In Your Pants with Dr. Susie G - Nutrition for Pelvic Pain in Men

Episode Date: April 25, 2022

Dr. Jason Stevens is a Doctor of Clinical Nutrition and Registered Dietitian Nutritionist who completed his advanced practice residency with Dr. Gronski, working primarily with men with chronic pelvic pain / chronic prostatitis. In his twelve years as a dietitian, he has worked as a clinical oncology dietitian, taught clinical nutrition in an accredited educational program for dietetics students, and is currently a full-time college educator. His research interests include advanced-level practice in the field of nutrition and dietetics, and the role of nutrition in pelvic pain. 🤩 When you sign up for the Men's Online Pelvic Pain Relief Program, you get two complimentary support calls with Dr. Susie Gronski and with Dr. Jason Stevens. Sign up here [https://drsusieg.com/pelvic-pain-in-men-online-program](https://drsusieg.com/pelvic-pain-in-men-online-program) From the gut microbiome to low FODMAPS, anti-inflammatory, and mediterranean ways of eating, Dr. Jason shares how you can introduce balance, variety, and moderation into your relationship with food and eat more fruits and vegetables. 🥦🍒🥑🥕 Food is a collaborative journey! Dr. Jason's reminds us that the role of a RDN is to help you find a way of eating that supports your health and is enjoyable (the best diet is the one you can follow and implement in your life!) 🧘 You've heard about the research supporting mindfulness and pain: and there are positive results in weight management, eating disorders, and diabetes with mindful eating. Your whole health picture includes looking at: - nutritional deficiencies and excess - drug interactions - diet history - health history review - blood work 📚 Resources: Harvard Healthy Eating Plate: https://www.hsph.harvard.edu/nutritionsource/healthy-eating-plate/ Mindful Eating Resources: https://amihungry.com/mindful-eating-resources https://www.thecenterformindfuleating.org/ Dietary Supplement Fact Sheets from the NIH Office of Dietary Supplements: https://ods.od.nih.gov/factsheets/list-all/ For more information on Registered Dietitians (and to find one in your area), the Academy of Nutrition and Dietetics: https://www.eatright.org/ https://www.eatright.org/find-a-nutrition-expert

you're listening to in your pants with dr susie g the physiotherapist for your private helping you get in the know down below hi friends dr susie g here and welcome to another in your pants podcast today we're going to be talking about eating to fight pelvic pain and to help me do this i have special guest jason stevens who is a registered dietitian nutritionist and on the show today we're going to be talking about considerations for including an experienced registered registered dietitian nutritionist on your health care team and individualized diet counseling may be part of your health journey and so we're going to unpack when and if you should consult with a registered dietitian nutritionist. We then talk about mindful

eating practices and tie in mindfulness into a strategy to reduce pelvic pain. And then we chat about foods that actually fight pelvic pain and what the research says around certain nutritional practices and diet practices that may help reduce pelvic pain. And then lastly, we touch base on antibiotics, proton pump inhibitors, and how these can impact your gut microbiome and what this does to your digestion and how this can influence pelvic pain. So before we dive into the details of this episode, I'd like to formally introduce Jason to you. Jason is a registered dietitian nutritionist, completing his advanced practice residency through Rutgers University as the final part of his studies in the Doctorate

of Clinical Nutrition program. In his 12 years as a dietitian, he has worked as a clinical oncology dietitian, taught clinical nutrition in an accredited educational program for dietetics students, and is currently a full-time college educator. His research interests include advanced level practice in the field of nutrition and dietetics, and the role of nutrition in pelvic pain. This is a really, really fun packed show, so I hope you enjoy. Hi, Jason. Thank you so much for being on the show today. Hi, Susie. Thank you so much for having me. So let's dive right in. I am curious as to, just for our listeners, I've been working with you for some time together. We've been collaborating on CARE, which is such a wonderful opportunity, but for our

listeners who may not know what the role of a registered dietitian nutritionist is, can you explain that for us and give us a little background? Absolutely. I'm happy to do that. And I think what you'll find is a lot of folks in my profession feel eager to share what we do because there is still a lot of misunderstanding about what the role of a registered dietitian nutritionist is, and how that differs from a nutritionist, because that is sometimes what you'll hear. And even though that term is technically accurate, the word nutritionist has

no legal definition. So a registered dietitian nutritionist, or RDN, has to meet certain professional requirements in order to practice or to have that credential. And so a registered dietitian nutritionist, really even to get there, we can kind of discuss what they do once they get there. But really to get that title, you know, it requires a certain amount of education. So that's typically a didactic coursework. It looks a lot like pre-med on the front end, you know, anatomy, physiology, biochem, all of that good stuff, metabolism. And then with a lot of nutrition tacked on, and that's really anything from, you know, the pathophysiology of disease and how nutrition sort of interacts with that, drug nutrient interactions, medical nutrition therapy,

but also we take, you know, sort of like cooking classes on steroids. We learned like the science of food. You know, I got to play around with different types of dough balls in the kitchen, you know? So really the, the, the education of the registered dietitian nutritionist is really broad and diverse. And I think, you know, not to brag on my profile, I do want to brag on my profession a little bit. Brag away, Jason. You deserve to. Thanks. That we're really well-rounded members of the healthcare team, I think, in terms of what our knowledge is. But also we get to talk about food for a living. So who doesn't want to do that? So that's sort of the didactic or educational piece. And just for our listeners understanding, we're actually moving to a

master's degree requirement by 2024 to become a registered dietitian nutritionist. So right now it's only an undergrad, but that is changing and you'll see most educational programs have already made that shift. So then on top of that, we then have a number of supervised practice hours, which I'm going to get this wrong. I think it's around 1200 supervised practice hours. So that is, you know, under someone else's supervision. A lot of folks call that an internship. And then after that passing a credentialing exam. And so then once you have that, you're a registered dietitian nutritionist. And then you keep up continuing education credits. So then the big puzzle is sort of, okay, what do we do now? So my specific focus is on is as a clinical dietitian and

dietitians do work in a wide. So talking about that broad experience, we work in a lot of different settings. So there's, and I, again, I'll miss something and anybody, any dietitians listening out there, you're welcome to add it to the comments, you know but we, we work in a wide variety of settings for education to business, private practice, community settings, to clinical settings. So we're not just in the hospital, we're everywhere. Which is a good thing. Yeah, I know. It's a good thing. Sorry, that sounded creepy, but no, it really is. It's a good thing because nutrition is so important. And when we look at the context of nutrition and pelvic pain, which is a really it's a it's an underserved area in health care, period. Agreed. And then

nutrition, you know, so when I went looking for dietitians who were doing this, there aren't any, you know, if they're out there, please, you know, shoot me a message. I'd love to know where you are. But it's just not an area that we're really involved in right now. So but looking at how the the RDN can be a part of the health care team is really the process of providing medical nutrition therapy as part of a patient's care. So that involves a thorough assessment of really hearing the patient's story. So, you know, tell me what's going on with you and really getting the full picture of what brings them to the table, so to speak. So what's going on with you? And that can be, that also includes like a head-to-toe physical assessment, looking for

signs of nutritional deficiencies or excess. That also includes reviewing, you know, medication supplements that they're taking, looking for drug nutrient interactions. And we've, you know, seen that already happening in our collaborative care, you know, then a thorough review of what they're eating and how that's contributing to what's going on with them. So looking at diet history, health history, you need, so it's a complex picture, lab work even to, you know, looking at blood work and how nutrients are, are interplaying there. So once we have that big picture of a patient story and then working with them.

So, so my big thing with, with being a clinical dietitian and think something that I think our profession is getting better at is really working collaboratively, collaboratively with patients. So rather than a directive approach, which I think a lot of patients are sort of scared, but that's what we're out to do. Like we're the food police. We're here like, no, you shouldn't have that. Don't like put, put that down.

Like, no, it's really, you know, this is a collaborative journey. Like I want to work with patients with what they're doing and figure out how we can find a way of eating that supports their health. That's also something that they're willing to do comfortable with doing fits their culture, their lifestyle, um, and really working together. And a lot of that's counseling. Right. It was just so complimentary to, you know, my work as a pelvic therapist, you know, physical therapist and, and also beyond that. Right. So, so you are an integral part of the healthcare team for wellness and wellbeing. And what I want to just, you know, summarize and unpack, cause that was a lot for us to chew on. No,

but that you're, this isn't just a weekend course that you took and, and you know, that you're like, okay, I'm, I'm an expert in nutrition and I'm going to tell you this new diet fad or nutritional fad or what have you. There's so much of that out there. No, these are registered dietitian nutritionists are folks that go through a very intensive curriculum to understand the impact of food as medicine and also understand, as you so well put it, the from head to toe holistic approach to working as a collaborative care partner in their health goals, their health needs, etc. And so it's not just about, yeah, put me on a diet or tell me what not to eat. I mean, most of us know, we know, we know, you don't need to have someone tell you, maybe we should, you know, take pizza off the table for one day out of the week, you know, like we, it's not about that. But as you're saying, Jason, it's really about this comprehensively educated, a lot of education, a lot of counseling. And also, I liked when you mentioned the supplements and medication management, because with pelvic pain, you know, as we have collaborated together on patient's care, we have noticed the perhaps unnecessary, in most cases, unnecessary supplementation.

And even to the degree of just making sure that we're being aware of medication side effects and medication influences on someone's digestive system and their pelvic and their pain. And so having that perspective from the registered dietitian nutritionist perspective, I think is so important and very often overlooked, as you mentioned earlier, that there aren't a lot of folks who are doing what you're doing as far as what we're doing complement in this collaborative way. And particularly when it comes to chronic pelvic pain syndrome in those who identify as male, right, or our penis havers, right? yeah yeah so i have an interesting story with that too and and um i was talking to a nurse colleague of mine just as an example of this and was telling her about my residency experience which is again such a unique like innovative thing to be able to partner these two health professions together i always say it's like peanut butter and jelly like what we do complements each other so well but when i when i said to her yeah i'm working with chronic pelvic pain she says oh

so you're seeing women with chronic pelvic pain and she acknowledged when i told her actually predominantly working with men. And she said, you know, see, that shows my own bias about, you know, you say pelvic pain and immediately I think it's cisgender women. Um, so, so you hit the nail on the head there. And that's something I think, um, is, is makes us an underserved population. Absolutely. And, and you like, again, this collaboration that we've had has been so helpful for, I would say 90% of the folks that I see are talking to you, right? I was like, no, I really think that we need to talk to Jason. And so Jason, let's talk about some of the cases that you're seeing or some of the diagnoses or issues that folks have that are

um, perhaps tied into overlap with pelvic pain, right? So, so what have you been noticing as, as we're working together? I just wanted to, yeah, that's such a great question because I was reflecting on this earlier that, you know, um, yeah, I came into this resident residency experience, um, thinking a little one dimensionally and I, and I knew better because in clinical practice, I always saw it's never just one thing, right? Like, you know, I worked in oncology nutrition, but nobody just had cancer. It was like cancer and diabetes and chronic kidney disease and hypertension. And, you know, so the list goes on of like things that you can touch upon. So in our population, what we're seeing, you know we've caught like early case, like

prediabetes, like we had a patient that we were able to like identify that. And you know, that's going to contribute to their pain and possibly to like sexual health difficulties. And, you know, those, so there's an interplay there. Digestion for sure. So a lot of interplay with, you know, folks who have maybe been diagnosed with irritable bowel syndrome, either predominantly constipation or diarrhea or mix, functional constipation, discernergic defecation, that's always a tongue twister for me, hyperlipidemia, high cholesterol. Yeah, I just think there's so many things that when you start cracking open the walnut no pun intended like it's like oh it's a surprise like there's so much in here that um we can influence with nutrition and that these the important thing

is they're not isolated right so these conditions that i'm able to help patients with related to nutrition that they may think have nothing to do with their pain may have a lot to do with their pain or maybe a significant driver or contributor to that and it's never just one thing but it's like, Hey, yeah. Sometimes just telling patients that like, Hey, did you know that this particular, like if we work on your metabolic syndrome, that may actually help with your erectile dysfunction. And it's like, Oh wait, now I'm really motivated. I'm really motivated. Right. Yes. Yes, absolutely. And again, and I know we're kind of bringing some light heartedness to this topic, but it, and we get it, you know, it's very distressing, you know, when all these changes to

our bodies start to happen and we start to lose function or abilities or where things are just changing. And, and there aren't, there isn't a, a supportive reasoning as to why, because traditionally in the biomedical traditional sense it's very rare for, for folks to be tying in all of these other prongs to our health. Right. So I think it's just worthwhile mentioning that again, we have to, when we're addressing pain or any other chronic illness, as you're mentioning, Jason, we have to look at it with a wide lens and not, and not just this narrow myopic view of, okay, the symptom, this fix that symptom, this fix, you know, it doesn't work that way because all of our systems and our body are working together, communicating together. And there's

this interplay, as you said, Jason. So, you know, definitely considering that, you know, again, this whole person approach to, to every, um, to our health in general is going to be very important. So I'm so glad that we're having this conversation. Um, so that being said, I want to go, I want to segue into talking about more about pelvic pain and foods that fight pelvic pain or help to support. And we've kind of, we're just talking about that, but I want to dive deeper into that concept of food as medicine and, and foods that contribute to, or don't contribute to inflammation, uh, pain, et cetera. Yeah. Yeah. So I first like to start sort of talking about sort of an approach to food. So I think that before, and with a lot of patients, I usually,

I do introduce the concept of mindful eating. Um, you know, some, some folks are into it. Some folks like, ah, I don't know. Um, but usually when I, when I share the idea with them, they're like, oh, yeah, I can actually have a relationship with food that is not based on this like value judgment system of like, bad or good. You know, so we a lot of times we start there, or at least I try to introduce that concept and sort of gently re re approach it as as time goes on. Because I think we can talk about foods that are helpful, or maybe not so helpful. But we really have to establish a good relationship with our food first. And mindful eating is just one way to do it. But it's one of the ones I like, like the most. So I always have to, I have to put the caveat out there that is

there research that supports like mindful eating specifically with pain? There isn't. But this is a situation where maybe we've talked about this before, but it's like, there's, there's enough like sort of out there. For one, it's, it's, there's no way it's going to hurt you. I mean, there's just like, there's zero, there's zero risk, but there is good evidence about mindfulness and pain reduction. And so any opportunity we get to sort of meld those things together, like I'm sure, you know, if, if researchers out there are listening to me, like we need to do this research. So somebody needs a mindful eating protocol for pain. Like, you know I don't know if I'll dip my toes in the water or not, but they've done it with diabetes, depression, binge eating

disorder, um, a number of other conditions. It makes perfect sense that mindful eating would have an application in patients with chronic pelvic pain. And another thing that makes me think that too, and maybe you have experience with this as well, is the distress that we hear around the eating experience. So patients will tell you things like, well, I'm just so afraid to eat. And when you, when I hear that, I know like, Hey, we need to do some work around that first. Um, because there may be a lot of fear around, like, if I eat this thing, is it going to trigger my pain? Or if I don't eat this thing, is that going to help with my pain and, and an idea of like, I have to be perfect around this or else, you know, um, I'm glad you're bringing

that up because I just wanted to chime in about from the, from the pelvic floor perspective, you know we're working with folks too that have pain with defecation or pooping pain around in and around the anus or after defecation or even just with anal play if that's if that's your thing um you know those are all pertinent to do i want like eating because when you're eating you're going to be pooping and if there's an associated trigger that increases the pain dial with a physiological function like defecation, then the tendency to want to eat and your appetite around eating is going to be changed. Yeah. And the same, you know, the same with beverages. I've had patients tell me like, I, you know, I know I'm dehydrated, but I'm afraid to drink too much

because then if I drink, then I'm going to have to pee. And if I'm uncomfortable when I'm peeing, you know, and it sets up the cycle, right? So chronic dehydration, of course, that's going to drive, you know, pain. So then, you know, we end up in a bit of a cycle. Absolutely. Absolutely. So it didn't, didn't mean to kind of disrupt your flow, but I just wanted to add like how, you know, it is, it is all connected and that we need to be mindful of the behaviors and the patterns that we may find ourselves in when we're in pain and they are habitually protective responses initially, it might be helpful, but as time goes on, uh, it's, it's, it's, it becomes maladaptive and, and very detrimental to your health and your progress to recover from

pain. Um, so yeah. Yeah. I think that's, that's super important to note. And I think we've even talked about like on the other end of the spectrum, mindful pooping, it's like, you know, can you, can you be mindful going in and coming out, like, you know, reduce any opportunity, I think to reduce, turn down the dial, um, of, of pain and anxiety. Um, yeah, with, with mindful eating, what, what appeals to me about that again, I'm, I'm a very like, let's get away from diet culture. I don't like that. I mean, it's included in my title, so it's, it's hard not to use that word. Right. But, you know, trying to get away from that culture and I've seen it, you know, some, some, um, prominent folks in the mindful eating community talk about the cycle

of um eat repent repeat so we make a decision to eat something then we feel guilty like we must repent for our sin you know um and then that cycle sort of repeats itself where you know if we can kind of get ourselves out of that cycle of feeling so much guilt and shame around the experience of eating um you know kind of what i what i will tell patients and we'll get to you know yeah of course there are things we want to eat more of any less of like we're definitely we'll get to that, but it's also letting them know like, Hey, when you've committed to eating the thing, let's now just eat the thing, right? Like whatever that is, let's eat it, enjoy it. Let go of judgment because at this point it's going in your body. There's nothing we can do

about it, you know? But also the thing that's cool about mindful eating is that it's not just this crunchy, like outer space, like, like, cause it sounds like it's got a sort of metaphysical component to it. And if that's your thing, cool, but it's also got a science is I guess it works because it's reducing cortisol in the body. It's allowing time for those hormones to get to your brain that says, Hey, I'm full. So it's about checking in with yourself. Like, Hey, am I full now? You know, how often do we even pause to ask ourselves the question? Or am I really hungry? Or am I just eating out of boredom or because it's a stress response because I'm in pain or not in pain. And you mentioned enjoying it and having a sense of pleasure from being present with that

experience of eating. And so often in our world today, we're very busy, we're distracted, we're often eating in front of a screen. And that is just, we're in this upregulated nervous system state a lot. And it's very rare that we have those moments to, to have that downtime and to actually take a couple of breaths, which with pain, I'm, I'm always telling folks to let's slow down. Let's find the ingredients for your recipe for a low pain day, right? What's your recipe for a high pain day and work, work to be able to recognize, Hey, when I slow down, whether that's with eating or with movement or with touch or with sexual activity or whatever it is that that person wants to get back to doing in a pain-free state we kind of have to do those

things but we have to find ways to do them that are enjoyable as you said jason pleasurable and that is part of sensory integration and folks have heard me name that before but sensory integration is just using all of your, all of your senses, right? Not just touch, not just movement or what you see. It's, it's what you see, what you hear, what you smell and what you taste. And all of those experiences within that sensory landscape or that terrain has the power to influence your pain dial. Yeah. I love a, I love the food metaphor with the recipe. obviously you're speaking my love language but um too you know eating is like a total sensory experience if you think about you know it's not just taste right you know i love to use the example

of like a clementine or tangerine or orange because it's it's one of my like my favorite fruit like anything in the citrus family but you think about like it starts with seeing it right and we have this, like, you can imagine, like, okay, I see this, and then that orange color almost tells me what I'm about to experience, and it speaks its own language, you know, and there's texture, you know, the rough texture of the orange, and then as you peel it, you get that sort of spray of, like, that citrus, you know, you're like, oh, I'm about to have this really yummy thing, you know, and so, yeah, and so you smell it, and that's before you even put it in your mouth, right like we haven't even got there and you're already using you know the sound too like of the

the orange being peeled and then when you put it in your mouth you're still feeling it then you begin to taste it and then still smelling because it kind of goes back into your nasal passages and like yeah i mean all of it is a total sensory experience yes and i have to just give credit to dr rachel zoffness who's a pain psychologist california for the recipe pain ingredient metaphor. So credit where credit is due. So thank you, Dr. Zoffness for that. But I love that. That is an activity here that I want folks to try because when you're so engaged and you intentionally shift your focus away from the painful parts, you are training your brain, your nervous system to dial that pain volume down. So not only are you mindfully eating, you're also reorganizing

your nervous system, creating new pathways to help your brain shift attention away from the painful parts that hurt. Because with pain and pain that persists over time, that becomes chronic and persistent, your brain is going to get really familiar with paying attention to those parts. And it's like a magnifying glass. And the more that you attune to that sensation, the more we pay attention, the more that we change our behavior, and the more that the thoughts and beliefs around our pain get bigger and louder, the sensation, the pain volume is going to go up. So this actual activity that you're describing to us, Jason, is such a wonderful activity to practice presence, mindfulness, sensory integration, creating a healthy relationship with food, and really, again, a helpful practice to literally turn down, reorganize your nervous system to downregulate to help turn that volume dial down. And so again, those are activities that are so complementary to how we work with persistent pain and how we help move folks forward to getting back to doing the things they love and introduce, you have to, you're going to be eating something you do every day, just like brushing your teeth, I hope. But, but you can use those moments, you don't have to add more to your plate, so to speak, you can actually just shift your perspective shift the intention of the activity that you're already doing to become an exercise to become a training opportunity. Yeah, I love that. And you know, what I was thinking when you're saying that is, you know, this is food as medicine, before we've even changed anything about what you're eating. Like, that's the cool thing about it. And of course, you know, then we can start to make adjustments. And they're definitely things we might want to think about. But one of the things that strikes me about this, and I've already had a few patients kind of commit to this practice of just, hey, let's check in with ourselves when we eat. How do I feel?

Like even just checking in with yourself about what emotions, what emotional processes are happening, what's my mood like, what's my sensory experience like, I've seen patients change their diet, just doing this, because when we start to check in with how we feel about the sensory experience, our emotions, all that stuff, when we're eating, we actually start to make different choices. And you said this beautifully earlier. And if I had a dime for every patient who said, you know, Jason, I know everything I'm supposed to be eating, I'm just not doing it. Like, literally, I like as the moment I hear that

I go, uh huh, you know, because nothing and I'll get into some of the specific foods, too. But I don't think any of it's going to be earth shattering, like a lot of it's stuff that we kind of know, but we need help putting it into practice. And one of the things we need help with, I think the most is changing that relationship with food. It's like making better decisions. And something else you said too, about, about a practice, making it a practice or training, I think is the word that you use is that it is like that. I think just like with meditation, you know, and I'm still a novice with that. I will be the first person to tell you, I sat down to meditate and go, am I doing this right? Am I doing this right? You know, but that's part of the practice, right? But that

once you begin to have those moments of, of clarity or whatever, you know, with the thing that you achieve there, you can start to bring that into your day-to-day experiences. So I think of, you know, if you, cause you're not going to eat mindfully at every single meal, let's face it. Like there is just not like, yes, I would love to tell you, you're going to sit down to your Thanksgiving dinner and be like, Oh, I'm going to mindfully eat these magic hitters. It's not happening. It's not happening. But what might happen is that if you've had enough experience sort of training, the practice of it, you might start to go, you know, I'm good. I'm good. You know, I've had what I want of this and I can now stop. So that's the goal. And, and you know,

not everybody's going to achieve that. And I do also want to point out that some, some people do have, you know, there are hormonal situations that can drive changes in our appetite and satiety signals. And that's where a good registered dietitian and a healthcare team who can kind a look at things like, let's say for example, sleep apnea, um, can completely disrupt all of these cycles. And, you know, we tend to look at this getting off into another subject, but it's a good example. We tend to point the finger at folks with sleep apnea and say, well, oh, you have sleep apnea because you're overweight, but there's evidence to suggest that you're actually maybe overweight because you have sleep apnea and that's changing this hormonal system that you,

that you have going on driving hunger signals when we really shouldn't be having them. So, you know and then vice versa so just as an example of you know a whole person approach oh absolutely and how important we know pain sleep is for pain modulation or turning down that dial like there's so much literature just to support and back up how important sleep is for decreasing pain and improving function so sleep is very important and i'm so thankful that named like hey it's not how much you weigh that's impacting your sleep right it's it can be what kind of nutrition what's going on underneath that is impacting your weight or like you said satiability and desire to eat and hunger and etc so yeah let's not point the finger it's so easy to

just try to point the finger at one thing uh but we don't live in a vacuum folks it's impossible to do that. That could be a whole, like a whole topic for an entirely different podcast. It's like talking about diet culture and weight shaming and all those things that happen that make it, it just makes our job harder. It doesn't work. You know, pointing the finger at people and saying, well, it's your fault, you know, that you live in this food environment that is super saturated with all of these, like, you know, easy, you know, a lot of times, you know, we're, we're in an inhospitable environment to make the best choices and something has to be said about that. Um, you know, which kind of leads us to, okay, so what, what can we do? Like what, what,

what different decisions can we make, um, to help us with, with chronic pain? You read my mind. Wonderful segue, Jason. Can you tell we work really well together? Like on the same parallel universe here. So yes, let's talk about, you know, food does matter. And what we put in our mouth, you know, does matter. And it is food is medicine as, as we've been talking this whole time about. So, you know, specifically for pain and just for an overall healthy optimal just body, right. And we can go into what, what does, you know, health look like for folks. And that's going to be individual, as we've already said, you know, what's healthy for one person might not be the same for another person. And, and we're working within an individualized approach,

but generically speaking, I mean, we do need, you know, nutrients and other things to keep our bodies functioning optimally. So what are those things? Let's talk about those important factors as far as our nutrition goes. Sure. Yeah. So I think you kind of touched on that too. Like the key pillars of good nutrition are balance, variety, and moderation. So what it really means and variety is so important and we're learning more and we can talk a little bit about this too, about the gut microbiome and how we sort of keep a healthy and happy gut really means like eating a varied diet, but particularly, you know, we're not talking about different colors of Skittles here. We're talking about, you know, wide variety of, you know, again, everything in

moderation and if you're going to eat them, eat them mindfully and enjoy them. But, you know, fruits and vegetables, plant foods. I mean, if I could say, and in fact, I would just put that at the very top, like, let's just start with like the most important thing you can do, whoever you are, whatever you, whatever condition you're, you're looking to improve, whether it's pain or anything else, eat more fruits and vegetables, period. Like if you just do that one thing that will transform your health, just that one thing. And it's so simple in theory, right? This is where that sort of like, okay, let's practice some skills to, to get these things in our diet more. But sometimes as the, the, the right solution is a simple one. It's like, let's eat more plant

foods and particularly more fresh fruits and vegetables. Um, and when I say that, you know, cook them, that's fine too, but, you know, but, but really focusing on that. Um, there are so many compounds in fruits and vegetables that help our body reduce inflammation that help to fight pain that helped to fight some of those inflammatory chemicals that our body may be producing. Um, that, uh, there are more things in fruits and vegetables that I could possibly name And the other thing is we're still learning about these things, right? I mean, we're still finding new compounds in fruits and vegetables that we're going, oh, hey, this one thing in this food might actually help with this particular health condition. Now, as a, as, as a caveat to that, what I always want to say is also your strategy to getting fruits and vegetables is wait for it, eat them, eat them, you know, because

the tendency is we always look for like, there's gotta be a shortcut, right? Like, is there some, you know, and I get this question a lot from patients, like there's gotta be some like magic powder, some pills, some juice, some like celery juice. Yeah. Oh, boy. You know, again, is celery juice healthy? Sure. But is that going to cure everything? No. And we should, you know, it should be pretty common sense to us to go like, hey, anytime somebody is promising a quick fix, or like, it's just this one, you know, the thing I hear a lot in the world of nutrition is, is the promise of magic. It's just like, well, did you know, it's just this one thing you haven't been doing, but that will cure everything. It's like, you don't say. because we've heard this story a lot uh over the years you know i've been at this for over a decade now and these things keep sort of and they'll be uh they're like zombies that won't die you know like i i fully expect some of these diets that are like ancient dinosaurs i'm not even going to speak them because if i do i will speak them to life um they will resurrect and then someone will

go we all should be doing this now you know oh it's a physical therapy world too i just had to say that like with taping and you know trigger point stuff and here's the next magic exercise and here's the dry needling i mean again like yeah i hear you i that's again like i said i i even try not to speak speak the names because it's like if i do your comment section's gonna fill up with people going no you know yeah i've been doing this diet for you know x many years and we can get into some of that too but but really nobody's gonna either think the beautiful thing about eating more fruits and vegetables is that no one can argue. The science is so clear, like in the world of nutrition, there's still a lot of muddiness. It's a newer science. There's

a lot of poor quality research out there, but that's not even a question. Like more fruits and vegetables are going to help you. Um, and let's figure out how to get more of them in your diet. You know, let's start there and just build on that. And sometimes what I think it takes is not taking my word for it. Like, so, so I've shared this bit of advice for you is that when patients ask me for a diet plan, like, Hey, will you give me a menu? What I tell them is sure. I can give you a menu. Guess whose menu that is. It's mine. It's the foods I think are good. Not the ones you you're going to want to eat. And at some point in time, you're going to go, you know, I don't really want to have asparagus, you know? So sometimes it's helpful.

Like, let's just sit down and go through, like make a list of all the fruits and vegetables you enjoy eating and then maybe the ones like hey i tolerate these and then a list of like yeah i'm never gonna eat these because let's be real if you know if i have those two i mean they're just things that i kind of go you know nope yeah and that's okay like if you don't love okra don't eat okra right right i agree you know so i think you know starting there and again i don't want to spend our whole time talking about that but but it's so important and in a wide variety of them So kind of misconceptions, too, is like some people will just find like, OK, I ate a banana, so I'm good. It's like, OK, well, what else did you have? You know, like, how can we how can we expand the menu of different like that's a great place to start.

And I don't want to knock them. Bananas are wonderful. But let's kind of expand, expand our variety. So then kind of looking at other strategies overall. So I think this is where your expertise really comes into play, too. And what I've been learning from you is like, Hey, let's also kind of figure out what, what are the driving factors of this pain? Because that may sometimes drive what we want to do with diet. So is it inflammation? Then we might want to look at an anti-inflammatory pattern of eating, uh, you know, is digestion

and that sort of crosstalk that's happening. Is that driving this? And maybe we want to look at, you know, what foods might be want to shake up to help your digestion out. So, um, but I think overall, like an anti-inflammatory eating pattern, again, not going to hurt anybody and really what i think of is like a mediterranean style of eating so plenty of plant foods fiber is your friend healthy oils like extra virgin olive oil um encouraging and i'm gonna say this and if you get if you get comments then so be it but whole grains like i'm just gonna put it out there

yeah it's like yeah come on you know um so and a wider variety of them too but you know um there is a fear right now. There's, there's this, um, we're in a, a very, um, carb fearing state as a, as a society right now. And I just want to put out there that, that, um, in fact, I'm going to do something pretty wild. Uh, I will, I will quote, I'm going to quote a drag queen. Um, the great calorie carb Dashian said, carbs are friends and food carbs are your friend. um and i and i love that when i heard that um i'm a big drag race fan um when i heard that i was like yes yes yes you know absolutely look at population studies because i think you know folks are going to argue like oh everyone should be doing you know low carb diets like you know you look at

populations pockets where we have longevity those folks are eating carbohydrates people you will get blue zones where people have you know the longest longevity on the planet they're eating carbohydrates it's not carbs that are the enemy it's what we do to them so it's it's how we process them and then refine them and then what we have them with so when we take a grain like wheat barley oats you know whatever you want to spelt there's a wide variety of them out there When we turn that into a refined grain and we add a bunch of sugar and saturated fat to it, that's going to negatively impact our health over time, right? We've taken something that actually has some pain-fighting compounds in there that have antioxidants in them, that have gut-friendly fiber in them. When we strip all that away and we take it down to just the starchy goodness that remains, then we have a food that may be problematic in excess.

So I guess to kind of boil it, to summarize that is eat more whole grains and limit refined grains and sugar. And again, all things in moderation. This is where a good, you know, some mindful eating strategies can help because what I always tell patients is it's not that I'm saying eat no sugar, because I think that's quite impossible. It's, it's really tough. It's really tough.

It's more like, Hey, maybe pick the thing you really want to eat and really savor and enjoy that. and how can we learn how to do that like you know I have patients who can stop like and say like yeah I have a square of dark chocolate and I really really enjoy that and I'm good you know right and sometimes yeah I'm gonna have the piece of birthday cake it's gonna happen it's also about what what else are you doing you know what does the overall pattern look like exactly exactly so all of our prongs to our lifestyle where we are at in our life you know mood as you said mood we're paying attention to all of these ingredients and menu items that again contribute to a high pain

day recipe or a low pain day recipe and it's the awareness slowing down and being mindful that will allow you to start to recognize these patterns because it isn't just random that you have you know ups and down of it it's not random it may seem like that for sure but if we take the time to slow down to be present to be aware and to create some space with our within our experiences right and start to basically lessen our our identity and enmeshment with pain or food or what have you and just be present for the experience without being judgmental or negative to ourselves or what have you it's a completely different mindset and approach and and also allows you to really get more clarity on your own situation um and what what ingredients are

going to work best for you and and also being flexible with that with those ingredients right jason sometimes you want to add a little bit extra spice you know right maybe a little bit a pinch of more salt, extra vegetable in there. So, so, so, you know, you have a baseline recipe, but then once you kind of get really comfortable with that recipe, right. I, I like to cook, my husband would beg to differ, but I like to cook. And once I get really used to like, Oh, I know the ingredients now I can actually play with it a little bit more. I can change it up or mix it up. And then I become a master with that, with that particular recipe. Right. Cause I'm not afraid to steer away from that protocol recipe, I'm now really fluid with that process. So you will get, you will get there,

but you kind of start somewhere, right? We all got to start somewhere. Yeah. Yeah. And I think, you know, we talk about this too, this idea of like experiment, you know, sometimes we do kind of have to be willing to play with things and saying like, Hey, you know, um, maybe I need to take this particular thing out of my, my eating plan for a while and see what happens. Um, because maybe this isn't playing well with my particular body chemistry in my particular situation. And that's where I think a good, you know, this is something it's like, don't try this at home, kids. Like this, this is where I think a registered dietitian nutritionist can really be a helpful partner and helping you look at the pattern and going, Hey, you know, I'm noticing

this comes up a lot on these days when you have, you know, more pain and maybe we need to look at maybe taking this out or replacing it, I would say, replace, replace, don't take away. Maybe there's something we could substitute this with that might allow us to see and maybe we find out this isn't bothering you this, you know, we did a little experiment, we took something out of your, your day's eating plan, and nothing happened. So you know, that's probably not a problem for you. So and that happens to, you know, so we have to be willing to experiment. So something, you know, when we talk about digestion, something I might work with some patients, and again, this is really um, a job for, for a dietician, um, would be like low FODMAPs, you know, that may be appropriate

for some of the patients, especially with digestion, especially if they've been labeled IBS. Um, you know, that may be something we look at, but it is restrictive. And these types of things are not meant to be like a long-term thing. They're meant to be a, let's see what's what works and doesn't. And then once we know a lot of times, it's also like, um, the dose makes, I don't want to say poison, but it's dose dependent. So let's say, for example, we find, I'm just going to use this as an example, and I'm not at all saying this is a bad food or a no food for no, Jason, sorry. Don't mean to interrupt, but I could you clarify for our listeners and viewers what low FODMAP means just in case folks don't know what that means. Sure. So FODMAPs are

fermentable carbohydrates. I, I, I could, I believe it's fermentable oligosaccharides, disaccharides polysaccharides and no sorry hang on polysaccharides and polyols i think that's correct it's a mouthful it is a mouthful um and i may have missed one of the the letters of the acronym but but essentially at the heart of that these are carbohydrates that can actually they get fermented within the gut and can produce symptoms of gas and bloating and for some people that makes them more uncomfortable and for whatever reason you know these are normal process. We all make gas. Like, you know, it is totally normal. It is a part of life. Let's embrace it. But we know that some people are actually more sensitive to the distention that

happens when, when, and they may have more gas and bloating than others do. And so, and, and, and specific components in these carbohydrates, um, may be more problematic for some people than others. So you kind of go through the alphabet and you pull out specific, you know, offending foods. And then what happens is you find you can actually tolerate them, but only in certain amounts. So it's never about completely eliminating these foods. That's not our goal. That's rarely my goal for anyone, unless there's an absolute medical necessity, like an allergy, celiac disease would be another good example of something we have to pull then gluten out of the diet forever. But even with, with a low FODMAPs eating plan, it's not forever. And what we're

really trying to do is find the triggers, then pull those things down, not out, you know, down to a tolerable level. And then again, like you said, sometimes it's just knowledge is power, right? Like when you figure out what those foods are, then, you know, like, Hey, I'm going to make a decision to have a whole cup of this. And I know it's not going to be good for me, but I really want it, you know? So sometimes you make those decisions. Exactly. And that's the same thing for activity. So, so kind of bringing that back to, to pain, right. And with food. So if you know that this certain food, you know, gives you a little bit more bloat and gasp, and that tends to, you know, visceral sense sensitization and that distension, you know, that can activate alarm

bells in our body and increase the dial. But that doesn't mean that you're in danger that you're injuring or harming yourself. It just means that the sensitivity dial is going to go up. Just like, you know, the smoke detector goes off. If you burn popcorn in your, you know, in your house or burnt toast, right? It's meant to be sensitive, but it doesn't mean that the house is burning down. Right. And so, so we want to respect that system because it's such a beautiful system to protect because we wouldn't be here if we didn't have pain as a great protector. But, but sometimes it does get a little too protective and, and all of what we're talking about is to help to lessen that sensitivity, to bring back tolerance to various types of tissue and body demands. So

whether that's with food again, with distension of organs or activity and activity, it's the same concept that we're talking about that so beautifully blends in with, with what you're speaking of, of diet nutrition is that, um, we, we will choose to do things that are more important for us, even though we know that it's, it's going to ramp things up for us. But the beauty of that is that we have that choice and we choose to participate in those activities and to eat those foods because it brings us pleasure and brings us joy, even though it ramps up, it can ramp up that sensitivity. But as you keep doing it too, I do believe that that dial does turn down incrementally as you, as you continue to slowly kind of experiment with food, with activities, with touch,

it really helps to desensitize or lower that sensitivity and that neural upregulation. Um, and the body acclimates and adapts over time. It's kind of like a callus forming rather than a blister. You know, it's like, it's like friction pressure. I, you know, sometimes I tell people like, yeah, like that happens over time. And you're really not aware of it for the most part, because your body has enough time to adapt to the demands being placed on it versus a blister. it's the same process, but it's too fast, too soon, too quick. And then you have a blister and then it hurts, you know? So, so think callous, not blister. That's such a good analogy. I mean, I think, you know, you could even say like lactose intolerance. A lot of people don't know,

they imagine like lactose intolerance, but they can't have any dairy at all. And it's like, actually usually they can tolerate some, it's a limit. Like it's once we exceed that threshold and that's like the blister, right? Like, you know, like I can have like a half a cup of yogurt, but if I have a whole cup of milk, you know, I got, I got to go like, you know, and it depends on what form, like yogurt doesn't actually have a lot of lactose in it because of bacteria broken it down. But just as an example, you know, it's dose dependent, like and, you know, it also depends on the pattern, you know, it's like, I can maybe tolerate a little bit of this, but not a lot of this, you know that's where I think I guess a good overall message to about nutrition is focus on the

good. Because if you focus on the positive things you want to include in your diet to make you healthier, you're gonna kind of nudge out other stuff. And you don't have to get into this cycle of like, guilt and shame and all those negative feelings we can have. And kind of getting past that and really just saying like, let's focus on how to how do I fill up my plate with the healthiest stuff possible? Let's just focus on that first. And there's again, there's there's there's a lot of different avenues we could take towards that um i think it starts with you i think it's it's starting with finding out like what what eating plan i try to substitute the word eating plan for diet it's a four-letter word for some people you know what eating plan you know

sustains my health that i'm okay with like i always once i am a full-time educator so when students ask me like hey what's the best diet it's like the best diet so when you can follow right that's what I say about exercise I love it see this is why we this energy and this collaboration is so powerful because I it's the same message I say for exercise people say well what's the best thing I can do for my but what's the best exercise with the best stretch it's like the one that you're actually going to do and the one that you're actually going to enjoy there really is not the one magic exercise or the one magic stretch or the one magic axe you know it's it doesn't exist it's really about trying uh being playful feeling first thinking later like

don't think too much about it and and we've over as us humans we tend to over complicate things and i think you mentioned this earlier jason we're like it doesn't have to be that complicated even though all these systems that we're talking about are very sophisticated and complex the treatment and the approach doesn't have to be that's the beauty about all this we do not have to be specific or hardcore with our protocol or structured. It's really about finding what your own flow, your own dynamic that you can work with, feel confident, feel safe and feel comfortable. Absolutely. And, you know, I think just to giving patients a template for like, what, what does this look like? That isn't so specific, you know, to, you know, we talk about,

so looking at a good example, and I would, I share this with patients all the time as like, Hey, if you want an overall, like rather than give you a menu, I love the Harvard healthy eating plate. And maybe you can link out to this like in resources, because I think it's a wonderful, just like, Hey, this is sort of like the overall pattern that supports good health that to me, you know I hope no one from the USDA is listening to this, but I'm just going to say that the, my, you know, our, our history of developing these sort of like food guidance systems, like the old food pyramid, and then my pyramid, which was, I'm just gonna say it was a mess. And then we evolved to my plate, which is still kind of a mess. Appreciate you naming that

because it's, it's the truth. Yeah, it is. It's kind of a mess. And it's not always if I were just to show that to a patient, they would just kind of go like, well, first of all, how big is that plate? You know, so we got to talk about like, okay, let's, you know, get real with that. but but also it's missing some things and an activity i always do with my students have them look at my plate and say like what do you think about this and we'll look at other countries like belgium has a fantastic food pyramid like we could throw that out there too i think theirs is wonderful um and really a lot more illustrative than than our current sort of um dietary guidance system is a little bit flawed um water is not on there like that's the thing that always like

drives me nuts it's like oh my goodness water put water next to the plate like you know that's a good point you bring up oh yeah and you know i have my own theories as to why it's not on there but um we can get into that another time but you know it's an overall you know again it's it's an anti-inflammatory pattern of eating sort of illustrate it it's a lot of plant foods focusing on more plant proteins less animal proteins especially less red meat um healthy fats especially like let's get some omega-3s in there fatty cold water fish if you eat fish um you know if you're following a vegan or vegetarian pattern, then plant sources like canola oil, walnuts, ground flax seed, and then micronutrients. I didn't even, we haven't even really touched on

that, but you know, some micronutrient deficiencies can also be driving pain. So we look at things like magnesium, maybe B12, especially if folks have been on proton pump inhibitors for a long time, you know, looking at vitamin D status. And these are all things too, that I say, you know again get some guidance don't just jump in there blind you know right um sometimes supplements are almost sort of like it's like an open drug cabinet like like supplements can behave like like medications and so you know you wouldn't just walk into a pharmacy and say give me some of that and some of that and some of that i mean they wouldn't let you for one thing right but we kind of have that model with with supplements right now um where there's a lot of misinformation

it's poorly regulated you know we could again we could probably do a whole segment just on supplements but they have to yeah I yeah bring it I'm I'm down yeah so so maybe more to come but but again I think it's just a good kind of disclaimer like hey do your research there are there are resources out there one that I really like a couple actually one as a consumer the the current supplement market is buyer beware. What that means is because there's so little oversight in the supplement industry, the, the onus is really on the consumer to protect themselves, which is never the best situation to be in, right? Because that relies on the consumer having access and knowledge that we may not have. So consumer labs is one place that patients can

check. Um, it is a subscription based service. So I think you do have to pay to get access, but they do actually some quality testing on different supplements. And you can kind of see, like, because the thing is you can get stuff on the market that does not have what it says it has in it does not, you know, there's no guarantee it does what it says it does. There's no company that can guarantee that. But again, like, it's like you may go buy saw Palmetto and it's actually saw dust. Right. And that's, that's the reality folks. Yeah, it is, you know, so, so that's one place you can go in another totally free resource is the national institutes of health has something called the office of dietary supplements. Um, and they actually, um, it's the NIH ODS. You can just

Google that, but you can search almost any ingredient and they have like a repository. Like if you're curious, like, Hey, what's a safe dose of this? What does this actually work for this particular health condition, spoiler alert, the answer is probably no, but you can go there and have the NIH tell you why it doesn't work. You know, I'm not totally anti-supplement. So to be clear yet, I, you know I do recommend them for patients when it's appropriate, but I probably do more taking folks off of stuff and putting them on stuff. So great. Agreed. And so important when you're having like urinary urgency and frequency bladder pain, you know, like, and constipation and such. So I'm always, and I know you and I are constantly looking at medication lists and

supplement lists. And is this really kind of interacting with what's going on here as far as like drug nutrients and how they're feeling and such? So I wanted to quickly, and I know there's probably going to be a whole conversation that we can have on this a whole episode. And I'd like to talk about antibiotics because for chronic prostatitis, and I do that in air quotes, because that is an umbrella term that is used historically for pelvic pain in penis owners it is also treated based on the diagnosis and the label which means infection inflammation of the prostate but we know now through the literature that less than five percent of folks actually have an active bacterial infection not to say that bacterial prostatitis or or chronic

bacterial prostatitis isn't a thing because that certainly can can be the case but it's it's it's rare you know so so 95 97 percent of cases are just pelvic pain plain old pelvic pain um and it may not have uh you know a direct connection or correlation to a specific thing that kind of started it it might be immune mediated it might be an injury and actually it might be who knows right so we don't have that information now but we do know it's multifactorial in nature and it does require a multimodal approach for for treatment and for recovery so on that tangent circling back antibiotics are treat are the first line of treatment really when um when people go to get help for pelvic pain uh slash chronic prostatitis and air quotes here they're given

antibiotics, but not just one round of antibiotics. It's like another and another and another, despite negative tests, despite negative lab work, they're still given antibiotics because that, you know, if everything, if I have a hammer, everything looks like a nail, right? So let's talk about that a little bit here for a few minutes about the impact that antibiotics have or persistent use of antibiotics, right? They're great, but they shouldn't be abused, uh, and, and how that impacts gut microbiome digestion and pain. Yes. Yes. I'm so glad you brought that up because, um, it is, as you and I know, like you're lucky if you've gone through this, this journey and you've only had one round of antibiotics because

many men get multiple, multiple rounds. And, you know, I think the answer to the question is probably the scariest answer. What's the result of this? We don't know, you know, we can speculate. And I think what we can speculate based on what we've seen in the literature is that constantly wiping out your healthy gut flora. I mean, we know some consequences. So let me give one example is like a C. diff, Clostridium difficile is an infection that you can get as a result of being over-treated with antibiotics and wiping out the healthy flora.

And sometimes with these broad spectrum antibiotics, you know, maybe we leave behind one or two kind of particularly nasty bugs. and then those kind of take over and populate the gut, you know? So that's just one potentially negative consequence. Not maybe as, you know, you see that more in the healthcare setting, but I've seen it among, you know, ambulatory, healthy walking, you know, adults who've been given antibiotics. I had it actually as a teen, which is kind of like a wild story. Like at the time I was given antibiotics for acne and actually got it. And likely the doctor thought I picked it up in a nursing home where my, my grandfather was. But the gastroenterologist was like, we've

never seen this before, 19 year old, 20 year old, but now you're hearing it a lot more. And again, that's, that's just one example, but we know that this, this sort of the healthy population of microbes that live in our gut, we think sustains our health, like much more profoundly than we, than we ever knew before. And we're now seeing these connections to, you know, to our mental health, even, um, very likely to pain. And there is some research that research that's starting to support that. Um, and then, you know, we, we've talked to about sort of the gut brain access and this idea that they sort of, you know, the, the conversation is not one way, um, and the, the microbes that live in our gut, um, are part of that conversation and a part of our overall

health. So I feel like I've gone into a circle of this meaning to say that, you know, the consequences of this could potentially be quite profound and really poorly understood right now. That, that what, what are we doing when we consistently wipe out the colonies of healthy bacteria that live in our gut? And then what are we repopulating them with? You know? So I think supporting gut health And there's, you know, again, a lot of things we've talked about today, support repopulating your gut with healthy bacteria, you know, it's not just a matter of probiotics. So we can talk about that too. Um, that's still, there's a lot of questions about probiotics, even still, um, like that's

still such a new area of research. Um, but really I think with nutrition, let's, you know, prebiotics, these are the, the things that feed healthy gut bacteria. so um my analogy hopefully this will work because is that it's like a party like in your gut it's like a party right uh and if we want to have a great party we're gonna have good food right you know like and you know what kind of what kind of food i serve maybe says what kind of party i have and what kind of guests show up at that party so you know like a bucket of kfc is very different than you know vegetable platter right like what kind of guests do we have at

this party. That's kind of the thing, the food that you eat sort of invites a different population of bacteria, different species of bacteria into your gut. And we can influence that actually pretty quickly one way or the other, depending on the choices that we made. And really, this is another opportunity for me to plug fiber, because I think fiber is our friend. With the caveat that, you know, if you're having digestive problems, let's talk to a dietician and figure out like, what kind of fiber is right for me, it's not going to aggravate the situation. But assuming you don't have issues like that, you know, we are chronically fiber deficient in the United States. And we know that that has got consequences to our health. And I think what we're learning is one of

those, like some of the drivers of those consequences may actually be related to the gut microbiome. That it's not because we used to kind of think, oh, fiber is just really about, you know, preventing chronic constipation and diverticular disease and these kinds of things. And now I think we're realizing actually really about like feeding these healthy gut bacteria and that sort of having an overall systemic effect on our health. So, you know, this is all yummy stuff. It's so important and overlooked, not really talked about. And if it is, it's really done in a just misinformed way. uh and that just causes for more confusion and frustration and really uh it it taps into our financial resources especially for doing supplements and being on particular diets and things like that

and i just think it's important like what we're talking about is so important to to give folks hope, but also in a like pretty large, like a logical, simplistic way and not over-complicating things as far as, you know, nutrition and diet goes. And also hopefully not creating more of a safety or safe space around talking about diet and nutrition. And, and, and really, I think you've really modeled what an awesome registered dietitian nutritionist is and working with one to complement their health and well-being. So thank you so much for doing that with us today and also for sharing all of your wisdom.

I mean, you are amazing. All of my patients rave about you. I just have to say that. I don't know, okay, because they do. And it's been such a wonderful complementary collaboration for folks to have. So, you know, thank you again for shining this wisdom and for being on the show today.

Um, is there any, are there any last minute or just burning, uh, uh, points of wisdom that you wanted to share before we bring closure to our segment today? Yeah, I, I guess what I would say too, um, just to, to, to echo what you say, it's a joy working with you and with your patients too. I think there's such an opportunity. Nutrition can be a source of empowerment. It's something we can do for ourselves, um, that we all have to eat. we do to live. So, you know, making these lifestyle changes doesn't have to be some like

icky thing that we have to like, you know, like it can really be a true source of joy and empowerment and a way to positively influence your health. And honestly, it's just been my pleasure to help patients on this journey. Thank you. Thank you so much. And to all of our listeners and viewers out there, thank you so much for being here with us. This is Dr. Susie Susie G in loving wellness for your pelvis and gut. This is Dr. Susie G signing off. Until next time, my friends. Thanks for listening to today's episode. Be sure to head on over to drsusieg.com where you can get more information, show notes, and related articles on today's topic. Also, if you like what you're hearing, head on over to iTunes, subscribe to the podcast,

and leave us a rating and review. We'd love to hear your feedback. Thanks again.