say, “Well, I’m fine. It’s not my problem.”
Dr. Levesque: Yep. Totally. And the saying that I like to say is, men don’t go to the doctor, they go to the emergency room. All my men who come on, they’re like, “Everything’s fine. Everything’s fine.” And then I look at even half the stuff and we test and I’m like, “Oh my God, how are you not…” Because there isn’t that report card that you get every month. Males in general are not … You don’t have this cyclical, where we as women, if something is wrong, we will know it in the second half of the cycle. Men’s cycle is daily, right? That testosterone, it’s up and down and then peters and then up again and down. And so, it takes a lot for a male to be very aware and in tune to say, “Hey, something is off.”
Dr. Weitz: And men tend to ignore their health.
Dr. Levesque: Yes.
Dr. Weitz: They fill out those health questionnaires that we have everybody fill out, and the guys will have one or two and you start asking them and they go, “Yeah, actually I do have constipation and bloating, but it’s fine.” So, they put zero down. And, “Yeah, I do have fatigue, but I put nothing down because it’s okay.” And once you start going into their history, there’s a million things going on. They just don’t-
Dr. Levesque: For sure. And some of that I think is training, right? I’m not sure what you experience in your practice, but societal that, “Hey, I have to be the strong tough guy and I can’t show weakness.” That we really need to start breaking that barrier because I know for me, it was a big, with my husband when we first met, it’s like I’m a naturopath, he was into fitness, but it’s like there’s a big discrepancy in terms of what you do when you’re working out in a gym versus a naturopath. And I was very straightforward of, “This is really important to me. I want to grow with someone who is also going to want to be healthy and grow a healthy family together.” And this was before we got married, because it’s like, “Hey, if we’re not on the same page now, it’s going to be very hard to be on the same page down the road.”
Dr. Weitz: Your husband’s into fitness?
Dr. Levesque: Yeah. We owned a CrossFit gym four or five years and we have been in the fitness industry. I was a personal trainer for a while, and then looked into nutrition and just deeper layers of like, I had IBS and weight loss resistance after you gained the freshman 15. For me, it was more like freshman 25. And it’s like, hey, I’m exercising, I’m eating well and my weight is not coming off, so something else is going on here. And as a trainer, I used to see women and men who would work so hard and they would eat so well and nothing would happen. And it was just like, okay, there’s more to it than just nutrition and exercise. I think it’s an important piece, but I call my approach the pizza approach, where nutrition and exercise is important, but now you have to look at detoxing. You have to look at environmental toxins. You have to look at labs. You have to look at supplements. You have to look at mental and emotional health. You have to look at community and who’s supporting you, and stress. So, when you look at just exercise and nutrition, now you’re like, oh, that’s just two pieces of the pie. So, if you’re doing that and you’re not seeing results, just know that it’s not that you don’t need to do those pieces. You absolutely still do, but there’s at least six other pieces that are missing.
Dr. Weitz: Yeah. My path to functional medicine and health and chiropractic came initially via fitness, and I did the whole bodybuilding thing back in the ’80s.
Dr. Levesque: For sure. Yeah.
Dr. Weitz: And learned how to manipulate body fat and everything else.
Dr. Levesque: Yep. Yeah, it’s funny, we’ve come full circle. I started in the bodybuilding and then we got into CrossFit, and then we went back a little bit into bodybuilding. Now we’re getting into running. And it’s just exploring different ways of moving your body and what your body’s capable of. But the theme doesn’t change. It’s what I was saying in the beginning, it’s like you have to move your body. That’s not an option, not to.
Dr. Weitz: Right.
Dr. Levesque: That’s just the machinery and how it works and what it needs. So, how can you make it fun for yourself?
Dr. Weitz: Yeah. So, you mentioned nutrient levels and looking for micronutrient deficiencies. What tests do you like to run? My guess is you like the Vibrant micronutrient test.
Dr. Levesque: Yeah. Yeah, I do. I like to run the same lab if I can, because for the most part, it makes it easier for myself, but obviously for my patients as well, because they’re getting one package versus 17 different ones.
Dr. Weitz: Right.
Dr. Levesque: And they run the red blood cell and the white blood cells. So, the red blood cells show us what’s happening now versus the white blood cells shows us what deficiency has been around for longer, so usually minimum three months, but sometimes we can see that six to nine month mark if it’s been truly deficient for a long time. So, I like that test. And it gives, of course, lots of different antioxidants and vitamins and minerals and amino acids and fatty acids. And fatty acids are really important, like the omega-3, omega-6 ratios, because there’s a lot of different diets out there now. And so, people have thrown themselves into different diets, whether it’s keto or metabolic diet or you name it. There’s just so many different stuff that people are trying. Where I like to see, hey, how’s the body doing? And then we feed it what it needs, because if your diet is missing something and you need to supplement, like we all need to supplement now, but you know what I mean? It’s like if it’s really deficient because you’re not getting in your diet, then it’s probably not a good diet for you.
Dr. Weitz: Right. Better to test, don’t guess, rather than just pick a diet based on philosophy.
Dr. Levesque: For sure. Yeah. Yeah. And with that advice, I say it depends on where you are. If you’re just starting out, you can probably get away with just some general advice of, “I need to drink more water. I need to start moving my body.” But if you’ve been at this for a while and you feel like the amount of effort you’re putting into your health doesn’t match the output, meaning, I’m putting in all this effort and my cycles are still irregular and I still can’t lose weight, then there’s a missing piece. And so those general approaches are not going to work for you anymore because you’ve already done that. And so, that’s kind of, if I can bridge the gap for some people to say, “Oh, and I’m ready for the deeper level.” Versus just generalities of eat better, exercise, sleep more, all that jazz that we all need to do anyways.
Dr. Weitz: What are some of the most common micronutrient deficiencies you’ll see, let’s start with women who are having issues with fertility?
Dr. Levesque: For sure. So ,I mean, vitamin D is pretty up there. Selenium usually. Selenium and zinc. So, thyroid. Sometimes I see things like the vitamin A and vitamin E, so those really strong antioxidants. Surprisingly enough, I don’t see a lot of CoQ10 because so many women will supplement with CoQ10 because they’ve seen the research and the studies. And so, one of the things I always say is, “You might need CoQ10, but you might not.” And so, if your CoQ10 levels are good, but you’re taking it, that’s the whole, “Well, I tried this and it didn’t work.” So, a lot of the thyroid nutrients, like I said, the selenium, zinc, vitamin A, vitamin E, even sometimes vitamin C. And that usually depends on what’s going on with the immune system. Vitamin K, if there’s a lot of digestive stuff, K1 and K2, because we produce a lot of that in the gut. So, I’ll see that deficiency. So, usually I never just run one test, right? Not one test is going to give us all the information. So, it’s being able to connect those dots. And then the omega-3 and omega-6, the omega-6s are usually high and the omega-3s are low, so it makes that ratio way off. And so you’re more inflamed, and that comes out in different ways for women, whether it’s painful periods, whether it’s heavy period, maybe it’s skin issues. It’s inflammation, so it shows up in different ways for people.
Dr. Weitz: So, let’s talk about fish oil or omega supplementation. For a woman who tests is low, what would be a typical recommendation, let’s say for 100-and, I don’t know, 30 pound woman?
Dr. Levesque: Yeah. So, I actually first look at the diet because sometimes it’s not so much that the omega-3s are really low, it’s that the omega-6s are really high and that ratio is thrown off. And so, omega-6s are going to come from seed oils. Right? And it’s not that we don’t need omega-6s, it’s just that we can’t have too much, and there’s even omega-6s in eggs. Right? So, it’s not that, “Oh my God, I need to stop eating eggs.” It’s understanding the ratio and how much balance.
Dr. Weitz: Yeah, there’s omega-6s in nuts and seeds.
Dr. Levesque: Exactly. And so, it’s not that we don’t need it, it’s that where’s it coming from? And so, the big popular trends of the oat milk and the almond milk, if you look at the ingredients, and I like guilty, jumped on the train was like, “Oh my God, amazing. Another milk alternative.” But if you look at oat milk, it’s seed oils and it’s really high in sugar because it’s oats, oats are sweet. And so it’s probably one of the worst combinations that we can throw into our system with this really high bad fat, high seed oil and high sugar.
And then you look at conventionally grown meat, and even chicken, chicken breast has probably the lowest nutrition profile. So, all my fitness geeks out there who love chicken because it has the best macronutrients on there, it’s so high protein, no fat, no carbs. It has the worst nutritional profile, and it depends on what those chickens were eating. So, if they’re eating a lot of seeds, and the same with beef, it’s like why grass fed? Well, grass fed beef becomes high in omega-3s, but conventionally grown corn and grain fed beef is now high in omega-6s.
So, it’s switching the type of food that you eat will actually make this big difference because now let’s talk about fish. We have to look at, it’s really hard right now to source high quality fish without any contaminants of heavy metals, plastics, BPAs and phthalates and all this stuff that literally the fish is absorbing, and that includes getting really high quality fish oil. So, I would make sure that that company is reputable and they do the testing. And you probably are still getting some exposure, but it’s very minimal and the pros are going to outweigh the cons.
So, I go through the food first to make sure that, hey, what’s happening with our diet? Because again it’s, “Oh, I’ve been eating chicken breasts exclusively for however long. I don’t eat red meat because I thought…” Whether it’s a macronutrient thing or, “I can’t digest it because I don’t have enough…” Or whether it’s, “I decided to be a vegetarian or a vegan.” And then, “Oh, I’m having all these milk alternatives that turns out have really high seed oils.” Or even crackers and popcorn, things that are healthy, there’s still a lot of seed oils in there.
And so, it’s everything in moderation, but it turns out you’re not having it in moderation. It turns out it’s the majority of your diet. And then we look into high quality supplementation, and I’ll do anywhere three grams to six grams of total omegas. The EPAs we’re looking at probably a gram a day is what I’d like to get in. So, you have to read your labels, because like a high potency one it’s usually one teaspoon twice a day versus if you’re just getting something on the shelf, it’s like you’ll need to take 12 caps to get that.
Dr. Weitz: Yeah. Especially if you’re using a … What’s that one source of omega-3s from the little fish? What’s it called? I drew a blank. Anyway.
Dr. Levesque: I know, I was like aqua-something, but I’m not sure if that’s the same one that I’m thinking about.
Dr. Weitz: Anyway.
Dr. Levesque: NutraSea.
Dr. Weitz: What about adding additional DHA, since DHA is so important for the nervous system, brain development?
Dr. Levesque: Usually, I do both.
Dr. Weitz: You do both?
Dr. Levesque: Yeah. Usually it’s a combination. Yeah.
Dr. Weitz: So, you do a typical EPA, DHA and then add additional DHA? Yep.
Dr. Levesque: Yeah. The-
Dr. Weitz: Yeah, oh krill oil, I was talking about. Most krill oil capsules have maybe 100 milligrams of EPA and DHA.
Dr. Levesque: Yeah, that’s right. So, I mean, it’s really understanding because the micronutrient testing again will show you the EPA and DHEA. And once my patients are pregnant, especially in that second trimester, I’ll put them on a much higher dose of DHEA. But usually the fish oils, they’re not just one omega, they have the ratio, and so it’s just playing around with the ratio. So, instead of it being two-to-one of EPA to DHEA, that ratio is flipped. And so, it really will depend on your needs and where you are in the process. Like I said, in pregnancy, I’ll hype that up even more. And with supplements, when you’re just exploring it yourself and doing it yourself, you’re going to stick on the lower side of the recommendation or whatever the recommendation is. But it’s like half the times that’s maybe a quarter or maybe half the dose of what you need. So you’re like, “Oh, I didn’t notice the effect.” It’s like, well, yeah, what if you got prescribed a medication and you only took half the dose? Unlikely you would feel that same effect. Right? So, it’s the same with supplements.
Dr. Weitz: Yeah. In terms of not getting enough EPA and DHA, the same thing goes for some of these prenatals.
Dr. Levesque: Yes.
Dr. Weitz: Sometimes they’re prescribed and they contain fish oil in it, and patients feel like, “Well, this has everything I need.” But if you’re taking one tablet or capsule, the amount of EPA and DHA you can get in there is minuscule.
Dr. Levesque: Well, in sticking fish oil with everything else, the way that fish oil is stored should be different than the rest of your vitamins.
Dr. Weitz: Right. For sure.
Dr. Levesque: And so to me, that’s a red sign. If anyone who’s watching this was like, “Don’t want to do that.” Because number one, I know you’re going to get a low dose. Number two, it’s unlikely that you’re keeping your prenatal in the fridge. And then you can’t extract where that fish oil is coming from. So yeah, there’s certain things that we just need to keep separate. And that, I would say, is one of them.
Dr. Weitz: Yeah. What are some of the other nutrients that women particularly tend to need more of during trying to get pregnant and important for raising a healthy baby?
Dr. Levesque: Yeah, I think protein is really under … If I go back to the micronutrient analysis, if I test the amino acids, you can see different types of amino acids that are missing for women. So, if you have a lot of digestive issues, L-glutamine is going to be way off. Usually if you’re seeing a lot of stress, serine is going to be off, and that heightens that anxiety and inability to sleep and just feeling like things are not right, if you will. So, women need that 30 to 40 grams of protein per meal. And ideally, it depends on if you’re exercising or not and what your goals are, but you should be hitting that minimum 100 grams a day. And I think you would be-
Dr. Weitz: Yeah, I would say most women are not getting that or even close to that.
Dr. Levesque: Yes. No. Yeah, if you actually track your food, use MyFitnessPal and write in what you’re eating. I have a lot of people, even my marketing manager was like, “I’m eating so well.” And blah. And I’m like, “Show me your breakfast.” And as soon as she shows me her breakfast, it’s like, that’s seven grams of protein. You have one egg, you have a bagel, and you have some whatever fruit on there. And it’s just like that’s considered a healthy … And then it’s like punch that in and understand that you need to make that 30 grams. And she’s like, “Oh, so even two eggs is not enough?” Yeah, even two eggs at breakfast is not enough. And so that if you think that you have enough protein and you think you’ve tried everything, just go ahead and punch your food in for three days and you’re going to learn so much about what’s happening in your system. Because I can tell by just the way that the body looks as I’m sure you can, how the person is feeding themselves, how they’re taking care of themselves, what they’re taking, what they’re doing. And so, it’s like if you’re not getting enough protein, you need that for literally everything in the system.
But your hormones, we talked about FSH and LH, they’re amino acid hormones. We have fat-based hormones, so those are all steroid hormones. Vitamin D is needed for that. Omega-3s are needed for that. Then we have the amino acid hormones, they’re peptide chains, that’s your FSH and your LH. So, your system literally cannot function without protein. And then talking about building a new human, guess what it’s build out of? The things that you eat and your tissue. And so, if you’re tired and exhausted and your nutrients are depleted, the body has nothing to draw from, and so it just can’t do it. I say that we as women create from a place of abundance and vitality. It’s like that energy needs to be overflowing like it has nowhere else to go but to make a baby. It’s like, how many women listening to this right now feel like that? 1%, 2%?
Dr. Weitz: A nutrient that’s come up on the radar screen for me and I’ve seen it on some of the micronutrient tests with women trying to get pregnant or even who are pregnant, being low, and at least one company has started adding 500 milligrams to their prenatal is L-carnitine. There’s actually quite a bit of interesting research on its importance for fertility.
Dr. Levesque: Yep. Yes. Yeah, I don’t see it a lot low on my stuff, but I do know about it. Of course, it’s the same as CoQ10, I think it just depends on who comes through your … But L-carnitine is huge. I see it a lot in weight, of course weight loss, but L-carnitine is important for mitochondria. Right?
Dr. Weitz: Yeah.
Dr. Levesque: And so, mitochondria is the essence of our fertility. Everyone is doing research on it in terms of aging, anti-aging. If you have good functioning mitochondria, you’re basically, you’re set because the mitochondria does so many things for us, but it’s a very important nutrient. I would agree with that.
Dr. Weitz: What are some of the micronutrient deficiencies that tend to come up among men?
Dr. Levesque: Yeah. So, for men, again, it’s going to depend on what’s their picture, but for fertility sake, if you will, so stress is a big one. And then stress impacts testosterone levels. And so, then you’re looking at is it digestion that’s preventing you from absorbing all those nutrients? Do you have pathogens that’s taking that up? So, in males we’ll see actually very similarly, selenium, zinc, vitamin A, vitamin D, vitamin K, if their digestion is off. But now it’s playing a different role for them, meaning that it’s not so much the thyroid, but production of usually you need all those nutrients for production of good, strong sperm. And then with the immune system connection, if there’s a lot of environmental toxins or even pathogens like gut pathogens, then if all those nutrients are going towards dealing with that instead of making good sperm.
I’ll see amino acid deficiencies as well. And cysteine is a big one. So, N-acetylcysteine, that’s a really important antioxidant, really important for fertility as well. And so it’s funny, right? The nutrients that we as females need are very similar to the nutrients that the males need as well. They just play different roles within the body.
And then L-glutamine if there is a lot of digestive. And I’ll see glutathione low, and glutathione is a really strong antioxidant. And I find typically that’s because males are not as … Even when couples say, “Oh, we basically eat the same thing.” But the female just adds a little extra micronutrient, microgreens on her salad, or she throws a little extra hemp seed or some other antioxidant powder into her smoothie that the male just doesn’t tend to do unless the female is making it for him. But those little things add up.
Like the females will get the salads at the restaurant where the males are more likely to go … Right? And I know that I’m making some general statements here because obviously, it’s not true for everyone. But what I see is that glutathione will be on the low sign because males are more likely to drink a little bit more, they’re more likely to maybe stay up a little bit later. Not make those little choices of … And I speak from my experience, my husband is not the one who’s like, “I should sprinkle some microgreens on this.” I’m like, “Put this on there.”
Dr. Weitz: So you mentioned toxins, and we’ve heard a lot about estrogenic substances in the environment that are common in BPA and phthalates and pesticides, et cetera. What type of toxin testing do you like to do? And then, what are some of the typical detox strategies you like to incorporate?
Dr. Levesque: Yeah. This is a big topic, and honestly that is the 99% of my practice is getting people cleaned, cleaning out their environment and helping them clean out their system so their body can work the way that it’s designed. I use CellCore products. I don’t know if you’ve heard of CellCore, but they’re really big in the detox space and have made some groundbreaking products that have been very defining for my practice and my patients and myself.
But I use the Vibrant America total toxin burden test because I get the heavy metals, I get all the environmental toxins, so the plastics, the phthalates, the parabens, the volatile organic compounds. They actually just released a test where you can test the PFAS, so the forever chemicals as well, to see how much your system is excreting. And I’ll look at organic acids, which is just how your cells are metabolizing things, right? Nutrients, fatty acids, carbohydrates, and then bacteria, yeast, that fungus, we can see that.
Because the belief here is that the toxicity is actually the thing that’s causing the nutrient deficiency. I’ve come from a place where I’ve supplemented a lot and nothing shifted. And so, the idea that if you have to throw a bunch of supplements at your body just to barely function, doesn’t add up. So, I use the bathtub analogy a lot like with a shower head, and then you’re the goldfish swimming in that bathtub. The water coming in, the cleanliness of that water is going to be really important. So, that’s you figuring out what’s in your environment that needs to be tidied up. Is it the lotions and the potions that you’re putting on your face? Is it the quality of the water that you’re drinking? Do you have a good reverse osmosis or distilled water or are you still drinking BRITA and bottled water?
What is the quality of the food that you’re eating? How much of it is organic or locally grown or you grew yourself versus processed versus conventionally grown and heavily sprayed with pesticides? Because we can look at all those things and we can test all those things. And then of course, any past exposures, like I have patients who grew up with parents who smoked in the house. And unfortunately some of those heavy metals like cadmium and mercury, they’re still very much present and persistent in the system because it takes a long time for the body, the body tries to protect you, and so it stores it in the fat. And so, those are the same women who have a hard time losing weight, they have painful periods, they have endometriosis, adenomyosis, because they’ve had this really heavy toxic load and the body has just not been able to process it.
So yeah, we’re going to clean up the environment, that’s the shower head, but now let’s look at the drain and then let’s look at the sewer. Because if you put clean water in, that’s fantastic, but what about all the grime that’s still left on the sides? What about the murky water? You need to open up that drainage. So, you need to make sure that that liver is working, that gut is working well, right? You’re sweating on a regular basis.
And then once that drainage and the sewer is working well, then we’re going to get in there and we’re going to scrub and we’re going to scrub the sides. And so, you’re not going to start with a heavy metal detox. You just need to open up that drainage first and make sure the body has enough energy to even detox. And then once you’re having two or three bowel movements a day and they’re really full and you’re eating enough veggies and you’re sleeping well … And for some people that takes months, for some people it takes years. So, I always say, “I don’t care if you’re a slow cooker or a microwave, you want to move in the right direction. It doesn’t matter the speed, but move in the right direction, but don’t start scrubbing before you do the other things because it’s wasted effort. Right? We don’t want a wasted effort. Let’s be strategic because we all have limited amount of time. That’s our most precious resource.” So yes, clean up the environment, open up that drainage, make sure that sewer is not clogged and nothing is coming back up. And then we scrub so that water is clean and that fish can be happy.
Dr. Weitz: Cool. Let’s hit one more topic. Let’s hit thyroid and then we’ll wrap and you can give us your contact info.
Dr. Levesque: Yeah.
Dr. Weitz: So, thyroid is super important for fertility, for being able to get pregnant. There’s been a lot of focus on it.
Dr. Levesque: Getting pregnant.
Dr. Weitz: So, give us your take on thyroid. What tests you like to run, what interventions do you recommend?
Dr. Levesque: So, I’ll say that thyroid is never the only thing. I find it’s rarely the culprit. I find that it is impacted, but it’s not the root cause. And so, it works in conjunction with stress with the adrenals and the ovaries. It’s a whole hormone picture. But most people, first of all, do not get the proper thyroid panel. So, you test your TSH and you’re told that it’s fine. Your TSH just tells us how well the brain is communicating to the thyroid, doesn’t actually tell us how much thyroid hormone your body has. And so, that’s not a complete test. So, you need to have a TSH, but you also should do free T3 and free T4. And then you should probably run some antibodies to see if there is an autoimmune condition that’s present within the thyroid, because autoimmune conditions are going to put you at a much higher risk for miscarriages, and they go unnoticed, undiagnosed all the time.
And then even things like reverse T3, I don’t want to say that necessary, but it’s good to look at it. Right? I’ll run all that stuff. A lot of docs will just run the free T3 and free T4 and the TSH, and it won’t look at the antibodies. But thyroid, it’s your metabolism hormone. It turns everything on. It’s so important for being able to conceive, but also to be able to maintain the pregnancy, and that’s something that should be checked. Again, I have so many patients who have to fight to get these tests, which is insane to me that, hey, your TSH is high, you’re pregnant. You should be like, “We need to address this right away.” As opposed to, “Oh, it’s okay, it doesn’t matter.”
So, I find that a lot of people will focus on thyroid if they have weight issues especially, because everyone’s educated themselves, “If I have poor thyroid function, I’m going to struggle to lose weight.” But in reality, usually there’s a bigger component. Usually the liver is involved. Usually there’s some sort of inflammation. For some people, the immune system is going to be involved. And so you want to look at the gut, thyroid, the stress, the inflammation, and look at it as a whole picture instead of just these single … When I see the thyroid is off, I just know that something is off, but we don’t understand why. So, let’s dig deeper.
Dr. Weitz: So, let’s say you get a patient, and I am not sure what figure you like to see as far as TSH, if it’s 1.5 or 2 or 2.5.
Dr. Levesque: 1 to 2. 1 to 2 is where I’d like to see, yeah.
Dr. Weitz: 1 to 2. Okay. So, let’s say you get a patient who has slightly elevated TSH, like 2.5, 3, and then their free T3 and their free T4 are in the low end of normal, maybe there’s no antibodies. What would you do? Would you send them back to their primary care doctor to get Synthroid or what would you do?
Dr. Levesque: Yeah. That’s a great question. So no, usually when it’s just you’re starting to see it low, this is where natural medicine really, this is our jam. Right? We just start to see that the thyroid is sluggish. The next thing I’m going to look at is, well, why is that low? So, if both free T3 and free T4 are low, it’s likely that you don’t have enough nutrients to make those hormones. And whether it’s amino acids, whether it’s that vitamin C, selenium, zinc, vitamin A we talked about, or iodine, or then the communication between the brain and the thyroid, because everything is a negative feedback loop.
So, you’re just going to look at, okay, if both of them are low versus we make mostly T4 and then it’s converted into T3 in the liver. If you’re making lots of T4, but that T3 is really low, chances are that liver is sluggish and so that conversion isn’t happening. And so, you can start to get an idea of what’s going on, but this is worth some more testing. If I look at micronutrients and all your thyroid hormones are low, hey, guess what? You probably just don’t have enough of the actual nutrients. So yeah, we want to boost that.
But then the next question is, well, why are those things low? “Oh, let’s look at the gut. Okay, you’re not absorbing. You have these pathogens. Okay, so let’s fix the gut.” And then, “Why do we have all these pathogens and why is the liver overburdened? Let’s look at the environmental toxins.” So, I say there’s the test that shows what’s happening and tests that shows why it’s happening. We want to know the what because it helps us get quick wins. I want you to feel better now so you can keep going, but if we don’t address the why, you’re going to be stuck in the what all the time, right? You’re going to be now dependent on those supplements. So, that’s my approach is that, okay, this is good. We want to keep an eye on this, but let’s go deeper. Let’s go a little bit deeper.
Dr. Weitz: And that, of course, is the true magic of the functional medicine approach and what really looking at root causes is.
Dr. Levesque: 100%. Yeah. And I have a lot of people come to me who’ve come to practitioners said, “Well, they never looked at this.” And so if there’s practitioners listening to this, I encourage you to dive deeper. I know that some of your patients don’t want to do it. I have a ton of patients who I don’t accept because they don’t want to do it. They’re just like, “Oh, I want help, but not really.” So, it’s okay. What I hope is recognized for those patients that know that you don’t really want the help, and that’s okay if you’re okay with that, but if you want the help, this is the work and there’s people who want to do the work. And I think it’s our job as practitioners to really show people that this is what’s possible and here’s some general advice that’s really great, but if you want to take it to that next level and actually heal your endometriosis or your PCOS instead of just manage it, then it’s not going to be just take CoQ10 and inositol and whatever and hope that it works. It’s going to be doing some much deeper work, the scrubbing, getting the gloves out, and doing the scrubbing.
Dr. Weitz: That’s great. Good. So, how can people get a hold of you? What’s the best contact information?
Dr. Levesque: Sure. Honestly, the best place to contact me is going to be through my Instagram. I’m on there, really active. I go on stories, I share lots of valuable content. I have my own podcast as well, Modern Health with Dr. Jane. But @drjanelevesque and lots of resources. On the Instagram you can send me a DM and say hello, and then I have the resources for the website.
Dr. Weitz: Can you spell your name for the listeners?
Dr. Levesque: Yeah. So, Dr. D-R J-A-N-E and then L-E-V-E-S-Q-U-E.
Dr. Weitz: That’s great. Thank you so much.
Dr. Levesque: Thanks so much for having me, Ben. It was a pleasure.
Dr. Weitz: Thank you for making it all the way through this episode of the Rational Wellness Podcast. For those of you who enjoy listening to the Rational Wellness Podcast, I would certainly appreciate it if you could go to Apple Podcasts or Spotify and give us a five-star ratings and review. That way more people will discover the Rational Wellness Podcast. And I wanted to let everybody know that I do have some openings for new patients, so I can see you for a functional medicine consultation for specific health issues like gut problems, autoimmune diseases, cardiometabolic conditions, or for an executive health screen, and to help you promote longevity and take a deeper dive into some of those factors that can lead to chronic diseases along the way. And that usually means we’re going to do some more detailed lab work, stool testing, sometimes urine testing, and we’re going to look at a lot more details to get a better picture of your overall health from a preventative functional medicine perspective. So, if you’re interested, please call my Santa Monica Weitz Sports Chiropractic and Nutrition office at 310-395-3111, and we can set you up for a new consultation for functional medicine. I’ll talk to everybody next week.
