#81 Menstruation & Menopause with Clare Pyers

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Tahnee is thrilled to be speaking with the wonderful Clare Pyers on the Women's Series today. Clare is an integrative medical practitioner who specialises in women's health, particularly in the areas of reproductive health and complex health conditions. Clare has a broad educational background including Chemical Engineering, Chinese Medicine, Integrative Medicine and Yoga. Clare is a leader in the industry of Chinese Medicine, having written the first comprehensive textbook that shows practitioners how to translate between the paradigms of Conventional, Functional and Chinese Medicine. A true renaissance woman, Clare also hosts Qiological, a podcast specifically crafted for Chinese Medicine practitioners. Clare joins Tahnee today, to bridge the gap between the East vs West approach to women's health, sharing her insights in a manner that is highly informative and easy to understand. Clare's clinical work is practical and thoroughly grounded in a holistic approach. Clare's methods allow women to feel safe, held and completely nourished on their journey to harmonious health.

Tahnee and Clare explore:

  • How Traditional Chinese Medicine (TCM) views hormones, and the East vs West approach to addressing hormonal issues.
  • The natural ebs and flows of the female reproductive cycle and the importance of the 'Chong Mai' vessel in TCM.
  • The significance of the transitions between the body's phases of Yin and Yang, and how a disturbance in the body's natural course of Qi interferes with establishing menstrual harmony.
  • The masculine nature of Western society, and how operating a system that is dominated by this energy impairs female reproductive health.
  • The Heart as the female palace of glory, and the Daoist system views this important organ.
  • The misdiagnoses and misuse of herbs in polycystic ovarian syndrome (PCOS).
  • Reproductive capability as a reflection of overall health, the idea that an organism cannot create new life in an environment (the body) where life is deficient.
  • The Liver's role in female reproductive health.
  • The difference between deficiency and excess.
  • How TCM views menopause.
  • The connection between the thyroid, iodine and salt.
  • Hashimoto's and Graves Disease.

Who is Clare Pyers ?

Clare is known for her expertise in the area of women’s health, specifically with women who have complex health problems. Clare has worked in the health industry since 2001in both mainstream and natural medicine settings. Clare has a broad educational background including Chemical Engineering, Chinese Medicine, Integrative Medicine and Yoga.

Clare hosts a podcast for Chinese Medicine practitioners, exploring a range of topics that are relevant for colleagues in her field. Clare is a leader in the industry of Chinese Medicine, having written the first comprehensive textbook that teaches practitioners how to translate between the paradigms of Conventional, Functional and Chinese Medicine. Clare is considered an expert in being able to explain the way these 3 different ways of understanding health and illness overlap with one another.

Resources:Clare's Website Clare's Facebook Clare's Instagram Heavenly Qi Podcast

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Check Out The Transcript Here:

Tahnee: (00:04)

Hi everybody and welcome to the SuperFeast podcast. Today I'm here with Clare Pyers, who I'm a massive fan of, so very excited to have you here today Clare. Clare is known for her expertise in the area of women's health, and especially with complex health stuff, as well as fertility. She has an amazing podcast called the Heavenly Qi podcast, which is a little bit technical, but even if you are new to Chinese medicine, it's a really great listen, and I've learned so much from it myself over the years. And Clare's been working in the health industry since 2001, so she's done all sorts of things from chemical engineering Clare, all the way through Chinese medicine, integrative medicine, yoga.

Tahnee: (00:46)

And she's just this incredible leader in Chinese medicine in terms of really bridging these worlds of functional and conventional, and Chinese medicine. So she's got this amazing book which I have here, The Integrative TCM Guide to Pathology, which if you work in the health space I'd highly recommend you get a copy of. It's a bit of a bible around the SuperFeast office. And, yeah I love how she articulates things and how she teaches so I'm really excited to have her here today. So thanks for joining us Clare.

Clare Pyers: (01:16)

Thank you so much for having me, and what a fabulous introduction. I'm very honoured to be here with you today, and I'm looking forward to our chat.

Tahnee: (01:24)

Yeah, same. So we've had a few requests from our audience around, kind of bridging the divide I suppose, between the Western idea of hormones, and the TCM ideas of patterns and Yin and Yang and Qi, and how all these things work. So, I know you've worked a lot with women's health and fertility, so I imagine this is something you're dealing with all the time. Are you able to kind of, I guess give us a sense of how hormones fit into the scope of Chinese Medicine practise? Because they didn't identify hormones per se in the ancient texts but, we can see the effects of their actions, right? Would that be an accurate way to describe it?

Clare Pyers: (02:03)

Yeah. And so, Chinese Medicine was created thousands of years ago, and the concept of hormones really is a, it's a Western science, reductionist, I guess understanding and description of the flows, the ebbs and flows of the body, which is essentially what hormones are. It's a complex interconnected series of systems in the body, that really regulate the ebb and flow of our daily life, and our weekly and monthly life, all of the cyclical things that happen in our body. And so, Chinese medicine came about through a lot of observation, a lot of trial and error, what works, what doesn't work. And obviously, the most obvious place to start when we're talking about hormones is female hormones, and in particular women's reproductive hormones. Because there is a very obvious way to track the cycle with a woman's menstrual cycle.

Clare Pyers: (03:10)

And so, from a Chinese medicine point of view, we talk about, there's a concept of this, the Chong Mai, this very, very deep internal reservoir of Qi and Blood deep within us. And throughout the month it fills up with Qi and Blood, and it reaches a point where it overflows, and that is how a woman menstruates. It's where menstrual Blood comes from, this idea of the overflowing of this Chong Mai vessel, kind of like this, I forget the, you'll probably remind me what the English name of it is, but it's like this very deep-

Tahnee: (03:55)

Is it the conception vessel?

Clare Pyers: (03:56)

No, no, no.

Tahnee: (03:58)

Yeah I actually don't know. I always call it the Chong Mai too. It's the one that ends between the breasts, right? Or is that where ...

Clare Pyers: (04:05)

Yeah. And it's very deep. I think it's called the, no, I can't even remember. I won't even try. It'll come to me later. But the Chong Mai is the place where women's menstrual cycle comes from. And obviously we see the natural ebbs and flows of the hormonal pattern in a woman, and it should arrive on time every month. And so from a Chinese medicine point of view, we see any disturbances, any deviations from that kind of, that optimal hormonal picture as indications of where a woman's disharmony is. So, if a period arrives early, if it arrives late, if there's pain, if there's emotional symptoms, if there's any other symptoms that are going on, then that helps to give us clues as to which particular parts of her body, and which particular ways her you know, she's lost her harmony within herself and how we can then use that information to help get it back, get things back on track.

Tahnee: (05:13)

I think it's the ... Is it the penetrating vessel?

Clare Pyers: (05:16)

The penetrating vessel, yes.

Tahnee: (05:19)

Is it sea of Blood? Is that the ...

Clare Pyers: (05:20)

The sea of Qi and Blood, yeah.

Tahnee: (05:21)

Qi and Blood, okay. Because I know it from like the esoteric stuff that I've learned, like our ... So one of the things we do is breast massage, which can disperse that Qi and Blood through the body and actually prevent menstruation. But in a healthy, non Daoist person. Really what ... The energy rises and then it drops. Is that the kind of Yin Yang function, is the peak of that, like the Yang and then the Yin is that descent down to the uterus? Is that kind of how we would look at that from a Yin Yang perspective? Or, am I losing the plot completely there or?

Clare Pyers: (05:56)

Well, yeah, so we talk about, so the two phases of a woman's menstrual cycle. So, before ovulation, the follicular phase, or the proliferative phase, which is, starts with menstruation, and then once menstruation finishes, then the lining starts to build up again, and the ovary is developing the egg ready for release. So, that part of the phase is governed primarily by Yin, and so Yin is that very, I guess your listeners are very familiar with the concept of Yin and Yang, but Yin is the female aspect, that quietness, solitude, going within introspection. And then there's a big surge of Yang. So there's ... Yin never stays as Yin and Yang never stays as Yang, they're always constantly engendering one another and flowing between one another.

Clare Pyers: (06:48)

And so, once we reach a certain point, there's enough strength within the Yin to allow the Yang to rise up, and that's what sparks of ovulation to happen. And then the second part of the cycle is governed by Yang. And so we have the Yang part of the menstrual cycle, which is the luteal phase. So after ovulation, there should be an abundance of Yang in a woman's body, and then once the Yang has kind of done its thing, then the Yin starts to come back in again. And that drop of Yang back into that Yin zone, is what sparks menstruation. So we kind of have those two phases of the cycle, and that flow of Yin and Yang. And so, when, I guess there's lots of listeners who, women who are listening and even men who are listening, who have women in their lives, and familiar with the idea of painful periods or PMS, I guess are the two most common menstrual problems that people are aware of.

Clare Pyers: (07:55)

And that's, in a very broad sense, is a problem demonstrating a problem of that transition from Yin to Yang, and that transition back from Yang to Yin. If there's a problem with that transition, then that's where we see problems with PMS and period pain and things like that.

Tahnee: (08:14)

And so I mean, a lot of people will write to us and say, "Oh, I have low progesterone," which is a Yang, am I correct? Is a Yang hormone.

Clare Pyers: (08:22)

Yeah.

Tahnee: (08:23)

And sort of governs that Yang phase of the cycle. And so then, I guess one thing I'm often trying to ... I mean, this is something I've really been working on in my own head is like, coming out of that linear Western model of cause and effect, and there's a symptom and fix it. And I feel like I've been, for a long time still trying to untrain my brain from thinking that way. But, it's kind of like you're looking at relationships in Chinese Medicine, right? You're not just looking at the progesterone flow, that's the problem, you're looking at what really like, how is that relating to the kind of, I guess the harmony in the body. Is that a ... I'm not sure I'm phrasing this question particularly well.

Tahnee: (09:02)

But, for me I think when I started to look at functional medicine, when they were saying, "Okay well it's really the relationship of the levels of the hormones, it's not just one hormone." That made a lot more sense to me than the more kind of conventional model which is, low progesterone, take Vitex, you'll be fine. That doesn't really land for me anymore.

Clare Pyers: (09:22)

Yeah. And it's way more complicated than that, you're right. And from Chinese Medicine, we go deeper. So we say, "Okay, great, you've got low progesterone and that corresponds with Yang and so you have not enough Yang." But then we go further and we say, "Okay, well, why isn't there enough Yang? What's going on? Which part of that process of the body naturally creating enough Yang to support, to support life essentially," that's what progesterone is for, pro-gestation, is to support a baby. And so which part of this woman's physiology is having trouble in being able to create this? And so, as a practitioner I'll often be looking for signs of Yin deficiency, or Blood deficiency, and that can stem from poor digestion, it can stem from an inappropriate diet for that person's constitution.

Clare Pyers: (10:22)

It can stem from excessive stress, not getting enough rest, too much exercise. All of those kinds of things is kind of where we come from, from a Chinese Medicine point of view. And I really like that you made, you made a really good point that it's not just purely about the actual hormone levels, it's about the relative levels of hormones to each other. So, a person can have low progesterone and low oestrogen, and they might present as being both Yin and Yang deficient, or maybe just Blood deficient. Or a person can have a good level of progesterone but not enough oestrogen, or vice versa. They can have good levels of oestrogen, low progesterone, and that can you know, any imbalance between the two can cause problems in and of themselves.

Clare Pyers: (11:12)

And so, you've got to look at that relative harmony between the hormones themselves, as well as the actual levels to be able to determine what the best course of action is. And of course in Chinese Medicine, we're blessed with, a whole framework of the Chinese medicine diagnosis and so, I think it creates a lot more richness in our approach to being able to treat women really effectively, and especially with the difficult cases.

Tahnee: (11:44)

Yeah. Well for me, I had amenorrhea after coming off the pill for a long time two years something. And when I started to learn more about Blood deficiency, like the Spleen and Liver and that relationship with the Kidney, then it sort of all started to go, oh, okay, well that ... Now I'm understanding that I'm eating this diet that's really cold, that isn't appropriate for me. My Kidneys are struggling already because I'm stressed out, and they're not able to pilot like my Spleen, and my Spleen's kind of just like, not doing anything, having a tough time. And I'm getting all these symptoms of bloating and I'm not making any Blood and so I'm not bleeding and, it was not that difficult related to just starting some meat, stop eating as much sugar, and really make a few simple changes that for my body were really effective.

Tahnee: (12:28)

And I'm not saying this works for everybody, but that was my specific pattern, I guess. But that was a lot easier for me to understand even then going, like I'd been to all these Western doctors who were doing all these tests and blood tests, and it just was confusing me because, I was kind of healthy but I wasn't. I wasn't having my monthly report card and all those things. So it was, yeah, it's an interesting ... I think the storytelling and the imagining of the organs and their roles, is a really powerful way to engage with the body and to really come into sort of a place of relationship with the body, which then I think builds to help anyway, because you're trusting and understanding the body more. That's my opinion on that one.

Clare Pyers: (13:09)

Yeah I think you're definitely right on that. One of the common things that I see, in terms of that relationship with yourself is that, women, particularly in today's day and age, although we have been afforded somewhat of a break from that with our Corona virus interlude. But, women are really in a male dominated world and we're encouraged to, you know for many women you're working five days a week, plus the extra responsibility perhaps of children or other things that you've taken on board. And, it requires a lot of masculine energy to be able to run a life in such a full on way. Being at 80 to 90% capacity all the time, really takes a toll, and it's not the way that our female hormones are designed to work at their best.

Clare Pyers: (14:04)

We really ... One of the ways that I encourage my patients to reflect on this idea is, to really embrace the idea of, what would lady Tahnee do? How would lady Tahnee do this? Like, if you were Royal, and the old school idea of royalty. Because I think modern day royalty have very full calendars and a lot of responsibility, a lot of pressure.

Tahnee: (14:30)

Meghan Markle or something.

Clare Pyers: (14:32)

Yeah, yeah, yeah, exactly. But if you were a queen or a princess, and you just had to sit on your throne, and you could just kind of sip on tea and take long walks around your garden. You wouldn't be power walking around your garden and sculling your tea, and racing around. You'd be living a leisurely, peaceful, spacious existence. And even within the confines of a busy schedule and lots of responsibility, it's still possible to just connect with that idea of creating space, especially in the Heart. So from a Chinese Medicine point of view, and even when you look into female specific, Qigong, it's all centred around the Heart. So the Dantian is for men. Women very easily can get their Qi, their focus, their mind, their attention to their Dantian. But for women, our palace of glory from the Daoist point of view, is in our Heart, it's in the chest.

Clare Pyers: (15:43)

And that's where we get a lot of a lot of binding, a lot of oppression, a lot of stuck energy. And if we can work out a way to experience the sense of spaciousness and release in this area, then it does a lot of benefit for our whole entire hormonal system, not just reproductive, but also thyroid and our digestion. So, pancreas and the other aspects of the hormonal system too.

Tahnee: (16:11)

So we always call the pancreas, the 'spancreas'. Because it's kind of in the Chinese systems of the Spleen's body really. And I mean, I don't know if you know of Dan Ken's work, but he's actually arguing that the pancreas is a part of the spleen organ, like he's done some membrological work that would suggest that that could be true. But so when we're talking about that organ function, and that ability to sort of assist in regulating hormones, and I feel like Western Medicine is starting to get to this idea of like, the entire system, which was around a while ago, and then they kind of lost it and now it's back. But really like Chinese Medicine we're talking about the Heart as the emperor and as the brain, but then we've also got all these kind of sub brains, I suppose, that have responsibilities and roles to fulfil.

Tahnee: (16:59)

And this Spleen, is obviously to kind of transform what we eat into this Qi that we need and also into Blood. And this is especially relevant for women, right? Because women are governed by Blood, so to speak. So, how does ... When we look at diet and we look at menstruation, and we look at women's hormones, and even things like insulin and the pancreas, and this kind of production or ... Because you know, I know a lot of women have issues with blood sugar and stuff as well. Is there stuff you see in clinical a lot, or what is sort of the common themes you see around the spleen and Blood and how that relates to women's health?

Clare Pyers: (17:36)

Great question. And I'll bring it back to the example that you gave before with your own health and your own situation. So, it's quite common for me to see women who have amenorrhea,, and that could just be, they came off of the pill and their period never came back. Or there could have been a specific period of time that they noticed that they stopped having their period. And this idea of, everyone's going getting scans and getting tested, which is a great idea. But then, what's happening is that a lot of women are being diagnosed with polycystic ovaries.

Tahnee: (18:11)

Misdiagnosed, you're right.

Clare Pyers: (18:13)

And this ... Yeah. And this idea of amenorrhea in a woman who's not the typical, the classic old school diagnosis of polycystic ovarian syndrome, which is linked in with high testosterone, insulin resistance, excess weight around the tummy, maybe some facial hair, and that classic idea of insulin resistance. But then we've kind of transposed that onto this other set of women who are not overweight at all, in fact, a lot of them are underweight and they're not having periods, and maybe their hair is dropping. Maybe they've got some dry skin, yeah thinning hair. But we see these cysts on an ultrasound and we think, oh, that woman has polycystic ovaries so we treat it with insulin sensitising medication and, we just transfer it all across from this very different clinical picture to ... From one end of the extreme to the other.

Clare Pyers: (19:22)

And these women instead of needing less insulin and less nourishment in their diet, they actually need more. And for some of these women, increasing their carb intake is what they need. A lot of the Blood tonic herbs and medicines that we use in Chinese Medicine are, they're fruits and they're very sweet. And a Blood tonic herbal formula is actually really quite yummy most of the time. Well, if you're into herbal medicine, I'm into herbal medicine. But you know, they're really yummy.

Tahnee: (19:55)

Herbal medicine that's yummy.

Clare Pyers: (19:56)

Yeah, we're not putting bitter-

Tahnee: (20:00)

Yeah, pungent like [inaudible 00:20:01].

Clare Pyers: (20:02)

Yeah, exactly. They're really nice tasting herbs. And so, I think that's a real trap of, when we're looking at digestion, that it's really easy to think a one size fits all diet approach, is what we need. We need to still be looking at, well what specifically is going on for this woman? And whether we're looking at it from a Chinese Medicine point of view, or from a Western medicine point of view, we need to be using that information, and assessing it for its merit, rather than having these preconceived ideas that, oh, I've got PCOS, I'm going to take Vitex. It's not going to work for a woman who's Blood deficient, it's not going to work if you're giving it to someone who is depleted because it has a very dispersing action.

Clare Pyers: (20:50)

And people who are depleted need to be nourished. So from the idea of the Spleen, and Blood, and how we make Blood, and what our diet should look like, we need to be taking into account the entire picture of what's going on for a woman. So, if a woman is carrying extra weight, and has those kind of, the old school classic PCOS type of symptoms going on, you know drop down sugar intake-

Tahnee: (21:23)

Yeah that's more your paleo style kind of.

Clare Pyers: (21:25)

Yeah, yeah, go paleo. But if you need more Blood nourishing, then it needs to be a different approach. The Spleen is in charge of, of the sweet flavour and distributing the sweet flavour kind of goes to the Spleen. And we can also, as well as getting too much sweet food, which is, I guess the typical Western diet, is-

Tahnee: (21:54)

Or the idiot that was eating like a packet of dates a day.

Clare Pyers: (21:58)

Yes. Yeah, yeah.

Tahnee: (22:00)

Healthy food.

Clare Pyers: (22:01)

Yeah. But you know dates are a great Blood tonic and so part-

Tahnee: (22:04)

In moderation though right.

Clare Pyers: (22:07)

Oh yeah. You've got to also eat protein.

Tahnee: (22:11)

Well, that's the thing I think people intuitively like, they crave sugar, it's like your body needs that. It's just it needs it in a form that it's absorbable and usable, and it's not just what we eat, but it's how we absorb it and transform it, right? Our chemical kind of magic of the Spleen, I think is one of the things that for me has really healed my relationship with food. It's like, I don't know, just coming to this like, like this little guy makes my body thrive. So I want to feed it well and nourish it.

Clare Pyers: (22:41)

Yeah. And we need that good combo of protein and carbs, you can't just sit down with a packet of dates and hope for the best. There actually needs to be the building blocks of life, which is protein. And if we're not getting it from our diet then, your body starts to get it from wherever it can, which is your muscles and your internal organs, and the different tissues and fascia in your body. It doesn't leave your body in a position to be able to thrive. And really reproductive hormones and getting hormonal balance is all about being able to support life. For a woman it's about being able to bring another person into existence, which takes a lot of energy, and this is stuff that happened ... This is the leftover.

Clare Pyers: (23:27)

We've got to run our Heart, we've got to run our Lungs, our brain, our digestive system, and really the hormonal system thrives when all of the rest is kind of taken care of. And so, when we're talking about optimising hormones, we really got to get a person's entire body into harmony, in order for the endocrine system to really be able to thrive. And so I guess that's where some of the complexity comes because, sometimes people are like, "I just want to fix my hormones. My digestion's screwed-"

Tahnee: (23:57)

Not my life.

Clare Pyers: (24:00)

Yeah like, "I don't want to change my life."

Tahnee: (24:03)

I love working 60 hours a week, and running triathlons and not eating and it's like, cool.

Clare Pyers: (24:07)

Yeah. So, we need to be realistic about what can be achieved by just kind of only focusing on one part. Sometimes we just have to come back to an understanding of what is actually going on in the body, and what's the purpose of our hormones.

Tahnee: (24:26)

Yeah because I always think of sex hormones and, this is probably something we've talked about on the podcast before but, my partner and I talk about this all the time as it's, the sort of, you're only going to reproduce if you're thriving, that's sort of an evolutionary bias. And I mean obviously there's exceptions but, in general, that things have to be pretty harmonious for those things to be optimised so that, you know and the body feels safe to actually reproduce and that sort of makes a lot of sense to me from an evolutionary perspective. Like why would an undernourished girl menstruate if she's not going to have the Blood and the Qi to hold the child through?

Tahnee: (25:04)

So it's sort of like a natural and intelligent design of the body. So when I started to think like that it made me realise, well, yeah, it's my job to nourish and support, and to really create the conditions where the balance, just occurs, almost on its own, and obviously there's lots of great medicines we can work with to get there faster. But, you do have to take some responsibility, I think at some point, and yeah change the flow. But yeah. And I mean, so that kind of brings me to the Liver I guess, I was just thinking because, that go, go, go kind of energy is really that strong Liver energy, like that expression and using your will to really get shit done.

Tahnee: (25:50)

Which again is a very masculine energy, and also very prominent in our culture. And so many times when we look at hormonal issues, we are looking at issues with Blood stagnation and all, like you're saying, Yin deficiency or Yang deficiency, which can be Liver Yin and Yang deficiency, right? So, can you explain a little bit of how the Liver functions in terms of hormones and western and Chinese medicine if you like? But, a lot of people might know, but it'd just, yeah be good to get your take on that as well.

Clare Pyers: (26:18)

Yeah, yeah. So the Liver really is in charge of, I guess, processing a lot of the hormone in the body. And so, if we're making a lot of oestrogen, if we're exposed to a lot of xenoestrogen, so this is from chemicals in your environment, chemicals that we choose-

Tahnee: (26:41)

To put on ourselves.

Clare Pyers: (26:43)

Yeah that we choose to put on ourselves that ingest, and exposure to things like plastics and things like that. A lot of those have an estrogenic effect on the body and, it just creates extra burden for the Liver. So our Livers are very, very busy in a modern day life, and that there's a lot of burden that's put onto the Liver. And so we need to pay close attention to the Liver from a western point of view and from a Chinese medicine point of view. And in addition to that, from a Chinese medicine point of view, it's not just the physiological aspects of what the Liver does, it's also those emotional and spiritual aspects.

Clare Pyers: (27:21)

And part of that emotional, spiritual wellbeing of the Liver is, having that freedom of expression, especially around frustration and anger, and resentment. And things are definitely better now than what they were 20, 30 years ago, but women still, from a cultural and society point of view, are still not celebrated for speaking their truth and for being able to vent their frustrations. And this repressed anger, and repressed resentment, and smiling and nodding, instead of saying what you actually feel, and what is actually true for you-

Tahnee: (28:04)

Or crying instead of being angry, like that was when I had to really work on.

Clare Pyers: (28:09)

Yeah. That has it, it takes a real toll and it does manifest in in hormones for a lot of women. And so that's something that, I guess for the listeners, I really invite you to think about the ways in which you feel comfortable to express your anger and your frustration. A lot of women don't have the words for it, we have a lot of shame around this idea of being aggressive. We don't have this picture of, what does assertiveness look like in a woman? What does it feel like to be assertive? How can I be assertive without wanting to label myself as a bitch? And so I'm sorry if I'm not allowed to say that-

Tahnee: (28:50)

No I was actually thinking it but I didn't want to interrupt you. Because it's like, yeah it's very true, a lot of women are afraid.

Clare Pyers: (28:56)

Yeah. Yeah we're afraid of being called a bitch or aggressive. And, there's actually plenty of times where, it can be a very feminine thing to be assertive. Women often have their first experience of being assertive when they have young children. And you're trying to get out the door and you can become very assistive, and very effective in your communication when you're talking to a three year old, and you're trying to get them to put on their shoes, put your jacket on, we're getting out the door. That's a very assertive way of saying it. And when we get into mum mode, we can really embrace that. But for some women they're not at that particular stage of life, or they're choosing not to have that as part of their life. And so, there's other training grounds, I guess, but you need to create them a bit more for yourself.

Clare Pyers: (29:47)

So the Liver is absolutely very important and, as we talked about before with the Spleen, there's times when the Liver is in excess and we need to do kind of more dispersing stuff, and that's where things like, milk thistle and things like that come into play. But then there's also a time in the Liver is weaker and needs to be nourished and supported. And that's where things like goji and schizandra can come in. And so we need to be mindful from a Western and a Chinese Medicine point of view, okay, well there's a problem with the Liver, what in particular is going on with the Liver, and how can we be targeted and specific? Rather than just going, everyone with Liver stuff gets milk thistle. Because it's highly inappropriate for so many people and the same with goji and schizandra and things like that.

Clare Pyers: (30:37)

And so I think it's, we're clever people, we can apply this discernment in our thinking, when we're looking at the ways in which we treat our patients, if you're a practitioner, or the way that you can choose which types of herbs that you would like to take.

Tahnee: (30:57)

You're working with.

Clare Pyers: (30:58)

Yeah.

Tahnee: (30:58)

So I mean, I didn't ask you to explain excess and deficiency before, but I wouldn't mind if you would just kind of touch on that idea for people. Because, yeah I just sometimes feel like these words maybe go over people's heads. So, you were talking about a Liver excess, or even just excess and deficiency in general, how would you be explaining that to the lay person coming into your clinic?

Clare Pyers: (31:23)

Yeah. Well, that's a good question.

Tahnee: (31:26)

Doozy for you. Sorry,

Clare Pyers: (31:27)

Excess and deficiency in general, how about I start with that? So, I guess I often use the analogy of a river. And so, there can be lots of reasons why a river might not be flowing. But ultimately we want to be in flow, we want everything in our body to feel harmonious. And, that would be represented with a nice healthy river, that flows really well. And if the river is not flowing properly, then we need to fix it. And that's usually why people come to see me. And other practitioners is that, their river is not flowing properly. And so the river can get stuck, and filled with branches, and rocks, and all kinds of crap, debris, that's stopping the river from flowing properly. And that would be what we call an excess type of problem.

Clare Pyers: (32:20)

So, there's extra stuff in the river that doesn't belong in that particular place, it belongs elsewhere in the world or elsewhere in the body, and so we need to support the body to be able to clear it out, send it back to where it belongs, so that the river can flow again once more. And those excess types of conditions, might manifest with things like, headaches and being really grumpy and, things that improve with exercise, things that improve with a nice cup of tea, things that, if we clear out some space, then you feel better.

Tahnee: (33:03)

You usually get better, yeah.

Clare Pyers: (33:03)

Yeah, yeah, generally speaking, it's difficult to describe in blanket terms.

Tahnee: (33:08)

Yeah. But would you also put like detoxification in that category as well?

Clare Pyers: (33:13)

Yeah, yeah. So a typical detox will be to get rid of excess. Then, we've got the other type of reason why a river might not be flowing, which is because there's not enough water in it. And so you just kind of get these patches of little puddles, but it's not really a properly flowing river and to be able to restore flow and harmony for that particular person, we need to fill them up. So we need to replenish them, refill the cup, and then their river will flow again once more. And so, things like nourishing diet, and having rest-

Tahnee: (33:47)

And tonic herbs and those kinds of things.

Clare Pyers: (33:49)

Tonic herbs and doing all the Yin things like in life is what will-

Tahnee: (33:54)

Resting.

Clare Pyers: (33:55)

I know, it's like a four letter word to some people, right? People like, "Tell me exactly, I'm just doing errands and I'm running around." I'm like, no, if you are not laying horizontal-

Tahnee: (34:06)

Lie down.

Clare Pyers: (34:08)

... You're either on your couch or you're in bed, if you're not doing either of those things, you're not resting. So I've learned over the years, I have to be very specific-

Tahnee: (34:18)

Black and white.

Clare Pyers: (34:18)

Yes.

Tahnee: (34:20)

R- E- S- T, yeah.

Clare Pyers: (34:28)

Exactly, exactly. So, for those people, detox is not appropriate for those people, and they need replenishing, and rest, restoration. And so, that's where tonic herbs come into play, and those people will tend to feel better after having a sleep or a rest. A headache that doesn't get fixed with painkillers or the usual type of approach, it's a headache that gets better when you eat something, or a headache that gets better after you've had a sleep. And so that would be the way that you would identify if you've got some symptoms that I guess are deficient type symptoms.

Tahnee: (35:07)

So, I think when we're talking about then hormones and looking at, I guess if we're looking at the women's menstrual cycle. So, if women are noticing at certain times that they're hitting, like say, I've spoken to a lot of people lately actually that are finding the luteal phase to be really long and kind of they're getting the PMS symptoms quite early and that sort of thing. So we'd be looking at someone who's Yang is deficient at that stage, is that kind of what-

Clare Pyers: (35:38)

Yeah, more than likely. So if there's problems in the luteal phase, then usually speaking, if a woman's got a 14 day luteal phase, that's really great because, often that time between ovulation and menstruation can be shortened in women who are deficient. But it can be either, it's not just a hard and fast rule that all luteal phase problems are deficiency. But, yeah I would be looking more towards, what makes it better. And if it's ... Or what makes it worse. If it's worse after you have a fight with your partner, or if it's worse after a stressful day at work, or it's worse after you've done a workout, then that's all going to give clues as to whether ... The types of things that's going to improve it as well.

Clare Pyers: (36:37)

But if there's problems all the way through the luteal phase, it's, I guess for me, the women that I see in my practise, usually they're really, they're just really depleted. It's almost like their body used up everything they had, to be able to get ovulation to happen, and then the body's like, okay, I'm done. I'm done. And a woman will experience that as you know like-

Tahnee: (37:00)

It's become the princess.

Clare Pyers: (37:01)

... Yeah. Like sore tender breasts for like two weeks, and bloating for two weeks, and feeling grumpy or teary and emotional for two weeks, that's tough going. It's really tough going and often for those women they just need to dial things back and nourish themselves more. For a small amount of women, it's a combination of both as well. So particularly with women, for example, who have endometriosis, they can have a lot of problems being able to ovulate in the first place, especially if they've got a lot of endo-

Tahnee: (37:37)

Like inflammation and stuff?

Clare Pyers: (37:38)

Yeah. If there's endo on the actual ovaries, it's like their ovaries can't kind of breathe properly. And those women can have a lot of problems of excess and deficiency, and that's a little bit more complicated, and usually requires a lot of diet change as well as stress management, as well as herbal medicines so.

Tahnee: (37:58)

I mean, I feel like people with endo need a practitioner just to really sort of guide them through and someone who's really sensitive. Like that's why TCM I think it's so great, because it looks at your unique pattern instead of, just kind of like oh endo is this, do this and do that. It's, obviously and that does not work so many times for people. You just got to go find someone who can really guide you through your healing journey, and help you understand what got you there. And then you've got the information not to get back to that place so. So when we're talking about menopause then, because this is one that we've been sort of, we're trying to do some podcasts on it actually, which we've got in the bank.

Tahnee: (38:39)

But, yeah I just feel like it's a really common thing that I hear from women that they have pretty rough menopauses, and I always come back to evolutionary ideas, I'm like, how is it evolutionary beneficial for a woman to have a shitty, shitty, shitty time during menopause? It just doesn't make sense. It's the same with PMS, I'm like, why would nature give us PMS? It just doesn't make sense to me. And then when you learn about the Dao, like no nature does not give you PMS, our western culture gives you PMS, our behaviour gives you PMS. So I mean the same sort of thing with menopause. It's like, it's this accumulation of a lifetime of stress, and not listening, and going hard and then bang, big change, and women just do not have a great time sliding through that.

Tahnee: (39:24)

So is that a kind of a ... Is there a moving into a more Yin phase and that's when we start to see like these things come up? Or is there a way you can describe that for us, that kind of embraces the TCM framework?

Clare Pyers: (39:35)

Yeah, yeah. So look, I mean going into menopause is, you know it's a very important transition for women. And there are women out there who, are the very non vocal minority, who transitioned very easily through menopause, they don't have any symptoms at all, and they really do keep their mouth shut because, their friends and their colleagues have such an awful time, and they don't want to rub it in. And yeah. So, it's absolutely normal to just stop having periods, at an appropriate age. So we're talking about a woman who's around the age of 50, we're not talking about women who go into menopause at 40 because, my very strong belief is that that is just misdiagnosed, that it's amenorrhea. Because a lot of those women will see their periods return if they come and seek treatment for something else.

Clare Pyers: (40:32)

So, if you have gone into menopause and you're not 50, then it's probably not menopause, it's probably just extended amenorrhea, regardless of what Blood tests say. A Blood test is just a snapshot in time.

Tahnee: (40:44)

In time, yeah.

Clare Pyers: (40:46)

Yeah. So I will preface it all by saYing that. And so I guess then we have to ask the question, what is the purpose of all of these symptoms? Why would nature come up with such a cruel set of symptoms? Insomnia and night sweats and, hot flushes during the day. And really we can trace things back quite a few years. It's not like a woman has perfect health leading up to menopause, and then all of a sudden starts experiencing these awful symptoms. Usually there's a very long lead up of some level of disharmony where the body has given out invitations along the way of, "Hey, I'm not happy, can we do something about this?" And it could be bloating, it could be period pain. Some women might have problems with fibroids, if we're talking about women's health in their 40s. And a lot of women at this age are kind of done with their families, and so they might just say, "Right, well, I'm just going to have an IUD put in. Because then I don't have to think about my contraception, and it's also going to sort out my heavy periods, and then I don't have to think about it anymore."

Clare Pyers: (41:58)

Except then you do have to think about it at some stage down the track because all of a sudden you get smacked in the face with these really full on symptoms. So, there's an opportunity for women who are in their late 30s and early 40s, to really connect with their body and to get a sense of, what is it that my body really wants here? Do I need to be working five days a week? Is there a way that I can work less? Is there a way I can do less and conserve my energy for the things that really matter? And so, taking care of your adrenals and your Kidney energy, taking care of your Blood, taking care of your Yin are all things that are going to support an easier transition for a woman, as she transitions into a really important phase of her life. There's also a lot of cultural stigma around women over the age of 50.

Clare Pyers: (42:53)

This idea of the wise old crone, we don't celebrate that. We dye our hair, we're 60 year old women who still have perfectly jet black hair, there's no framework within our society to celebrate the graceful ageing of women. It's slowly starting to change, but I think that as we embrace ageing, and as we celebrate wisdom in our older women, in our society, I think that that will also support an easier transition into menopause. But, it's the last big transition as a woman. We're born, that's like a massive thing that happens to us, we hit puberty, that's a massive thing that happens to us and there's lots of things that can go wrong or can go right. So we can correct a lot of things as in the transition to puberty, as well as things can go really wrong.

Clare Pyers: (43:51)

The same with pregnancy. So for a woman, pregnancy can correct a lot of things for a woman, but it can also be a time when a lot of things go really wrong and stay wrong. And menopause is also another time where, if we have a really great environment around that transition, it can be an opportunity for a lot of really great healing to occur. And so, I think as for me, myself, as I get closer towards that age, I'm only 41 at the moment, I'm still a few years off, but I think I'll start to put some more attention towards creating resources for my patients to-

Tahnee: (44:32)

And yourself.

Clare Pyers: (44:32)

Yeah and myself, to have a better transition through menopause.

Tahnee: (44:38)

Because I see a lot of thyroid stuff comes up as well, around that time. So can you explain a little bit about ... Because thyroid I feel like, I don't know, every time I mean I read something in functional medicine it's like, this new ideas about what's going on and how to test for it properly, and what you should really be doing and, so I'd love your take on what you see the thyroid's function is in the body and then, how that relates to transitions like menopause and, even because part of a lot of women have issues with the thyroid.

Clare Pyers: (45:08)

Yeah. So the thyroid it's really the metabolism centre of the brain, it's like the great control switch that is in charge of a lot of things, it helps to transport energy into our cells, it helps to keep us warm, it helps to ... I guess it also helps with the flow of reproductive hormones and other hormones in our body. So if there's a problem with the thyroid, you can end up with Blood sugar problems, you can end up with menstrual problems, as well as problems with your sleep wake cycle. So, it affects everything, everything's all connected, the endocrine system, it's really difficult to separate out one part from another, the thyroid is very important. And the thyroid needs salt and iodine, to be able to make thyroid hormone.

Clare Pyers: (46:02)

And so there ... Iodine is something that a lot of people don't get a lot of in their diet, and we're all told that salt is bad for us and so a lot of people are on this salt and iodine depleted diets, and wondering why their thyroid doesn't work so well. And so there are two things that are really easy to fix, really easy to fix is just have more salt and get some more iodine. And that can be a really supportive thing to do for your metabolism and for your hormonal health. And I guess from the point of view of the throat chakra, the thyroid is all about, being able to freely speak your truth. And so, coming back to what we touched on earlier, that's a really important thing for women in particular to get the hang of, is to, just to speak freely to allow that free flowing energy to happen through the thyroid and the throat area.

Clare Pyers: (46:59)

In terms of, what happens around menopause and that transition, I guess there's a lot of pressure that's going on in the endocrine system and big fluctuations of progesterone and oestrogen as they're finding their new normal, and the adrenal glands take over in this time. So the adrenal glands, they kind of tick away in the background and have been the whole time and they create low levels of background hormone for us when we're in menstruating years and our child bearing years. But then, once the ovaries kind of shut up shop, say, right I'm done, I'm out of here, I've hit retirement.

Tahnee: (47:40)

Vacay.

Clare Pyers: (47:41)

Yeah.

Tahnee: (47:42)

Bahamas.

Clare Pyers: (47:42)

and the adrenal glands are continuing to create these low levels of hormones and, there's this beautiful relationship between the adrenal glands and the thyroid where they kind of ... They work in partnership to run our metabolism and our energy production. And so this is where we come to see our true debt I guess, to our adrenals and how much we've borrowed on credit, to be able to live the life that we have. And so if our adrenals are suffering, then the thyroid kind of has to pick up its game and that's ... And if your thyroid has been unhappy also from years of not having enough iodine, not having enough salt and eating a low carb diet and not speaking your truth, then the whole thing just kind of goes kablamo.

Clare Pyers: (48:35)

And so that's where supporting the adrenals and just being judicious with the way that you spend your energy is really important to being able to maintain that thyroid health during the menopausal transition, just to make things a lot easier. And some women find that, a lot of women will develop thyroid issues around that time, and for a lot of women they end up on thyroid hormone replacement, and that can provide a lot of relief for women who are going through menopause. Who otherwise would end up on HRT or higher doses of HRT than they need to be on.

Tahnee: (49:16)

So just, I'm conscious of time but I just wanted to quickly touch on the autoimmune sort of side of that because, that seems to be incredibly common now, that Graves and Hashimoto’s, those, both sides. Do you have a sort of lens on that for your work on what's actually going on? Is it just what we've been talking about? Too much, not enough, kind of that's the either side of it or is there, a little bit more nuance to it than that or? Because it's something I feel like-

Clare Pyers: (49:48)

For a lot of people there's ... It comes back to the gut. And for a lot of people their gut is really not, it's not in good shape at all. And it's easy for people to collect these low grade, lingering infections as they go along through life. And it could be some type of gastro bag or Bali belly type of thing that someone gets and they never really quite felt the same afterwards. But for some people, there's not necessarily a particular event that they can pinpoint. But, an infection can find its way to the thyroid and can start attacking the thyroid. And it may not necessarily show up in Blood tests. So, there was a study I looked at, was very cool, was never reproduced and it was someone somewhere in Scandinavia.

Clare Pyers: (50:40)

And he basically did a biopsy of all of his patients' thyroids, if they had symptoms of low thyroid, regardless of what their Blood test said, he did a biopsy on all of them and found that all of them had antibodies, they had thyroid antibodies there, and he treated them with thyroid hormone and all of them got better. And this is regardless of what their Blood test said, he just went based on symptoms and I'm like, wow, that's really cool. But no one has done it since so it's kind of not reproduced and so therefore it doesn't have a lot of scientific significance. But it's a very cool idea. And it does demonstrate that there can be problems with your thyroid that are not going to show up on Blood tests.

Clare Pyers: (51:20)

So it is important to look at other metrics such as, your basal body temperature and how you maintain your body temperature through the day, and your heart rate as well. How does your heart rate change across the day? Does your heart rate improve or go down with eating? And what happens across the day. And there's a lot of very cool information from a guy called Ray Pete, who talks a lot on that.

Tahnee: (51:45)

He's the guy that does the orange juice and ice cream diet.

Clare Pyers: (51:48)

Orange juice and ice cream.

Tahnee: (51:50)

I was really into him for a while because I was like, this sounds amazing. It didn't work for me.

Clare Pyers: (51:55)

It sounds amazing. Yeah so there's, yeah so that idea of being able to, I guess support your thyroid in that way is very cool. But from what I see with my patients with Hashimoto's and Graves disease, a lot of them do have that low grade lingering infection, as part of what drives their antibody process. And so, more and more over the last few years I've been seeing a lot of success with my patients who have autoimmune thyroid disease and other autoimmune diseases, with addressing that, kind of that triad of, the autoimmune, whatever is happening with the actual organ, and then also the gut, and then also the immune system overall.

Clare Pyers: (52:38)

And as we know as practitioners, if you've got one autoimmune disease, you're more likely to get another, there's lots of links between things like, autoimmune thyroid disease and autoimmune infertility. There's lots of links between thyroids and endometriosis, there's lot of links between celiac as well as rheumatoid arthritis, and celiac and ... Yep, there's so many autoimmune diseases now that are classified. And so it's definitely a very exciting and emerging area of medicine, and for practitioners who can do a really good job in identifying and treating autoimmune conditions, they're the ones who are going to be seeing the greatest success with their patients in the years to come, because it's becoming a really important part of clinical practise.

Tahnee: (53:29)

Yeah. That's exciting that it's becoming more recognised too because I think even probably 10 years ago people were just suffering and didn't really ... It was just less clear what was going on but there's a lot more information out there now.

Clare Pyers: (53:42)

Yeah. And that's probably a whole other episode, is all on gut and-

Tahnee: (53:45)

Yeah if we can-

Clare Pyers: (53:45)

... Autoimmunity.

Tahnee: (53:47)

Yeah, immunity.

Clare Pyers: (53:48)

Yes. And we didn't even talk about men today either.

Tahnee: (53:52)

Well I was going to say it'd be great to get you back on to do a men's, I think they do deserve their own podcast, [inaudible 00:53:59] speaking.

Clare Pyers: (53:59)

They definitely do.

Tahnee: (54:01)

Yeah and exciting that you're working on a book, right? So we can maybe wait for that to be finished, and then we can, yeah, jump on about that. But yeah, just wanted to say thank you, I feel like that was just a really awesome snapshot for people to just sort of start to merge these two sides of, I guess broad views, I suppose, of like the Western and the Chinese. Because so many people we speak to see a GP, but then they'll also be interested in that oriental, I guess lens of health. And so, yeah I think it's a really useful place to start bridging that information.

Tahnee: (54:35)

So if you guys really enjoyed today, I would recommend Clare's podcast and her book. If you are a practitioner, I cannot tell you again, this is really good. And actually a lot of this stuff, how you've got all the descriptions of sort the Chinese patterns, that are associated with the different levels, I feel like that's just such a useful way to think about things and it's ... My partner and I always do our Bloods once a year and go through all this and see what's happening. But it's been really, right?

Clare Pyers: (55:03)

Yeah.

Tahnee: (55:03)

It's just a great, happy to have a book honestly for us, us nerds. But yeah, we've also got your website, so clarepyers.com, we will put your links and everything on our website but it's C- L- A- R- E P- Y- E- R- S.com. Do you do social media or anything else like that Clare? Do people find you on Facebook or?

Clare Pyers: (55:23)

I'm very shy on social media, I post occasionally. Please give me encouragement if you see me post anything on Instagram or Facebook.

Tahnee: (55:32)

You're a clut.

Clare Pyers: (55:33)

Yeah. Yeah I'm there occasion, I hang out, yeah.

Tahnee: (55:36)

Yeah, okay. And if people want to reach you, you have a clinic in Melbourne is that right?

Clare Pyers: (55:40)

Yeah. So my clinic's in Prahran, and I see patients from all around the world actually. I see patients locally as well as online.

Tahnee: (55:48)

Oh cool, via Zoom or something like that, yeah.

Clare Pyers: (55:51)

Via whatever works at the moment, whatever the internet dictates. So I've been doing a lot of FaceTime this week.

Tahnee: (55:58)

Oh yeah of course, yeah. Well and I guess everyone's internets are behaving weirdly in this time.

Clare Pyers: (56:03)

Yes, indeed.

Tahnee: (56:05)

Okay, great. Well yeah I hope if you need support you can reach out to Clare, or find someone similar who knows what Clare knows. I don't think there's anyone out there, but yeah. So thank you so much again for your time Clare, we really appreciate it and look forward to chatting to you again soon.

Clare Pyers: (56:20)

Thanks for having me on, it was great to be here and I look forward to coming back soon.

105 episodes