← Extend Podcast with Darshan Shah, MD
Extend Podcast with Darshan Shah, MD
155. Dr. Eboni Cornish: Neural Longevity, Brain Inflammation, and the Hidden Root Causes of Mental Health Symptoms
00:55:24
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A
Welcome to Xtend with me, Dr. Darshan Shah. A podcast dedicated to cutting edge science research tools and protocols designed to help you extend your health span. Having become one of the youngest doctors in the country at the age of 21 and trained and board certified at the Mayo Clinic, I've accumulated three decades of practice as a board certified surgeon and longevity expert. Over that time, I've discovered that a mere 20% of health knowledge yields 80% of the results. When it comes to your health span, we are living in a new era where we are creating a new healthcare system no longer focused on disease management, but achieving optimal health and vitality. Join me as I interview world renowned experts offering you a step by step guide to proactively avoid disease and most importantly, extend your health span. Brain health is often treated as separate from the rest of the body. Yet many cognitive and mental health symptoms are driven by underlying physiology like inflammation, blood flow, hormones and chronic infections. Most people are diagnosed based on symptoms alone without ever understanding what's actually happening inside of their brain at a physiological level. In this episode of Xtend, I'm joined by Dr. Ebony Cornish. She's Associate Medical Director at Amen Clinics and President Elective Eyelads where she focuses on neuroinflammation, complex chronic illnesses and brain imaging. Dr. Cornish integrates advanced biomarker testing with SPECT scan technology to uncover the root causes behind cognitive decline, mood disorders and treatment resistant conditions. We're going to unpack. Those spec images reveal real time brain activity and blood flow. How conditions like ADHD and depression might stem from inflammation, infections or hormonal shifts. And how factors like perimenopause, sleep apnea, metabolic dysfunction reshape brain function over time. Hey everyone. Before we dive into today's episode, I want to talk about something that you hear me talk a lot about. Your biomarkers. And I want to tell you how I'm approaching this situation right now with all of the patients that are calling me from listening to this podcast. So what happens is every day patients are writing to me saying they feel exhausted, they can't lose weight, they're having brain fog and they see their doctor and the doctor tells them all their blood work is normal. But the problem is this doctor usually is only checking about 10 to 15 blood biomarkers that only tell you if you have a disease developing. Meanwhile, your body has 160 different systems that are running and all of these have blood tests that we can test on how effective they're working for you every single day. So if Someone is not close to one of my clinics, one of my next health clinics, then I tell them, go to their local laboratory and get on Function Health. Function Health gives you access to 160 different biomarkers, the same kind of comprehensive testing that we do at all of our next health clinics. And if you tried to get this on your own through your regular doctor, it can cost you thousands of dollars. Hormones, inflammation, toxins, nutrient levels, they're all tracked over time in this one platform called Function Health. They can even help you get an MRI scan or a CT scan if you want one. So what I love most about this company is that they don't have a crazy incentive to do this. Function doesn't push supplements. They don't have pharmaceuticals they're trying to get you to take. You're just getting the data, and you're getting insights from the data, and you can bring this data to a clinic like ours, and we then have the information that we need to tell you how to improve your health. Membership is now only $365 a year. Literally, it's just a dollar a day. And right now, if you're one of my listeners, you can get a $25 credit towards the membership. You just go to the link in the bio or go to functionhealth.com DrShaw and use the code DrShaw25 for a $25 credit towards your membership. Dr. Cornish, so good to see you here in this beautiful city in the morning.
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B
I know it's nice and cold, but, hey, I'm from Virginia, but I'm having a good time here. It's a busy day for me, but you're my first stop and I'm so excited.
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A
So glad to catch you before. You're speaking at the Integrative Health Symposium and here in New York City, where we're at today for these podcasts, and I'll be speaking tomorrow there as well. And we're talking about some of the same kind of maybe a little overlap on the mental health and how it's affected by inflammation and all the things that you and I talk about in functional medicine, all the things I know. Well, I'm really excited to talk to you because this is. I always call this, like, the black box of the brain. Like, you know, I think that our brain is so resilient for symptoms that a lot of times, by the time we're feeling symptoms, there's been a lot of damage going on for a while, either whether it be through inflammation or blood flow issues. But then by the time those Symptoms are actually addressed by a doctor or a practitioner. It's even decades go by. Right. And we see this a lot. And your specialty is looking at scans to help us assess like what's really going on in the brain, right?
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B
Yes. Is it really an issue? Right. With the brain, is there blood flow issues? I can tell you. Right. You know, because I see so many patients like you do, they come in with all the biomarkers and they're inflamed in these markers. But is that what's really causing your neurological symptoms? So that's kind of my passion with neuro longevity is what is that root cause and is it inflammatory or not? Trying to find out what patterns we see.
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A
And so let's talk about how are you assessing blood flow in the brain?
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B
So what we do. And this is so awesome. All right, so SPECT scan imaging. First of all, I'm a functional medicine doctor, I'm not a neurologist, I'm not a psychiatrist, but I'm forced to do that because that's what we see. And with SPECT scan imaging, it tells me kind of what areas of your brain are working too hard, what areas aren't working well enough. And with Dr. Amen, you know, he discovered this years ago and we have data of over 200,000 or more scans. But my part is a little different because I'm saying, okay, where is the activity? So what we can do, especially in active scans, we can actually look at activity of that cerebellum. Because remember in school we thought, oh, cerebellum, that's the little brain, whatever. Am I dizzy or not? That's position sense. But now we know cerebellum is the boss. And it's sending signals everywhere. Sending signals to the frontal lobe, sending signals to the limbic system, temporal lobes. Yeah. So when I. That's like one of the first places I really focus on because that should be the most active part of your brain on a 3D spec scan image. So when I see little changes in blood flow there and little changes in the tracer material, I'm like, eh, we gotta talk about this. Because that can be a problem. And blood flow issues can lead to a whole host of things. Inflammation, mental health problems, chronic fatigue, sleep apnea, and even all the things like, even the reactions can affect blood flow. And you really gotta watch for those deficits. It's amazing.
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A
So, okay, let's walk through the process, like, of this spec scan. Cause I think a lot of people probably haven't even heard of it. And I've had a SPECT scan done. I think I did mine like five years ago.
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B
Okay.
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A
Not happy with the results, so I need to redo it.
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B
I'm sorry. Come see me. Come on.
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A
Yes, we did fix my blood flow. But tell me, kind of like, how does someone get a SPECT scan? What is the process like of getting this scan? I think a lot of people, the only scan they know of their brain is maybe they think about an MRI scan. So this is very different. So can you talk about that?
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B
So, yeah, so it's a 3D functional image of your brain, which is what makes it different from like just an MRI or a CT scan. So we can actually tell you. Right. What is happening in live in your brain, in the areas of your brain. And so when you're making a study, we do different types of studies. So usually because our clinics, we focus on functional psychiatry, but also functional medicine. So you can go the psychiatric point. Oh, something's not right. My mood is down. Let's see what's going on. And a lot of times where I come in is they'll find inflammation and they're like, this doesn't appear just depression or anxiety. This is more of a issue with something root cause. Because you start finding areas where the blood isn't that active or the activity isn't as active. That's called deficits. And so you get your scan like 15, 20 minutes. We go to clinics around the country, you send it to the doctors. And so where I come in because my skin's. I focus on the root cause. So if a doctor said, I think this person has adhd, but why. And I look at the skin, I say, hey, they have what you call scalloping and that's inflammatory. So let's work you up for mold, let's work you up for infections. Let's do those testing to figure out why this pattern is so unique. Why is this inflammatory pattern present? And I can tell that before I even see a patient or review their scans. And also I can look at things like sleep apnea. I can look and tell if a kid or adult is going to be in fight or flight. Like that's going to be. That patient comes to the door, I'm like, eh, they're not going to tolerate. They probably have histamine problems. They're not going to tolerate anything. So I got to calm that brain down. So it just really tells you the activity and then you can see before and afters and it changes.
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A
Yes.
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B
And that's what's fascinating about it.
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A
Yeah. So this scan, I mean, you're putting dye in someone's arm through an IV, it's. How long does it take? Like, 15, 20 minutes?
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B
Yeah, if that. 15, 20 minutes.
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A
Okay. You don't really feel anything. And when I did the scan, they asked me to relax for a scan, and then they asked me to, like, be mentally active. And they did another scan.
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B
Yeah.
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A
Is that still part of the process?
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B
It is, but it also depends on what you're asking for. So most of the times, if you want to get more accurate assessment, you'll do, you know, resting and, you know, that's our baseline and a concentration scan. However, I look more at neuro longevity and neuro inflammation. So a lot of times, you know, if I see a patient who says, hey, I'm not really as concerned about my mood, I got these lingering symptoms. They've diagnosed me with metabolic issues, and all these labs and Lyme. I don't know what's going on with my brain. Then I focus on just a concentration scan because that, to me, is the most helpful when it comes to those root causes and if it really is an inflammatory process in your brain or not. And, you know, it's so cool because you can look at traumatic brain injury, you can look concussions, you can look at so many different things like sleep apnea, dementia, and you tell a patient, oh, I'm sorry, you thought it was just one thing. I see that every day. But actually it's a concussion.
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A
Yeah.
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B
You know, it's that thing you didn't tell me about.
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A
Yeah. And so this is like the process that people should think about going through. Like, I think, you know, you and I were talking earlier. A lot of people get diagnosed, for example, with adhd, and then they get put on a medication that they end up taking for years, if not decades now. Right. They just think it's a normal part of life that they have to take this medication. But what you're saying is there's many potential causes why someone could have attention deficit. And this scan, depending on the blood flow pattern of the brain, can tell you we need to figure out the why behind the attention deficit diagnosis. Right?
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B
That's absolutely right. And it's not necessarily just only blood flow. It's activity. So what I find, you know, we'll have patients who present with adhd, since we're talking about that. And then you look and they're like, I failed so many meds. That's who our patients are. Even from a psych or just a functional. I failed everything, Doc. Help what's wrong with my brain? And when it comes to adhd, because there are so many different patterns, you can say, ooh, you can't take a stimulant. Your brain is already too active and overstimulated currently. So me giving or a diagnosis of adhd, just throwing stimulants at you won't necessarily help the problem because your brain is too active. Let's look at other things. So I have found, like, even in some patients with adhd, I've treated their Lyme, I've treated their mold, and their focus has gotten a lot better. And I've treated their histamine problems that keep you very active, and it calms down, especially that frontal lobe. And, you know, you see all that activity but then decrease and you see deficits simultaneously. So a lot of people don't have that classic ADHD brain. They think they have ADHD symptoms, but it's something deeper. So that's a cool thing. And then checking hormones and doing all the things we do from a functional medicine standpoint, and then reevaluating the brain
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A
afterwards, after you put into place a treatment protocol. And then you can see the blood flow pattern, like, calm to where the ADHD is now better, not from taking a medic, a stimulant medication, but for maybe treating a chronic infection, reducing inflammation, these kind of things.
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B
Yeah. And it's also activity is calmer. Right. And it's like, okay, these were. And especially when you look at the frontal lobes, you're like, wait, they're dopamine seeking. How can I fix those frontal lobes? And then you're. That's where the inflammatory workups can come in, and that's where the calming can come in. So it's like the calm before the storm. And people tell me that every day, they're like, I'm off my med, and I feel great. Cause you treated, you know, my thyroid, something as simple as that. Or you treated my vitamin D, or you treated my infection, like, I didn't need that in the first place. And that's the coolest part of what I do.
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A
Got it.
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B
That's the coolest part.
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A
So, you know, from you mentioned a little bit earlier, you said the cerebellum, which is that part of the brain kind of in the back of the brain that. You know, in medical school, we're taught that that's the part of the brain that controls your movement, right?
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B
Yes.
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A
And that's the part of the brain, like, if you're in sports or athletics and you are trying to get good at tennis, for example, you're developing the neuronal connections in your cerebellum, so you get good at a sport. It also helps with balance. Right. But you're saying the cerebellum is more of the control center for many parts of our brain activity. Could you go into that a little bit more?
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B
Yeah. And this. I'm so happy you asked me, because the cerebellum, right, we've learned over time that it sends signals diffusely. So it is the CEO. So you're going to get those signals to your frontal lobe. And in the frontal lobe, that's where you're thinking about focus and executive function, right? And when you have those ADHD problems, that's deficits there. You're going to get signals through the temporal lobes where you think of memory and dementia. But then you get this. You also get signals, deep regions like the limbic system and the basal ganglia, where you're getting that fight or flight response, you're getting that mast cell, we're getting that anxiety. But when you have depletions or deficits in blood flow and activity to that cerebellum, you can have problems in all those areas. So it's really important, because what we see on spec scan, on these 3D images, that in a normal brain, it's lit up like a Christmas tree. In our active skin, I mean, it's the most active. It's got these different colors, red and white. So we're like, wow, that's. That's what all of us want.
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A
Even when you're not moving, it's active all the time. All the time.
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When you're sleeping, it's active. It's the boss. When you have cerebellar dysfunction, it's going to impact you in different areas across the board. So that is key. And when we talk about blood flow problems, you gotta pay very close attention to that cerebellum. Especially when I'm treating patients with infection, I'm like, oh, lights out. There's decreased activity there. I gotta get that blood flow going. And so you do things like nitric oxide or hyperbaric oxygen or just increasing exercise to get that blood flow and oxygen to that cerebellar region.
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A
And, you know, you had mentioned earlier, too, hormones. And we were talking a little bit before the podcast about perimenopause. So let's talk about how hormone levels, estrogen levels, can affect your cerebellum.
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B
Okay, so are you gonna tell on me or not? Cause I told you I was in perimenopause. Man. Now, I gotta remember what I said. You're telling your audience for clickbait. Oh, Dr. Cornish is perimenopause. But no, honestly, I always talk about this because when we think about perimenopause, we always just think of hormonal change, cognitive issues, fatigue, mood changes, and among other things. But it really is a change in blood flow that occurs naturally as we age that we can see on brain scan imaging. It's a decreased activity as we age. And one thing we know is with estrogen, as it drops, blood flow can drop. And also as it lowers, your inflammatory markers go up. You know, you start seeing high levels of IL6 because it does suppress certain inflammatory markers. So when it goes down, the brain is slightly more inflamed. But more importantly, you're having decrease of perfusion in the brain scans, unfortunately. And that's what I think contributes, especially with that perimenopausal fatigue and even those cognitive changes that we naturally see happening. It's more of a blood flow issue than just only a hormonal issue.
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A
So perhaps a mechanism of some of the brain fog or forgetfulness you get through perimenopause can be due to the blood flow, the decrease in blood flow in the cerebellum from the hormonal.
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B
That's exactly what it is. It's not contrib. It is because it's straight science. Estrogen impacts blood flow. That's why before we had those black box warning when my mother and grandmother were going through, oh, you're going to get more blood clots, you're going to get more of this. If you're on estrogen, right? That's circulation. You get worried about that. But it's this actual science that women, as we age, our effects on vascular system changes from a neurological standpoint, which I found was fascinating. And it was after looking at different scans and I'm like, oh, this is cool, you know, and then I started thinking about myself because I got my own scan and I was like, I need my brain, I need to get with it, like, what's happening here? And so you have to increase blood flow, things like exercise. That's why we say it's all so important, right? Things like nitric oxide, like I talked about earlier, things that increase blood flow. Like, you know what we say, fibrinolytics, you know, things like nanokinase, lumbrokinase, these systemic enzymes that get the blood going, sauna, things that increase circulation. That's why women, one of the reasons women have improvements in brain function when you improve circulation. So all my patients and even me, I'm like, I gotta exercise, gotta get that oxygen up, gotta get that blood flow going. Because right now, I'm at a disadvantage as I age.
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A
So, you know, you mentioned a lot of great treatments there for someone that's going through perimenopause to decrease some of the neurological symptoms. You mentioned nitric oxide, which is a molecule, it's actually a gas that lives inside of our blood vessels. That can increase the pliability of the blood vessel, but also increase blood flow through the blood vessel. Right, yeah. So how does one increase nitric oxide?
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B
Well, sometimes you can do it through supplements. Right. There are a lot of supplements out there which I find are very helpful. That's usually my first line recommendation. Right. We can increase oxygenation with the methods we talked about earlier that you tell all your patients to do. Right. And give them realistic expectations. But typically, I'm supplementing for that.
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A
Yeah, yeah. Isn't it like the beet extract?
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B
Exactly. That's what I use a lot. Right, yeah. In my patients.
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A
Yeah. I think, you know, that's becoming more and more a core supplement, especially after, you know, 40, 50, 45 years old, 50, for many patients I see now is improving nitric oxide levels. Are you measuring nitric oxide in any way?
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B
I'm not, because a lot of times, like I said, I look, because I get all of these biomarkers every single day. I see, and I know you do 30, 40, 50, 100 pages of labs that patients come into my office with because they've seen all these wonderful doctors. So before I'm adding more blood work, I'm looking at that brain. Is it even a blood flow issue, or is it just an underlying inflammatory issue, or is it just that trauma that you had historically, or is it an oxygen sleep apnea issue or hormone issue? So I'm looking at the brain primarily to see what's happening, you know, to that person. A lot of times now, if I don't have the beauty of having that scan, that's another conversation we're doing a lot of work of. But I prefer to have that root cause I'm looking at.
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A
Yeah, just go right to the source
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B
and then compare it to the labs. Right. Sometimes I'm fooled. Right. So I think that's the beauty of, like, knowing what's really going on in the brain.
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A
Absolutely. I want to mention another molecule you talked about, which is nattokinase, which is getting a lot more attention now. Nattokinase is from The Japanese natto plant, when they ferment it. Right. And so Japanese have been using this for centuries now, fermented natto plants. But it's getting more attention in recent years for being able to actually reverse arterial plaque in heart disease. Right. And so you're saying this is also something that can improve blood flow to the brain.
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B
Exactly. And I've seen it especially, you know, now we have a lot of patients, they talk more about nanokinase and even lumbrokinase, which is the derivative of earthworms, which does the similar mechanism of action. Especially post Covid, because we were finding a lot of people with the cognitive impairment, the question in the cardiovascular risk, what's happening with circulation? So I find that those things are very helpful. And they look at them sometimes in patients if it's not contraindicated. Right. Because if you have platelet issues or easy bleeding, or you're on other meds to improve blood flow, you want to use some caution. But I found it life changing in so many of my patients because not only, you know, we know now the infectious piece, but we get more acknowledgement with COVID but we see the same thing in tick borne diseases that affect the vascular system. So as you improve that circulation, those patients get better. And I also see it with depression. I've seen it become a blood flow perfusion issue in some of the scans that I see with patients with depression. Right. They have that decreased activity diffusely in a lot of cases or in certain regions of the brain. And improving blood flow does help. Does help.
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A
So interesting. I mean, you know, I think the way you traditionally think about depression through the lens of traditional psychology and psychiatry is depression requires antidepressant medications. Right. But you're just covering up the symptoms. You're not getting to the root cause of why from a physiological perspective, your brain is depressed. Right. And it could be a blood flow issue.
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B
Exactly. And you know, I don't want you getting me wrong. Some people, they might listen, I need my meds. And that's true. In some cases it can be of value. But I also think in conjunction with the things we're talking about, the lifestyle thing, but most importantly the root cause. Because honestly, no one really wakes up like, sweet, I'm depressed today. Woo hoo. I love being this way. Ah, this is great. So you gotta think of looking at something bigger than that because it sometimes is an immune issue, blood flow issue, inflammatory issue, and if you treat those root causes, then they're coming off their meds, then they're feeling Better. So you looked at the longevity piece of that patient, and that's what I say is the way we should take the mental health. And that's what we do at the clinic. It's functional neuropsychiatry you're looking at. Yes. You have mood problems.
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A
Yes.
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B
But let's look at why you have those problems.
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A
Yeah. I think it's so important to look at. At that in psychiatry because a lot of times with a lot of these psychological indications for meds, like antidepressant medications, I think the gut instinct for people is like, why am I depressed? What's going on in my life that's depressing me? Maybe it's a breakup, maybe it's divorce, maybe there's a death in the family. And that's true. Those events in your life can cause sadness. Right. But if you have prolonged depression, there, more often than not, seems to be some sort of physiological reason for that.
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B
Right.
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A
Especially if time has passed since the event that caused a depression in the first place. And so a lot of times people don't go looking for what is the root cause, and they just end up on meds for years and years and years, and they don't even remember sometimes. Like, why was I depressed in the first place?
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B
Exactly. I see that all the time, every day. And that's actually how I started working with Amen Clinic, because I started my practice in. It was just a Lyme infectious focused practice. Right in Virginia. Right in Virginia. So I looked for a job on Craigslist that said doctors who think outside the box was the title. And I was like, I'll check out. That's cool, you know. And I came in. It was a Lyme practice. We focused on infections, pans, pandas, all the bugs, you know, even mold. And then we got a patient who had failed numerous meds. She was at the Amen clinic in Virginia at that time and failed seven meds, still depressed. Did her workup, and it was positive for Lyme disease, treated her infections, did those lifestyle changes. She no longer needed meds. And we saw that inflammation on her brain scan. So this was like 12 years ago. And from there just exploded. Because you need to understand the root causes. You have to. It's. I think I'm dramatic. It's almost malpractice if you don't. Right. Because so many things can be toxic in our world that if you just tweak it, the brains work so much better. And we see it.
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A
Yeah, absolutely. And, you know, Lyme and mold are a big problem that goes Completely under recognized, undertreated, sometimes for decades, as well as you probably see in your practice a lot.
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B
All the time. Yes, I see it all the time. And we know, like, we just had the Lyme Disease Roundtable at HHS with our. And that's one of the things we talked about were neuropsychiatric manifestations of Lyme. These patients, they don't present. They're like, I'm never in the woods. I don't have a rash, I don't have joint pain. They present just with neuropsychiatric symptoms. And then you do the workup, and it can be Lyme disease. When I like to say Lyme is an umbrella term for multiple different chronic infections that have persisted in that patient and that treatment can get better. And even you take it a step further, people have, like, situations where there are kids overnight, my kid got a fever and now they're depressed, they're ocd, they're anxious, and that's when you're talking about the pediatric autoimmune problem with strep throat and mycoplasma. And those kids have something called pans and pandas, and you can have that with Lyme as well. So all of these are infectious and immune dysregulation that's impacting the mood. And when you treat those things, may that be herbal or if they need antibiotics and you treat their lifestyle, in their gut, those mood changes are huge. And it's so rewarding as a doctor, you know, especially when you're with a patient who's been through so much and they just aren't getting there. And it's just when you see that shift, it just kind of gets me choked up at times because I'm so passionate. I live this, and especially with the perimenopause piece, I'm really living it. But it's like, it works. It is real and it's so simple. And people don't think about it, like, just take it a step further.
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A
So if you're thinking, you know, I've never been bit by a tick, like, probably Lyme isn't the cause of my issues, what do you say to those people that they don't remember a rash or being bit by a dick, that
- [28:46]
B
you don't have to, because less than 50% of patients recall having a tick bite or a rash. Less than 50% less. And a lot of times the test by LabCorp and Quest can miss up to 60% of cases. So if you're going to your standard GP and they're just doing the, you know, two step, two tier testing, you might get missed. And that's one of the things we talked about at the Lyme disease roundtable was we need to invest in better, more quality, affordable testing because of the fact that this disease complex and we're talking about Lyme disease co infections can present and you can be so nebulous that you need to do your due diligence. And it's global. You know, I have patients from Qatar, I have patients from South Africa. You know, they're like, where do the deer come from? I mean it's just one of those things that we don't think about. But it can be so easy to look for. And it's when it's missed and you don't catch it, that's when you're in trouble. But if you catch it early, it's better for you. But it's one of those things. You need to put so much in the media now about Lyme disease and people are like, oh, is this a celebrity disease? But it's been around since the Iceman and it is a debilitating process. I have patients who have Ms. Symptoms versus the person who's just tired all the time or think they have dementia. So it should be on that differential diagnosis, especially if the other things aren't working.
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A
Is there a line panel that you really like to run in your patients?
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B
Oh, I like so many, but I usually I'll use things like Vibrant labs or Igenex or Galaxy Labs. Those are more but they're out of pocket tests. But they're more accurate and they're more sensitive. So those are kind of like gold standards for, you know, limed literate physicians and health professionals because you really want to get that answer. But more importantly, I'm a clinician so I use my ears and I use my hands and I use my eyes. So when I train doctors cause with ilads by organization which is international alignment Associated Diseases Society, we train doctors every day how to be doctors. We train health professionals. You're a human and they are too. You need to touch them because I don't know how many times I'll see a patient who has a misdiagnoses and they come to my office, I'm like, oops, that's bell palsy. You have some skin issues that look like Lyme disease. You know you're having cerebellar signs. Romberg, you're having all these physical symptoms that if I didn't look or touch you, I wouldn't know or even Your heart rate is going up, like so. It's so Lyme is a great imitator, man. It can look like so many things. But if you're not being a clinician, you're missing the point.
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A
Absolutely. And on the brain scan, Lyme looks like inflammation.
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B
Well, it's not just Lyme. Chronic toxicity can look like inflammation. And I see patterns. So in the initial phases, you might have decreased through diffusely blood flow. Because Lyme, especially some of these co infections like Bartonella and Babesia, they impact blood flow. They go inside the red blood cell. So you'll see deficits and decreased blood flow. But then the kicker is you'll also see inflammation. And we look at this area on the top of the brain that's like the money shot. It's called the parietal lobe. So right at the top, and you'll see these, like, what we call bumpy grooves. That just means decreased activity. That's galloping.
- [32:13]
A
Right.
- [32:13]
B
And then you're like, hey, let's do some digging. It can be Lyme, it can be mold, it can be metals, but something inflammatory has happened. And then you can look for areas of the brain that are too active that shouldn't be. Because I told you, when you look at an active deep skin, that cerebellum should be on fire. Then you look at other areas that are just all over the place, active. You're like, this doesn't make sense. And that could be another sign that that's an underlying inflammatory process. And I have. We have over a thousand line brains. One day I'll publish. What? My triplets are in high school because they're nine. It's too much.
- [32:46]
A
You have triplets?
- [32:47]
B
Oh, my God. That's why I'm getting out of here soon. Yeah, man. But honestly, you'll see those same patterns. But get this, sometimes you don't. And then you have to ask yourself, okay, this brain is not inflammatory. I see some beautiful brains with Lyme patients. But then they might have thyroid issues or immune issues that are just dysregulated. So you gotta shift a little bit because the brains are pretty. Pretty standard and not inflammatory.
- [33:17]
A
Right. So can you pick up. We talked about hormonal issues like low estrogen. Can you pick up thyroid issues in the brain scans as well? Potentially. Are there signs that indicate that?
- [33:28]
B
Yeah, I tend to work up thyroid hormones, kind of mold, inflammatory markers, blood flow, CBC, C&P, all in my initial workup before. Like when you're getting your scan and you're doing a functional medicine workup. We're doing those basic labs. No matter what you come with, you know, you can say, oh, I just, I'm curious about a scan. I just want to know in my rain. We are working up the basics first through LabCorp. And thyroid is on there and because sometimes you'll see decreased acne activity and blood flow and that's the primary symptom. Like I have a two week intensive program where I treat patients intensively with Lyme infections. They come and they stay with me for two weeks, but then I'll have some brain scans and I'm like, okay, yeah, this is inflammatory. But has anyone ever talked to you about your thyroid? Because we see those inflammatory patterns and you have to work that up. So you can't treat these infections we're talking about without doing a global kind of endocrine workup. Because that definitely will impact brain scan and brain function.
- [34:34]
A
Yeah, absolutely. Yeah. It all goes together. The hormones, the metabolic health, the brain scan, the blood flow. And you know, once again, I'll just keep emphasizing this, that if someone is out there listening, that is suffering from any mental health diagnosis, go deeper with a functional physician to really figure out the root cause of why.
- [34:55]
B
And there's pretty much a root cause. You know, I'm always surprised by how simple it is, right. Some people who might present that I know you see every day with hormone problems that you treat and their mood gets better. But one thing that I really got fascinated with, definitely the traumatic brain injury piece and how suppresses of hormones and impacts mental health. But then the sleep apnea piece.
- [35:20]
A
Yeah, let's talk about that. That's so interesting. I didn't know that you could pick up signs of sleep apnea on a brain scan.
- [35:25]
B
You sure? And that's pretty amazing because you'll also see, you can even see that bumpy scalloping presentation, especially posteriorly in the parietal lobe with sleep apnea and decreased cerebellar activity simultaneously. So I'm always, no matter how small you are, how skinny, you know if you snore or not, if I see scalloping in that patient and they have this fatigue, I'm asking them about their sleep history. Because sleep apnea, I tell patients, well, that's priority number one. Do you want to keep killing those brain cells but getting oxygen, I can treat you with all the things we want I could treat. Sure. But if your brain cells are dying every day because you're not getting oxygen to them while you're sleeping, well, a lot of this might be in vain. And I think a lot of doctors, because I know when I first started, I didn't do this. You want to jump? Let's treat the root cause immediately. But the root cause is multifactorial, and sleep is so key. I see that. And even in my perimenopause, menopausal women, my Lyme patients. And that's one of the things I do. I'll ask questions. Has anyone ever done X? No. Okay. Put that down on my list. You know, because sleep apnea is missed so often, and it just makes a difference.
- [36:40]
A
I totally agree with you. I mean, it's like when I diagnose sleep apnea, I'm like, this is the most urgent thing that we have to fix right now is the sleep apnea. Because this is affecting every aspect of your physiology. You know, your blood flow to your heart, your blood flow to your brain. It's affecting. So it's causing inflammation throughout your body. All of it is connected to so much. And the problem with sleep apnea, like you said, is there's no typical patient for sleep apnea, right? People think it's an overweight person that snores a lot. And that's true. That person probably has sleep apnea. But like you mentioned earlier, I see so many people that are skinny, you know, they're thin people. And you would never think that they have the anatomy for sleep apnea, but they do, right? And so it's a really, really. It's a much bigger problem than we're
- [37:30]
B
diagnosing, and people don't put it on their differential diagnosis. And like you said earlier, when you talk about root causes, I do want your audience to know that you gotta think of systems, you know, in all of my patients, the first step. I don't care if you have Lyme, Mississippi. ALS, mold. I say, okay, we gotta stabilize your hormones and your sleep. If not, we're wasting our time. We gotta do your gut. If not, we're wasting our time. Then we can get fancy and look into that root cause, that immune dysregulation. But if I. You don't have your hormones and your gut and your sleep. What are we doing? We're wasting a lot of time and a lot of resources because we didn't do the basics. And that's where brain scan imagings come into play as well, because you're looking at these inflammatory scans. So you do the workup, but then you're like, okay, are you sleeping? Did you hit your head? Do I gotta treat your concussion? And so it takes it another level when you're looking at neuroendocrine and neuro longevity, you go there first and then you build from there because if not, it leads to a lot of hard work. And I found that when I started, I'm like, I'm getting their Lyme, I'm getting their pandas. And then they come back and I'm like, hey, it's been a couple years, you're good. And they're like, no, because you didn't check my hormones. Like, yeah, I didn't because I didn't want to. But then I have to. Now I have to look at the whole person. If we want optimal success, if we want neuro longevity, brain longevity, you can't, you can't cheat. I tell people it's like a train. You start at home based brain hormone support, then your gut, then your toxins, then you can treat the root cause and get healthy. But if you're just going in there and someone's like, hey, you have this, let me give you some drugs, that's the world we live in. And that's why people don't really achieve healthy maintenance long term, right?
- [39:16]
A
And you mentioned this term neurologevity quite a few times. And so that healthy maintenance piece, all of the root cause stuff, all of the basics like sleep and hormones, without addressing those, the longevity of your brain is definitely affected negatively, right? I mean you can't have brain longevity without getting those aspects right.
- [39:38]
B
And you wanna look at it, you know, so, you know, it's looking at the imaging and the biomarkers and the clinical exam altogether. Because I find, you know, when I go to longevity meetings and conferences, we focus on a system, you know, let's focus on the biomarkers, let's focus on the mitochondria, let's on the hormones, let's focus on the toxins separately. But if you take all those biomarkers and we apply it to what the brain looks like and we tell you, even we have the ability on brain scans to say, this is how you'll look if you do something that I tell you to do 20% better. This is how we can get your brain. If we eat right, if we treat these root cause problems, if you listen and you do the right things to love your brain, right? And you're putting the right things in your body and your gut, we're fixing your immune system, you can look like this, but it's not as if we're saying magic, voila. It's simple. We can do longevity markers, sure, all day, but how is your brain responding to it? So if I'm treating your hormones and I'm treating your infections and your brain is still inflamed even though your hormones are perfect, then what are we doing? What are we doing? What are we missing?
- [40:53]
A
Yes. So could you define, like what does the word neuro longevity mean to you?
- [40:58]
B
It means I love my brain for the rest of my life and I'm gonna do everything possible to take steps to healing it for a long period of time. So I'm gonna do the homework. And it doesn't mean you have to be fancy. Cause people always hear longevity and they think the fanciest test there is in the world that they can't afford. You can have longevity just treating your gut better, just treating the basic medical things that your primary can draw, like the hormones. You can get that with LabCorp and quests. Right. It may not be as accurate as something like, you know, hormone zoomer or something of these other tests, but you can get that basic workup I designed for patients now, recommendations for diet for longevity. Because usually you'll say gluten free, dairy free, sugar free. But you have to be culturally sensitive, you have to make it individualized. So I asked myself last year, how could I do a low histamine, gluten free, sugar free, brain longevity diet? Is that realistic for me being a mother of three kids, all day working? And so now I kind of create those longevity kind of brain longevity diets based on your needs. Like for example, it's so funny, I had a patient, hope they're not listening, but he's a truck driver. He looked at me, he said, look, yes, I have Lyme and all this. What do you want me to eat? Like seriously, you're telling me gluten free? I drive all day, I don't have time to cook, I don't know how to cook. So I had to craft for him a diet. Healthy alternatives at restaurants and fast foods and how to bump up your protein and just give real options. And doctors don't really do that. So when we say longevity, we're saying gluten free, dairy free, sugar free, or carnivore or this ofore, you know, but we're not individualizing it. And I think, I think that's what we, that's one key part for brain longevity. Long term resolutions. Not just fads, not just quick fix. Something someone can do to love their brain for the rest of their life.
- [42:59]
A
Yeah, it needs to add up day after day after day versus just one intervention.
- [43:03]
B
Exactly. Because I Found patients would fail and then they would get guilty and then they'll get more depressed because they're stressed out about what to eat around their friends and family or holidays. And so that's a key piece. Loving the gut in your brain because they're connected, but trying to find those steps to keep people going the right direction, even when it comes to increasing blood flow. People are gonna tell you, I don't feel well, doctor, Life feels like it sucks. I don't wanna get out of bed. How are you gonna tell me to optimize my longevity, I'm gonna exercise 30, 40, 50 minutes a day. So it's all about baby steps to love your brain and forgiveness and granting yourself grace and taking it one step at a time so that long term you can adhere to those recommendations.
- [43:48]
A
Sure, it makes complete sense. And so I'm curious, all the brain scans you see all the time, is there like an optimal, like a beautiful brain scan that you've seen? And, and what's the oldest person you've seen with like this beautiful pattern?
- [44:02]
B
It's probably you. No, it's not. Well, I haven't looked at your brain yet, but I'm just, I'm just gonna tell you it's probably you. You tell people I have perimenopause. I'm gonna tell people you have a beautiful brain because that's a term Dr. Amen use all the time. Your brain is beautiful. And so, I mean, a beautiful brain is nice and smooth. You have a lot of activity everywhere in the front of your brain, a frontal lobe. So you're not being addicted to things, addicted to your phones, addicted adhd. Temporal lobes are nice and beautiful and symmetric. So your memory is good. Your parietal, that top of the brain is nice and smooth. So it's symmetry. And then that cerebellum is like, oh my God. That is hallmark. That is the most active. No other areas in your brain are working too hard. You're focusing more on cerebellar function now. That is beautiful. That's like brain. I'm jealous. I want that brain. You know, not a lot of us have it, but that's our goal. And I actually saw a 72 year old woman. Wow, 72. She looked like she was 40. She looked younger than me. This woman, all of her life she had ate organic, she was training for marathons at 72, she optimized her immune system, but she also optimized her faith. And faith is so important no matter what you believe in. As far as brain longevity, just having that belief in something bigger than you. And she. I was like, is this her? You know, like I kind of went back and forth and I was so impressed. But it's easy. It's not hard. We think you gotta have a closet full of 60 supplements or 700 pages of labs. Brain longevity, neuro longevity is so simple. And it starts with taking care and doing things that love our brain. It's that simple. It's that simple. But she was. I was jealous. I'm still jealous of her.
- [46:00]
A
Yeah, I'm getting jealous of hearing about her perfect brain to 72. And so like you said, she's eating organic, she's exercising, she probably does not have sleep apnea.
- [46:10]
B
No, no sleep apnea. Her hormones are stable. She's on bioidentical. She's been on that for years. And all her levels, I mean, this woman was like an alien patient. I was like, are you serious? And she just came to me because she said, look, you know, I had Lyme disease years ago. It was like 20 years ago. She wanted to make sure it wasn't still active. She was curious because she had Covid. And you know, Covid reactivates a lot of. And she said, you know, she wasn't even. It wasn't just organic, it was just healthy. Like she didn't eat processed sugar. She was really focusing on things that loved her brain. She wasn't out there eating too late, she was intermittent fasting. She was putting those easy things in play long term. And even despite having these inflammatory exposures, she was able to compensate for it. But she just came out of curiosity. She heard I looked at inflammatory skin. She's said, is mine in plan? I wanted my brain to be great for the rest of my life. And I said, you know what, you should be the poster child of brain health. Yeah. Because I see so much dementia. Like I'll have patients. When you talk about brains, there's so many sad, heartbreaking cases. Like I had a patient with Lyme disease and he had been on IVs, he came from all he has seen, like some of the most world renowned Lyme specialists through the years. And cognition just wasn't getting better. And his mri, he didn't have plaque, he didn't pass all the Alzheimer's labs, but when I looked at his brain, he had prefrontal temporal dementia. And you know, you can take a lot of antibiotics. Sure, that might give you some treatment, but it's kind of irreversible. And we wouldn't have known that unless we look. So that to me was a heartbreaking story. And I do see cases like that where it is, you know, advanced stage, you know, cortical brain atrophy. And you have to have those real life conversations about what you can realistically do for that patient, but also provide them that type of support. And they were so grateful because they were like, you know, I just did peptides and ozone and IVs. And this went to this country, in this country. And I just have to make use of the brain I have and try to support that.
- [48:27]
A
Yeah. And you know, like, I think also to your point, like, a lot of times it's never one thing. It could be a combination of things like hormones, sleep apnea, and then maybe even dementia that's been occurring for years and years. And I think that's kind of the beauty of being a clinician, but also having all these tools available to you, like blood tests and brain scans that you can, can paint a picture of what are the different aspects of your biology that are affecting your brain and what can we improve and what we can't improve and then just having a realistic move forward plan for that individual. Right.
- [49:02]
B
Yeah. And that's why. Another reason why I got into personally loving brain imaging, because both my mother and my grandmother had dementia. And I know because when I was younger, we moved into my grandmother's home and it was a moldy home as well. So having that risk. I've checked out my Apo E3 E4 jeans. Luckily they're not there. But still knowing I need to be more proactive, you know, looking at my own brain, doing the things that I can do to the best of my ability to love my brain, to try my best, because that risk is there. And that's something that became more passionate to me and what I like to tell everyone, you know, look at your family history. Even with dementia, sometimes there are things that are published like mold and even depression and infections. You know, they have Lyme disease and amyloid plaques that is being published that can make it worse. So by me looking and being proactive, you know, I can't avoid what my family history risks, but I can stay on top of it. And it's something I think about, you know, especially when I was going through perimenopause. Cause it mimics ADHD memory issues. And I'm like, help is this. You know, but then I'm like, oh, okay, let me get on my progesterone, you know, okay, I can find my keys now. You know, like, you know, that's kind of but it's all about loving the brain you have. Because we can't prevent life.
- [50:30]
A
Yes.
- [50:31]
B
Things are gonna happen, right? We're gonna be throwing curveballs. No matter how much we try to be like my other patient, that perfection is not realistic. So we just have to try. And that's what I do for myself. I try every day. I have my faith, and I know that if I focus on what I can control, all I control is what I eat and where I live. Everything else is just natural occurrence. But if I put those in perspective, that helps me help my family and help other people. But you gotta love yourself.
- [51:00]
A
Yes. So true. And I think, you know, to your point, you have to love your brain. And people think about that way too late in life sometimes. So the time to think about loving your brain is now. And we gave people so many actionable tips. So I really thank you for coming on the podcast and giving people, like, a list of things to do. Get checked for sleep apnea, get your hormones checked, check for mold. If you live in a moldy house. Right. I mean, you can get a blood test as well or a urine test to get mold markers. Lyme disease can be a potential thing to check for. And then get a brain scan.
- [51:36]
B
Yeah. And viruses and metals. The list goes on and on. And your immune system. Just get those things checked. And it can be done for insurance from a great, functional doctor, people like yourself, who can help you from a specialist in these infections, like eyelids. There are so many different doctors that look at these things and can help you if you catch it. But if you're just ignoring it, it's gonna be a harder journey, right? It's gonna be a harder journey.
- [52:05]
A
Yeah. Well, thank you so much for coming on the podcast today and talking about all this. I think we gave people a lot of. A lot of things for sure.
- [52:13]
B
This was so awesome.
- [52:14]
A
So much fun.
- [52:15]
B
He's the coolest podcast. Well, I can't say, but he's a really cool one. I don't want to get in trouble, but this has been amazing, wonderful.
- [52:23]
A
I really, really appreciate you doing this. Where can people get more information about you and the organizations that you work with?
- [52:29]
B
Yeah, so I do a lot of quick tips on social media, so. R.ebony e b o n I Cornish. Also Dr. D R Ebony e b o n I CornISH.com and Eamon Clementine. You know, I work out the Virginia, But I have 11 licenses, so I do telehealth around the country and even internationally, so. Amenclinics.com if you want an intensive, like someone's listening and they're like, you know, I've been on this journey, I need some help. I need that neuro longevity, all this stuff has failed me. I need a two week get in, get out. I have a two week neuroinflammatory intensive program as well where I can treat you intensively. IV's testing in Virginia, all the things, things that we're talking about in Virginia for you. You become a best friend for a couple weeks and you can learn that through the amenclinics.com but I'm easy to find. I'm easy to find and I'm here to help because this isn't a job, this is me. I've shared so many personal stories like I do in one of my patients. And we can help people, doctors like you, doctors out in this. We're on the grind, we're not here. It's not easy.
- [53:32]
A
So we're sitting even get, get a scan. I know amen clinics, there's scanners all
- [53:37]
B
over the country, all over the country. And you can get a scan. We have clinics, we have em at all over Arizona, Texas, California, Virginia, Florida, Chicago. And I know I'm missing tons of other places, but we have them everywhere. And that's where you just get your scan and you can have it read via telemedicine, you know, from someone like myself. Especially if you're interested in a neuroinflammatory, like you're not, you're like, okay, yeah, I've moved, but then I also have inflammation. You have the ability and we have other functional doctors as well that do the functional piece of mental health or just in general, you know, Lyme disease, mold, all the toxins, but you can go to the one closest to your home and if you look@AmazonClinics.com, you can find those clinics and then get that treatment from doctors all around the country.
- [54:24]
A
That's beautiful. I really appreciate you coming on here. Thank you so much.
- [54:28]
B
Thank you. Thank you so much. I mean this is awesome.
- [54:34]
A
Thank you so much for listening to the podcast today. Please remember to subscribe if you like this episode and give us a good review and share a link with your friends. It really helps to support all of our efforts. I also want to remind you that the information shared on this podcast is for educational purposes only and is not intended to replace professional medical advice, diagnosis or treatment. Please consult with your healthcare provider or physician before making any decisions or taking any action based on what you hear today. Especially if you have any underlying health conditions or on any medications. Your doctor knows your personal health situation the best, and it's always important to seek their guidance.