Intro

SPEAKER_01 0:00

Welcome to the Five Codes Podcast, where we discuss evidence-based methods to elevate yourself to the next level through optimizing the way you look, move, perform, feel, and connect. On today's episode of the Five Codes Podcast, we have a very special guest, my personal medical provider. Leah Strike is a PA who I have worked with for many years. She helped me start the entire functional medicine part of our practice, which I wanted as a key surgical adjunct for my patients to have access before surgery, to get them prepped, prepared, to be as strong and metabolically ready as they could, and then to have the most incredible postoperative recovery experience. Leah was a really big part of that entire process, but also takes really good care of me and my patients and their overall health outside of anything that has to do with surgery. She's just a wealth of knowledge beyond anything that I can comprehend. And I get like nothing but the most incredible feedback from my patients who see her. Like, oh my gosh, Leah's incredible. Well, I feel the same way. So I really hope that you enjoy this episode as much as I did talking through it and recording and learning. And you're gonna get a lot of little actionable nuggets out of this. Enjoy. Leah, thank you for being here today.

SPEAKER_05 1:13

Thank you for having me.

SPEAKER_01 1:15

Leah is very special to me because Leah is my provider, everybody. So, like, this is really cool to have my actual medical provider here with me. And um, our relationship goes kind of before that when I was trying to create an infrastructure basically for my surgical patients to have all the things that I would want to have myself in-house. Um, and this included a lot of functional medicine preparation and recovery-based things, and you were the person, you were the one, the like the somebody who knows so much more about it than I ever could and could help me pull the important factors out of the ether that is a very amorphous field of functional medicine, right? It's developed even a lot since we've been working together, definitely, um, which is kind of cool. And Leah had so much more experience in it than really anybody else ever. So um I was very grateful to have you uh be my provider and come work with me. So thank you. Um and and you still work with a lot of my patients now, in addition to having your own patients. And um, I think today I would just love to take the journey through a little bit of like what people are missing or could be missing, or and this could be well, maybe we'll see if it takes a little surgical tilt, but I think it's also just like in your health at baseline, right? Because we were just kind of talking offline a second ago about like all the tests that exist now that you can get, um, which is cool and important, but it it's not generally a substitute for having like the direct relationship to interpret the test. Even like as a physician who knows quite a bit and has a special interest in this, I still I need your help to be like, okay, what does all this mean? Um and I'll tell a story first

Dr. Chesnut’s Functional Medicine Story

SPEAKER_01 3:07

of uh I I and I've told the story to a lot of patients um about you and the first time we ever sort of worked together, where I had been a very, you know, fit person, right? Very high-level athlete at one point, but I always knew that I had like a little bit of elevated blood pressure, like just a touch. And I just always assumed it was familial or that I was sort of managing the risk that I knew that prevented or that that presented for me, I should say, on some level. I knew that that risk presented by the high blood pressure, I was mitigating in every, I was pulling every other lever that I could, because I was like eating as perfect as perfect could be. I was extra, I was like a high-level endurance athlete. I was like, I was doing all the things, right? Um, but that one little like risk factor was sitting out there and it wasn't budging. And so this is where this is, I think a lot of people are there. Like, and I was pulling these levers hard, right? Not even like I'm sleeping as well as I was, I was like on it. This was my job, right? And this is what you don't know what you don't know, even in though I was in medicine, and so I see you, and we kind of like start, and I'm older at this point, I'm in in my career, right? And we just do uh thorough lab screening. Yeah, and you also did a genetic test on me. Um, and and then we took all these pieces and put them together. And I feel embarrassed to say this, right? That like in like 10 seconds, you looked at all these things and you're like, oh, you have a heterozygous mutation for the way that you methylate fully, your MTHFR gene, and your homocysteine levels because of that are very high. And this gets into like the first thing you ever study when you're studying for your MCATs, like the electron transport chain, right? Um, you have a elevated homocysteine that's making your blood pressure high. And I was just like, oh my gosh, I'm that 50-year-old super fit marathoner who drops dead running, right? That's gonna be me. And this is why, and it's been there the entire time that I knew I had these things, but I honestly I had no idea why.

SPEAKER_02 5:10

Right.

SPEAKER_01 5:10

And in seconds, you like put all these things, you took uh an important, you you sought the right data and then you immediately put it together, which I mean quite literally changed my life, changed my life, my lifespan. You changed my lifespan in like 10 seconds. So thank you. And I also love the part of the story is like the way that you changed my lifespan was I'm not on a medication forever, or I didn't have to all I changed my multivitamin and watched how much like fortified crap I would eat, which I wasn't eating anyway, so it wasn't even that, you know. It was just like you need a methylated folate in your and I'm like, oh my gosh, it's embarrassing to say that. All these years.

SPEAKER_05 5:53

But it's so many people I feel like are in the same boat, right? We are doing all the things, and right now it's just information overload. Take this supplement, eat this diet, and I think that's like the art of functional medicine is having a relationship with a practitioner who can meet you where you're at. Like you've already pulled all these levers in your lifestyle, and so you just needed that extra data to kind of put together and link your risk factors and your symptoms to be able to like make that change, but helps you from a longevity perspective.

SPEAKER_01 6:24

For sure. And I was definitely guilty of just like blindly taking supplements sometimes because I heard it could help things, which you have cleaned up for me drastically, you know, like okay, maybe we look at these and ignore these. And so it's you know, the total number goes down, but also it's much more curated based off of everything. Because, you know, again, the multivitamin thing is embarrassing. So I was, I was probably I was taking like a not particularly special multivitamin, you know, and that was doing it or contributing to it at least. And so um

Key Areas That Could Be Improved in People

SPEAKER_01 6:54

what you know, I have this surgical lens that I like, it's my magnifying glass that I look at everything with, and you know, so there's a lot of things that I talk about on this podcast all the time that fall under there, but then there's this world that you live in that I know when you're working with my patients and with your own patients that I just don't know as much about um things that tie into what we're doing, right? Um, but that I think are these mysterious worlds um outside of like direct surgical preparation. What are what to you, when I say that, what are the areas that you think that are like could be improved in people with their overall health are going to contribute to their longevity and their health span and uh but also like how things that can contribute to surgery but aren't like the main focus? What do you think some of those like key areas in your practice are?

SPEAKER_05 7:42

I think some of the top areas that I see like every day would be um hormonal balance and not just giving bioidentical hormones, but looking at stress hormone pathways, the thyroid hormone, nutrients that affect hormones, and finding a good balance for each person at whatever stage of life they're in.

SPEAKER_03 8:00

Yeah.

SPEAKER_05 8:01

Uh gut health is huge. I mean, we hear it all the time now, like the gut-brain connection, the gut-skin connection, that's a key component of functional medicine, is that all systems are interrelated.

SPEAKER_03 8:12

Okay.

SPEAKER_05 8:13

We have all these specialists, right, that we see for cardiology and brain health and different things, but a lot of the time things or all the time things are interconnected. So if we go after optimizing the gut, then often people's brain feel better and their skin gets better, and you can just pull certain levers that affect the whole system together.

Gut Health

SPEAKER_01 8:37

What are the how do you look at somebody's gut? How about that? What does that look like?

SPEAKER_05 8:42

So a lot of times I just start with symptoms, you know. How do you are you moving your bowels every day? I mean, that's one of our major modes of detoxification. Are you having gas, heartburn, bloating? And how many of us have like some sort of like symptom that we just ignore because it's not enough, you know, bothersome enough that we go to the doctor for it? But it's a sign or a symptom that something is off balance, and if you keep ignoring it, it can turn into a lot bigger issue. And so I start there, but there's definitely other testing that you can do. You can look at comprehensive stool analysis, you can look for food allergies or food sensitivities, and that could be affecting your immune system. But there's a large um link of, I mean, people have heard the term leaky gut or intestinal permeability. And when you start having, you know, signaling that's supposed to, you know, not go outside your gut going into your immune system, that can cause a whole whole host of issues that you wouldn't realize are coming from an impaired gut barrier, like autoimmune conditions and skin issues, especially in you know, kids who have really good immune systems, you'll have eczema or rashes and different things, and you might find um altered microbiome or gut bacteria or food sensitivities that clear it up pretty quickly because their immune systems do respond well. You just have to figure out the root cause.

SPEAKER_01 10:08

Yeah. There's I think there's a lot of people right now who are like, I have a little like I don't go to the bathroom every day and I have really I have acne or I have rashes or so. Explain to me a little bit of the mechanisms that are just like foundational, like layman's term, let's go eighth grade level here, of like how um a symptom like that, whatever symptom you want to choose would be common, could lead to something that we manifest and see on our skin. How about that? Let's just go whether it's acne or ashes or whatever, just link that together with the leaky gut. Let's like like tie all that together for me.

SPEAKER_05 10:42

So if you know things that cause an impaired, you know, intestinal barrier, like our cells should be keeping food in and other signaling out, and things that can lead to leaky gut could be stress, toxins. We all know that we live in a more toxic environment than ever. Um, taking antibiotics, which sometimes we need, and you just get all these insults, and then maybe our body doesn't have enough nutrition or time to repair that gut barrier. So then, you know, you're eating your diet healthy or not, and that leaky gut barrier, you're starting to like say, eat your you love nut peanuts and you're eating them every day, and that signaling molecule is going into your immune system where it shouldn't go, and your body starts mounting an immune response, and you get this kind of I guess this isn't maybe a little over eighth grade level, but basically your body is reacting to it, and then you get a rash because of your immune system being disruptive.

SPEAKER_03 11:42

Right.

SPEAKER_05 11:43

And then what we can do is we find, oh my gosh, peanuts are of really high food sensitivity. And what we do is maybe we remove peanuts for, you know, a couple months and we try to really support the gut lining and the gut bacteria, and the rashes go away and your immune system improves. And then side note, the kid is getting less colds and because of the immune system being improved.

SPEAKER_01 12:09

Yeah. And I love this because, well, you and I were both nutrition majors, same same place. Yep. Right? You went further with it than I did before, but then we go both go into medicine, right? Um, and then and in that there's like, you know, there's a a lot of interesting things that like, well, this food causes this. Like dairy contributes to acne or something like that. That'd be a really common one in like the dermatology world. But the way that you just framed it up, I think illustrates that even in some in an individual you're with a food sensitivity, there can be variability in how sensitive you are to it based off of well, many things, but what's going on in your gut, right? Right. So it's not all like X, it's there's it's not all causative. Like X leads to something else. There's other factors that go into it.

SPEAKER_05 12:58

And I think sometimes people go through the realm of like, oh, I have like 30 food sensitivities, and then they just stop eating all food, and they come in very like weak and malnourished, and their mitochondria, their energy is not there because of all this food elimination, when really we just needed to like heal the gut and help open up detox paths.

SPEAKER_01 13:20

And this is why you need somebody to help you interpret your right. You can't just order the blanket of everything available to you, get the information, and then cook for any anything out of range. Because I also say that sometimes even when things are in range, you can like play with other numbers to interpret them. Right. Um, just not just things that are upper l higher low, and you're like, well, those are the things I need to work on. Sometimes you're like, nope, actually ignore those.

SPEAKER_05 13:41

Look at this thing that's actually in range, but that has more of a lever on impacting your overall health.

SPEAKER_01 13:47

Yeah.

SPEAKER_05 13:47

And I think it's cool we have more direct to patient, you know, testing available. But then it's, you know, what do you do with that information and working with someone to go through what's the highest priority in comparison to your health goals? You know, AI isn't gonna know that you have XYZ, and really you need to start here before you start doing some crazy detox or something that's gonna make you sicker.

SPEAKER_01 14:13

It's very definitive that it knows that though. Yeah.

SPEAKER_05 14:15

It thinks it knows it. Yes. I know.

Toxins

SPEAKER_01 14:17

Yeah. You mentioned um detox a few times now, actually, just organically mentioned detox. Talk to me about toxicities, detoxification, common things that you see there, just anything, whatever the toxin may be. What are the what should we be aware of?

SPEAKER_05 14:35

Right. I think I mean people are becoming more aware. Definitely, there's heavy metals, we hear about mercury from metal amalgams or large fish. Uh, plastics are a big thing right now, especially microplastics. There's a lot of hormone disrupting chemicals in um skincare products, and you know, people are getting more educated on it, but they don't, some people don't realize how all these artificial fragrances and chemicals could really be um disrupting hormones and making it hard to balance. And that's where looking at you know, root cause is so important because I can give you detox pills, but if you're slathering on chemicals every day, it's not really improving overall health. Um, but yeah, I think when I look at patients in general, I am always thinking about supporting our natural detox pathways. I mean, fiber is a natural binder, you know, but there's all these fancy like binders out there, which I do use, but fiber's nature's binder.

SPEAKER_03 15:42

Yeah.

SPEAKER_05 15:42

And Christopher's vegetables are supporting liver health and detox pathways, pooping every day and sweating, you know, the sauna and that type of thing. It's just starting with the basics, lymphatics, people are becoming more aware of jumping, dry dry bushing, and helping move move things through the body. Yeah.

SPEAKER_01 16:04

Well, you changed that for me in my internal morning bath that I do every day. I now add fiber to it basically because of you. So it's like when it's hydrogen water and usually a little bit of electrolytes, and then poop, I start start adding fiber to it. Just like, oh, that was a simple addition into that detoxification pathway for me.

Detoxification

SPEAKER_01 16:22

Um I want to pull two things out of that that you just mentioned. Um, well, I think three things actually. You talked about endogenous or intrinsic detoxification pathways. I want to know when those aren't enough, and then what kind of things you do. And then I'm gonna ask you about endocrine disruptors and I'm gonna ask you about microplastics a little bit. But when you say like, so can I just like make my internal detoxification systems good and then just kind of not have to worry about it?

SPEAKER_05 16:52

That's where you start, right? You want to start with um supporting your natural detox pathways, and sometimes that is enough for people, and they've you know limited their exposures, they have good detox genes. But what I've seen more often than not, you know, doing a lot of genetic testing is a lot of people do have genetic impacts that are impeding their ability to detoxify, and then the amount of toxins that we are exposed to just like sometimes outweigh our ability to compensate for those. So, in general, when I do toxin testing, everybody has toxins. So we can assume that there is some sort of toxin load. Now, is it causing an issue that is a manifestation in both labs and in our symptoms?

SPEAKER_03 17:34

Yeah.

SPEAKER_05 17:35

So, you know, I look at kind of the liver enzymes really closely. Are they at the higher end of normal? Is your GGT high? It could be an indirect way to show that you have a higher xenobiotic exposure. And then there's toxin testing. A lot of times I'll do urinary, you know, mycotoxin, heavy metal, or um, environmental toxin testing too. And that way we can see how much of that could be impacting your your system. And when I after those natural detox pathways are hit with lifestyle, then we can pull in maybe additional like liver or mitochondrial support and binders that might be more specific to the things that we need to get rid of.

SPEAKER_01 18:18

Which you did for me. Yeah. So there's another little personal story. Um, I wear a continuous glucose monitor, and I I, you know, I I knew my blood glucose levels very, very well. And then with one round when I started wearing it, I was like, oh, this is a higher than I would expect. And we sort of started looking like weights the same, exercises the same, no reasons for it to be different. And you were like, Well, let's look at your toxin load. And I was like, What? You know, and long story short, um, mycotoxins was my thing. I still am not a hundred percent sure where this mycotoxin load came from. You put me on a very specific binder for that because I couldn't really, I can't do much else for my endogenous detox. I can't exercise or be in saunas any more than I am. I, you know, got a great bowel situation. That was one thing you looked at me like, good, you don't need to do anything. I'm like, whoa, all right. Um, but the binders or the I guess that detoxification for me in particular changed my baseline blood glucose, which we saw and change in my hemoglobin A1C, and then what I see every day in front of me. And so that was just like I was like, Oh, I cannot. Another one. And I was like, that's a longevity, like that's my aging, that's my skin health, that's my everything. It's like, huh, simple thing that I would have never known. Uh, do you so with and with me, you had all the information first. If someone was just coming to you, De Nova, like no information, would you look at their endogene, like their genetics, their endogenous like detoxification pathway genes first, or would you rather see their like laboratory work first, or do you really need them both at the same time?

SPEAKER_05 19:56

I usually start with lab work just because it's the most accessible, right? So then I can take the big themes like do you have inflammation? Do you have nutrient deficiencies? Is there a burden on your liver that we suspect? And then I'll usually layer in the genetics if they're able to, and then using the two together is like the superpower. But blood sugar and toxins is one that people don't typically think about. I had one patient that had pretty severe hypoglycemia. I even was like, uh, maybe you should actually consult with an endocrinologist. It is dropping like super low, was wearing a continuous glucose monitor, and I we did a toxin test as well, and I did like a simple like detoxification support. She already had the lifestyle things in check, and then I didn't hear from her for a long time, and I had reached out and she was like, Oh yeah, everything went away. My blood sugars are fine.

SPEAKER_01 20:49

So yeah, there's some fun patient overlap with us there in that um both of us tend to have patients who are already like pretty high performing, pulling the levers. I always say they're kind of before they see me, they're doing everything. They're not like, oh, I'm just showing up on your doorstep. They're at a high level. That's how they find me in the first place. But it's the same with you. People aren't just showing up unhealthy. You have a lot of patients who are like overall doing a lot and they care. Obviously, that's how they find you, because they care. And and it's these like very individual things, which I think makes your job significantly more challenging. Because I know that I could pull somebody off the street and give them to you, and you would change their life. But if I, you know, you take the selection bias of the person who's already doing they're super into it themselves already, and then they have just thought you just get the hard problems, the things that take a little bit more problem solving to get.

SPEAKER_05 21:34

Definitely, and there's just more like complex chronic illness, too. There's the people that have like seen all the doctors and seen, you know, maybe multiple integrated practitioners that have a lot of like chronic inflammation, and that's really where you're having to do a lot of mind body and like very succinct like detox strategies at like certain times to really help. Those people, but it can be transformative.

Endocrine Disruptors

SPEAKER_01 22:02

Well, I'm gonna ask you a question about what your definition of functional and integrated medicine are a little bit later, because that brings up a good like can you just lay that out for us? But I do I don't want to skip over the idea of I think two really resonant points here, especially in a podcast that you know generally talks about like uh the face. How about that or physical beauty or whatever we want to call that? You talked about endocrine disruptors. I just want to leave it at that. I don't want to lead down the cosmetics route because it's not just cosmetics, it's fragrances and things like that too. I have two young your mom, young kids. I have young kids, my daughters love smell good things. And um what just like run us through how worried should we do we should we be worried? I'm not trying to fear monger here, but should we be worried about that? Do I you know I love Courtney Swan, um, who has this idea that you know you're just gonna have some exposures to toxins in your life. And you if you're you know, you you're you don't want to like bombard yourself with them, but you also can't completely avoid them and live a normal life. So do all the things you can do, limit what you can, but also like enjoy your life. Right. So should I just be letting my 10 and 9-year-old daughters enjoy their smelly good things? Uh there I which I don't because I, you know, I'm yeah, because I'm I'm trying to teach them all these things, and I any like normal parent, I don't even know what that means, that would see me as like, oh, like yeah, you maybe get maybe get a small piece of cake at a birthday party and it's one and over, and like, you know, like there's I'm already the weird dad, basically. I'm already the weird dad of like we don't do those things. Like, why do we have to have that to, you know, they're not eating processed foods, they don't like all the things. And so is this another one that I like food dyes, or we can get into all those things, but like where how does fragrance fit into that paradigm? Because currently I tend to be relatively like I I throw them away, uh, much to their chagrin. I throw those things away when they're not looking, they usually forget that they ever had it, but that doesn't, it's not always the case. Right. Do I need to be that extreme? I don't what it what I know that we have some alternatives. I'm gonna ask you what those best things are, but like what do we do?

SPEAKER_05 24:14

I know. It's a hard world that we live in every day, like you know, snacks after games and different things. Oh, yeah, that's a good one.

SPEAKER_01 24:21

Yeah, yeah, yeah. That my kids are the kids who don't get the snacks after the game. You are not gonna have goldfish and gator enough. I'm just not gonna have to do it.

SPEAKER_05 24:27

Can I have one sip of the red dye?

SPEAKER_01 24:28

I'm like, nope. Right.

SPEAKER_05 24:30

Yeah, yeah, I know. But in the scheme of things, I mean endocrine disruptors to me are a big one, especially for young girls. Is it different for girls in boards? Hormonal development. Um, just with women having a little bit more complex hormonal, you know, changes. I would say I would not want like a whole bunch of fragrances just being rubbed kind of all over the skin. Like now I notice the extra fragrant thing at the whatever we're visiting somewhere, their soap or something. I'm not obviously going to like bring my own soap. Some people might to places, but just kind of the day in and the day out. I think it's good to try to look for cleaner products. Um, definitely ones most should are advertising, you know, paraben-free. Of course, there's other toxins out there. There's a lot of good, easy apps to kind of run through like lower toxin items. I think there's just a lot of um opportunity to lower that toxin load. So I think it is a priority, um, just from a hormonal standpoint. Yeah.

SPEAKER_01 25:32

So you mentioned parabens. Are there any other like this is I'm asking you for my knowledge too, um, like almost everything is paraben-free now that I would even dream of.

SPEAKER_05 25:43

Phalates. Um then there's probably and then there's all the things with all the long names that we'll never all memorize. So that's where I'm like, okay, let's check the app or use a product that's essential oil. I mean, I use a little bit of a little bit of a. I mean, I have like five on the probably, but I don't really use that many products on my kids. I have a lot of primally, pure, I use baby bomb a lot. And yeah.

SPEAKER_01 26:16

Yeah, real, real simple stuff. Yeah. Um, I like that because I I wonder that all the time. You know, it's it's the yeah, it's everywhere. And I see it in products that are good products, like expensive. And I'm like, expense does not equate quality in these things at all. Um, which is interesting when it comes to you know, facial products or sprays. Like I, you know, just I just got back from a trip, and when I'm getting Ubers, I'm almost thoughtful about which Uber I book based off of what I know is gonna smell like in there, because I know that some are just notoriously like these are the ones that have all the smell stuff in it, and it makes me sick.

SPEAKER_05 26:54

I know. You get definitely get more sensitive to it. I mean, I was like lathering on bath and body back in the day. Right, yeah. Love it, you know, and now I go somewhere and I'm like, there's like an air freshener in here. It's just like a a lot. I mean, and I don't want to, yeah.

SPEAKER_01 27:10

So is that air freshener disrupting our endocrine system? That simple, is it? When I get in that Uber and I don't feel good, is something happening? Like legitimately, is that like affecting it?

SPEAKER_05 27:20

I mean, it's one of those things where you can't like single out a one particular item. Like we have, it's just like when people don't eat bad foods, but then they, you know, use their lotion or they do eat some bad foods. I don't know. It's like all relative to like our exposures. And so it's just one more drop in the bucket. So it's like wherever you can kind of like lessen that minimize and you know, function in the world and back to Courtney's philosophy. Exactly.

SPEAKER_01 27:49

What about um what's a worst case scenario? We like someone's getting really, really endocrine disrupted. What does that mean for um let's use our our daughters as an example? Like, what does that mean for our daughters? I guess it could be our sons too, but what does that mean?

SPEAKER_05 28:04

So a lot of times there's a lot of like estrogen like mimickers, a lot. I mean, the age, I think they are even changing the age of like average menarch because um girls are starting their periods so much younger. Um now can we pinpoint one endocrine disruptor that's causing it? Maybe not, but it is like the food, the chemicals, all these different things. And now we're kind of normalizing it rather than fixing the problem. And so I do, you know, so many women come with have had terrible periods and cramps and you know, learning in the conventional paradigm, it's like, okay, well, we can give you birth control.

SPEAKER_02 28:44

Yeah.

SPEAKER_05 28:45

And that isn't the, you know, getting at the root cause. And so you go down that route route where you might have symptoms that are, you know, disrupting your life, but then that can turn into insulin resistance, which can turn into a longevity issue. So again, all those systems are interrelated. And so it can be a big deal over time, but there's so many levers that we can pull and do, and you don't have to do everything at once, right? Like it gets, I think it gets overwhelming when people see, like, oh, you're not supposed to do this or eat this or take this, and it's like, well, what can I do? And so I think reframing it and like meeting people where they're at and just trying to reduce that load is where we start.

SPEAKER_01 29:30

So I'm gonna ask you this question in a few ways about a few different things throughout this conversation, but I'm just gonna lay this out. So when I'm saying if we go out a 30,000-foot view and we can see the whole spectrum of uh people's opinions or medical evidence on things from the deep in the rabbit hole to the generally consider regarded as safe opinion, like yeah, this is generally regarded as safe. Um where on that spectrum, because the truth is not either one of those, right? It's not killing our daughters and it's also not doing nothing. Where do you think like uh the endocrine disrupting types of um scents or fragrances or topicals are falling in the on the spectrum in real life? If you were to just like kind of like have to, you know, stamp your opinion on it based off medical evidence and what you see, like is this like we should be worried? Or is this like, you know, it's just suboptimal.

SPEAKER_05 30:25

Right.

SPEAKER_01 30:26

Yeah. I think that or do we just don't because one of these I'm gonna ask you about microplastics. I'm interested to hear what you say there too. We don't actually we just don't know. We don't know that it's a thing. We know that it's not totally safe, right? Um, but I also don't know that it's killing everybody. Maybe it is, right? But we just don't know. It could be anywhere on that spectrum. If you were to narrow endocrine disruptors down, because uh from a sunscreen standpoint, we actually know that like we know, oh, that wasn't good. Some of those are like very potent endocrine disruptors, and there's but those are like very distinct ingredients. Like you can point to that one. I know the names of them off the top of my head versus these. I don't even know what a lot of these products are. So where how where are we on our spectrum there?

SPEAKER_05 31:08

I know that's a difficult one.

SPEAKER_01 31:10

The crazy the crazy dad and mom, or towards the ignorantly blissful dad and mom.

SPEAKER_05 31:14

I feel like I'm above half, like okay, okay, but maybe not like at the very top. But I that's just my personality is kind of moderate about everything, just because I know there's just so many. Which makes you great at what you do.

SPEAKER_03 31:24

Yeah, but yeah.

SPEAKER_05 31:25

But yeah, it it's something that I think about, but I don't scare

Microplastics

SPEAKER_05 31:30

people about it.

SPEAKER_01 31:31

Okay, so on to microplastics then.

SPEAKER_05 31:32

Okay, yeah.

SPEAKER_01 31:33

Um because this is one too that I think we've never talked about. This will be everybody gets to see our first conversation about this directly. Um, I went through a big hard try to get microplastics out of our operating room, you know, and that was challenging, expensive, onerous. I think my staff sowed greatly because they have to order special things now. It's like it's like that embarrassing thing when you go with somebody to lunch and they're like, Do you have any food allergies? And they like list 79 things and they're like, that's me now in the operating room, basically. Like, you can't this, you can't that, like all the the restrictions that come with it. But it was kind of what I would want, and not kind of, but was what I would want. That's why I did it. And I went on this, like, okay, how important is this really? Like, we know that we're accumulating them, strong to like you know, there's evidence to show that, unquestionably. Um, but what's it doing? What do you see with it? How where are we at on that spectrum? What do we do about it? Um, besides not get it when you're having surgery with me, like that's a huge reduction, you know, and it's all it's not embarrassing because you don't know what you don't know.

SPEAKER_02 32:40

Right.

SPEAKER_01 32:40

But when I look back, I'm like, yeah, everybody that was getting an IV or getting surgery is getting into exposed to a lot of microplastics, even by me in my career, until I knew what I know, you know. Right. Um how do we manage all this? What's your opinion on all this?

SPEAKER_05 32:55

Yeah, I feel like there really isn't a ton of data out there. There's not even a really good way to test it that I'm aware of.

SPEAKER_01 33:02

Yeah, you yeah, I mean there's just certain elements, yeah. But you can search for PFAS now.

SPEAKER_05 33:07

Right, yes, yeah, like some of the specific elements, but the micro, like that level of prop plastics, we just don't know as much about. So I put it in the bin of toxins, and actually, I think there maybe was a study related to like fiber reducing microints.

SPEAKER_01 33:22

Oh, interesting. Because it's accumulating in organs, like the famous one that was like, oh, it's getting in your testicles. That was like a big guy one. Like, what's that doing? Right, right. Like, is that causing microinflammation that's changing your testosterone levels or something? I mean, do we have do we know anything about that? Or is this just on the spectrum of like we know it's not good, but we're gonna do that.

SPEAKER_05 33:43

How much is it impacting us and what can we I mean, what can we do about it is reduce our known exposures to plastics the best that we can. Like don't have a plastic water bottle as your like everyday water bottle. But then when you like go to a conference or travel and it's kind of like, you know, you look at ewg.org and your water, the tap water database is uh not great. So yeah, it's kind of it's all part of that spectrum. And I I just can't like overly emphasize one thing because there are so many things that impact our health and yeah.

SPEAKER_01 34:21

Yeah, that's that's kind of where I'm at with it too. Like, but I I found a very obvious exposure and you know did my best to get rid of it for my patients at least. Yeah.

Hormones

SPEAKER_01 34:31

Um let's talk about hormones in general. We talked about endocrine disruption, but what about hormones in general? That was another area that you mentioned. Um, we've talked about detoxification, we've talked about the gut a little bit, and you mentioned hormones. My approach to this and my lens has always been um and medicine has has, you know, been on quite the roller coaster with this over the years, right? But this isn't something that I directly control with my patients. Like if I have somebody who does or does not want to do hormone replacement at whatever age, I'm literally staying out of it. But I do get to observe then how different people age. I get to observe how they recover from procedures, and I get to the I would say that and um their longevity of their procedures are noticeably different in different phases. So men and women, really. Um what where are you at on this? What what should people be aware of?

SPEAKER_05 35:34

I think hormones are essential to longevity. I really do. And but I also think, I mean, I'll say it over and over, I'm all about finding a balanced approach. And but especially like perimenopause to menopause transition, I think um hormone replacement therapy can be really, you know, helpful for that longevity purpose, for quality of life. But I think you have to look at the full spectrum. You have to look at gut. Gut impacts the way we metabolize hormones. We have to look at cortisol, adrenal, stress health, uh, thyroid optimization. And so it just, you know, there's a lot of like hormone clinics that mostly focus on like giving hormones, but I think that having that full spectrum approach, um, especially, I mean, both men and women, like testosterone for men, especially, it does have a large impact on brain health, cardiac health, and those those big things for you know, aging well and preventing chronic disease. It's just being able to have a balanced approach to it to support longevity and not miss out on those other systems that need to be optimized.

SPEAKER_01 36:47

Yeah, it's good to hear you say that. Because I have, you know, I hear this, I work with a lot of women, right? And and something that I deeply like am curious about and understand, but also can't relate to, right? And the like this idea of this perimenopausal time frame, which honestly in my head is a widely massive range of time. It's not like you know, I I'll have women say all the time, like, I feel like I fell off a cliff. Um, and and they're aging. They're talking about what happens with their facial aging, and I'm like, well, the there's an underlying reason for that, which there's definitely more precipitous changes in our hormones, but the actual like delta, the change in them happens very slowly over time, right? So if somebody's in that perimenopausal phase, but they're earlier on, you know, in that like they know it's coming, but it's not they're not actually, you know, near going through menopause yet.

SPEAKER_02 37:34

Right.

SPEAKER_01 37:35

Um, how do you handle that with like a young, like someone who's just early on in the prod? Is it do you go to replacement early? I'm I'm asking and for a woman specifically, I'm gonna ask you the same question for a guy. Do you go to replacement early? Do you do you have other methods first? How long do you give them of like let's just call it lifestyle or other types of changes like stress management? How long do those take? Do the are there natural ebbs and flows that you might have just caught somebody at a low point? How how does how do you manage all that?

SPEAKER_05 38:02

It depends on you know what symptoms they're having at the time. A lot of people, by the time they come to me, they're having symptoms, right? They're having insomnia or night sweats. Um probably like 40s, like um, sometimes late 30s, you'll start to get some changes, but earlier on, like I can pull the levers of like um obviously I'm always looking at lifestyle and those foundational things, like sleep, right? It's essential. But if you have low progesterone and you're not sleeping, like that is going to be um life-changing and over time really helpful for overall health and longevity. Um I use progesterone a lot early on in perimenopause. I use estrogens a little bit less because um until like later on and getting more low estrogen related symptoms. And um, but then always looking at kind of gut health and all these other things that we've talked about to make sure because even people come to me on hormones feel imbalanced, but maybe we haven't optimized like adrenal health or their new general nutrition status.

SPEAKER_01 39:10

So yeah, there's a lot going like especially for females, there's a lot of lot going on there. It is a balance, you said balance, which I really like because you know, um, there's feedback loops in there. And what about the ebb and the flow idea? Do you do you like tend to follow people for a decent for some period of time before you really start making determinations about whether they need replacement, or can you get a snapshot of a lab and be like, yep, we gotta do something about this?

SPEAKER_05 39:35

Yeah, I can definitely get a snapshot, but not even of a lab. Really just like where they're at in their um hormonal journey and their symptoms. I mean, I think I will I mean not always, but I can start people on some like low doses of progesterone therapy at their first visit if I feel like that's the right fit. And I also want to meet people where they're at as far as what they're open to, what they feel comfortable with, give them the education that they need, you know, obviously look at risk factors and cancer screenings and that type of thing as well.

SPEAKER_01 40:10

So that the segue into my next question is for that 40-something um who you year old patient you're talking about, progesterone, like starting low, what is what do you talk about as far as like things they should be concerned about? Safety. Is there anything that really is like this is important to talk about?

SPEAKER_05 40:26

Right, definitely. I mean, you don't want to give hormones to anyone with active cancer, obviously. There's hormone receptors, and I think just knowing that um, like if you were to have cancer or like a breast cancer, I tell women, you know, and I gave whatever hormones you are making or I that I give you could cause that cancer to grow in size. It's important to stay up on cancer screenings, whatever that looks like for you. And um then, you know, estrogens can sometimes play a bigger role in some of the risk factors and um DNA damaging metabolites as far as cancer risk goes. And so, yeah, there's a lot of things to that are nuanced and that you have to keep in mind from a safety profile where you know there are a lot of people that come way what I feel like way overdosed on hormones and maybe not look, you know, making sure they have that safety profile too.

SPEAKER_01 41:20

Which is the perfect segue into guys because this is my world, right? Um I have never done testosterone replacement, and I am in a world of like jujitsu where I am like highly competitive as a human and and um it's hard for me to find people in my like age who I could grapple with where it's almost like a level playing field, you know. Um everybody's we've got I'd say super physiologic, that's my word. They're like they're on T, you know, and you just like you're this is there's no way that this is real, you know. Or it's not even that it's not real. How about that? Because it is real. Um is it the same situation with guys where, you know, say is it the same ages? Is it the same sort of symptom symptomatic treatment? Are you do you need a snapshot of labs? Do you give it time? How does all that work?

SPEAKER_05 42:12

Right. I definitely look at labs for men and symptoms. I s actually see lower and lower testosterone in younger men, even in their 30s. Um, stress, stress, chemicals, all of these different burdens. Yeah, heavy metals, toxins, environments. You gotta look, right? Toxins, right.

SPEAKER_01 42:31

And but have you seen people treat like um a toxin that showed up on a test of yours and had their testosterone change meaningfully based off of taking care of a toxin?

SPEAKER_05 42:43

I mean, I do things simultaneously, but I definitely have seen endogenous testosterone increase, pulling lifestyle, and detoxive you know, life measures. So uh, but you know, when we get into testosterone replacement therapy, it's just an important conversation. Like, are you supporting like endogenous testosterone production? Do you have enough zinc? Are you strength training? And then if you're on TRT, you know, you're dependent on it because it you know shuts off that production. And then you're looking at kind of the downstream metabolites. Do you have higher estrogens or DHT, you know, related to like hair and these things? But I've had men come with really, you know, the blood can thicken, and you know, they're like, oh, my doctor said that's okay. And I'm like, no, there's definitely cardiovascular risk factors there.

SPEAKER_01 43:38

So I kind of mention that because um I see, and I've talked about this actually before, with a lot of um heat, I will say, or a lot of like strong opinions about it. And there's I, you know, we were talking about how I love cognitive biases and understanding why people react the way they do or that make the decisions that they make, and there's a lot of just like self protection involved. Um somebody's already made a decision and they're they have a confirmation bias towards that. But I see um at some point more aging related changes in faces with patients who are on just testosterone replacement specifically. It can cause some changes. There's there's some aspects of things that get better and some aspects of things that get worse. And overall it creates sort of a signature in somebody's face. You can I mean I this is I think for a lot of people, you can it's hard to explain, but you know it when you see it sometimes. Like you can, oh, there's something up up there, but you don't exactly know what it is. It may just be like the vascularity of the skin changing. Like, yes, maybe the skin's stronger, but the vascularity changes, so it makes them look older, actually. You know, people don't love that, you know, sort of statement, but it's true, and it's my observation, and it's real. Um, and it's based off science and based off of how our brain perceives the face, neuroanatomic changes. Yes, you can argue about the structural strength of the skin, but when the rubber meets the road, it doesn't look as good, right? To our brains. Um, and so but I I tend to find that that's I I I'll have patients who come in and they are very, very, very, very, very super physiologic. Um, this is common, common, common, common, and or people that I know or athletes that I roll with, or whatever, because and you know, I've experienced this too, um, where you just like if someone were to ask you, like, do you ever like feel like you're lacking a little motivation, or you're and and I see, I don't know, I'm not trying to like single out clinics or something like that, but people that like you could convince any guy that they're low T, like literally any guy. Um, how what happens? How does that work? What you know, I I have this in my head that, and you might change this for me a little bit actually, but I have this in my head that anything that um is anabolic and builds you up is also borrowing from your total lifespan. Is that true? Should I be thinking that way?

SPEAKER_05 45:59

That's a good question. I guess it just depends on what pathways it's going to impact long term, you know.

SPEAKER_01 46:06

If I mean on a very simple vascular risk, you know, and you're I mean you were just talking talking about like brain health is on a very get basic level, let's just get simple with testosterone, is being super physiologic and feeling like you, and I I hear guys talk about this, like you know, oh my gosh, my sex life, my erections, my workouts, my motivation, my mood, my like they all elevate. Like I feel like a young man again, basically. Which, yeah, you feel like a superhuman. So why why wouldn't everybody do that unless there was a downside long term, even like and so I'm asking, is does that exist? Is that tie there? Or are you saying, like, oh, the brain health benefits of it are so good that yeah, you should probably if you have these symptoms, you should because that's how some people think, right? Like, yeah, if it's if you're even like mid-normal or slightly higher than mid-normal, well, we kind of want that like right at the top or supra should is that okay?

SPEAKER_04 47:05

I think you have to look at the whole picture.

SPEAKER_05 47:07

Okay, well, so and like I always want to look, and that's the thing, it's not that I don't want to optimize testosterone because I do, and men can feel incredibly a lot better, you know. And it's I have so many people that are like, I need 1100, or you know, whatever the lab value they're shooting for is versus like how they feel and what else is going on in their system. You know, if you have a testosterone that's 1100, but you know, your estrogen is high, your DHT is high, your red blood cells are high, your insulin, you know, you have prediabetes, like, is that pulling a positive lever? Not necessarily.

SPEAKER_01 47:43

Like you feel great.

SPEAKER_05 47:45

Right. So I think it's just being able to stratify risk and longevity looking at the whole picture and not just one thing. And you know, I'm like, I don't like the idea of chasing a total testosterone level because everyone's different. But everybody, and then you know, your free testosterone is your active testosterone. What does that look like? And so it is it's like a thing now.

SPEAKER_01 48:09

Like in my age group, like I could probably ask half the guys at my jujitsu gym who are 40 or over, and they probably know it off the top of their head. You know, they're it's like a thing. So it's become part of this. I don't know. I did so you you have a guy who's 60th percentile, say, like not low, not high, 60th percentile, but they have symptoms that you know would you like, oh, you're testing and all of their other lab values are super strong. Are you gonna replace that guy?

SPEAKER_05 48:35

If he wants to, I might I mean I would start with maybe natural supports and R. That's a great thing. Yeah, exactly. But yeah, I think that there is certainly just like I would with women, um, that area of optimization when you have a lot of your lifestyle stuff in check.

SPEAKER_01 48:53

There could be Okay, so let's let's run through both those scenarios. That guy, that guy comes in. Help great, like solid lab work overall, has like maybe a couple of like lipid things that are like, you know, well, this could be a little bit better, but overall you're doing great. 60th percentile, but they they're like, you know, I just kind of feel I'll fill in the blanks, all the things. I feel a little lethargic. I don't feel as motivated, I don't feel like I have as much libido, blah, blah, blah. And they're like, and I wanted that to be better. Okay, what's the first thing you do with them?

SPEAKER_05 49:22

Besides like after their labs?

SPEAKER_01 49:24

Labs are in and everything's, you know, they're like, their vitamin D is okay, and they're eating cholesterol and they have zinc and all the things, right? Because you're gonna do cholesterol, vitamin D, and zinc, right? Those are gonna be supplements that you gotta make sure those are good first. Right.

SPEAKER_05 49:38

And then discuss, yeah. I mean, are you interested in testosterone replacement therapy?

SPEAKER_01 49:43

What if they're well, what are you gonna go right to that, or are you gonna have them do so what lifestyle things do you have to do first?

SPEAKER_05 49:47

I mean, strength training would be at the top of the list for sure.

SPEAKER_01 49:50

So it's lift heavy things. Yes. Should they grunt when they do it?

SPEAKER_05 49:53

Preferably, yes. Yes.

SPEAKER_01 49:55

Um, exactly. Yeah.

SPEAKER_05 49:59

Maybe just absorb some testosterone from the other guys. Uh yeah.

SPEAKER_01 50:03

That's actually a good point. I never thought of that. I never thought of that. Anyway, go ahead.

SPEAKER_05 50:08

But yeah, I I think that it's reasonable. It can it can improve quality of life for sure. If they're symptomatic, that's a thing. Is I'm not just going to I'll never just treat a lab. I mean, I guess there is our labs that are like bigger things longevity-wise, but as far as hormones go, I'm not always gonna just treat a lab. I need to have that correlation with symptoms and body function with that. But I think it needs to be done, you know, in some areas, like people are not replacing enough and like supporting optimization. And then on the other hand, we have people like way over um shooting, I think, hormones where sometimes even people get neg come to me and are on high doses and have negative symptoms and we've lower their hormones and they feel better. So just being aware of kind of all the parameters.

SPEAKER_01 51:02

And for you, that sort of are you is it testosterone alone? Are you ever using like growth hormone for guys and things like that too?

SPEAKER_05 51:11

No, I'm not. I know a lot of people are, and there's definitely, I would say, tend towards more the growth hormone hormone supporting peptide therapies. Right, right, right, yeah, yeah.

SPEAKER_01 51:23

Interesting.

GLP-1s

SPEAKER_01 51:24

Well, so you just mentioned peptides a little bit, which um I think we're gonna see a lot of changes around the regulations with those here. I mean, it's actually we're seeing it right now. I shouldn't say we're going to, it's already happening. Um, because I have a lot of patients who are on peptides of various forms, and I like it, honestly, when they are, because I see differences in their healing and and um how that gets supported. And the growth hormone that we just talked about is one again. I kind of take the same avenue with um growth hormone when it comes to peptides, because there's certain peptides that are very good for soft tissue healing, right? And you taught me a lot of those. But when it comes to the growth hormone ones, if they're on a growth hormone or growing mimicker, you know, like I'm like, you're gonna have a great recovery, you know, from this, but I'm not I'm neither stopping nor starting them on those things, right? That's kind of coming from somewhere else, usually. Um, and so we could talk about we could do a whole podcast just on peptides. We'll probably wait for that to change, uh the things to change, but um GLP and ones are a peptide as well, essentially, right? Um FDA approved, have uses. What I know what I see with them, um pros and cons, right? I think some people think they should be in the water, right? Um, and others, you know, like I see some of the downsides of them. And not that the I've to say that does not mean that the benefits outweigh the, you know, the detriments, but I I see the detriments often, which is like you know, I had a 40-year-old patient last week um who had some genetic predispositions, but ultimately she's like, Yeah, once I kind of started on a GLP one, like all these things got better, but I really noticed this change in my face.

SPEAKER_02 53:02

Right.

SPEAKER_01 53:02

So would she do it again? But now what do we do about this? You know? Um, what does your use and landscape with those look like? Are you on the everybody they should be in the water? I mean, or is it uh I mean, uh because there's this part of me that kind of wonders, like, I mean, I know the answer, but is there anything they're doing that I couldn't the the patient or you know, that I couldn't do with you know, like discipline and like, you know, all the hard stuff. Like, are they actually doing something special and unique? Are they pulling a lever that I can't otherwise pull?

SPEAKER_05 53:40

Is that it it's interesting. I mean, I think no, I don't think it should be in the water, but also I utilize them frequently. I think the brain piece that the talk about that, like limiting the effect on neurons in the brain as far as you know, people equate it to like not having that food noise anymore, um, is different than trying to do CBT for that, or you know, it just yeah, that has not historically worked really well. I think when you have a little bit of that insulin resistance, which a lot of people do, or pre-diabetes and you know, hormonal changes, especially in perimenopause, we can only do so much. Your hormones are going to be shifting no matter what I give you. Then it it can be a big game changer in the way that people feel and the way that they respond to their lifestyle measures. Uh, I rarely do full dosing and I emphasize, you know, macronutrients and strength training. But, you know, there are people that are just kind of chasing, you know, the weight loss without looking at the whole lifestyle measures. And that's where you get, I think, more of the negative effects. And when and at other clinics where people just maybe prescribe it and people are not eating and not being tracked for those key things. So yeah, it I think it's changing uh medicine in a a big way because we have so much chronic disease based on like metabolic disease. But then I'm wondering like 10 plus years from now, how what will the landscape look like as far as um mortality, you know, related to like hip breaks and malnutrition, and I'm just curious what that might look like for for people. Yes, yes, and lack of muscle mass and just finding the balance of those things, right?

SPEAKER_01 55:43

Yeah, that's really interesting. Um yeah, I I I kind of wonder those same things in in my world, right? And uh if people haven't picked up on this, there's both you and I tend to function with like pulling a lot of little small levers instead of pulling one big lever really hard. Um, and in my world I see that all the time, and it leads to bad outcomes and disaster. Like, I'm gonna do the one thing, I'm just gonna go for it, right? Um but similar GLPs would be that thing. Like you there's a lot more elements than just that one thing in it, which is I think where this like the microdosing is coming in, right? It just becomes one small lever and a series of other levers that you should be pulling at the same time with your nutrition and your exercise, and and um and then it becomes my job to figure out if there's a way to mitigate the facial aging part of it, really. Um, because it's hard to there's there's no like magic bullet at this point that will stop that part of the whole equation, even with the other levers getting pulled, you know. Um is there anything this and I asked you this, but I'm gonna ask you directly, is there anything special about it that can't be done another way? And I'll just give you an example of a friend of mine um who is you know very fit, very active, very beautiful, very, you know, like the your the total goals, right? Um, in her 50s, say. And the microdose is a GLP. And sort of I'm like, why are you doing that? What is and um her like internal opinion on it is that there's some aspect of what it's doing that she it's adding to the she's she's pulling those other levels, let's just say levers perfectly. Let's say she's pulling them perfectly, um, which nobody's actually doing, but she feels like, you know, like I can't imagine what you would do any different with your diet and your exercise and your food choices. Is it adding something at that point anymore?

SPEAKER_04 57:42

It depends.

SPEAKER_01 57:42

Like, like, should I be on? I'm not on one, but should I be on? I can't like I can't imagine doing more than I do, but like would it add something to my life to be on one? I think I that's where I'm looking at it's not weight loss and stuff, but just like metabolically, is it gonna add something?

SPEAKER_05 57:55

That's where I'm looking at more like your insulin and your blood sugars and your liver and different things because I think there is a place where it maybe is just because of the risk of cardiometabolic, you know, risk factors. But I never I'm not at this point putting people on them like prophylactically. It's more like okay, I mean, but so many people have insulin resistance and visceral fat and different things that I think can be improved. With that said, I also have people, you know, not on GLP ones reducing visceral fat and gaining muscle and you know, doing the other things that we've talked about. So I don't think it's a must, but yeah, it's a lot of things. I like that perspective.

SPEAKER_01 58:44

Basically, I read that answer is like, well, you gotta look under the hood a little bit and see what else is there because it's not just like what would appear to be like what you see from the outside. I like that answer. What about you just mentioned decreasing visceral fat? Like, what is she doing, or what would I be doing to you're saying decrease visceral fat? Like, what else could I do? I I think is that the answer is the GLP can help me reduce visceral fat in a way that you're not I'm I can't do anything else, really. Is that an answer to help that?

SPEAKER_05 59:12

I think the biggest lever again, it would be like strength training, high-intensity interval training, the right diet, and there are but there are genetics where people are unable to lose fat as well. That's like one of the things that we look at in the genetic markers, is and some people's fat are more prone to inflammation.

SPEAKER_01 59:32

Right, right.

SPEAKER_05 59:33

And so that has an interplay with um.

SPEAKER_01 59:35

If somebody has that genetic um d predisposition to have trouble losing fat, did the GLPs struggle in that person at all? Or is it because it's not, it's appetite dependent, right? So it wouldn't matter at all.

SPEAKER_05 59:45

You know, I have a lot of patients that I feel like are doing the right things and have kind of a weight loss resistance. There is some genetic components, and the microdose of the GLP one does make a big, a big difference in body composition changes. Um, but then I also have people, you know, cranking up their GLP one and things aren't happening, and I think we're missing something else, you know. Then I'm looking at the gut, your detox pathways, your hormonal balance. And we also have to remember that fat holds toxins. So, you know, if people are losing weight rapidly and releasing toxins, they often feel sick and can be harmful to their health too.

SPEAKER_01 1:00:29

So fat releasing toxins is in that, is that like unquestionably established? We know what the toxins are. Do you see fluctuations in people's like toxin loads when they're in like a massive weight loss or when they start a GLP? Is that like everybody should be checking on that? You start a GLP, let's make sure we're watching your toxins because we know that X, Y, and Z tend to go up.

SPEAKER_05 1:00:51

Is that a I don't necessarily I'm not testing, it's just more like symptomatic. I think the same, you know, symptoms that people have with you know elevated toxin load, it might be heightened when they're losing fat rapidly. I tend to try to think about liver either natural or supplemental and bile support when people are losing weight just for that purpose.

SPEAKER_01 1:01:15

But as far as like the true fast, like hard science, it's more of like that pathophysiological are there fat-soluble, like specific fat-soluble toxins that we're concerned about or something. You used to mention the liver. I'm gonna get really nerdy here for a sec. So well, no, because you're talking about weight loss and how it affects the liver. Do you, if you like have a patient who, I don't know, like loved high fructose corn syrup or something, and so you know they've got fatty liver disease. Like not that everybody with some, but like let's say something very specific, like we know that fructose is directly changing that. Um, do you have to watch their liver different when they start losing weight because you know that their fatty liver is gonna change more than maybe somebody who didn't have as much fructose before? Is that a is that a thing?

SPEAKER_05 1:01:58

I guess I'm always thinking about the liver or just detox pathways in general. And when somebody already is prone to like an impairment in their liver function, then any extra additive to that could impair it further. You know, people will have you know higher liver enzymes easier than others. I mean, common with viruses or different things, but there's certain people, I think probably some genetics play a role in that where I'm like, oh, something just happened. Like I just had a patient today had like a cavitation worked on, and her liver enzymes had been normal prior, and that was in a lot of immune system disruption, and then you know, yeah, her liver enzymes changed, and that is the only thing we can think of that was different when the onset of her symptoms happened and the change in her labs.

SPEAKER_01 1:02:54

So from the procedure itself, you think?

SPEAKER_05 1:02:57

Yeah, I think maybe just the tr kind of trauma of the procedure. I don't know what's happening when you're like trying to clean out infection and what's being mobilized, a little bit of Tylenol probably for pain, and you just kind of add in some of those layers too. So but more than just the liver enzymes, it's like the way, like kind of some of those detox symptoms that pop up.

SPEAKER_01 1:03:21

Talk about toxins.

What Is One Thing You Hope Everyone Knows?

SPEAKER_01 1:03:25

Okay. All right, I'm gonna go into some. I'm making these up off the top of my head, these rapid fire questions. I don't know. They they could be as rapid as you want. What would be um with most of your patients coming in, if you could just pick probably the most common thing that you wish people knew coming in to see you, or what's the most common piece of information that people even leave with after seeing you for the first time? You're like, that's gonna be really valuable to you for the long term that you maybe didn't know before. What is what would that piece of information be, do you think?

SPEAKER_05 1:03:55

I'm gonna say nervous system support.

SPEAKER_01 1:03:57

Oh, okay.

SPEAKER_05 1:03:58

I think I always try to hit on like mindfulness, meditation, breath work practices. I always talk about like, I mean, even if you're just running around, taking kids' places, like pick a breath, four seconds in, six seconds out, breathe your nose, breathe into your belly, and as you're like driving around, do that breath. And there are people, so many people that just add that little bit and they feel better.

SPEAKER_03 1:04:23

Yeah.

SPEAKER_05 1:04:23

And you know, put your feet up the wall. Like, I think that we miss that a lot. Um, we're like take more, do more, but sometimes you know, we just need to like calm our nervous system down.

SPEAKER_01 1:04:36

Yeah, that's interesting. Um there's a mountain of medical evidence behind that, that what you just said, that has mounted more lately, too. I mean, that was what you just said. If we talked about it 10 years ago, it would have been like a little like a little granola, hand wavy. There's like hard science behind it now. And people and if we go back hundreds of years, people have known this forever and ever and ever. But it's just funny that it takes us that long to kind of catch up to that. Um, because yeah, speaking of hundreds of years, like we're we're built for a different environment than we live in, you know, very much so. Right. So that's a I like that.

SPEAKER_05 1:05:12

It's ancient medicine.

SPEAKER_01 1:05:13

Not what I was expecting you to say.

SPEAKER_05 1:05:14

Yeah, I know. I was like, oh, the top four supplements, but no, I think nervous system, and you know, I love like the research that HeartMath has done about bringing like your heart and brain into coherence, um, largely through just like calm breath work and gratitude practices at the same time. You can actually see yourself get into coherence and it can improve your HRV.

SPEAKER_01 1:05:36

There we go. Oh, I guess the metric. So, what is that? What is your practice for that look like?

SPEAKER_05 1:05:40

Usually combining like a calm breath work practice with some sort of gratitude practice, like thinking of a person, place, or thing that you feel grateful for and like feeling it in your heart space. You know, they have like an app, they have their inner balance device, you can like try to see if you're in coherence, but in the simplest way, you don't need the app and things.

SPEAKER_01 1:06:00

To do it. You can just do it yourself.

SPEAKER_05 1:06:01

And I try to just do that, you know, like in between patients, like, you know, like thinking something I'm grateful for, kind of clear out, be prepared for the next patient.

SPEAKER_01 1:06:11

It's interesting. I've uh there's some research showing that versus think because I tend to do that, like here's the things I'm grateful for. I like to do that anyway. But to really um mimic the being grateful, to like mimic that is it it's uh more effective generally to go back to a situation where you felt grateful or made somebody feel grateful, like where there was an actual exchange of that emotion and try to relive those moments, interestingly, to get the actual like benefit of it, versus just like thinking of, you know, like a list basically, because I think that's what a lot of people do. But you sort of like hinted at that, which reminded me that it's like actually better to like kind of like relive moments, and like feel it.

SPEAKER_05 1:06:50

Yeah, yeah, yeah.

SPEAKER_01 1:06:50

Where you felt grateful, or you very clearly like I could see someone else feel grateful for something that I did, which is apparently I think even more powerful than my own personal feeling, because it's like the things that I can tangibly read in somebody else. So that's kind of interesting. Um okay, I like that. I like that. Um

If You Could Put One Thing in the Water What Would It Be?

SPEAKER_01 1:07:10

if because nothing should actually be, but if you could put one thing in the water, what would you put in it?

SPEAKER_05 1:07:18

I'm gonna say magnesium.

SPEAKER_00 1:07:20

Oh, okay. Let's go into that. That's a good one. Okay. Which type of magnesium?

SPEAKER_05 1:07:25

Oh, uh just some sort of chelated green magnesium.

SPEAKER_03 1:07:31

Yeah.

SPEAKER_05 1:07:31

I just see that you know, so many people are low kind of in that intracellular magnesium. It's vol involved in over 300 functions of the body, and it's hard to replete. I mean, people will take magnesium every single day, and their red blood cell magnesium level will only go up like this much, but they're also stressed and they're working out, and you know, there's all these things that we're burning through, and we can eat more nuts and seeds and leafy greens and different things. But as far as getting the amount that we need from food and the soil, it's just I don't, it's difficult. Usually that would be like a supplement that's kind of top one. Interesting.

SPEAKER_01 1:08:12

Yeah. I use magnesium sulfate specifically because there's lots of different types of magnesium, and it's interesting. I think it's and um I just think it's very interesting. I'll just leave it at that. That the different types of magnesium tend to have different CNS effects specifically, like different effects on our brain. So the magnesium sulfate that I use um is reducing my anesthesia load, has a bit of an analgesic effect. It's it's incredible, you know. It eases the transition out of surgery, actually use it towards the beginning of surgery. Um, and but that's different than you know, citrate and three and eight and all the other types that exist. It's very specifically mag sulfate. Um, so that's interesting. That's not so not what I thought you were gonna say. Magnesium. Okay, now I gotta come up with one more. Um,

What Should People Stop Doing?

SPEAKER_01 1:08:58

if you for your same patients, so I've asked what they should all be taking, essentially, what piece of information they leave with from you, like the most important thing on general. What's the one thing that you feel like if you could like just blanket stop people from doing um in your patient population? Like this, I see this like you know, obviously, don't eat processed foods. Let's not go something that basic. But like I see people do this and it's a mistake that they probably didn't realize. Everybody knows they shouldn't be eating their bag of Doritos or whatever. Like, not to pick on Doritos, but like what's the thing that you see that's like I actually didn't even know that, like, or like, oh, really? I didn't okay. What's the thing? The thing, nothing, not the thing, a thing that's like it's just common enough that like well now.

SPEAKER_05 1:09:43

I have like the plastics on my my brain. It's like when we get a hot coffee, yeah. Okay, that's a good one. Take off the lid.

SPEAKER_01 1:09:49

Okay.

SPEAKER_05 1:09:49

Or pour it into your mug or something because we're just eating the hot drink and through the plastic lid.

SPEAKER_01 1:09:56

So that's a good one. Yeah. Because I think a lot of people don't think of the paper cup as having microplastics, but yeah.

SPEAKER_05 1:10:03

There's lining and lid and all the things, but I always think of it.

SPEAKER_01 1:10:07

Lid's often black plastic too, yeah, which is uh um, but it's in there. Right. Um, and you just mentioned I think with that is like heat definitely changes. So, like a and this is the issue with water bottles. Like, you have no idea how many times they've been heated up and cooled down in this process. Yes, it's cool now, but was it sitting on a truck in the heat or whatever? Um, so we like glass for that better. Um, but in my operating room, this was an issue too, because we'll warm IV fluids before we give them to them. So I was just like, once I started figuring like, oh, we're warming it, you know, or um things that are lipid-based liquids, uh, or anything, but lipid-based liquids for me tend to pull more of the phthalates or whatever out. And um, and then we're one of the anesthetic agents that I use is in a lipid base. So I was like, dang it, warm lipids, all the things. And so um the container matters, what's in the container matters, like how quickly you drink it, but yeah, I like that one. No simple think of your think of your coffee cup and try to use your own if you can. Or um, I've seen some places that have like uh semi-disposable type of like clay cups. That's kind of cool. That's cool. Yeah, so maybe we'll see that change.

Types of Hormone Replacement

SPEAKER_01 1:11:16

Yeah, yeah. I'm gonna tap into your expertise here a little bit about the hormone replacement and just educate me a little bit. When you're talking about progesterone, estrogen, testosterone, they come in a bunch of different forms, injectable and oral and topical. What are your preferences for these? And do you have like strong feelings about why?

SPEAKER_05 1:11:32

Yeah, so for progesterone, I typically use oral progesterone. It tends to have a little bit more sedative effect as far as like improving sleep.

SPEAKER_03 1:11:41

Okay.

SPEAKER_05 1:11:42

It also protects the uterine lining, especially when with estrogen therapy. And then estradiol or estrogens, I typically do either in a cream or a gel or a patch.

SPEAKER_03 1:11:56

Okay.

SPEAKER_05 1:11:56

The transdermal estrogens I tend to lean towards, they metabolize less into those potential harmful metabolites versus oral that's going through your liver and potentially creating those. And then testosterone, typically a cream or an injection.

SPEAKER_01 1:12:14

Gotcha. What how do you make that preference?

SPEAKER_05 1:12:17

Well, it depends on the dosing and the person if they are willing to do injections and then tracking labs. Like some people, I will start with transdermal therapy, but if I we don't feel like we're getting where we need to go, then we'll train change to the injectable form. Yeah.

SPEAKER_01 1:12:31

What about women on testosterone? We didn't talk about that at all. How does how does that fit in with you?

SPEAKER_05 1:12:36

Yeah, I definitely utilize it if I feel like there's a need for it, or it's symptomatic, and I will look at the precursor like DHEA as far as to testosterone and estrogen. Sometimes I will replete DHEA and treat adrenals, and I'll see testosterone actually go up. And then sometimes I'll utilize a little bit of a transdermal gel for that. Uh I have less women on injectable, not to say that that's not um a reasonable thing too, but I mean less needles in the general people like better.

SPEAKER_01 1:13:10

What about pellets for hormone replacement?

SPEAKER_05 1:13:13

I don't do pellets. Okay.

SPEAKER_01 1:13:14

Why?

SPEAKER_05 1:13:15

Because I tend to see pellets uh be prescribed in superphysiologic levels. And I see patients with the negative effects of pellets where you know they get maybe an initial good response and then start having negative effects because their levels are too high or imbalanced with their other hormones. It's not as easily titrated to meet the person where they're at. And so they can be done and they can be great for some people, but I just I don't do so.

SPEAKER_01 1:13:44

Why do we see them everywhere?

SPEAKER_05 1:13:46

Uh they are also they make a lot of money and they keep people coming back, not to say that you don't want a good follow-up with any hormone replacement therapy, but there's definitely like a marketing piece of it. Again, some people do great and it's a good you can get people where you want.

SPEAKER_01 1:14:04

Right. Is there like is there an element of addiction's not the right word, but we'll get what that is. Is there an element of like this physiologic addiction to being on something super physiologic like a pellet?

SPEAKER_05 1:14:19

I've seen it in patients where they do, yeah, get that initial effect, and I feel like they're chasing that effect, and it's not because they need more testosterone, it's because they need balance in all the other areas. I see.

SPEAKER_01 1:14:36

With women on testosterone, does it fall in a line you were mentioned, sort of like progesterone first? Is it generally do we have women that are just on testosterone, or do you does it tend to be prescribed with progesterone, or how does that work in your practice?

SPEAKER_05 1:14:51

Testosterone is kind of on its own term. And I usually very much base that more on labs. And I do test progesterone and estradiol. It's just that those are fluctuating so much more. Yes, you can test it on a certain day, but if you know, women's periods are irregular, then you're getting kind of less of a key point to look at whether those are imbalanced or not. So then I lean a little bit more on symptoms for

Birth Control

SPEAKER_05 1:15:14

those.

SPEAKER_01 1:15:14

Yeah. So what about birth control for non-contraception purposes? Not to not have a baby, but just simply for medical reasons. You sort of brought this up earlier. Is that something that you ever do?

SPEAKER_05 1:15:24

No.

SPEAKER_01 1:15:25

No. Why?

SPEAKER_05 1:15:27

I like to balance hormones and using the synthetic hormones to me is just a band-aid. It's not getting after the root cause. And so a lot of times it is a diet and lifestyle, and young women and eating the right foods and getting enough sleep can really help their hormones. I do use nutraceuticals or supplements to help, like herbs to help balance hormones. Um, and that seems to work really well. But I just think that there's a lot of things you can do from a root cause perspective without the negative effects of birth control affecting your microbiome and, you know, other hormones. And a lot of times, too, you know, people get put on birth control for non-birth control reasons, but then have, you know, other side effects of hormone imbalance.

SPEAKER_01 1:16:17

Well, you so you just said you talked about synthetic hormones inside of the birth control pills. Leads me to the question of when people are talking about bio-identical hormones, what are they talking about? What does that mean? Is that different than birth control pills?

SPEAKER_05 1:16:30

Right. So obviously, a lot of, I mean, all hormones that we're getting exogenously are synthetically made, but bioidentical meaning in the chemical structure or form that our body would naturally make it. So progesterone, super important for overall health. And I see a lot of women, even you know, perimenopausal, postmenopausal women on progestins instead, and they are still very symptomatic, and we change that to the bioidentical form, and then that often relieves symptoms. So I think that form can make a big difference. It also does change risk profiles too.

SPEAKER_01 1:17:06

Yeah, why would anybody ever be on a synthetic versus a non-bioidential versus a bioidentical? Why would that ever happen?

SPEAKER_05 1:17:13

It's typically from a birth control that kind of turns into like a hormone replacement therapy. Morphs over. Yeah.

SPEAKER_01 1:17:20

I see.

unknown 1:17:21

Gotcha.

Pre Operative Nutrition

SPEAKER_01 1:17:22

Okay, so I'm gonna switch gears to a little bit of a selfish question for you here because I love in my nutritional world, I love to pre-pair my patients. I call it like pre-covery, prehabilitation, basically, before surgery. I love to get their diet dialed in. And that means a little bit different for everybody. I don't have like a you have to go ketogenic or you have to go paleo or mediterranean. I just I actually kind of work with what they already have and then try to optimize. And you've helped me with this before. Um, what would be your pearls for either like foods or strategies or this like idea of an anti-inflammatory? That's what I really want is like to have them, their anti-inflammatory environment optimized before they come. What are some of those simple things that people could think about if they're having surgery somewhere else, or what does even anti-inflammatory diet mean to you, a nutritionist in this world too?

SPEAKER_05 1:18:13

Yeah, I think anti-inflammatory first is removing inflammatory foods. So trying to get rid of processed foods, excess grains, sugars, seed oils, which equate to processed foods. And then you want to like build the density, nutritious um, the nutrient density of your diet. So eating healthy fats, grass-fed beef, wild game, wild fish, uh extra rich foods and like polyphenols, like berries and pomegranate, dark leafy greens, even dark chocolate or green tea, that type of thing. So getting rid of the inflammatory foods and then bolstering the nutrient density of the foods you are eating.

SPEAKER_01 1:18:56

Yeah, I love to have my patients eat um refrigerated fermented foods, like low sugar fermented foods, let's just say that version of it. Um, what are your thoughts on that? Like what is that is that strategy futile for me? I mean, I I have reasons that I like to do it, but what are your thoughts on that?

SPEAKER_05 1:19:11

I mean, fermented foods and doing a variety of them really can help your microbiome, right? Diversity, it's all about diversity. This is my gut lever. And function. Now I will say there are, you know, this world where people are more reactive, genetic components where you might be more reactive to fermented foods because of histamine issues. So that is one area that I'm cautious of because some people are a little bit more prone to that sensitivity. But in general, what do you look for in that? You know, getting reactions from high histamine foods like the fermented vinegary foods, maybe flushing or hives or headaches or nausea, some different things. It I see a lot in genetics. It's kind of interesting to be able to correlate histamine and inflammation for people. And they might not realize that that could be a lever in their inflammation because we might not be thinking about it on a day-to-day basis.

SPEAKER_01 1:20:03

I think I had that. Yeah. So you're looking, there's a specific gene that or gene group or something that will tell you this. Interesting.

SPEAKER_05 1:20:10

Yeah.

SPEAKER_01 1:20:11

Cool. So should I be um having my patients do all their genetic testing before I suggest that they do their fermented foods? Okay.

SPEAKER_02 1:20:17

No.

SPEAKER_01 1:20:18

I'll send them to you for that, yes,

Fasting

SPEAKER_01 1:20:20

beforehand. So yeah, I'll also have people fast, or how I should say it this way. If somebody fasts regularly, if that's like part of their practice, um, I will utilize that as a tool leading into their procedure. If they don't fast, I actually don't have them start. It's not like, oh, you should fast leading into it, but there's it's unique how the evidence has evolved on this um when to fast, how to recover. And you know, you I know like to utilize like fast mimicking types of diets, which has some like evidence behind it to support surgical pre-covery, I'll say as well. But very interestingly to me, I think this is the like in a nutshell, it's the refeeding that is the benefit leading into my procedure. I they act I don't want them coming in fasted. Right. I want them to fast before, then be in their refeeding, which is going to upregulate. Um, for me, it's a lot of like uh I was gonna say growth hormone, but it's like um more growth factor related stem cell. Exactly, stem cell mobilization, and it's the refeeding that that really does it. Um, what do you see with your patients who are doing fast mimicking? Because I know you like that quite a bit. Yeah.

SPEAKER_05 1:21:25

Yeah, I think that a lot of people, I mean, there's some people do great with it, some people do not, but in general, like mental clarity, I think the research really goes around the kind of the cardiometabolic profile improvement over long periods of time where you're, you know, if someone just doesn't feel up to doing like a five-day or three to five day fast with clear liquids, they can eat some food, but be able to still get some of that the autophagy effects. You're not turning on like the mTOR sensors to get kind of that cycle boost.

SPEAKER_01 1:22:00

So you're the perfect person to ask this question to actually that I'm about to ask, because I get this all the time in various forms. Like I'll get in the ice bath and people be like, oh, what do you think of women in the ice bath or um fasting? What about women fasting? We know that there's physiologic differences, there's hormonal differences, there are all kinds all kinds of differences between men and women. Um and there's been a lot of attention drawn to women shouldn't ice bath or women shouldn't fast. And I honestly believe that to be not true as an absolute. Right. Um, I think it's all it's on the spectrum of great. Like, does it have to be crazy intense? Does it with in you, you're like the reason you're the perfect person to ask is that you have a functional medicine practice, you have a nutrition background, you understand women to a level that I don't. What is fast mimicking a good sort of it is there truth that women shouldn't fast? And is fast mimicking a good option within that if we still want some of the physiologic benefits that or metabolic benefits that come with fasting? Talk talk me through this.

SPEAKER_05 1:23:02

Yeah, I think that women, I think fasting is a key component of life in general. We all should be fasting, right? But to different levels of the five. Even women. Even women should be fasting. Yes. Uh obviously, typically we fast overnight. And you know, that window of time can be different for different people. And depending on their hormonal state, their metabolic state, in general, like pre-menopausal women tend to do better fasting for longer periods in their follicular phase, more estrogen-dominant phase. You tend to also be able to maybe do a little bit higher intensity training as well. And then your luteal phase, typically you don't want to be doing as higher of intensity of training and less fasting. And, you know, it's all based on that hormonal cycle of you know, building and kind of repleting the body. So everything's in a cycle, and listening to where your hormones are at with the fasting piece can be a big game changer for women's metabolic health. Because if you're trying to fast at a time when your body is not optimized for fasting, then you're causing more stress. And more stress causes more inflammation, and you're not getting the benefits that you want to get out of it.

SPEAKER_01 1:24:16

It's supposed to be a hormetic stress on purpose, right? Like within a realm, and if it turns into not that, of course it's not good. I like that.

SPEAKER_05 1:24:23

Like keeping up with, you know, the hormetic, you know, sauna, I always tell people, you know, all those things are stressors, which are good and been shown to like bring more resilience to the body, but if you don't have enough antioxidant capacity to keep up with it, then it can decline your health. And there are also genes where you might be prone to more oxidative stress. And you know, symptomatically, there are people that might be overburdened with toxins or pathogens or gut imbalances where they don't tolerate as many hormetic interventions.

Perpetual Birth Control (IUD)

SPEAKER_01 1:25:00

Yeah. You peaked me on this question a little bit too. In the Gen X um and millennial, you know, sort of generations with women, I would say it was, you know, not uncommon to sort of be on a perpetual type of birth control, whether it was uh oral version of contraception or whether it was an IUD that would essentially make you amenorrheic, right? Like is that still happening? Is that a bad thing for people like let's say you had your IUD and you got you're gonna have it in for five or ten years? Is that what's that doing to um to women who are, you know, not maybe perimenopausal, or some of them maybe in those generations getting perimenopausal? What's it doing to is that something that you're like, get stop doing that?

SPEAKER_05 1:25:48

Not necessarily. I mean, if it's being used for birth control purposes, um, typically a lot of people do fine and don't have any negative side effects in my mind of you know, balance, typically I like to mimic what would be natural in the body.

SPEAKER_01 1:26:04

Yeah, you peeked me with the like building and yeah, exactly.

SPEAKER_05 1:26:08

And um I think that sometimes later on in that perimenopausal time period when people have been, you know, skipping periods and just having a birth control method, that's where I don't know if research-wise, if you know symptoms might occur earlier, but definitely symptoms are occurring where you might want to bring back in more of those bioidentical hormones.

Alcohol

SPEAKER_01 1:26:31

Aaron Powell So one of the pre-operative things that I'll have my patients do too, and that I personally do, I just don't drink much in general, but I try to have my patients like limit their alcohol before and after for metabolic reasons, inflammatory reasons, it's a toxin, as you have said, right? Um what are your feelings on your patients' alcohol? Is there a specific way that you counsel them at all?

SPEAKER_05 1:26:51

I mean, it is a toxin. So, and I individualize it. I think that things in moderation, and obviously we have our bucket that we're filling with various toxins. It's interesting that there are like the blue zones in different areas where they consume alcohol on a regular basis and have very good longevity data, but how much of that is related to kind of that social emotional component.

SPEAKER_03 1:27:18

Right.

SPEAKER_05 1:27:18

And, you know, if it's I think at one of our, you know, conferences or something, someone asked about, well, you know, the only time I drink maybe a beer or something is when I'm, you know, golfing with my friends or something. And, you know, it's like, do you you don't stop golfing with your friends? And sure, you could give up the one beer, but as part of that experience, like you look at that whole picture and that bucket and that life quality of life.

SPEAKER_01 1:27:48

Um Professor Galloway, I heard talk about this and I thought it was very interesting because he's very um focused on like what's happening with youth and their lack of Interacting, dating, mating, what's going to happen to our birth rates and things like that. And so I I kind of loved his count counterpoint to what my actual life practice is, which is a little bit of like, you got to go out and get drinks with people and make some bad decisions and learn some life lessons. And it it's funny to hear him talk, acknowledge he fully acknowledges that, like, yeah, I don't know about the health stuff about it as much. But like it is that balance a little bit, you know, because I I think about this all the time. I've actually probably moved past that phase of my life where I felt like the social pressure to do it, because there is, but now I think I've just adapted and learned other ways that like it probably doesn't actually affect my social life at all. But when you've I honestly, when you first like stop drinking or don't drink, or I'm not like an absolutist. If somebody had made this delicious cocktail that they're passionate about and they're like, this is the most amazing thing, this is my life passion, try it. I'm like, Yeah, let me try that, you know. Um, but at the same time, I like can still have the social interactions about it. Um, trying not to make any bad decisions anymore, you know, like that type of thing. But I really thought that was an interesting. Yeah, it's it's all the balance, right? Like taking that in. I really like that. But pre-surgically, nope, no bad decisions. I want I want everybody primed for that. Yes. And I had a patient recently, this is interesting too, um, like last week, who had had filler 20-ish years prior. She was young. She had filler when she was really young, in her 40s now, one time of having had filler, and we know that filler can get like a foreign body response, like systemic inflammation, whether it's like a vaccine, a teeth cleaning, you get a cold, you have allergic, you know, sinusitis, or for her, um, drinking alcohol would give her a reaction, an inflammatory reaction in her filler.

SPEAKER_02 1:29:47

Interesting.

SPEAKER_01 1:29:48

Um, and so I mean, no, I I just was really like, you know, floored by that from just like not only is filler there 20 years later, which nobody believes until I remove it, you know, and like, yep, there it is. Like, oh my gosh, nobody believed believes that. That that's starting to change in our field. Yeah. Um, to the fact that like how inflammatory alcohol is from a I mean, this is systemic. Like, she's not pouring alcohol on her face, it's like she's drinking it and her face is lighting up. So yeah, there's a lot to it that way. That definitely illustrated to me just like um, you know, another one of those like interlinks right there. Yeah.

SPEAKER_05 1:30:20

Impacts on the immune system.

SPEAKER_01 1:30:21

For

Outro

SPEAKER_01 1:30:22

sure. Well, Leah, thank you so much for your time and sharing your expertise with.

SPEAKER_05 1:30:26

Thanks for having me. Where can people find you?

SPEAKER_01 1:30:28

Where can people find you? Clinic 5C. Clinic 5C, um, yeah, your Instagram, we'll link all those things in here. Um, and yeah, thanks for taking care of me and my patients and sharing your knowledge.

SPEAKER_04 1:30:40

I appreciate you.

SPEAKER_01 1:30:41

Yeah, you're if you have any questions or topics you would like me to explore further, please leave them in the comments. I read them all and they often help shape the future conversations here. If you would like to learn more about my surgical practice, you can visit clinic5c.com where you will find additional information on my approach to surgery, recovery, and performance-focused care. But I also want to be clear that the views shared on this podcast are my own and are not associated with or representative of my clinical teaching affiliation with the University of Washington School of Medicine, nor should this be taken as individual medical advice. Thank you for spending your time with me. I appreciate you being here, and I will see you on the next episode. Bye.