Today's episode is another listener Q & A, and this is actually the second time we've done this. I'm bringing it back because we got such good feedback the first time, you all sent in fantastic questions on Instagram, and I am going to answer as many as I can on this episode, we're covering all the things, hormones, gut health, autoimmunity, general wellness, basically all the things that you might be dealing with, but don't always get clear answers about these questions are directly from you, and hopefully I'm going to answer them as if I'm talking to you today, right now, sitting across the table from you. If this episode is helpful, it would mean so much if you'd leave us a quick review or share it with a friend. That's what helps us keep showing up here and offering the support for free. I have lots of questions to answer, so let's get started.
I have a whole list of questions that I'm going to answer for you. I'm going to try not to go too quickly, but to cover a bunch. So hopefully we find that right balance. You asked lots of questions about hormones and hormone replacement therapy, so of course, I'm going to spend some time there. There were also lots of questions about gut health, and the vast variety of recommendations from everyone needs this to no one should ever do that. So we're going to talk a lot about gut health, and then there's a fair number of general health questions, like what to do about insulin resistance or high cholesterol, and then some mental health questions as well, and then some pregnancy questions. So we are going to just go through these different categories. I'll also encourage you to check out the list of podcast episodes we've had, because we have some really great in depth answers to some of these questions in terms of some PCOS episodes, hormone replacement episodes, insulin resistance episodes, we are starting to get a really good bank of episodes there that cover these topics in such great details with some leading experts. So check that out and let us know if you find it helpful, and if you have any other topic ideas, because we are always open for ideas. This podcast is for you. It's It's all for you. So if you have something that you want to hear, I'm, I'm ready for it, I'll do it. So let's start off with hormones, because this is such a popular topic, and for good reason, because media is telling us right now that everything that's wrong with us is due to our hormones. And it's not completely false. Really. I think when we go through the perimenopausal and menopausal transition, it messes with a lot of stuff. So let's dive into that. One of the first question that I had was, perimenopause is really affecting my sleep? Any tips? Yes, progesterone, if you are perimenopausal, progesterone does magical things for sleep. Some other supplements that I really like are L theanine, glycine, magnesium glycinate is has some crossover there. Ashwagandha. I also really like tea. So like passion flower. Tea is a really nice way to support sleep, and then, not forgetting sleep hygiene and checking your stress levels with perimenopause, like I said, when we're in the perimenopausal phase of life, or post menopausal phase of life, so that would be like 35 to like 60. Everything gets blamed on our hormones, and it's true that hormones are affecting everything, but that doesn't mean it's the only thing we can do to support those symptoms. So for sleep, we still want to go back to do you have a dark room? Are you shutting down screens in enough window before you're trying to sleep? Are you doing some sort of, I call it a gateway routine, some sort of crossover from day to night, so you can tell your brain, we're done with this, the cares of the day. We're done with the I call it fighting saber toothed tigers. We're going to put that to rest, and now we're going to focus on just going to sleep. So do you have some sort of ritual or routine that's helping your brain understand that it's time to shift gears? But also progesterone? The second question is, I tried pellets and they made me feel terrible. What do you do differently? So I don't use pellets in my practice, mostly because of cost and because I don't think it's the right first line approach to hormone replacement therapy. Pellets, for those who don't know, are medicated implants that are placed into, usually the hip, and they usually have testosterone. They can have estrogen as well. The trouble with them is they're meant to last for three months, which, from a convenience factor, is great, but when it's three months, if you get the dose wrong, then you're just stuck with it for three months. You can't do anything about it. The other thing that I don't like about it is they overdose inherently. In the nature of what they do, they kind of give you a big whomping dose at the beginning, and then it slowly continues to disseminate into the tissues over the three months, and people are known to have higher levels of testosterone, sometimes higher than are physiologically safe, sometimes up into the male testosterone levels. So I don't love pellets, because, like this person says, they they can make you feel terrible. Many people have great experiences with pellets. I.
Don't think the pellets are somehow evil. I think they're more expensive than is necessary, and it's hard to get the dosing right. But the time that I do think pellets can make sense is if you have been stable on testosterone and estrogen and you are post menopausal, I think if you're perimenopausal, your dose is going to change at some point. So that doesn't make as much sense. But if you have already stopped having periods, and you know exactly what doses of estrogen and testosterone you're happy with, then you could consider a pellet, but they're still very expensive, way more expensive than other HRT. So what do I do differently? I do not do pellets. Usually we start with progesterone, then we add estrogen and or testosterone, depending on symptoms and age and what's right for that patient, what hormone is causing me to get crazy itchy right before and during my period? Usually that's either elevation of estrogen and or a deficiency in progesterone. Neither of those hormones actually cause itching, but there is a link between estradiol levels and histamine. And histamine makes you itchy so very frequently, if women have a condition with histamine, the most common is called histamine intolerance. It's not accepted in conventional medicine, necessarily, but the idea is that as your estrogen levels surge, it can increase histamine levels and increase histamine sensitivity. And so as the estradiol levels surge, you can get more of these histamine symptoms, mostly that's itching. It can also be moodiness, brain fog, insomnia. It can be associated with PMDD or severe PMS, mood symptoms before your period, and then also pain with ovulation. So if you track your symptoms, and you have one day of symptoms, right when you ovulate, that's unpleasant, then it gets better for a couple days, and then the week before your period, you have this other uptick of symptoms, then that can be histamine intolerance. One of the things that you can do as a little science experiment is to take antihistamines like Claritin, not Claritin D, but Claritin, and if those symptoms get way better, then that's an indicator that you have histamine intolerance. It's not the solution that I would recommend forever, but it is a nice diagnostic tool to say, yep, that's what's causing those symptoms around your cycle. And then we work on increasing progesterone at appropriate levels and decreasing estrogen to appropriate levels as well. Another question, which is such a good question, is, is 39 years old, too young for hormone replacement therapy, and the answer is no, but that's not the answer you're going to hear from everyone. If you are still having regular menstrual cycles, it is still possible that your hormones are starting to slide off, to go a little bit on more of the perimenopausal side. The trouble is perimenopause, especially in early perimenopause, which there's no way to define that for sure, but I think of it as the late 30s to early 40s, for most women, is going to be early perimenopause. And in early perimenopause, the estrogen can actually go up while the progesterone is going down. And if that's the case, if you add hormone replacement therapy, like this person is asking if you had progesterone hormone replacement therapy. Sometimes that's all you need. At that point, it's also helpful to check testosterone levels, because if your testosterone is super low at 39 then you might feel quite a bit better if you start hormone replacement therapy. But there's this idea that HRT or hormone replacement therapy is all the hormones, it's estrogen, progesterone and testosterone, so that if you're ready to start, you have to do all of it. And that's not true at all. You can't do estrogen without progesterone, but you can certainly do progesterone or testosterone without estrogen. So there's no age limit that says you cannot have hormone replacement. We do hormone replacement in younger women for other reasons when their hormones are low. So there's no rule for that. What I will say, though is, the younger my patients are, the less likely I am to just start hormone replacement therapy I'm still looking for Why are you so symptomatic in perimenopause? Is your body aging a little more aggressively than it could be. Could we help your body feel more resilient so that those hormones can level out? Certainly, if someone is 39 and feeling perimenopausal and they want to have a baby, then we're not doing hormone replacement therapy. We're saying, how do we get your ovaries to secrete more hormones more effectively? How do we help your egg quality? How do we help insulin resistance and sleep and stress and circadian rhythm? So those are all the things that we do for fertility at 39 and it's it's quite doable, but if you are 39 and not wanting to have a baby, we can still do all of those things. And as we help your ovaries and your hormone levels come to healthy ranges, then you won't need hormone replacement therapy. So it is very doable at 39 to start. HRT you want to go to someone who knows what they're doing, because a lot of hormone clinics will just whack hormones on you, and then they just assume that it's hormones, so they just keep going up and up and up. And sometimes it's not hormones that's causing your symptoms. Is it possible to have labs come back normal?
When they really aren't, especially hormone levels, the idea of normal is complicated with labs. So with hormones, especially
in a healthy hormone cycle, they're fluctuating in a predictable pattern. So if, for example, we're trying to support pregnancy, or, for various reasons, evaluate hormones in a woman who's still cycling. We want to know what day of the cycle we're testing those hormones on. If I send you to the lab with a blood test for hormone levels, and they come back
like, what does that mean to me? Are they high? Are they low? Are they appropriate? Are they not? It doesn't mean anything unless I know where you're at in your cycle. So you've probably seen this, or you can totally google it. But there's a normal hormone curve that goes with the menstrual cycle. In the first half of the cycle, the estrogen spikes, and then in the second half of the cycle, the estrogen goes up, while the progesterone goes up as well. You can look at this graph, but look at that graph, and then say, if I tested my hormones on day 12, what would those hormone levels be if I tested them on day three? Day 21 day 27 that's when we say, like, Are my hormone levels normal? It's it's not really a good question. The question is not that this patient person isn't asking a good question, but the right question to ask is, are my hormone levels normal for that point in my cycle? Now, if someone is having really wacky cycles, then it's very difficult to interpret hormone levels, because they might be high one day and low the next. If someone is not having any periods at all, then we interpret hormone levels through that lens. So the idea of normal versus abnormal is not quite right. And then there's also the question of normal versus optimal. So for example, a progesterone level in the second half of the cycle will often test that for perimenopause and or for fertility, and just to see how well that progesterone is doing, how well that progesterone is rising. And if we have a level that's around six or seven according to the lab range, that's normal, but it's not optimal for ovulation, and it might not be optimal compared to what your estrogen is. If your estrogen is at the upper range of normal and your progesterone is at the lower range of normal, then you're not going to feel very good. Then that that can be an explanation for symptoms. So this person asks, Is it possible to have labs come back normal when they really aren't? Yes, because what is normal? It's really easy for people who don't understand hormones to test hormones and to say, well, your progesterone is low. Well, when, when did you check it, and when did you bleed next after that progesterone level, and where in your cycle was your estrogen. So you just have to get someone to help you interpret them to know if they're appropriate. Is what I would say, not normal. Is it appropriate for what your cycles are doing, your age, your goals, et cetera. Another question is, I am afraid of hormone replacement therapy and cancer risk, and I don't blame you, because there's so much mixed information out there. Even in my own exposure to social media and and not just social media, but to conferences I go to, there are vastly different messages out there. So I don't blame you for being confused. I will say that the vast majority of physicians who are treating menopause at this point, do not have a lot of concerns of hormone replacement therapy causing cancer. In fact, there are more studies showing a decrease in risk of breast cancer a decrease in all cause mortality. Was the most recent big study on estrogen replacement therapy that showed a decrease in all cause mortality, meaning women who took estrogen replacement therapy died of everything less that's heart attack, stroke, breast cancer, osteoporosis, dementia. So I think in general, that's less of a concern,
as with anything we want to look at the big picture. So again, I might rephrase this question. I'm afraid of HRT and cancer risk, I think we should separate that and say, what are the pros and cons of HRT and how do I decrease my cancer risk overall? That's how I would phrase it in my life. So how do we decrease our risk of breast cancer? We avoid insulin resistance and pre diabetes. We don't we limit our alcohol intake, we avoid being overweight or obese, because that's associated with increased risk of breast cancer, stress and sleep, those are all associated with increased risks of cancer. So could there be a tiny increase with hormones? I will say yes, because hormones are supposed to do certain things and they're supposed to be in certain balances, and they're your body has to know what to do with those hormones. And I don't think that we fully understand this and the implications on breast cancer. We do know that there are certain breakdown products of estrogen called metabolites that are associated with an increased risk of breast cancer.
Okay, so if you have estrogen, your your whole, you know, reproductive years, if you have estrogen and your body's not doing the right thing with it, is it possible that you have an increased risk of breast cancer? Yes, that's possible. If we then give you hormone replacement therapy estrogen, and you're still not doing the right thing in your body to metabolize that estrogen? Is it possible that that's going to increase your risk of breast cancer? Yeah, theoretically, we don't have data on that, to my knowledge, but my point being, we should optimize the whole person. So I don't think there needs to be a lot of fear around HRT. I prescribe it all the time. I think it has so many benefits, and we should optimize your health in general, to decrease the risk of cancer overall, and especially to decrease the risk of hormone associated cancers. I think there will be data coming out, I predict in the next years, looking more at this idea of how are our bodies processing the hormones that we have? Because bodies aren't created equally. So if you take 100 women and you put them on HRT, and one of them gets cancer, then that's going to say, well, that's the normal rate. But could we say, could we help that woman not get cancer? Is she metabolizing hormones poorly? Is she drinking alcohol in a way that is causing stress to our body and leading to cancer. There's just more we can talk about from a one to one personalized medicine standpoint. So more than you asked for, but I am afraid of HRT and cancer risk. I wouldn't be too concerned about that, but I would do HRT and I would optimize cancer risk period. I would optimize health. That's my approach.
Now, what's my best advice for dealing with painful periods? Painful periods can be a really mixed bag. I think it's one of the more complicated hormone things that we deal with, because it can be so multifactorial. There are lots of reasons why someone could have painful periods from inflammation, chronic infection in the uterus, endometriosis, fibroids, adenomyosis is another condition that's caused by estrogen imbalance, inflammation. Some people, like with celiac disease or gluten sensitivity. Non celiac gluten sensitivity can have painful periods when they're exposed to gluten, and then as you cut gluten out, the pain can go away. Same thing with dairy. Some people have dairy sensitivity, and as you remove dairy, you can have improvements in painful periods. And then you have a whole other class of painful periods, which is more chronic, pain related, trauma related, childbirth related. So when I'm dealing with someone with painful periods, I want to understand structure. First of all, do you have a structural abnormality? I also want to understand where you're having pain in the period. I also want to know what else you've tried and do you have any other hormone symptoms that can clue me into any other hormonal abnormalities? So then I'm looking at what other symptoms they have, if they have a bunch of gut symptoms, if they're exhausted, if their diet is not very nutrient dense, if they're not sleeping, if they have insomnia, I'm looking then at saying, Okay, this causes most more likely inflammatory if I have someone who doesn't really have any inflammatory symptoms, but their pain started after a traumatic incident, then I'm going to be diving into that. So, so the idea of painful periods is actually quite complex and and a little bit annoying for patients, because it can take a lot of time to peel back the layers and say, what is actually causing this? That, being said, progesterone sometimes helps. So sometimes while we're peeling back those layers, we'll start progesterone. Some people, it does amazing things for and solves all their problems. Some people, it doesn't do anything. Another thing that can be beneficial is high dose vitamin D. There have been some studies. You can look them up on PubMed. There have been a couple studies looking at high dose vitamin D right before the period. There's a couple studies looking at dose ranges of like 100,000 international units to 200,000 and then there's one study looking at 300,000
This is a whopping dose of vitamin D. In your multivitamin, you'll have 1000 international units. And this is 300,000 international units of vitamin D. But there have, there have been these studies, and I have found success with that in some of my patients. So a combo of like progesterone, high dose vitamin D, there's a couple other studies, or there's at least one study I know of looking at N acetylcysteine for patients with endometriosis, leading to improvements in painful periods. And that's something that can be fairly safe to try. But what I would say is, find help. Have someone help you. Break it down for you. In my clinic, I don't know how my patients feel about this, but I will often to get my brain straight in these complex topics, I will often draw like a diagram. I have to draw like a bubble in the middle with the diagnosis or the symptoms. So I'll put painful periods in the middle, and then I draw.
Of like spider legs out from that to say, Okay, let's think through what are all the possible things that could be contributing to painful periods. And then I make a list of all of those things that I just mentioned. And then we go back one on one, and the patient and I will kind of eliminate some of these. Like, you haven't had any of this, so we can, so we can eliminate this. You tried vitamin D, it didn't work. So we can eliminate that. You tried gluten and dairy free, didn't work. So we can eliminate that. And so going through that together in a process, can feel much more organized and can feel much more empowered. Instead of me saying this, and then you being like, Oh, great. How am I supposed to chip away at this myself? It can be really hard. I also think there's lots and lots and lots of supplements out there that claim to help with this, and I'm not opposed to trying them, because some people will find them helpful. You will see them, those influencers who find them helpful, then will talk about them non stop, and your brain will think, Gosh, I've heard this 100 times, so it must be legit. But really, there's so many different causes that one person is going to find luck with a supplement and aid other people. It's not going to do a thing for so I prefer to take a more organized approach to it. So not super helpful, but I will say there is hope. There is definitely hope for managing painful periods.
When you're a women's health expert like I am, you get to talk about a lot of taboo topics for women, and that includes periods and how inconvenient they can be, among other things. I grew up in the era of only tampons and pads, and I am so glad that we now have better options. I switched years ago to using period underwear and a menstrual cup combined, and I will never go back. I've tried several brands, but the brand I'm really loving is salt that's s with two A's Lt. Their cup discs and period underwear are not only comfortable and reliable, they also take extra steps to make sure that when you're using products in intimate places, that they're not going to release toxins like PFAs or other chemicals that we really don't want to be absorbing into our bodies, plus, they're more sustainable and more cost effective compared to traditional products, which is a win in my book. We love that salts products are made with medical grade silicone, free of toxins, and designed to actually fit real bodies and lifestyles. Whether you're brand new to reusable period care or looking to upgrade, we highly recommend checking them out. And please, if you have a teenager who's starting to have periods, please get them some period underwear. All of us who are older know what it was like to walk around with a sweatshirt tied around your waist. Let's get rid of that. Just get them some period underwear. Click the link in our show notes to shop salt and explore all of their options, and you'll see why so many of our patients are making the switch. Now back to the episode. Second question in that line is, do you have any information on PMDD? PMDD is premenstrual dysphoric disorder, so this is really terrible PMS, it's, it's not actually PMS, but, but it's really terrible mental health symptoms that come on right leading up to the period. And I don't know if I have any PMDD information that I've shared socially. I'm sure there's some social media clips somewhere about it, but we do have a podcast episode coming up on PMDD that'll be really helpful. And in general, PMDD is another thing, like painful periods that can be really tricky to treat. Progesterone is usually first line, so trying progesterone that can be helpful. It's different than progestin, which is in a birth control pill. Some people will find improvements in a birth control pill, and that's a longer conversation about pros and cons. But with PMDD, it can be so severe that if someone finds something that helps, then I'm more likely to be like, Okay, let's stay there. Let's keep doing that and deal with any negative repercussions of that, because PMDD can be life threatening. It can be really life altering. It's it's something that, for some women, threatens their marriages and threatens their relationship with their children two weeks out of the month. Well, that's half the month, which is half your life, that is affected by something that feels like it's out of control. You know, you're you're being affected by hormones. So the first thing I would say about PMDD is number one, track your symptoms. If you're struggling with mood, track your symptoms. Is this happening all the time? Because that's a completely different set of diagnoses and treatment options. If it's truly just the luteal phase, just the 10 ish days leading up to your period, then that's going to be more consistent with PMDD, so very frequently. I'll start with progesterone. Antihistamines can be really helpful. Just plain old. Claritin can be really helpful for people after that, then we have to get a little fancier. And same thing that I said with painful periods, I have to know what else is going on in the body. And this is something that I think as women, we under value. And the medical system has created this because you go to the doctor and your gynecologist says, I don't want to hear about your hair loss or your gut, your diarrhea, your constipation, your bloating like I don't know anything about.
Those symptoms. So you need to go talk to your gastroenterologist about those, if it's okay with you. This is your gynecologist talking right? If it's okay with you. I just want to hear about your symptoms leading up to your period. For me, that's not how I work. I have to know what all of the other symptoms are so I can start to put puzzle pieces together, because if it's isolated, then I have one set of treatment options that may work, but if you have 18 other symptoms, then we're going to help optimize the body. And the magical thing is that as we optimize the body, a lot of symptoms get better. So sometimes we don't even know which part of our optimization helped with which symptom. We just know that as the body gets healthier. Symptoms go away. So PMDD can be really hard and it can be really frustrating. There can be nutrient deficiencies associated that can make it worse. There can certainly be food sensitivities and inflammation and gut health that can make it worse. Histamine can make it worse as well. So it is complicated, but stay tuned for more information on that from an episode we have coming up. I like this one, and then we'll wrap up hormones here. This one says my opinions on free bleeding. This is where social media is just my favorite, because there's so many things that you never even thought about and never even considered would be important, and then now the internet is telling us that you're not a real woman if you don't free bleed. So for those who don't know, free bleeding means you are having a period without using any sort of tampons or pads, that you're really just not obstructing the body. You're just no cups, no IUDs, just let the blood come out. I have zero qualms with anyone who wants to try free bleeding. I do not care if you free bleed. I also have zero qualms with using other products to help with the cleanliness process that is a period. I think that there are, anecdotally, some women who really feel better. What I will say, from my own clinical experience with patients, is there are some people who don't feel good with tampons, and that's organic or not organic cotton tampons. That will say, when I don't use tampons, my periods are less painful, that I will say I have seen that be a thing. So trying to have a period without a tampon is something if you're struggling, by all means, try that and see if it works, I think a menstrual cup or a disc or a pad, I have zero qualms with that. I'm a big fan of the period underwear. I think it's such a good invention, especially for younger women having periods that can have really embarrassing episodes with leaking and with staining, and life is too hard to go through that if we don't have to go through that. So I am a big fan of period underwear. So if you like free bleeding with period underwear, and that works for you, I think I'm a fan. I think it's great check the brand and make sure that you don't have chemicals or microplastics or things that shouldn't be against your skin all the time. But if you want to use a tampon and it doesn't cause you a problem, then I have zero problem with that. I do prefer organic cotton tampons, because it's in your body and it's being absorbed into your body. We know that the vagina absorbs because we give medications through the vagina, oftentimes in the hospital when we need to. So we do that because it gets absorbed through the skin into the body. So if the body can absorb medications. It certainly can absorb pesticides. And cotton tampons are not regulated as as food grade. They're regulated as textile or, I think it's textile grade. They're they're regulated more as clothing, but you're putting it in your body. So organic tampons is what I recommend. But other than that, I do not care. Do I have to be on birth control pills to manage PCOS. No, you do not. And I think in some ways it can make it worse. I wouldn't if you are doing great on birth control pills and you need birth control for pregnancy prevention, then it can be a really helpful option. And I will never shame someone for taking a birth control pill. But if you are just trying to manage PCOS, that's more where we start looking at primarily insulin resistance and optimizing that and using other supports to manage insulin resistance, we can often just manufacture cycles through bioidentical progesterone. So if someone doesn't need contraception and they just need to cycle while we're working on healing the hormone balance, then just plain old, progesterone can be a better alternative. In my opinion, we also look for inflammation and gut health to try to help with PCOS. So lots of ways to do that. We talk about PCOS a fair bit on our podcast. So scroll through and find those episodes that talk in more detail about what we can do there have I read on up to date, which is a medical database that the Mirena IUD has been shown to negatively affect those with a history of depression and anxiety. Yes. And what I say with the Mirena is and with all hormone of any kind that you're putting in your body, never say never. If you come to me and you say, I started this hormone something, and this is what I'm having that I'm going to say, Yeah, could be No, I don't think that's some.
Thing we should be afraid of, because life is tricky. Life is complicated. We need contraception sometimes, right? Sometimes you're not ready to have a baby and you want to prevent that pregnancy. You may also have a negative reaction to other birth control methods, or you may not be in the phase of life where you can use fertility awareness method or other methods, and if that works for you, wonderful. I'm thrilled. If it doesn't. I'm really grateful we have the Mirena IUD, and I don't think we should be afraid of it. But if you have a history of anxiety and depression and you've had an experience with progestins in the past worsening your mood, and you want to do the IUD, what I would tell you as a patient is, get the IUD if that's what you want to do, and watch your moods, and if they get worse, let's take it out instead of what I think a lot of women are told is, like, no, the IUD doesn't do that, that couldn't possibly do that. Like, yes, it can. And if that's your experience, get it out and try something else. So it absolutely can influence depression and anxiety, but not all the time. It affects depression and anxiety less for most women than a birth control pill, so I still think it's a good option. Same thing with weight gain and decreased sex drive. Some people will say like, no, the IUD can't cause that. Yes, it can. It doesn't for many people, and it doesn't for most. But if you think that's happening, then trust yourself and it is, and decide whether you want to get it out or not. What are my thoughts on dim, which is a supplement used for estrogen. I think if you are the right person, then it works really well, but it's often used in the wrong circumstances, so it's not something I would recommend just trying willy nilly, because you have hormone problems and you want to see if they get better, because sometimes it can make some hormone symptoms worse. It does help to decrease the amount of estrogen in our bodies. And there's this idea that we all have too much estrogen, but actually there are problems with not enough estrogen, and if you take that, then it can make it worse. Do I prescribe only estrogen to women with a hysterectomy? No, I like progesterone. I think we should all have progesterone with our estrogen. It balances other places in the body, like the brain and the breasts, with in ways that we don't know, but also, people feel way better on progesterone. So I very frequently get women who come to me and say, I had a hysterectomy, I've started estrogen and I still don't feel well, and we start progesterone, and they feel great. So because the data shows that women who have had their uterus removed do not have an increased risk of uterine cancer when they take estrogen alone, right? Well, of course, they don't, because they don't have a uterus. But that doesn't mean that you can't give a woman progesterone, and it doesn't mean that she doesn't need progesterone to feel better. It just means that you don't need progesterone to balance the estrogen in the uterus because you don't have a uterus. That is very different than I don't need to give you as a woman, progesterone for hormone replacement therapy. I think some doctors even have it in their minds that I can't give you progesterone, and that's weird and not right. You can always give progesterone just about and so if you've had a hysterectomy and you have symptoms of progesterone deficiency, absolutely, I would give you progesterone. And then the last hormone question. How do you know if you're in perimenopause or menopause? If you've had a hysterectomy, it's very difficult talk to someone who knows.
If you are between the ages of 40 and 50, you're probably and having a bunch of symptoms, then you're probably in perimenopause and menopause. How do you know when you're officially menopausal and post menopausal, meaning zero periods, you don't, you won't, I don't know that it really matters. You can do blood tests at some point, but it doesn't really change management. Let's move on. Do you need a breather? Do you need a break to catch up? I told you, it's going to be rapid fire. So hopefully you find this helpful. Let's move on now to gut health, because this was another one that I had a lot of questions with. Do I have a recommendation for a quick gut reset or anything to eliminate that helps?
Yes and no, I suppose it depends what you mean by quick. I'm not a big fan of quick because there's not a lot of problems that came on quickly, and that therefore can be resolved quickly. I am a fan of healing. I'm a fan of letting the body repair itself. That being said, when I'm dealing with anything gut related, bloating, diarrhea, constipation, you name it. I am a fan of frequently doing stool tests to see exactly what we're dealing with, but also doing some sort of gut rehab protocol, and that takes time, and in fact, to do it well, it takes longer than I typically even recommend. So a quick reset. You can always try cutting out foods that you feel like are bothering you. So I would say, for quick pay attention. If every time you eat gluten, you get a stomach ache, you should try gluten. Try cutting that out and see if that's a quick help for you. Same thing with dairy. I would say gluten and dairy are the top two that I see that when people cut them out, their gut gets way better. Now, not everyone, but those are the.
Top Two that I see patients say like, gosh, I don't think I can bring that back in. Soy and corn are the other two that are most common, but I honestly don't see that too much. I don't see a lot of patients that could just be luck, but I don't see a lot of patients who are like corn. When I reintroduced corn, it was really upsetting some, but not as many. So those are the four that I typically recommend, as gluten, dairy, corn and soy as the first trial of like, how am I doing? Nuts and seeds for some people, can be upsetting to the stomach, so that's always worth just paying attention. I think with this movement away from dairy, there's lots of dairy substitutes and lots of gluten substitutes that have almonds. So almond milk, almond flour and almonds can be a little bit hard to digest for some people, so that's worth thinking through, like, when did the stomach stuff start, and did I make any dietary changes? Another one that goes under the radar that's a little bit new to me, that a patient helped me learn, was stevia, actually. So we know that various sweeteners can disrupt the microbiome, including some forms of stevia, but stevia is in everything. Now. It's in protein bars and just about all of our protein shakes, all of our flavored drinks, the electrolytes frequently, the flavored electrolytes frequently have stevia in them. And I'm not opposed to stevia, but if you are really dealing with stomach stuff, then that can be a nice thing to eliminate, and you can do these one at a time if the full elimination feels too restrictive to you, but I do think the results are better when you eliminate a grouping of food so that you can see the results. Now, when I do a gut rehab, I'm also doing a bigger gut rehab that has multiple purposes. I remove two categories of foods, and I do this myself about twice a year, partially to sympathize with my patients that I'm asking them to do hard things, that I'm doing it myself, but also because it's just a really nice reset for my body, I always learn something. It's always a good reminder of how to appropriately care for our bodies. So I do this twice a year, and ask my patients to do it as well. We will eliminate two big groups of foods. One is groupings of foods that is naturally not doing our bodies any favors. So that's alcohol, sugar, oils like fast food, fried and canola oil, additives, dyes, that grouping of food isn't really doing any of us any favors. So to take those foods out of the equation. And then the second grouping of food that I get rid of are those four that I mentioned, gluten, dairy, soy and corn. The reason that I like this is not just because of the elimination, but because of what's left. That is a lot of food to cut out. But what can you eat when you eliminate those foods? It's all the foods that we should be eating, meat, fruit, vegetables, nuts, seeds, and then I leave in rice and oats for most people, so suddenly, every bite you're taking is nourishing the body and anti inflammatory. You know you're eating berries and pumpkin seeds and eggs and zucchini and carrots, all of these things that you're eating suddenly are helping do something good for your body. I have found that if we don't eliminate it's very difficult to get people to eat enough of the good because you can say like, well, I'm going to keep gluten and dairy and sugar and alcohol in but also I'm going to eat all these healthy foods. No, we don't. Most of us don't, and if you do, then the elimination trials should be super easy for you. So it's also a nice
will I say honesty check for ourselves. I get a lot of patients who are like, I eat super healthy. I never eat that stuff. And I say, Great, let's do it 100%
and they'll come back and be like, oh gosh, that was harder than I expected. And that's a really good barometer check of like, how are we eating on a daily basis? So I'm going off on a tangent, but that's the gut rehab that I recommend. So the question was a quick gut reset? No, I don't have a quick gut reset, really, but I do think that in order to heal the gut, we have to stop irritating the gut with things that are irritating, like sugars and dyes and food that the body doesn't know what to do with, and alcohol at the same time that we're giving the gut really, really good things, and that would be things like fiber and then fiber, and then fiber, and then phytonutrients. So the brightest, colorful foods that we can find, beets and dark green leafies, we the gut also likes cruciferous vegetables. So as we're eliminating foods that are irritating the gut, then we're bringing foods in that are healing the gut. You add to that fermented foods or garden fresh vegetables, both have probiotics in them, and those are now introducing the good guys into our gut. And then we're feeding those good guys with fiber. You have a little bit of bone broth or foods high in glutamine and zinc that are help helping to calm the inflammation in the gut. Suddenly, the gut is a really happy place to be, but for most people, that's going to take about three months. And we do it for 30 days, typically, but we're we're sort of adding on as we go. And three months is really how long it takes for the gut to really.
Rebalance itself along those lines, someone asked, Should everyone take probiotics? I don't know the answer to this, but what I tell people is, I don't think so. I think that we all need good bacteria in our gut, and I like getting that from food, fermented foods like sauerkraut and kimchi and kefir, if we're getting that good bacteria. And we grow carrots in our backyard, and we wash them, but don't peel them, and we're not put spraying them with pesticides, and then we eat that, that tiny, tiny, micro bits of dirt that are still stuck on the carrot. That's really good for our gut. So do we need a probiotic? The only reason, I would say maybe, is because we kind of live in a toxic soup. You know, we live in this culture that we're not eating like that every day, and we don't even have access, necessarily, to grow carrots in our backyard, and we may be taking antibiotics chronically, or we may be doing other things that are killing off the good things that we can't do enough but my belief is, if you do a really good gut rehab, and you're regrowing these and doing a stool test to see, like, gosh, I have great levels of bacteria, I think that we can get by without a supplement, probiotic. I think we should eat lots of sauerkraut or kimchi or fermented foods just to plug here, there's a great website, and I can't remember what it's called. I think it's called a cultured life. But she, I don't know her, but she has lots of recipes for homemade fermented foods that are really tasty. So that's a it doesn't just have to be kimchi or or sauerkraut, if you hate those. There's some other ones on there that are pretty normal, that are are really tasty. So eating fermented foods eating enough fiber and not bugging your gut with alcohol and artificial sweeteners and things like that, then you shouldn't need a probiotic. That being said, if you need a bunch of antibiotics, as an aside, we should deal with that. But if you do need in a lot of antibiotics where you're killing off good bacteria constantly, if you don't like or you're not going to do the fermented foods I just said, if you are irritating the gut, like you're not going to cut out alcohol, or you're not going to cut out other things, then yeah, you should probably be on a probiotic,
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now, back to the show. Let's see, are food sensitivity tests accurate?
No, but are they helpful? Maybe, so food sensitivity tests do a really good job at testing what your body was exposed to recently and or what you're sensitive to. So if you get a positive result on a food sensitivity test, it can be a helpful guide. If you have a food sensitivity test done and you have tons of positive results, what I wouldn't say is you are sensitive to all those foods, cut them all out, never reintroduce them. I do not think that's a good answer. What it does tell us is that your gut is in need of repair, that it's leaky, is the word we use leaky gut, or that you are being exposed to more of those food proteins. Your immune system is reacting because it's seeing more of those food proteins than it should. So we do need to work on the gut. If you've got a bunch of food sensitivities, if you do food sensitivity testing, and there are three, they usually come back in, like red, red, yellow and green, or red, yellow and blue, if they come back in the red zone, then it is absolutely worth it to use that as a guide to do an elimination trial and see how you feel, and then do a slow reintroduction after you've healed the gut. If you get just one thing on the food sensitivity test, by all means, cut it out. Do a gut rehab, and then try to bring it back in and see how you feel. If you get no reds and no yellows, but a bunch in the mild category, that's where I find it a little tricky, because if there's a bunch of them that are usually the tests will categorize it in different forms of dairy, different forms different forms of gluten, different beans, et cetera. So if you have multiple in one category, then I would eliminate that category. So for example, if it says that you're sensitive to multiple versions of dairy or multiple versions like egg whites and egg yolks, then I'd eliminate.
It do a trial and then bring it back in. But if it's just a smattering of random things, some things will come back as like black walnuts, or like okra, and the person's like, I've never eaten okra in my life, then I would not worry about it. So I will say, maybe next up I'm going to talk about autoimmunity. There's a couple questions that come up with autoimmunity. Autoimmune diseases are conditions in which your body's immune system has been turned on to overdrive and is attacking your own native tissues. So for example, one of the biggest ones in the media right now is Hashimotos, which is when your body starts to develop an immune system reaction to your own thyroid tissue, and so your body will start to destroy the thyroid tissue, which means, over time, you're not good at producing your own thyroid hormones, and you often need to supplement with prescription thyroid hormones so that you can get the benefits there. There are lots of other autoimmune diseases, and many researchers suspect that there are many other autoimmune diseases that we just don't have. We haven't identified the antibody to be able to test. So when we think you have an autoimmune disease, we will do a blood test that can test for the downstream effects of the autoimmune disease in thyroid that would be your thyroid hormones. And then we also where possible check the antibody to the tissue. So in that example, in Hashimotos, it's usually thyroglobulin antibody or thyroid peroxidase antibody, and those are the antibodies we can check in the bloodstream. And if those are super, super high and your thyroid levels are very, very low, then we know that you have an autoimmune disease that is destroying your tissue, that is making you hypothyroid. There are other examples of the body destroying native tissue, rheumatoid arthritis, celiac disease. These are examples where your body attacks a certain tissue and then causes downstream effects of that so when we're dealing with autoimmunity, one of the things that we want to look at is preventing ongoing tissue damage. Let me back up. So when we're looking at autoimmunity in the conventional medical world, one of the first things they'll do is to see, how do we replace what's wrong? So in hypothyroidism, we want to give you thyroid hormone frequently. It ends there. The next thing in conventional medicine, they will often do is to prevent ongoing damage of the tissue. In conventional medicine, there's no real pathway for doing that. They just say, your body is attacking your thyroid tissue. Let's just keep adding thyroid hormone and so on. In other things, like rheumatoid arthritis, where the tissue being damaged is actually in the joint. It's the tissue of the joint itself. Then we can't just fix any downstream. There's nothing to replace in there. So the rheumatologist will help to decrease damage to the tissue itself, because it can be debilitating.
Those are both really important steps. So in conventional medicine, when we identify an autoimmune disease, those are the first time sensitive approaches we need to take. We need to make sure that we can fix what's what's missing, and then we need to see if we can slow tissue damage. So typically, we're using prescription medications to replace that what's missing, and then using prescription medications to to kind of shut down the immune system, things like methotrexate and biologics to help. Just say, like, immune system chill out, like, stop killing this tissue. And I get patients sometimes who will say, I don't want to take those medications, and that you really have to think about it from a case by case, because if you have ongoing tissue damage, the first priority has to be to get that tissue damage to stop, because we can't always undo it. Even in functional medicine, we can't undo tissue damage like that. So sometimes the medications are are really beneficial to get this to calm down. From a functional medicine perspective, we like to take it a step further and say, Why did this happen? Why did your immune system start attacking your own body? Why did it get up regulated like that? And there are different things to think about in that. One of them is,
could you have had an infection at some point that triggered the immune system, that caused this cross reactivity, and now the immune system is kind of run astray, and now it's overreacting, that can happen. And so sometimes we're looking for any chronic infection to treat. Some examples of that are gut infections, SIBO, sometimes parasites, sometimes other infections like that, sometimes viral infections that are tricky because we can't treat viral infections as easily as like treating a parasite with an anti parasitic agent, or treating a bacterial infection with an antibiotic. But the idea is, is there an infection that's continuing to spur on the immune system? Another kind of sneaky little infection we'll find sometimes is dental infections. So if you've had a root canal or a dental implant, then oftentimes there's no nerve there.
In order to pull the tooth or to do the root canal, they remove the nerve, and that means there's no sensitivity there to detect if there's ongoing inflammation. So it's a little bit easier to have sneaky infections up behind the implant or the root canal that can just be brewing there and triggering the immune system constantly. So the immune system is just like trying to be helpful and kill everything, but in the process, it's it's also killing our native tissue. So we're, when we're dealing with autoimmunity, we're looking for chronic infection or hidden infection that could be triggering that immune system. The second thing we're then doing along those lines is to say, can we get the immune system to chill out a little bit? Can we boost the good part of the well, they're all good parts of the immune system. But can we boost the part of the immune system that may be be struggling to kill off the infection, and can we calm the immune system that's stuck in overdrive and inflammation and in autoimmunity? So that's kind of one of the first things we think of when we're when we're dealing with autoimmunity. Another big thing that we see with triggering autoimmunity is stress and nervous system regulation. So frequently, you'll find when you ask patients, when did these symptoms start? And they go back and back and back, and it'll be like, Well, it started with, you know, that traumatic episode I went through, whether it was a divorce or a parent passing away, or a very difficult time as a parent, or, you know, whatever the case may be, after my car accident, after a really terrible illness, I went through, oftentimes, it's that stress that kind of puts the body into aggressive fight or flight, not just in your mind, but in the body. The body's mechanisms are actively overly aggressively looking for danger and fighting somewhat in the immune system as well, so calming that stress response and recovering the nervous system not just saying, like, Well, that was that was this traumatic thing I went through eight years ago. Like, I'm over it. It's not an issue anymore. It doesn't mean your nervous system ever decided that you were safe. So sometimes we have to recover the nervous system and say, I'm so glad you dealt with it, but has your body gotten back out of that mode? And that can help decrease the ongoing damage of the nervous system. And then there's some other things. Gut is really big in autoimmunity, and so doing a stool test seeing how your leaky gut markers are, you know, do we need to rehab the lining of the intestine? Do you have enough good bacteria? Do you have too much bad bacteria? Are you digesting? Well? We have to really make sure that everything in the gut is going well. This can be annoying for people, because if you have Hashimoto thyroiditis, and your thyroid is well managed on medications, it's going to be tricky. And you feel okay. It's going to be tricky for me to be like, You know what we should do? We should do a bunch of nervous system work and a bunch of gut healing work and double check that you don't have any infections. For some people, it just feels like too much. But if you are the person who's like, I am not getting better. What is going on? That's when we do have some avenues to say, nervous system, gut, chronic infections first up. Now we also look at heavy metals or other toxins or other things that may be burdening the system, but that, for me, doesn't come up quite as often, but it's still it's still there, and we can still manage that. And then also, do you have any nutrient deficiencies? I don't think that's the main trigger here, but certainly it's part of the allowing the body to heal is making sure it has enough of what it needs. So that's the general recommendation for autoimmunity. The question that I didn't read was, what do I suggest for autoimmunity? How can I support my autoimmune condition holistically? It's big, and you need comprehensive care. You need someone who's going to think about I've talked about it before, but pillars, right? I have my pillars and my foundational elements of health, and if you have an autoimmune condition, especially an unstable autoimmune condition or multiple autoimmune conditions. So if you also have lichen sclerosus, or you have an inflammatory bowel disease, or you have psoriasis, if you have multiple autoimmune conditions, then we really need to take this comprehensive approach to see where are the most important areas for us to dive into and to help your body recover. There's also specific questions about Hashimotos and Hashimotos. I would do all of the things that I just said. There are some other helpers we think about. You'll hear this over and over, but making sure that you have selenium, making sure that you have iodine, which is tricky, because you can overdo it with Hashimotos, and then also supporting stress levels. Myo inositol is a supplement sometimes that can be helpful there. And then this is what can you do to support thyroid health when your levels are borderline? I'm going to be really honest. There's a bunch of thyroid help supplements out there, and I have used a bunch of them with patients, and I have yet to find a patient that had borderline thyroid levels. The only thing we did was add the thyroid supplement, and they came back and their thyroid levels were way better. I just haven't seen it. I would take the thyroid as a reflection of how your body is doing. Do you need stress levels?
Control. Do you need to sleep? How's your circadian rhythm? How are your nutrients? Is your gut working to absorb the nutrients that you were supposed to be absorbing? How are your cortisol levels like? If you really want to dive in, I would be looking more at inflammation and holistic healing, rather than just the unique supplement to help with thyroid health.
All right, we have time for one more kind of big topic area, and I think I'm going to do the general health questions, because I think they're really good. What are my thoughts on ketamine therapy? I think it's a really great opportunity that we have to try things when we're stuck. So if you are struggling with mental health and it's not getting better, then that can be a good option. But I also think that a lot of ketamine clinics do not do it well, and it can be damaging, not necessarily physically, but it is opening up emotional channels to help soften them and to steer them in a different direction. And it's no joke like it's not something that we should just mess with but I think it can be really valuable for people in in a deep rut. That being said, I don't think it's enough. I don't think that's the the one and only answer. I think we need to say what is happening in the body that got you in this rut? Do you have inflammation? Do you have metabolic disease? Do you have insulin resistance? Any symptoms of that that that are going to change the way that the neurons in your brain are firing, we get way better results when we pair the appropriate treatments for the right people. So I wouldn't say, Just go do ketamine and call it good. I It's It's delicate, but I'm very grateful it exists. And I think there's good things happening. White coat hypertension. What to do about it? One of the things you can do that white coat hypertension means that you Your blood pressure is high every time you go to the doctor.
The first thing we want to know is, is it white coat hypertension, or is it just chronic hypertension? So whenever I have someone with white coat hypertension, I recommend they get a blood pressure cuff. Honestly, we should all have a blood pressure cuff at our house. Now they're 20 to $40 on Amazon, like just go buy a blood pressure cuff and keep it there as you age, you're gonna want it so then you can check your blood pressure as needed. And if you're checking it at home once a week, you don't have to be crazy about it, but once a week, check it at rest and your blood pressure is at all borderline, then that's chronic hypertension. It's not white coat hypertension. It's chronic hypertension that gets exacerbated. If it's totally normal every single time you check it at home, then it's white coat hypertension. So what do we do with that number one, you bring your blood pressure log from home every time you go to the doctor, and you say, I've checked it every week for the last four weeks. Here are my numbers. And if they're 110, over 70, then your doctor feels way better. And they say, Great. Try to chill out when you come here now. Otherwise, for white coat hypertension, you can kind of advocate for yourself to making sure that you check it appropriately. When you're checking your blood pressure, your feet should be flat on the floor, so you should uncross your legs. If your assistant doesn't ask you to do that, then go ahead and do that. You should also not talk to the nice person taking your blood pressure, because it can raise your blood pressure just pressure just a little bit, just talking. So in a perfect world to check a blood pressure in a clinic, what that would look like is you would have 10 minutes of sitting, no talking, just enjoying the peace and quiet of the medical office, not feeling stressed that they're running behind and you're not going to make it to your next meeting because they're running behind and they're going to make you late, right? There's so many reasons why our blood pressure goes up at the doctor. So in a perfect world, we would have moments to sit and let our breathing Calm down, let our stress calm down. Then we would be sitting, seated in a comfortable chair that has a firm back that you can sit up straight with your feet flat on the floor. Your arm would be about at heart level. And then they would check the blood pressure without talking to you. Did I miss anything? You'd have an empty bladder. You wouldn't have just climbed stairs. It's quite difficult, actually, to get a fully accurate blood pressure. We don't do any of that at our office. Usually we try not to talk to you, but if you're talking to us, then we're very polite. And then we recheck your blood pressure. We have stairs in our office, so so many people's blood pressure runs high. It is not ideal, which is why I like people to be able to come with a blood pressure log from home. Having an empty bladder, though, is something you could do. Taking some time to take some deep breaths in your car before you come into the office. Can help if you're rushing into the office and you're late and you're stressed, chances are your blood pressure is not going to be an accurate reflection of your reflection of your healthiest blood pressure. So hopefully that gives you some little tips. Thoughts on DEXA scan. I like DEXA scans. I like them for bone health. I like them for body composition, but they are not usually the same. So if you get a community DEXA scan from a commercial entity, they will often comment on bone health, but it's not considered in most cases, it's not considered as appropriate as a hospital DEXA scan for bone health. So if you're worried about osteopenia or osteoporosis, you need a hospital DEXA scan. If you're looking for body composition, then the hospital won't comment on that. You have to get the commercial entity DEXA.
Scan. But I like them. I think they're they're helpful. Are they essential? I mean, for bones, when you need it, yes, and insurance will pay for it, but for body composition, no, but super helpful. So if you have 100 bucks and you want to get it, I'm not opposed to that. In the setting, though, of osteoporosis screening, I do think it can be helpful to we have, do we have, do we have an episode yet, or we have one coming up on osteoporosis? I think in our one of our menopause episodes, we talk about osteoporosis and hormones, but Google look up risk factors for osteoporosis and poor bone health. If you have those risk factors, your insurance will pay for a DEXA scan. And doctors as the medical field, I think osteoporosis and osteopenia flies under the radar too much. I think we kind of forget about it a little bit because we're dealing with heart disease and high cholesterol and now menopause and all these things. But if you are at risk for osteoporosis, your insurance will pay for a DEXA scan. They're not that hard to get covered. If you have early menopause, if you had your ovaries taken out early, if your mom had osteoporosis and had especially a fracture, if you've had a fracture, that doesn't make any sense. If you've had multiple fractures from low impact, I believe insurance pays for it, for being on chronic steroid use. So there are lots of reasons why you should have a DEXA scan, and we miss it as doctors way too often, so finding out the recommendation is to have a screening DEXA scan at 65 I kind of think that's too late for like, what are you going to do at 65 to reverse osteoporosis? There are things you can do to help but they're a lot easier to do when you're 50 and 55 than when you're 65 like, starting to exercise or starting to bear weight on your joints. You want to make sure that you know where your bone health is, so look and see if you qualify for an early DEXA scan, and then just ask your primary care. It should be covered. It's not hard. And if it's awesome, then wait 10 years and get another one. What to do about low bone density? Mostly it's a matter of nutrition, inflammation and bearing weight on your joints. So walking vibration plates are having their moment in social media. I think they can be beneficial, but if you have osteoporosis, they can actually cause damage. So there are also ones that are way too aggressive. So you want to kind of do research and understand which vibration plate is appropriate for you. Jumping is great. You could jump in place every time you put something in the microwave, and that's super beneficial. Making sure you have appropriate levels of vitamin D and calcium. Don't just take calcium. You need to know what your levels are, because most people are appropriately getting calcium in their diet, even if you think you're not. Oftentimes, the calcium levels are okay, but vitamin D very frequently were low. So I would aim for calcium containing foods and vitamin D as you need it to supplement bearing weight, and then really looking at inflammation, if you've got a bunch of other symptoms, address those from a holistic perspective with functional medicine or someone who's really going to go through those pillars of gut health and movement and nourishment and sleep and stress and all of those things. All right, that was a long episode. If you stayed with me, I hope it was helpful. We'd love to hear from you. We always want to hear from you. If there are things you want us to cover, if anything piqued your fancy and you want me to dive in more, please reach out. You can reach out on Instagram. You can reach out through our website. You can leave a comment on YouTube or any of the podcast sites like Spotify or Apple, and please leave us a review if you don't mind. That's really helpful for us to get the word out so that we can keep doing this, because we love doing it. I love doing it, and I hope it's good information for you, like I said before, this is just for you, so if it's helpful, let me know, and we'll keep doing it. And with that, I'll see you next time. Thank you so much for tuning in to today's episode. We are grateful for the incredible support from our sponsors and to all of you listening. We couldn't do this without you. If you enjoyed this episode, please consider subscribing on your favorite platform. You can find us on our website, uplift for her.com, YouTube, Apple, podcast, Spotify, or wherever you love to listen. And if you found value here today, please share this episode with someone who would benefit from it. Leave us a comment or give us a review. It really helps us reach more listeners like you. Thank you for being part of our community. Stay tuned for our next episode. Lastly, this information is for educational purposes only and not intended to be medical advice. You.
