Dr. Sara Gottfried: How to Optimize Female Hormone Health for Vitality & Longevity
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Welcome to the huberman lab podcast, where we discuss science and science space tools for everyday life. I am ander huberman and i'm a professor of neurobiology and opened ology at stanford school of medicine today. My guest is doctor Sarah got freed.

Doctor Sarah got freed is an obstruction gonee logic, who did her undergraduate training in bioengineering at the university of washington in seattle. He then completed her medical training at harvard medical school. And SHE currently is a clinical professor of integrative medicine and nutritional sciences at Thomas jeffson university. SHE has also been a clinician treating men and women in various aspects of hormone health and langevin for more than twenty years.

SHE is an expert in not just traditional medicine as IT relates to hormones and fertility, but also nutritional practices, supplementation and behavioral practices, and combining all of that expertise in order to help women navigate every aspect and dimension of their hormones, longevity and vitality, ranging from puberty to Young adulthood, adult red Perry, maniatis, maniap and nowsaid. She's also treating men across the life span in terms of longevity, vitality and hormone health. During today's discussion, doctor got free chairs and enormous amount of information and tools that women can apply toward their hormonal health, fertility, vitality and longevity.

We discuss the gut microbial, which many people have heard about. The doctor got three points out, the specific needs that women have in terms of managing, they're got microbes on, and the ways that that influences things like estrogen levels and meta lisp to stop roone thread and growth hormone and much more. We also discuss nutrition and exercise.

We touch on how the omega fat assets play a particularly important role in managing female hormone. Health doctor got free points out why women have particular needs when IT comes to essential fatty assets and how best obtain those essential fat AIDS for hormone health. We also discuss exercise and SHE offered some surprising information about the types ratios of resistance training to cardiff asia, training that women ought to use in order to maximized their hormone health.

We also talk a lot about the digestive system. This was a surprising aspect to the conversation. I did not anticipate doctor got free shared with us, for instance, that women suffer from digestive issues at more than ten times the frequency that do men. And fortunately, that there are tools specific to women that they can use in order to overcome those digestive issues, and that in overcoming those digestive issues, they can overcome many of the related hormone issues that so many women face.

Doctor got fired also shares with you tremendous knowledge about the specific types of tests, not as blood tests, but also earn a microbiome tests that women can use in order to really get a clear understanding of their hormones status, not just of present, but also where the trajectory of their hormones is taking them. So we have an other discussion about puberty, about Young adults, ult, pari manohar, and how best to manage and navigate parameter pause and menopause, including a discussion about hormonal replacement therapy. In addition to her academic and clinical expertise, str got feed has authored many important books on nutrition, hormones and supplementation as IT relates to women and to people generally.

The two books that i'd like to highlighting that we provided links to in the show, no captions are women, food and hormones and the hormones cure. I read the hormones cure and found IT to be tremendous ly interesting and informative, not just in terms of teaching me about female hormone health and various treatments for female hormones alth, but also as a man trying to understand how the underground system interacts with mindset, nutrition and supplementation more generally. So I highly recommend the hormones cure for anybody interested in hormones, in hormones, health and women, food and hormones in particular for women, although, again, in both books are going to be strongly informative for women wishing to optimize their hormone and health, vitality and longevity.

Before we begin, i'd like to emphasize that this podcast is separate from my teaching and research roles at stanford. IT is, however, part of my desire and effort to bring zero cost to consumer information about science and science related tools to the general public. In keeping with that theme, i'd like to thank the sponsors of today's podcast.

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Again, that drink element element dot com slash huberman. And now for my discussion with doctor Sarah godfried. Doctor got freed. Sarah, welcome.

Thank you. So happy to be here.

Delighted and very excited to ask you about an enormous number of topics you are expert in so so many things. So uh the chAllenge for me is going to be to uh constrain this walk as they were. But um i'm hoping that we can touch on a great number of things today, the first of which is really about hormones and female hormones in particular. And I have a question, which is, is IT ever informative for a woman, regardless of age, to know something about her mother's, perhaps even her grandmother's experience viso v hormones, not just pregNancy chAllenges with or ease with pregNancy and child rearing, childbirth this sort of thing, but know what sorts of conversations should women be having with themselves and with family members to get a window into what their specific needs might .

be of this question? So my work is really at interface between genetics and environment. So your question gets to both.

And I think it's essential that you understand what you grandmother went through. I'd even see your great grandmother, depending on longevity in your family. So I grew up with my great grandmother. I get that, and especially your mother.

So I would probably start first with trauma, an intergenerational trauma, because I think that affects the underground system so hugely, especially cortisol signal, but the broader pine system, psycho m unna neural and decline system. And then there's, you know, if I think about this state is the lifecycle that a woman goes through. If you think about puberty, I think I don't know how genetically determine the age of puberty is.

Certainly there's a lot of environmental influences like toxins can affect IT. But um pregNancy they eat at which you start to go through every menippus menippus. Many of those have a genetic component.

So we've pregNancy him and you can certainly think the shape of the problem is your ability to have a vacation birth. Some of that is generally determine. I mean, you do have you know the this firm donor affecting some of that.

But you know in my family, for instance, we have no the syrian sections. So everyone goes through this process of a relatively easy, rational earth I for a baby but you know for the most part um you can find out about that. And then there's certain female conditions that have a very strong component genetically, most of which run in my family.

So that includes enemy trio sis fie raids. I just had to interact me. I had fifty plus vibrates and policies tic over in sync me.

And of those three, how frequent are those? And maybe I can constrain the question little bit by saying today's discussion images can be heard by men and women of all sorts of ages so maybe i'll direct a question a little bit toward, you know at what age should these discussions start?

Um you know we always imagine that women in their um thirties and forties and fifties and onward should be getting certain tests and addressing things like very in reserve and and other sorts of things, but you know we could march through, just say, for a woman in her teens who's already hit puberty, what sorts of biomarkers, whether or not their blood based or or um a typing the outward appearance of should those Young women be paying attention to? Likewise for women in their twenty thirties, maybe we could take IT a more less by by decade at starting at puberty. Assume that woman is puberty sometime.

What between? What is that? Now the average in the U. S. Is somewhere between twelve and sixteen years old.

I have that right now.

You do not so great I to be wrong.

So so IT used to be a twelve to sixteen. I would say fifty years ago, it's been moving Younger. And we think some of that is related to toxin exposure, as I mentioned.

But I was done when I went through peering. So, uh, well, I should say monarchy and I started growing brass much before that. So I think now i'm going to step away from the science for a moment.

I'm going to do that pretty fluently, and i'll try to call IT out. I think there's also a huge influence from stress and like the development of the atran al plans. So going back to the science.

The issue in teenagers is that the hypothermic patuit tory adrenal access, and I like to think of IT broader, so stay with me. Hypothermic peti adrenal, good at all of recent women, tees, men, thread, get access. So that means the control system. So i'm kind of expressing my bio engineer inside here.

I think it's great to include the other organs and tissue systems of the body because as we both know that the narrow definition of just hypothermic c patuit toria dro IT can't be just that, right? I can't right now .

IT doesn't tell the whole story. So if you look at, uh, the main sex warmth in A A Young woman whose the teenage years, the hypotheses c capital, a dream o gattle part of that is not fully mature. So they're more likely to cap periods, especially under stress.

They have a lot of influences that really doesn't get well established until you're done with adolescence. And i'm told that adolescence now is not like edge twenty five to twenty six. I heard that that was like i've got two daughters. I was that's a really long time.

not just a psychologically defined or biology .

psychologically defined. I heard that from a psychologist. So biomarkers you asked about in your teenagers. What I think is really interesting is to look at cortisol, to look at the dance between emerging and progesterone in those years is less helpful because I think there's a lot of due to the immaturity of the system. If you've got someone has got really regular periods, it's probably Better to do some benchmarking at that age. But generally, if I that enchant kin is best performed in your twenty authorities.

are periods not that regular in terms of duration of the meta cycle when the menstrual cycle first .

sets in IT depends. So I was like clock work every twenty eight days until I have my, his direct me in August champing with my daughters. I've got two daughters, once seventeen, and the others twenty three.

For a lot of women, they're not regular. And then there's the whole piece of oral contraceptives and other reforms of contracts tion or you have no idea what the Normal cycle is. And I hope we'll have some time to talk a little bit about oral contracts tips because I think that is this is no opinion again and not science. I think that is the number one and a creaative y that is a gene for women we will definitely talk about.

I get a lot of questions about oral contraceptives in the social media space and also questions about I U D, quite a lot total, in particular copper I U D on mono. Ud, so we will definitely touch on that.

I am an I U D crude or so. I just want to you give you that warning.

You're a fan. I have that right or anti. I am a huge fan, which iud in particular.

So I like copper because it's non hormonal. It's as effective as getting your tubes tied.

Who have thought me, is that toxic to the sperm mobility as that? How works? That's my understanding of IT. Is that IT basically it's like a more less than electronic fence to the sperm cap and just that's IT electric .

fence is a bit of a harsh analogy, but i'll work with that. But it's you know to have something that can last for ten years so that you really have complete tony y and sovereignty over your sexual life does profound. And to not get all those downstream is there is a ated with birth control pill.

The other thing that's important to know about that, I know this simple women who use the cop rid have the higher satisfaction rate of anyone on contraceptives, the highest satisfaction rate. And yet IT is the least used of all forms of contraction. Now, my favorite is victim, but short of the seto me, I think the idea is, is a really great choice.

There are some business with they are not saying it's was free, but I love guide and I love IT for Younger women too because I used to be that when I went through my training, which was thirty years ago, we were told, you know, don't put IT in someone who asked at a baby and that is Peter oral messaging. But getting back to original question, which is about biomarkers per decade. In your twice, that's when you want to do some base casing with esterton protesters and test room. So I think it's really helpful to know about this. This tango, you're from argentina or .

you're argentine's. Yes, my grandparents did tango into their late eighties. I am i'm in my late forties and I I still haven't started. So I suppose there's .

time I might be time for you to okay.

And that might .

be a factor in their longevity. Do they have go to half .

and not just span? And my grandfather smoke cigarettes daily, remain mentally sharp until he died in his late nineties, but almost burned down the apartment several times, falling a sleep with a cigarette. Mal, so I don't recommend anyone spoke, by the way.

But IT was coffee, muti, red meat and cigarettes. And they lived into their ninety, that side of my family has the genetic advantage, the other side less so. But in any event, tango um is is a twenty twenty three goal IT has been every year the I know that holds you .

accountable and we .

and there there will be no youtube video of me.

at least not .

initially tif errs actually phenomenal. Pocatello is a at tango dances. I know this is very sources. Yes.

I yeah. So this tango between estra and progesterone is incredibly important. You want to have the the right lead. You want to have the right follow between the two warmth again, i'm stepping away from my science that, but what happens a lot of the time is that astringent dominates in that tangle. And when that happens, IT sets you up for a greater risk of vibrates and emetrius rupee, probably in association with the microbiome in the astro bem.

Can you familiarize me with storm the to know that I don't recognize the term?

yeah. So the instability is the set of microbes in and their DNA theydon a mostly in the gut microbiome that set of microbes entertained. So it's in the, if you look at the totality, the subset of particular bacteria modulate emergent levels.

So a lot of his work was spread ed by Martin placer. And what we know is that there are some women who have in a tribu m that makes them have a greater risk of certain emergent mediated conditions like breast cancer and the metro cancer and a men prostate cancer. So the exact room is incredibly important.

There's not a lot of attention paid to IT, but I always think in terms of my patience, you know, could this be someone who's got a faulty, a tribal and we need to adjust IT with, you know some of the microbiome, a modulating uh nutrient metrostav al, that we have so that they're less likely to have that that tango that's not working with austerity protestant. So getting back to the bite markers. If if you gave me an unlimited budget, which I kind of have with some of my clients that I work with now, what I would want to know is estrogen, progesterone, testosterone, and I want the timing rate for that.

I D want to know about D, H, A and sort of the whole interesting pathway. I'd want to know about the metabolites of restraint, because some of them are protective and very helpful. Others are a bit like homer simpson.

N I mean, they are just like causing in all kinds of problems in your body, increasing the risk of canoes like DNA damage and potentially an increased risk of breast cancer. Although that data, I think, is mixed, i'd also like to know about their stool. So I want to know about the microbiome. So the best that we have right now is to look when we do store testing, and I do a lot of store testing, we can look at things like beto glue on IT. Is are you familiar with bg?

Um familiar with IT as a term. And so for those listening and very often, not always, when you hear in A A S C, you're dealing with an enzo, we can take staff there and and IT sounds like it's somehow involved in um glue cos metabolite .

of some sort edition. So it's involved in when you produce estrogen in the body. This is like the simplified version, but when you produce estrogen, you are meant to use IT like sending to the receptors where it's meant to go and then lose IT like you don't want to keep your circulating estrogen like bad karma.

And that's IT happens with people who have high belated bea granice. So it's the entire that's produced by three bacteria, in particular in the gut. And I see a lot of men and women who have elevated begonias and then they have a semesters tion dominance related to that. Is that the total reason we don't really know, but it's one of the drivers, it's one of the lovers.

And IT can be detected from a microbiome k still sample, that's right. And in terms of blood testing or various test for these other biomarkers getting emergent testosterone and other ratios, I realized there are people have different means, financial means, but in general, people wanting to do a blood test IT sounds like they're going to need to do IT what women will need to do IT at different stages of their mental cycle if they had to pick one. You know, either in the fully lar phase and or in the ludie stage of their ovarian mentor cycle as you obviate ory mental cycle, when would you suggest they do that if they had to pick one?

So if you forced me to pick one, I would say probably day twenty one to twenty two for someone in your twice. So we're focused right now in that decade. So for most women, theyve elemental psycho did that average out of twenty is so this is about a week before they start their period.

For women or more regular, it's harder to do that as women get older. And i'll talk about this new moment. Usually the cycle gets a little shorter.

So as they started to decline in the protesters and production, their praise gets a little closer together. Like mine before August was about every twenty six days. So at that point, you wanted test sooner like day nineteen, twenty.

And i'm not talking about a blood test. Or blood test is the cheapest thing. It's usually what's covered by insurance.

But my preference would be to do drive you in. I like to use saliva for cortisol. I like to use drive your in so that I get metabolomics and addiction the levels of these formats. And if i'm forced to, i'll use blood testing and that certainly the gold standard for all of these hormones that we're talking about. But um it's not as comprehensive and as you know, it's a quick little snapshot while the needles in your vein for no thirty seconds yeah .

the celebrity cord is all makes sense to me because my understand you get free court is all which is the active court is all you said with you and you're also getting them a taboo that and then for blood testing, you're getting sort of a crude window .

into the average a static total level. So let me go back and say one of the thing about playmakers, a big part of the testing that I do in fino typing my patients. I practice precision medicine to I I like to almost start with nutritional testing.

I don't think i've ever had a teenager. I've got some men be players that are one thousand and twenty twenty one. So maybe those count. But uh, those are men, obviously.

But for nutritional testing, that would be a potentially a helpful thing to do in your twice becomes less important as you get older and you develop more micro neutral deficiencies. But micro nutrient play a huge role in terms of harm and production. Magnesium, you the magnesium is hugely involved in the way that you get rid of estrogen, a snack, ample.

So mico news to and testing what I usually do is a combination of blood neuron. And so i'm looking at all of the micro new trends that we can measure that have some clinical scientific basis spine them. If I could do that for a teenager, I think that might be helpful, because I recently gave lecture on breast cancer risk reduction another quick siber.

And I was sad, defined that intake of vegetables, please, fine also, is such an important predict, a future risk. Breast cancer, like when you're fifty, sixty plus, and the most important time is when you're a teenager. Now I have one daughter that eats festivals, SHE loves them, and have another daughter who eats food that page. And it's very hard to get her to eat the volume of vegetables, you know, five colors a day, which is what I do. And if you have evidence that you could show a seventeen year old that they've got MC neutral gaps, I think that would be a motivator for them to eat differently at a time when it's so critical, even though it's know twenty five hours in the future that it's gonna potentially change this arc that they're on.

What do you do for Young woman who doesn't like vegetables is or is not somehow able or willing to to get those five colors a day of vegetable to help support the microbial IT? Are supplements a useful tool in that case? Um what other sorts of tools, behavioral or or otherwise, are useful?

Such a good question. So here a minute, invoke rob night at you yesterday. So I think his his has got project has really been helpful in terms of understanding what kind of modulators are gonna be important.

So what I try to get that person to do, and I don't see many teams anymore other than NBA players, what I try to get them to do is never a smoothly, very hard to get them out of a smoothly every day. But if I could get them off a smoothly three times a week and to throw some of these vegetables in, that makes a huge difference. I mean, we know that makes a difference in terms of microbiome change .

to be a blending up broccoli or kill.

call flowers. So call flowers, please.

They're putting things into the smoothed yeah I don't .

know if you can get a teenager to do that, but they often will use like I have them do steam rockley that's in the freezer because it's got very little taste so that they could do that in a chocolate smoothly. They could add some Greens. I like Greens powder are a super convenient so that with you know kind of A A taste, they like whether that's chocolate, which is what most of my clients want, or willa with berries and that sort of thing.

So I can go a long way if you don't like vegetables and sort of that, I would say some supplements, but I would say that's a distant second to making a smoothly. I've got one patient that I have to mention because. He took us to the extreme, so he is a retired physicist professor at U.

C. S. D. He found out that his, my roby on was a hot mass and developed autumn encies. And so he became her bent, like only if this could, on changing this microbial. And he dramatically shifted IT by having a smoothly every day with fifty seven vegetables and .

fruits and the .

and fifty independent. So I mean, this just warms my heart the way that he did this. But he would go to the farm er's market.

He would just get a bunch of this, a bunch of that, and he would go home, make the smoothly, and then stick IT in the freezer, so we would have a serving every day. And he became a completely different person based on this microbial change. His, a automated e disease is in remission. He he dropped a huge amount t way.

He went from being, you know, kind of the punoo pe, but I know you know well of a professor, high performing, traveling around the world on so many boards, so much innovation, so many great ideas, supercomputer guy to be someone who gets up in the morning, gets in its hot tub exercises for, like one to two hours a day, and then does a little work like he completely shifted in the way that he lives and his microbiome shift. Know who knows what, what's the chicken and what's the egg there? But he had a huge change in his physiology. Glucose went from being quite high. He had, and he tracks all of this, of course, it's like scientists.

all right. And retired, I suppose.

might have had. And he's retired, but he's got the longest time series of anyone I know and he's tracked his gookin insula going back twenty years so he can show you. Okay, here's where I started out in my smoothly and here's how my gook us instant change as a result that i'd like to .

take a quick break and acknowledge one of our sponsors, athletic Greens. Athletic Greens, now called ag one, is a vitamin mineral probiotic drink that covers all of your foundational nutritional needs. I've been taking athletic Green since two thousand and twelve, so i'm delighted that they're sponsoring the podcast.

The reason I started taking athletic Greens, in the reason I still take athletics Greens once are usually twice a day, is that IT gets to be the probiotics that I need for good health. Our god is very important, is populated by gut microbial to that communicate with the brain, the immune system and basically all the biological systems of our body to strongly impact our immediate and long term health. And those probiotics and athletic Greens are optimal and vital for microbiology alth.

In addition, athletic Greens contains a number of adaptations in vitamin minerals that make sure that all of my foundational nutritional needs are met and IT tastes great. If you'd like to try athletic Greens, you can go to athletic Greens dot com slash huberman, and they'll give you five free travel packs that make IT really easy to mix up athletic Greens while you're on the road, in the car, on the plane, at sea, and they'll give you a year supply of vitamin d 3k two。 Again, that's athletic Greenstock comm slash huberman en to get the five free travel packs and the year supply of vitamin d 3k two。 Is there a case for also Young women but Young women and men um using over the counter probiotics as a way to enhance the microbial om this is something I hear about a lot.

I've heard that excessive doses of capsule probiotics can give a brain fog like condition. Um I persons don't use capsule probiotics unless I feel like my system is under significant amount of stress in which case I might at that in for brief periods of time or if I have just taken antibiotics for a period of time. Do you ever recommend that the college student or the high school student that SHE or he take capsule probiotics, assuming that they're getting, let's say, three to five savings of vegetable les per day, either in smoothly form or some other form, what do you have thoughts on on supplementing probiotics?

IT sounds like such a simple question. IT is such a complex answer, and I don't think we really have the answer. So i'll tell you the way that I proceed.

I look for animist trials to support my use of probiotics and Frankly, i'm underwhelmed. So i've seen some data if I evoke of my um N B A players for a moment, almost every player i've tested has increased in teston formidable. They just have such a high training load, probably immediate by cortisol, very high glue cos is when they dream that they have increased in tesone al promise order.

So those tight junction in their index and become loose. They developed ed a lot of information as a result of that. And when you're a professional NBA player and you're making twenty million a year, like you don't want a lot of inflation tion, you want a little bit to make help your muscles recover, but you don't want IT to be um adding to problems when you developed an injury.

So this is .

leaky gut key god, yeah I don't love that term but yeah we'll use IT here. So there's there's particular robotic that is hopeful in athletes with leaky gut. So that's a kind of specificity and rent of my trial that i'm looking for. The rest of IT, I think they're support if you find help from IT as you described, if you take a course of about about odec, I mean, possible, I would question whether you need them.

I trying to avoid them. There have been instances where they're been described. I took them mostly in the past. I was in college. They simply they give him out, had a science infection that give you in a .

biotic ah the words tricks and ever yeah so if you're coming off about this, I think that's a good time to do what we call replacement of providers. I think what's far more interesting is prebiotics. I think the data is much Better for prebiotic and um a selective use of profiles.

How would a person in their teens and twenties or any age, for that matter, no what, whether not they have nutritional deficiencies? What is the best way to analyze if one is getting enough magnesium? And for that matter, what is going to be the best way to test the microbial? He said through sample, and i'll come right back with the same question I asked about a blood test.

What time of day went during the month to establish a baseline? This would be prior to embarking on ninety seven vegetables or super day and fifty seven. Well, I love the idea that we're telling us, if i'm gathering correctly, that yes, there's a case for probiotics.

But for the typical person, regardless of age, eating more vegetables or drinking more vegetables as as the case maybe is going to be beneficial for the cut microbiome, perhaps without the need to go test whether not one is making a certain number of emergent related metabolic ts or not. Just that, that's a great starting place, eat or consume more vegetables. But if one wants to analyze our got microbial, are there good test available to the general public and are not a named companies.

But i've been tracking this over the years, and it's never been clear to me that we know what constituents that we got. Microbes are best. We know that this BIOS is is bad, and we know that diverse, the microbiome is good.

We hear this, yes, but no ones ever told me that you want a particular ratio of one microbiota to another in a way that has made any sense. To me at least I am not a microbiologist where, as with, you know, with test aston one and men, we hear, okay, you want your free test astoria to be about two percent of your total. Perhaps with women, women are going to have more test astern than air gen on average, but still less than men.

When you look at test open IT set at a, you can to get some crude measures. The microbiome just seems like long list of microbiota for which I just get the zy. I just if you just roll out a bunch of eyes and els and S S have what you a little a bit the same information.

I'm not trying to poke at that field. There's a beautiful field. But they having told me what to what I what my microbiota t to look like, like what's a healthy microbial on chart?

Well, that's because we don't know. I mean, the best we have as rob night's work, but even that is limited in terms of, can I tell you that a woman in her twice should have this particular pattern with her microbiome? No, I can't.

So um let me go to your first question because I think you just asked about six. Your first question is about nutritional test. What I like to do with nutritional testing is run a piano that's looking at any accidents. So like to an nave I am and see off, like poacher, plant, pest, any accents, because you can measure that in the blood.

I'd like to look at some of the key vitamins, especially the b vitamin range, because as you probably know, if you've got particular genetic pully morphisms c might be less likely to be absorbing the right level of vitamin b nine for late vi, be twelve with ZARA. Um i'm also looking going back to the any accident and if ion because I think that's such an important level when IT comes to detox vacation, which we haven't talked. And then i'm looking at some of the minerals. Magnesium is really the most important and we know that somewhere around seventy eight percent of americans are deficient. And magney, and that's like the the lowest tanking fruit.

I would be curious, princess, like with magnesium, if the number of people are deficient, does that mean that that number of people should be targeting their nutrition town's foods that contain magnetic sim and or supplementing with magnesium? And if so, what forms of ban easier? We've talked about mac three and a sleep, there's a max, there are so many forms, can be a little bit of overwhelming to people. So any any detail and sourcing that would appreciate great.

So first, in terms of testing, what I prefer to do is to mention one more than one lab and more than one brand um and I can just i'm speaking mostly from experience. So uh for testing, I do a lot of nova neutral else during the pandemic they developed. And at home test Normally with the you have to get your point, I have to do with your example.

So lot people can do that. The great thing about this test is your insurance usually paste for most of IT. And so the cope is about one hundred and fifty dollars.

So during the pandemic, they developed another test called metabolomics, which does much of the same testing, but it's a finger prick. So most my patients prefer that. In fact, they haven't gone back to the neutral val second lab.

Inspector S, L, I use spect result. Occasionally I find IT not quite as easy in terms of fitting into my practice. I've got friends and mentor's like Marcus an, who does a lot of a kind of precision cardio metabolic health.

He thinks CT ourselves the best test out there. So you asked about magnesium. You have to measure, read blood. So magnesium, my co blood, and with deficiency, it's interesting with 我 for my patients who tend toward constipation。 And that's Frankly about eighty percent of the .

women that I take care of, really. yes. Wow, I be curious ous to why that that is, I can guess, a diet stress um pater .

archy ridge.

the psychosis in the pine system, right? A C psychology and minor logy neural and underground factors combined. Is that?

yes. And then I would say there's another factor which is. Being female is a health hazard.

So we've twice the rate of depression in soma. We've got three to four acts increased risk of multiple gloss. We've got five, eight times the risk of thrate function. So if you just look at that and you look at subtle preclinical fery dis function, a huge number of the women that I take care of, one let me pack of. A large number of the women that I take care of have theri diffunce that's contributing to constipation.

And if we go back to that control system by with lamia rate in authority and at all god access, and they have a lot of perceived stress together with a border line, thyroid function that no mainstream medicine doctor has told her is a problem. And then she's got a problem with the tango between east and progesterone. She's going to tend toward constipation.

Women have a lot more constipation than men. The gut is about ten feet longer in women compare demand. We should talk about some sex and gender differences and define us. And they are much more likely to have a torturous collen in the way, you know, that is, you get a colen Oscar y and they tell you, is really hard, like getting there and do what we need to .

do as a brief tension. But I think this is the time to ask, at what age now do physicians insist their female patients get con scopes for men? I think the ages to be fifty now it's getting ratcheted back to forty five or forty. Again, these are recommendations, not requirements, but they're pretty strong recommendations from depending on where you live at at for women, how early do you think they should get a call oski to to explore for possible polypes and or calling cancer?

Yeah, a really good question. I don't know the answer. So what i've always Operated with this fifty, the way that I answer that is to go to the us.

Prevent of test force rating to determine based on their synthesis of data what IT is the most appropriate has the change, as you just describe, for men from fifty to Younger? I don't know. So we should act to that.

All these additional health hazards for women, imagining some of the you broadly mention psychological impact, right? And of course, these things are all related psychology of minos gy. And one of, I think, wonderful things about neuroscience and science and general and medicine is that there's now and and understanding that all the organs are connected to one another, it's a network, a network and that the microbiome sits that had at a key node within that network. And I think most people accept that now yeah yeah that seems to be a theme that at least in the last ten years is really wonderful because um certainly for neuroscience, he was thought that unless it's in the cranial volt, it's not neural, which is ridiculous because there's lots of neuva system outside the school but in any case, for every six, yes, please.

So I think you're right that there's an understanding about the network effect, but I think that as much as I love mainstream medicine and I trained in IT and I am so grateful for my education, I still think IT is a silo based way of taking current patients.

So even if there's another standing of the network effect, more at the science level or as you described in neurotic science, there's still you know if you are a woman who has constipation, fatigue, um maybe an auto mune condition, feel stressed out all the time, feel like your hormones out of work, you get sent to the gain error gist for the concentration. You get sent to the romeo logic for your automated issues. You maybe get sent to an intro ologies if you've got direct problems and there is very little collaboration between these groups. So even though there is understanding of the network effect in your life, it's not happening.

Let's let's go deeper down that path because you put out something really important and and you've mention constipation a few times, can we view constipation as a serious enough symptom that IT warrants in immediate intervention? That is, does IT flag or signal problems that are severe enough that that should be the issue that's dealt with for anybody that's experiencing IT? I mean, serve an odd topic for many people because I think, oh, you know balo movements and so you know, there's that kind of preadolescent humor around this, but I think it's it's so important here.

What i'm hearing you say is that constipation is far more common in women and its signals, a general many problems occurring. Does that mean that women should address constipation? And if so, what's the best way to address constipation?

Yeah, I love this question because you're doing can we have a quick little meta conversation so you're doing something that I knew you would do, which is you're teaching me something and your changing like there's a social genome happening where you're changing my thought about this. So I just wanted to acknowledge that.

Thank thank you. Well, I think for me know when I hear that there is a kind of know you time about a finot pe constipation of finot pe. It's one that people generally don't wear A T shirt explaining IT to people but that i'm guessing anything to do a sexual health bow health urology people just don't talk about right um for all sorts of reasons and those reasons are probably so obvious that they are not even worth discussing but and also because we won't change them except by talking about them. So if you say um women are far more constipated and that's signaling a larger set of problems, then my media thought is, well well, relieving constipation handed retroactively.

Will that assist in a great number of issues? And or will I get them down the road of thinking about those other issues more specifically? Like do I need more magnesium or should I be putting vegetables in my smoothly? Know some curious about constipation as a target yeah for intervention that then opens up a bunch of other discussions because there are the certain nodes in the in the mental health, physical health space that when someone you like we talk about deliberate cold exposure, do I think it's magic? No, but I think that if someone's getting themselves into a cold shower once a day, IT opens up A A number of questions about themselves and reveals a number of things to themselves.

Like how do I buffer stress? Yeah what sorts of levels of controlled do I actually have? And on and on. So craps, not the best example.

But some of us hate cold exposure.

And we have like .

a gene that makes us stress out, like you won't believe.

which called, which I would argue makes IT very likely that even ten seconds of called exposure gets you the effect that you want as supposed to. Someone who adoors called exposure, like a penguin, needs a lot more cold exposure for to have the the adaptive response. Anyway, that's my way of bumping through that. Quite you you're quite correct.

Um so so let's enter the page issue. Yeah so this is how you're changing the way I think about this. So you're asking, okay, instead of looking at consumption as a conStellation of symptoms, what about if you just use IT on its own as sort of a um a key indicator or signal of this function with my network or maybe something broader? And I think that's right.

So IT makes me think of a few things that makes me you're also changing this book that i'm writing on, community and trauma. So thank you for that. So women experienced more trauma than men.

This is well established. If you look at the eight studies that we're done by the cdc and kiser in one thousand nine hundred ninety eight, we know that men for the most part, milage men. How about um about fifty percent of them experience significant trauma as defined by the east? questioner.

Women are at sixty percent, and that's pretty doubled since ninety ninety eight. So women have more they do have different forms of abuse, much more likely have sexual abuse. They have a different H P A response when men, their perceived stress be higher.

And i'm generalizing for a population side note, you know, on precision medicine, we don't do that. We do medicine for individual, not the population, not medicine for the average. And so if you look at the physiology of a female, I think that constipation and that need to let control and restraint and hold things in, tighten the anal filter.

I think that's part of the psychology. So i'm wearing away from the science, but I do think that IT is a really important signal to pay a lot of attention to. Now you also asked .

about microbes on testing. Have a couple more questions about, I think, by the way, also this morning I taught medical students are stand for about the fact that we are basically a series of tubes, so that you talk about the the anal sprinter. We are a set of sprinters from one to the other.

I mean, we are a set of tubes at our nervous system being one of those tubes. And but and I in astern us and they talk about the various locks between those tubes and chAmbers. And it's not without coincidence. There are some .

real wisdom there.

of course. Did you just talk about omi less? I didn't.

The d it's the bonus. The bonus, right. Are the swingers? Yes, yes, that's right. Thank you for for that. So what defines constipation? I mean, in other words, think about the healthy rather than think about the unhealthy.

How many ball movement should um a woman or a man have per day, assuming this is where he gets tRicky? Because some people are doing time search and feeding. Some people are eating more.

Some people eating more fiber, more about larger meal, the end of the day, larger meal beginning day. We will never be able to sort out all those variables. But on average, how many about movements and is timing during the day for bw movements at all? informative.

What works for you?

Well, when i'm a sleep, I don't want a baLance movement, so i'm going to be like my school. Right, mary, right? exactly. I always assumed that morning time, yeah was a was a healthy time for the aroma. And I think almost everybody, babies included, recognized the feeling of being lighter and more energetic when they've vacuity totally.

Colin o, in fact, so much so that i'm obsess with Young an of frye psychology, that the first thing we learn when we come into this world, right, is that we want something. We we feel some sort of automatic arrow stress, whether not its food or warmth, or they need to have a about move in. One of the first things that parents learn is how to recognize that not by the older coming from the diver, but by the look on the baby's face, or their agent, agent signals the need for some sort of relief, right, temperature relief, relief, evacuating, the ballot relief.

So my understanding is that as automatic seal increases in the early part of the day. After a good night sleep, that bell movements to become more likely, unless that arrives, will becomes so great that then people feel so quit quit locked up right um because of the baLance of the automatics features. So early day, i'm guessing. And again, in the second half of the day and here i'm totally guessing and certainly not having to wake in the middle night um yeah those are my best guessers.

That's great. So I would agree with when I was at harood medical school in uc, a suffer residency, I was taught that constitution is having about movement less frequently than one every once, every three days.

So I don't think I ever laugh out out on this point. Test is the consequence of of textbook medical knowledge. Are you kidding me? That sounds like intended. That sounds like the the conclusion of some very .

content emotionally .

and and and and in other ways, constipated individuals. And again, this might seem like an odd conversation, but the discussion around conservation is is present in psychological literature is because of this relationship to the automatic system.

Well, it's a metaphor rn literature. It's crucial. So you you spoke to a number of different threats that I think you're important here. So that's the definition that I learned.

And I was I heard that and I was like a hell, no, that doesn't work for me, doesn't work for anyone I know. And I spent a lot of time, especially in medical school and in my internship, where you rotate on medicine, this impacting women, like older women who come in. You have an out about movement in a month. wow. And that, let me tell you, that is not nice for anybody.

Believe me, I became a scientist and and physician for any of reasons, positive and negative. That's one of all.

Yeah so my definition of constipation as a western mostly wait girl is that if you're not having a about movement every single morning and you have a feeling of complete evacuation, anything less than that is constipation. So that's how I define IT. If you're in india and you're eating food that's got a fair amount of micro bes and IT, it's less sAnitary using that word um as carefully as I can.

Generally they have a about movement after every meal, but they have got a different microbiome. They're exposed different microbes. Here in the U. S. I would say wednesday, you also spoke to something very important, which is the baLance between repair a sympathetic nervous system, rest and digest and poop. First is the sympathetic nervous system, kind of the on button, you know, fight, flight, freeze, fun. So I think for those of us who've got issues with automated ic bound, once IT can lead to constipation, and I like that conception could be pulled out and kind of rit larger as an important signal.

What's words of tools you recommend people use to relieve constipation in creating more fiver? Sounds like reducing stress is going to be a huge one. yes. What are your favorite stress reduction tools? I'd like to divide these into um real time tools. So big proponent like philological sign real time, you know, these sorts of things, but things that can really lower the baseline on stress overall to facilitate consumption and other, other broad indicators of health.

So i'm not a of lowering stress. I'm a found at VLAN ing perceived stress. And I think the distinction is really important.

I learned when I was in my thirties that I was a mouse of stress case. I didn't know IT IT was a sort of I think I throw residency through working under twenty hours a week. I just was so accustomed and sort of that .

was one hundred and twenty, not under twenty folks. Yeah not unusual in in medicine changed training so .

that you work no more than eighty hours. So we now, but that was before my time. So I became accustomed to a massive another court, massive.

And I would say I i've spent the past twenty years really working on perceived stress to find, I think all of us mean all a cart menu of what is most effective. So what works for me now at my age is different than you know, the the T. M.

I did as a college student. Trans and dental meditation, it's different. Member, I became a certified yoga teacher when I was in authorities that is very effective for a lot of people.

IT wasn't enough for my matrix. I do holo topic breath work. Um I didn't read IT, but I saw that you just had a paper and sell on your side. And IT can make me think, like, teach me how to decide. Teach, teach me how to say I C can you say a little bit about that?

Like how do you do IT? Yeah very briefly. That study, we wanted to find a minimal effective dose intervention. So five years today, we need to figure out what people do every day. Yes, and we monitoring subjective mood at that, but also biometrics remotely.

So it's come a nice .

study biometry. V, V night's sleep. Porto, so I wish so this was done during the pandemic, more than one hundred subjects.

The advantage was that we got data twenty four hours a day because they're pinging us in their data. Wearing me twenty four, yeah, nice. So that was nice.

Resting heart rate, subjective mood, we will get in touch with them daily so when people were swap between groups like any good study, but five months a day of standard, if you will forgive me, meditations to sitting, no instructions about how to breath, just focusing on um closing their eyes and focusing on focusing um another group did box breathing you in hell holds exhaust d for equal ation. The duration of each of those in hills and holds were set by their carbon oxide tolerance. So somewhere between three and eight seconds, depending on how well they regulate to common oxide, another group did significantly.

So this would be double in hell through the nose, so big in hell through the nose. Followed by a to lunch empty x sale. That second in hill after the first big long in hill through the nose is really important because IT make sure that all the collapsed abb longa snap open and then the excel you off look, a lot of carbon dioxide .

that's very similar.

Holo tropic red works. Not, yes, not not unlike holtman pic breath work little bit pond yuma ish. But the x hae is rather passive as opposed to active.

And then the fourth category was sick ict reventlow tion, which is a lot like to moo A K wim hf ish breathing, different than wim half breathing. So this would be so very active in the hills and x sales. Every twenty five cycles of in hill x sales, there will be one cycle long. X sales hold lungs empty fifteen to thirty seconds, then repeat for about five minutes for everyone did that for five minutes. And what we found was that the specific sign LED to the greatest improvements in mood around the clock, not just around the the practice or during the actis, as well as lowered resting heart rate improvements.

And sleep at Sarah and you got a publishing soul.

fortunate. I I think the thankfully the reviews and letter is understood that these minimal intervention things hopefully are going to be a useful people.

So, so useful to people. I mean, how often do you read a paper like that that could offer a behavior change that is so easy to implement? I mean, I love that question.

Thank you.

So what about did you tell them not to drink? Because alcohol is such a huge fect on each erme.

So in this case, we didn't tell them to alter anything else about .

their behavior was round, ross, the yes.

and some more time for students. Others were from the general population.

Any fat boys were .

drinking heavily, probably not well during the pandemic. I think alcohol intake went wait way up across the board. I mean, is in a via magic wand. I I would ask that people either not drinking or drink two drinks per week maximum at the least. That's my understanding of the literature.

Are you familiar with the woop data without alcohol?

No, but we have a collaboration with you through that paper. Um and IT certainly disrupts patterns of nighttime sleep, in particular, my mind understanding that first phase of sleep that's related to the massive growth home on release that you all really need and want in the first world, we did not know. The second iteration of the study will certainly include free quarters, all by solve a hormones anela.

Well, i'm beginning in to think that we should also um be asking people health and their going to the bathroom in what time of dead. Yes, I mean this thing on constipation is a is super interesting and I think that plus blood blood markers and then i'm very excited to learn that, that you're in contains additional markers that could be informative. So yeah, was that I was a fun study, uh, not easy study to do with that number of of subjects.

Takes a lot of training for your research assistance .

yeah was a big group, was nine people in our group and three clinical and a lot of lot of phone calls and a lot of back in force. But and thank you to the subjects who served as the the real life ginny pigs. So you I think that stressed people's I think people are starting to appreciate that there are are ways that they can relieve their stress that that don't only fall under the categories of vacation and meditation. But I want to say that meditation is obviously a wonderful tool. It's just it's a tool done unlike any other tool that IT is great for some people and less great for others.

Well, it's certainly is a great tool and it's got such a scientific basis bind IT. But there's so many things on this old cart menu sax organ connection, feeling her and scene and loved. Um let's talk about that.

Know you mentioned IT earlier the only stress factors you said patriarchy, right? But I think what if I may at risk of of just strengthening that stand. I mean that to me is is signing a bunch of other factors around, as you said, like keeping keeping things in.

What do you think explains? Let let's talk about that because I think that that's likely to have raised a certain flag in people's minds. Like what exactly is he talking? Are you talking about less opportunity?

Are you talking about less opportunity to um to vocalize? Are you talking about less opportunity to vocals and be heard? I mei realized that there are infinite number of variables. But given that that sounds like A A really strong input to the system, what I mean by that is that psychology is influencing biology. And you're saying that that these that these power power dynamics, structures and dynamics are impacting I love lets hear your thoughts on that because I, I, I hate to let a flag like that go by without flushing IT out. And let's good flag well.

and let's preface .

IT by just saying that like people will have different opinions on this and that and I think that's healthy. And like with the discussion about gun stability, let's talk about what people earn will. But when IT .

comes to health, well, that so we might need to talk about patriot on part two, but i'll give you some material that i've been working with. I started I did not even understand the existence of patriarchy until I was a .

by engineering and which has always had a bit of a of a male um rescued male in terms of .

faculty numbers.

Well true, while my post dog advisor was the late ben barris, who was a female to male transition transgender first change gender member, the national academy sciences were my closest friends, unfortunately died of a pancratium cancer. We are very, very close, actually making a documentary about them. But then this is interesting.

Ben went to MIT because he wanted to be around a lot of men yeah, that's a lesser known, in fact. But then he was a very strong advocate for women. He went as barba when he was barba.

And by the way, he's given me permission to share all this prior to his death that recorded a lot of conversations I only ever knew him has spent, by the way. But when he was at IT, he was identified and he later talked about the intense suppression oppression. There is how he described IT, especially given that he was performing so well.

Yes, so you just defined Peter rokey. You did IT yourself a couple things. When I was in bioengineering, I took a women study's class.

And IT was all about teaching undergraduates about the existence of pateley, which I want to find, maybe at its simplest, as power over. I'm not saying men are Patrick. I'm saying something very different, which is power over.

Let me correct one thing that he said I didn't go to M. I, S. And graduate. So I am from, I was in alaska, a, and I went to the university, washington for by engineering seattle. I dropped out of a graduate program and bioengineering to go to the harvard MIT program for health sciences and technology in boston.

Thanks for that clarification. In washington and also wonderful place. I have many, many, many, many, many wonderful close colleagues. There is an incredible place especially for vision science.

It's especially good for engineering by engineering but um yeah so my my md is jointly between M I T and harvard and it's the oldest, maybe largest although harvard says us a lot program for biomedical engineers and A M D P H D passion for scientists training program.

Thanks for that clarification. I'm going to blame the internet for this one. I am I think we need to send our our wikipedia editors out.

I think .

link is correct. OK great. Well, wikipedia editors note, get out there and make make the correction now you heard IT. Um so stress that is what you're really talking about is systemic stress in the body as a as a consequence, excuse me, a systemic stress of environment.

that's right. But there's you know there's particular forms of IT. I would say this also relates to White privilege IT relates to uh, racism.

And when you look at know kind of the way that systems, including my beloved MIT, the way that there are set up is that might make make right and generally the people that are the strongest, you know big men, strong men, they're the ones who tend to be the most successful. So for people who are bypass, for people who don't have White privilege, for women, it's a different experience. And so i'm using paid turkey is kind of a umbrella here. But IT connects to many other things.

I want to use this as an opportunity to a keep this in mind as we turned to a question I didn't close the hatch on earlier and its my fault, which is i'm now clear on the fact that a woman in her late teens early twenty years, ought to know something about her testosterone nest and throw cortile levels, should start at least thinking about her microbial, should be thinking about how how many ball movements in the timing of those bw movements per day, really. And i'm assuming that what I just described is also true for women in there, twenty eight thirties, forties, fifties on up to hundreds. Is that correct?

That's correct. But I would say that there are differential opportunities I decade. So i'm glad he's circle IT back to teenagers and test astra because I think if you know, for instance, in your teenage years that you have high energies and that you've got this potential for type way into the future that you may not even notice.

And me maybe you knows you've got a few extra heroes on your chin or something if you know that your testosterone is alleviated or some other androgen IT might change the arc of how you take care of yourself. So I think that could be very helpful in your teenage years, in your twice for people who are a stress case like me. So each twenty seven, on the words at U, C, S, F, if I had known that I was such a high quarter sl person, I think I would have done things differently.

I would have changed my behavior. And I don't know, because I didn't base cases. But your testosterone can decline.

Turn your twenties, kind of depending on how much stress your matrix is under. So for women, that can start as early as twenty eight. Usually your testosterone declines by about one percent per year.

What level of testosterone do you like to see in a woman once sha post? Let's say, after age twenty five, what kind of range is healthy? I know what the reference range is only because I know one could look IT up. I don't know off the top of my head immediately. But what what's a kind of a nice reference point there?

So the way I tend to describe this on podcast is the top hf of the Normal range.

great.

So that I think is a good benchmark. You know for pcs generally, it's much higher than that. You know i've seen patients with pcs where there are total test, test is one hundred to two hundred.

Do they always have preferable manifestations of that little bit of hair that the skin packs i've heard about the dark in skin packs s regular periods is that I get a lot of questions about pco. S yeah and you're the first person we've had on this podcast. It's really qualified to talk about pcs and in a real way.

So here we're talking about too many androgen system on the over irregular vary meant keeps saying the obvious ory slash menstal cycle. Um what are some other indicators? And do you recommend that women start taking energy en blockers? Or I mean, how seems to be a lot of pcs out there. I'm hearing about IT a lot.

So glad to ask about this. So pcs is one of those really poorly understood conditions that gets a kind of flows, flies by the rain until a woman once skip pregnant, or she's got some other issue that drives her to a physician. The problem is that IT is a syndrome, right? So policy, stick over a syndrome.

Sometimes policies, tic ovary syndrome and syndromes don't necessarily fit together into a really clear diagnostic criteria. Ia, so in this instance, there are three different criteria that we look for. So system over is having a clinical manifestations of hyper androgens.

M, so that could be hersell. Sm, acme, other things. And then usually a regular periods.

And the way that that's defined, at least by the latest criteria, ia is having a period every thirty five days or less. So a typical cycle length twenty eight is thirty five days. You you're skipping a period here and there.

So those are the those are the criteria that we use to diagnose pcs. There are about four different systems out there in the literature for diagnosing POS, which is where IT started. Sk, confusing. So there are some women who have notices on their overall, but they have got here. Citizen, and they've got irregular periods.

Find hair. Citizen, citizen.

is increased hair growth usually in place you don't want IT. So for women, IT can be no kind of meal pattern. They might notice IT on their breath, on their chest. Um and then there's, of course, a familiar quality to that. Like I was just looking at the paper last night looking at israel and how much here citizen may have and whether this is related to cag repeats on the international receptor.

Do they get not israelis, but do women who who might have pcs experiences androgens? Aloha, so her loss, that sort of the quote and coat male pattern baldness, of course it's androgen pattern baldness as opposed of male we're taking testosterone D H D .

related sometimes you know this is where i'm in to in the clinical experience rather than um what i've seen a military women definitely can have some metrogas ic alpha. I tend to see you later in life. But this is an important point because we think of pcs as you I was just talking about IT in teenage years, like wouldn't IT be nice to know that you have the final type in you're risk for all of things that people are at risk for.

And we haven't talked about glucose, an insane ET. We should what we know is that POS is not just a problem in terms of irregular periods and then pregnant. So those are mostly problems in your twin thirties, early forties.

But IT is a massive race factor for party meta lic disease. As you get older, so many people attend a pitch in hole p CS is a problem of reproductive age. We have to be thinking of IT over the entire female life cycle.

And I would say it's even more important to consider IT over the edge of fifty know average age of monopoles fifty one and fifty two because we know that that elevated tester on the high rogen are probably the greatest cardy etb lic driver of disease for women with P. U. S.

Well, now one of the things I want to mention, and I still have my notes that we're going to talk about microbes I M testing because that such a fun subject. What I was hard to do again, saying, this was so much love for the people who have taught me how to do medicine. What I was hard to do is that if you have a woman with pcs, you make the diagnosis, you measure your test stone, and you see if he is acme babble.

You asked that women one question, do. You wanted get pregnant or not. So then you have these women with pcs who get started on a birth control pill if they don't want to get pregnant, if they want to get pregnant, then you help them get pregnant by addressing some boy's POS.

S is like, maybe you give them columbia, or are you do something to make the modulate more frequently? That is the way that most conventional medicine approaches. And IT does women at gigantic disservice.

So one of the things i'm speaking into is the gender gap that exists. So I my feeling is that the research money that was into women's health is a business more compared to what goes into mental, really, and I think that's changing. But there's also a huge lack of awareness of sex and gender differences when IT comes to the way that we construct clinical trial. Another experiment.

well, that's absolutely sure. I mean, I sit on I set on an age review panel for more than a decade now, a regular standing member, which is only to say that I see the research as it's being proposed. yes.

And now it's required. No grant will get funded without sex as a biological variable. And here, and by the way, folks, this is sex, biological sex, the now, not sex, the verb. Both are super interesting, obviously. But when we say sex as a biological variable, meaning even if it's a study on mice.

did that start though?

I didn't start that long. Go must have been. I think we can think, I don't want to this attribute here. I think we think Francis Collins.

for insisting on this man, Francis na, demi bernadette hili, has done so much to help us. But you know, SHE made the women's all initial, where I hope gets you, which is a hot man, is like, so confusing the data that came out of that.

These trials are long, and so the data are only now starting to emerge. So just to be clear, I mean, I have a question that I don't think it's going to take us off track. But this is i'm going to oppose this question as a hypothesis because I think it's likely to be a little bit of a of a not a barb wire question, but maybe like a africa question when people first hear IT, but it's opposes a hypotheses.

Mention some of the psychosocial stress issues based on at the organizational level, institutional level, societal level, maybe right down to the family and and just life that are biasing health outcomes for the worst in female populations OK you refer to as the patriarch. I am just trying to put make sure that we're going talking about the same thing, and that's non exhaustive. I realized that's just a subset of the issues.

I'm also hearing there's a lot more pcs, which is is hyper android animation of the over in we're talking about. You mention you access to stop one which females naturally have more testosterone than they do estrogen anyway, but which I had elevated levels. Here's a hypothesis.

One hypothesis would be that the increased androgen and the pcs are a consequence of the psychosocial conditions that are, and we say, forcing, but are biasing the need for females to think, behave, react, act in certain ways to survive? Little, little one thrive is that I don't say this for any kind of political correctness hypothesis. This is a IT might.

This would be a fun, interesting and I think important study to run, right, depending on stress and the conditions. The specific type of stress do females and produce or overproduce androgen? Or is IT a neutral effect? So I make make sense.

I love this question, so let me just pay for is the last part of IT to make sure I got IT IT sounds like which you're asking us. Could pcs or at least some finot pes of pcs be a response to what i'm calling Peter eri? And then you add a second part to IT, which is, do healthy women, like what is their production of testosterone .

like with knowledge ment? And a year, the expert here, you, the physician clinic and expert in hormones. And i'm not, but with the understanding that absolute levels of hormones are interesting, but perhaps not as interesting as the ratios of testosterone one to estrogen.

So when we're talking about access testosterone, we're really not talking about, oh, women making a lot of testoon because Frankly, they already make a lot right. Then most people that were aware of that, I wasn't aware that women make more testosterone. Women, right? And so it's not saying that testoon and women is bad or is always a reaction to the environment, yes.

But when IT becomes um super physiological or hyper elevated is I could imagine all sorts of social conditions that would create that um so in males and females. But here we're talking about P, S. And females and particularly s so i'd love you to speculate, should we run this study?

We totally run this study because I don't know the answer. I suspect that you're on to something IT may not explain all of the women with P O S because as I mentioned, there's lot of different finot pes, but I think IT could explain a significant portion.

And you know you're almost you're seeing if we look at the gene environment interface, this environmental influence of having being someone who's got power over you, if if pcs was response to that, the way that we treat that would be completely different. So on the one hand, I want to be careful not to dismiss the suffer and experience of women with P. U.

S. I've got a lot of women with pcs of my family. And IT is there is so much pain and suffering, you know, especially if you want to have a baby and you try for years and you just can't emulate.

On the other hand. I read a paper recently and maybe could say this, that compares the finite type of a woman with P. U.

S. To a mean who is hypo entropy ic. And I think that's a really interesting way to look at us because the thread we haven't talked about with P, U, S.

Is the the role of insanity lus. So for some of the few types of P, S, the problem is hyper instant, ima high. And in the blood is driving those leka cells and areas to overproduce testosterone.

These women are inclined, insensitive. So more issuance being cracked out and the cells in the overall, therefore making more androgen.

you don't like to say insulin resistant.

Oh, I I don't have a prom saying just i'm just .

a little bit outside .

the laying lines of my expertise. I was try to use what what is the correct oman creature so that we can make what .

what I like about instant insensitive. The way that you just said, IT, is that I think that offers people away. And and I love to do that in terms of messaging. Instant resistance starts to lose people because they don't really get what that means at a receptor level.

I think I say instant insensitive because when people hear insulin sensitive IT almost sounds like a bad thing, but that's actually what you want. So I think I think that's how I defaulted .

to insulin in what .

I don't know what I do for a blood test. Yes, you are. I due for a blood test? My head blood work about you.

sure. That would be great. I i'm always experimenting with different supplements in different behavioral regiments. And i've kept charts .

since I was nineteen.

Oh, you like my patient been assessed by this, and I would say, everybody, if you can afford IT and at the time, actually I had to save up insurance, wouldn't cover IT, get some basic blood works done so that .

you have a reference. Do IT as soon as possible, because even you know that we've been talking about these women over the life cycle. I wish I knew what my insurance was when I was a teenager. I wish, I wish I know what my fast in land was. I really wish I knew my post rendel's like in my teenage years, in my twenties, in my thirties, what I knew IT, in my thirties, starting at thirty five.

Are you a fan of continuous glucose manners .

that you just made? Straggling ic. Fan of C. G. M. I've never seen any tool that i've ever used in medicine change behavior the way that cgm do. Wow, why do you .

think they are so effective at changing behavior? I've tried one, and I really liked IT. I learned that in the sona, my insulin, my blood glucose, goes up probably by bit of dehydration. I learned what kind of foods work for me, which don't um I thought was fascinating I learned however behavior you could possibly imagine use your imagination impacts blood glue cos to totally fascinating to me including how a two wake wake up during the middle night versus one versus non impacted blood lue coast the next morning fascinating for a data junky like me is like I was in heaven. Why do you think they are so effective in changing behavior? Is because of that that people can see that real time controlled, like scan in and like, oh, that's the that's the swich.

I think I think it's many things. I think it's generally the enchantment of learning about your own .

chemistry.

And I think for me, what i've seen, you know, I feel like doctors are basically marketers, like a sacred marketing, like our job as a physician is to convince people to do something that we think is good for them based on the best science. But we can to say here when if you feel this prescription for cdm, you have to market IT, you have to say, I think this completely changes the way that you approach your credibility.

I think this could dramatically affect your risk of all zimmer's disease that were so worried about the true mother is so our jobs physicians is to be that secret marketer. So cgs are one of my tools that I think are so crucial. So in chapter number two, yeah, it's the real time of fact.

So if you go get through glucose instance and measured or maybe you do like a two hour glucose chAllenged, right, look at lucus in san at the fastest point, one hour later, two hours later or more frequently, that does not have the same kind of behavior effect as having continuous data where you can say, okay, I drove to see you, Andrew, from my place in berkely. And IT was stressful. Was trench ally raining? And I know microcar was elevated.

Like I think really understanding what the the mediators are of your glucose control is essential. Now that said, it's also kind of a later effect. I mean, i'd rather know your instone and we know from a the White and White hall study that inslee, especially postprandial insulin vast island too, can change years and years before you get a change in glucose.

So um that's more for prediabetes and diabetes. So I think those are the main reasons why I think it's such an important tool. Third thing is a democratized, which you do too. I mean, incredible how you do that with your podcast, but I think one of the most hopeful and exciting things that i'm seen right now in the whole space is that we're going from this patriotic relationship where doctors hold the power and are the gatekeepers of data to patients and clients having much more access to that in chapter about their own chemistry and their own biology. So to me, that is so exciting.

Like for me to be able to i've got you know probably hundred patients that in a data stream with me where we're looking at the glucose and I can I mean, i'm on statics. I'm not doing this so much anymore, but I can call a patient be like, why is your google so high? Like, what did you do? Oh, is my birthday? How a piece birthday? He like that kind of collaboration that also is teaching the patient to be their own clinical.

To me, that is a loop of benevolence and integrity that I think is essential to creating health. We've got a disease care system. We need the democratization of data to become a health east system.

a men to that a million times over. We share that sentiment. I can tell at a deep level, I I think the pandemic actually assisted in IT harmed many things. But IT assisted in people's understanding that no magic ferry, nor the government, nor any anyone, was going arrive at their door with a kit of things to make them healthy, that provide unlight movement, sleep in all the various aspects of nutrition. No, nothing, nothing that everyone has to have access to, first and foremost, and then implement those things as best they can.

Speaking of which, and kind of circling back to this idea of people in their last teens, twenty stories and onward, if you add a magic one and you could give a two or three dots or to make a personal, you could go back in time, a race, certain behaviors, what would the the dots category be? Um you can not tell us more than two or three, but if the goal is to maximize vitality and longevity, and those are not always parallel to one another, certainly not the same thing, sometimes we are not. But let's just say fertility being a proxy for vitality in langevin.

I think people will soon as forget this, that fertility and just about people want to conceive children. It's also it's a km service, a proxy for vitality and launch chavis. So what would you like to see patients? Let's focus first on fee male patients. But um if IT extends to male patients, well, what would you like to see them not do yeah or do far .

less of I really like that. So I would see a few things i'll just set like them and then we can go into detail. Number one, sleep. I do anna diverge from you a little bit on something, but sleep is partly now one of them.

Well, feel free. You're the one that worked one hundred. You the one that work one hundred and hundred and twenty hours a week. And I can't imagine unless unless you lived in a different reality than I do. And there times in my career where I was pulling all nighters and sleep to brothers just I don't .

recommend IT but I did IT .

I hope you don't do any no longer if I can avoid IT but there were years many years where I was like right here we go and i'm quite um adapt at IT for one cycle yeah but two nights .

or so I would say sleep I high perceived stress and i'd love to talk about maybe um the date on tel me years and what we know so you would .

like to see people get enough sleep so don't don't this .

yeah not all of these are concordant so um not enough sleep too much jack all too much perceived stress. Eating the wrong foods, toxic relationships. And isolation in the number six, not moving enough or not moving and exercising in a way that really fits with your body.

We start with that one actually because it's such and then work backwards. That's interesting. I I think nowa ys people appreciate the need for, quote, quote, cardio. I know that the exercise physiology crying and dissolve into a pudding of tears when I say that, but getting the heart rate up over some period of time longer than ten minutes in order to generate Carter vascular health circulation. So in resistance training of some kind, maybe flexibility, what what do you mean by body type and exercise?

I'll speak from personal experience. So what I did through, I mean, I gave up my is to medicine. And during that time I occasionally go to the gym.

You know, you see sf on pronounce. You could go to the gym and then as soon as your people, when off fear, back into the hospital. But I didn't exercise much.

I had um demeter nord tracks. I had had an ord track in my house. And there was I was like that what I believe, because for me, the primary outcome that i'm interested in is cardy meta oc health.

So when IT comes to exercise, when I really feel if we are going to be at a population level, I feel that about a third cardio two thirds resistance training is based on my sympathy. Is of the literature the best combination? And I think there's you know as you described with your sign um study, I think there's a minimal effective dose, which for a population is about one hundred and fifty minutes.

I think most of us need a lot more than that per week, per week. But I think you know for me, because I have seen a type that produce a lot of inslee, kind of depending on how am on my game, I have a lot of glucose. So I have to exercise a lot more to dispose that glucose. So I think you then have to move from medicine for the population or prescriptions for the population to what works for the individual. I think that .

recommendations is fantastic. I think resistance training, well, the input this way, i'm neither a trainer nor a physician, but i've and family members that we're doing IT, I won't say a lot of cardio, but just cardio that when they add resistance training, everything in terms including their biomarkers have improved dramatically. Yes, this is particularly for female members of my family.

But one of the one of the meats that I think is important, especially for people who do what I call chronic cardio, which is what I did, is cortisol. So we know that um runners, specially marathon runners, people who do a lot of cardio and don't do much resistance training, they tend up my high cortisol levels. And you can buffer that if I didn't see, if I didn't see can decrease the effect.

But quantic cardio doesn't always serve people. So a quick personal example. When I first started measuring hormonal panels in myself, I went to my physician and I said, i'm thirty five.

I've had one kid. I want to have another kid. I've never been so exhausted in my life. I just feel like i'm pushing a rock up the whole.

I've got this belly fat that I don't like and um I know want to sexed with my husband. So what do you think? What could we do about this? And he offered a birth control pill in an entire .

to present.

So I left him, and I went to the lab, and I ran a hormone panel. And my courtesy was three times what I should have been. My insulin was in the twenties, I was fasting.

My glucose was one hundred and five. My thread was mildly abNormal. My protestant was low. And that set me on this course of realizing that what I was doing as physician taken care, especially with women, was not getting to some of these root causes that are so essential. And I would say I had to start first with cortisol.

At that time, I was running four miles three times a week, four times a week. That was just raising my quarter, sell further. So that was not the right exercise for me.

I needed more adoptive exercise. I start doing ploy, more yoga that helped to lower my cortisol. I mean, that started me on, you know, changing the way I was managing perceived stress. And IT also changed my supplement ridgment IT.

Could we talk about that with the moment you said a lowering court is all thought of? And the two supplements that come to mind are, uh, uo ganda, which I think can potently reduce cords all. But i've heard some recommendations about cycling IT.

And I always wonder about time of day for rush were gone and take because sort of and want court is all elevate in early part of the day. We know this. We know you do not want cortile peaking later in the day.

No, you do not interference asleep.

interference s of sleep. Um and and then the other supplement is rodia roza. Do I have my pronouncing accurate dio?

That is very effective. It's been shown in multiple ammie trials to lower sol, so that could be a very effective.

So i've started taking IT recently, by the way, and I made a huge mistake. I like to make the mistakes first so than my audience don't make them. As I was taking IT, I heard IT was an adapt to gen.

So I thought i'll take IT before resistance training. But of course you want the court is all picture in resistance training because that's gonna in motion, the adapt of response. So I started IT later in the day and it's really improved that out in my late day, second half a day cognition. This is subjective. To be fair, I just feel like i'm anymore even plain of attention in the second half of the day.

So you're describing an of one experiment.

A well IT is .

not anecdotal. So I was taught at her with medical school that the hierarchy of evidence starts the lowest with expert opinion, you know case studies. Then you've got cohort studies and you've got um observation data that's perspective than if I mize trial.

But the highest quality experience of all is the end of one experiment where you service your own control. So what you're describing with radio, I would frame that as none of one experiment we have a washed out period and you compare before and after. And i'd like to measures some other matrix to see if there, in effect, including your cortile.

So radio has been shown in multiple animist trials to reduce cortisol. The other thing that I think is super effective is fast potito syrian P. S.

For short fish oil, also more modestly reduces cortisol. Oh, wagon is interesting. So in my first book to home care.

which I read, by the way, you did.

I did. I was hoping that was the way I did.

I read IT, and it's spectacular. And I thought going into IT, I had this like, you know, literally called what I was just come made by as like as there are going to anything in here for me because I don't have over reasons and this can be. And IT was immensely informative.

So thank you. Yeah, I have very fun recollections of the walks I took listening to IT. And then I own the print version too.

So I like to switch back and forth. So thank you for that. It's a per book for anyone to read.

Yeah, I so appreciate that. So in chapter four, you may or may not remember that, oh, uganda, at least the time that I wrote that book, oslo ganda data is not great, but lack of proof is not proof against. So with osgod a most of the data comes from thousands of years of using IT animated medicine.

And it's considered, again, not my science tap. It's considered a double adapter gen so that its potentially helpful when you are um a high quarter of cell in a type like I was like I sometimes still in or a low court is on. I haven't found that in my patients, although give you one exception.

So oh, uganda is mostly based on animal studies. There is not as much human data, but IT is used a time in an integrated tive medicine. The um there is one supplement that i've found to be incredibly helpful for people who tend up a high court court night and that's called a cortisol manager spite any great to therapeutics. I don't have a second um supplement manufacturer that makes something similar. Is there number one selling supplement because it's so effect.

This is a cocktail of several.

It's a community of fast potato syrian and oh wonder.

Tell me more about fast potato syrian. I I familiar with IT for it's been mentioned by some guests that were on the infair podcast long ago. For other reasons.

I think we late to sleep. Yes, and maybe that's another reason why you like IT. But before we move on from radio, is there a dosage of radio university that you?

So I would refer people to my book because the reim zed trials and the doses that were used are in there. So I can't remember with radio a, although I took IT this morning .

to prepare to be with you. We can look at up and show no caption .

that does with fast fit les, because I take out regularly. So four hundred and eight hundred milligrams is the typical does for p. And what's interesting is that in the animist trials that we're done, four hundred milligrams was more effectively than eight hundred. Milgram.

interesting. I've found that for several supplements that the lower dose was more effective. yes. Yeah, I IT doesn't matter what those were. And so when you say P, S, you are referring to buy the way folks, not P, C, O, S. When scientists, cent, clinicians are familiar with and military familiar with acronyms, bus title, syrian P, S of four hundred, eight hundred million grim, four hundred been more effective. Taken later in the day or early day.

Does that matter? IT depends on when your cortisol is. So for me, I tend to you know, what's the pattern for court is all typically IT rises to its peak thirty to sixty minutes after you get up, and IT has this gradual kind of athenodorus ine until you go to bed.

So if you're someone like me who peaks like way crazy, hi, I don't do that anymore, but that's what I used to do. I need a photo ital screen in the morning. For people who are high at night, who have what's known as a flat cortisol pattern or a inverted pattern, you want to take IT at night.

And the flat pattern, just quick side bar, is that, that's associated with a number of conditions that most mainstream positions don't know about. So a flat pattern where is slow in the morning and its high at night is busy with anxiety. Depression, decrease survival from breast cancer that was studied at stampeded .

by David speaker that he was my close even collaborator even on the breath work study .

that interesting yeah.

So see a chair of psychiatry so wonderful human being has has been a guessed on this podcast and and i'm now fanatic zing about a conversation that includes a panel of of of incredible minds like you and David from the clinical side so in any case um yeah the late shifted court is all .

not good not good. And IT seems to have the worst immune downstream issues of any of the cortisol veterans. So that's really important to know about because IT then maps to things like um it's related to P T S D. So that's the pattern we see like in vets you've got P T S D as well as others. IT maps to auto mundo IT maps to fibre milder.

I was told that one in twelve people um have our hei gus so one milton copy or hype morph for some some mutation in a general related genes so can general general hyper pleasure.

Is that true? And if so, that means that one and twelve people walking around or cracking out far too much court as all or not enough court is all or the course seal system is already sued in the direction that makes life more chAllenging at the levels we're talking about. Did I hear that correctly? Because that one in twelve is not a small number.

is not a small number. IT fits with what I see clinically. I mean, I have wanted see that ita, just to see um what does that mean and could you module IT with environmental influences? But IT certainly fits with what I see.

You know I was taught once again a mainstream medicine that in terms of a terminal function, it's very binary. How most clinicians think about IT, you either have additional ones disease, you don't make enough course of all, or you've got cushions or cushing wait pattern and you make too much courteous all and anything in the middle is Normal. And my experience is that, hell, no, like there are those of us like me who make a lot of quarter sl, I don't have cushions.

Maybe i've got one of these. I wouldn't all IT a mutation gene I would call IT more of a vulnerable. So maybe I have one of those. Maybe that's part of the reason why I make you know, two, three times what I should be.

I'm aware of certain groups of individuals from within the military sector that have there's a more frequent occurrence, save some mutation and C. H.

Can general gender hypertension not a story? Two copies, which, if people looked that out there are going to go, oh well, there's all these finot pes and but sort hyper morph type thing so you know less than or too much courters all and they're very good at staying up multiple days per night, right multiple nights in the series so they can pull all nightmare easily yeah, they can push harder when most people quit. And everyone think, well, that's a great final typed to have.

But guess what, it's because they hyper produce cortical you. And so that's interesting. And I think if we were to panel medical students and graduate students, and you were look at, you know, who's pulling excessively long hours, who stressed out a lot even outside of academia and medicine, and pushing, pushing, pushing really hard, I think the ability to push and not crash, we think of IT is adaptive. But in some sense, it's maladaptive over a series of years, which is what you described earlier.

Yeah it's such a good point because you know you in some ways you want to select for the ad in certain professionals like in the military, like in medicine um but I would wonder for those folks about the .

downstream consequences.

But even the data shows that if you someone like me who makes a lot of quartile higher rates of depression, like fifty percent of people with major depression, have high cortisol levels, higher rates of suicide, a much more meta lic disfunction. We know that trauma as an example, maps to an increased risk of glucose medal ism issues and certainly high court is all because it's one of the jobs of cortisol is to manage a glucose and it's IT kind of sets you up for um this one number five, which is toxic relationships. Know someone who hyper produce this court is all it's hard to live with someone like that.

It's also, I would say, people that have this, let's just call IT biological resilience. It's not always adaptive because you can stay in bad circumstances longer.

The ability to crash provided, not suicide or life life destroying or you know long ark of of pause and the requirement to you take two years off from worker or schools something um the ability to keep pressing on is is a double sort of um I want to make sure an instance within this conversation uh because you mentioned ed faster syrian, we talked about radio A A. I would talk a bit about ohg anda. You ve also talked about a megaera fishel in particular.

I'd love to know your favorite sources of these. I think nowadays more general acceptance that getting these essential fatty assets is important. Do you have a threshold level grams? I've encouraged podcast listeners to consider, depending on what you're reading, to try and get a gram of epa or more per day.

Does that seem excessive? And what are the real data on E P S? Because then the a cardio ashlar experts always hit back and say, oh no, you know, it's not good for cardiff, asked lar health. And then you Better than enter the presence another studies and they go, no. So I feel like if if you really want to make your life difficult, you want to raise your cortisol, you go on twitter and you say something positive, bottle mega es of ice and and you learn a lot. What are your thoughts on the mega trees I take a lot of.

and I always been a big fan. yeah. So that's where I personed. I think some people need more than others. And what I do is I measure your level.

So if this gets back to the nutritional testing, so for you, I was just in a mega quant, or one of my favorite cardie ta oi piano is to do a clive l in art lab. So I think they they give me the most reliable information, not just for lipids and up classes. And you animal are a fractionation, but IT also gives me an insulin resistant score. IT gives me levels of a megaera. We'll provide .

links to these different sites so that people but one .

quick thing about that, the whole story is not a mega series in taking fish oil. So the work of charlie saha at the burgan is showing that the way that we resolve. Our understanding of IT is really, I think, in the learning to crawl stage.

And so if you look at the a make a three, six pathway in the body, fishes can help you know kind of push the reactions in a particular direction. But typically, they're not enough for the resolution of inflation tion. Now what most people do, including my N B A players as they pop and i'd be proof in or something like that when they've got information that's got lots of other side effects that are not so good for you.

And we know in terms of the resolution of inflation tion, that taking in something like I rio fin reduces the implications of inflation tion by about fifty percent, but then IT potentially blocks the complete resolution of information. So there is these new supplements that you may have heard of called specialized for resolving mediators. There's a lot of different supplement companies that make them.

And that, combined with fishel, seems to be the best combination. And what I do for athletes who've got kind of the Normal accent pains of the training look they have is all combine a little aspirin, small dose just like um eighty one milligrams are to those baby aspirin together with visual plus specialized per resolving immediately. And there's some Better nus they're sartin ed for sports.

But the the dose I would say with my patients, some of them only need a thousand milligrams like your gram. The three mention for the population, some of them need six grams together with s bms. So I think IT has to be personalized.

How Young is IT OK for people to start taking omega trees? Um for instance, Young women in their teens, people they're twenties and their thirties, Young guys and their twins and three, should they take visual, if just as a assuming they are not going to get anything tested, everything about the college student who is really into biomarkers and that everything will go to some of this but many people want, but they want to do the right thing.

So they're trying to drink a little less, hopefully, hopefully want smoke. Or vae, please don't smoke. Or vae, the idea that vapor is OK, it's like we had at all so bad, so bad.

Everything that exactly, so just you avoid hopefully they are trying to avoid those things. Hopefully they will avoid hard drugs. Hopefully they avoid getting any S T S. If they do, they resolve them quickly. Hopefully yes. Um so but they might say, oh well, okay, i'm willing to take some magnesium or takes some possible al syrian buff from my court is all eat some vegetables should they consider taking visual as kind of across the board and oculi thing.

So I like to rank order these I would say fishel. Yes, I think a thousand programs as a general recommendation is good, but I also have a food first philosopher. So my preference would be that they're having salmon or some kind of smash fish, and they're getting that as the primary source of there are make a trees.

And then the day is that they don't have fish. I recommend IT probably twice a week that they take visual. Then I would put magnesium next. Since so many people are efficient than I probably put vitamin d.

What how many I U of item d per day?

Well, you keep ask me this, like for the population.

yeah. Well, for let me put this way for the last for the lazy person 我 and this isn't or not an end um or the person who um just doesn't have the finances to go get measured yeah levels measured because you know our audiences is a huge range。 We ve got people who can have tons of disposable income that listens, disposable ly income.

So one thousand and two thousand and national units. But you know, what I do is I dose to a serum level that's between about fifty and ninety. great.

And so I have a vet in d recept. A snip. And so I need to take about five thousand a day to get to what I need.

A lot of people don't need that. And you know, there are some supplements that I don't know if they need. So you mentioned for potato syrian, for someone who is a college student and their cortisol is completely Normal, they're waste your money on pius. They don't need IT. They might need IT later, but they don't need you.

Now i'd like to make sure that we circle back to birth control, in particular oral contracts of earth control, and we should touch on perhaps IT a little bit more. But what are your thoughts on pie rogen? Worth control is what I learned when I was in colleges that birth control is basically tonic estrogen.

So consulting, taking estrogen ex ro gen women are taking exercise so that they don't get the x rogen priming of progesterone. You're going in any violation. And i've known women that have been taking oral or that took at oral contraceptive, like exchanging pills basically for five, ten, fifteen years.

Are there long term consequences of this? As IT relates to pregNancy? Acer s men, a pause.

If so, what are some of those consequences? What are your concerns? What do you like about oral contraceptives? What do you .

dislike about them? I like how baLance you ask that question. So women who take oral contraceptive as long as you're describing, like ten years or a longer, we call those a limp oral contraceptive users in terms of benefit.

I think that especially when they first came out and even now, IT gives women reproductive choice, and that's essential. As you may know, our reproduction choice has been declining recently. So i'm a big fan in that regard, and we've got a lot of data to show both the risks and also the benefits of IT.

So i'll speak first into the benefits because um i'm going to get on a so ox a little bit about the risks. So we know that IT reduces the risk of iran cancer. So there's something about this idea of incessant evaluation that is not good for the female body.

So if you look at, for instance, women who are nuns who ah don't take oral contraceptives and they have a period every single month of their reproductive lives, they have a greater risk of iring cancer. So if you look then at women who have several babies and they have got a period of time when they're pregnant, they're not violating and then they are breast feed for some period time, they're a lower risk of hearing cancer or so oral contracts. Tips, help with reducing violation and reducing risk.

We know that if you take the oral contraceptive for about five years, IT reduce the risk of iran cancer by fifty percent. And that's significant because we're so poor at that. No scene of your own cancer early.

There is really no method that's really effective. We use C A one twenty five and ultrasound screening, especially in women or at greater genetic risk. But even that often we I know that you know in a later stage.

maybe just because that state is going to highlight for a number of people the question of what are some of the earliest st symptoms that people can recognize without a blood test. So is wearing cancer is IT going to be pain.

So the problem is the symptoms are so big and they're so nonspecific, one of the most common symptoms is bloody. And we've already talked about constitution. We've talked about how women have the longer track, gi track. And so bloating is a really common experience for most women. You get to bulk symptoms, you know, feeling like your your lower belly is kind of pressed out. So the way that we inform women in terms of watching for this is to get regular gyn logic exams um for women who are at high risk where they have, for instance, in motors' for some reason that shows a mass that were concerned about there's way to tree asset in terms of what kind of evaluation that they need and that the situation where you might get a blood test called the ca went twenty nine, C A went twenty five. The um yet the problem is the symptoms are so ague IT could be IT depends on how big the tumor is, how much work you have, what is pressing on.

So if if taking estrogen and thereby reducing the frequency of violation lowers the risk of ovarian cancer, should women that are even women who are not sexually active so they're not actually be trying to get Price or avoided getting present, but if they're not actual active than the probability of conceiving unless they go through some I U I or some other route is is very low as far as I know. So I was taught in high school anyway, would they be wise to suppress violation for periodical using hormone based contract action just so that they can offset the risk of a very in cancer?

That's a very rational question. And I would say that what mainstream medicine has had at its back to recommend oral contraceptives ves, not just for women who are seeking contracts tion, but for acme, for painful periods, for really kind of the dropper. If I had they're prescribing ing oral contraceptive, that's what I was not to do.

But there are so many consequences. And I think the issue here is more about consent, because in O B G Y N, and I started out as board certified O B G N, and I now mostly seem in, but I was taught as new B G N to convince women to go on the oral contraceptive. And I think a lot of that as pharmacy al influence. So maybe we could talk about the risks and why the answer is no to .

your question. As we do that. Could I just ask, is the the sole of ring the new I used to be called the new for ring.

Maybe that's a brand name, but when I was in college was always discussion about the ring right by both men and women for reasons I don't belong on the podcast. Use your imagination, folks. So um is the ring? Obviously it's not A L it's not oral hormone contraction tion, but it's hormone based, right? The rain is releasing emerging locally as opposed taking IT. But you would you slotted under what you're about to tell us .

in terms of the concerns? So we have less data about the ring. So the oral contraceptive is to ormonds its effects dial. And it's a protestant so it's not the Normal uh, protesters on that your body makes the year always make in your dream OS make IT is a synthetic form m of protestant and IT is the same protestant similar, the same class that was shown to be dangerous and provocative tive in the women's self initiative so i'm not a fan of progestins.

I do not recommend them for any woman unless the consequence of not taking them is surgery or some other unless IT IT gives them some freedom in some way so I don't like protestants the, uh nevermind is estrogen plus progestin, but it's released transparency through the vagina. So given the the way that um it's delivered to the vagina, the doses are lower than what's taken orally. But in terms of some of the rest and about to talk about, we don't know about much of the data.

We think that it's similar. There's probably a spectrum of risk and the neighing is a little more towards the middle than you know what i'm talking about with world contraceptives. What are you ready for that?

Yeah i'm ready for the risks.

okay. So like with almost any any pharmacie, the oral contracts tive deplete certain micro atrix. So magnesium they're certain invitation.

Bees are depleted. IT also affects the microbiome. That data is not as strong, but there seems to be some effect.

And there is also an increased risk of inflammatory about disease in automobile condition. IT increases inflammatory tone. So the studies that i've seen increases.

One of the markers of inflammatory tone has since to do erp by about two to three x IT seems to make the hythloday c peotta rino access more rigid so that you can kind of roll with the punches and wax and win in terms of courtesy production. The way that you can off the birth control pill IT can affect sy road function. I'm thinking of the slide that I have that has weak ten problems that is do with the oral contraceptive. But that's what I can remember right now.

That's very helpful. And IT makes me wonder whether night, if, on the one hand, oral contraceptives are protective in women. And so varian cancer, but then they have these other issues.

There is one other I want to mention, please. And new time you take oral estrin IT raises sex format by Nicole lin. And you've talked to other podgers guests about this skill, I think sex warm binding clubland, I think of as a sponge that soaks up free estimation and free testoon.

So when you go on the birth control bill, you raise your sex warm bine clubin IT soaks up especially free testosterone. And for some women, it's not a big deal. They don't notice much of a difference, but then there's a 4 type maybe related to C A G repeats s on the entertained recept tor， who are exquisitely sensitive to that decline in free testosterone.

So this then opens the portal of talking a little bit about testosterone women. So we've mentioned already that is the most abundant, biologically the most abundant, warm in the female system. Even though men make almost ten times as much or even more than ten times IT is so important for women.

IT is essential to use summer things, not just sex, drive and muscle mass, and seen a response to resistance streaming, but also confidence in agency. And so those women who are so sensitive to their testosterone, an level you've got this high taxes and biting global in their testing and clients. What they describe is bagging al din us, maybe a decline in sex drive, but there's also this bigger issue related to confidence agency even rise, taking from studies that we have done with MBA students that I think is a serious problem. Maybe the most important out of all of these things is that I can shrink the catteries by after twenty percent, twenty percent. And that includes IT.

a regression of the of the nerves that interval the the clitter is that I mean.

that's a very good question as a scientist.

Yeah I would think is to teach a the neural side of of reproductive health, we need to do a series on sexy health, maybe cold that me we could certainly use your expertise, I think. Yeah, that's a dramatic that's a dramatic number.

Yeah, but then let's go back to the secret marketing. If i've got a woman that I think should not be on the bird control pill, maybe just taken IT for act mayers, taken IT because her periods were a little painful, what i'm going to do is say, let's leverage these other ways of making your period less painful.

Let's take the message of european ful periods and figure out, okay, it's that you're inflammatory tone and we give you some visual in S P M. Maybe a little aspirin when you get period like let's find some other ways to deal with IT then to take the oral contraceptive, which you have not received an informed consent about because IT can trick your clip by up to twenty percent. Now that usually convinces the .

most people to come.

The elevation in sex, woman biting global in does not seem to go away when you come off the birth control pill. To me, that is the biggest problem with prescribing oral contraceptives. Now the data that we have is limited.

There is one woman who, uh, cloudy as something something who looked at sex form on binding global in a year out from stopping the control pill. And IT was still elevated. IT wasn't as high as IT was when they were on the pill, but I was still elevated. So you are question about reversibility. I don't know if we know the answered to that.

wow. okay. Um that's that's a significant statement, something that for a consideration related to this, although this might seem not related IT, is how early do you recommend that women go get their followers number assessed, in other words, to get a size a sense of the size of the Opera reserve and their amh levels measured. I am an amateur outsider as I say this, but we have an episode on the fertility where I just described the oval tory menstrual cycle um and i'm not the best person to that yeah well we come too far from IT okay. Well um suppose then from taking the perspective of somebody who things about fertility in terms of at least congruent with vitali and longevity with given that it's fairly non invasive, it's an ultrasounds and a blood draw her A M H or both.

Is there any reason why woman would not want to get her follow member assess or her amh levels assessed? Is there any reason why? Because I was shocked to learn that most women don't do this until they're hitting their late thirties or early forties, and they either haven't conceived or they suddenly decided that they want to conceive. And I thought, why doesn't every doctor insists that their female patients get have their amh level addressed so that if they need to freeze eggs.

they can? yeah. So I think if you've got the disposable income to do IT go for IT.

it's not included in a standard blood panel. no.

wow. The only women in my practice who have had image has done and have looked at their follow count are women who one of freeze eggs or in that requires this was well income or they are having trouble getting pregnant. So they are in the reproductive and chant ology system and they're getting and evaluation and then they're also um the women who have symptoms of early menopause, so premature of iran insufficiency, which is before eight forty.

Ah those are the women that I see getting a tested. And I think you're right that IT should be offered more broadly. IT speaks to the democratization of data again, and I think most women don't know that. So you're doing a huge service, I think, to be speaking into this. One other point related to that is that what I see in conventional medicine is that when a woman asked for a hormone panel and she's not trying to get pregnant, SHE usually gets told that hormones very too much is a waste money. You don't need that or if you're feeling horn, when is going to birth control pill unless she's trying to get pregnant. If she's trying to get pregnant, suddenly those same tests are very reliable and they get you know there their test aster, their free testosterone on their thyroid ano, they get their estrogen and progesterone, maybe they get their cortisol, they get their m so there's a double standard between those who wanted a pregnant and those who don't and that need stand.

Yeah I totally agree as i've learned more about avila ory cycle and A M ation and the central population of policles on, it's fascinating IT just seems to me, wow, a relatively straightforward, definitely invasive ultra sound but I don't .

consider that .

yeah and not terribly invasive, but invasive least. But the other one, just pure blood test just seems like why I wouldn't I wouldn't this be offered to covered by insurance or or you know that anyone that wanted. But now, now I understand why you mention menopause. Huge topic, enormous topic. We had a guest on the podcast is not a clinician who said something in passing.

So I want to I likely to get this wrong um but what they said was that the results of the large scale trials on hormonal placement therapy for women for menopause said something to the effect of if the hormone on therapy was started early enough IT was very beneficial for yes, vitality and health outcomes, whether if women went through menopause and then initiate the hormone therapy, hormone replacement therapy, that I could be detrimental to their health so first of all, do I recall that statement correctly? And then second of all, what sorts of hormones are being replaced? Is IT just estrogen? And how is that done? Is IT done through birth control that so oral contraceptive tips, what are your thoughts on menopause? When should people start thinking about IT? And what is the pallet of things available so that we can do an entire episode view on on this topic in the future? But just to you know, I get a lot of questions about this and and i'm guessing this on everything you ve told me today, that there are women in their thirties that while they may be twenty years out from menopause, probably should should be doing things now in the anticipation of that.

yes. So even talked about the thirty something, but I totally agree with you. The more you know about your feet type, your hormonal finot pe, when you're in your thirties, you're set up in terms of what to do in the future, especially things like you're thyroid, your astrand progesterone models because you can replace to a state of youth. I read whatever that is for you, you can replace I don't usually go exactly back to where the australian protesters al levels were or but we can get pretty close. So in your thirty is having a base case, I think, is really essential.

So you spoke to the women's help initiative, which was published in two thousand two, and we went from a huge number of women taking hormone therapy to a very small percentage, like in the range of five percent and that means we've got millions, millions of women who are suffering needlessly with things like insomnia, difficulty with their mood, difficulty with sex drive, um feeling like they are closing the store in terms of sex because they're not on hormone therapy. I would agree with the statement that you made that hormone therapy, particular forms that are similar to which your body always made when it's given judiciously at the right time, typically within five, ten years of menopause, which is fifty one to fifty two, that IT is incredibly safe. So it's a complicated study the women tells initiative.

But IT was the the wrong study in the wrong patients with the wrong medications and um with some of the wrong outcomes. So IT was powered to look at cardiff, asked lar outcomes. IT was not powered to look at breast cancer.

IT was stopped because of breast cancer risk. But what happened in the control ARM of the study was that they had an incredibly low rate of breast cancer. And so as a result, they ended up having this increased risk of breast cancer at five years.

And they stop the study. Now the study was done with synthetics IT was done with conjugated equine estermen known as premarin and medical xy protesters. An asset is where the so called estrogen and progesterone those are uh, synthetic cormon's.

We think especially the protestant is associated with the greater risk of breast cancer, although the the subsequent reevaluation of the data now eighteen years out have shown that um this problem with the control group and no increased risk of breast cancer um and for the women who got extradition, only those who had had struck me that Cameron, they actually had a decreased breast cancer risk and decrease breast cancer mortality. So there's a lot to be said about this. I'm trying to keep IT really brief.

But if you look at the women, fifty to sixty, so within ten years of metal, as they are the ones who seemed at the greatest benefit, so they had uh decrease subclinical authorial crisis, so less cardiff al disease, they had an improvement in terms of bone health, um less progression to diabetes. And then over the edge of sixty they started to have greater risk of certain outcomes such as created vasovic, my cardio inversion and so on. You asked about what do I do? And to me, this problem is not just minimise.

What's more interesting is to talk about Perry minimise. So para manos use is the the period of time before your final monster cycle. And for most women, depending on how it's tuned you are to the symptoms, IT can last for ten years.

So i'm still important. My place it's been like twenty years because i've been tracking IT so carefully. IT usually gets kicked off by having your cycle get closer together.

So that can happen your thirties or forties. You go from twenty days to twenty five years, that sort of thing. You may notice that you started sleeping more poorly because protestant, so important.

You talked about that with kyle. You may notice IT as more anxiety, difficulty sleeping. And that probably is related to the astro receptor.

So your alpha is uh estra recept, alpha is nzo um IT increases anxiety. E R beta is associated with an existing list activity. And then there is a total about success and receptors. Now there is the the GPT coupled astern recept earth, and those are mixed anxious etic zog enc. So um there's there's whole period of parameters.

And what's most fascinating insects, and we've got to talk about this either today or another time, is that there is this massive, massive change that happens in the female brain that people are not talking about enough. And so looking at the work of lisa oni at cornell from, uh, starting around each, there is this massive change into liberal metabolite m. So you can do fd g pet scans, you can look at goose uptake.

And there's about, on average of twenty percent decline from criminal pose up to, like each thirty five, to Carry menials to post menopause. The women who are having the most symptoms imperii maniple SE menippus. The hot flashes, the nights sweat, the difficulty leeching, those are the ones who have the most significant liberal hypo metabolic.

It's almost like A I I don't want to scare people with this language, but this is a low level, or let's call IT suda dementia sort.

Yes, IT seems to be a finite type that you can then map to alzheimer's disease because that's least of us gonee work she's looking at. okay. Alzheimer disease is not a disease of old age.

IT is disease of middle age. What are some of the biomarkers that we can define that can tell you which your risk is? I've got a mother and a grandmother with all sam's disease. You can believe I am all over .

this data and insulin resistance, huge part activity, as we taught before, um seems to be somewhere in there at which I think when that first when that idea first surfaced, a few people like really but then of course, right I mean the brain is this incredibly metrology demanding or and you deprive irons of fuel sources, they where you make them less sensitive to fuel sources, they start dying. They certainly start firing less.

That makes perfect sense. And I think now it's thanks to least as work, work that you you've done and talk about quite a lot of in your books and elsewhere. I think it's really, you know highlighted for people that metabolize a metabolically is going to be as important as genes and genomics when IT comes. Dementia, perhaps especially in women.

is is safe to say that I think I think so because. We believe that the system is regulated by estrogen. So the decline in estrogen starting around the age forty forty three is kind of the average seems to be the driver behind liberal hypo at applessome.

The way I described to my patients is it's like slow brain energy. So you walk into a room, you can't remember why. Like you just notice that you can't managed all a tasted what you once could like.

Things are just a little slower. And I say that to women or like, I have that like helped me. So this is then circling back to W H, I, where women are scared to death of taking hormonal therapy.

And we've got all of these women that are marching tour, potentially a greater risk of alzheimer disease. And they have this opportunity in their forties and their fifties to take core on therapy. And they may not be offered IT because the typical conventional approach based on W.

H. I is to say, unless you're having holidays, the nights weds that are severe, i'm not gonna give you warm on thread. I just wanted call that out. I would say no, that is not the way to approach further. The concept right now in conventional medicine is that hot flashes and nightspots are these nuisance symptoms that we will take care of temporary with a little bit of a street projection or birth control pal.

because it's given a lot or they are idea up.

suck IT up doesn't matter that you're not sleep in anymore, you know, turn down the temperature in the room. And that's not right because have fish is a nights' are a bio marker of cardy meta lic disease. They are a biomarker of increased bond loss.

They are a biomarker of changes in the brain, or so many. These symptoms that occur in parameter pose are not driven by the overnight. They are driven by the brain.

Yeah, it's the the by directional cross talk between the body and the brain keeps, you know, I think is this resounding theme. We are Chris palmer on here, a psychiatric genetic day for mental health. I know we can have hold the discussion of, and we will, I hope, if you agree to IT about nutrition and as a released to hormones of specific diets and and so forth.

But the and that's a question to whether this problem of the liberal hypo metabolic, could we solve IT with estrogen and or increased media lic flexibility. So I just wanted to footnote that interact.

No, please, please interpret. I know you, I were there. I know you are fan in some instances of intimate fasting time, strict feeding and or ketogenic diet, yes, to get cells sensitive to insulin, which is not to say if I understand, recall, which is not to say that women need to stay on the key generic diet for long cords of time or intervention fast, while only time are treated, treating for eight hours or six hours a day. But that by increasing, you said, meta possibility ability, excuse me, but by increasing cells sensitivity in sand and then maybe returning to a more typical leading pattern and periodically switching back and forth, that might actually be be beneficial to .

I have that right? Yeah, I love the pulse. So I feel like it's much more physiologic than, say, going on epidium ic diet and staying there for years.

All of the data we have on the candida is pretty limited in termini ration, the longest players that we have in terms of the data are the focus with epilepsy, and that's just a different finite type. So I think in terms of microbial effects, diversity disputes of those issues, we really don't know in terms of long term effects. So I prefer with a kidgin nic diet that is used as an end of one experiment, and that to do IT for four weeks.

Maybe you measure biomarkers before and afterwards. Maybe you look at our store before and afterwards we stop and start about the test yet. But you could measure your faster in saline and your glue cose you could just start there to four weeks of kito clean to including vegetables. Doesn't have to be fifty seven a day. And then .

measured again afterwards. Mention still testing. What what is your recommendation about still testing?

So my recommendation, this is again in the the field of if you have the disposable income. So I usually start, which is nova because they've got a good copy system with insurance. That's what I typically is.

So I usually do there one day school test where you have to go digin through your stool and send IT off to the slab. It's in north CarOlina. I usually do that one day unless i'm concerned about parasites.

In that case, I tend to do three days. I do that for people who travel if the amount and go to places where there's greater risk or they just have got symptoms. Another test that I do a lot is because I was like to mention two labs.

S is IT test by wAngel ity. And this is much more of a data walk type of task because is powered by A, I was designed by a guy who's got inflaming tory about disease and he is um he's appears he deep finit typing bioinformatics y who wanted to make this really easy. So the test is is under the umbrella of thorn and these collar up bio, they might have another name for IT and they just improved IT so that it's A A wipe instead of directly through her school. And so my athlete, tes, i'll do IT. Now they were not so into taking through their stock before.

Is anybody really? No one is. I don't want the answered. I know the answer. I prefer to that.

but that's a super interesting test because it's you get much more dense data. The issue is um with apologies to my friends at thorn, the issue is that their recommendations end up in thorn supplements so that can be very easy for people who want to connect the dots. That's not always the way .

that I like to do IT. Um first of all, three things you've shared with us an immense amount of knowledge and in that first stand I also want to apologize because I threw at you with the entire lifespan of female lifespan, reproductive health, contrast action, diet, microbial, so many things but I first I just want to say you've taught me a tremendous and out including I think, something that most people, including myself at night thought about enough, which is the psychosocial impact on things that we're all familiar with, constipation, bal movements, what we eat, what we avoid.

I have to say really a huge thank you for that because it's not something that's been discussed on this podcast before, sort of know that brain communicates with body psychological biology or linked. But I think this is the first time that anyone's ever directly linked circumstances and biology and psychology in such a concrete way. So that's that's the first thing.

And and I know I speak for many people in that. Second of all, we barely scratch the surface of your knowledge and which is both frustrating for me because I always want to learn more and know many other people do as well. But also very, very exciting because with hopefully without much persuading, we can have .

you back on to talk about things.

I know you're working with men now, man, health, some particulars around I think there's more frustrate explore in terms of pcs menopause, contract action and all of the above. But then something that you and I were talking about off camera um before we started, which I think is a really important factor that tie back to this issue of trauma and stress and the by directional relationship between biology and psychology.

Hopefully someday we won't even separate those two. Um which is the use of specific medicines, including plant medicines, yes, and how that can influence overall health, which no double will include hormone on health. So I say all of that for two reasons. First of all, to cue up the we won't call IT apart too, but a equal to to this, i'm gratified to hear you will join us for that. And then also did just really extend a huge thank you. The amount of knowledge that you shared is is immense and is going to be very, very useful and actionable for for men in terms they're thinking of their actions and for women in particular, today's discussion, in particular, for women in terms of how to think about their health and biology, how to think about their psychology and the environment that all of that is embedded. I just want to say an enormous thank you.

Thank you, Andrew. I so appreciate that. I so appreciate what you offered to the world in terms of a way, in a way to understand physiology and how to craft A A Better life.

Um can I just add one last thing I didn't talk about IT sce. We didn't get to the forties and the fifties in those list of biomarkers. So I feel like if people, if women went away with one thing today IT would be to do a ordinary artery calcium score by eight, forty five and sooner. If you've got premature.

her disease.

how is that taken? So it's A C T. Scan of the chest. You can self order IT.

Like, I think at stanford hospital, you can self order IT. Last time a patient checked to a tuner, fifty dollars. So again, disposable income.

But IT IT tells you IT IT almost gives you this fork in the road in terms of how much you need to pay attention. And according metabolic alth as a woman, and it's forty five, four men too. So if you have a had one, if you have one, you need one in one. cortisol. Cc.

great. So n it's really .

essential and it's some yeah it's it's so fascinating because you know there are some women who have a zero, my score zero, and that's great. So often you can just keep doing what you're doing. But if you're forty five and you're starting to be elevated or you've got maybe you ve got pcs or you've got some mother biomarkers tending you in the direction toward the number one killer, really eight, nine out of the top ten killers in U.

S, that allows you to really start to make changes. And I I think it's essential to know that data. It's probably not gona be offered by your doctor. Certainly a Peter at t is gonna IT, but most conventional doctors are not onna do IT. And the last thing I want .

to say before you mentioned, so if I were to go to my doctor and I just say I want to a .

cordia calcium score, that's what people C A C.

So everyone hear that and know that if you're forty or older and maybe if you're forty five, forty five or older, get get IT.

So the last thing is in this four minute, and women, is your a score. So adverse childhood experiences, knowing your a score is so essential in terms of a baseline for how much to trauma your system, your pine system, in doing when you were a kid. And we know that childhood trauma, whether it's abuse or nuclide or you having an alcoholic parent, that maps to disease in middle age.

And I can give you so much insight, i'll give an example. I've got a patient who had an elevated corner artery calcium score who does everything right with her food. I think I was her trauma elevated her cc when he was forty five. So I think in a score, knowing your a score, starting as a teenager, like knowing IT and knowing how to work with that is really essential.

There are certain people, they are exceedingly rare. But you are one such person that when they speak, knowledge just comes from, comes out of them and ably, useful and helpful knowledge. So thank you.

I'm going to get both of those things, okay? And I highly recommend everyone else pursue ways that they can get those if they can get them, that they remark those of things to get at the point where they they can obtain sufficient disposable income. Sounds like that the health the detriment to health that those can offset will be well worth the cost totally.

Thank you.

Thank you for joining me for today's discussion all about female hormonal health, vitality and longevity with doctor Sarah got free. If you'd like to learn more about doctor god feeds work, please check out her social media channels. We have provided links to those in the shown ote captions.

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