#73 How To Get Your Period Back Naturally

The Holistic Nutritionists Podcast

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THE PODCAST

"Hypothalamic Amenorrhea is when your period stops coming, you're not ovulating, you're infertile, and you're not releasing the hormones needed for a healthy menstrual cycle. It's all caused because your hypothalamus (in brain), which is the master control gland, stops communicating to your ovaries to release those hormones for a healthy menstrual cycle."

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SHOW NOTES

In Episode 73 of The Holistic Nutritionists Podcast, Natalie Douglas and Kate Callaghan discuss how to get your period back naturally and Hypothalamic Amenorrhea treatment options.

  • What hypothalamic amenorrhea (HA) is
  • The main causes of HA
  • Why it’s important to have a regular menstrual cycle and what happens when you don’t (hint- it ain’t as grand as it sounds)
  • Nat & Kate’s experience with HA
  • Can someone have HA if they are overweight or if they don’t over-exercise/under-eat?
  • Getting diagnosed with HA
  • How to recover from HA 
  • What to do if you’ve got thyroid/gut/adrenal issues too
  • Recovery time for HA and getting your period back
  • Does everyone need to gain weight to get their period back?
  • Supplements and essential oils in restoring your period
  • Details of Kate’s upcoming Healing Hypothalamic Amenorrhea course 

Intro 0:00
Hello and welcome to The Holistic Nutritionists Podcast, with your hosts Natalie K. Douglas, Thyroid Healer, and Kate Callaghan, The Holistic Nutritionist. Nat and Kate are degree-qualified dietitians and nutritionists, certified fitness instructors, speakers, and authors. If you love unfiltered banter, unedited bloopers, and authentic heart-sharing, then we are your ladies! Now it’s time to sit back, relax, and get ready for our latest tips on living your healthiest life possible.

Natalie K. Douglas 0:36
Hey, guys! Welcome back to The Holistic Nutritionists Podcast. Kate, what’s up?

Kate Callaghan 0:42
Hey, Nat. How are you doing?

Natalie K. Douglas 0:45
I’m pretty good. I was just telling you pre-recording that there is a man at 7:30 AM in the morning obviously, that’s what AM means. When it’s overcast, there’s someone like using that leaf blowing machine. I’m like, dude, your leaves are going to get stuck to the ground while you blowing in the morning. Anyway, so, if you guys hear a little bit of that background noise I am very sorry. I will try and mute myself but just know it’s I have no control over the blowing man outside.

Kate Callaghan 1:14
You don’t scream at him?

Natalie K. Douglas 1:16
I couldn’t. I’m just not that person. I was having this discussion with my husband about like assertive people in those kind of situations. I’m just not one of them. Like, I’ve never been someone and I’m not saying this is a good thing. I actually, we wish I had more balls but I’ve always just like if, for example, like if, if something comes out in a restaurant and it’s like a bit wrong or if someone’s like, making noise above their apartment, like really loud, like way, like at a really inappropriate time. Like I would never go up and knock on the door and say something, or I’d never like at a cafe speak up that I’d like gotten the wrong thing or they forgotten something. I’m just like, oh, that’s okay. That’s fine but then my husband’s the opposite, like he’s really assertive like that. I’m like, I wonder what like, what’s with that? I think it’s because my mom was always like she’s very laid back and like, oh, it doesn’t matter like and so that’s what I’ve learned like no one really around me ever you know would speak up, my grandma maybe but anyway just interesting. What are you like? Are you someone that like says something, or are you like oh, no I won’t bother anyone.

Kate Callaghan 2:25
It depends on the situation. If someone’s messing with my sleeping then yes. Yes.

Natalie K. Douglas
Yeah.

Kate Callaghan
A bit like assertive. I’m very protective of my sleep.

Natalie K. Douglas 2:37
Yeah, I know, like it’s funny like, like if it was someone that I knew like if it was my husband making a noise, I’d be straight out there being like what the hell are you doing? Well, it’s a strange. I don’t know, maybe I care what people maybe I don’t, I don’t know what it is. It’s not a good thing though.

Kate Callaghan 2:51
Yeah, if it’s I mean, if we’re in a cafe and there’s something minor, then I probably would let it go but you know if they’ve given me some gluten obviously on and I’m gonna say.

Natalie K. Douglas
Oh, yeah, it’s like that. Yeah.

Kate Callaghan
You or, yeah, it depends on what the situation is and how hungry I am.

Natalie K. Douglas
Yes. Very cool. Very cool. Oh, very funny.

Kate Callaghan
There were times. I just can’t be bothered waiting for another meal to be made.

Natalie K. Douglas 3:23
Yeah, that’s true. Yeah, are you like, I don’t know, I just need to get better at it. It’s just like there’s so many things that like just don’t matter like to me but then I think that sometimes I hide behind that excuse and it and it does matter to me but I’m just too uncomfortable with confrontation which is funny because I have no problem like speaking in front of hundreds of people or like, like that kind of stuff. Like I have no problem with that but when it comes to yeah, like confrontation or something like that, I’m like, oh, so uncomfortable. Anyway, first world problems. So, today, as a truck goes pass, while the blowing machine has a break, we are talking about hypothalamic amenorrhea, which is a topic that is very close to both of our hearts. And Kate, we are, well I am and I’m sure you are too, really excited that you’re actually launching another round of your Healing Hypothalamic Amenorrhea course. And I think it’s perfect timing intentionally, that we actually talk a little bit more about this because I feel like it’s something that a lot of women suffer from in silence, and that sometimes there can be like, it can be really overwhelming to implement what needs to happen. So I’m not going to go into too much detail because I’m sure we will cover it. Why don’t we just start off with telling everybody what exactly hypothalamic amenorrhea is and let’s call it HA from now on.

Kate Callaghan 5:03
I know you’re about to say that. So yeah, so as you said I’m about to run another round of my course. I love running it around the end of the year because it really sets people up to just enjoy eating all the food. It’s nice.

Natalie K. Douglas
Starts the timing. Hey, because everyone else is in the spirit.

Kate Callaghan
Well, because a lot of the times and we’ll go into this but a lot of the times the HA have troubles with food restriction, and not being comfortable eating all the things. And so if you go into it and finish the course around your Thanksgiving and Christmas and you’re like, I’m just sweet with eating all the food and then you can really just enjoy the experience that is the festive season.

Natalie K. Douglas
Yes.

Kate Callaghan
Anyway, backtrack. So what is HA? So Hypothalamic Amenorrhea. So amenorrhea, we’ll break it down, amenorrhea is when you have lost your menstrual cycle. You have no period, you do not bleed any longer. Hypothalamic refers to your hypothalamus in your brain, which we’ve spoken about many, many times. It’s your master control gland, which tells all of your other hormone systems in your body what to do. So basically, hypothalamic amenorrhea is when your period stops coming, you are not ovulating, you are infertile, you are not releasing those hormones for a healthy menstrual cycle because your brain, your hypothalamus stop communicating to your ovaries to release those hormones for that healthy menstrual cycle in a nutshell.

Natalie K. Douglas
Good nutshell and I feel like that was very easy to understand but what actually. So you’re saying there is no like the communication is lost, but what actually causes that communication to shut down?

Kate Callaghan
So there’s just few different things and most commonly, it is undereating and or over-exercising, and this doesn’t necessarily mean you have an eating disorder, although a lot of women with eating disorders do also have HA but you can also just have what I call disordered eating, where you might not actually be deliberately restricting your food or deliberately acknowledging that you’re over-exercising, you know, like, and you don’t have those clinical signs of an eating disorder, but you’re just not nourishing your body, how it’s meant to be nourished. So, that was me, I had more disordered eating but not an eating disorder. Do that make sense?

Natalie K. Douglas 7:29
Yeah, yeah, it does.

Kate Callaghan
Yeah.

Natalie K. Douglas
I think I would be probably the other one. Well, like, I did have an eating disorder.

Kate Callaghan 7:35
Yeah. So it can be it can be both, and all one or the other. Overexercising it can also be psychological stress and it can be psychological stress alone. So this is a big thing. So women often think that it’s just around the eating and the lack of calories and all the overexercising, but it can be psychological stress alone, that’s a big big factor. And then the other one that I see that can contribute to HA is oral contraceptive pill. That’s more what we call post-pill amenorrhea but it’s a similar mechanism because when we take the pill, it’s basically telling your brain that your body doesn’t need to produce those sex hormones because you’ve got those synthetic sex hormones coming through. So it’s, again, switches off communication between the brain and the ovaries.

Natalie K. Douglas 8:25
Bloody pill. Not that I’m judging anyone that’s on it. I’m just judging the medical system that pushes the pill for everything. Anyway.

Kate Callaghan 8:36
As we spoke about yesterday, not on a call, for them to listen to.

Natalie K. Douglas
That’s all right. Me and Kate we’re having a chat. Yes.

Kate Callaghan
I was in that Nat’s awesome thyroid program. So if you have any thyroid concerns go into that and then you can listen to our chat about that but we spoke about how the pill should really be a last resort for addressing hormone imbalances and also contraception. It shouldn’t be that first line of defense because of those side effects that come along with the pill.

Natalie K. Douglas 9:09
Yes, I agree. I was just thinking, can you, I feel like this is a question that a lot of people would have, like, do you have to be underweight to have HA?

Kate Callaghan 9:20
No, no. So this is another thing that women think, they’re like I couldn’t have HA because I’m not underweight, I have plenty of body fat but there’s a few things there. So number one, psychological stress, as I mentioned can trigger HA. So if you’ve had trauma, if you’re really really stressed at work or just in life and not handling it well, then that can trigger amenorrhea. Grief can trigger it as well. Grief is a significant psychological stressor and you can be, you can have significant enough, you can have enough sufficient, that’s what I was looking for not significant, sufficient body fat levels and you could be in a healthy quote-unquote BMI range but still be undernourishing your body. Still not be eating enough calories, or enough of macronutrients that are required for a healthy hormones, and or exercising too much, and you could have been on the pill. So I don’t actually like to use BMI at all when I’m working with women with HA. I don’t think it’s a marker of anything.

Natalie K. Douglas
Yeah, that’s pretty stupid.

Kate Callaghan
It’s pretty stupid. The one thing that I do ask women with HA because it’s a common thing is I say, can you see your abs?

Natalie K. Douglas
Negative, no, I cannot. I’m good.

Kate Callaghan
And that will give me an idea of whether or not they do need to put on body fat and that it’s because insufficient body fat can be a trigger for HA as well because you have insufficient levels of a hormone called leptin, which also signals to the brain sufficient energy levels. I mean if you don’t have that sufficient body fat, you don’t have sufficiently leptin and your brain kind of gets that message that you’re in a famine. So simple self tool, look down, can you see your abs? If you have defined abs and you have no period, then you probably need to put on a bit of fat. And that again doesn’t necessarily mean you need to put on a lot of weight but you need to put in a bit of body fat. Can be two different thing.

Natalie K. Douglas 11:23
Yep. And so okay, so in HA, we don’t actually have a cycle. I’ve heard a lot of women. And I feel like I said this at one stage myself that oh, awesome I don’t have to bleed every month. But I feel like this is a really dangerous, like pattern of thinking to encourage because it is really important to have a menstrual a regular menstrual cycle and there are a lot of negative implications of having HA when you don’t have a regular menstrual cycle. Can you talk us through that? Like why do you think that it’s important to have a regular menstrual cycle and what do you actually see go wrong health wise outside of just like body weight and stuff and body fat? Like what, what can go wrong when someone has HA if they’re not regularly menstruating?

Kate Callaghan 12:11
Yeah, I mean, it’s so dangerous that that message is coming through and it is coming through from medical professionals as well because you know, younger women might go to the doctor and say I don’t have my my period. And I said it’s fine, you know, just come back and see us when, we’ll put you in a pill now then come back and see us when you want to have babies. It’s really not that important unless you want to conceive.

Natalie K. Douglas 12:41
Makes me grumpy. Makes me want to be assertive everybody and go in and march in there and have a confrontation.

Kate Callaghan 12:48
Yeah, yeah. So um, so fertility is a big one. Obviously, if you’re not menstruating, you’re not ovulating. If you’re not ovulating, you can’t have a baby. And that’s important for some people, but it’s not important for all people, especially women who are younger, you know, in their teens or early 20s, even late 20s. And they’re like, I don’t I don’t really care to have a baby or even in women in general, you don’t have to have a baby some women just don’t want to. And that’s totally fine. And so they go, why do I need to get my period back. And there’s a few things that I think more important than fertility. The big thing that I really like to drive home with women that don’t have a period is bone density. So when you don’t have a healthy menstrual cycle, when you’re not producing estrogen in particular, you don’t have that protective effect of the estrogen on your bones, and you’re at a much higher risk of developing osteopenia and osteoporosis, and basically having brittle bones at a young age. I have seen women in their 30s and 40s, who have been chronic runners and not nourish themselves properly. They’ve got HA, they don’t have those hormones, and they fractured the neck of their femur.

Natalie K. Douglas 14:06
Oh, God. That’s very difficult to do.

Kate Callaghan 14:08
Yes. So for those of you who might not know a lot about our anatomy, if you could Google that, you could Google this glial system and if you have a look at the bone that goes into the hip, it’s like a little ball, essentially that goes into the hip and then you’ve got your femur, which is your thigh bone. It is really, really thick. It’s a it’s one of the biggest bones in your body, and to fracture that is quite significant. Like it takes a lot of work to do that. You’d have to be really brutal to be able to do that and I’ve seen it a couple of times actually and that’s a really fact.

Natalie K. Douglas 14:44
Wow, did you have, did you have a low like, did you have a bone mineral density scan done when you had HA at any point? And what was, did you have any negative like low-bone mineral density or anything?

Kate Callaghan 14:58
I did. Yeah. I had to take some scan when I was 27, I think, and yes, I had osteopenia, which is before osteoporosis. You can repair your bones if you get on top of it. The research shows also, I need to point out that the pill does not improve bone density if you’re not also addressing the underlying causes of HA. And there are other things as well other implications of HA, heart disease to increase risk of heart disease, increased risk of immune concerns, increased risk of neurological concerns like Alzheimer’s, dementia, then you’ve got other things that might not be as fatal, potentially fatal, skin concerns, some acne, breakouts, dry skin, low energy, fatigue, low libido, that’s a big one, vaginal dryness, painful sex, lots of things. And then brittle nails, your hair won’t grow, because basically, you’re not nourishing your body.

Natalie K. Douglas 16:07
Yeah. No, well I kind of touched, you did touch on a bit. I was just going to reemphasize the point of of mood and mood disorders like, I was diagnosed with depression and put on antidepressants when I had no period. And as soon as I like actually, the truth is when I actually I was not into Holistic Health at the time and I got put on hormone replacement therapy when I was like, I want to say maybe 19 or 20 and I have got put on antidepressants at the same time. I stopped taking the antidepressants but continued with the hormone like bioidentical hormone replacement therapy, and I didn’t like, my mood was completely changed and that just goes to show like, how much of an impact it can have and I see that all the time as well and I think everything you’ve described like sometimes we, I feel like we rattle off symptoms and possible outcomes and things. Like oh, yeah, but probably wouldn’t happen to me. But I can tell you like, honestly pretty much everything that you just said there I, I had I had osteopenia, I had definitely had dryness, every possible place you can imagine, like hair loss, I had depression, I had absolutely no sex drive at all to the point where I was like, oh my God, like what’s wrong with me. Everyone’s like, finding everyone so interesting at this age and I’m like, gross. Anyway, and I also like, just I had a really low immune system and I ended up getting like, almost septicemia, which is when your blood basically gets an infection kind of thing from a belly button piece piercing that got infected. And usually it would just be like, okay, if that happens, you know, just keep like keep the area clean, take the ring out or whatever and you’d be good. I ended up in hospital on IV antibiotics and then got two parasites on the back of that and it was like, it’s just amazing what can happen from just ignoring this part of your health because really, your cycle is a sign of health, whether you as Kate you said, like whether you want to have children or you don’t, like it’s almost irrelevant because menstruating and having a regular cycle is just a sign that your body feels safe and feels capable of you know, reproducing, which from a biological standpoint is what we are supposed to do like it’s not saying you have to do that but just purely for as a marker of health like it’s huge. Anyway, I’m ranting again, so sorry.

Kate Callaghan 18:50
All right. Warranted.

Natalie K. Douglas 18:52
Yeah, so I just really passionate about it. Anyway, tell us about your experience with HA because I just totally just stole the stage because of Leo. I want to hear more about yours and share it with everyone as well. When did it start for you?

Kate Callaghan 19:07
Look, who really knows, when it actually started? So I’ve probably been, I’ve been willing to exercise since I was three.

Natalie K. Douglas 19:19
Honestly guys, Kate when we’re at uni, she looked like she was running an exercise class just when she was walking. She changed now but I was like, oh my God, are we in BodyAttack is this like a flash mob of BodyAttack that walked in to uni?

Kate Callaghan 19:32
Pretty much that was my life. I didn’t know slow. I did not know slow. Everyone, speed for me. My mom is insane, she was like, oh you have high maintenance.

Natalie K. Douglas
Oh, sorry, keep going.

Kate Callaghan
Although she has told me that my daughter’s more high maintenance than I was which kind of scares me a bit.

Natalie K. Douglas
Oh, gosh.

Kate Callaghan
So I started gymnastics when I was really really really young. And I grew up, my mom’s a vet but before she became a vet she had a brief stint in white watches. As in teaching about white watches, so we had that kind of education, you know, house of fat is the devil, basically, and a bit of body image concerns going on in there. And when I was about 12, I remember one of my best friend is saying to me, if you ever want to get your period, you going to need to stop doing gymnastics, which broke me a little bit but okay, all right. And so I stopped and then I got my period in my teens, at like 14 or 15. And it stayed for a little while, but then when I was 16, I went on the pill and so I’ve got to bleed, but that’s not really a period as we know, it’s not a healthy menstrual cycle and I was at that stage, my brain was trying to communicate to my ovaries to establish those pathways, but I had showed off with the synthetic hormones, and around 17 I became a group fitness instructor and started doing a lot more exercise once again, also playing hockey, and dancing, and all the things that you do at school, and then when I went to university, I started doing more intense exercise, and think that’s a lot of drinking. I don’t know how I did both, really.

Natalie K. Douglas 21:17
I mean, I don’t know how you did both either. I just, you know what? I wouldn’t drink because I couldn’t. I had like a feel that I wouldn’t be able to exercise the next day, which is also ridiculous, but like, I don’t know, yeah wow. Impressed.

Kate Callaghan 21:30
Horrible feeling, horrible feeling. Anyway, so I was doing up to 16 classes a week in my early 20s, and then in 2012 my periods stopped while I was on the pill. So not even mens could fall as a period. I was very, very lean. So if you, I have been in some body fat, and so if you think about what a fitness competitor looks like when they’re up on stage competing on the day, that’s when I looked like year around, very very lean. So I had an eight pack, never six pack, had an eight pack. Just a little bowl of muscle. And so I went off the pill and still no sign of period and around this time I was studying nutrition and dietetics with you Nat. I was planning a wedding. I was exercising like a maniac. I was working in PR. I was doing all the things and I was also following a low carb high fat, very strict paleo diet, and potentially, no not potentially, I was because we track our calories. I was undereating, so I was eating about I think 1400 calories per day, while also doing up to three hours of exercise per day, while also having significant psychological stress. Perfect storm. And I’ve just been on the pill for 10 years. Yeah, it was a shit storm.

Natalie K. Douglas 22:53
Wow. So, what was the prompt like, what was the prompt for you to be like, oh shit, I better do something about this like, when when did the ball drop? And like how long after you realize it was a problem? Did you actually start moving towards getting help?

Kate Callaghan 23:10
Yeah. It’s two different things there. So I knew, I knew that I needed to pull back on the exercise and I probably needed to put on a good body fat, probably for a good year before I actually pulled my finger out and did it because I had been of this group fitness instructor and I would stand up in front of groups of hundreds of people. And they would come up to me and say, I want to look just like you, you have the perfect body and I had become defined around my body to the point of when I would go out with my friends at pub. I would be introduced by my friends and they would say, this is Kate, feel her abs. And I have a nickname Abs by some people. So I was not me, I was my body essentially. And so losing that meant I lost myself and I would have to redefine who I was and everything I essentially stood for and that was uncomfortable but we wanted to have babies so I had to give myself a good talking into and eventually I did see a good naturopath, Angela Hywood, and she gave me a good kick in the bum and the permission to do all things. and yeah, it was really just the final final straw of like okay, my bones are shit, I need to I want to have babies. This not good. I’m meant to be a health professional. I’m meant to be advocating for health and it’s just a lie really.

Natalie K. Douglas 24:46
And was it a linear process of healing like did you just decide and then you are just on track and just ate more, exercise less, and had no setbacks, or what was the recovery like?

Kate Callaghan 25:02
Squiggly lines everywhere.

Natalie K. Douglas
Yeah.

Kate Callaghan
No, I mean, in theory, healing HA is pretty simple. You know, we we eat more, we nourish our body more, we exercise less, we exercise more gently. We manage our stress, we put on a little bit of body fat if needed. We do all the things, we reduce those chemical exposures, the environmental toxins, but in reality, it’s tricky, mentally tricky, emotionally tricky. So yeah, I did have setbacks of going okay, I’m going to just you know, pull back on the the eating for now and I’m going to go and do more BodyAttack classes. And then obviously, that would set me back. I got my, I had one cycle back when I went to Broome which was kind of five months of nature joy. Four or five months after I started going all in because Broome is the most chilled out place in the world.

Natalie K. Douglas
Yeah.

Kate Callaghan
So I’ve got one cycle back and I was there for five weeks, and just really excited and then I went back to Sydney. For me Sydney was, I love Sydney and I love my time in Sydney, but it’s too much of a stress on my body. And so that was kind of the instigator for us to move away from Sydney, to the land of Long White Cloud. And yeah, so we moved here at the end of the year and then I got my period back in January and from then it was regularly irregular. But it started you know, it started at 90 days or every two to three months apart and then it slowly got shorter and shorter and shorter.

Natalie K. Douglas 26:53
Yeah, and would you say that’s pretty common? Like for people like it’s, I mean, my experience of HA like with myself in treating it. It’s not just like you get it back and then yep, completely regular and perfect cycles straight from the get go. It’s it’s kind of like almost being a teenager again, in a way of like, it takes a little bit of time to establish a normal regular cycle.

Kate Callaghan 27:16
It totally is. It totally is, it’s like starting again. It’s getting those pathways like this communication pathways from the brain to ovaries going again. And that takes time. And one thing that I do say to women when, I got my period back, yay, now can I start introducing exercise? And then I’d say no, and I say, look, I don’t want to be a party pooper but you may not get your period again next month, every now and then I’ll have someone who does, they’ll go straight bang on, like, monthly. Now, that’s awesome but that is very, very rare. Most women will have long cycles to start with and overtime if they are consistent with everything they’ve implemented and that is key. If that’s the big if, then their cycle will shortened down to more monthly regular cycles.

Natalie K. Douglas 28:07
Yeah. Yeah, and I totally think that’s important for people to be aware of because otherwise it can feel really disheartening like, I’ve put in all this effort. Now, I got it like why why hasn’t not come again. And I think you just have to be patient with your body like, think about probably how long it’s you’ve not had a period for or you know how long you’ve been doing what you’ve been doing. It’s going to take a while for that to just re-regulate. And that’s why I think like your program and having constant support is so important because you, like you get mind fuck like in the process. Like honestly, you just well at least that was my experience and it can feel if you don’t have support around you, from people who are going through the same journey or a practitioner it’s really hard sometimes to keep going when you feel your body changing physically and mentally and also just in the way that you’re you’re feeling in your body you know, things do start to shift as hormones start to come back online and it takes a little bit of time for that to balance out and consistency is is key and not getting ahead of yourself in like as you were saying, I’ve got my period back, awesome like going to go sign myself up for a half marathon.

Kate Callaghan 29:30
I do see that sometimes I think. I think sometimes when women are doing my HA course they forget that I am friends with her on Facebook.

Natalie K. Douglas 29:40
I know. Isn’t that funny? Same.

Kate Callaghan 29:42
I see them doing these things. Come on, right?

Natalie K. Douglas 29:47
Yeah. And I think also comparison, like sure there might be someone that you know that runs marathons or does triathlons or is a Crossfitter and it’s your friend and they still have their period, but like it doesn’t matter, like eyes on your own lane because you don’t know what else is going on for them. And even if you did, and even if that was the case, like, that’s their story. And, you know, I just think comparison in this kind of situation or any situation is just going to make you fit fall into that victim mindset and that is not going to help you move forward mentally or physically.

Kate Callaghan 30:25
Totally. That’s such a good point. Everyone is so so different. Everyone’s physiology is so different. And everyone is different in how they respond to different stressors. I mean, one of my best friends is pregnant at the moment and she’s so so small. You will look at her and go how, how? But she she doesn’t she’s got sufficient body fat. She doesn’t do a lot of exercises.

Natalie K. Douglas 30:50
Yeah, yeah, like I just think it’s like everyone everyone’s journey is different, and how you end up looking physically will also be a little bit different as well, like everyone has a natural body fat that their body functions best at. And everyone’s body composition is a little bit different. And you just, you really have to just do your best to keep on working at accepting that, like Kate, like, I hope you don’t mind but I’ll use us as an example like, I, like I would say that my body naturally carries like a little bit more body fat for me to be able to have a regular cycle and when we were both going through healing, I mean, this is just my my observations. Like I would say you’re naturally, like now, for example, you’re naturally still quiet. No, I don’t want to use the word lean but you’re like when when people look at you because I know people will listen and then look you up and be like, oh, what does she look like now that she’s gone through healing and she has a period like you still look quite lean because that is your natural natural body but you still have adequate body fat for your body to be able to menstruate, whereas I carry I need for me to be to have a period. I actually my body needs a little bit more body fat then I would like in my, back then when I was healing in my ideal mind or ideal picture would be like oh no, I don’t want that much but you kind of like you just got to accept what is optimal for you and continue focusing on body love and the good parts and like continue growing that list because everyone goes into healing. Well, I can’t say everyone but I would say the majority of people go into healing with a fear around their body changing but you kind of just have to surrender to the experience and trust that your your body will find its its way to what is naturally optimal for for you.

Kate Callaghan 33:04
Yeah, yeah, that’s awesome Nat and I think that the fear around the body thing is is more our own internal fee and to just. I like what Gabby Bernstein says, fear is false evidence appearing real. So when we think we put on if we put on weight, we think that we’re going to be judged, or our friends won’t accept us anymore. And so I like to encourage women to think about what they value most in their best friends. And if their friend, if the situation was flipped, and if their friend was to put on weight for their health, would you want to stop being friends with them?

Natalie K. Douglas
Exactly.

Kate Callaghan
I expect, I hope the answer would be no, if it’s yes, you’re an asshole.

Natalie K. Douglas 33:47
Yeah.

Kate Callaghan 33:50
Yeah, like we do it. I’m sorry. I shouldn’t say that but.

Natalie K. Douglas 33:53
Well, I backed you on that like.

Kate Callaghan 33:56
But we shouldn’t be friends with people for the way they look and people. If people, someone’s friends with you just for the way you look then I don’t know if that’s someone that you want to really have in your life but it’s not an easy, easy journey. I remember justifying my weight gain to people all the time that I just met. Looking back, I’m like, you idiot. So, I wouldn’t say to them and say I used to be much leaner. And and they would look at me going I don’t really care.

Natalie K. Douglas 34:26
Like, thanks for the update.

Kate Callaghan
That’s more are weirdo. Why you should telling me this.

Natalie K. Douglas
Yeah.

Kate Callaghan
Like, yeah.

Natalie K. Douglas
I know and I agree and look, I honestly like to some extent, like we all judge and so like those that are close to you, if someone that’s close to you is is judging you for your weight gain, then obviously get rid of them. But to some degree, you have to accept that there are going to be people that may notice that your body composition changes, but don’t project on to them that they’re thinking oh God, look what happened to her like that’s your that’s your thought not theirs. You have no idea what they’re thinking. Like, I would say that a lot of people when I started to put on weight, were probably thinking, God, she looks so much healthier.

Kate Callaghan
Yeah.

Natalie K. Douglas
But for me, in my mind, I was like, oh my God, they’re staring at me because I’m like, I’m that girl that, you know, gotten fat, like that was my internal voice and no one’s going to respect my opinion any more or you know, it’s going to, you know, like, love me basically, or accept me and I’ve changed whereas, I think like, that’s, like, we create our own reality. There’s no such like, you are the only creator of that and you’re projecting your thoughts on to someone else when you have no idea what they’re thinking. So just keep that in mind along the journey, like, you don’t need to hide but you also need to remind yourself that people actually don’t care that much about your body to be honest, like, no one cares.

Kate Callaghan 35:59
Yeah, but honestly, most people are just too concerned with what’s going on with their own body.

Natalie K. Douglas
Exactly.

Kate Callaghan
Yeah, looking back I don’t actually think I thought you put on weight, I just did mind your boobs.

Natalie K. Douglas 36:11
Yeah, if you, guys my boobs grew like over a uni break to the extent where and this was because just for so people are like, oh my boobs going to grow so much. I, as I said, I got put on hormone replacement therapy and it was over. I started it over like the uni break and I came back to uni and people were like, did you get your boobs done? And I was, and most people would think oh, great. Like no, like, thank you for the compliment. I was like, oh my God, this is terrible. And so but and in my mind, I changed so much and I was so uncomfortable and I did all of the things I’m telling you not to do in terms of projecting other people’s thought. Like I was just thinking, making up stories in my head of what everyone was saying about me or thinking about me and I wouldn’t go to parties, I wouldn’t catch up with friends that you know knew me when I was much thinner and I would avoid all of that stuff and I missed out on so much and I lost so many good friendships that I could have kept if I had not put so much weight on what I thought other people were thinking. So don’t make that mistake because the people who love you the most don’t give a shit about what your body fat percentage is, if anything, they’re going to be so much happier when you’re more flexible with eating out and you’re not as anxious around food like, I became a much more pleasant person to to be around to be honest.

Kate Callaghan 37:44
Yeah. Yeah. I remember actually communicating to some of my best friends that I thought that they wouldn’t want to be friends with me anymore. And they got so mad. So so mad at me and like really, honestly hurt by that. So think about that when you’re going through it as well but if you’re thinking that poorly of your friends as well, does that make sense?

Natalie K. Douglas 38:07
Yeah, it does. Yeah.

Kate Callaghan 38:08
They’re really upset by.

Natalie K. Douglas 38:10
Yeah, I think it is. Yeah, it is offensive. And I remember saying that to or my husband was kind of there towards the very, very end. And I remember, like, projecting that thought on to him as well. And you just, yeah, I think we create so much of our own suffering and I think the easiest way to access back to a point of compassion is think about if the roles were reversed, and your friend was the one that was putting on necessary body fat in order to be a much healthier human. Like, what would you think of them, you’d think nothing other than I’m so happy that they are doing what is necessary for their health, and I like nothing about how much I love them has changed at all. And I think that if you can’t do it, If the access point to feeling that way, you can’t just do it for yourself straight up, then use use a bit of like role reversal and and picture what you would think or say or feel for someone else.

Kate Callaghan 39:15
Yeah, and it’s the whole body love and self-care and self-respect is a big aspect of the cause. It’s something that we focus on every single week. It’s really, really, interesting.

Natalie K. Douglas 39:28
Yeah, and I think we’ve yeah, well, I think we’ve ranted a lot about all of that. Can you like there’s a few other key questions I want to ask you as well before we get to to through lengthily. So we kind of already addressed whether someone could be like if you have to be underweight in order to have HA and the answer was no, but can someone actually be overweight? Or, you know, do they, can they be someone who’s actually not overexercising and undereating and still have HA?

Kate Callaghan 40:02
Yes, absolutely. And I would say the contributed that would be the psychological stress most likely. Most likely.

Natalie K. Douglas 40:09
And sorry, I keep going.

Kate Callaghan
You go.

Natalie K. Douglas
And so if, like, if that’s the case, like, is your program still appropriate for them? In terms of like helping them deal with the psychological stress and an environmental load of toxins and, and that side of things?

Kate Callaghan 40:28
Yeah, absolutely. I mean, we focus on food a lot but that’s, that’s not the main part, not not the only part of it. We address all the different areas. I would just say with that, it’s important to rule out polycystic ovarian syndrome. So, the two main reasons other than other than pregnancy, why you would lose your period is or HA, PCOS, polycystic ovarian syndrome and that the differentiating factor is a blood test with testosterone, so elevated androgen levels, intricating PCOS, and potentially insulin resistance but polycystic ovaries on ultrasounds can happen with both. So that’s not diagnostic of polycystic ovarian syndrome.

Natalie K. Douglas 41:15
Okay, gotcha, and how like, how you actually get diagnosed with hypothalamic amenorrhea like, is it some airy fairy thing or a conventional doctors and practitioners actually diagnosing this now?

Kate Callaghan 41:28
Sum up. It’s a diagnosis of exclusion really. So you rule that polycystic ovarian syndrome with those elevated androgen levels, you rule out pregnancy, rule out thyroid concerns, and they would be the main things, and ruling out any gym as well.

Natalie K. Douglas 41:47
Okay, and in terms of recovery, so you’ve touched on the food side of things and nourishing your body. You’ve touched on you know, sensible amounts of exercise, and reducing toxic load, and managing stress. What, are there any other elements to someone recovering from HA, and how long does it actually take?

Kate Callaghan 42:13
So in terms of what to do, the main factors are nourishing your body with sufficient food, sufficient carbs, proteins, fats, all the things not lacking in any of those, managing your stress as we mentioned, exercising appropriately and gently. So often you have to cut out all intense exercise or at least pull it right back but I often recommend cutting out completely. I don’t recommend not moving your body at all. I don’t think that’s healthy physically or mentally. So, I do still recommend gentle exercise, walking, yoga, tai chi, dancing, getting out in the world, the nature, the natures, and then we also look at other areas that need to be addressed. So gut health, thyroid health if necessary, mindset, and then being consistent with it.

Natalie K. Douglas
Yeah, consistency is key.

Kate Callaghan
It’s a key.

Natalie K. Douglas 43:17
My motto in thyroid rescue program is consistency not perfection because I feel like people get hung up on this, I have to be perfect to get the result, but I’m like cool, bullshit. You have to be consistent to get the result.

Kate Callaghan 43:31
Yeah. Totally.

Natalie K. Douglas 43:33
Yeah. And and what about the length of time it takes to recover? Like, is there a certain like amount of weeks, months, years like that you say someone will recover in?

Kate Callaghan 43:49
I always get this question. So when I have a consult with people with HA, I can, when I say do you have any more questions? I know, I know that they’re gonna ask.

Natalie K. Douglas 43:58
Yeah, so true. Could you please mark it in my calendar for me?

Kate Callaghan 44:02
Yeah. And the answer is hell is a piece of string.

Natalie K. Douglas
Yeah.

Kate Callaghan
I don’t know. In my experience, those who go all in, in terms of really nourishing their body, really pulling right back on the exercise, really being diligent with the stress management, using their supplementation, getting rid of the environmental toxins, doing all of the things like straight away, and being consistent with that, they’re the ones who get their period back sooner. The ones who dabble a little bit here and dabble a little bit there, and kind of just go up and down and up and down and pull back and go back on the course, that can draw things up a long, long, long time, but I did have a question on the Instagram. When I was posting about people wondering about questions for HA, there was one lady who asked, she said after having 10 years, after 10 years of having HA, do you think it’s possible to recover? And I would say, absolutely, yes.

Natalie K. Douglas 45:02
That was me.

Kate Callaghan
What?

Natalie K. Douglas
I had 10 years.

Kate Callaghan
Oh, I’m going to say no, I had.

Natalie K. Douglas
Nat, you didn’t asked that question. That was so, that was me, I did have my period from 13 to 23 or 24.

Kate Callaghan 45:18
Yeah, and I suspect I had it for just as long but the pill was just masking it really and but I’ve had women in my course who have had HA for 14 years and got it back. I think she was 40, so she’d had it for 14 years and got her period back and she thought it was impossible but she got hers back so it is totally possible.

Natalie K. Douglas 45:36
And yeah, like totally agree with the length of time. You kind of got to detach from that that goal and just focus on what exactly you can do and trust that it will come back as soon as it is supposed to come back. And I say that with compassion like mine took quite a while but it was because I was the jump on jump off, jump on jump off, jump on, oh, I got like I got some signs, I’ll just do some more exercise kind of person. So it took me two years of actively trying with jumping on and jumping off to get it back but if I had been really, as you said, Kate, you know, focused, consistent, and done all the right things and not tried to still get away with all of the things I was already doing, but just maybe eating a tiny bit more food, then I would have gotten it back way faster. So need to kind of get out what you put in.

Kate Callaghan 46:29
Exactly, exactly. I’m not the period fairy.

Natalie K. Douglas
What? You’re not? Whatever.

Kate Callaghan
Sometimes I will, you know, I’ll educate people on what they need to do. And then after a month, or two, or three, or four, they’ll say nothing’s happening, I’m not getting my period back and I say, okay, what what have you done and they say, oh, nothing. You gotta do things. If nothing changes, nothing changes. Like, I can’t wait, my period wand, and poof, you get your period back. I will support you through it. I will educate you through it, I’ll hold your hand but you’ve got to also do the work yourself.

Natalie K. Douglas 47:05
Yeah, yeah, no, I’m just painting it out because I’m picturing you over the fairy wand, doing your wild dancing in New Zealand. But no, I agree. I think you do. You have to do the work like you cannot, like, shift that responsibility to like to anyone else, not not Kate, not your partner, not your friends, like you have to do the work but there are people around you that can support you and love you and hold the space and container for you to be able to do that. But at the end of the day, like you’re the only one that can can continue. Yeah, work working on that side of things. So Kate, you touched on you know, thyroid-gut adrenal issues. What what happens if people do have those those issues like how is that contributing or what what do you have to say around that?

Kate Callaghan 47:58
So we do talk about that in the program and it really depends on what’s going on. So we address gut health, and we address thyroid health in gentle ways, but it really depends on the severity of what’s going on. So if someone has an underactive thyroid, and depending on the severity then they might need to look into potential medication and like desiccated thyroid or other options that you speak about all the time Nat, and with gut health, we, as I said, we do address looking at your gut, but then I often find that there’s a lot of other gut issues that go along with HA particularly SIBO, I see a lot of and or they might be other bacterial imbalances, there might be parasites, so they also need to be addressed because the gut is really really important in hormonal balance. And then with adrenal issues, that needs to be addressed because if you have adrenal issues, then you’re affecting your ability to produce those sex hormones. So we do talk all about those but some things do need to also be our cells, didn’t we? With further testing.

Natalie K. Douglas 49:08
Yep. Perfect.

Kate Callaghan
Yeah.

Natalie K. Douglas
And do you have to gain weight to get the, get your period back like just everyone across the board with HA have to gain weight to get their period back?

Kate Callaghan 49:15
Not necessarily but they do need to have sufficient body fat levels.

Natalie K. Douglas
Okay.

Kate Callaghan
But for me, so for me, I put on 10 kilos to get mine back I think, and now I’m around three to five kilos heavier than what I was when I have had HA, that three to five kilos my body composition will be completely different now. There’s not many or as much muscle.

Natalie K. Douglas 49:39
Yeah.

Kate Callaghan
More question.

Natalie K. Douglas
I was gonna say something inappropriate, but I’m not going.

Kate Callaghan
Yeah, you are.

Natalie K. Douglas
Okay, and what about supplements, essential oils, like does that play a role, and do you actually speak about that in your course?

Kate Callaghan 49:56
I do. So there are some key supplements that are shown in research for helping women get their period back, one of which is acetyl-L-carnitine and that helps to support the mitochondria or the energy houses of the ovaries. That’s a big one. I often recommend a really good quality multivitamin, multimineral because your body’s probably depleted. I mean, I often recommend that for most people now because our cells are depleted but particularly for HA, particularly if you’ve been on the pill, you need to replenish those nutrients. Other ones that we look at might be more specific to the individual depending on what’s going on, depending if they want to be conceiving anytime soon. So it’s really on an individual basis and I don’t, I work through the course with people so I’m there with them and I work individually with them a little bit through the course to see what’s going to be appropriate for them. But across the board, I usually say acetyl-L-carnitine and the multivitamin multimineral. With acetyl-L-carnitine the dose depends on whether or not I have a thyroid concern as well. So, if they have thyroid concerned probably drop it those down. If they don’t, then I’ll increase it.

Natalie K. Douglas
Yeah.

Kate Callaghan
Essential oils. Yes, they do play an awesome role in helping with this. The biggest factor is helping to eliminate sources of environmental toxins where you might be getting those endocrine disruptors as hormone disruptors from your skincare that you’re using, your deodorant, your perfumes, your cleaning products, your air fresheners, everything in the home that could be disrupting your hormones. We can use essential oils and simple carrier oils and you know, baking soda to make very, very simple, effective, and cheap alternatives. And then there are some essential oils that really helped to balance the hormones by applying them topically or diffusing them. So some key ones will be frankincense and clary sage, doTERRA’s Clary calm blend, and geranium, and a few essential oils are known as emmenagogues which encouraged menstruation. So, that would be marjoram and peppermint. Peppermint.

Natalie K. Douglas 52:07
I was like, what?

Kate Callaghan 52:10
Did I just said that weird? I think I’ve said it weird.

Natalie K. Douglas
Yeah.

Kate Callaghan
Peppermint.

Natalie K. Douglas 52:15
It’s feeling than for peppermint guys.

Kate Callaghan 52:17
Like you need to say don’t think that you can just apply essential oils without doing the underlying work, and expect them to force a period because you need to build up that healthy uterine lining first in order to have that lining shed as a menstrual period. So if you’re not going to do all the other work the oils are going, they might support you in other ways. Definitely, your moods, and physically, emotionally, but they’re not going to force a period if there’s nothing there forced.

Natalie K. Douglas 52:50
Yes, yes, so agree. Okay, so you’ve you’ve told us quite well, it went from kind of dribs and drabs told everyone what is included in your healing hypothalamic amenorrhea course. So, by the sounds of it you’re covering pretty much everything possibly possible that it could be covered like food, supplements, stress, essential oils, decreasing toxic load. I think I already said supplements, exercise, it like so much but what else can you tell us about it? Like, what like, is there anything else that involves like, is there a Facebook group? How long is it for and more importantly, how do people actually sign up?

Kate Callaghan 53:32
Yeah, so it is an 8-week online course but I am in it with you. So I’ve considered to setting it as an evergreen where people can just do it on their own terms, but I think there’s real value in doing it as a group and having me there to support you as well. And we do have a Facebook group which is incredible. The women in there are absolutely amazing they blow me away all the time with their incredible support for one another. And their vulnerability and their openness, and it’s just nice to know that you’re not alone in it and you can reach out and share what you’re going through and get this support, not just from me but for everyone else from everyone else who’s going through it. It’s beautiful, often has me in tears. But so we go through eight different modules. So the first week is really focused on mindset. So you really need to have a strong, solid mindset, and really set your why and understanding your obstacles, understand potential triggers, set your goals, and have that somewhere we can refer back to it all the time. And this might change over time. But it’s really important to have that solid why. If you kind of like, oh, I think I just should get my period back. You probably will go up and down with that. Really nothing out why it’s important for you is going to be so important. We set up supplements, we look into what you’re eating. So that in module two, the second week, we talked about reconnecting your brain in your ovaries and making your brain feel safe through stress management. We talked about, we might for some women, we might track the calories but for other women who find that triggering, that I might just get them to write down a typical day of what they’re eating, and then I’ll go through and assess that and give some pointers as to what they can change, what they can add, how they could really nourish themselves a little bit better. We talked about the role of different macronutrients, so carbohydrates, proteins, fats, we talk about stress, we talk about body weight, body fat, we talk about hunger and satiety, as well. There’s a few other things that we talked about, like seed cycling, which can help balance your hormones. We talked about your thyroid and exercise. As I said, self-love. There’s a bonus module for women who have been on the pill and some post-pill cleansing, essentially to get rid of those synthetic hormones out of your body. Week three, we talk about nourishing your gut for hormone health. So a whole week on digestive health, and everything that can impact that. Week four we talk about liver health for hormone health. Week five, we talk about looking after your adrenals for sex hormone production and everything that affects that. Week six, we talk about alternative therapies, a whole lot of alternative therapies, which is really cool. I kind of went, I spent thousands on alternative therapies and so they have their place but again, it’s important to be able to be doing the groundwork first and foremost. And week seven, we talk about external factors. So talking to your family and friends about HA, endocrine disruptors from the environment, resources that are going to help you. We talked about medications. We talked about body acceptance again, and other other factors that can be coming from the outside in. And then module eight, we really talk about, what next? So when you get your period, what next? How do you keep your period coming regularly? What to do if you’ve got any period concerns, that painful periods, heavy periods, PMS, all of the things. It’s a very holistic, cover all of the things.

Natalie K. Douglas
Wow.

Kate Callaghan
You’d get a recipe book as well. For in a meal plan as a guide. It’s not that you have to follow this. It’s more of a guide as to hear some inspiration. We’re going to have weekly interviews with some experts like Cassie Mendoza-Jones, who is a naturopath, nutritionist, kinesiologist. Lara Briden, who’s the author of the Period Repair Manual. Jodi B who’s a naturopath and nutritionist. Laura Schoenfeld, who is a dietitian. Kelsey Knox Dinah, who’s also a dietitian. And Nicola Rinaldi, who is the author of No Period. Now What? among others, and weekly live calls where you can ask anything and everything and we can just sit down and chat.

Natalie K. Douglas 58:05
Wow, that’s so like, as someone who’s been through hypothalamic amenorrhea as solo, I would say like if I, touch wood, had HA again, I would 100% sign up. And I don’t just say that, as your friend or as a colleague. Truly like that support is and information in one place and also going through it with other women is so powerful because it’s, as you’ve kind of touched on Kate, that often the solution is simple, but it doesn’t mean that the application is without its challenges. And I’d say like, you’ve covered so much stuff in that and the support, like the interviews, the Facebook group, all of that stuff is just like priceless. So anyone who is considering doing it like, honestly, I 100% think that it would, it is so worth it like, wow, like the speechless. I just wish that I had this when I was struggling.

Kate Callaghan
Thanks.

Natalie K. Douglas
No prob. So when does, like how to people sign up and when does it actually start so that people can get in because I know that it’s only a limited amount of spots. So I want to make sure that people listening can go and kind of get their get in first.

Kate Callaghan 59:34
Yeah, and the reason why it’s limited is because, I give that individual support and that emotional support as well. So I want to be able to give as much as I can without burning out essentially. I do have to take my own advice not give more than I am capable of giving. So we’ll be starting on the sixth of October, and they can sign up via my website. So if they go to www.TheHolisticNutritionist.com, navigate to the shop page and in there you’ll see the first one on the left is the E-course and you just click on that you’ll be able to sign up. I’ll be opening up enrollments, signups, next week, so next week.

Natalie K. Douglas
Oh, exciting.

Kate Callaghan
Yeah. 23rd of September.

Natalie K. Douglas 1:00:28
Awesome. Alright, well, any any final words to say on the program or anything like that that you need to share besides all of the wonderful information that you’ve already given us?

Kate Callaghan 1:00:40
No, I think that’s it. If anyone has any questions or are concerned about whether or not the program is right for them, then feel free to contact me. You can shoot me a message on Instagram at The Holistic Nutritionist or you can email me [email protected] and we can have a little chat about whether it’s appropriate for you.

Natalie K. Douglas 1:00:58
Awesome. Amazing. Well, thank you so much for sharing all of that information with us and your story. And I am really excited for everyone who gets to be guided by you in that 8-week program. And that’s it. So thank you guys for listening and we will catch y’all soon.

Outro 1:01:18
Thanks for tuning in to The Holistic Nutritionists Podcast. Remember, we love to make the show relevant to you. If you have any questions or topics you’d like us to discuss, just submit them to [email protected] and we’ll get them answered for you. Also, don’t forget to subscribe, rate, and review the podcast on iTunes and share it with your friend. And if you’re looking for more info about how we can accelerate your journey to your optimal health, you can find me, Nat, over at NatalieKDouglas.com, and Kate, at TheHolisticNutritionist.com. See you next time!

OUR MISSION

The Holistic Nutritionists Podcast - with Natalie K. Douglas and Kate Callaghan

Welcome to The Holistic Nutritionists Podcast!

If a professional, polished, well-edited podcast is what you’re after…then we’re not for you!

But if you love unfiltered banter, unedited bloopers and authentic heart sharing then we are your ladies.

We also have the most practical tips on holistic and alternative health care too 😉

Have a question that you want answered on the podcast or want to be interviewed? Get in touch!

YOUR HOSTS

Natalie K. Douglas | Thyroid Healer

Natalie K. Douglas | Thyroid Healer

Natalie K. Douglas ("Nat") is a Holistic Dietitian and Nutritionist dedicated to Thyroid, gut and hormone healing.

Nat shows stressed, burnt out, overwhelmed women how to value their worth again, change their mindset habits, prioritize healing, and reclaim their vitality. Guaranteed.

Her clients say she’s the right girl to see if you’ve tried the conventional approach and nothing has worked.

Kate Callaghan | The Holistic Nutritionist

Kate Callaghan | The Holistic Nutritionist

Kate Callaghan is a Holistic Nutritionist, Personal Trainer and Lifestyle Coach who specializes in women's hormone healing.

She recognizes that there is no “one size fits all” diet or “magic bullet” which is going to cure all illnesses.

She focuses on having a thorough understanding of your personal goals, needs, likes/dislikes, support networks and lifestyle in order to create a food and lifestyle approach that suits YOU.

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