Latest / The Lila Rose Show / E27: Why This IVF Doctor Changed Her Practice with Dr. Lauren Rubal

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E27: Why This IVF Doctor Changed Her Practice with Dr. Lauren Rubal · The Lila Rose Show

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I was considered crazy by my colleagues.
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I mean, here by all accounts. I was at a huge hospital system,
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salaried, all these great, you know, seemingly desirable parts.
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And I just knew that for me, I felt like my soul was at stake.
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Hey, Doctor Raval, thanks for joining the podcast.
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Oh, thank you so much for having me.
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I'm excited to be here. So your name precedes you.
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I have a lot of, we have a lot of mutual friends who talk about
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what an amazing doctor you are. And you are a rare breed, which
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is very important one because you work in the fertility
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awareness space and fertility support space, but you do it in
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a really holistic and amazing way.
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So I'm excited to get into it and to get into some of your
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past experience because I know you've had your own journey.
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So starting out, tell me a little bit about where you're
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from and your background. Oh, absolutely.
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So I am born and bred in Florida.
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I went did all my schooling there, went to University of
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Miami both for undergrad and my medical school, and then came
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out to USC and Los Angeles for residency in OBGYN and then
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stayed on after that four year residency for a three-year
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fellowship and reproductive endocrinology and infertility.
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And did you always growing up think you would be a doctor?
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Or where did the desire to even go to Med school come from?
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I all, I think this is a common thread for many physicians.
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Yes, from the time I can remember, I wanted to be a
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doctor, I wanted to help people. I actually until the end of
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medical school, I wanted to be a pediatrician.
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And then I was on my Pediatrics rotation and unfortunately I
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realized how much I loved communicating with my patients
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and really being able to share their journey.
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And so wasn't for me for in some parts of Pediatrics.
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And then really fell in love with OBGYN and being present at
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birth and walking with women throughout the course of their,
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of their lives really. And so decided to go into that
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field. And what was your upbringing
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like before we go into your practice?
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You know, I had a lovely upbringing.
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I'm the old, stereotypically oldest of four, and so my mom is
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a nurse who actually immigrated from the Philippines in her 20s.
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She was very brave, didn't know anyone in the States, but came
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over because there was a need for nurses and met my father in
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Sarasota, FL. And so we lived again in
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Sarasota, which is on the Gulf Coast of Florida for my whole
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life until I left to Med school. But it was a really lovely
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upbringing that was rooted very much in the desire to be be a
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successful. And I would say that that would
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be not only academically or maybe in the of the world, but
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also to really try to be close to God.
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So my family's Catholic, so I was a cradle Catholic and was
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really surrounded by a lot of those influences because my
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aunts were there. And you know, Filipinos are very
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devout in their faith. But unfortunately, I feel like I
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knew the how, but perhaps not the why.
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I feel like I wasn't very well catechized.
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And that does lead to parts of my journey later on for myself
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personally. OK, so you're, you're you're
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finishing up Med school and you're choosing you what?
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Tell me about your specialty and how you chose it.
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Oh yeah. I mean, I just again, I loved
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just I love the sisterhood. I love being with my my
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patients. I really enjoyed OBGYN is a huge
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mix. And so for someone like me, I
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like I never have the same day twice.
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I'm doing lots of different procedures.
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I'm having continuity of care. I get to know my patients really
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well, but I also get to be using my hands.
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I discovered how much I love surgery.
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Who knew? I did not.
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I was not anticipating that. But for all those reasons, I
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just felt like OBG and was the field that would be that.
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That is my vocation actually. What do you mean by that?
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Your vocation for those listening?
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I mean that term. I think different folks mean
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different things by it. What do you mean by?
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It when you say that my calling, I think my way to really fulfill
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myself, but hopefully other fulfill other to fulfill others.
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Like I said, to be able to. It's such a special gift to be
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able to be with people in their suffering, to walk alongside
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them, hopefully to provide peace and perhaps hope is obviously
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the ultimate goal. It's really, it's amazing.
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So that's what I mean by it. I love that.
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All right, So tell me about your first practice, your first time
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practicing outside when you're done with your residency and
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done with your fellowship, your first job, although those are
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jobs too. I know a little bit about it.
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I know it's like you, you study for a million years and then you
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work more, right? Yeah.
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Well, you know, residency and fellowship are definitely their
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own, their own beast. You're you're working 80 hours a
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week in a hospital and there's a lot of hierarchy and lots of
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learning happening still. So but yes, its own its own
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place and so going out and being an attending, which means that
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you are now you are it. There is no, you know, you of
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course have colleagues you can talk to, but you are the end all
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be all in making decisions together with your patients,
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right. And so I came down to Orange
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County at that point, I was working at a large healthcare
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system and you know, it was a wonderful system in some ways.
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I think they do a great job supporting the physicians so
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that they can practice medicine and don't have to worry about
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maybe the administrative parts of medicine that that a lot of
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us aren't drawn to quite as much.
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But I also think for me personally experiencing and
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again being that one ultimately making those decisions in
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conjunction with my patients was, was really was difficult,
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was more difficult than I had realized in my training.
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And I say that because the field of reproductive endocrinology
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has many moral and ethical issues.
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And you know, as a result, it's something that I'm dealing with
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or was dealing with certainly on a daily basis with people.
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So what sorts of things were you facing?
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I mean, there's the whole world of reproductive technologies,
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there's birth control, there's all of these issues that I want
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to get into. And your experience with it and
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your positions on it? Well, yes, all of the above,
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right? I know.
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Listen, it's such again, there's so much suffering that can
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happen when, when especially for fertility, for example itself.
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So I would see patients with fertility, I would see patients
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with multiple miscarriages. I would see women who also had
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abnormal cycles, be it irregular or heavy or painful, OK.
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And in all of those circumstances, I really believe
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in some ways I was offering a very biased approach, quite
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frankly. Since then, I've completed my
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integrative medicine fellowship and I feel so much more armed to
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give women a range of options that are scientific and evidence
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based, but also natural and just an alternative.
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And so I say that because when I was practicing before,
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especially for fertility patients, you know, again,
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they're, they're consumed understandably by this desire
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and this fear of, for children, you know, fear that they may
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never have a child and a desire to become parents.
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And those are all completely understandable and causes and
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and sentiments. But with that being said, I
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think that what is very difficult is that just because
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medicine can do something doesn't necessarily mean that we
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should. And in some ways, I believe we
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as physicians have inserted ourselves into a very mysterious
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and beautiful act and creation of a child.
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And it's a slippery slope because once we start doing
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that, where does it end? OK.
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And there's a dark side to this that I think can occur.
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So tell me more about that. So you were you working actually
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in a place where they were doing IVF?
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Was that part of the the focuses of the system you were working
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in? And then what was that like?
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And then you mentioned there's a dark side to it.
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Tell me more about that. Right.
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Yeah, I was doing, I was doing IVF and was working at A at a
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center that performed in vitro fertilization, which is
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essentially where a woman is given medications to stimulate
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her ovaries to produce more than one mature eggs.
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And then there's a process called an egg retrieval, where
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those eggs are removed from the body through a needle that's
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placed through the vagina and watched under ultrasound
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guidance. And then outside of the body,
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the mature eggs are combined with sperm and the embryos that
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results are watched over a period of days.
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And then a certain amount of them may be biopsied to be
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screened for certain issues or chromosomal screening and or
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transferred back into that woman's or another woman's
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uterus. And so that's the process of IVF
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in general. And so yes, I was doing it all
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the time. And I would say that my
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experience with it, again, I think that it wasn't all
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negative, it wasn't all dark. There was a lot of joy in in
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when people were able to get pregnant and they were, again,
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that was, that was beautiful in that sense to be able to, to
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what I thought help right in that way.
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But I would say in terms of the dark side is that, Oh my
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goodness, again, there are multiple things.
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I think that for me, it's that for some reason we've all put it
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into our minds that IVF is the perfect cure, that we're going
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to have 100% chance of success and we are in control.
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Ultimately #1 #2 it isn't perfect.
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Again, just like anything else, there are pros with everything
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and they're cons, and those cons can be short term risks, but
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they can be long term issues for the mom.
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Let alone the possibility that for babies.
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We do know that there might be an increase in risk of things
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like birth defects in babies born after IVF and IXI, which is
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a way to place sperm into an egg, for example, and which is a
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slight absolute risk, but a risk nonetheless.
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We know that there's a lot of data coming out now looking at
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this incidence of donor half siblings and, you know, 50, you
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know, 10s to 20s of donor siblings that might be meeting
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now and falling in love. And what does that kind of
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ramification look like as we move forward with more and more
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of this technology being used, right?
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So in that case, there's a sperm donor and then he, that man and
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his sperm is all these different places in terms of who's which
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eggs, you know, it's turning into sync, you know, embryos
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with. And then there's different
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adoptive families or there's not adoptive, but families that are
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maybe asking for the sperm donation.
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And you're saying in some cases they're actually later on
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growing up and then finding each other, these children, once
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they're adults and falling in love and not realizing that
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they're a biological siblings. I think it was an article in the
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LA Times. I think it was actually that
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discuss this one specific donor and there were 50 plus of his
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biological offspring that were in potentially close proximity
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to each other. And then again, yeah, discussing
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what does this mean in even, you know, 30 years when there might
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be even more. And so there's really a lack of
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some regulation I think in some parts.
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And that just is again, one piece of it, OK, there's the
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adoption of new technologies, which again, the progress in
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scientific progress is not a bad thing, but sometimes we don't
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understand the long term ramifications.
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And this goes even for embryo screening and making these
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decisions on whether you're going to transfer that embryo
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back or not. And I've, I remember being in
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that chair sitting and there's a couple has one embryo and we
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tested it and it was screened as what's called aneuploid or
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abnormal. So.
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Like do they know what that? What does that mean?
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It means that the chromosomes are not a normal number.
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The normal 46 chromosomes that that are considered normal.
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So what kind of condition might that child have?
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And so that does include things like Down syndrome, which is 3
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copies of chromosome 21. There are other types.
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So you can have one less chromosome than you should or
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multiple or complex abnormalities again.
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And then to tell this couple and to have to make that decision
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with them that a transfer would not be done because of that is
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is is heartbreaking. What does that mean?
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A transfer won't be done. That because the embryo was
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again screened, it's on a diagnostic test, it's a
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screening test, was screened as abnormal, that the embryo would
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not be placed into that woman's uterus.
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So what would happen to that embryo?
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The embryo would then be destroyed.
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How often would that happen? How often were embryos being
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destroyed after screenings, or maybe just not selected for
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other reasons? I'm not sure of the actual
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number, to be frank. I can't, I can't quite recall.
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So I don't know. But I, but I will say it's not
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uncommon. I mean, absolutely.
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And we know that there are about a million embryos frozen in the
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US currently. And again, these embryos might
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be excess, meaning that the couple's already done IVF and
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they have additional embryos that are in cryopreservation,
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which is just a fancy way of saying freezing and storage.
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OK. And it's not clear if those
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couples will ever have another child or try again.
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Or in the cases, I think again, there was that one case with a
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celebrity how they had done gotten divorced.
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And then who is going to retain possession, right, of, of these
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embryos and what they were going to do with it.
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I think they're, I recall something like that happening.
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That is not that that happens. And so you think about the fact
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that this embryo, I mean, again, I feel as, as an OBGYN and as in
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my early practice, I truly was, I felt so blinded in some ways.
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And that was my own ignorance, I think, and lack of catechesis,
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which I mentioned earlier for myself because of my faith.
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But I also think it's again, the bias that's inherent in our, in
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our current medical system, quite frankly, that they
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actually changed. Conception occurs and a new life
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begins when the egg meets the sperm.
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And that happens in the tube actually within 24 hours after
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the egg is released. And then that embryo divides on
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its own from that point and it'll eat, the embryo will
16:09
divide in a dish on its own if you give it of course, proper
16:13
nutrition in the environment, but will completely start to
16:17
divide itself. It goes from couple cells to
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hundreds to millions within the course of days.
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And that's, that's life. And so it's so interesting
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because they changed that concept of life from conception
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to implantation, which occurs about five days after the embryo
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is formed in the tube and when it enters the uterus and
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attaches to the wall of the uterus.
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And so again, it's very interesting the semantics and
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how important words are in some ways because it, it matters.
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It matters. And I felt so confused by that,
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or I didn't realize that in some ways.
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So the medical system and they've you're right, they've
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changed it from conception fertilization to implantation
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like you're describing. And so in vitro fertilization
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and IVF clinic, they're not even considering this a human life
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because it's not he or she has not been implanted yet.
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So what is the for frozen embryos?
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What happens to the million? Were there embryos frozen at
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your clinic? And what would happen to them?
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Well. They'd stay in storage
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indefinitely. But I think again, it raises all
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of these, this ripple effect and the downstream issues that can
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arise from this. So certainly they're supposed to
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be a process where they're in storage afterwards, however,
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that storage costs money. And so the couple would then
17:39
have to pay an annual fee to continue to keep those embryos
17:43
stored. But the other dimension of this
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is what if that couple we, we, you, you stop hearing from them,
17:50
they move, something happens. And now here you have these
17:54
embryos, what to do with them? And I think the default that
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most clinics do these days is that they just continue to keep
18:01
them in storage and try to, you know, track down the couple.
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But yes, I think it raises a great point is they could be
18:10
there forever. And then the couple could just
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request destruction of the embryos at any point, Yes.
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And there's not like, are there like questions asked at that
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point? No, there's just a.
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You have to draft a legal document because embryos are
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considered, again, property. Property right?
18:29
It's a it's crazy. Literally human beings are
18:33
property, considered property. So, so tell me about so you're
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doing this work in IVF. Were you also doing more other
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forms of gynecology work with patients?
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Yes, yeah, I was still operating.
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I was doing lots of hysteroscopies, which is a way
18:49
of looking inside the uterus. Love doing those.
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I was still treating women who have hormone imbalances again
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for abnormal cycles, taking care of of, you know, doing general
19:00
GYN in a smaller scale, Certainly seeing lots of women
19:04
with recurrent miscarriage. So at some point you decide to
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leave and start your own clinic. Tell me about that decision
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process, that decision making that you had we went through?
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Again, for me it was it was a long time coming, but I also
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feel like I told you I love what I do.
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I feel so blessed to be able to participate in people's lives
19:30
the way I do, as I already shared.
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And I started just dreading going to work in the morning and
19:37
every day I'd wake up and I just really have this weight on me
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because like I told you, I was having to counsel peace.
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It's a very when you realize finally that again, this embryo
19:50
is a life and what are what are we?
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How am I, how, why am I in charge of this?
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And why, again, I felt like we were starting to treat embryos
20:00
as a commodity. I felt I felt just not wanting
20:05
to be involved in it. And so as a result, I think it
20:08
really for me, it was my conscience, which, and it was
20:11
the, the Holy Spirit for me telling me and, and you know,
20:16
really to examine my life, what I was doing and what my goal was
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ultimately and where my ultimate, you know, where I
20:24
wanted to be both in this life and the next.
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And as a result, I, I, I knew that I had to change.
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And I have the world's best husband who's incredibly
20:39
supportive because I was considered crazy by my
20:42
colleagues. I mean, here, by all accounts, I
20:44
was at a huge hospital system, salaried on my way, had to wait
20:49
maybe a year or more to get a pension, healthcare benefits,
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all the, you know, all the all these worldly things, not even
20:58
to worry about admin, all all these great, you know, seemingly
21:02
desirable parts. And I just knew that for me, I
21:07
felt like my soul was at stake. And I also wanted to help women
21:13
who wanted alternatives because I think that there I'm not.
21:16
I think there are alternatives that are more natural, that are
21:22
more holistic, that are going to change women's lives and improve
21:25
long their longevity overall as well as their baseline health.
21:28
Instead of all these band aids we keep offering to women, both
21:33
in the form for me, I think of contraceptives or synthetic
21:36
hormones, as well as these more aggressive procedures.
21:39
So how many years when you had this turning point moment, how
21:44
many years had you been practicing up until that point?
21:47
I'd already been practicing for for 6-7 years at that point.
21:55
And so you're at this moment of I want to leave or I want to do,
22:00
do something different, do practice differently.
22:02
You don't want to leave medicine.
22:04
You love. You love what you do.
22:06
What did you do next? So again, talked a lot with my
22:10
husband about it and also talked to again, I was really prior to
22:18
that, I was really finding my faith, I think.
22:20
And so also talked to a priest and had a wonderful
22:25
conversation. He was very instrumental in
22:28
helping me actually see the truth and also have the courage
22:33
to make the right decision for myself.
22:37
And I, I don't, I just did it. You just have to kind of do
22:40
things sometimes. And so I just left and did.
22:43
You have another job lined up. No, I mean I, I know I created
22:47
my own practice and so you just. Quit and you're like, I'm going
22:50
out of my own. Yep.
22:51
I'm hanging on my own shingle. That's right.
22:53
And so I opened my own practice, which is really again, dedicated
22:58
to a restorative approach to, to reproduction.
23:03
And it, it, it's been a wonderful journey because it,
23:08
it's so funny, actually, right before I left or right after I
23:12
left. It was the beginning of 2020 and
23:15
I've got 3 little ones. And then the pandemic hit and I
23:20
had to be a homeschool teacher at that point.
23:23
And I, there was no way I was working full time before.
23:26
There was just no way I would have been able to juggle it all.
23:29
So I really feel like it was providential, everything that
23:32
occurred and I felt like I was really got really took care of
23:37
it all, you know, And once I surrendered to him and really
23:42
followed the truth. It's amazing, I feel like that I
23:45
was just talking with another woman recently who was sharing
23:48
about what a blessing in disguise the pandemic was, but
23:51
truly how God works out all things when you take the leap of
23:54
faith. Which you did.
23:55
So you are basically homeschooling during the
23:58
homeschooling during the pandemic.
24:00
You've got 3 little ones and then what?
24:02
What? Tell me about emerging from that
24:04
and starting your practice. Yes, and so.
24:06
And tell me more about your passion for holistic care for
24:09
women, because I think it's such a it's so needed today.
24:13
It's so needed. I know a lot of people
24:14
listening, maybe they're seeking it themselves or they've had
24:18
friends who've gone through infertility or have been on
24:20
birth control and they're like, this is just not working.
24:23
And there's so much, there's so much trouble with it.
24:25
You know, even a separate from the ethical considerations which
24:28
I want to hear your thoughts more on, but also just the the
24:30
real ramifications for when physically and emotionally and
24:33
the psychological health, you know, the mental, the ill
24:38
effects mentally that it can happen women birth control.
24:41
So talking about what the alternatives?
24:43
Are absolutely well, I have to say I think that the integrative
24:50
medicine fellowship was life changing.
24:52
It was wonderful. It felt like medical school over
24:55
again. I didn't feel like I had heard
24:56
any of it in medical school. I'm sure I did and it was my
24:59
recollection, but we get maybe a couple of weeks on nutrition,
25:03
for example, whereas this is a 2 year fellowship that's really
25:07
dedicated to the important of mind body medicine of again
25:13
lifestyle choices. Food is medicine, exercise and
25:17
it's important different nutraceuticals and botanicals,
25:22
environmental toxins and their impact.
25:24
And so I think and there is data showing that all these things
25:28
impact women will all of us, but women and our fertility
25:33
potentially are onset to menopause.
25:36
There's an interesting study kind of correlating quartiles of
25:40
Bisphenol A, which is a type of plastic that I feel like
25:42
everyone may have no knows about and urinary levels showing our
25:49
higher exposure of this is associated with entering
25:52
menopause a couple of years earlier actually even.
25:55
And so that's just one example showing that these are
26:00
controllable factors in some ways in our lives that we can
26:04
optimize and feel better and also hopefully normalize our
26:10
cycles and not have to rely upon some of those band aids like I
26:13
was talking about, because you're right, they have they
26:15
have all effects. So the study you just mentioned
26:17
plastic ultimately is leading to women having going through men
26:21
of entering. Menopause earlier.
26:23
It's just so. Kind of.
26:24
It's not that. So that wasn't the type of study
26:27
that was done. You have to have a different
26:28
type of study. This is an association and so we
26:30
can't say it's necessarily causative.
26:32
I see. But the fact that on this large
26:34
scale study, there was an association that was seen
26:37
between these higher levels as well as a, you know, a younger
26:43
age at menopause is compelling and it deserves further study.
26:48
Yeah. Yeah, if there's a lot of, I
26:51
think people out there who are looking at their environment and
26:54
you know, there's a lot of talk about toxins and but there's
26:57
also just a lot of it seems inconclusive.
26:59
We're not really sure exactly. There's a lot of correlation and
27:02
we're not sure is it actually causing this thing, but we do
27:05
know that there's health issues that women are having, lots of
27:08
different kinds of health issues.
27:09
And so people are scrambling looking for answers.
27:11
So what does holistic health look like for women, especially
27:14
when it comes to women facing infertility?
27:18
Well, I'll tell you just from my personal experience, it's so
27:20
interesting. I, I think that there are so
27:22
many, we're faced with an onslaught of, like you said,
27:25
different potential toxins, a different environment, a much
27:28
more fast-paced life that's going to affect us mentally.
27:33
And social media, which has its own layers as well as I found a
27:38
lot of hormone imbalances. And so the amount of women who
27:42
are dealing with, for example, something called hypothalamic
27:45
insufficiency, which is a fancy way of saying that the the
27:51
gonadotropins, which are hormones that come from our
27:54
brain and talk to our ovaries and eventually cause ovulation
27:57
to occur. They cause the release of the
27:59
hormones estrogen and progesterone, which help support
28:02
our bodies and also help support a pregnancy, For example, that
28:06
that hype with hypothalamic insufficiency, those hormones
28:11
because of stress in some ways, be it emotional or physical or
28:15
nutritional stressors, they might become lower that they
28:19
might not be released as readily and as a result, you may not
28:24
ovulate as quickly as you normally would.
28:27
You may not produce as much progesterone to support a
28:30
pregnancy as you normally would. And they're all these other
28:32
hosts of effects. Again, for example, I feel like
28:36
in my practice, a large number of patients have begun
28:41
presenting with these issues. And I think that it's partly
28:44
some of the stressors from, you know, 2020 and then 2021 and
28:48
2022 and all of this. Yeah.
28:50
So that's one example are the the incidence of thyroid issues
28:54
that I'm seeing some of these other hormones.
28:56
The nice thing is, is that again, this can be mitigated and
29:01
addressed by both a root cause approach, for example.
29:05
What are these stressors for you?
29:06
How can we build a plan to help recenter yourself in daily life
29:10
as well as different botanicals? And so you can really use both
29:18
to try to heal this woman. And the same goes for something
29:21
like polycystic ovary syndrome, which is an imbalance of male
29:23
and female hormones. And so it's exciting working
29:26
with women and seeing them improve.
29:28
It's just wonderful. And not having to rely upon,
29:32
again, birth control pills, for example, to try to just mask
29:36
their symptoms. So the difference in your
29:38
previous practice, you when a client would come in, a patient
29:42
would come in and they had let's say a hormone imbalance and so
29:46
they were having trouble becoming pregnant as an example,
29:49
or that repeat miscarriages. Would you do that same analysis
29:52
in your previous practice to understand those imbalances?
29:56
And would there be an attempt to treat them or would there be?
29:59
What would be the how are the treatment plans different in
30:01
what you're doing today versus what you might have done in the
30:03
past? I mean, I think that a lot of
30:05
them share in terms of evaluation, a lot of it is, is
30:08
similar. We're going to look at all of
30:10
the reproductive hormones because we those are areas that
30:13
we can try to normalize and correct.
30:15
OK. With that being said, I think
30:18
I'm more complete and thorough now and even within evaluation.
30:24
And that's because again it's integrative medicine model that
30:27
we are whole people. We're not just ovaries in a
30:30
vacuum is kind of how I think about sometimes the way I used
30:33
to treat people. And as a result, for example,
30:38
with recurrent miscarriage, they're microbiome matters.
30:42
That's the good guy bacteria that protect us against the bad
30:44
guys. And we have specific defense
30:47
systems and these bacteria in all different parts of our body.
30:51
And so I think everyone hears about the gut and how central it
30:53
is and importance for even immunity and mood and all of
30:57
these other factors, the reproductive microbiome that
31:00
exists. And there are studies
31:01
correlating a normal complement of good guy bacteria with again
31:07
association with optimized pregnancy outcomes.
31:09
And so I'll focus on those parts of it as well in again, in
31:14
addition to maybe the baseline hormone testing that I was doing
31:17
more before or kind of deepening that hormone testing.
31:21
So that's the evaluation part for the treatment part.
31:24
Certainly unfortunately, I think so much in OBGYN, the answer at
31:29
least previously in my practice was birth control pills.
31:33
So pain with periods, acne, abnormal cycles, heavy bleeding,
31:40
it was the same answer. And it's interesting because a
31:43
woman's natural cycles is beautiful cyclicity.
31:47
And they're interesting studies because those hormones, estrogen
31:50
and progesterone, they're they're actually, they come go
31:54
into our brain. They're receptors for them in
31:56
our brain, which accounts for all the mood issues that might
31:59
occur, right? Certainly even with our within
32:01
our own cycle, let alone with synthetic hormones, right.
32:05
And instead of kind of nurturing and, and, and trying to
32:11
normalize that beautiful cyclicity birth control pills,
32:14
what they do is they create a flat line.
32:16
It's just an unseizing amount of low, you know, essentially low
32:20
estrogen and a low amount of progesterone that that is
32:24
removed for a week, a week, a month.
32:27
And so you're fundamentally altering what we should be
32:32
experiencing. And so it's no surprise there
32:35
are side effects from this. What are the side effects?
32:38
So there can be the one I see quite frankly the most is mood
32:42
issues. But there can be side effects
32:44
like any hormone may increase the risk of blood clots in the
32:50
blood vessels. Fortunately and especially birth
32:55
control pills and the reason for that is it's ethanol, estrogyol,
32:58
which is a much more potent synthetic form of estrogen.
33:01
And so as we take that and it gets metabolized through our
33:05
liver, it can increase the production of clotting factors.
33:09
And then that's the mechanism by which you can have an increase
33:12
in risk. For example, there is a study
33:14
that just came out quite recently showing that all forms
33:19
of contraception, be be it both combined with estrogen,
33:23
progesterone or progesterone only, which many more women are
33:28
using now, will slightly increase the risk of breast
33:32
cancer. And so that was just published
33:35
recently. There might be an increased
33:38
risk. Again, the mood issue, there was
33:40
a huge Denmark cohort study looking almost a million women
33:44
and showing that unfortunately from an age group of 15 up to I
33:47
believe 30s, there is a statistically significant
33:51
increase in the incidence of depression, which is double that
33:56
in teens. Because their brains are so
33:57
plastic, there's a lot of plasticity and neuronal
34:00
connections developing and this risk persists even after you
34:03
stop it. And the same goes with
34:05
suicidality. When you think about this with
34:09
the other pandemic that we're having right now, which is this
34:11
teenage really a mental health crisis for I think all ages and
34:16
in particular we worry about it for the teens.
34:17
I think it's quite concerning that so many of our girls are
34:21
are on contraceptives. It's, I think they quoted that
34:26
out of the 12 million teenage girls in the US, half of them
34:31
are sexually active and another half of them are on birth
34:35
control pills. And so that's sort of, that's an
34:39
order of millions that might be affected.
34:41
It's crazy. Especially with that latest
34:43
study that came out, about 1/3 of teen girls, I don't know if
34:47
it's as of 2021 or it's a recent year that they're getting the
34:50
data from, but 1/3 of teen girls considered as suicidality had
34:55
suicidal thoughts, 1/3 And you think about, OK, birth control
35:01
and all of that impact on them. And then social media I think is
35:05
another factor and just the addictive nature and the it's
35:09
proven to make that, you know, your mood poor, you know,
35:13
increase your mental suffering. So that combination, I mean, you
35:17
put them on birth control and you stick them in front of
35:20
Instagram and TikTok for hours a day.
35:22
I mean, that makes for a very sick teenage population.
35:26
Absolutely. So what would be the solution
35:28
for a teen girl? Do you see teen girls at your
35:30
practice and what's the what's the solution for them?
35:34
I think this is the question and I still feel like I'm trying to
35:37
find the. I think that the I still, I
35:40
think I'm trying to find that solution.
35:41
Quite frankly, I think the solution for all of us is just
35:46
being, having a solid foundation, being rooted well
35:49
again in in faith in our being in God and our family and
35:58
ourselves. How do you do that though in a
36:01
healthy way? Treat yourself, try try to take
36:05
care of yourself. How do you do that?
36:09
I think that again that that's when it comes into body, mind,
36:12
soul that you have to nurture. You have to try to take good
36:16
care of your body. We know that all these, you
36:17
know, if there's one thing I tell my patients is they try to
36:19
decrease processed foods. It actually can matter.
36:22
It can increases inflammation and this is all.
36:25
So what are examples of processed foods?
36:27
Oh, I mean, I would say that anything that doesn't that will
36:30
sit on a shelf for a long time and not go bad, for example,
36:32
that isn't natural. Anything that doesn't resemble
36:35
its initial constituents, Right. So that would be a lot of, you
36:41
know, even what I sometimes feed to my children because it's easy
36:45
and it's convenient. So yeah, breakfast cereal
36:47
certainly are fast food, right? Or chips, cookies, all of those
36:55
things. And again, we start getting into
36:57
this, and I always tell my patients that my number one goal
37:00
is to decrease their stress because it can be very easy to
37:04
start feeling enslaved by a diet or enslaved by these
37:08
restrictions. And that's not the goal.
37:10
We have to give ourselves lots of grace, but small changes can
37:14
have such profound impacts. Again, that study on the BPA, it
37:18
was quartiles, right? And so it's not the absolute
37:20
amount. We just can bring ourselves down
37:22
from higher exposure to lower exposure that can make all the
37:26
difference with some of these outcomes.
37:28
I want to go back to the teen girls for a minute because I,
37:31
it's such a, it's so important. They're the future and how
37:35
they're with how they're faring now can determine outcomes for a
37:38
lifetime for them. And so you're seeing some teen
37:41
girls and you just mentioned the solution for teen girls.
37:44
It's more than you can just do right.
37:47
I mean, you mentioned a strong foundation.
37:48
It's about, you know, what are they doing with the rest of
37:50
their life and the family that they're in and the school, the
37:53
friends they have, There's so much more there.
37:55
What do you think? I mean, what, what should, what
37:58
should the medical system at least do when they're dealing
38:02
with teenage patients and not even patients who are sick and
38:06
they're coming because something's wrong.
38:08
But if you are a, you know, pediatrician, so you're still
38:11
seeing teen girls regularly, Let's say I don't know what the,
38:14
I don't, I've never had a teen daughter and I don't remember
38:16
being a teenager. What I, you know how often I go
38:18
to the doctor, but I, there's regular check insurance, right?
38:21
What should be the approach for teen girls?
38:25
Well, I think that we have to check in.
38:31
I think that for everyone, it's good to have a purpose in life
38:35
and to really be looking forward and trying to see how can I
38:39
become a better person, but how can I also contribute to this?
38:43
Sounds a little cliche, but how to become the world, becoming a
38:46
better place? And so I think that really
38:50
fostering that with, with all of us and especially our teens is
38:55
so important because it's a time when very, you know, I remember
39:00
feeling like it's you're, you're very, I, I felt very self
39:02
absorbed, like it was just in very superficial concerns and
39:06
really reminding them that there is more to life than this.
39:08
And then that's what they should be kind of striving towards.
39:11
I think it's one big part that you can really check in with
39:14
during the course of the visit. I think that supporting them,
39:19
treating them as a mature individual who can, who can, who
39:25
can do well. But also I say that with with a
39:29
grain of salt because they are still children and they're still
39:33
developing who they are and their thought processes and
39:37
their logic in some ways. And so also providing some
39:41
guardrails. I don't think that they can make
39:44
all the decisions and have in some ways that maturity to No 10
39:51
consequences down the road. And so we have to still be able
39:54
to be those. I don't, I don't know if
39:57
authority figures is the right word, but just people that love
40:01
them and support them and want the best for them, but also can
40:03
counsel them wisely. And so if we can do that as
40:07
physicians, I think that would be really wonderful.
40:09
And again, I mean, my bias again is always just to try to
40:12
minimize the amount that we're going to be.
40:15
Intervening with them in the sense of pharmaceuticals and
40:18
whatnot, I really again and counsel them if we're going to
40:21
be doing something. Wow.
40:23
Why do you think we're so over medicated?
40:28
I think that medications in many ways are it's so much easier to
40:32
pop a pill than to have to make a foundational shift in what
40:37
you're eating every day and stick to that.
40:39
I know that feels harder for me. I mean, it is harder.
40:42
It is it takes three weeks to form a habit and then it gets a
40:44
little bit easier. But it is a process of change.
40:48
And so I think that's one reason.
40:50
And I think that personally, there are a lot of other vested
40:55
interests that that want us to be medicated, even though there
40:58
are alternatives that ultimately are cheaper for all of us as a
41:03
society and again, better for all of us for our health that at
41:07
the minimum should be adjuncts and hopefully if we catch it
41:10
early enough, might be alternatives.
41:13
What would be your message to medical students or maybe
41:16
aspiring medical students who are looking at the landscape and
41:20
they have values and they have, they're trying to build their
41:23
own foundations and they just see, you know, with abortion and
41:26
IVF and just the challenges in front of them, they maybe feels
41:30
daunting about how do I get into the space and like you said, not
41:33
lose my soul and get into the space and actually treat
41:36
patients holistically. Yes, I have thought about this a
41:40
lot and wrestled with it because I I look back at my own personal
41:44
again journey here. I would say #1 you are needed.
41:50
Have courage. There needs to be.
41:54
Medicine, unfortunately, in my estimation, is becoming a very
41:57
biased field where we're starting to have one viewpoint
42:06
that is promulgated instead of listening to what the patient
42:10
needs and trying to help that patient in some ways.
42:13
And so we need other voices in the field, first of all.
42:16
Second of all, I wish I had done some background in philosophy.
42:21
I think that is so important. I prefer the seemingly black and
42:25
white concepts of biology over, you know, the, the, the struggle
42:29
with metaphysical reality that philosophy I think really
42:32
focuses on more. But I do believe it's so
42:35
important because we as physicians are wrestling with
42:38
metaphysical and spiritual issues that have spiritual
42:41
weight every single day. And you need to guide people.
42:45
Well, we're not the experts on that.
42:46
That's fine. But we need to be able to
42:50
navigate that and consider that in our decisions for patients.
42:53
So take a course in that if you can.
42:56
And there's a lot of alternative schools in the sense that maybe
43:04
if they don't want to deal with one issue because they're afraid
43:09
of what they may be required to do or asked to do, for example,
43:13
in the fields of OBGYN with regards to abortion or other
43:16
factors. The nice thing is a lot of new
43:19
schools are coming into being that offer alternatives and a
43:23
more holistic and way to look for fertility awareness based
43:27
methods which are safe, effective, natural.
43:30
We didn't really go into that, but there there there's one
43:33
school that may be a designing its curricula with this approach
43:38
in mind for all four years, for example, that's coming into
43:41
being. And the 4th 1 is that there's a
43:43
great elective that they can consider called Facts About
43:47
Fertility that really allows them to look at other ways to
43:51
assess for hormones and empowers you to understand your body and
43:55
how fertility should work. So I encourage them to check
43:58
that out. That's nationwide.
44:00
So good. And how can people learn more
44:01
about you, your work, your practice?
44:04
So I am I'm online and my website is laurenrubalmd.com.
44:09
So that's that's. Still taking, still taking
44:12
patients. Still taking patients.
44:16
Thank you so much, Doctor Rubal. Of course.
44:18
Awesome. We'll have to do this again.
44:20
Thank you so much for having me.