Gut Health And Women’s Hormones with Tabatha Barber, MD

Content By: Ari Whitten & Tabatha Barber, MD

In this episode, I am speaking with Tabatha Barber, MD – who is a triple board-certified in obstetrics and gynecology, menopause, and functional medicine. She is the host of The Gutsy Gynecologist Show, where she shares her wisdom and unique perspective with women everywhere to reclaim their health. By incorporating functional medicine into her women’s health practice, she’s able to provide women with the tools they need to optimize their health and happiness. We will talk about hormones and gut health.

Table of Contents

In this podcast, Dr. Barber and I discuss:

  • The most common hormone imbalance that affects women from all walks of life
  • The life-altering effects of excess estrogen 
  • Why treating the root cause of hormone imbalance is essential for health and happiness
  • The link between hormone imbalance and gut health 
  • The detrimental effects of the overexercising
  • The most hormone-friendly diet
  • When to consider hormone replacement therapy

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Ari Whitten: Everyone, welcome back to The Energy Blueprint podcast. I’m Ari, your host. With me today is Dr. Tabatha Barber who is triple board-certified in obstetrics and gynecology, menopause and functional medicine. She has the unique situation of being licensed to practice medicine in over half the country, so you now have the ability to work with a functional physician virtually if you’re interested in her areas of specialty, which is what we’re going to be talking about.

She is the host of The Gutsy Gynecologist Show, where she shares her wisdom and unique perspective with women everywhere to reclaim their health. She’s also a keynote speaker, mentor, wife, mom, and grandma. Wouldn’t have guessed that

By incorporating functional medicine into her women’s health practice, she’s able to provide women with the tools they need to optimize their health and happiness, which in turn allows those women to pursue their purpose in life. The Gutsy Gynecologist thing is a node to the emphasis on gut health in particular. I love the name of that show. Welcome to the show, Dr. Tabatha.

Dr. Barber: Thank you.

Dr. Barber’s story

Ari: We recently did an interview on your show, where you interviewed me, and I was so impressed with your knowledge that I said, “I need to get you on my show to talk about your specialty.” That’s what we’re doing here. One of the things you told me as we were chatting after the interview is your personal story of coming to do what you do now, going from typical conventional gynecologist to seeing the light. I would love for you to share that story.

Dr. Barber: Oh my goodness. Thank you so much for having me because we need to talk about this stuff. Women need to know why they go to the doctor when they don’t feel better. Every day in my practice, I hear women say they feel dismissed, they feel unheard, they’re not getting answers, they’re getting more medications.

I went into medicine because I wasn’t being heard. What happened was, I was a wild child, I ended up pregnant in 11th grade. I dropped out of high school, I didn’t finish. I had a really traumatic birth and pregnancy and delivery. Things were done to me, things were not explained to me, I was treated like a second-class citizen. I came out of that experience just feeling an overwhelming need to help other women have an advocate for themselves, have a voice and a choice in their health.

I got my crap together, I went back to school, I figured it out. I went to medical school, I did all the stuff you have to do. Then I found myself 10 years in the practice burnt out, miserable, frustrated, not really helping my patients, not healing them truly. I reached my breaking point and I left. What I realized was God put me on this earth for a purpose. I derailed from that purpose, I needed to come back to it.

Really, what it’s about is telling the truth and helping women realize that they are the only ones that can heal themselves. They need to take back control of their health, they need to ask why, they need to question, they need to seek alternative sources of support and help. That is my mission now, is to get the truth out there because, honestly, conventional gynecology is hurting women and they are actually making women sicker. I can say that because I was one, but once you know better, you have to do better, so we need to talk about these things.

How conventional gynecology is harmful to women

Ari: Let’s talk about some specific examples. You can, I guess, answer this from a perspective of sharing patients’ stories or from a perspective of just specific topics within gynecology where standard practice is leading to poor outcomes or is counterproductive. What are some of these areas where conventional gynecology is hurting women?

Dr. Barber: I would say the most common thing I see is women, perimenopausal age, 35 and up, who are in this estrogen dominance pattern and they are being treated in a certain way through conventional gynecology. These all occurred to me because I went through it myself. I was sleep-deprived, living on donuts and Mountain Dew, and giving to everyone else except myself. I ended up having crazy heavy periods, and bad mood swings, and depression, and weight gain, and all the typical estrogen dominance signs, breast tenderness, headaches, all these things.

I actually finally went and sought treatment and the gynecologist to me said, “Oh, you just need an ablation or hysterectomy.” I was like, “Wait, what? Time out? I don’t want major surgery. That’s scary stuff.” Remember, I was a surgeon. I did this all day long to people and I never thought twice about it, but when it came to me, it really stopped me dead in my tracks. I stopped and evaluated and thought, “Why is this happening to me?”

I was studying functional medicine at the time, trying to heal my Hashimoto’s and my back issues. I figured there has to be a reason, a root cause issue for this estrogen imbalance, which is another topic. Gynecologists aren’t taught estrogen imbalance. Honestly, here’s a major thing your audience needs to know. Gynecologist are actually surgeons. They’re not hormone specialists.

I learned probably as much as family practice or the pediatrician about hormones. I spent four years in residency, cutting people and sewing them back together, removing their organs, delivering their babies, doing procedures in the office. I didn’t study the endocrine system and all those intricacies. I knew the basics and I knew how to prescribe synthetic hormones to override those systems, but literally, that was the extent of it. That was a tangent, but that’s really important for women to know.

Here I am, I’m in the throes of this hormone imbalance. I’m not healing any of my patients. I start to notice a pattern. My patients would come in with the heavier periods, with the hormone imbalances, and when the birth control pill didn’t work, we would do the IUD, when the IUD didn’t work, we would do the ablation, where we would burn the lining inside the uterus. When that didn’t work, we would do the hysterectomy.

Then a few years later, they would come back and say, “Oh, I just got diagnosed with breast cancer.” Nobody was putting the pieces together that all we were doing is masking these symptoms of estrogen dominance and never really fixing the problem. Yes, we got rid of their period problem. They weren’t bleeding through their pants anymore and having accidents, but that estrogen dominance continued to feed their breast tissue and cause breast cancer.

Estrogen’s amazing. It’s supposed to be imbalanced. It’s healthy, it keeps you young and vibrant. You want it, but you need it to be at a balanced form, you need it to be metabolized appropriately, and your body is constantly giving you signals as to whether that’s the case or not. Gynecologists are trained to get rid of those symptoms for you. We’re very much trained to look for disease and Band-Aid it. It’s either a pill or it’s a surgery. Unfortunately, not addressing these root causes are really doing women a disservice.

The other piece of it is I see a lot of gallbladder disease. Women, unfortunately, get their organs removed much more than men in this country, unnecessarily, and too much estrogen causes your gallbladder to slow down. Then you start making gallstones. Next thing you know you have your gallbladder removed. Little were they told you need that bile to transport your hormones and remove them from the body, you need those to remove the toxins from your body.

Then women, they got rid of that symptom of their right upper quadrant pain and their pain with eating, but they didn’t actually fix the issue, so now they’re going to go and have another issue. That is the pattern I see over and over in conventional gynecology, and we have to do something about it.

How a functional medicine gynecologists approaches hormonal issues

Ari: Absolutely. How would a functional medicine gynecologist approach these kinds of issues differently?

Dr. Barber: Yes. Like I mentioned, I wasn’t trained to really evaluate hormones in-depth. We’re taught like, “You can’t really measure hormones because they change every day of the month. You don’t know where your women are at in their cycle, so don’t really worry about it.” We’re given reference ranges from the lab that are extreme, “Your estrogen from 10 to 800 is okay, above that, worry about a tumor, below that they’re in menopause.” Literally, I’m telling you how I was trained.

It turns out we actually do know how to measure hormones. We’re just not taught in conventional medicine. The world of functional and integrative medicine has been studying this for two decades or more, and so we know how to test hormones, it’s just that your conventional doctor does not. I had to go through a whole bunch of training, almost like another residency, to become a hormone expert. Being a gynecologist did not make me a hormone expert. We can test, we can figure out where your deficiencies are, where your excess is.

Here’s the bigger piece, Ari, this is what I tell everybody, your hormone imbalance is the result of something else, it’s not the cause. Your sex hormones being imbalanced are because your adrenals are out of whack, or your thyroid isn’t functioning well, or your gut is an issue, or your liver is sluggish, or your gallbladder is not helping you, or you’re exposed to xenoestrogens. Always trying to chase hormones. I see this all the time with bioidentical hormone replacement. Let’s balance those hormones, let’s balanced those hormones.

If you don’t fix those other root cause issues, you’ll be changing the dose every few months, you’ll feel good for a minute and then you’ll be miserable again, and you never actually get balanced because that’s not the problem.

The root causes that drive hormone imbalance

Ari: Absolutely. Speaking of those root cause issues, what are these root causes? What are some of the root causes of these hormone imbalances that are driving so many of these women’s health problems?

Dr. Barber: This is a really important point. When I went through medical school forever ago, it’s been over 20 years, we didn’t talk barely about perimenopause, there was no such thing as hormone imbalance, endometriosis and fibroids were uncommon and it was really exciting if you saw a case of that. Now it’s everywhere, and it’s because we are living in the most toxic time in our entire history of civilization.

A hundred years ago, all of the plastics that we use did not exist. They were created in a lab, there’s thousands of chemicals that our bodies were never meant to see. Our bodies are trying to constantly handle all these toxins coming in all day long every day, your care products. People put on body lotion every day, and they spray the perfume, and they get the glade plugins, and they’re drinking out of their plastic water bottles trying to be healthy.

All of these are putting plastics into your body, and your body does not know what to do with them. It likes to store it in the fat cells, so we’re fatter than we ever have been. They also like to bind to our hormone receptors and send these warped signals like we have too much estrogen, so we have a whole category of chemicals called xenoestrogens. You cannot underestimate the power of all of this stuff, and coming at you all day long. It’s really important to clean up your environment and evaluate what are you putting in your body, on your skin? What are you breathing, all of that. It needs to be evaluated and dealt with or you’ll never have hormone balance. That’s the biggest one I would say.

Then what we’ve gone through in the past two decades, everybody’s drinking alcohol. Women are drinking alcohol like they never have before in history. A female body should really not be consuming more than six ounces of alcohol on a regular basis. Our bodies just have too many hormones to metabolize and other functions to deal with. What I saw was, “Oh, well, I’m bored. I’m sitting at home for two years, so I’m going to drink,” or “I’m super stressed, so I’m going to drink to relieve that.”

Every time you drink, your liver has to metabolize that estrogen. When your liver does that, it has to put the hormones and everything else on the back burner for later because it always wants to deal with outside foreign stuff before it deals with its own natural stuff. You get this backup of estrogen specifically, and that can really drive a lot of estrogen dominance. We are hard on our livers, we’re taking Benadryl to sleep and Ativan. We’re on statins and proton pump inhibitors and all of these medicines for decades. I get women coming to me, they’ve been on a statin for 20 years, “I don’t know if I need it, but my doctor keeps giving it to me.” It’s like, “Holy cow, that is destroying you.”

We’re hard on our liver, our gallbladders can’t function, and then the biggest piece that I like to talk about is the gut. This is untouched territory for conventional medicine, and it’s really the answer to everything. There’s actually bacteria in your gut that cause you to reabsorb your hormones that you’re trying to eliminate. Our liver works so hard to metabolize our hormones and get them ready, put the garbage tag on them to send to our stool and our urine. If they finally actually do make it out with the help of the gallbladder and everything else, there’s bacteria that will cut that garbage tag off and tell you to reabsorb them.

If you’re constipated or if you have the wrong bacteria living in your gut, you are just recycling and reusing those hormones that your body’s trying to get rid of. It’s all connected. It needs to be addressed. I think a lot of my colleagues poo-poo me, no pun intended, about the fact that I’m so focused on the gut. When I was a surgeon doing surgery all the time, I would spend hours literally peeling bowels off of ovaries, uterus, fallopian tubes, because your bowels are not separated from your pelvic organs in your abdomen. They all live together, they lay on each other.

When you have inflammation in your gut, all those tiny little cytokines and interleukins and all those inflammatory microscopic chemicals, they seep over into your pelvic organs and vice versa. Endometriosis often looks like your bowels scarred to your ovary, fallopian tubes, and uterus. I’ve seen major Crohn’s infections invade ovaries and fallopian tubes and just take them out.

That’s a really important thing for women to understand. It literally does matter what’s going on in your gut because it’s living right on top of your pelvic organs and that affects your body’s ability to make hormones, and more importantly, be fertile, for a lot of women. I can’t underestimate the importance of the gut.

The biggest factors that disturb women's gut microbiome

Ari: What are some of the biggest factors that disturb women’s gut health and lead to some of those issues that you described?

Dr. Barber: That’s a great question. I already said alcohol. Alcohol kills the lining of the gut. It causes leaky gut, or in medicine it’s called increased intestinal permeability, because leaky gut’s not real, but it really is. If you do a PubMed search for intestinal permeability, there’s tens of thousands of articles by gastroenterologists, internal medicine, they are clearly aware of this issue, they acknowledge it, they study it. They don’t know how to treat it so much because there’s no drug, there’s no drug to make money for this treatment as of yet.

Alcohol is a huge factor. Not only does it cause active leaky gut, but it actually kills your beneficial microbiome that is trying to protect you. We have certain bacteria that will make a mucosal barrier over those intestinal cells and help protect things to not get into your bloodstream. When you kill off that bacteria, it’s like a free-for-all, everybody’s going in. It’s like there’s no bouncers at the door. Everybody’s rushing into the club, and it’s havoc. Alcohol is the big one, our food.

I’m sure you talk about this all the time. Our food, it’s Frankenfood. It’s not even real. It’s full of toxic chemicals, pesticides. Then we heat it up in the microwave in the plastic and put that in it and that all destroys your gut too. Those are some big drivers.

The other piece we haven’t really talked about for women is chronic cortisol production. I was living proof. I was living on sugar and caffeine and wine to get me up in the morning, put me to bed at night, and a lot of my patients are come to me like that because we are chronically pumping out cortisol to handle all of the stress because women are doing it all now.

We want the careers, we want the family, we want to look good, we want to go out with our girlfriends and have cocktails. We want it all, but that comes at a major price and that constant cortisol production drives sugar into your bloodstream and insulin resistance, but it also causes leaky gut again. Everything affects the gut, it really does.

Can overexercising cause gut issues?

Ari: Excellent. I’m curious, here’s another thing that you didn’t– I don’t know if you mentioned quite that much, but the exercise, over exercising, have you seen a lot of issues with women who are chronically over exercising and who are losing their periods? Exercise is another factor that at least induces transient gut permeability. Have you seen any issues with that or is that maybe a more rare thing that you deal with?

Dr. Barber: No, it’s actually super common. That’s a great point. Especially younger girls who play a lot of athletics in high school and college, it– Our body wants to survive before it wants to thrive, so your reproduction is the first thing to go if your body senses that you’re not balanced. If you are super physically active, you’re going to shut down that hypothalamic-pituitary-ovarian axis and not make your hormones.

I see this a ton in women in their 20s and 30s, “I want to run a half marathon. I want a full marathon. I want a triathlon.” By the time they’re done with all of that training, six or eight months later, they have wiped out their adrenals and their sex hormones, and now their thyroid is carrying on that burden and can’t keep up with it. It takes a long time to recover from that.

I’m just going to be truthful here, God created women to not be these high-performing athletic women. Our bodies are made to be able to get pregnant and carry a pregnancy, and nothing against it. I want to be a bodybuilder and do all that stuff too. It’s really amazing to be that super athletic, but it does come at a cost because our body wants to reproduce and procreate. That’s what our species is supposed to do at the end of the day.

I just want women to be aware like if they’re going to make this choice, “Hey, I’m going to run this marathon,” I need to really love on my gut, because every single day, I’m going to be causing leaky gut to occur. The cool thing is, the cells in our intestines, they turn over every 48 to 72 hours, so you can heal your leaky gut pretty quickly, but if you never stop insulting it and removing those triggers that are breaking it down, then you invite autoimmune conditions and food sensitivities and chronic disease and all of this stuff. I would say I just want women to be aware of what their actions are doing to their bodies so they can counteract it or maybe choose to do it a little differently.

That was the big thing with birth control pills, we were never told they cause leaky gut, or vitamin and mineral deficiencies, or change our hormones and shut down our own production. They say stuff like, “Oh, it balances our hormones.” That’s all a bunch of crap, and women need to know that that’s what they’re signing up for. I’m all for the pill, I would have probably not made it through med school without the pill. That prevented me from getting pregnant again, but I probably wouldn’t have stayed on it as long as I did. I would’ve taken better care of my gut. I probably wouldn’t have gone back on it with my Hashimoto’s.

You need to have informed consent. You need to know what this stuff does to your body, and so you need to find a practitioner who understands all this and acknowledges this and talks you through it. Right?

The impact of alcohol on gut health

Ari: Yes. Are there any other big contributors to poor gut health that you find that are pretty common? Psychological stress, sleep and circadian rhythm issues, nutrition issues? You focused on alcohol a lot, which is- Actually, I’m really glad that you did because it’s something that has– I don’t know what the best way to describe this is. It’s like everybody has heard alcohol is bad for you at some point and now I actually feel it’s neglected to the point where people don’t talk about it because there is always a desire to maybe focus on something more novel than that. As a result of that, many people have lost sight of the fact that consuming a lot of alcohol every day is very problematic.

I can’t even think of another podcast that I’ve done where someone has put that kind of focus on alcohol that you just did, so I’m very grateful for that. Are there any other nutritional issues that you find that are common or some of these other things I mentioned?

Dr. Barber: Yes. There’s two parts to that answer because alcohol not only destroys your gut and in long-term causes depression and causes insulin resistance and pre-diabetes, but it affects your sleep so much. Literally, women wake up at 2:00 or 3:00 AM if they drink alcohol in the evenings. They never want to believe me, but when they stop drinking for a couple of weeks, they’re like, “I’m not waking up anymore.” That’s assuming they got rid of their nighttime snacking, and everything else because waking up in the middle of the night, especially with hot flashes, is not usually a hormone issue, it’s a blood sugar or a cortisol issue.

Alcohol affects both of those. You can really help yourself and kill two birds with one stone by getting rid of the alcohol every evening. Make it special again. If you want to go out for drinks with your girlfriend a couple of times a month, or your man, you’ll enjoy it, you’ll need less drinks because you build up a tolerance. Stop doing it every day. That’s not a very favorable thing. I get a lot of complaints, but it’s the truth. If you want to feel better, you have to do that.

The other piece is, as long as you have gut issues, you will not absorb your vitamins and minerals appropriately, and your body will struggle to do its physiologic processes. You talk all about mitochondrial health, I see women going on these vegan diets, there’s no L-carnosine in their diet, or they’re not getting any B12 in their diet, or they have major gut dysbiosis and they can’t even absorb vitamin D and vitamin A, or they don’t have a gallbladder, all of this affects your body to be able to create energy at a cellular level. We forget about that.

It’s funny, that was one of the first classes that we took in medical school, biochemistry, physiology, all of that cellular stuff down to the microscopic level. Then you get into residency and they’re like, “Screw all that, none of that matters. Which drug for which symptom?”

Ari: That’s right. [crosstalk]

Dr. Barber: You forget about choline and all of these amino acids and processes and things that are so important for your body to function.

Ari: Because diseases are just deficiencies and drugs.

Dr. Barber: [chuckles] Right? No, they are not. You do not have a Prozac deficiency. Probably have a vitamin D deficiency and a zinc deficiency and a choline deficiency and things like that, where you can’t handle metabolize process, your hormones, your toxins, all of that. Finding someone who understands that is a key. That is right there. If you heal your gut, you get rid of all this extra burden on your body all of the time. Your body might actually be able to get back into balance and you’ll feel better.

The impact of lifestyle on gut health

Ari: What about sleep, circadian rhythm issues, and psychological stress, do you find those are big things, and what strategies do you use to optimize those?

Dr. Barber: This is the kicker for women because what I hear all the time is, “My husband falls asleep in five minutes. He wakes up so fresh, he gets five or six hours, screw him.” Women are angry at their husbands because they’re laying there for hours listening to their husbands sleep, or they actually can fall asleep, but then they wake up and their mind starts racing. Not only for the sugar and the other reasons we talked about, but I am seeing an epidemic of women being disconnected from their higher power, from their purpose in life and it’s not sitting well with them subconsciously and it’s keeping them awake.

That’s not a thing that anybody wants to admit or really talk about, but I go there because that can be life-changing. I have women who, they’re just cranking it out. From the minute they wake up to the minute they go to sleep, they’re doing all the things. Then they come to me around age 45 or 50, “I have an amazing job, an amazing husband, amazing kids, and I don’t like my life. I don’t want to get out of bed, I don’t want t do it anymore,” because they’re chasing the superficial, they’re chasing everything that is wrong with this country. They’re trying to keep up with the Joneses.

“I need to drive a Range Rover, I need to do this. I need to go back and get my MBA.” I see that a ton. “I need more degrees, I need to prove who I am,” instead of just sitting with the fact that you’re a child of God, you were put here for a reason. You need to step into yourself and figure that out because until you do, you’re going to keep waking up. You’re going to keep not feeling comfortable in your own skin and you’re never going to heal.

That’s the hard piece. We can heal your vitamin deficiencies all day, but that takes the work of that person. It’s like doctors are supposed to be the ones to heal everybody, but we can’t actually. I can’t heal anybody. I can give you tools. I have more tools in my toolbox now that I’m a functional doctor, but I still can’t do the work for you. I still can’t make you sit with yourself and figure out why you’re miserable and why you’re drinking every night and why you’re searching for a pill and something else to heal you. That deeper work has to come from within.

The best diet for women

Ari: Well said. Do you have any favored dietary patterns, diet plans that you prefer that you use in your practice? Are you a fan of Paleo, or Mediterranean, or keto or anything like that?

Dr. Barber: I’m a little biased because I have Hashimotos. Gluten pretty much kills me, it destroys me. I have yet to meet a person who says, “I feel great on gluten.” It’s been so genetically modified that our bodies don’t even recognize it. They’re like, “What the hell is this foreign protein? I don’t know.”

Ari: I might be that person, actually.

Dr. Barber: Really?

Ari: I don’t notice any negative effects from bread.

Dr. Barber: You are so blessed. I’m also biased because I almost only see women. I think because women have a much higher propensity for autoimmune conditions and their immune response is so much enveloped in their hormones that we tend to respond more. That’s a big point.

Ari: Just to be clear on that, I’m certainly not doubting the validity of anything you’re saying, I’m just saying, personally, I’ve experimented with eating gluten, not eating gluten, trying to pay attention to any negative reactions, and I really just don’t notice any negative effects from it, but I guess I’m lucky in that regard.

Dr. Barber: I don’t like you right now.


Dr. Barber: I cannot-

Ari: Everybody wants to eat bread.

Dr. Barber: I can’t even eat a little bit. I’ll be on the couch for three days depressed and scratching my eczema right off my body. Good for you. Where I find women do the best is just focus on clean whole foods. Actually getting back to nature and eating stuff the way it grew, and not being vegan. I don’t think that we were made to go without animal products. We need more healthy fats. We’ve done a lot of disservice to women over the past couple of decades, telling them to eat no fat, low fat, that really killed all of their hormone production, and then filled those foods full of sugar, that caused diabetes to go rampant.

I’m really a proponent of figuring out what your body responds to, very individualized. I did this major genetics thing on myself and I found out I’m a great carbohydrate metabolizer. I can eat potatoes and all of that stuff all day long and it doesn’t affect my weight because of where I come from, but there are some people, they eat even a little bit of it and they’re storing all of that as fat. I love finding out what works for you individually and figuring that piece of it out.

I don’t have one generalized plan, although I will say once women get into perimenopause and menopause, keto seems to really be king for them. They feel so good and so amazing doing a clean keto with intermittent fasting because once those hormones shift and they’re not cycling any longer, you just do better with ketones as your fuel as opposed to sugar. I don’t necessarily love it for recycling reproductive-aged women because we do need some more carbohydrates during the second half of our cycle and all of that. Follow Dr. Stephanie Estima. She does a great job talking about all that.

Ari: Yes. I’ve had her on the podcast.

Dr. Barber: It’s like for women it’s so much more complicated. I used to wish I was a man because it’s just we have to think about how we shift every week of the month and how we transition through pregnancies and into menopause. One diet that worked amazing for you at one point in your life might not be the right diet for you in a different season of your life. That’s what I usually see with my patients.

Is gut microbiome testing a valuable tool?

Ari: Speaking of– You mentioned testing and trying to individualize these kinds of things. Since you specialize in gut health, I’m curious what your take is on gut microbiome testing. I know that there’s been– I’ve seen over the years– I have a lot of functional medicine doctor friends, and I’ve seen various test favored or not favored or people saying, “This one’s good, this one’s not good,” and I’ve seen that shifting a lot. I’m also curious what your take is on something like biome or Ubiome.

Dr. Barber: I did a biome test on myself, probably, gosh, two years ago at this point. Honestly, I felt overwhelmed because I had so much data. It listed every little possible bacteria ever. I’m not sure if the test has changed since then. I have found the most consistent shift when I go based off of GI-MAP from diagnostic solutions. It’s a DNA-based microbiome test, where they’re showing you, who’s running the show, who’s too high of levels, who’s too low. They’ll tell you, are you making your digestive enzymes, what’s your immune system doing at the front line, your IGA, which I like to think of as your army. They’re ready to defend you at the border and not let people across.

I’ve seen a ton of low IGA probably in the past six months. I have a feeling it has to do with all the chronic viral stuff that we’re fighting, but I’ve been seeing a ton of that. It will show you if you have active leaky gut. When I do gut healing protocols off of that test, I see results. I see women shift, and we’re asked about food sensitivities a little bit. These are very controversial, like, “Oh, you can have antibodies here and there.”

What I’ve found is, as long as you have active leaky gut, your immune system is going to keep responding to everything it sees because it’s trying to protect you. It actually doing its job, it’s doing what you want it to, but every time it sees something that it normally doesn’t, like undigested almonds and chicken, because they’re getting into your bloodstream when they shouldn’t be, you’re creating antibodies against these components, and every time your immune system sees it after that, it sees the antibody and says, “Oh, yes, we don’t like that guy, attack.”

It’s like you’re chronically adding fuel to the fire, and as long as you keep that leaky gut going, it’s a never-ending vicious cycle. I have women all the time who are like, “Oh, I tried food sensitivity, it didn’t work,” because they didn’t heal their gut and they kept creating new antibodies against all of this stuff. It just becomes overwhelming and confusing. The important key with any food sensitivity test is calm your immune system down, heal the leaky gut so that your immune system quits attacking everything. It’s just confused and angry.

It’s not that you can ever eat broccoli again or chicken again, it’s that your immune system needs support. If you come at it from that angle, you’re going to have so much better results. I see women all the time, they remove those triggers that are pissing off the immune system, they heal the gut, they can almost always reintroduce those foods and no longer react to them because those antibodies went away. That’s the cool thing.

The IgG half-life is like 21 days. If you consistently avoid it long enough, they will go away. Your immune system will forget it was confused and you can reintroduce those foods. It matters how you do stuff and how you look at the test, not just which tests.

COVID and hormone imbalance

Ari: I have two more questions for you. The first one is related to COVID and the second one’s related to bio-identical hormones. I’ve heard a number of reports, and even there have been some peer-reviewed publications on this at this point, I’ve heard many, many anecdotes of women talking about their cycles being disrupted, either by COVID or the vaccine, and especially the vaccine. I’ve heard a ton of stuff with regards to that, but I’m not a clinician treating women. As a woman who is a clinician specializing in that, I’m curious what your take is on all of those anecdotes, and if you’ve seen any patients who are struggling with those issues, what your take is.

Dr. Barber: Oh my gosh, I’ve seen so much of that. I would say, oh my goodness, I’d venture to say 70% of women who had COVID or got the vaccine messaged me complaining of their periods coming too early, spotting in between, or things flaring back up. Like, “I was doing amazing and now my gut’s a mess,” or “My PMS is back,” or your endometriosis pain.

Our body makes something called natural killer cells and they’re going out to fight the fight when you get infected or get exposed. We’re finding now that natural killer cells play a big role in what’s going on inside the uterus, in the endometrial lining, and that can be a hostile environment. Now we’re figuring out that’s a real issue with miscarriage, pregnancy loss, and infertility. It seems as if this virus or the vaccine increases natural killer cells in the uterus.

Say you’re going along, your estrogen’s beautifully rising, it’s growing the endometrial lining really nice. You ovulate, the progesterone comes in to keep that lining stable, and then boom, all of a sudden you get bombarded with these natural killer cells, it just disrupts that entire lining and then you shed it earlier and you have all this inflammation going on.

Ari: Would you categorize that in the realm of autoimmune reactions?

Dr. Barber: I would not. That’s a natural immune response that happens for everybody. We’re not so far seeing any antibodies against our own uterus, but that’s a great question because we have identified them in the ovaries. We now are seeing an autoimmune component with infertility in the ovaries. I don’t think that we realize how much our-

Ari: Is that with COVID or the vaccine or both?

Dr. Barber: That was before that. That discovery has been going on a long time. I don’t know if they want to know that about COVID and the vaccine.

Ari: I’m sure they don’t.

Dr. Barber: You know what I mean?

Ari: [chuckles] I’m sure they don’t.

Dr. Barber: I think that kind of research is going to be suppressed.

Ari: Of course. Yes.

Dr. Barber: Because the American College of OB/GYNs does not acknowledge any cycle issues with the vaccine especially, because they very much promote the vaccine. That’s my governing body as a gynecologist. I have to pay them dues every year and I have to go by their guidelines and their standard of care as a practicing gynecologist, yet they are very much supported by drug companies and things like that, so we probably won’t see that kind of information come out.

Ari: Yes. There’s hundreds of billions of dollars that depend on that information not coming out, so I’m sure that that will help ensure that.

Dr. Barber: Here’s the good new, it is reversible. I do see women’s cycles get back on track, their inflammation calms down if they’re doing the right stuff. Don’t freak out and be like, “Man, I’m ruined because I got the vaccines,” or whatever. It does seem to be short-lived.

Bioidentical hormones are they good or bad?

Ari: Awesome. That’s good news. The last question is bioidentical hormones. I’ve had a number of women’s hormone experts on the show from Stephanie Estima, who you mentioned, who’s a good friend of mine, to Mariza Snyder, Magdalena Wszelaki, who specializes in the nutrition side of things, to Christiane Northrup, and then more conventional gynecologist, Dr. Mache Seibel I don’t know if you know him.

Dr. Barber: I don’t.

Ari: He’s a OG of the field. He’s been around forever. He’s the lone male among all the women’s– Oh, actually, no, I have Dr. Shawn Tassone, who’s also a gynecologist, who’s been on a couple times as well. He’s the other male who specializes in women’s hormones. I’ve had a range of opinions on hormonal replacement and bioidentical hormones and those kinds of things. What is the context where you would see the use of hormone replacements as being appropriate or not appropriate? What’s your take on that whole thing?

Dr. Barber: Oh, that’s a great question. I love the guests that you listed off, I’ve probably had half of them on my podcast, and I love that we can have discussions and agree to disagree on different things. I feel like I have a unique perspective as coming from conventional gynecology and going through that training, practicing like that, and then going into the functional medicine space. I can see both sides.

I went through training right when the WHI came out. The Women’s Health Initiative was this big study done on a gazillion nurses, and in 2002, they revealed the beginnings of their findings and the media went insane. Everybody panicked, everybody got taken off their hormones literally overnight. Women were miserable, threatening their doctors, their doctors were scared to death because they thought they were causing breast cancer and stroke and all of these things.

Ari: What a mess.

Dr. Barber: It has literally taken almost 20 years for conventional gynecology to actually sit down and evaluate that study and acknowledge its major faults and the truth behind it. Here’s the truth. The average-aged woman in that study was 64. They were 10 to 15 years into menopause. They had already started having heart disease, diabetes, and obesity, and all of the issues that we know predispose to blood clots, stroke, and breast cancer.

They were given synthetic hormones, which we now can all acknowledge does not function the same way in our bodies as physiologic bioidentical hormones. That was not acknowledged 20 years ago. They kept saying, the progesterone arm of the study, it was not progesterone, it was progestin, a synthetic hormone which acts very different in your body. We made all these rash decisions and we ruined women’s quality of life when they had been on hormone replacement. I don’t know, in the 1920s or 1930s is when we first started using it.

All of a sudden, you see all these miserable women trying to suffer in menopause and we didn’t acknowledge anything. Then we get this backswing come out of, “Bioidenticals are amazing. Let’s do that,” and you get practitioners trying to put women on doses that are reproductive level doses, trying to get them back into cycling and being 40 years old or 35 years old again, and we finally realize, “That doesn’t help women either.”

We’re at a point, the pendulum keeps swinging, where we realize, “Let’s try and maybe put women in the 48, 49-year-old level of hormones and suspend that time period and slow down the aging process,” because what we’ve learned is estrogen is actually very beneficial to the rest of our body, we have receptors everywhere. As soon as our estrogen levels are consistently low, the heart disease goes up, diabetes, dementia, the bone loss, and then the physical stuff that nobody wants to see. We lose collagen and fullness in our face, or skin gets thin like tissue paper, our vagina dries up, all that bad stuff.

I don’t have a strong opinion either way. I think women should be informed and have the ability to make a decision, “I want to go into menopause naturally and support my body and all my other systems so that, it’s tolerable,” or, “Heck no, I’m going to slow down the aging process and do whatever it takes to stay where I’m at and feel amazing and keep doing what I’m doing,” because women are at the prime of their life at this age. If you look back in the year 1900, the average age lifespan was 49, so women died.

We didn’t have to live half of our life in a menopausal estrogen-deficient state. Men would never put up with that or tolerate that, they’d be like, “Give me my hormones. I’m trying to run companies. I’m trying to run marathons, I’m busy.”

Ari: Oh, when you said men would never put up with that, I interpreted what you said in a different way. I thought you were saying men would never put up with women in a bitter menopausal state for decades.

Dr. Barber: Oh, that too.

Ari: Then I was going to ask, is that why women’s lifespan was only till age 40?


Dr. Barber: Oh, yes, you just whack them over the head when you are done with them. I don’t know. [crosstalk]

Ari: “I just can’t tolerate this any longer, sorry, Susan.”

Dr. Barber: Well, I actually do hear that, women are like, “I can’t even tolerate myself. I hate myself,” because it doesn’t feel good to not have hormones in your body, hormones are your messengers. I’m all for supporting natural menopause if that’s what you want to do. If you have a slow, chilled, beautiful life where you can do yoga and cook your food and you aren’t majorly stressed and trying to work 12, 14 hour days, or go to CrossFit, you probably can go into menopause and have a beautiful life.

If you’re a high-powered woman trying to do all this stuff, you probably won’t make it without your hormones. It should be an individualized decision. I agree with Dr. Mariza, I agree with Dr. Tassone, I agree with all of them because they’re all right. It depends on the individual and that’s where we forget that.

Ari: Dr. Tabatha, I’ve really enjoyed this really good stuff. Thank you for the work you’re doing. Thank you for coming on the show and sharing your wisdom with my audience. Are there any final ideas or concepts or strategies you want to leave people with before we say goodbye?

Dr. Barber: Oh, on the note of menopause, going into menopause naturally, I do have a free eBook if people want to check it out. It’s how to balance your hormones naturally so that you don’t have to take hormones. I think everybody should do that foundational work. If you go on my website,, it’s on there. It’s a free little book. You can download it and start working on all of the stuff that you and I talked about today.

Ari: Beautiful. Thank you so much for coming on the show. Really enjoyed this. Where can people find you if they want to learn more about your work or get in contact with you to work with you?

Dr. Barber: If you want to work one-on-one, go to, it’s three As no Is, Dr. Tabatha, or you can follow me on Instagram and Tiktok at The Gutsy Gynaecologist or you can listen to The Gipsy Gynaecologist Show and listen to Ari’s episode because it was awesome.

Ari: Thank you so much, my friend. I really enjoyed this.

Show Notes

Dr. Barber’s story (01:37)
How conventional gynecology is harmful to women (04:13)
How a functional medicine gynecologists approaches hormonal issues (09:15)
The root causes that drive hormone imbalance (11:26)
The biggest factors that disturb women’s gut microbiome (17:29)
Can overexercising cause gut issues? (20:00)
The impact of alcohol on gut health (23:23)
The impact of lifestyle on gut health(28:13)
The best diet for women (31:07)
Is gut microbiome testing a valuable tool? (35:20)
COVID and hormone imbalance (39:20)
Bioidentical hormones are they good or bad? (43:38)


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