Elizabeth Stein 00:00
Hi, everyone. I'm Elizabeth Stein, founder, and CEO of Purely Elizabeth. And this is Live Purely with Elizabeth, featuring candid conversations about how to thrive on your wellness journey.

With one of the most downloaded episodes, Alisa Vitti, top women's hormone expert founder of FLO Living, integrative nutritionist, and best-selling author of WomanCode + In the FLO is back on the podcast this week. Alisa is the creator of The Cycle Syncing® Method where she teaches women how to use their biological rhythms to optimize their health and create extraordinary lives—a graduate of John Hopkins University and the Institute for Integrative Nutrition. Alisa has been featured on the Dr. Oz Show and is a regular contributor to women's health MindBodyGreen the Huffington Post and Yahoo's health hormone whisperer column. We asked you on Instagram for your burning questions for Alisa and in this episode, she answers everything from Is it normal to have inconsistent cycle lengths? What is cycle thinking? What are the top ways to balance hormones? Is it normal to have PMS and cramps? Why seed oils are a top hormone disruptor? How the pill affects our gut and tips for going off the pill. What is perimenopause? And what can we do to minimize menopause, we cover so much ground in this episode. I know you guys are going to love it. I just wonder why did they not teach us this stuff in grade school. Anyway, hope you enjoy it.

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Alisa, welcome back to the podcast. Such a pleasure to catch up with you. I think it was about a year ago that we did our last recording. And it was one of our very top episodes, which is why we're so excited to have you back.

Alisa Vitti 03:03
I'm so happy to be back. Thanks for having me.

Elizabeth Stein 3:05
Yeah, so certainly it was one of the top episodes because women want more answers. And we've been in the dark for so long. And you've just done such an incredible job of educating the community and bringing so much of this to light that it's incredible that we just are grown up knowing so little about it. So thank you for all the work that you do and the impact that you've had on so many women.

Alisa Vitti 3:32
You know, I just have been loving the whole concept of menstruation since I first heard about it when I was … how old are you in sixth grade 12? or 11? And it's been unendingly fascinating to be. So it's a pleasure to do my part to educate women on the powers of their hormones and their cycles. It's a good thing.

Elizabeth Stein 3:57
Amazing. Well, everyone can go back and listen to the last episode and hear your story, which was season four. But for now, that's around us, we went and asked our community questions. So that's what we're going to be talking about today. But that's first ground us in the four phases of our cycle. Because while it's so basic it might be it's still a big thing that many women don't even know.

Alisa Vitti 4:19
So yes, your cycle has four phases. There's the follicular phase, the ovulatory phase, the luteal phase, and the menstrual phase, which I like to call the bleeding phase because it does get a little confusing and convoluted when you're saying the menstrual cycle, menstruation, and the fact that we use one piece of vocabulary to describe both the entire cycle and the moment of bleeding. I think it's confusing. So you can either call it the bleeding phase, or you can call that the menstrual phase but then call the rest of it just your cycle to keep it straight in your mind. These four phases do specific things within the reproductive structure. So for example, in the follicular phase, your ovaries are producing are starting to mature several eggs at once. During ovulation, one of those eggs reaches full maturity and is released and travels down the fallopian tube into the uterus. During the luteal phase, you 3d print an entire organ called the endometrium fresh every month no big deal. And that develops inside the uterine wall. And then during menstruation, that's when that is sloughed off and leaves the body if it's not needed. So that's what's happening inside the body, and then there's the hormonal patterns that take place, so we have low to rising levels of estrogen in the follicular phase, then that which is helping with all of those eggs maturing, but also has effects on our mood, on our metabolism on our brain and all of these other things. We have in the ovulatory phase, the peak surge of estrogen as well as follicular stimulating hormone, luteinizing hormone, and testosterone, which has a whole bunch of effects on the body, brain metabolism, immune response system, and stress response system.

And that peak surge of all of those hormones, of course, causes the release of the egg from the ovary. Then in the luteal phase, in the first half, the luteal phase is the longest phase of the cycle, it's 10 to 12 days. It's my favorite phase of the cycle. I know everybody thinks ovulation is going to be my favorite. It's a close second. But I love the luteal phase because I love progesterone so much. The effect of progesterone on your body is what makes its first and only appearance during the whole cycle during the luteal phase. As it rises in your body, it has profound effects on brain chemistry, making you very calm and focused. As somebody who likes to work, this is why it's my favorite phase because it adds a lot to that phase. And, of course, it's building the lining of the uterus along with that rising level of estrogen, it's holding it in place inside the uterine lining. And then when those levels start to decrease in the second half of the luteal phase, that's what has now indicated to the body that a conception has not taken place and to start to release that lining. And then when they reach all their lowest levels at the end of the luteal phase, beginning of the menstrual phase, that's when you start bleeding, and then the cycle starts again. And all of this dynamic pattern is designed to facilitate this incredible physiological process. But it also has an important effect on major systems of the body. This is my big discovery that I wrote about in the second book of the flow, it's governed by a specific biological clock, called the infradian clock. And this makes sure that it keeps the time of all of this dynamic pattern in place, and affects all of these other systems in the body.

Elizabeth Stein 8:04
All right, so one other grounding as you're talking about the cycle and the rhythm, your whole ethos is living in sync with these different phases and how we can eat and think and exercise according to those different phases. So if you want to touch on that, that is an overarching overview. That would be great.

Alisa Vitti 8:26
Yeah, so as I was unpacking this infradian rhythm, and its implications and impact on metabolic rate, on stress response, it became apparent that the whole premise that we had been operating under as women, because women were being left out of medical fitness and nutrition research, this premise was, well, there were just smaller versions of men with slower metabolism. So we just should restrict a little bit more calorically and do a little bit more cardio to compensate. But that whole premise falls apart. And that doesn't make any sense. In the sense that if we were circadian beings, which men are, their hormonal pattern follows a circadian clock, then it does make sense to eat the same amount of calories day in and day out and do the same type of workouts in terms of intensity regularly, even doing a workout at the same time of day, for example, is also relevant if you have a circadian only clock. And that's true, let's say of children and of women who are postmenopausal because their circadian only as well. But in your reproductive years because of this infradian effect that creates this dynamic pattern, for example, your metabolism is slower in the first half in the follicular and ovulatory phases, but it's faster during the luteal phase and the second half of your cycle. Studies show you have to eat 279 more calories per day in the second half of the cycle. So this whole idea of just trying to be “good” and eat the same amount of calories every single day is ludicrous, totally ridiculous. And we have to just jettison that and let it go because it's not serving you. What it's doing is disrupting your blood sugar. If you eat the same calories in the follicular phase and try to maintain that, let's say, it's 1200 calories a day, and then you try to maintain that in the luteal phase, you're going to disrupt your blood sugar, you're going to become more hypoglycemic, that which is going to trigger a cortisol response, which is going to decrease your progesterone levels, which is going to increase your PMS. That's just within that one cycle. If you keep doing that, then of course, we're talking about prolonged PMS as a reality and other cycle disruption, elevated estrogen, and insufficient progesterone are one of the environments in which many menstrual disorders arise, whether it's fibroids, or ovarian cysts, or heavy cramps, heavy bleeding, all of that really can only take place when there's this imbalance, imbalance of estrogen and progesterone, which we can prevent with proper cyclical management. When I was looking at all of these things, it just occurred to me that what we needed was a method to properly take care of these cyclical patterns. And that's when I created the cycle sinking method, which has you synchronize not just calorie intake, but also your food type, to match your hormonal patterns throughout the cycle. And then also, your workout type and intensity is very important to shift that as well throughout the cycle. Then as I mentioned, in your first question, there are all these powerful brain chemistry effects that these hormonal concentrations have throughout the month, it's advantageous from a stress management and productivity point of view, to start synchronizing some of your work and productivity choices with the phases of your cycle as well. So that's the cycle thinking method. I created an app to make this super easy for people and intuitive, it's called MyFLO, and it's free to download and has a circle icon like the book, and you can join the revolution. This has become something of a revolution. We have, I believe, at the last check, it was 500 million searches for cycle syncing. So it's become something of a revolution because you can imagine what it feels like to go your whole having this whole situation around your cycle being a blind spot. And then also absorbing a cultural narrative that says you have to deny your body to succeed in the world because it's a world that's oriented around this male hormonal pattern. And then you're given the correct information for the first time and a method to thrive in your biological reality. And it feels revelatory and celebratory to start living this way. So I think a lot of women are enjoying coming home to themselves for the first time and feeling good. Getting rid of symptoms is such an easy thing when you do this. But it's really about thriving from a different perspective as well.

Elizabeth Stein 13:23
Yeah, it's incredible. And 500 million US certainly shows the amount of this yearning that women have to not only feel better but educate themselves and open up to a world that they didn't know. So we'll start with some of the questions. And I think this is a perfect first one to start with, which is just on the basics of PMS and cramps. We've been taught our whole life like, you get PMS and cramps, and I may have inherited that from my mom, which I know is not true. So if you can explain, is it normal to have PMS and cramps? And is it inherited?

Alisa Vitti 14:05
Okay, so it's commonplace to have PMS and cramps because of what we just talked about in the sense that women aren't given the proper education and they don't know how to take care of themselves. So as a result, it's very common to have PMS and cramps. Is it normal? No, it's a sign of a hormone imbalance. And I want to stress that you need to take those signs from your body very seriously. And that's not just my opinion. In 2016, the American College of Obstetrics and Gynecologists decreed very historically, that women's cycles must now be considered their fifth vital sign. The other four that they take in the emergency room, while your cycle is now, from a medical perspective, considered a fifth vital sign. Just think of it this way, if you have a fever, you're all over that, you deal with that, you're on top of that. If you have cramps, if you have PMS, if you're having other issues with your cycle, that is the equivalent of having a negative reading on one of these other four vital signs. Then you would want to take that very seriously. So yes, it's a hormone imbalance. Why do we have cramps? I always think it's fun to understand the science behind it because then it just makes it like a fun game to sort it out. So here's the deal with cramps. Your uterus is a muscle.

And for any of you who've ever given birth or been pregnant, you understand it does its thing. It is a powerful structure. And it's controlled by these things called prostaglandins, the ability for it to contract and release as controlled by prostaglandins.

And so there are three of them, PGE1, PGE2, and PGE3. If nature designed you to have cramps, you would at least have to have more prostaglandins that control the uterine contraction, like two of them would have to control uterine contraction, but only one does. Two of them are designed to control uterine relaxation, so PGE1 and PGE3 control uterine relaxation and PGE2 controls uterine contraction. The challenge is when you eat foods that are processed, especially processed seed oils, that have the wrong omega fatty acid balance, you start to drive up the production of PGE2 and suppress the production of PGE1 and PGE3. So what you have is a uterus who is overworking unnecessarily to expel the endometrium. And it doesn't need to be that way. Just by changing within one menstrual cycle, you can get rid of your cramps, so long as this is the cause of your cramps. Now, you could of course have fibroids, you could have adenomyosis, you could have endometriosis. And that's a separate issue in terms of let's say, the uterus being a little bit more challenged to do its job of expelling that lining. But if it's just what we'll call garden variety cramping, even if, like it used to be for me before I figured this out, and I've been in labor, I will tell you, my cramps were equivalent to labor pain. And if I did not catch it at first feel it in my thighs before I would feel the cramping and I was, oh, it’s coming. And if I didn't take ibuprofen before the cramps hit, I'd have to lay down for at least six hours while my body went through this labor. And it was like labor. Would come and go, I'd have intense moments. And then I'd have a break. It was labor pains. And this was just the cramping. I would be green and white. It was horrible. When I talk about how I get painful cramps, I do. I know women also can blackout I mean and pass out. And it is no joke. And I know that there are these simulator devices that they put on men, which I just think is the funniest thing ever, and so great. But there have been all sorts of memes about how painful menstrual cramps are. So I take it seriously. And for me to tell you that this is something that you can resolve in a cycle, I would not even try to tell you that if I hadn't seen it personally and professionally for so many women. But it's just so exciting to be able to solve that problem for yourself and to get off the roller coaster of pain medications and days off of your life and all of that discomfort because it's also very stressful. When you're feeling all that pain, it's very stressful. So it's not just the pain, but you're also anxious and upset and it's draining. So I hope that just by switching up your fats, just by getting rid of seed oils, getting rid of canola oil, eating more coconut oil, eating more flax oil, eating more avocado oil, olive oil, just having healthier fats all around within a month, you'll start to have a major improvement and then month over month, it'll only get better from there. But I'm here to tell you I do not have any cramps.

And this is also important if you're preparing for childbirth. It doesn't need to be so painful if you eat properly leading up to it because again, the uterus has a big job to do.

And it's going to use a lot of prostaglandins to do labor, but you can be efficient about it. This is why for example, a lot of midwives recommend using raspberry leaf tea towards the end of your pregnancy to help your uterus be very tonified, just efficient. It's like a muscle you want it to be working efficiently. So that's the story around cramps. PMS is also a hormonal imbalance where there is too much estrogen without enough progesterone opposing it. In a healthy cycle, in a healthy luteal phase, you should have much more progesterone compared to estrogen in terms of a ratio of balance. And when you do, do you have no PMS, zero PMS? Let me say that again. You can have zero PMS, even if you have all the PMS right now, you can completely get rid of that like for real. And I think that that's important because there is a cultural narrative that says, if it was painful for your mother, or difficult for the women in your family, that that's what you're… it's this mythological, toxic story that women believe because we're not given the correct information, we don't understand the science. But this is 100% something you can manipulate with diet and lifestyle. And the cycle thinking method is your best tool to get rid of PMS. Period. Pun intended. Because what you're going to be doing to flip that ratio to get out of too much estrogen and not enough progesterone, to flip it to the other way, you've got to keep blood sugar consistent throughout the month, you've got to eliminate excess estrogen throughout the month properly, you've got to eat strategically to build progesterone levels, you got to make sure you're not overworking your cortisol by changing your workouts according to the phases of your cycle. So the whole method behind cycle syncing is designed to optimize the hormonal output in each phase, and you can't spot-treat it. You can't just, okay, I'm going to take care of myself in the luteal phase, it doesn't work that way.

Because each phase of the cycle is contingent upon the phase prior. So you do have to be committed to taking care of your cycle as a whole. Just download the MyFLO app, it'll tell you what to do, what to eat, and which workouts to do. And you don't have to think about it, and that'll let you track your symptoms, it's just you watch how your symptoms evaporate within a couple of cycles. And you can be rid of PMS forever.

Elizabeth Stein 22:01
Well, for anyone listening who has PMS or cramps, hopefully, you're feeling much better now knowing that there's a way that you don't have to feel that way. And I think it's so important hearing that and also hearing, you said at the beginning, talking about cramps, like this is normal, and you need to listen to your body. I think this was a big takeaway from reading your books and talking to you and a little bit about my journey last year, in the last couple of months when I had gone off birth control, I always had a regular period, and I never had cramps. And then six months later, I had a really heavy period where I had a ton of cramps. And I thought this is not normal. And I think I'm so in tune with my body that I did something with about it. But I think there's a lot of people who might not be and so you might just think, okay, this was a different month, but I ended up going to my doctor and getting a bunch of testing and bloodwork. As it turned out, I had high prolactin and I had to go get an MRI and turned out I had a small non-cancerous tumor on my pituitary gland. But long story short, the important part was listening to your body. And when something is a little bit different, that wasn't that way, like it wasn't normal to have those cramps. And that's what set off my path. So really want that to be a lesson to people to not take that lightly and to go and talk to someone if something is off or alarming.

Alisa Vitti 23:32
Yeah. And I think that's what's so powerful about tracking your cycle, which is the other thing that the MyFLO app allows you to do is track your symptoms over time.

Because when something is off, it's relative to what is normal. So for you, you were trying to even establish what is normal for you, because you had been on oral contraception for so long. And as so many women are when they do go off, they're not even sure what's normal, what's not. So tracking for a few months can be a powerful tool to help you understand, what feels right, but then also listening to that little voice inside of you that says something doesn't feel quite right. That's always a good thing. It's always great to go get testing and follow up when you are feeling that way.

Elizabeth Stein 24:21
So our next question on that topic was on going off of contraception and what can you expect after you've been on birth control.

Alisa Vitti 24:31
Well, I wish I could give you a whole bunch of good news but what I will say is, it will be manageable if you prepare and support yourself properly. So here's what happens when you're on this medication. First and foremost, it shuts off all your production of your hormones. That's how it works. And instead of you being able to make estrogen and progesterone, etc., you are dosed with it through the medium of that oral contraception or a shot or a ring or whatever it is that you're using, but it does you as opposed to you creating your own. And that's important to understand because you're not making any hormones the whole time that you're on it, and you're not ever ovulating and you're not ever having a period when you're on oral contraception. You can say, oh, wait, I get I get some bleeding every month. That's just breakthrough bleeding because your uterus is being stimulated a little bit by the synthetic estrogen and progesterone. But most gynecologists when they prescribe these things will tell you that you should expect that to go away altogether and that you wouldn't have any bleeding at any time. So you're not ovulating, you're not menstruating. And the reason why I want you to know that is just because there's a big opportunity cost to not having ovulation every month. Ovulation is the most important part of our cycle in terms of long-term health benefits. Short term, every ovulation confers cardio, neuro, and osteo protection to you, protecting your brain heart, and bone density. This is why for example, let's say female athletes in high school, if they're getting down to a very low BMI, and lose their period, doctors are concerned for their bone density health. So ovulation is very important. But it's also important because someday you will be postmenopausal. And when you are postmenopausal you, of course, are not ovulating.

But every ovulation you do have, that you had when you're in your reproductive years, continues to protect your brain, your heart, and your bone density in your post-menopausal years, which is so important. So the big opportunity cost is if you're stopping ovulation for 20 years of your life, you're also robbing your future self of that protection, which no one's talking about. I think if women were given that information, they would be like, well, what are my other options? You know, they just want to know, what are my other options. So that's just blocking and tackling what's happening. And then the third layer of what's happening is while you're taking the medication, it's actively depleting your system of key micronutrients and disrupting your gut. This is very problematic in the short term because it can have profound effects on mental health. It can have profound effects on weight metabolism, and muscle density. And long term, when you go off of this, you have to clean it up. It's difficult. And some women never recover from the effect of, for example, there's a potential side effect of being on birth control, where for every woman, temporarily it elevates the levels of sex hormone binding globulin. So it suppresses your sensitivity to testosterone. But then for some women, even when you go off of it, this is a permanent change. So your sex drive never comes back. So that's another potential side effect. So all that being said, what are your other choices? If you want to prevent pregnancy, how do you do that? If that's why you took this if you got on this medication to fix your fibroids, your PCOS or endometriosis, your PMS, your cramping, or your acne, that's not the solution that you need or want, there is a better way. Cycle syncing is the better way.

If you went on it to prevent pregnancy, let's just understand, that the egg is only viable for 48 hours. For any of you who are listening and who are in your fertility journey, trying to conceive, struggling to conceive, it's like this big twisted joke once you get to that point where up until the moment where you're trying to have a baby, everyone's like you could get pregnant at any time. And then when you want to get pregnant, you're like, oh, you can only get pregnant for 48 hours out of the month. It's like what?

Why aren't we just told this all from the beginning? And it's frustrating because it's a very short window, and you're being given medication that flattens you every single day when you only need some protection for those 48 hours plus the five days that sperm can live in the body. So it's a seven-day window of time, you've got to protect yourself as opposed to every single day. So it's about looking for other options. And now we live in a more technologically advanced femtech moment. 70 years ago when birth control made its advent on the scene, this was a huge technological advancement, and wonderful for women to be able to do family planning. But as always, we're not putting VHS tapes in our players anymore. We're streaming things now. Technology changes and we change with it. And I think this is just one of those moments where we can and do have other options and we should be investigating them as really viable options. One of those is using wearable devices that track basal body temperature so that you know with precision when you're ovulating and when that 48-hour window is—then using barrier methods for that one week out of the month. It's just one week, if you don't want to get pregnant you have to use a barrier method. And if you're with someone, you don't want to use a barrier method. Another product is FDA-approved, and my prescription from your gynecologist is called Phexxi.

And it's a lactic acid vaginal gel. You guys are using lactic acid on your face at night. So gentle. It just prevents the sperm from doing anything and going anywhere. It's not a spermicide. So it's more gentle and it has no hormonal side effects. And you could use that. You could do whatever you want. But with tracking that is possible today, there's no need to use such an overkill method of birth control to prevent pregnancy if you're only using it from a family planning point of view.

Elizabeth Stein 31:09
Thank you, those were such great tips. And I think especially if you knew as an adolescent, taking the pill off, here are all of the benefits in the future and what you're suppressing, that's pretty big.

Alisa Vitti 31:28
It would be so exciting to think about, like, what would an alternate reality look like for teen girls? Right? Well, it would look like they would just be getting a wearable device really getting into tracking their cycle, intimately understanding their bodies and their patterns, cycle syncing to take care of their hormones, and being smart and responsible around what they're doing in terms of protecting themselves, which in your teen years should always include barrier methods because you're in your teen years. So I think it's a different potential reality than the one we've been living with. And you also asked a question about what you do when you come off. When you come off, from a skin perspective, the pill reverts your sebaceous glands to pre-pubescent function. So when you go off, you're going to have a little bit o