← The Thyroid (and Hormone) Fixer Podcast: Thyropause, Menopause, Metabolism and How to Fix It
The Thyroid (and Hormone) Fixer Podcast: Thyropause, Menopause, Metabolism and How to Fix It
592. The Female Heart Crisis No One Warned You About
00:49:53
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- [00:01]
A
When it comes to cardiovascular disease, the problem is, is that it builds up in silence. Then you don't necessarily feel a problem until it's too late. And so I love what you're saying, and, in fact, I say the best way to manage a heart attack is to manage to never get one in the first place.
- [00:17]
B
Welcome to the new and completely reimagined Thyroid Fixer podcast, a podcast that refuses to sound like every other health show out there. We're here to disrupt this entire space, and now you are part of that disruption. If you're listening right now, it's because you've hit your breaking point. And I'm here to tell you.
- [00:37]
A
Good.
- [00:38]
B
Because this is where everything changes. This is where you finally say, no more. No more being dismissed by your doctor. No more being told your labs are normal. No more recycled medical advice. No more recycled biohacking advice. No more being told to accept what you know isn't right. Here, we do things differently. This podcast gives you information you can actually use. Real tools, real direction, real answers, so you can take back your energy, your metabolism, your hormones, and your life. Every episode will leave you with something actionable, something that moves you forward, something that reminds you that you're not crazy. You're finally being hurt. This is Thyroid Fixer Podcast.
- [01:25]
A
And this.
- [01:26]
B
This is where you rise. I completely and totally hear you and I see you and I understand you, and I know exactly where you're at. You're gaining weight. You can't lose. You have all the symptoms that no one's listening to. The fatigue, the hair loss, the brain fog. You can't remember why you walked into a room. You don't want to get dressed and go out because you know, if you have that glass of wine with your friend, you. If you have that dessert with your husband or even order an appetizer, you're going to be five pounds heavier the next day, and your clothes are already tight. Every single doctor is telling you that you're normal and everything is fine. You've been to multiple conventional medicine doctors trying to use your insurance, hoping to God that somebody has an answer. Then you've dropped thousands of dollars on functional medicine or integrative medicine because you keep hearing how functional medicine gets to the root cause of the problem of. But not every functional medicine practitioner knows the thyroid and knows the hormones and can treat you as a nuanced, personalized individual, a unique person. That is exactly what my team and I do. We specialize in thyroid problems. We specialize in hormones. You can't do One without the other. You cannot just see someone for your thyroid and have them ignore your hormones or have them half ass your hormones. They better be a hormone and thyroid expert if you are going to spend your time, your energy and your money if you are going to invest in functional medicine. They need to be a thyroid and hormone expert and treat you as an individual. They can't have a cap on how much T3 that they're going to give you. They have to personalize your treatment plan to get you feeling your best, no matter what that looks like. So that every system in your body functions at the very top, at the very best. And that is exactly what we do. I made it my mission because I went through this. I was dismissed, I was gaslit, I was misdiagnosed and I dropped thousands of dollars before I found an answer. That is why I made it my mission to be able to treat people in all 50 states so we can prescribe via telehealth. Thyroid and hormones and peptides. Yeah, the GLPs as well to all 50 states, most of Canada and now Puerto Rico. That is my mission to be able to help you wherever you are because I want you living your best life. I want you to join me in optimization land where you can go out and love life and go out with your friends and go out with your partner and not gain weight looking sideways at a brownie. Yes, we do have financing options available. I'm talking like 0% or 12 months, the whole thing based on your credit score. We got you. And our programs are affordable. They're completely and totally affordable and they will get you from point A to point B. They will bring you into optimization land. So please don't waste another moment struggling, please. I want you living here with me, a great happy life in optimization land. So go to my website@dramy.com, click the Become a patient button so we can have a chat. Let's talk it out. Let's hear what you've done, what you haven't done, what's worked, what hasn't worked, and let's get you on the right path to feeling your absolute best. If you can imagine the best life ever, that is absolutely possible for you. I'm not BSing you. I am not BSing you. I was in your shoes. Many of my patients have been in your shoes. We will get you there and that is my promise to you. Healthy hormones begin with healthy cells. So when we talk about thyroid or hormone health, we usually focus on labs, supplements or symptoms. But there's a deeper story happening in your body, and that's one that begins in your cells. Every hormone your body produces relies on healthy, energized cells to do its job. And at the heart of each cell are the mitochondria, your energy centers. As we age, or when the body is under stress, mitochondrial function naturally declines. That can show up in so many ways. Fatigue, slower recovery, or just simply that feeling off. This is where Timeline Nutrition's breakthrough mitopure comes in. Mito pure is a highly pure form of a nutrient called urolithin A, if you've ever heard of that. It's backed by over 15 years of research, multiple human studies, and has been shown to support mitochondrial health, muscle function and overall cellular performance. By helping your mitochondria work more efficiently, you're supporting the foundation of your energy and your long term wellness. I personally found that this deeper cellular approach to health is a powerful complement to everything we do for thyroid and hormone balance. It's not about quick fixes, it's about building resilience from the inside out. If you're ready to support your body at the cellular level, Mitopure offers a clean, clinically backed way to start. So you are going to go to timeline.com Dr. Amy so that's T-I M E L I N E.com Dr. Am Am I E and you're going to see the code on there. Dr. Amy 10 D R A M I E 10. But if you want to try the gummies, the mito pure, it's actually going to give you 20% off your order. So just go ahead and click that code. D R a m I e 10. You'll see it on the page or you can add it at checkout. You're going to save some money while giving new life to yourselves. We have not yet dove into the number one killer of women yet on this podcast in like 580 episodes, which is ridiculous. But ever since I met my dear friend and colleague, Dr. Sanjay, well now, I mean, it's a must have on the podcast. It's a must discussion. Because here's the thing, ladies, if you're like me, you think that you're invincible to heart disease. Now I truly believe that I was invincible to cancer too. And then it bit me in the ass last summer. But I still have this belief that I am invincible to any type of cardiovascular anything, because come on, I'm healthy, I take care of myself, I'm going to defy the odds. But the bottom line is this is the number one killer of women. And we need to pay attention and we need to be proactive and not reactive after something happens. So if I can give you. If we, Sanjay, and I can give you all the information that you need to do things now, implement things now, then you won't need the band aid medications and you won't be on an operating table or have your death certificate say cardiovascular disease, heart attack, cardiac arrest, whatever that is. So let's dive into it. I know it was kind of scary there. That was a scary intro. But it's real and it's raw and it's unfiltered, and that's what we are on this show. So, Dr. Sanjay, welcome to the show.
- [09:24]
A
Game on. And Amy, I just want to say from the start, I am not the number one cause of women's death. It's cardiovascular disease.
- [09:31]
B
I'm gonna ask for what I don't know.
- [09:33]
A
I'm the crusader against not, not the cause of. But thank you for that introduction. And I think it frames our discussion beautifully because when we think about what kills people, and in particular, what kills women, you know, if you do one of those street level interviews like they used to do on the talk shows, most people are probably thinking breast cancer, and most people are probably thinking car accidents or Covid or any number of things. But again and again and again, we are number one, meaning heart disease is number one. And my crusade is to make it number two, meaning we've held the number one position. So for so long in the cardiovascular universe, I want to give somebody else a chance, right? But it is so true. And I think when we think about women's health in particular, right, when you say women's health, most people think of hormones, right? Because when you are deficient in hormones, when you're experiencing menopause, when you're in that perimenopause, all those things, those are situations that you feel, right? You feel brain fog, you see your hair falling out, you feel fatigued, all of these things, your sexual energy goes down, whatever it may be. These are feelings. But when it comes to cardiovascular disease, the problem is, is that it builds up in silence, right? And you don't necessarily feel a problem until it's too late. And so I love, you know, what you're saying. And in fact, I say the best way to manage a heart attack is to manage to never get one in the first place. And I hope, you know, out of our discussion, hopefully some of your listeners out there will learn some of the strategies, the prevention, and some of the new imaging. I think that's available to get out of the way of cardiovascular disease in the first place. But I'm going to give you a little hint here, is that one of the most amazing screening tests for cardiovascular disease is something that women are doing on an annual basis anyway, which is. We'll just start with this, which is a mammogram, really. Right. Okay. Yeah. So believe it or not, when we look at mammogram, you're taking X ray of the breast tissue. Not the most comfortable test. My wife just had one. And so I'm like, man, if guys certainly had to do something like that for our testicular prostate cancer, they would have figured out a much better way to image. So we'll put. Put that aside. Right. But we're not using that test for its full power because while we're looking at soft tissue, the breast is very vascular structure. Right. And you see that women, you'll see that with fluctuations in breast size, with your menstrual cycle and things. I mean, those hormones are getting delivered. And so you've got an intricate network of blood vessels supplying that very important tissue. And on mammography, we can actually see calcifications within the arteries that supply the breast. And. And that then gives us insight into what's going on with the rest of the body. So it's one of those things where I don't think the mammography community is very aware, Certainly the cardio. I mean, if you have a cardiologist looking at a mammogram, that's like, that may be happening. Like, I may be the only cardiologist that actually opens those images when I see them available. And probably a handful of women's health cardiologists and things. But it is such a powerful tool. And I think that the important kind of take home from this is we see vascular disease so much earlier than a heart attack or any of these kind of major things. So we really need to play heavier on the prevention side because we're getting the information, we just know how to use it.
- [12:41]
B
So outside of someone getting a mammogram, what are some early signs, symptoms that women can look for, pay attention to, that could point toward cardiovascular disease or that even doctors miss when the woman goes to their doc and says, hey, doc, I'm feeling xyz, and then they get dismissed and blown off and then have heart issues later?
- [13:03]
A
Well, I think that what we need to realize is the conventional elephant on my chest sweats kind of going to the arm and the jaw. These are descriptions of cardiovascular disease in A bunch of old white dudes in the 1950s, right. So this all came from Framingham, Massachusetts, something called the Framingham Study, where they looked at people who had cardiac events and then asked them later to describe their symptoms. And while that may be true for middle aged men in Massachusetts, what we've learned, particularly in women, is that is not the common presentation. In fact, what they tell us, and it's kind of a dumb thing to say in cardiology, but what they teach us in cardiology fellowships is that the most typical presentation for women is an atypical presentation. Right? So that's like saying the most normal thing is abnormal. It just, it doesn't make sense. Right. Because at that point, the abnormal thing is what's really normal. Right. So this atypical presentation is really normal. And what I mean by that is it's not the elephant on my chest and things. I've been humbled many times in my career, but I've always erred on the side of caution with women because I tell patients anything from nose to pelvis is cardiovascular to me until proven otherwise. I've had one woman who had a chronic toothache that she kept going to the dentist and then she finally saw me for a non wasn't a chest pain console, it was like a blood pressure cholesterol consult or something. And I asked about this toothache and she goes, yeah, it's weird. Every time I exercise I get this toothache. And that clued me into boy. That could be a manifestation of this woman's chest pain equivalent, or what we call angina. And sure enough, we did a stress test and she had a 90 something percent blockage in the artery down the left side of her heart. I fixed it and all of a sudden her toothache went away. Right. So it's humbling and feelings of anxiety. I had another woman who presented to a different hospital earlier in the day because she just felt something was off. Didn't, couldn't exactly put a finger on it, but she, you know women, you guys know your bodies very well. And she said, something just isn't right. She went to this other hospital and they did the full workup and said nothing's wrong. And this kind of really just kind of creams my corn because they told her, why don't you just go home and have a glass of wine? It's probably anxiety, you know, it's that medical gaslighting that happens. It just gets me so angry. But. But she ended up saying something's not right, was discharged from that ER and Had her husband drive her to my ER where I was located. I mean, she didn't come there for me, but just came to a different hospital, get a different set of eyes. And as she walked through, through the door, she had a cardiac arrest. Like at the threshold of the emergency department. Right. I wish I was making this up, but it's. But I'm not. And so full chest compression, shocks. We get her to the cath lab, she had like a 99% blockage down her left anterior descending artery. I went in, I fixed it. She did great. But, you know, she just knew something wasn't right. Right. And so I always respect when a patient, regardless, man or woman, tells me something just doesn't feel right. I can't put a finger on it. That's the person that makes me a little bit more nervous. And that's the person that, you know, of course, is going to get the cardiac workup because it can be so variable. So women out there, it could be shortness of breath, it could be a toothache, it could be acid reflux sensations. Right. Certainly it could be elephant on the chest pressure or shortness of breath. But, you know, if something doesn't feel right, go to your doctor, your general doctor. But I think have a low threshold to ask to be seen by a cardiologist. And, and I'll tell you, unfortunately, with my guild of cardiologists is a lot of them won't pay attention, but you got to find someone that's going to listen to you and pay attention. Right. And if not, come out to California and see me because I've seen too many people that I saved from falling through the cracks as a result of or just as. Because they didn't have the typical chest heaviness type nonsense that most people equate with cardiovascular symptoms.
- [16:32]
B
Wow. Okay. Now I'm just going to throw in here because I know, I know what is going through my audience's mind right now. Right now. They're freaking the hell out because pretty much 99.9 of my audience has anxiety.
- [16:45]
A
Right.
- [16:46]
B
Because you're talking to perimenopausal, menopausal women there, Sanjay.
- [16:49]
A
Oh, yeah, yeah.
- [16:51]
B
If we're throwing. Which we're going to do right now, we're going to throw hormones, we're going to throw thyroid. We're going to throw heart health into a big bucket and stir it all up. So I'm going to have you unpack why low hormone function puts us at a greater risk how thyroid dysfunction puts us at a greater risk. And how that affects the heart. But before we do that, the symptoms of low thyroid and low hormones can overlap the symptoms that you're just saying right now. So how do we differentiate?
- [17:21]
A
Yeah, and that makes it really confusing, Right? I totally agree. And we call it second year med student syndrome. Right? Where you're reading in the books of, oh, I've got fatigue and I had hair loss and I can't sleep, I, I must have leprosy. Right. Even though I have like, you know, we kind of come up with these things. So first and foremost we want to look at reversible causes. And in the, what I love about the world of functional medicine is that you understand that everything is related to everything else. And while it can be a bit overwhelming, you know, what we have to do is put that in the context. And so that's why for your listeners, I didn't mean to be fear mongering and all those things, but that's why you need a doctor like Dr. Amy, who knows, how do we put these pieces together, right? I say that's knowledge without wisdom, right? You may know the facts, but you don't know how to put them together. And that's just, that's the role of a doctor, right? That's why I don't think we'll be replaced by AI or anything in the foreseeable future. Because you still need a human to be able to put these things together. Now that being said, perimenopause and the perimenopause fairy has touched my house here as well. Is, I mean, can I just say, a bitch.
- [18:19]
B
Can I say.
- [18:21]
A
I mean, it's just women are amazing to me. All the different phases of life and all the different stages. It's like your four different beings at different prepuberty, puberty, conception, childbirth, all these things are completely different stages. So it's never one size fits all. And of course everybody's flavor of ice cream is unique. And so you have to look at the individual in front of you. Now let's maybe just start with perimenopause before we move into thyroid. Because when I look at the majority of my female patients coming in in that kind of 40 year old plus kind of range, sometimes 35 year old plus, some of the first things you'll notice is that your genes fit a little bit differently, right? Your sleep might be a little bit off and those are actually signs that your hormones are chang. One of the things that I see as a cardiologist is this cute, I call it this cute little ldl Bump. That happens. So ldl, when you get your cholesterol check, is the quote, unquote, bad cholesterol, although there's no good and bad cholesterol. But that's a whole other podcast episode. And we see a little shift that bumps up. Like, women will say this all the time. Oh, my gosh, my cholesterol, my. My LDL cholesterol. My bad cholesterol used to be in the 80s forever, and all of a sudden it just jumped up to 100, and I don't know why. And the cardiologists are great at gaslighting again and saying, oh, you must have done something different in your diet or, you know, did you start smoking? Who's going to start smoking, right? Or you must be doing something different. But what that is, that's insight, right? That's a canary into the coal mine. In the coal mine that now we're seeing these shifts happen. So as you start to lose that estrogen, right, or as it starts to go down, the effects start to go down, what happens? Well, you're more likely to become hypertensive, right? So your blood pressure might pop up a little bit. And I'm just going to talk about pure from a cardiovascular standpoint, you become more insulin resistant. So what does that mean? So you start to pile up a lot of that visceral fat. And now the body shape kind of changes from pear to apple, and you have that kind of belly that doesn't go away. And the genes fit a little bit differently, right? That's a hormone shift. Right? And as we look at the blood vessels and things, they're losing that estrogen. I kind of think of estrogen as the spongy hormone. It makes everything youthful and spongy, your skin and all your different things. And so your blood vessels now start to become less reactive and more like a guy's blood vessels, which are piling up atherosclerotic plaque and things. And so that's why you see now this bump in cardiovascular disease in women in the 50s, things like heart attacks and whatnot, it's really what's happening in your late 30s, early 40s, that loss of estrogen, now that drop in estrogen that gives you normally a protective effect, meaning estrogen protects you, is now going away. So now you're kind of taking off that security blanket, and you're now exposed to the things that guys have been exposed to all their lives, because we don't carry as much estrogen as women do, right? And so from the menopause standpoint, that's what's going on. From a thyroid standpoint, a lot of people don't realize the connection between thyroid and cardiac. Right. And there's so many different things. Hyperthyroidism can lead to weak heart. Hypothyroidism can lead to a weakened heart muscle. Hypothyroidism can also lead to swelling.
- [21:12]
B
Right.
- [21:12]
A
We call that myxedema, that a lot of times gets confused for cardiovascular swelling from things like heart failure. But at a molecular level, I mean, when we're talking about the cells and the aspects that make up the cells and the ion channels that allow the electricity to go through and the heart muscle to contract and whatnot, that's all affected by thyroid hormone. Dr. Amy, you can probably tell me what cell in the body doesn't have a receptor for thyroid, like everything does, right? Like. Like a red blood cell, because it doesn't have receptors for anything, basically. But hormone health is really cardiovascular health. And as you talk about thyroid, certainly we're talking about the actual function of the heart itself, but similar to that drop in estrogen, when you do see a change in thyroid hormone, that can actually cause your cholesterol to elevate, right? That can cause an increase in LDL cholesterol and total cholesterol. So one of the first and most important things that I do with my mouse click, because we don't have pens anymore, is rather than writing a prescription for cholesterol drug, is writing a lab slip to check for thyroid function in the appropriate patient. Because I will tell you, the number of times I've caught hypothyroidism just simply from a change in cholesterol values is not zero. Right. I mean, it happens. So it's just one of the things that we have to screen and watch for. But as with anything, optimizing everything is optimizing everything. So as you optimize thyroid, as you optimize your, I guess they call them the pet hormones now, the progesterone, estrogen, testosterone, we don't refer to them as sex hormones anymore. So I just learned that. But as we optimize these pet hormones, everything is going to work better. Your heart is going to act more youthful, and we're just going to really thrive, which is, I think, what we're all trying to do.
- [22:45]
B
Exactly. And, you know, I want to circle back to the thyroid because I have been saying this forever as well when we talk about hypothyroidism, especially to my community, of course, I'm guilty of this as well. I always talk about the things that you see. That's what you started this conversation out with, is the things that you see. Well, same thing with the thyroid world. It's the weight gain, it's the hair loss, it's how we feel, feel on a day to day basis. Oh, we're dragging. We have anxiety and depression, we forget about the inside. So women will just accept the fact that their doctors are telling them that they're normal. And here's your Synthroid. And okay, well, I guess I'm just going to have to live with these extra £20. But wait, wait, wait. What about your heart health? We can't ignore the damage that is occurring year after year after year as you sit in that non optimized hypothesis hypothyroid state, being gaslit by your endocrinologist and your cardiologist at the same time while damage is occurring. So I'm really happy that you brought that up because that's the piece that women aren't thinking about. They're thinking about how their genes aren't fitting and how they don't have enough energy to go out with their friends and how when they go on vacation, they gain 10 pounds. They're not thinking about heart disease and their heart health.
- [23:57]
A
And just to kind of temper our enthusiasm here a little bit, heart disease takes years to develop, right? So we're not talking about a year or two. I'm talking about decades, right? Like 5, 10, 15 year time frames. So if you're out there and you're like, oh, can I swear on your podcast?
- [24:12]
B
Yeah, absolutely.
- [24:13]
A
Okay, good. All right. I'm a girl, dad, so I always want to make sure I want to use the right language so you don't have to be like, oh, like my thyroid is off, I'm gonna die from a heart attack. No, you got time, right? You know, the best time to change is 10 years ago. The second best time is now. So if there is that lab finding that happens, okay, it happened. Don't freak out. Let's just start by starting and do something to optimize your heart health. And Amy, you'll know this just as I do, is that a lot of the same diet and lifestyle optimizing changes that you need to make for thyroid health or hormone health or autoimmune health are the same for cardiovascular health, right? So get out there, move, see sunlight. I mean, when I say move, do something fun and exciting. Check your adrenal status. Don't be in like hyper adrenal states trying to do CrossFit like that's not like, find an appropriate workout for you that's going to fit. Don't be intermittent fasting. If your heart rate of variability is like through the floor, that means you're already overstressed. You don't need to stress the system more. Right. Find a doctor who kind of knows what he or she is talking about. But, you know, realize that the timeframe on these things is long term. Right. Medium to long term. So don't freak out if you've got these labs abnormal. That's just the call to action to be like, okay, I need to make a change. And now I've got some evidence as to why that needs to happen.
- [25:26]
B
I actually do want to talk about the labs a little bit because in the thyroid and the hormone world, women are often outside of gas, being gaslit. They're also being given band aid medications. And I remember that was one of the first things I ever asked you when I first met you is I'm like, I want to pick your brain on statins and on cholesterol numbers. And you really have a fantastic outlook on this. So let's unpack that a little bit. Number one, women will get handed a statin or a blood pressure medication instead of giving her hormones and proper thyroid treatment. But let's talk about the use of when we use statins, NBP meds and then the actual cholesterol panel. Because there's so much confusion around that I can't. Oh, the amount of women that write in saying I have high cholesterol. And I look, I go, yeah, so your total is 212 and your HDL 60 and you know, your LDL is like 90. Like, who told you this? Oh, because it was flagged high. You got a little H next to it. I got it, yeah.
- [26:31]
A
Yeah. I mean, there's a lot there. So let's maybe just start with statins. Right? So, number one, I'm a trained interventional cardiologist. I was the heart attack doctor for years. And statins certainly have their place, right? So I'm not like a statin denier. And I don't think that they're the worst thing that ever happened. I just think they've become lazy medicine in the sense that whenever we see anything high, it's really easy to give a statin prescription. They're really inexpensive now. It used to be when I started my practice, I trained in Detroit and, you know, it was people making decisions about rent versus medications. Right. Now you can get a statin, a really good statin for like five bucks a month. So it's much less expensive than the fifty or eighty or a hundred dollars that it cost before. So as a result, now we're just looking at numbers and just doctors are shooting from the hip. If it's this level, then give that medication. So I think that the use of statins has maybe evolved. I would maybe call it a devolution. Like we've just kind of made it the standard for everything. So certain high risk patients will still need statins. And even though I'm integrative and functional, if you come to me and you've had a stroke, if you've had a heart bypass, if you've had a heart attack, that's going to be a different discussion than probably what I'm hoping are the majority of your listeners are people who have not had a cardiac event yet and want to be in the prevention mode. Right. So I'll kind of start with that. And in particular in women. There have been a lot of papers recently that are really looking at the absolute risk reduction in women. And what we've realized is in women we're not really decreasing the cardiovascular events as much as we thought we did, partly because there are certainly much fewer cardiac events in that patient population to begin with. Right. So what are we really doing by giving people all these medications other than potentially exposing them to side effects and whatnot? So I do think that there's a role for statins. I think we have to be much more intelligent than we are about how to deploy them. And that's where, as you talked about, some of the advanced lab testing and stuff really does give us an idea as to what's going on. Now, when I think of high cholesterol, high blood pressure, insulin resistance, I think one of the things that one of the approaches I take differently than most cardiologists is I don't see those as disease states. Right. I don't see blood pressure as a disease state. I don't see hypercholesterolemia as a disease state. I don't see insulin resistant as a disease state. What I see them as are warning signs of an imbalance. Right? It's your body's cry for help.
- [28:48]
B
The struggle is real when it comes to losing weight. Listen, I know because I've been there. You're trying all the things, you're doing the diet, you're tracking your macros, you're getting to the gym, you're going to the Pilates, you're doing all the things, but it's not working. It's not working. And this is independent of a thyroid problem. Maybe you have a thyroid problem. Maybe you have low hormones or maybe you don't and you're just like, I just have a really crappy metabolism that I am putting on weight or I can't lose weight no matter what I do. Then you need some help. But what you don't need is a stimulant fat burner of the old days where you literally thought you were having a heart attack. You need something that is actually going to work to increase your metabolism without jacking up your heart rate. Enter Thyroid Fixer. Yes, I know it's called Thyroid Fixer, but I named it after myself and the brand because it's my baby. It's my child. It's a product that I have been studying for 15 years and using it on patients for 15 years before I brought it to you. Thyroid fixer contains T2. And what this does, I call it the forgotten thyroid hormone. No, there's no tests for T2, but your body does produce T2 in small amounts. T2 will increase your basal metabolic rate, literally the amount of fat that you're burning at rest. It's also browning white adipose tissue. So this is why you jump into cold plunges. Or maybe you're like, I don't want to jump in a cold plunge to brown your white adipose tissue. That helps with insulin resistance, it helps with metabolism, it helps with inflammation, helps with overall health. So that's a good thing as well. And here's the other thing. With T2, it's not going to affect your thyroid. So many of you know, if you take T3, if we give you T3, or if you abuse T3 when you're not supposed to, it will have a feedback loop, a negative feedback loop on your thyroid. And you're going to either look like you're hyperthyroid or you're going to shut down your own Thyroid Production. T2 doesn't do that. It's working at the cell level to just simply increase your metabolism. That's a win all the way around because now you're going to burn fat. Now you're going to lose those extra LBs, and that's ultimately what we want. It also bonus, helps with ATP production at the mitochondrial level. This means steady energy through the day. No highs, no lows, no caffeinated Red bull spikes, just really nice, steady energy through the day to keep you going. So you want to add in Thyroid Fixer and just literally watch your body change over the next couple months, because Listen, I mean, it's, it's time. Well, it's time all year long. I mean, there's no good time of year to lose body fat. We want to be in shape, we want to look, feel, and perform our best. Add in thyroid fixer and your body will absolutely thank you and then you'll come back and you'll thank me.
- [31:51]
A
So in the functional medicine world, we have to think about root cause. And the majority of things are inflammation, diet, lifestyle, all of those things. So my approach to this, and it's just my approach, it's the American College of Cardiology and American Heart association and all these entities come together and create guideline documents and that say when you are confronted with a patient with one of these disease entities or these states, the first intervention is three to six months of diet and lifestyle optimization. Right. And so it's not like I'm practicing crazy medicine. I'm just doing as the teacher told me to do. It's just a little bit different. So I don't think that we should jump unless there's an emergency situation. Someone's hemoglobin A1C shows that they're like profoundly diabetic or your blood pressure is 300 over patent pending. You know, all these sorts of things. So outside of those emergency situations, I think we really do need to optimize diet, optimize lifestyle, which is what I focus on now. And it is remarkable, and it is really cool to see how many people I can get off of medicines or reverse these blood pressure medicines and all these things with just eating well, sleeping well, managing your stress. Right. We don't realize what a toll that takes on us. So I guess the bullet point, that first chapter of the response is, yeah, I think statins are good drugs in the right people, but I do think that we overuse them. And I think we need to rely much more heavily on diet, lifestyle. And part of that is optimizing the hormonal milieu before you go to something else. Right? Because if I treat high cholesterol because of a thyroid disorder, it's not really going to do the job that it needs to. Right. But if you treat the thyroid disorder and that fixes the cholesterol, everybody's happy. Similarly, if you have someone on bioidentical hormones that needs estrogen, and now I've seen it where you put people, women on estrogen and. And all of a sudden their LDL drops back into a normal range because they now have that protective effect of estrogen. Hey, I've just saved You. A pill. Right. That's awesome.
- [33:32]
B
Right?
- [33:33]
A
I'll take a pause there. Any. Clear. And, like, I. Sometimes I get super nerdy when I talk about this stuff. So, like, I kind of have those Sheldon from Big Bang Theory movements. So I just want to make sure that I haven't lost anybody yet.
- [33:44]
B
No, no, no. I love it. I love it. I want to add one thing just based on what you just said, because I think it's an important point for women. There's a lot of. I won't even say the majority of my audience, but there's a subset of my audience that I even have to break out of the mindset that estrogen, progesterone, testosterone, bioidentical hormones, and thyroid hormones are a pill, a medication. So you'll have this subset saying, I don't want to take a medication. I haven't even taken an Advil my whole life. And it's like there's a gold star given out for not taking, you know, any kind or not picking anything up from the pharmacy. Like, there's no gold stars, people. There's. There aren't any.
- [34:23]
A
Yeah.
- [34:23]
B
However, if you just to Sanjay's point right here, if you can replace your hormones, we bring up your estrogen, and he saves you a pill. So here's your goal of never being on a, you know, an orange prescription bottle medication that you picked up from Walgreens. Well, the way you do that is sometimes as simple as addressing your thyroid and your hormones, and then you can stay off of the band aid medications that might be thrown out at you like candy.
- [34:53]
A
Yeah. And I think the way to think of that, maybe as you're describing that, is like wearing a knee brace when your knee hurts as opposed to just going for a knee replacement surgery. Right. Like, we want to do the less invasive things first that are going to have a lot of benefits. And again, when it comes to hormone health replacing estrogen, we're just focusing on cardiac stuff because I'm a cardiologist, and that's really all I know. But when you look at all the other benefits, like aesthetically, of course, but then vision benefits and brain health benefits, not having parts of your brain shrink down and all these things, really what we're doing is keeping your body the way it's supposed to be. We weren't designed to live after the age of 35, if you think about caveman times. Right. Or whatever. But, yeah, I mean, I think that there is. I call it this menopause machismo where you'll see some Women be like, well, I don't need hormone therapy. I'm just going to tough through it. Well, why, you know, why would you need to do that? Number two, the way I frame the hormone discussion, particularly, again, coming from a cardiology perspective, is I'm not very conversant in hormone replacement. That's why I'm thankful for you and friends of mine who are. But, you know, me not being a hormone doctor doesn't mean I don't address the improvements that hormones will make. Just like if I saw a patient who's smoking, it would be irresponsible of me to say, well, I'm the heart doctor. Go to talk to your lung doctor about quitting smoking. Right? No, I've told patients several times in the office, I'm going to staple your mouth shut next time you come in this office if you're still smoking, because it's that important of a cardiovascular risk. And similarly, now when we look at the reframe and the newer data that's coming out and even the new ways of looking at the old data from Women's Health, it is really, I think getting those hormones in when you start to get in that perimenopause is just as protective as. Or as important, I should say. Maybe not just as protective. I don't know the stats off the top of my head, but as important as telling someone to not smoke to prevent heart attacks. So, again, I love what you said. Don't think of it as a failure, but just think of it as kind of continued optimization.
- [36:40]
B
Right.
- [36:40]
A
And I think that's an important thing. Now let's get into lab testing.
- [36:42]
B
Yes, fun stuff. Love it. Right.
- [36:45]
A
Because I agree, it does get super confusing. And it doesn't need to be because we can get, again, there are levels to the depth of nerdiness and all of these things. But what I want to kind of focus on is kind of, we'll talk a little bit about cholesterol, but I'm going to start, well, maybe let's talk about cholesterol and I'll get into kind of my hot take on something. But when you look at cholesterol, right. We look at total cholesterol, HDL cholesterol, which is the good cholesterol. And what we mean by good cholesterol is it's really a scavenger school bus that picks up damaged cholesterol particles and returns it back to your liver for metabolism and breakdown and all that stuff. And then there's something called triglycerides, which are essentially kind of shuttles for carbohydrates, or we call it fat in the blood, but it's not. It's kind of. It's a result of carbohydrate ingestion. So back in the 1980s and the 1970s, when they were looking at risks of cardiovascular events, they were looking at triglycerides, primarily. And then somebody realized that, hey, you know what? There's this thing called ldl, which we can't directly measure, but that seems to correlate as well with cardiovascular things, so with cardiovascular risk. So initially, LDL was a calculated number. So you took your total cholesterol, and I don't know who came up with this formula minus HDL divided by 3, minus triglycerides over 5. And that was your calculated LDL number. And it still gets reported, reported out. And so that's where then LDL kind of came into the fold. And then there's all the cholesterol trials in the 70s that were done, and that kind of cemented LDL as something that we thought was related to atherosclerosis. So we still call that the cholesterol hypothesis, although it's kind of become like truth or like dogma. So when you get a standard cholesterol test, that's what you're getting, right? You're getting your total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides. And that served us well for a while, but now we know so much more about cholesterol. And so there's a few other numbers that I think are important. There's something called ldlp. So what that is, it's an actual measurement of the number of cholesterol particles. And what that really gives us some insight to is the size of your cholesterol. So we've learned not all cholesterols are the same, particularly LDL cholesterols. We have what are called big and bouncies and small and stickies. So the small and stickies are the heavily damaged, oxidized, really angry cholesterol particles that are much more likely to go through and cause plaque buildup in your arteries. And the larger, fluffier, big and bouncy LDLs are bigger. And as a result, they don't fit through the gaps in the cells in the arteries. And so they are less likely. Not that they don't, but they're less likely to cause atherosclerotic disease. So LDLP gives you an idea that's an expensive test to run. And additionally, there are a lot of other cholesterol particles that aren't accounted for in that situation. So there's things like IDLs, which are intermediate density lipoproteins and VLDLs and all these other nerdy things. But one test that's really kind of come to the fore and has actually been proven to be more predictive of cardiovascular events than LDL alone is something called apob. So if you're out there, if you've got your notebook, that's really, I think, the test that most people can run. Even if you're in the middle of nowhere, like I grew up in the middle of nowhere, Indiana. Like, you can still get APOB to be checked. And the reason that's important, it kind of tells us the entire population of these what are called atherogenic cholesterol particles. So if that's all you're getting, I think that's great. And the remarkable thing about that is as you do supplement thyroid and other hormones, you can see those shifting pretty quickly. So that I think is the 10,000 foot view. Now in the 5,000 foot view, as we get a little closer, there are some newer markers that came up and one of which is called lp, which you may have heard of, and then it's kind of gaining of a lot, lot of popularity. And so that is a modifying protein on an LDL particle, on this bad cholesterol particle that makes it more likely to be atherogenic. And I'm like addicted to gangster movies and like prison movies and something for some, that's my dirty, my guilty pleasure or whatever. And so it's like in those movies, like you see some guy with a teardrop tattoo that means he's murdered someone. So I say LP is like, if you see a lot of lp, it's like all the LDL particles have teardrop drop tattoos, right? They're more likely to kill you. Okay? And so I promise there is a direction for that. And so now when you see those LP lays, now you have to be even more aggressive because we want to drive those numbers down. And that can be with a pill, that can be with an injectable cholesterol medicine, or there are now medicines directly targeting those LP particles and you can get them out. So that's the 5,000. Now if we want to be at like the microscopic level, and we will not dwell on this, you can look at things like APO B100, APO P40, all these. Like you can specifically drill down to LDL particle distributions and things like that. If you're getting to that Point, come see me. Come see a cardiologist that specializes in lipids. There's no reason to have to test those on a regular basis. But if you have access to, like an advanced lipid profile, like if somebody is on one of these online pharmacies or Function Health or something, they will report those numbers. But I would say it's been humbling and surprising to me as to how few actual cardiologists understand those numbers to have that conversation. So really find someone who knows what they're talking about. So.
- [41:36]
B
And I would say that's. Oh, no, that's beautiful. As beautiful. Now, I would say most cardiologists also, obviously, like the rest of the world of conventional medicine, don't go by optimal ranges. They are looking for that little H, the little L next to the lab value. And at that point of time, they'll stop and they'll say, oh, Sally, you have high cholesterol, so can you break down for us what are your optimal ranges? When are you okay with people having a high cholesterol but it not being an issue?
- [42:06]
A
Yeah. And so I think that this is a, you know, more so than just a number. This is where you have to look at the person and the overall gestalt and all the imaging that you have. I will say one thing that's been frustrating for consumers and patients alike is that it just seems like every few years, the goal posts seem to move right on this. And so, like, I remember when I went to medical school a thousand years ago, the threshold for therapy was I think, 120, and then it turned 110, and then it was 100 for a while and 90 and then 70 and then 42 as goal or triglyceride. Yeah, exactly. For LDL cholesterol. And part of it depends on your risks. Right. So if you're diabetic, being Indian is what's called a risk enhancing factor. And so we have to have people from. Of Southeast Asian descent. You have to kind of put it a little different kind of fudge factor on there to be a little bit more aggressive. And so there's a lot of factors in play. I'll say that for the most part, we want your LDL cholesterol, assuming you haven't had a heart attack or stroke or bypass or anything like that. We want it. I'd say a good range is in that 70 to 100 range. Now, if it's higher than that, that doesn't necessarily mean that you need therapy. But that I think would be kind of where I'M comfortable if somebody comes in. And it is increasingly difficult to see somebody with that kind of a cholesterol walking around because of the toxicities in the environment and the food that we eat and all of these things. Right. A lot comes up about these goals of cholesterol and how low we can go. And there's data that shows, of course, that the lower your ldl, the lower the cardiovascular risk is. And so somebody extrapolated this in 42 seems to be a magic number where if you have your LDL less than 42, it seems, seems like you don't die of cardiovascular events. I mean, or I should say very few people that have cardiovascular events. But you know, God created cholesterol for a reason. Right. And so we need some sitting around. Right, Right. And every cell in the body is able to synthesize its own cholesterol. Right. And so I don't get as worried about brain health, although I should say it this way, and it's going to sound weird, but I don't worry about the LDL numbers causing issues with brain health. I warned her about the drugs that we use to get LDL down causing brain health issues like mitochondrial health in the brain from statins and CoQ10 depletion and all that stuff. But your brain can create all the cholesterol it needs, just as your adrenals can and all that stuff. I mean, I don't think that you can get it so the circulating pool so low that you're affecting it at that level. But I worry about the again, and that gets to why not everybody needs to be on a statin. So for me, I would say if you've not had a cardiovascular event, if you're living in, in the 70, let's even call it to 110 range, I think that's a comfortable range. If you're above that, then we have to look at the risks. And that's where we can do imaging like CAT scans of the heart to see if you have calcium. Or now there's CT scans that can be done to look if you have plaque. There are certain genomic and protocol precision medicine tests that I employ where you can actually see if there's atherosclerotic plaque around based on blood tests. And then I use that to inform my decision about cholesterol modifying therapy. Of course you're talking to someone that does this day in and day out. And I'm sure if I ask you, good thyroid is what's good thyroid. And that's like in my mind, that's a 30 second explanation and for you that's like an hour long masterclass, right? So, so it just gets nuanced. But what I will say is that if you're again living in that, that LDL cholesterol range of 70 to 110 or so, you're in a good spot. And if not, then you know, diet, lifestyle changes, and even then, if you're 120 or above, when we look at most people, their actual event rate is still low. Right. So we're not saying that 100% of people with an LDL cholesterol 136, you're going to die from a cardiovascular event. It's like depending on your age and your gender and all these things, it might be 6, 7%, meaning that 93 to 94% of people in your boat will live just fine, happy lives and go on about their daily existence. We just always as cardiologists, we're, we're like negative nellies. We always have to think of the worst situation and we look at that glass as half empty all the time instead of half full. Right.
- [45:57]
B
I totally understand that and the whole nuanced art of things because, right, this is your world and it does get very nuanced. And I love that you are taking that personalized approach and looking at every single factor of an individual and not just lumping them into some container. Now I want to go back to what you said about the brain makes cholesterol. Our body can make cholesterol, but isn't there a point at which we can lower cholesterol too much? So one thing I've said, and I want you to confirm or deny my statement because I don't know, but I said this years ago first. I said go to a Walmart. So this is the challenge I give people. Go to a Walmart and just sit there or go to amusement park, go where you have a nice subset of the population, right. Disney World is a great place for this. And just start looking at the guys and see how many sets of man boobs and wide hips and butts that you see. That's estrogen. So I truly believe that this whole demasculinization of America where men are starting to look more and more like women, not by choice, not that they want to, but they are morphing into these female bodies because of the prevalence of statins. And we're lowering cholesterol so much that it's affecting men's testosterone levels too. And then we have the whole subset of oh, we're telling men with a testosterone of a 300 that they're normal. And that's a whole other set of animals of issues with another podcast. But am I right in that statement?
- [47:25]
A
Well, I mean, I think there's a lot at play, right? I mean, I think we have so much more endocrine disruptors in our existence, and I've become so much more aware of wearing natural fibers. Like, I used to wear those, like, dry fit shirts. These are like wool shirt undershirts that I wear now, and cotton and natural fabrics because of the microplastics and the leaching and the endocrine disruptors and all those things. So I think that there's a lot. I do think that there is something about too low cholesterol. So I get a little bit nervous in my practice when I start to see cholesterol dipping into the 40s, meaning LDL cholesterol, again, dipping into the 40s, because you do want to have a circulating pool, right? And. Oh, and so the other hot take on cholesterol that you reminded me of now is that much more than an LDL number. I think what we need to look at is damaged cholesterol particles where we cause what we call oxidized ldl, oxidized lp, which is really coming from metabolic disease, from insulin resistance. Right? Because when you have damage to a cholesterol particle, that is really kind of part of what accelerates in the. What's called the media, the middle part of the blood vessel, that's what accelerates atherosclerotic plaque from forming. So you can have high ldl. I think that's like having a lot of dry grass around. But I think metabolic disease is the flame, is the spark that really sets this cardiovascular cardiometabolic world on fire. Right? So to your point, when you do have someone who is insulin resistant, right, we know that so much happens. You build up visceral fat. Visceral fat is super active. You're probably getting a lot of aromatization of circulating testosterone to estrogen. And so you see, I mean, in fact, men get most of their estrogen from aromatization, meaning just transformation of testosterone to est. Somebody adds a carbon on there or something, whatever the chemistry is, right? And so you do see a lot of this. And so I think it's a lot of the insulin resistance that drives this. But certainly I don't think that we can completely absolve statins from this. Right? And so I think that it is a. Again, nothing is simple in medicine, particularly when you are dumb enough to get into functional medicine, where you see all the interrelatedness of everything. But yeah, I mean, I think that's a big problem. And I think for the guys that are listening as well, I think one of the most underused cardiovascular drugs in the history of cardiology is testosterone. And testosterone replacement as a cardiometabolic enhancer. Burning off that visceral fat, getting rid of kind of masculinizing the body again, improving muscle mass so that you can be more metabolically in an advantageous position. So, yeah, I mean, I think it's a lot of things. And yeah, living like 20 minutes from Disneyland and having been there, I can speak to exactly what you're talking about. We see it all the time.
- [49:50]
B
Great people watching. Now, you mentioned testosterone for men, and I know we're totally going over because I can't stop talking, but I just have. Have many, one, maybe two more questions. So you talk about testosterone for men, but I totally. We forgot about touching on that for women. We talked about estrogen dropping, but yes, testosterone in the heart. How does it relate to women? Because they have declining testosterone as well after the age of 40.
- [50:14]
A
Absolutely. And again, like we said, every muscle or every cell in the body, with the exception of red blood cells, has receptors for estrogen, similar for testosterone. Right. And so as we look at cardiovascular function, as testosterone declines, you get greater fibrosis, you get weakening. Similar with the. With what's called the endothelium, which is the inside lining of the blood vessels, you start to see deterioration. And your users may be familiar with the concept of leaky gut. Well, as we get older and these hormone levels drop, I call it leaky vessel, where now you're getting the normal protective layer called the glycocalyx on the blood vessels starts to degrade. And now these cholesterol particles can have an easier track into leak the space behind where that cell layer sits to cause plaques forming and all that stuff. So, yeah, I mean, I think it's hugely important. I think that the role of testosterone in women, I think it used to be kind of something that we thought of primarily for, like, bodybuilders and stuff, but women had testosterone too, and it becomes very important for, again, insulin resistance and muscle mass and all of these things. And again, like, for those of you, Amy, you're a power lifter, I'm a powerlifter. Like, being that, like doing testosterone to the point where you're looking like, bulky and big, that's a choice, right? That's not physiology Right. Like I have estrogen, you have testosterone. There's an intelligent approach to this. Right. But yeah, again, I would say then, I know I said it in men, but to kind of maybe de Risk the situation. Men and women both. I think one of the most underutilized things is let's just call it hormone replacement. Pet hormone replacement. Testosterone and estrogen and all these. I mean, there's even some data in that I saw looking at getting estradiol E2 to men for plaque regression. Right. So there's some people out there that are doing that. It's a little bit more advanced than anything that I would be comfortable doing. But you're seeing this out there. And as that gets more common and more used, maybe something that we use intelligently to help manage cardiovascular risk. I mean, I think there's a lot of fascinating things, and I think that you're just the message and the space that you're in. Hormone therapy is so important, again, because it touches every cell in our body. Right. So I think it's. It's. The role is evolving. And luckily now we've got black boxes that have been removed and all these things. So we start to study this and intelligently come up with decision plans for our patients that make sense, Right. With body physiology.
- [52:24]
B
Yes, a hundred percent. And so to leave with one last question here, the whole. You had mentioned it. Insulin resistance, carbohydrates. Carbohydrates driving up triglycerides. How long have we thought, and people still think this way, that they have to avoid red meat, that fat gives us high cholesterol, that egg yolks give us high cholesterol. Please speak on that before I let you know.
- [52:49]
A
I. Well, I still fight this battle, right? And it's like the vegan mafia, like, hates me. I mean, ancestrally, I'm supposed to be vegan, right? In fact, I remember this was, what, probably 15 years ago when forks over knives came out. You know, the. I'm like, oh, my gosh. I'm a cardiologist and I'm eating meat that makes no sense. So I'm like, all right, let me try being vegan. And first of all, I was, like, unhappy all the time, but I felt spent. And, like, I just felt like I didn't have energy. Right? And I think there is something that was said for complete protein sources. Not that you have to be very intentional as a vegan, but I was drifting into unhealthy vegan, and I knew that I was like, My low was probably when I got, like, vegan hamburger patties. Right. And I think the whole benefit is eating unprocessed or less processed food. That's where most people get the lift from being vegan. But I just felt like garbage and then I went back to eating a normal diet and I felt great. So to your point? Yeah, I mean, I think that the science of kind of red meat and all that stuff has been kind of looked at and it's different now. Particularly eggs, I think have had a really bad PR campaign for a while. But there's so much benefit to egg and the dietary contribution of serum cholesterol is much less lower than we thought. We're not absorbing a lot of cholesterol through the food that we eat, but rather the LDL that we absorb is through bile salts. I hate to drop a new Easter egg on you, but it's like a natural process, has little to do with what we eat. Even when we look at saturated fat, which was vilified for a while, there's data now to show that you're really increasing, as we talked about before, the big and bouncy populations of ldl, not the small and sticky kinds. Now, of course, everyone's genetics is different and all these things, but you know, I, I don't think that you have to be vegan to be healthy. I mean, I eat meat and I think it's great. I think we do have to consider what our food ate, meaning that if you're eating like inflamed meat, that's going to inflame you. So really be insistent on grass fed and grass finished and kind of all of that stuff.
- [54:35]
B
Right.
- [54:36]
A
If you feel so inclined, limit it to like once or twice a week or something. But I don't think that we can in 2025. I think it would be irresponsible to say that red meat is the only cause. Right. And there's a lot of things that happen in our microbiome that affect how we digest the meat. And TMAO is what people. It's a metabolite of red meat that's increased when you have a lot of red meat intake. And that's been associated with cardiovascular disease. But I think that's really a sign of a dysbiosis, meaning your microbiome is off, because when your microbiome is healthy, you're not going to produce as much tmao. So again, it's nuanced, but I think that at my approach, and I'm sure your approach is, you know, live your life how you want to live your life. And we'll suggest lifestyle changes that may be of benefit. But you don't have to be a vegan, rock climbing, live in the cave somewhere kind of person to be healthy. You can certainly be healthy in modern society with a couple of changes. But, yeah, I think that the hot take on that is, yeah, I think that the vegan mafia is overplayed. And if you're eating red meat, it's just fine. I think you had, you said, you mentioned you had Jack Wolfson on and I think he would be in line with that as well. So.
- [55:38]
B
Yeah, yeah, definitely. Dr. Sanjay, thank you so much for this amazing discussion because we need it. We need it. We need these open conversations to help women elevate their health and really get the answers that they need, they deserve outside of the conventional medicine space because it's just not there. It's from people like yourself. So can you tell everyone where they can find you and where they can work with you? You mentioned about coming out to California. I mean, I got listeners in California and people can get on planes.
- [56:07]
A
So yeah. So the best place to find me is actually on Instagram. So My handle is Dr. Sanjmd. My practice is called the Laguna Institute of Functional Medicine. I'm here in Southern California. So if you're in Cali, I'm seeing telehealth visits and we'll soon have a physical location kind of coming up. So the website there is laguna medicine.com and I run an online cardiovascular cardiometabolic program to help people use diet and lifestyle to optimize their health. It's called well12. So you can find find that on lagunamedicine.com as well.
- [56:34]
B
Amazing. And we'll put all of that in the show notes. And you also gave our listeners a 500 off code. We're going to put that in the show notes if they're interested in jumping into that well 12 program. So I love it.
- [56:45]
A
Yeah. What a great way to start the year.
- [56:47]
B
Amazing. Well, Dr. Sanjay, thank you so much for jumping on and thank you, everyone for listening.
- [56:52]
A
Always a pleasure. Take care, Andy, and bye, everybody.
- [56:57]
B
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