PHYSICIAN, HERBALIST, MIDWIFE
Dear women near and far — Dr. Aviva Romm is THE woman you want to go to for any and all of you and your child's (or future child's) health wants and needs. The knowledge and inherent wisdom of this woman is healing and endlessly comforting in all the ways that a doctor should be. Midwife, MD, trained herbalist, wellness advocate, ecologist, and mother of four herself, Dr. Aviva is a total leader in the health care revolution to transform the current medical system and help women feel GOOD again. In fact, Dr. Aviva's mission is so aligned with that of Sakara's that she is one of the very first members on our Sakara council - a list of highly curated wellness gurus who guide Sakara and help her transform more lives around the world. Romm continues to serve as inspiration in so many ways (her protocol for elimination diets is the model for Sakara's Level II Detox), and our one advice to you? Read on, to start your own transformation.
What has the journey been like to opening your practice?
I’m a New York City inner-city housing project kid, believe it or not. I grew up with a single mom and was always very academically capable. I remember one year, she got into a health kick and made soy bread, which was just a bread made with soy flour — it was so bad. She didn't have a lot of time to cook, so I pretty much had a Standard American Diet childhood. Fast food had became really popular at that time.
I got sick a lot as a kid. My mom used to joke and tell me that I was sick every Monday and Thursday. I had growing pains, which people think is normal, but it’s not — it’s a nutritional deficiency. When I went off to college, I was extremely anemic so within a month, I became a crunchy hippie vegetarian girl with dreadlocks who was trying to feel better. It was amazing, all the symptoms I’d ever had — seasonal allergies, headaches, aches and pains, etc. — everything went away and it didn’t take that long. At the same time, I started learning a lot about food politics and environmental politics, environmental toxins and the connection between the food industry, the pharmaceutical industry and the pesticide and herbicide industries.
I decided that I didn't want to participate in or contribute to the illness of this planet. I started researching everything I could. I now knew that food could help me get better, but I wanted to know what else there was. I started studying herbal medicine at that time, and somebody gave me this book called Spiritual Midwifery, which is the most crunchy hippie book about birth you could ever imagine. I was like, ‘This is my life! Herbal medicine and midwifery!’ So I left school at 16 and moved to Boston and apprenticed with a midwife. She was a Muslim African American living in this Rasta Muslim community in Roxbury.
Around that same time, my boyfriend and I went to this place in Nevada where there was this guy named Rolling Thunder who was a Native American spiritual teacher. He had set up an alternative to a reservation where everything was focused on building an "intentional community". There were many women there having natural pregnancies and wanting to go as natural as possible with the baby once it was born. They didn’t want to give the baby an antibiotic for every earache, etc., so because of my herbal knowledge, I got involved.
What was amazing was how many things really did work and how many kids weren’t getting antibiotics and how many women were having their babies naturally. I realized that there were so many women who wanted this and that I could find really great people outside of the traditional medical system. I wanted to become someone that women can rely on — someone that has information from the system but can then change the system so it's healthier for these women and their kids. By this time, I had four kids myself and I was homeschooling. All my kids were natural home births and all organic.
I then went to Yale for med school. I did my internship and residency there and just continued to bring integrative medicine into that world. I’m now a curriculum developer for Yale’s curriculum. They use that curriculum in 150 different medical schools and residencies. Once I put that little MD credential behind my name, everything expanded. I did general practice for a few years to get my feet wet, and then Mark Hyman sought me out and I worked with him for two years. Then, I really wanted to add my own flavor, so last year I started my own practice here in the city.
Tell us about Thrive Health, and what you specialize in there.
It opened this past November — it’s just about helping women feel their best and find their best selves. I love seeing kids, not only because they're cute and it’s great to help the next generation, but it also takes such a weight off of the mom’s mind when they have somebody that they can trust with their child. I don’t throw the baby in with the bathwater — if somebody needs a medication in an urgent situation, I’ll prescribe it. If somebody needs a medical intervention or some kind of escalation, I can tell them what road to go down. It’s never like, ‘Let me save you, let me fix you!’ It’s an, ‘Okay, we’re partners in this scary situation, so let’s get you to the next level of treatment.’ That hardly ever happens though because you can do so much with food and so much with natural therapies as a first line.
Right now, I do everything from fertility, counseling, parental support, prenatal care, care of new moms, and care of women who are going through challenges when they’re pregnant. One of the great stories I've experienced was a woman who had pretty severe bipolar depression and infertility for two years. She had to get off the medications because they weren’t safe for her pregnancy. We worked together and got her off the medications, got her pregnant, and she had her baby just six weeks ago.
And I just love that! I do all of that for women’s fertility and women’s hormonal counseling throughout their life cycles — whether it’s PCOS or PMS or breast problems or vaginal infections, or menopausal symptoms. I would say the 98% of the time, I suggest food and herbs and supplements, and then there’s a small percent where I’ll say, ‘Okay, let’s do a medication for a minute and see what happens.’
How do you get women away from this idea of "having to do it all"?
I really love Wonder Woman as a superhero and as a power stance, but interestingly, I’m not really into trying to be Wonder Woman or Superwoman in my life all the time. I just turned 50 and I had this realization that I have to walk my talk for women of not pushing it and trying to do everything.
Part of it started about two years ago when I had a patient in her early 60s who came to me looking like Madonna — she was ripped. She was working out with a trainer two hours a day, six days a week. She had grown up really poor — her parents were Holocaust survivors, so she’s a first generation American having grown up in New York. Ever since she was little, she had — and excuse my French — this very ‘Fuck you, I’m not going to spend my life poor’ attitude. She worked and worked and worked all the time and it was exhausting. She had four grown, successful kids and is totally financially successful, but she never let herself rest. I told her, ‘I think you’re feeding hungry ghosts that aren’t chasing you anymore. I think you’re still reacting from patterns that are ghosts from your childhood that aren't actually chasing you, but you haven’t realized that. The trick hasn’t caught up with you.’ I wanted to help her hit the pause button more.
I didn't see her again until a couple weeks ago, and she told me that our first conversation changed her life. She still works out, but not like that. She now does what she enjoys and takes time for herself. She stops work at a certain time of day to relax. She said, ‘I didn’t know that I could relax because whenever I would relax, I always felt like I was doing something wrong or doing something I shouldn’t be doing.’
That made me want to start looking deeper into how many women are doing this. I found that so many of the things women are doing are around this idea of perfectionism and a fear of missing out, of being a good girl, of always having to achieve, and this idea that we have to be doing it all. But that's not healthy for us! Because fundamentally what it is, is us telling ourselves that we’re never good enough. That’s a big push of my next book, which is about the adrenals and the thyroid. I include everything about gut health, environmental toxins, but also mental toxins that we’re feeding ourselves, because of those hungry ghosts.
How do you guide people through the process of going towards more holistic supplementing, and less traditional medicine?
Right now, those that come to my practice are self-selected and they've often already done an elimination diet — they’ve gone gluten-free and they’re on herbs, but they’re still sick and some of the typical stuff isn’t working for them. I take a very non-judgmental approach and I approach somebody with where they’re at today and what they’re ready for.
Let’s say that I have a patient who has severe anxiety — because that’s so common for women — I won’t say, ‘Oh, go off your anxiety medication and never take it again,’ because that will make them more anxious. I’ll say, ‘You know what? Keep your medication with you, but try this too, and then if you feel like you still need it, then you can still take it.’ Then they see the results and start to get to the edge of the diving board and are ready to jump.
I try to approach everything very curiously and experimentally — I enlist that in my patients or when I’m teaching at a conference. I want people to get curious about it. This isn’t a test. This isn’t homework. This isn’t a chore. This is something you’re doing for yourself, just get curious with it and play with it!
For people who are used to taking a pill and getting quick results, a few things are important to keep in mind. First, there are literally no medications that people can take that don’t have unintended side effects. I call them unintended consequences. Yes, you may get an immediate drop in your blood pressure when you take a blood pressure medication for three days, but chances are, you’re also getting depressed and your libido is gone. I ask people to look at what the side effects are that they're compromising for quick results, and I educate them about that.
Health is a pay-now-or-pay-later situation. You can pay now with your time and your effort and a little bit more money sometimes with supplements, or you can pay later with poor health. I’ve truly seen the consequences of paying later and the extremes. Things like blindness or having an amputation because you have diabetes — it’s not a joke. This is happening all the time.
I believe that health doesn’t have to be that hard, but it can feel hard when you’re in the learning curve of it. That being said, you’d be surprised at how quickly you can get results with natural approaches. I try and always ease in a couple of those things right at the beginning that are going to give people a big bang for their buck. If somebody is really constipated, I give them more vegetables and magnesium, they’re like, ‘This is a miracle!’ But it’s really not — it’s just about learning what to do.
Once you have that baseline of health, what's the next step?
Even if someone had done an elimination diet, I ask them to kind of humor me and do it again, because food is such a big influence on how we feel. People who have food sensitivities really know it. You can eat something that doesn’t work for your body and you’ll be in a fatigue coma half an hour later. If you’re lactose intolerant and you eat dairy, you know it. For some people, that impact is very direct and obvious, but for some that impact is happening all of the time.
I start out by helping people with their gut because most people have gut disruption. If they’re under a lot of stress, I always try to work with stress, especially sleep, even if it's just developing a mindfulness practice. Sleep, gut and food are pretty much the biggest inputs that I can help with right up front because if you can get those back in balance, you’ll be good.
It also comes into acceptance and what our expectations of our health really are. Do we expect to feel perfect every minute of the day? Most of us do, and that’s not realistic! We’re not waking up with the sun and going to bed at sunset and living completely in harmony with nature. We’re out of harmony with nature, but we’re expecting our bodies to still be completely perfect all the time. We’re so used to thinking about that quick fix with a pill. But what’s the long game?
I have this really profound belief that our bodies know exactly what to do. We just have to take away the impediments and add in the things that our bodies need. Magnesium, for example, is involved in over 300 enzyme reactions and yet the World Health Organization declared that 75% of Americans are magnesium deficient...
The microbiome, thyroid, and adrenals are the hottest areas of functional medicine right now. Can you explain why and how they are all connected?
Many people don’t know that the microbiome, the thyroid, and the adrenals are the root cause of what they are struggling with, and that those three are totally connected. Before birth, this connection is made. Your mother’s microbiome is connected to you and you actually get it when you're born vaginally, and I love that because you can blame your stress on your mother [laughs]!
Your microbiome sets up your immunity in your gut. Your immunity in your gut programs your nervous system. It’s really interesting because you have tons of neurotransmitters in your gut, so a lot of your body’s serotonin is actually produced in your gut and you have other hormones produced there as well that affect your mood. Interestingly, if your mom had a lot of viruses, like gut problems that translated into vaginal flora, it might affect your microbiome. If when you were breastfeeding, your mom had a lot of stressors in her life, those things are transmitted, too. A little thing that might not bother somebody who had a really good foundation for their microbiome could set somebody else off.
I want to make a t-shirt that says “My Microbiome Made Me Eat It” because it dictates what’s growing in your gut. It dictates what you’re hungry for, what you’re craving, how you metabolize, and how you process and eliminate your hormones. That has a huge impact on your whole system. Interestingly, we have this whole system called the HPA axis — the hypothalamic pituitary adrenal axis — and it’s the most primitive stress response. It’s what causes fight or flight.
Think about a savanna in Africa — these gazelles are at a watering hole and then they perk up their ears because they smell or hear a group of lions. The lions come close and the gazelles run and there’s a chase and the lions catch the weakest or the sickest or the oldest. But then what happens? The lions go eat and the gazelles go right back to the watering hole like nothing happened. They had that whole fight or flight response, but it ended. It stopped and they went back to their normal baseline. Lions have to go through the fight or flight response too, and when they get what they need they also settle.
In human life, we have these personalities where you are an aggressor or more of a chaser. If you don’t get what you need, you never settle, but you can also be more of somebody who feels victimized or just gets your response as more of a flight response and you have a different set of reactions. But all of us never get back to the watering hole — we’re living constantly with that stress response triggered, whether it’s backfire or it’s checking your taxes at 11 at night and thinking, ‘Shit, I didn’t get that done today…’ And then that affects your sleep.
Your whole primitive stress response doesn’t know the difference between whether you’re being chased by a lion or whether you’re worried that your boss is upset at you, or you’re going to be late for something. That stress response, when it gets triggered, sends out a bunch of chemicals and those chemicals do two things. One set of things affects your gut and another set of things affects your thyroid. We know that stress translates to something in our gut, but also even just one day of intense stress can completely disrupt your gut microbiome and shift it from the good, favorable kind that helps you to the kind that makes you anxious and stressed.
Everything with our adrenals has a huge impact on our gut, and then interestingly, when you get stuck in that survival mode, you’re in that fight or flight all the time. One of the primitive responses that your body tries to protect for you is energy. It does that in a few ways. One way is to make you pack on belly fat. That belly fat is inflammatory, then it’s really interesting, because that belly changes the cross talk in your brain and it makes you want sugar and salt and fat and it makes them taste better, so then you’re eating that stuff and that affects your microbiome in turn.
It’s also about trying to get you to conserve energy. Let’s say that your brain doesn’t know, but maybe the emergency is that there’s a famine coming and you need to store fat. It stores fat around your belly and it stores it as cholesterol. This also happens when we’re in an energy crisis. And what are you then told to do? Turn down the thermostat. What is your thermostat? Your thyroid.
When you’re in this stress mode all the time, your adrenals produce cortisol and instead of producing a thyroid hormone that makes you burn energy, it makes you metabolize and keeps hormones regulated, it says, ‘No, actually, take these thyroid hormones and store them for later.' It takes your active thyroid hormones, changes them to other hormones that you actually can’t use and it stores them as a reserve. Then, eventually, you can start using it up again. But some people can’t — they become completely unable to not store it as storage. It’s like having money in a bank account that you can’t touch until you’re 50 or something. It’s not going to do you any good.
For me, a lot of us in the health and wellness space are going at the gut health first, which is really important, but part of it is that there’s a lot of stress going on or sleep problems, that has to move right up front because you can treat your gut all day long. If you’re still pumping out those stress hormones, it’s going to keep undoing itself.
How do you avoid the stress though? Because obviously, it's inevitable, and if you have a stressful job, what do you do?
Stress isn’t something that’s all bad. Actually, all these survival responses are meant to protect us and a little bit of stress actually boosts our immune system. It makes you cognitively sharper so a little bit of stress is actually not a bad thing. It’s when stress becomes distress. In that case, we have to reframe it as, ‘I can handle this, I have the reserves, I have the resilience.’
Just reframe stress and understand the benefits of stress, and then get really in touch with your experience of yourself — become super self-aware, not neurotically, but get in touch with how your body feels, how your thought patterns are, when you start to get too stressed and understand how you can recognize for yourself when stress is becoming distress.
What can you do to keep stress from becoming distress?
There are a few things. One is being mindful. Even for super high stress jobs, this has been shown to be effective. Doing more mindfulness activities helps, but it doesn’t have to be a lot. You can do five minutes of deep breathing and a light mediation in the morning. You can just take a shower and connect to the water and say, ‘Let the water wash over me, let all of my worries wash away.'
There are two really good studies that showed that if women who have super stressful jobs come home from work at the end of the day and take 15 minutes to decompress — it can be dancing, meditation, a walk, a shower, sex, a bath, playing with their kids, anything — their evening cortisol gets completely reset so that it’s in a healthy rhythm and impacts their sleep so that they can get a better sleep compared to those who don’t.
Keeping our circadian rhythms relatively healthy is key. As much as we can, we need to live in harmony with our body's need of about seven hours of sleep. We all know that when we don’t sleep well, we just can’t handle stress as well, and so that has an impact on our day. Then we’re drinking coffee and eating sugar, and our cortisol is going up more and more.
It’s just a matter of starting to think about this concept of what I call the “replenished lifestyle”. For me, it’s how we do live our lives instead of constantly running on empty, and put ourselves first that so that we can be the best that we can be. Stress is not going to go away. Our iPhones are not going to stop getting messages. Our email inboxes are not going to stop getting filled up. I think it’s also about prioritizing what’s important. How can we reset our priorities? It is doable, I promise, you just have to decide that you want to do it. For me, it comes down to really just one simple question that I try to ask myself regularly and encourage my patients to ask themselves: ‘How do you want to feel? Are you feeling that way in your life currently? If you were 70 and you had to spend your whole life living how you feel right now, do you think that would be how you wanted to feel?’
What is your idea of legacy?
I would say that there are two levels of it for me: one is my legacy for the people who are in my world — my family and my friends, people that I can count on — I want them to always feel like I was there for them and I want them to feel really loved and supported by me. I would say that my legacy for my work with women is the same. I would want my legacy to be making women’s lives a little bit easier and helping them feel just how beautiful they are, and what goddesses they are. I want women to feel their power so that they can bring their own beauty to the world and feel good about themselves. I want to help women in any way I can to lighten their load and make sure they feel awesome about themselves.
If I had one professional legacy — and it's the one thing I was known for academically — it would be to reduce antibiotic overuse and pharmaceutical overuse, and that also means helping people know what the alternatives are to take care of themselves naturally.