A (2:37)

Awesome.

B (2:37)

I love that. Yeah, I think the lab ranges, it's where you're like, normal doesn't mean optimal. And we're really starting to look at that. It blew my mind when I was talking to a male testosterone researcher and he was like, yeah, yeah, 300. Which is the lowest part of normal in a male testosterone. That's the lowest 2% of all men. And so you're like, oh, you're normal at the lowest 2% of all men. Like, that's a pretty low bar. That's fascinating with thyroid, though. Is it what thyroid labs? Is it all like tsh, which is thyroid stimulating hormone? Is that the most common lab? What lab should people get? And to add one more layer of complexity to my questioning, should we be screened for thyroid and at what age?

C (3:20)

Okay, so first of all, when we talk about lab testing, TSH is the lab that most women will get if they are talking about things like fatigue or unexplained weight gain or maybe even hair loss. Sometimes it's a missing piece of the conversation, like we discussed. But TSH is the most often examined, and it's an important marker, but it's not the full story. So TSH is really, as you know, a brain hormone. It is our brain's way of signaling to our thyroid that we need more hormone. And so from a very basic perspective, I think of it as when TSH goes up and high, it's like knocking on thyroid's door saying, hey, I need more thyroid hormones. So we've got this feedback loop, and so our thyroid produces T4. And so we can measure this in the lab, and it's called Free T4. Except a lot of times it's not checked in primary care. It's often left out. It will be checked if the TSH is high and outside of that reference range. But generally, you know, a lot of times it's missing. Most endocrinologists also check a free T4. In my experience, many primary care doctors do not. So free T4 is this. You know, it's the hormone your thyroid makes. But then we've got to convert T4 to T3, and T3 is almost always left out of that conversation. Now, free T3 is the hormone that interacts with our receptor. So it's really important. And there's a lot of women. This is a very functional medicine mindset, Right? But there's a lot of women who don't convert that well between T4 and T3. And so they can have some degree of, you know, we call that conversion disorder. It doesn't always mean you even have a problem with your thyroid, but it means we have to look outside of the thyroid and try to understand what's going on with that conversion and what are we missing here?

A (5:03)

Love it.

B (5:04)

So Quest Labs has a thyroid panel lab test that you can check. Is that all three of those things, the TSH, T4, T3, or what's in a thyroid panel, if you got that for a lab test.

C (5:15)

Honestly, I don't know. What I order is a TSH free T4 free T3. I also order a reverse T3. So reverse T3 is not a deal breaker, but it does tell me for some women who are basically shunting their metabolism to reverse T3, it tells me they're putting on the brakes. Free T3 is the gas. Reverse T3 is the brakes. And so it's an interesting piece of the puzzle as I look at the whole patient. It's not a deal breaker, but it is nice to have. And then the other aspects there are thyroid antibodies, so thyroid peroxidase antibody or tpo, and thyroglobulin antibody or tg. So a full thyroid panel, in my mind is all of those labs. TSH free T4, free T3, reverse T3, thyroglobulin, and thyroperoxidase antibodies. Now a thyroid panel at Quest. I don't know. My guess is TSH and a free T4. Maybe. Total T4, total T3.

B (6:07)

I mean, to me, I'm like, oh, my gosh, you just got complicated so quickly. Is this why most people don't want to address thyroid?

C (6:13)

Maybe. I think also there's a lot of challenges I think women in any phase of life encounter when we're looking at thyroid function in particular. Just to back it up a little bit, when women are trying to conceive, if you look at the reference range for thyroid, the lab doesn't know you're trying to conceive. But even the American Thyroid association says your teeth TSH should be less than 2.5. But that's never gonna be outside of the normal reference range on any labs. But we know, and everybody agrees TSH should be less than 2.5. So I don't know. I think it's left out of the conversation, frankly, because in primary care, we know a little bit about a lot, and sometimes we don't pull that full picture together. And when doctors look at your labs and the reference range is normal, just like I know you know this, they go and get their Testosterone checked. And you're like, well, technically it's normal. Even though, you know your free testosterone's like 0.54, technically that's still in the reference range. And so I don't think it's flagging doctors. And I also think it's under measured because most of the ACOG or ABFM don't recommend that we screen every woman for hypothyroidism.

B (7:21)

So. Well, let's back up one step for everybody. What does the thyroid organ do? Where's it located in our body?

C (7:29)

So the thyroid is in our throat. It's a butterfly shaped gland. And thyroid hormones are literally like, they're everywhere. Just like estrogen, it's all over our body. It's a full body hormone. It influences things like digestion, it influences our other hormones, it influences our brain. Different women are susceptible to the symptoms of hypothyroidism. Some women are really sensitive to it, some women are not. But generally a woman who has low thyroid function will have things like fatigue, sometimes constipation, sometimes it's just bloating and other digestive issues, even like reflux symptoms sometimes. Often it's like the brain fog piece, feeling like you cannot get enough sleep. Women with Hashimoto's have really nonspecific symptoms and there is so much crossover between those symptoms and perimenopause, it's hard to differentiate without labs. So it's literally all over. I mean, it's like digestive issues, brain fog, irritability. I can't sleep well, I'm gaining weight. Not all women do struggle with weight, but that's certainly, you know, metabolism. Getting really slow is a big one. Feeling fatigued could be dry skin and hair loss, losing the outer third of your eyebrow and things like that. But there's a lot of overlap and it can be quite non specific. Also, menstrual cycle irregularities.

B (8:43)

Yeah. Just for anybody who has missed the minimum. Hair loss is incredibly complex but incredibly common. Like hair loss is 50% of women in midlife, irrespective of being on hormones or not, just 50% of women will struggle with hair loss. And where everybody's looking for the silver bullet and it's like, dude, so many things can affect hair loss.

C (9:03)

Totally.

B (9:03)

Okay, so that's where the thyroid is. What's the incidence of women having thyroid issues in general or in midlife?

C (9:10)

In midlife there's different statistics, but about one in eight women have some form of thyroid disorder. Right.

B (9:18)

And it's probably more common than that because we're not Screening?

C (9:21)

Yeah, I think it's under diagnosed. I think we're not screening and I think sometimes, you know, we'll talk more about this, but the question is when does a woman really need medication? When does she need treatment? And I think we're looking at it. I look at it from a risk versus a benefit perspective. And how do we optimize hormones? But first, sometimes there's an opportunity to optimize other kinds of hormones like work on stress. There's a signal, there's thyroid's like the first thing that starts to decline when a woman's under really high stress.

B (9:48)

Yeah, let's pause on that for a second because I think so many people, and this is medicine in general, Right. But it's like so many people are like I have a thyroid problem instead of saying my thyroid's responding to the environment in which I am so.

C (10:03)

Well said. Exactly. Our body is responding to our environmental stressors and most of the time it's there to protect us. Right. Like our body doesn't hate us, our body loves us, our body's here to protect us. And female physiology is really unique because we are adaptable.

A (10:23)

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C (11:13)

And there's a reason for that. Reproduction. Our physiology adapts really quickly so that we can have babies and host a pregnancy whether we decide to do that or not. But it also means there's like this other side to that. There's a cost to that which comes at maybe thyroid function, maybe gut dysfunction, maybe reproduction and infertility, maybe hormone imbalance. I think there's a lot that is affected by the environment by chronic stress.

B (11:43)

Yes, I love that. So hypo means low, right? So hypothyroid means a under functioning thyroid. And the Most common type of hypothyroid in America, you're saying, is Hashimoto's. And so Hashimoto's, that's just named after the person who discovered it. Right. But it basically means. And correct me if I'm wrong, I'm always so aware of, like, this is a urologist trying to understand the thyroid. But at least. At least it's good. We're going on everybody else's level, too. So it's kind of an autoimmune.

C (12:11)

Right.

B (12:12)

So the body's doing something to the thyroid to make the thyroid not perform as well. Did I get that close?

C (12:18)

Yeah, close. Like you said, most hypothyroidism in American women is caused by Hashimoto's. Hashimoto's is an autoimmune condition. And so it's two separate issues. There's an autoimmune condition that causes low thyroid function over time. But sometimes, and often that autoimmune condition has been brewing for years. Women know it. They're like, something is wrong. But nobody's checking thyroid antibodies, and nobody's especially checking thyroid antibodies if they still have normal thyroid function. Right? So if a woman has got anxiety or bloating or, you know, sometimes she's anxious, sometimes she's depressed, she cannot get enough sleep, but then sometimes she's got palpitations. It's very nonspecific when she's got Hashimoto's. And so Hashimoto's can start out even in a hyperthyroid state, and then they go hypo.

B (13:06)

Sometimes, for lack of better words, it's burning it, and then it doesn't have.

C (13:10)

Function, and then it goes hypo, and it's not very long. Usually, like the onset where it's hyper in most women isn't. Isn't a prolonged period in my experience. I think we don't have enough research on that to really be sure. But in my experience, some women will go hyper and then go hypo. But this initial onset of Hashimoto's, like, this could be brewing for years before somebody actually sees the downstream effect, which is thyroid destruction. And after there's been enough destruction of that gland, a woman will have hypothyroidism. So not until she's truly hypothyroid and her TSH is outside of a normal reference range will someone or a physician usually be looking for Hashimoto's. And even then, often it's not checked because we just say, well, you got a hypothyroid. Like, we don't know what else to do about that besides put you on thyroid medication.

B (13:58)

Got it. So the lab test for Hashimoto's is thyroid antibodies.

C (14:03)

Yeah, thyroid peroxidase antibodies. So TPO or thyroglobulin antibodies, which is tg. TPO are the more common ones that are elevated. TG are less commonly elevated, but I still test them.

B (14:15)

Okay, fascinating. And so it's possible. Is it possible that you can have elevated antibodies but still have normal function? But maybe that's a warning sign of, like, something's burning here. Let's see if we can reverse it before we get hypofunction.

C (14:29)

Ding, ding, ding. Yes, absolutely. And that's the big deal, because if you've got this autoimmune situation brewing, like, there are things that we can do for autoimmune disease from this functional medicine lens. So in a conventional medicine lens, you know, when I went through residency, I remember diagnosing someone with Hashimoto's, and I'm like, well, what do I. That doesn't change my treatment. And often what do you do? Right. So unless you have an approach for that autoimmune piece, I mean, like, what do you do? So we can talk more about, like, how do you deal with the autoimmune component, but you can slow down the autoimmunity so that you don't have thyroid destruction and you don't end up on thyroid medication, or if you do, you don't have to keep increasing your dose, you know, year after year.

B (15:12)

So a traditional medicine, are they going to give you a drug for autoimmune stuff, or do they just say, hey, hey, let's watch this until the thyroids kaput?

C (15:22)

Yeah, pretty much. Let's just watch this until the thyroid's kaput. Now, with autoimmune disease, if we look at autoimmune disease as a whole, certainly there's a time and place in conventional medicine when we use immunosuppressant drugs for certain autoimmune diseases, but Hashimoto's is really not one of them. So typically it's just like a watch and wait. Got it.

B (15:41)

And from a functional standpoint, what are you prioritizing for women to say, hey, if you wanna slow the role of the body's basically inflammation against itself, what are you telling them to do?

C (15:52)

Primarily gut health. So Alessio Fasano is a researcher. He's an MD, I think he's a PhD. He did a lot of research looking at this triad behind autoimmunity. And so Genetics play a small role. Genes load the gun, environment pulls the trigger. Environmental triggers are huge. That might be pregnancy, postpartum perimenopause, and menopause. We see these huge hormonal transitions when women have increased rates of autoimmune disease. Those are big hormones, you know, big environmental triggers. There's others. Stress is a huge one, too. Like, a really stressful event could be a big trigger. And then intestinal permeability is the third one. And so when I have a patient who has Hashimoto's, I'm immediately thinking about gut health. How do we prioritize and fix the intestinal hyperpermeability? Which, you know, the layman's term for that is leaky gut. But the science. There is a scientific term. There's plenty of research behind this. This is intestinal hyperpermeability.

B (16:47)

Is SIBO real?

C (16:48)

Totally. Sibo's so real.

B (16:51)

Let's break that down for people. Like, I went on a tangent, but, man, we gotta address this.

C (16:54)

No, it's not. It's actually right on. Because over 50% in research, over 50% of women who have Hashimoto's have SIBO. So there's a huge correlation there. There's also a ton of research. Well, I shouldn't say a ton, but there's plenty of really solid research looking at the bidirectional influence between the gut and thyroid function. And with certainty, there is a huge component of autoimmune disease rooted in gut dysfunction.

B (17:19)

For anybody who doesn't know, SIBO stands for small intestinal bacterial overgrowth. I have, like. You know, it's all these ends of one, like, side note of how I figured this out. I saw a guy, older man, he'd been diagnosed with SIBO from some functional person and had, like. It was like, urinary issues, lower abdominal issues, blah, blah. And he got up high on the SIBO food chain, pun intended, of, like, support groups and fundraising, and, like, really got into sibo. Turns out he had a massive prostate, was in complete urinary retention, had, like, a blocked kidney from it. I'm a urologist. I helped him out with all that. All of his symptoms went away. And he's like, maybe it wasn't sibo. Maybe it was this urinary issue. And so, like, to me, I'm like, that's the. Like, people went down the wrong path. And that was my introduction. Like, what the heck is sibo?

A (18:10)

And now is it real?

B (18:11)

Because this was actually a urology issue. That's where I came from. Of, like, is it real because, like, how I got introduced to it, it was a guy who got better because we addressed his urology problem, which is why we need comprehensive care and, you know, all of these things. But so small intestinal bacterial overgrowth. What is it? How's it different from leaky gut? Now we know it's real. Thank you for telling me that. Let's. Let's explore that a little bit. We'll jump back into thyroid, I promise, for the people who are here for thyroid. But let's.

C (18:35)

Well, I think this is totally associated, and it influences things like thyroid conversion T4 to T3. Like, there's this big bidirectional influence that happens with the gut. And sibo, by far the most common gut infection. I see. But it's complicated, and it's important to address. But it's complicated. And it's not the only problem you have. Like, in your patient's case, like, maybe he did have sibo, but certainly it wasn't causing all of his urinary issues and his kidney stones and all of this other stuff. Right. He also had, like. I think it's a both and situation in many cases. And if you have sibo, you likely have other things, too influencing sibo, like nervous system dysfunction and too much stress. But SIBO is small intestine bacterial overgrowth. Like you mentioned, most of our bacteria be in the large intestine. The small intestine is where we have digestion and absorption take place if we have too much bacteria Here, people experience things like excessive belching or bloating because the fermentation process happening in the small intestine is causing this belching, bloating, and sometimes excessive gas. And then depending on the type of gas, it's either methane predominant or hydrogen predominant. There's a third type, which is hydrogen sulfide, less common. But women with hydrogen predominant SIBO tend to have more loose stool urgency. With methane predominant sibo, they have more constipation.

B (19:49)

Okay, how did we get bacteria in the small intestine in the first place?

C (19:53)

Well, SIBO is a cause of leaky gut, right? So SIBO can cause intestinal hyperpermeability. But the reason we get too much bacteria in the small intestine, I think it's multifactorial. Sometimes people say it's like, because you have basically backwash coming from your large intestine up to your small intestine, sometimes it's maybe you have low stomach acid. Actually, if you have low stomach acid, you're not killing some of the bacteria in your stomach. And so it goes into your small intestine. There's an association with dental stuff like what's going on in your mouth. If you have bad bacteria in your mouth or dysbiosis in your mouth, you're swallowing that spit every day. It's a highway between the mouth and the intestines. I think nervous system dysfunction is playing a really big role here. It's enteric nervous system and it's a migrating motor complex. So this thing called the mmc, or migrating motor complex, comes between meals and basically sweeps the streets of our intestine. Doesn't always work for eating meals every three hours if we are super stressed. There's lots of different reasons why the MMC doesn't work. Another really big one is there's post infectious sibo. So for people who have experienced a really significant food poisoning, that can be the nidus for developing small intestine bacterial overgrowth. And I've had plenty of patients who have told me they got sick when they went to the restaurant and their gut never got better. What's this post infectious sibo piece? So I think there's a lot of different reasons people can develop it. And often it's a sign that there's something else out of balance somewhere else in the body. But it also is a problem I think worth treating in many patients, especially, especially those with autoimmune disease.

B (21:22)

So are you if people are like, hey, I've got gut issues, are you running a lab panel? I know there's a lot of online, like food allergies and then like guts panels and. And to me, it's like, there's so much right now. It's like I don't know who what to trust. So are you diagnosing it with a test or are you like, these are the five things we can do for everybody's gut health. Let's just try the basic stuff first. How do you go about discovering and treating gut issues? Shoes.

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C (23:03)

There are breath tests that you can do for sibo. In fact, I did a breath test for SIBO in a gastroenterologist's office. I don't know, 12, 15 years ago. Long time. Gastroenterologists don't often run this test in their office. And you know, I was there for three and a half hours. Like, it's a complicated test. You have to drink lactulose, breathe into these bags, whatever. You can do it at home now. But gastroenterologists usually know about SIBO and they know it's real, but they don't always have a great way to test for it because the testing is so cumbersome and it takes up a lot of personnel and a lot of room in their office. So you can test for it at home. You can do different kind of breath testing looking for methane and hydrogen. Predominant sibo, some. There's another one test that tests for the hydrogen sulfide kind.

B (23:43)

Do you have a brand or an online website?

C (23:45)

You can, there's triosmart is one of them. That's the one that tests for methane, hydrogen and hydrogen sulfide. And then aerosmart diagnostics is the one that I typically use which tests for hydrogen and methane. Sometimes if you go through a gastroenterologist, it only tests for hydrogen. So hydrogen is the most common. That's the one that causes lew stool in addition. So this is my functional medicine lens. I do urine testing. So. So we're going to go a little off of a tangent, but it's super relevant. But people with chronic digestive issues who have maybe gone down the SIBO path or they can't get better, typically this is ibs, right? So SIBO is the number one cause of ibs. By the way, if you have ibs, there's a high likelihood that you have sibo. It's just like, if you have peptic ulcer disease, there's a high likelihood you have H. Pylori. So there's this infectious piece behind the syndrome, Right? IBS syndromes, like, don't actually mean anything. It's just a diagnostic code. Why are your bowels irritated? But there's other reasons your bowels could be irritated besides sibo. And one that I see often in particularly women who have been through a lot with their gut is sifo. So you can get fungal overgrowth as well. So urine testing? Yeah, the urine test. I do. I mean, it gets complex, right? That's why there's not, like, five things I do for everybody with gut dysfunction. I have to figure out, remove the infection. So, like, what is the infection, first of all. And then I have to think through, like, enzymes. Like, do you have enough stomach acid? You have pancreatic elastase insufficiency or some digestive enzyme problem. All of that's gonna influence digestion. But it is real that there can be fungal overgrowth in the gut. And in alternative circles, they say Candida. Like, people. Everybody has candida. Not everybody has candida, but some people do. It is a real thing. Got it.

B (25:24)

What about the food sensitivity tests? Or maybe we're getting a little bit more into, like, leaky gut with that. Like, are there specific leaky gut tests? Because a lot of the GIs I talked to, they're like those food allergy things, like, aren't gold. They're not great tests. Especially the online at home stuff for, like, your allergies or your sensitivities. So what are we doing for, like, leaky gut diagnosis?

C (25:48)

Yeah. So for food sensitivities, if you were to. If you have leaky gut and you're gonna do a food sensitivity panel, there's probably a whole bunch of stuff that's gonna light up on that panel because your gut's leaky and whatever you ate yesterday, you're gonna react to. Yes.

B (26:02)

Okay, so if, like, I'm just thinking of a person I just saw, she's like, I have allergies to everything. I don't know what I should eat. So maybe she should be treated for leaky gut. And is it possible then she can open her way up to, like, tolerating more things?

C (26:18)

Absolutely. That's always my goal, is how do we improve oral tolerance? And if you do one of those tests, and I, like, literally had a patient come to me and she's like, I eat green beans and cranberries. Because I reacted to everything else. I'm like, well, now you're reacting to green beans and cranberries. So, like, we need more diversity in your diet. And for patients who are really reactive to food, take out the big ones.

B (26:38)

That's what's happening is people are doing these home food sensitivity tests, pulling out the things that are flagged, and then they're left with like, I'm really dysfunctional.

C (26:48)

Well, Kelly, to be honest with you, sometimes they've seen other practitioners also who reinforce this, you know, sometimes. I mean, this is the dark side of functional medicine, if I'm honest.

B (26:58)

Let's be honest about it. Cause I think that's what's giving functional a bad name.

C (27:02)

Yeah, functional medicine, right. Like, I'm a physician. I'm a board certified physician and I practice functional medicine. Like, if you go see a functional medicine practitioner, you might be seeing a chiropractor. Not saying they don't know anything or they can't help you in any way, but like, hey, there is a difference in training there. And we have to be honest about that. So sometimes people will see a functional medicine practitioner or do these tests at home and they'll be like, I can't eat anything. All the foods are bad for me and they're causing inflammation. I can only eat green beans and cranberries from now on. And that is not the end of the story. The most important piece of that story is that, wow, you're reacting to a lot of foods. That tells me that's basically a diagnosis of leaky gut. I know you've got intestinal hyperpermeability. Let's take away some of the big foods that are perpetuating the permeability. So alcohol is a huge one. Alcohol is really bad for leaky gut.

B (27:56)

Super bad. And don't tell me, don't tell me coffee. Don't tell me coffee.

C (28:00)

Oh, I won't.

B (28:00)

I will tell you. Coffee.

C (28:02)

That's like the one thing. I mean, I've been through all of this as a patient and a physician. So I have this unique lens, by the way. Like, I have been in the place where I could not eat eggs or nuts or dairy or gluten or alcohol or like, I don't even know what I mean. I was so sick. I had Hashimoto's, I had hypothyroidism. I had dysbiosis. I had root canals and took a bunch of antibiotics. I was super stressed because I went through med school. My husband was deployed, and that created more stress. Then I had mold Toxicity at one of my homes where I lived, and that made me more sick. And then I had a pregnancy. It was like a whole vicious bonfire of stuff. And so I just had to start, like, pulling the logs out of the fire. And now I can basically eat everything, except I don't really eat a lot of gluten. I ate it in Europe and I did awesome. So yay for me. But that's been a decade of healing.

B (28:51)

Just to spread that, to make sense for people. American gluten is different than Europe. Gluten. That's the simple answer?

C (28:58)

Yes, that's the simple answer. Our food supply has been compromised in a lot of ways, including gluten. And so there are some people who react to gluten. And in particular, if you have autoimmune disease, this is one of the reasons why I say take the gluten out, because it does make leaky gut worse. Again, back to Alessio Fasano's research. He looked at gluten, and it increases this protein called zonulin. So back to your question about, is there a test for leaky gut? So the food sensitivities panels are sort of like a surrogate way to look at, like, do I have leaky gut? And if you're reacting to everything, yes, you have leaky gut. You need more diversity in your diet. You need, like, rotational diets. You need to take out some of the big triggers, but it doesn't mean you can't eat food anymore. We have to figure out how to have better oral tolerance to remove the gut infection and improve the permeability. People, by the way, we need to talk about this. But just like bookmark, estradiol improves tight junctions. So estradiol and HRT can help with leaky gut, but so zonulin. Zonulin. There are some tests that will look at zonulin. It's not very often that this is checked, but you can measure it in certain stool tests. And if zonulin's really high, then it tells you, yes, you have leaky gut. And so gluten can increase zonulin, which increases these tight junctions and permeability.

B (30:08)

Sorry, did I miss it? Is zonulin a blood test?

C (30:11)

It's a protein and it's a stool test. There are some that you can do in the blood, like, depending on the lab panel you use. The way that I use it is it's in the stool.

B (30:21)

Is that like a test you can order at Quest or is that like an online.

C (30:24)

It's one of the, like, specialty Functional medicine labs, not like a quest test.

B (30:28)

Okay, cool. Thank you. So a woman comes in, she's got lots of food sensitivities. You're like, probably leaky gut. You check the stool. She's got high levels of zonulin, which is a byproduct, it's a protein.

C (30:40)

And when it's high it indicates, yeah, leaky gut.

B (30:43)

Okay, so now we're like, okay, now you have leaky gut. Great. What do we do?

C (30:47)

Okay, the simplest way to look at it is remove and replace. Remove the gut infection, replace the digestive enzymes. So remove the gut infection is like, that's the complicated part. That's where I wish it could be more simple. And I could tell people like, do these five things to fix your gut. There are some five things you should do to improve your gut health, like eat more fiber and to exercise and avoid things like alcohol. Don't eat heavily processed, like the ultra processed foods. And really work on the stress piece because stress increases intestinal permeability and I think it's ubiquitous.

B (31:17)

I love it. Let's talk about that. Because I think, I think like, if the doctors aren't at this point saying, less stress, less stress. And people are like, great, nice to know. What the fuck does that mean? I have a woman and she, we're trying to figure out if she has mast cell. By the way, we need to tie mast cell into all this, right? Maybe I have mast cell and blah, blah. And I'm like, now one thing that seems to be common with mast cell people just see if they' this bounces off for you or how you receive this information. One thing that seems to be common is these people tend to let in a lot of the world. They let the world really affect them. And she's like, oh my God, how do you know me so well? And so I was like, okay, let's talk about that. In like the training oneself especially. It's difficult with like the hyper feelers, the hypersensitive people, right? Like, I get those people of like training you to be like, I get to choose what I let into myself, what I let into my nervous system in more of like an active way of living instead of like, I just let the world in. And by the way, I need to, I want to know what's happening with the world news. I want to kind of be up to date. But my God, I read one week of the Economist and I want to shut down.

D (32:25)

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C (32:59)

Yeah, totally. Boundaries. Okay, so this is the really interesting analogy here. Your gut is a boundary. Those boundaries get compromised. We get leaky gut, we get immune dysregulation. In our emotional psychological world, boundaries are really critical. But women are culturally conditioned not to have boundaries in many cases, right? We're selfish, you're a bitch, whatever it is. When we have boundaries and really choose to care for self first. And so I think that's really complicated, but I think it's a really important piece of the puzzle because what I say is, you can't heal your physiology without healing your psychology. And I agree with you that people with mast cell issues often have suppressed emotions. So one of the with mast cell in particular is suppressed anger. Because anger isn't always an appropriate or acceptable emotion for a lot of people to have. That depends on your upbringing and your family system. And what did that look like? Did you have to be happy all the time and pos allowed to have fear or anger or some of these less acceptable emotions? And when we suppress emotions, those also come out as physical conditions. Hashimoto's is another one. People who have Hashimoto's, the tendency is they swallowing something like, what are you swallowing? What aren't you saying out loud? What's going on there? Where you're maybe not speaking your mind or saying all the things that you need to say because it makes other people uncomfortable.

B (34:29)

Do you have a story just to give. You worked on them with this. They got their boundaries, they found their voice, they cleaned up that, and their health, their physical health got better. Can you give us a story?

C (34:40)

Yeah, no, I'm gonna share my story because I think it's important for other women. And I say this all the time. I am her, she is me. We are so similar. My patients, they are my mirror every day. And it's, you know, I see this collection of women who are high achieving, high performers. They're smart, they read about their health. They're not willing to settle on answers that are really superficial. Like, your hormones are out of balance. Here's a birth control pill. They're like, come on, there's better answer than that, right? And they tend to live under a high degree of stress and they're able to do it. They're able to play this game in the world and. And I was able to play this game in the world where I was high performer, high achiever, hyper capable, uber responsible. And there was a certain point in my life where I couldn't do it anymore. And part of it was I had mold exposure and like a whole like bucket of things happening. If you really look, you know, if you use. This is the dark side of functional medicine. If you really look, you're gonna find some stuff. And I'm not saying that living in a moldy house should be ignored or that that's not important because, because that was, you know, there was environmental factors. That kind of stuff is not, it's not good on your health. It's immunosuppressant. Like we can go down that rabbit hole, but we're not gonna go there today. But the point is, is there's only so much somebody can handle. And as women, especially high achievers, we like shove it down and push. And so for me, I did so much for my health. I was watching my diet, doing like all the, you know, I was exercising, like literally doing everything right. Everything in my home was like non toxic. And all the things.

B (36:23)

You didn't microwave using plastic.

C (36:25)

Absolutely not.

B (36:26)

Please don't do that. Anyways. Yeah, no, right. It's like all the things, but we're like, oh, if it's just that stuff, but there's actually like the emotional work.

C (36:35)

There'S this bigger piece. Yeah, like, yes, those things play a part in our health. And if we're constantly suppressing emotions or driving past or pushing on past the pain, that adds up. And it puts our nervous system in a place where we don't feel safe anymore. And if our nervous system doesn't feel safe anymore, we deprioritize things like the immune system and hormones and digestion in favor of survival. And so I was very much in stress and survival mode and I didn't even realize it. Like, that tends to be the thing when we're in stress and survival mode. There's a really narrow focus and that's part of survival. Right. So you can run from the tiger.

B (37:13)

Oh, yeah. I don't have a limb hanging off of my. A trunk. I'm fine. Yeah.

C (37:17)

For me there was like a universal two by four that woke me up. And that was when my toddler flooded our house, which is a story for another day. But it was the worst nightmare for me. But also I give such gratitude to that time because it was this cataclysmic event that made me wake up and really address the nervous system piece. And so for people who are listening, who are feeling like, ugh, where do I start? Like, if you address nervous system, often, that is a piece of the puzzle. So the story you told about the guy who came in and he thought SIBO was causing everything, this is common in my patient population. They think there's mold toxicity or lyme disease or something like that is causing all these problems. But really, it's like, we've got to heal our psychology in order to heal our physiology. And yes, hormones and thyroid and autoimmune disease and gut all play a role, but so does the way you talk to yourself. So do the thoughts in your head. 24 7. So a lot of it. My gut was my biggest teacher. I had recurrent sibo, and for sure it was real, but my nervous system was driving it more than anything.

B (38:20)

I'm kind of, like, stuck, I guess, on this. Like, we tell people to reduce stress, but I can't quit my job. I need my job. And, like, I've got three kids because I decided to have three kids and, like, you know all this stuff. And I like, I'm super passionate about X, y and Z, so I do those things. And by the way, I've got to exercise, right? So. So it's like, what tools to start learning boundaries, to start learning self dialogue. Where do we go for therapy? And here's the other thing. High achieving women. I don't trust you. Like, not I don't trust Christine, but, like, what therapist do I trust with trying to figure out something that I don't even trust, that it's actually a problem. But Dr. Christine said it's a problem. So, like, I should go talk to you about regulating my nervous system. Where do you start with that?

C (39:04)

I think the biggest place to start is showing up for self. And what does that look like? Because again, we've been conditioned to self sacrifice and give all we have to everybody else around us. But what does it look like to show up for me? For me, that was like, okay, I'm gonna start going to the gym regularly and nothing's gonna interfere with that. And then that got me stronger.

B (39:28)

And that was from a place of self love, not from, like, I need to go do more zone 4 cardio because I need to preserve my brain health, right? Like, it's like, because I love myself, I'm choosing, like, intention matters, right?

C (39:41)

Absolutely. I'm so Glad you said that. Because that is a piece of what we choose to put in our mouth. Right? We're not, like, restricting food from a place of, like, I wanna be smaller or shrink. We're choosing food that nourishes our body the best that we can. Because I have respect for myself and my body. I'm choosing to go to the gym and lift weights. And when it gets really heavy and it's hard, I'm like, do this out. Self respect. That's like my mantra. This guy's out of self respect. And then I, like, get that extra squat in or whatever it is. So I think the intention is critical here because even if you're not saying it out loud, like, your body knows these things. We have these systems inside. Like, we hear the way we talk to ourselves. And so I think it's just this place of, like, okay, choosing to show up for yourself. And the other piece here that's a little abstract but important is embodiment. And so a lot of women who are high achievers, who are pushing and just getting stuff done, they're like, put their head down and go. They go into that mode. I went into that mode. Put my head down and go. I can do anything. I just don't want to anymore. And so a little piece of me was disembodied. Like, there was this little disembodiment. And I think that's a chronic issue in a lot of women. They're just a little bit disembodied. And so what does it look like to embody again?

B (40:54)

Can you explain disembodied meaning? I don't know how I feel. I don't know what my shoulder's feeling right now. I don't know what my knee is feeling right now. But, like, knowing how you feel, like, how your body is in space and, like, tuning inward instead of like, I'm fine, I've got goals.

A (41:13)

Is that it?

C (41:14)

Totally, yes. I think it's like being a little bit disconnected with self and disconnected with our own needs and disconnected with what's going on in our body.

B (41:22)

Yeah, there's. We're so disconnected. And because of that, they can sell you a bunch of shit because you're like, do I actually want to buy that to try to feel better about myself, or is there some personal work that I can do instead that makes me feel better about myself?

C (41:36)

Right.

B (41:36)

Like, there's all these products to be bought to try to make you better instead of, like, there's actually an internal job to do. When I got into Coaching over a decade after surgical training, they're like, here's a wheel of feelings. And I'm like, there's a wheel and there's an entire wheel of possible feelings. I joke, like, surgeons have one feeling that that feeling is tight. Like, we only feel tight. There's other feelings. And I think for that high achieving woman to realize, like, it sounds so stupid. I think it sounds stupid, but that's where the work is. Is it so stupid to get to know yourself? It's actually very not stupid. Right. But we dismiss it because we're so disembodied.

C (42:18)

Yeah. And so like embodiment, like, what does that look like? I think so creativity and fun. Like, what do you do for fun? That's the big question. That's where I start. Because stress management gets stressful. It's like, oh my God, how many things do you have to do? That's just more stress, ultimately. And so really it's like, okay, how do we reconnect with self? How do we get embodied? Really get into embodied, who we are, how we feel. And then also like think through. What does that align with me and how I feel and who I am and what I want when they try to sell me that shit, like, like, how's that feel? And I think really too, getting into the feeling that comes from your heart and your chest, not the thoughts and emotions in your brain, because those are different. Like, these are thoughts, these are feelings. So honoring, you know, that gut feeling, that's another piece. So back to your gut. Like, all this does tie into gut health ultimately and actually thyroid function. Like, it really does all go together. Because, you know, that feeling like, ugh, just doesn't feel good in my gut. Like, listen to that. That is such gold. And it will tell you more information than anybody else. Like, that is the expert in your life is yourself. But it's tapping back into that intuition and tapping back in. And everybody has the power to do that. It's just a matter of sometimes slowing down and really listening to self and then getting to know yourself again.

B (43:39)

I love that. Let's go back to thyroid and estradiol. So many people now are like, I cured my Hashimoto's, I cured my thyroid. I got off my thyroid medication. And to me, that's very new in medical school, if I remember properly, like, it was a fixed condition. You had low thyroid. That's how well your thyroid was going to be for the rest of your life.

C (43:59)

Right.

B (43:59)

And now we're in this world of like, I cured it. I'm hearing a lot of people be like, I think it was just perimenopause. I got on hormone replacement therapy. I got off my thyroid issues, or I got off my thyroid medication. Cause I healed it. So let's talk about, like, do we have data on how many people cure or heal thyroid issues with functional medicine, hormones? Do we. Can we tell people how common that is?

C (44:23)

There's not data. I can tell you with certainty that women who address Hashimoto's will see declining antibodies. And so if you go see your endocrinologist and you can track it, and this is controversial, just for the record, most endocrinologists would be like, why would I check that again? Like, I'm never gonna check your thyroid peroxidase antibodies again. They're 600. You have Hashimoto's, end of story. By, that's not true. Like, you will see. I can. I know I've done this for 10 years. Like, thyroid antibodies decline as patients start to feel better and address the other underlying issues in intestinal hyperpermeability. So if you're addressing the autoimmune component, you can sometimes lower your need for thyroid replacement. If you have a lot of thyroid destruction that's gone on for many years because of Hashimoto's, it's really difficult to get off of thyroid hormone replacement. I'm not saying it's not possible, because I really do believe that we have the capability to heal. I just think it's really difficult to do, to heal fully from a condition like that. But I don't think it's impossible. Just to be really clear, I don't think anything is irreversible. But that said, so somebody who has subclinical hypothyroidism, who's on thyroid medication, she can totally get off thyroid meds. And you know what helps her thyroid work better is hormones. So estradiol in particular influences your hormone receptor sensitivity. So where TSH goes to T4 goes to T3. So T3 interacts with the cell, and that hormone receptor sensitivity is positively influenced by estradiol.

B (45:52)

And so this is possibly, I won't say absolutely, but possibly why we see more thyroid issues in people's 40s. Because estradiol is going down.

C (46:03)

Yes. Okay, you ready for this? So it goes back to gut. So it actually goes to something that's not talked about very often, which is the microgenderome. And so the microgenderome describes this triad that's all bidirectional. So hormones influence gut health or Gut microbiome influence immune system. And so we see more rates of autoimmune disease when women go through the perimenopausal transition because of the microgender. But let me tell you what's going on with gut health during perimenopause, because that's critical. So as we go through perimenopause, we start to, of course we see this decline in our hormones. And estradiol in particular plays a really big role in intestinal permeability. Or, I'm sorry, in intestinal permeability. Yes, but intestinal microbial diversity, microbial diversity is really critical for our gut. We want more of it, especially as women. So if we look at females versus males, there's something called sexual dimorphism. What that means is that males and females have a very different gut microbiome until women are age 40. And that's when that intestinal diversity starts to plateau. And we see decreased diversity over the next decade or so. Postmenopausal female gut looks like a male gut, which is not what we want. That creates more inflammation, more cardiometabolic risk, more colon cancer, more autoimmune disease. And so part of it is related to hormones, but it's that bi directional influence. How hormones are influencing gut, gut, how gut is influencing hormones, and how both of those things affect the immune system by way of intestinal permeability. But it's more than that. Like if we look at certain studies, women with lower testosterone levels tended to have more autoimmune disease. I mean, hormones definitely play a role in all of that and it's just very complicated. I think the tricky part is like, and I think to your initial question, why is thyroid underdiagnosed? It's because we tend to see things in silos in our medical system. We have specialists who see the ureters and the bladder. Right? We have a specialist who sees the colon and the stomach. But they don't care about thyroid. I think physicians are smart, they're trying their best, but they don't have the tools and they don't have. The system does not support really great care.

E (48:13)

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B (48:40)

Influences science, whether we want to believe that or not. But really, since the. I'm going off on a big tangent, but since the Industrial Revolution, really thinking of the body as a machine and thinking the thyroid, once the thyroid's broke, the thyroid's broke, right? That's the broke part of the machine. And, like, bodies aren't machines, though, and everything does influence it, including the environment and your relationships and the air and like, all this stuff. And like, we've really made the body a machine and now we're kind of, I think, getting out of that. Just like. Just like medicine separated the mind from the body, right? Like, that was stupid. So, like, we're starting to get out of that, that. Is there any data looking at the difference in formulation between oral estradiol and transdermal estradiol in the gut? And this just for people who are listening, if you haven't listened to all 300 other episodes, this is not saying we're going to put everybody on oral or everybody on transdermal. I just think in regards to gut health, there might be something to swallowing an estradiol versus doing an estradiol patch. Is there any data on that?

C (49:45)

There is data on oral estradiol improving intestinal diversity. So there's one study that looked at women with premature ovarian insufficiency, put them on HRT using an oral estrogen. I think it was an oral progesterone. I'd have to go look, but I know it was an oral estrogen and they saw a bunch of these indices reverse. And that microbial diversity got a lot better after a year of these women being on estrogens. So I will say clinically, I see patients who, like, I have patients with inflammatory bowel disease. I had this one in particular. She's an RN and she's a nutritionist. She's really darn smart. She's doing all the things. She just sort of flared like she wasn't quite right during perimenopause until she started HRT and it was transdermal and her gut got a lot better. So, I don't know. I think we just have a paucity of research in this area and we have a lot more to explore. But I do think I really only prescribe transdermal for the most part. I don't use a lot of oral, but I definitely think estrogen transdermally can help the gut.

B (50:45)

So we know transdermals work.

C (50:46)

Working. Yeah, we know it's working, but like is it helping the gut microbiome? I think so.

B (50:51)

You know, and the other interesting thing is the WHI is the biggest study to my knowledge, looking at oral with colon cancer reduction.

C (50:59)

Right.

B (50:59)

30% decreased risk of colon cancer in the. It's not estradiol, it's conjugated equine estrogen. Right. Which is a smorgasbord of different compounds and so to say like oh, transdermal estradiol is going to decrease your risk of colon cancer as much as the WHI study is. There are apples and oranges. Oranges, right. But I think it's provocative to say even the oral conjugated equine estrogen, which is a smorgasbord of things, including what our body makes and what our body doesn't make, had a profound effect. Because the theory is it's the microbiome that decreased the risk of colon cancer. Besides the fact that there's anti inflammatory properties and blah blah, blah. Can I ask you a question about oral micronized progesterone and bloating? Like oral micronized progesterone is kind of the gold standard when people need a progesterone now when they're on hrt. But there's a subset of women, we can speculate on how big of a population this is. But they're like, I am so bloated or I put on £5 with this like it's water weight. So oral micronized progesterone effect on the gut. Why are some women getting bloating and how would you troubleshoot that?

C (52:03)

I don't have a really easy answer. And my experience clinically, I mean most of my patients, any patient on HRT is on oral micronized progesterone for the most part. I mean the vast majority. Right. I honestly don't see a ton of bloating. I do see in a higher dose like with some women who are more sensitive to the higher dose of progesterone. If I'm using like maybe 300 milligrams nightly or something, they will have constipation. So I have a few patients who get constipated with too much progesterone, but I truly don't see that much bloating.

B (52:33)

Okay, what do you tell the constipated people?

C (52:35)

I tell em, well, we probably need to decrease your dose of progesterone cause you're more sensitive to it and that's okay. I mean if we have, you know, it's that double Edged sword. Like, it helps with one thing, but it hurts with another. And so we just have to find the balance. There's also an opportunity for, like, well, let's explore other causes of constipation. Like, might you have methane predominant sibo. Might you need more magnesium? Like, magnesium is a pretty decent way to mitigate some of the constipation, but ultimately, if it's not doing the job, we need to move on. And it's magnesium citrate, generally. But magnesium citrate is the type of magnesium that will generally cause. Cause more loose stool in women who don't need it. But women who have constipation, they tend to do really great on maxitrate. You just have to be cautious about it because it can cause diarrhea. Too high of a dose?

B (53:18)

Yeah, go slow. Yeah, go slow, go slow. Okay, that's perfect. Because I recently had somebody who was like, I think this was like 100 milligrams of oral micro, which is standard dose. But they're constipated, and it's bothering them. So I was like, okay, double down on the fiber. Let's double down on the water. I should add magnesium C citrate for them. And. And any other thought on people who start HRT and do say, I'm getting bloated. My stomach seems bloated. Like, are we thinking more gut permeability issues with them? Are we flaring something by throwing hormones on? Or do you think it's truthfully the hormones that are causing this?

C (53:53)

I tend to think it's multifactorial, because most of the time it is. Right. There's, like, a lot of different things. The answer is I don't always know. Right. And I think. I think the bigger deal, the first thing I think about is what's going on with the gut microbiome. I mean, in every patient I see, I'm like, okay, let's work on your gut, because your gut's gonna influence the way you metabolize hormones. Okay, so here's an interesting one. So the estrobolone, we talked about the ways that hormones influence gut. So as you go through perimenopause, you have a decrease in estrogen that influences your intestinal permeability. But it goes both ways. It's bidirectional, and that's really important. So your gut influences hormones. And so primarily, we can think of this through the estrobolome. So the microbiome describes all the bacteria in our gut, like, literally trillions. It's a very complicated system of Lots of different bacterias that narrows as we go through perimenopause. But a subset of that gut bacteria is called the estrobolome. And the estrobolome is responsible for metabolizing estrogens. It was first introduced in 2011 in a paper called Microbiome and Malignancy because it plays a role in cancer. And, and so there's more recent research looking at this. This is specifically regarding gynecologic cancers. But Laura Chambers, I think she's in Ohio, she's a gynonc and gynecology oncologist, and she's doing research on, like, how the estrobolome and how the microbiome of the uterus influences our uterine cancer risk. But anyhow, the astrobolome dictates how we excrete estrogen or how we suck it back up into circulation. So the estrobolome makes the. This enzyme called beta glucuronidase. So beta glucuronidase can unpackage estrogen so we can suck them back up into circulation. So if you're menopausal and you're having hot flashes and you have low estrogen, there might be a place where this is protective, which totally makes sense to me because, again, I think your body's protecting you. Like, most of the time when we look at these systems your body's got, there's some method of protection. But if you're a woman who has excessive estrogen or you have endometrial hyperplasia and you're sucking some of that estrogen back up, that's not helping you, it's hurting you. Right? So we want it to excrete it. And so there's three phases of estrogen detoxification. Phase one happens through the liver through CYP enzymes. Phase two happens through something called methylation, which involves things like magnesium and B vitamins. And then phase three is through the gut. And if you're not pooping out your estrogen, you're going to have a problem. And depending on your estrobolone potential, you might also have a problem. The estrobolone potential is this little extra switch that God gave us so we could regulate our hormones a little bit better, but it's broken in a state of dysbiosis. So maybe if they're not tolerating hormones, it's gut.

B (56:39)

It's so big. And I think this is used against women. You need to pay. We need to check these very expensive labs every quarter to make sure you're not getting Toxic. And if the human body's so complicated and there's so much fear that's involved, it's like, dude, we're just at the very beginning of figuring out gut, right? And like, oh, my God. Before I start you on hormones, do I need an extensive gut workup in everybody? Probably not. But knowing who we do need it in and who we don't need it in, like, because you and I can talk about it. Like, this is fascinating, right? But I worry about the people who are like, oh, my God, it's so overwhelming. I just don't know who to trust. I don't know where to spend my dollars. Can you wrap this up in a nice package for us?

C (57:19)

Yeah, Fair. Okay, so if you have digestive issues, right, like, you've got loose stool, bloating, belching gas that seems excessive, digestive, maybe it's pain, cramping, all that kind of stuff, we can talk more about histamine bookmark. So if you have digestive symptoms, you probably need to investigate what's going on with your gut. Don't ignore it because there's some collection of gut bacteria. That's a problem. I would say also, if you have autoimmune disease, you probably have some underlying gut issue. If you're reacting to a lot of foods, the solution to that is not to remove more and more foods. It's to address what's going on with your gut permeability. And so, yes, unfortunately, it's complicated. I wish I had some simple answer for women, but I will say the simple ish answer is avoid the things that wreck your gut. I don't even think I mentioned before, like, antibiotic use. You know, if you're using a lot of antibiotics, you have recurrent UTIs, recurrent sinus infections. Like, you gotta address that upstream stuff. Eating real food and really prioritizing fiber. Can you move the needle that way? If so, great. But if not, I think don't ignore it. Don't ignore your symptoms. The tricky part is, like, well, who's gonna help you address them? Because just like, thyroid gets missed out a lot of times. Like, it's left out of the story. Gut is also left out of the story. Like, gastroenterologists are good at ruling out serious conditions, but if you have ibs, and you're left thinking, well, I have ibs, that's my problem. That's not your problem. That's your diagnosis. We still don't know what your problem is.

B (58:48)

That's your symptom of something happening. Yeah, I mean, like, People are like, oh, I have. I have hot flashes. No, no, no. You've got low hormones that cause hot flashes. It's not that. Like, it's a symptom of something else going on. That's super fascinating. I like, to me, I'm like, I think the gut is going to be more and more big. I think the power of our mindset on our health has been hidden for decades. Like Gabor mates when the body says no. Oh, my Lord. That's an interesting myth of normal. Like, such good books for people who want resources on this. Dude, this has been so fun. I'm so sorry. I have to wrap it up. I'm so glad you're in Colorado because Colorado, I. I'm not. Like, there's one place in America that's overserved with us, but, like, I think Colorado is underserved. I hear from Colorado people all the time, like, where do I go? I need help with hormones. Where do I go? So thank you so much for being a Colorado resource for people. Can you tell us where people can find you?

A (59:43)

Yeah.

C (59:44)

So, I mean, connect with me on my website, which is drchristinemarin.com or Instagram, same name. Drchristinemarin.com I'm on Facebook sometimes too. And I also practice in Michigan and Texas. I did my residency in Texas. My husband did his spine fellowship in Michigan. So I've lived in all those places. I'm licensed in all three places. It's not as random as it sounds, but. But that shows you a little bit about my background.

B (60:08)

I love it. Oh, thank you so much for joining us today. I know this has helped a lot of people.

C (60:12)

Thank you for having me. I've been a long term fan of your show. You do such good work and have so many amazing guests. So I'm just honored to have been on.

B (60:21)

Thank you. Till next time.

C (60:23)

Till next time.

A (60:24)

Thank you for listening to this week's episode of youf Are Not Broken. If you wanna dig deeper with me, sign up for my Adult Sex Education Masterclass class where you learn adult things like communication skills, anatomy lessons and desire types, and how to talk to your doctor about sexual health concerns. If you want the Adult Sex Education Masterclass for free, join my monthly membership for more in depth exclusive content, more time with yours truly. A private podcast, coaching and educational empowerment. And you can watch my interviews live and get them immediately without advertising. Head over over to www.kellycaspersonmd.com for the membership and adult sex ed Master class members. Get the master class for free. This podcast is presented solely for educational, entertainment and informational purposes only. I am a doctor, but not your doctor in this format and all of my platforms and guests, including on this podcast are not giving individual medical advice or practicing medicine medicine. See in Consult with your own care team for your individual needs and concerns. This podcast is not intended as a substitute for the care and advice of a physician, therapist, or other qualified professional. This podcast does not constitute the practice of medicine, in case you were curious about that and no doctor patient relationship is formed. But I still love you. Using the information on this podcast or any of my platforms forms is at your own risk. Until next time. Remember, you are not broken.