Known as “the girlfriend doctor”, Anna Cabeca is triple board certified in obstetrics and gynecology, integrative medicine, and anti-aging and regenerative medicine. With 30 years of experience helping women optimize hormones and invigorate their sex lives, she is also certified in functional medicine and bioidentical hormone replacement therapy. Cabeca is the bestselling author of Keto-Green 16, The Hormone Fix and MenuPause. She has also developed a line of well-researched natural care products to relieve common issues such as vaginal dryness, incontinence, loss of libido and hormone imbalance, as well as nutritional supplements that complement her Keto-Green diet plans. She offers three online masterclasses, including Breeze Through Menopause, Sexual CPR and Magic Menopause. 

What prompted you to develop the menus and recommendations in your books?

They stem from my own journey through early menopause at age 39 and being told there was nothing I could do but suffer or take an antidepressant. Following an early version of my diet and lifestyle program, I was able to delay menopause and have my daughter.

When I hit age 48, I started to gain weight and experience mood swings, brain fog, crashing fatigue, and an inability to concentrate or sleep through the night, which led me to develop my keto-green, or keto-alkaline, approach.

Can women relieve hormone-imbalance symptoms without medications?

Yes. We can reduce 80 to 90 percent of symptoms in the first two weeks, and 90 percent over another couple of months, with natural interventions and no pharmaceuticals. My plans focus on the right nutrition and intermittent fasting to facilitate detox, support metabolism, increase insulin sensitivity and maintain an alkaline state. 

We also work on developing a positive mindset, getting good sleep by resetting your circadian rhythm, reducing stress, eliminating toxins, and testing, which helps you manage and chart your progress. Then I will consider adding hormones. For menopause and postmenopause, research says we do better with some hormone support.

What is the basic principle behind balancing hormones?

Getting your body to make and use your own natural hormones in a healthier, more efficient way. We do that with detox and by improving the sensitivity of the most powerful hormones in our body. It takes more than hormones to fix your hormones. More than 90 percent of the relief comes from food and lifestyle improvements.

What hormones do you target in The Hormone Fix, and why? 

When it comes to regulating and navigating the menopausal transition, you have to focus on the major hormones, which are insulin, cortisol, adrenaline and oxytocin. There’s a hormone hierarchy. I compare it to a university where the students are all the hormones in our body—close to 50 of them—and they each have their own purposes and responsibilities. Teachers are like insulin, cortisol and adrenaline because they regulate the classrooms. If you have an unhealthy professor that allows students to do whatever they want, there’ll be chaos in the classroom. The most powerful hormone—the president of the university—is oxytocin, the hormone of longevity and quality of life.

Can you describe your Keto-Green diet?

The Keto-Green medicinal menus support your body’s detoxification and the metabolism of your hormones. They include high-quality protein, high-quality fats and alkalinizing vegetables and fibers to support the gut and estrogen metabolism. To avoid the antibiotics and hormones in meat, we focus on nutritious, organic, wild-caught and grass-fed foods.

Can you explain the alkaline component of the plan 

A higher alkaline urine pH is associated with less metabolic disease (diabetes, hypertension and heart disease) and stronger bones. A more acidic diet takes you into a catabolic, breakdown state, instead of a build-up, nourishing state. We become more alkaline by eating alkalinizing vegetables and decreasing the acid load caused by things like sugar, stress, alcohol and dehydration. I have people measure and monitor their urine pH. 

Is the Keto-Green menu meant to be a lifelong way of eating?

I would recommend 10 percent fasting, 10 percent feasting (eating whatever you like within reason) and 80 percent Keto-Green. This gives you the flexibility to enjoy your life. When my daughter turned 16, I had a piece of cake, but as you follow this lifestyle, you start to realize that sugar and starches are working against you, especially in mid-life, when your body is not able to metabolize them as well.

What advice do you have for the cravings?

When you consume plenty of healthy fats and start intermittent fasting, you’ll get into ketosis, where you burn fat instead of glucose for energy. You’ll also improve insulin sensitivity and lower your hemoglobin-A1C, which is a marker of blood sugar, over time. In ketosis, you stop thinking about eating and you’re better able to control cravings. Willpower is more physiological than we realize.

What if dieters reach a weight-loss plateau or slide back to unhealthy habits?

Plateaus happen. That’s why I wrote MenuPause, which offers five different six-day menu plans that each pause something different. There’s one that pauses dairy, gluten and grains, which cause cravings and increase blood glucose. The Keto-Green Extreme menu pauses nightshades, nuts, seeds and other inflammatory foods. There is a paleo-inspired menu for people with an autoimmune condition, a vegan plan that combines vegetables and plant proteins to support gut microbial diversity, and even a carnivore menu that takes out all the carbs for six days. 

If you’re following the same diet all the time, you can get stuck in a rut and start gaining weight. These diets help prevent that. I like my clients to rotate through all of them periodically. There’s a cleanse plan, too, which is three days of shakes, bone broth or water fasting. I recommend doing that every time the season changes, four times a year, to give your body time to rest and repair on its own. I like to change things up with intermittent fasting, too. Sometimes I fast for 13 hours, other times it’s 16 hours, or I have only one meal a day, and then there are times I fast for three days.

How does menu-cycling help us?

Just like the seasons change, we need to change things for our bodies periodically. If we’re eating a chicken salad for lunch every day, that’s not the healthiest thing to do. It can be healthy a couple times a week, but when you’re doing it every day, you’re increasing sensitivities, you’re increasing boredom. Your body can become resistant to that, so incorporating variety and flexibility in our diet is important. Kind of like exercising your muscles, you target different muscle groups on different days.

It’s about metabolic flexibility, so that you're not confined to one way of doing things. If you’re just eating just one meal a day for a long period of time, and it’s pretty meat-based, you can be forming a lot of uric acid, and that slows down your metabolism. By changing things up, it keeps you progressing. It breaks the plateaus and keeps life interesting.

What recommendations do you have for loss of libido?

Sexual health is important for optimal health. We want to be fully functioning and capable in what we call the second spring of our lives. It’s hard to feel romantic on your dinner date with your husband or boyfriend when you’re hot-flashing or your clothes don’t fit comfortably. Getting your sexy back is about feeling good in your own skin, being healthy, reaching a happy weight, feeling strong and having good energy, all of which come from healthy eating and healthy hormones.

Another big issue is discomfort during sex due to vaginal dryness, which is why I developed my product Julva, a topical cream that has plant stem cells and DHEA [dehydroepiandrosterone], a hormone that your body naturally produces in the adrenal gland. I use Julva with most of my patients to keep the vaginal tissue healthy and to restore and rejuvenate it. Just like we use eye creams and lip balms, we need it for our vulva, clitoris and anus, which are some of the most important real estate of our body.

What advice do you have for staying motivated on our health journeys?

I’ve been there where I started gaining weight again. You get lazy sometimes, and you stop doing what really helps you, so I would say that if you’re hitting that plateau, work with an integrative practitioner or join a group that is working on a common goal to motivate you through healthy community.

My menu plans are empowering because people feel better quickly. I see it all the time. Patients are able to lose weight, sleep through the night and have more energy. They’re planning trips or advancing in their careers because they’re focusing on what’s really important to them, what makes them smile or brings them joy.

One of my patients the other day said, “You told me to have more fun, so I started taking dance lessons. I haven’t taken them in 30 years, and it’s so much fun.” Be sure to bring more fun into your life. Fun is the ultimate motivator.

Sandra Yeyati is the national editor of Natural Awakenings magazine.