Live Like a Girl with Dr. Mindy Pelz - Breaking Down The Hormonal Transition of Menopause – With Lara Briden

Episode Date: November 22, 2021

For full show notes, resources mentioned, and transcripts go to: www.drmindypelz.com/ep97/ To enroll in Dr. Mindy's Fasting membership go to: resetacademy.drmindypelz.com In this episode, we dive into hormonal changes and the effect hormones and missing hormones have on brain health. Lara Briden is a naturopathic doctor and author of the bestselling books Period Repair Manual and Hormone Repair Manual. She has more than 20 years of experience in women's health and currently has a consulting room in Christchurch, New Zealand, where she treats women with PCOS, PMS, endometriosis, perimenopause, and many other hormones- and period-related health problems. Please see our medical disclaimer. 

Post-reproductive is inherently healthy. You know, there's life after the reproductive years. Because the thing about non-reproductive phase or post-reproductive phase, we require fewer calories. From an evolutionary perspective, that would have been a superpower. I am a woman on a mission that is dedicated to teaching you just how powerful your body was built to be. I like to do that by bringing you the latest science, the greatest thought leaders, and applicable steps that help you tap into your body.

your own internal healing power. The purpose of this podcast is to give you the power back and help you believe in yourself again. My name is Dr. Mindy Pels, and I want to thank you for spending part of your day with me. On this episode of the Resetter podcast, we're going to dive into hormones and we're going to take it from a much different angle than you all have probably heard before. I really wanted to look at the effect hormones and missing hormones have on brain health. So my next guest is Dr. Laura Bryden. She is a natural path who has written two

amazing books that every woman should have. One is the period repair manual and the other one is the hormone repair manual. And it is an incredible go-to book. If you're wanting to understand your symptoms, you're looking for natural, easy solutions. She has it so well laid out. And in this episode, we talk about a variety of things. For starters, she has a term. I love her terminology. She has so many cool phrases that she talked about throughout this whole podcast. But one of them is she calls perimenopause the second puberty.

And for the menopausal women out there, you probably hear that like I do and go, wow, yes, that was very much like the hormonal ride I took when I went through first puberty when I was a teenager. But she talks about why it's so important to look at the changes that happen to us hormonally as we move through our 40s, move into those postmenopausal years as temporary. And this is key because what you will learn in this episode is that there are behaviors we can do to make this transition from ovulation and to perimenopause so that we protect our brain health. She used a term called brain recalibration. How important it is to realize as we're moving

through those perimenopausal years that our brain is recalibrating to the reduction in hormones and that all of the symptoms we are experiencing are temporary, which is phenomenal. So we dove into, of course, fasting, we dove into food, we dove into insulin resistance, we talked about nutrients that the brain needs. We also talk, she brings up several key points about the evolution of women and how important the postmenopausal woman is for the community and for relationships. This was an incredible conversation. So nothing I have ever brought you on menopause is going to sound like you just heard. And I hope you all walk away from this episode feeling hopefully more normal, feeling more empowered and wanting to work with your body as it goes through this brain recalibration.

Enjoy. This is another incredible brain that I got to pick. And as always, I hope it moves your health forward. I want to really start off with like this idea about perimenopause being the second puberty because I wish somebody had told me that when I hit 40 that I was in for, a massive change, and I don't feel like it's being discussed enough. So can you start off and explain why you call perimenopause the second puberty? Yeah. As you saw, there's a diagram in my book that shows, I really like this sort of mirror image of the hormones.

Like in our childhood, we have low estrogen and progesterone, of course, that's normal. And then in first puberty, estrogen fires up quite dramatically, quite a few years before progesterone manages to get going. And then the reverse happens in second puberty, which is actually anywhere from about age 35. Some women will start having these changes at age 35. And it's literally a mirror image of that. Progesterone starts to go away first,

estrogen spiking up. So that combination of high estrogen and low progesterone is a lot of what's going on in our 40s. And that continues for up to a decade. And then finally, with the final period, about a year after the final period, we dropped back down to that stable state of relatively low hormone levels. And the thing that's important about second puberty is that it's temporary, right?

I can't tell you how much messaging I see confusing, like just in the mainstream media, like confusing perimenopause, which is this time of transition, time of symptoms, time of turbulence, with menopause, which I know I use menopause. I mean, some people say postmenopause, but I use menopause to mean the life phase that begins one year after the final period. So those, and that's three decades of our life. And that should be fairly stable state and fairly healthy and not a problem. It's these 10 or so years in our 40s. And I think if a lot of women knew that that was temporary, they would feel a lot

differently about it. And in chapter one of my book, hormone repair manual, I give the example of women being diagnosed with things like fibromyalgia in their 40s thinking, oh, that's how I'm always going to be now. And actually, it's really just part of this somewhat inflammatory, somewhat, you know, anxiety producing, sleep disturbing, hormonal change. So do you think it's normal for a 35-year-old to go into perimenopause? Are we seen changes, hormonal changes at younger ages now? Okay. Well, I think, so how we define perimenopause is really based on symptoms, right? Like when we start to experience symptoms from that drop,

in progesterone, arguably, like from a perspective of evolutionary mismatch, I don't know how much if you're listeners, if you talk about that on your podcast, but go for it. Through the lens of evolutionary mismatch, you know, I think, I think perimenopausal, I think perimenopausal symptoms in general are not normal. I think there are, you know, a downstream effect from lots of things going on in our modern environment, including food environment and environmental toxins, things we don't necessarily have control over. But there's no reason like biologically why this change should cause so many symptoms. It's so I guess we can talk more about that. Yeah. Answer to your question like how early does it start? Well,

it's normal for the final period to be anywhere from age 45 to 55. And I think that's changed very much. I mean, I know yes, there's some evidence that smoking or environmental toxins can bring the timing a little bit earlier. But in general, through my biologist, lens because my first degree, my first career was as an evolutionary biologist. All the evidence points to the fact that we are genetically programmed to stop ovulating in our late 40s, early 50s, that's not, I mean, that's a normal thing. So then the question is, in the years leading up to that, I would say it could be normal to start that years leading up to that process by your late 30s. Okay. Do you just, just like we look at, just like we're seeing, I mean, this was my thought process was just like we're seeing teenagers go into puberty earlier, you know, nine year olds, eight year olds, seven year olds. I feel like I'm hearing more 35 year olds experiencing perimenopausal symptoms, missing cycles, spotting. And I just keep asking myself if that's, if that's normal. Is that what's supposed.

post-down. Well, I haven't seen any evidence that it's coming earlier. I might be wrong about that. I might have missed some of the studies. But again, I'd say, I think the severity of the symptoms is not normal. It's common. And so if anyone's listening and having symptoms in your late 30s, it's not that you've done something wrong or, you know, this is a common thing that's happening, which is why I wrote the book about it. I think you have a book too about this process. It can be very symptomatic. Yeah. And I guess I'll just say again, I think, the severity of the symptoms is probably linked to a lot of things in our modern environment, including environmental toxins.

Yes. I might speak to one of them, just one of an example of that. Go for it. A teaser of what I'm talking about. There's lots to talk about, but I include these citations in my book. So there's a couple of papers suggesting or, you know, building the case that some of the neurological symptoms of paramedopause, and a lot of the symptoms are neurological, you know, sleep, reduced ability to cope of stress, brain fog, migraines, all of these hot flushes,

hot flashes, as we say in North America. I still have my, I'm currently in Canada. I'm Canadian, but I've been down under for a long, long time. Oh my gosh. So you have like a hybrid accent, huh? I do. I start to have the lingo of Australia, New Zealand. But yeah, it's about, there's an evidence about body burden of lead, which is fascinating, which is a little bit scary, because you think about it. I mean, when I was a kid, I'm 51, when I was a kid, there was leaded gasoline. You know, there was lead in houses, paint. You know, this is, and so by body burden, as I'm sure you know, like when we're exposed to certain kinds of toxins, particularly lead, the body sequesters it in the skeleton. So it's been in our bones, it's been in my bones for 45 years. And then there's some evidence that when with the drop in estrogen, which is normal, um, and the mobilization of bone, the increased bone turnover that starts up because of that, that releases lead into the system and hits the brain, that that could be responsible for some of the anxiety and neurological symptoms.

And when I read those papers really rang true to me. That's that makes sense. So that's an example. That's just one example of evolutionary mismatch, right? Like here we are attributing all these symptoms just to the hormonal change. but I think there's other things going on intersecting with that hormonal change. Well, I am 100% with you on the lead. I know my story going through perimenopause and I'm like three months without a period right now.

So God only knows where I am. But was that I felt really healthy at 40. I was working out all the time. I was on the paleo diet. I wasn't fasting. I was eating all day. I still thought breakfast was the most important meal the day. And if I ate more, my metabolism would speed up. And like about 43, all my perimenopausal symptoms came crashing down on me.

And one of the big things I found was exactly what you just said was lead and that how it had been stored. And then I went on to discover that it actually can be generational and it can get actually passed down in the womb and get stored in your tissues. but it's the swing of estrogen that releases it, like you said. Right. So you measured your lead, your serum lead levels? Oh, I watch. I actually watch it and detox it a lot. Detoxing lead gave me my sleep back.

Yeah. So what do you? I mentioned a couple things in my book about detoxing lead. I mean, I talk about glycine and anesthetal cystic. What do you? And selenium calcium. What do you, what do you use? Well, so yeah, it's a great conversation.

So we, we go through. through three steps. We do, we prepare the body. So we do a set of supplements that support liver health, kidney health, high-powered probiotic. And then we get nutrients to mitochondria, the proper omega-3-6-9 balance for the outside of the cell. So we usually spend about a month, like preparing the body. And then we have a whole system where we pull it out of the body first. And then we pull it out of our brain, out of the brain. So you're doing like a chelation kind of thing, Right. Yeah, think of it like chelation, but we use a lot of binders, activated charcoal, Z-lights, because as stuff comes out, we want to make sure it gets out the gut. And we're very slow and systematic.

It took me about six months of detoxing before I started to see my sleep come back. But it was such a game changer. Like I literally went at 43 from being depressed and anxious and not sleeping and hot flashes, discovered, lead. in my, and Mercury was a little bit, but lead was my biggie, spent six months detoxing and all those symptoms went away. Interesting. Yeah. Yeah, I've been sort of plotting along with a sort of a continuous, gentle, like pulling, trying to pull the lead out through the gut and the kidneys.

But yeah, it's definitely something, I mean, that's, and that's just one example of things that can be going on. And I want to, actually, one thing I'd like to talk about now, if it's okay. go for it. I really want to debunk the narrative that menopause is unnatural because we now outlive our ovaries. Like that particular narrative is really, I find, well, it just irks me. Not helpful.

Just really want to. Okay. Tell us more. Yeah. Yeah. Because as an evolutionary biologist and what I've, you know, through that lens and a lot of interesting books, there's a book called, which I always reference to her book, called the Slow Moon Climbs by Susan Matter.

And she builds the case from a kind of from a good looking way back paleolithic all the way through, you know, all the way through historical and using evidence from modern day for, hunter-gather, forger people looking at building the case that menopause is not new. That in fact, quite the opposite that she builds the case that human longevity for both sexes, evolved or was selected for because a couple of decades post-reproductive for women it's so incredibly valuable for looking after descendants and passing on those long-lived genes. So it's a really intriguing. It's basically this idea, basically building the case that for really as long as we've been

human, however long that is, a couple hundred thousand years, it seems likely we've been And at least those women lucky enough to escape, you know, dying in childbirth and accidents and infection, all that. Like if you could get past all those hazards, then you live, you would live to 70, like that 70 or 80. That's not new. And so that really, and also that potentially that was a very valuable time of life, that these post-reproductive women were valuable non-reproductive members of our human groups, which we really needed. as part of our evolution. And so that just basically tells the story that post-reproductive is inherently healthy. You know, there's life after the reproductive years.

I've actually, now that I'm in menopause myself, I've sort of reframed. I've got this whole thing going on in my book about, you know, second girlhood, this sort of making this analogy with childhood, which is kind of interesting. So I now kind of see maybe female physiology. The baseline is actually the low, relatively low levels of hormones. we're making our estrogen inside cells with aromatase. You know, we're doing it that way. And that the three or four decades of reproductive years are amazing and important

for building metabolic reserve and, you know, really great. But that's always meant to be temporary. Like, you know, pregnancies and cycles and all the hormones that come with that, we get a big dose of that. And then we revert back to our more kind of lean conservative metabolism. Because the thing about not. non-reproductive phase or post-reproductive phase from an evolutionary perspective, we require fewer calories, which is kind of, you know, good and bad.

Like, if you think about it from an evolutionary perspective, that would have been a superpower. Like your baseline metabolism is a little bit lower. So you can still get a lot of stuff done and actually eat less, which means there's more food for the children and the reproductive women, which we require. It takes, it's calorie intensive to be reproductive, basically, to even be cycling, certainly to have babies. And then, so I don't know, I kind of feel like, I think we have this to acknowledge our metabolism shifts with menopause. And we always think of that as a bad thing. But from an evolutionary perspective, that would have been pretty great, actually.

Yeah. Yeah. Okay. So I have so many of thoughts on that. So that would tell me then postmenopausal women are more. in alignment with their design, their physiological, biological design when they're fasting, because, you know, I love fasting. We're supposed to be, I think our post-reproductive, I think we're supposed to be in

an ideal world metabolically leaning more to ketones. I think that would have probably been, because we do have this shift, and we can talk about this as it relates to the brain. like basically, as you probably know, estrodial, our main ovarian estrogen enhances the mitochondria's ability to burn glucose, preferentially to ketones. Like it makes it, you know, much more efficient at burning glucose, which kind of makes sense. I mean, I think when you're reproductive, you're going to need a lot of calories coming in.

And there is, we do, for lots of reasons, we can talk about, we, there is an imperative to be more metabolically flexible with menopause. called menopause or postmenopause and more adept at using ketones for energy. Whether that's with fasting or lower carb, I mean, as you know, there's lots of different ways to encourage that kind of metabolic flexibility. A lot of it's to do with microbiome health and circadian rhythm and giving all the mitochondria all the nutrients they need, like including things like magnesium can really help with that. I took the angle in my book of metabolic flexibility, rather than.

then yes, because I'm not keto myself, although I do definitely harness some, an eating window and some overnight fasting and kind of lower carb in the morning. Like I've got a few things going on for myself. And then from, but then that's all different for, because I don't have insulin resistance. But I think this now kind of brings us into the conversation about for people who do have insulin resistance. Well, you know what?

Go ahead. No, you go. And then. No, you got my brain going. You got like with insulin resistance that a metabolic flexibility is impaired. So that's when you really do, I think need some stronger interventions to regain the body's ability, the mitochondria's ability to burn ketones. That's something I talk about in my book quite a lot. Yeah.

And your book's excellent, by the way. And you guys listening, I really encourage you to get it. You know what I love about it is. So I dove into a couple chapters, easy to read. But you also, it's like a great resource. to have to go back and be like, this is the symptom I have. Okay, what am I doing? I'm all, I'm such a fan of checklist. Like, are you doing this? Are you doing this? Especially for the menopausal woman, because, you know, we can get a little crazy at times. So, but back to your point.

So, you know, the interesting thing about fasting, and I've been teaching fasting on YouTube for several years now. And I think what happened in the fasting world is that everybody, once they discovered fasting, intermittent fasting, longer fast. They thought that was the answer. But if you look into the research, especially the New England Journal of Medicine, the most one of the most popular meta-analysis on fasting, it's exactly what you just said. It's the switching. It's the metabolic switching is where the magic happens, which means we got to love food. We got to eat great food, but we also need to practice different styles of fasting. And what I'm hearing from you right now and the thought that you kind of elevated for me is that if a post-menopausal woman is biologically

designed to have less calories, if she's doing standard Western diet, she is setting herself up for more disease because she's working against her biology. Absolutely. So it's food environment. I talk about food environments from a, I think because it also just takes a bit of pressure of people feeling less guilty about what they've been eating. Yeah. It's our, we're like animals.

We live in a food environment that unfortunately, as everyone knows, is excess calories and empty calories and probably way too high carb and like trans fat. Like, you know, there's lots of things working against us in our food environment. And if you, yeah, potentially it with the, because with menopause in very simple terms, there's a shift to insulin resistance. We lose insulin sensitivity. So estradial during our reproductive years gave us. edge over men in terms of maintaining insulin sensitivity. Obviously, you can still become

insulin resistant even when you're in your reproductive years, but it's less likely. And then with the drop in estrogen, which actually happens kind of later in the perimenopause transition, but with the drop in estrogen, there's a shift to insulin resistance. And that you won't go all the way to insulin resistance if you have put in place a good food environment, if you're moving and maintaining muscle mass and fasting overnight. And, you're, you know, all the multiple things, then you're going to come through it okay and not have insulin resistance. But if you, if you do develop insulin resistance during menopause or heading into menopause or at some point, it has real consequences. I would argue that's where a lot of,

that can, one, it can worsen the symptoms of hot flashes and sleep. It is some really kind of scary things going on with the brain. We can talk about that. Yeah, I'd like to. Um, and two, the other thing, the shift with insulin resistance, the shift to insulin resistance with menopause is where a lot of the downstream health risks come from. So we hear this narrative that menopause increases the risk for cardiovascular disease. That's 100% true. But I would argue, again, evolutionary mismatch that our ancestors didn't have that risk or that even today women who get through, like get into menopause metabolically very healthy and with a great deal of metabolic flexibility and no insulin resistance, they're not going to have the downstream cardiovascular risk that is so typically

kind of associated with menopause. And also just on that topic, one thing I've kind of come to understand, and I'm certainly happy to get, you know, feedback from other people, I think. And one of the, so you know how the research around estrogen and menopause and cardiovascular risk is all kind of mixed? Like it's like, it's conflicting, right? Like it's like, yes, it protects or no, it doesn't. I mean, there's tons of things going on with that, including, of course, the types of hormone therapy that they used previously. Oral estrogens cause clotting risk, all these things. And, you know, transdermal estrogen is safer. So there's all that. But also, I think one of the things that's going on is that, put it this way, women with, okay, if, if for women who have insulin resistance,

taking estrogen is going to improve insulin sensitivity and reduce their cardiovascular risk. women with normal insulin sensitivity are probably not going to get the benefits from estrogen in terms of those things. Interesting. Would you agree? Does that make sense? I would absolutely agree. And where my brain goes with that is, but insulin resistance can be overcome with

with what we eat and when we eat. It's true. It's reversible. Yeah. So estrogen therapy is potentially, it's having a. arguably is helping to reverse insulin resistance, but it's not the only thing that can do that, right? Like there's tons of other things. Is there a downside to HRT is what I assume you're chatting about? Well, I'm fairly agnostic when it comes in a lot of my patients take transdermal

estrogen and I think, well, okay, put it this way. On the HRT topic, like, if you're going to take it, take body identical, which, in the states, the nemetrium for the progesterone component and take, if you're going to take estrogen, take it body-digical and transdermal, like through the skin a patch or gel or something. That's way safer. And fortunately, body-identical, unlike even 10 years ago, body-identical hormone therapy now is very easy to access because it's kind of the mainstream prescription now. But you have to specifically know, in my book, I give a list of brands and.

Awesome. I mean, I don't know. I think, I don't know. I'm happy to hear your thoughts. I mean, I guess I don't see, if you're using lower dose and body identical hormone therapy, I don't see, I don't see many downsides. I'm pretty okay with it for my patients to use that. What are your thoughts?

Yeah, I mean, my approach to health always has been try to solve it naturally first. Look at your lifestyle. Make those changes. Look at how you could supplement with something that doesn't have any risk factors to it. So typically the herbs and supplement vitamins typically don't. And then if that's not working, then that's when you have to lean into more medication. I am not a fan of HRT. I see too many.

I see when people say, here are the benefits. I'm like, I get that, but the risks are too big. Bioidenticals totally, yes, if you can't solve it with lifestyle, I can see a case for bioidenticals. But I think it's, in light of what you're telling me right now, I think it's a little bit like exogenous ketones. When we first had exogenous ketones, people were like, well, I don't need to fast. I don't need to go into a ketogenic state.

I'll just take the ketones and I'll get the benefits. So what you're saying is that if you are supplementing in with estrogen, and it's the lack of estrogen that's making you more insulin resistant is what I'm hearing. Drop it. Drop. Okay. So then we got to look at if we're going to metabolize, and produce estrogen at its highest,

we really also want to make sure we're staying in an insulin sensitive state, whether we're doing this through diet or medication. Insulin sensitivity is still at the root issue of menopause regardless of the path that you take. I would agree. Taking estrogen doesn't mean you don't have to do anything else for the insulin sensitivity.

What about estrogen? So now I'm now I'm being, the sort of the devil's advocate. Go for it. This is a piece of information. This is because there is a lot of fear around taking estrogen. Like I said, I'm fairly agnostic about it.

I think if you want to take it, if you feel better on it, that's fine. A lot of my patients don't take it and that's fine too. One interesting statistic is in terms of the breast cancer risk. Yeah. This is going to lead us into another topic here, but the risk from a low, you know, a modern transdermal estrogen,

patch plus primatrium plus the biodontal progesterone. The breast cancer risk associated with that is actually lower than moderate alcohol drinking. Oh, interesting. I am just putting that out there in terms of a risk assessment because, and this is leading us into alcohol because alcohol is not friendly to the parameda puzzle brain. And I say that I actually did have a drink last night. So I'm not totally off it.

I mean, I'll go months without it. And then because I'm visiting family, I have the occasional, very occasional. But I find that with myself and with my patients and many people that I've talked to, cutting alcohol, like seriously, you know, eliminating it, at least for a little while, can eliminate some of the symptoms, like including hot flushes and sleep disturbance. And it makes sense, right? Because changes are happening with the brain. So let's kind of loop back to the brain.

Yeah, let's go into that. Yeah. Yeah, because ultimately, there's a paper I said in my book, basically, where the basic premise is paramedopause is predominantly neurological. I mean, there's also heavy periods. There's other things going on in our 40s, but let's just from the brain perspective, there's a recalibration of the brain. This is analogous to first puberty where there's a recalibration of the brain because hormones have a huge effect on the brain. So it's undergoing quite a profound, the brain is undergoing quite a profound recalibration process in our 40s. And that's, we know that's happening because it's actually what's called a critical window or a tipping point for neurological conditions.

I mean, the risk is still low, but basically we know like for the onset of serious mental health conditions, there's certain windows, there's puberty, there's postpartum, there's, there's, perimenopause. These are all very similar things that I call in my book, I talk about it as a tipping point or kind of an inflection point because this like a computer software update basically is going on. That's another good analogy. Like you know when your computer software is updating, you're not supposed to turn it off or do anything.

You need to just let it happen as best it can. And I think if that's one of our jobs in our 40s is to try to as best we can support our brain health while it undergoes this recalibration. And then we're potentially going to pop out the other end once we get and achieve menopause or graduate to menopause one year after our final period, the brain will be in its new steady state and should be a lot more resilient, really, than it would be during these years. Let's start off with this because one thing that I feel like women are not hearing enough is the anxiety, the depression, your inability to handle stress. This is because of what you just said.

I love the idea of it's a brain recalibration. But what women are doing when those symptoms appear is they're turning to SSRIs, they're getting divorced, they're, you know, leaving jobs because they feel that it's there, it's the problem is outside of them. But if they understood that the brain was recalibrating, they may have a little more compassion for themselves than the people around them. So give me some examples of like, what are the major symptoms? And then how can we assist the body in that recalibration?

Absolutely. So the symptoms is a triple three times higher risk of anxiety and depression during our 40s. Amen. Keep in mind. We're talking about perimenopause. We're talking about up to 10 years before the final period or maybe up to 10 years before the 12 months after the final period, kind of that, that's the period of paramedipause. And just to say again, it's the risk is temporary.

And it's hard when you're in the middle of it. You think, okay, I'm anxious now. It's hard to remember. You're not always going to be like that for one thing. And also there's things you can do. So increased risk of anxiety and depression, resurgence of migraine frequency. This is usually people who had migraines before, but they will, that's a classic symptom that they start, you can start getting these monthly migraines again.

Sleep disturbance is probably right up there. The other neurological symptom is the night sweats. Often in the earlier pre-menopausal years, those will be pre-menstrual night sweats. So it won't be like you're having hot flashes all the time, but you do, you potentially can go through. Yeah, a few days, you know, a few days of that. Okay. So that's, that adds up to quite a lot.

And then from the sleep disturbance, you can get fibromyalgia. This is where I sort of talked about this, you know, downstream from that, you can start to get pain syndromes and absolutely where women resort to SSRIs, which I'll just point out, like I have lots of worries about SSRIs. The biggest one actually is that they have an osteoporosis risk. So that's not a good time to be the research I've seen. I mean, not to scare people because it's certainly, you don't want to make any rapid changes. This is like a long-term thing to think about.

But the research that I've seen is that the bone risk from SSR, eyes as equivalent is as bad as corticosteroids. So it's not, it's not insignificant potentially. I mean, the research is still being done. Yeah. And then also, of course, women are turning to alcohol. And I get it because you're anxious and you need to calm down, you know, at the end of the day, try to sleep.

But I'm saying to everyone, I'm just like hand on heart, alcohol is not the solution. It's, it's just not. It's a brain, it's a brain top poison. And I mean, that's overstated. It worsens intestinal permeability. It's just not helpful. So those are some of the symptoms. The other thing that's happening with the brain recalibration,

we alluded to this earlier, is what I call an energy crisis of the brain. So this is later in the process, later around the time of the final period when estrogen is really going down. You get this reduction of metabolic functioning. You get up to what the researchers have found is a couple of researchers that I quote in the book and most people have probably heard of them, Roberta Brinton and Lisa Mascone. Yeah, like Lisa's. My menopause of brain was able to retreat. All good.

I'm with you. It's working. They're a couple of neuroscientists. They've teamed up on this. So what they've discovered is with the drop in estrogen, there's an up to 25, you know, percent drop in brain energy. And they're picking up brain energy by doing these scans where they see like the brain lighting up as it's producing ATP basically as it's, you know, producing energy. And 25 percent drop is quite a lot. I mean, that's quite, it's quite scary. And it's because

the mitochondria have temporarily lost, well, I mean, not temporarily, they're less, they're less able to use glucose for energy. There's an imperative to start to use ketones for energy. preferably ketones from diet or from the body's burning the body body's own fat as you know like that's the best way mobilize them and then the brain can use those ketones. Roberta Brinton in one of her papers and I can provide the citation for this. She talks about if the brain can't do that, if it can't readily access ketones usually because of insulin resistance, it will resort to cannibalizing the mild. million of the nearby cells.

Crazy. Which if you just think about that is not good. And that is potentially where one of the mechanisms, probably one of several mechanisms that what both these researchers, Mascone and Brinton have proposed, that menopause is when dementia starts at menopause, basically. Right, right. The risk, as you never probably know,

I mean, women are three times more likely to get, dementia compared to men. There's probably several reasons for that, but one of them is, I'd say one of the reasons is a, is metapause, is an evolutionary mismatch through menopause, is this brain crisis that if you can't successfully navigate that and gain, you know, regain metabolic flexibility and brain health, you are on the track to dementia that could probably not manifest for another 10 or 15 years. But the stakes are high, right?

That is not a small thing. No. So this is why, so now in our household, I mean, I do, like I said, I don't have insulin resistance. So I'm not super strict with my diet, but occasionally if there's like a dessert on the on offer and I'll say to my husband, yeah, I'm not going to have that because I don't want my brain to eat itself. That's actually probably helpful because to overcome a temptation if you understand the consequence of it. Yeah. Would you say then that the most important thing that a perimenopause, menopause, postmenopausal woman could do is make herself do everything she could to become insulin sensitive? I'd say it's right up there. I guess the way I phrase it in my book is it's priority to identify insulin

resistance and reverse it. What was the second thing instead of rehearse it? No, and reverse it. Oh, reverse it. I'm like, how do we rehearse it? More dessert? Identify insulin resistance with proper testing. We can talk about, I don't know what you do, but I can talk about how I assess for it. And then reverse it and make that a priority. Yeah.

Yeah, talk about how you test because I've had, I don't know if you know Ben Bickman. He's a PhD researcher out of Utah and his specialty is insulin resistance. And when I asked him about hemoglobin A1C, what did he think of that? he's like, I don't think that's a good measurement of what your insulin. Yeah, so you agree. So talk about what, how would one, like listening to this podcast, is there blood work that they could go and have done? Can they go look at the blood work and interpret it different?

So what I do, I would say the, well, I said the gold standard from a clinical perspective is an oral glucose tolerance test with insulin, which is also called a glucose insulin response test. It goes by different names of different countries, but basically it's a test where you take a fasting sample, blood sample, but where they're measuring both glucose and insulin, this is the key part. And then you do a glucose challenge drink. And then at the one and two hour marks, you're measuring both glucose and insulin, the hormone insulin. So that's fairly sensitive. I sometimes try to fudge it by just doing a fasting insulin. Like I think with someone with severe insulin resistance, fasting insulin will be elevated.

And then that's, you know, that's what. And that we would see that either in fasting insulin or we'd see it in hemoglobin A1C. Is that kind of? Well, again, I don't know. I think you can have pretty strong insulin resistance and still a fairly normal. Have those no. Yeah. I mean, it's about hyperinsulinia.

Right. So it depends at some point in the progression, glucose is going to go high as well. And there's that through the whole issue of glucose control. But I guess I still find value. In testing insulin, the other, just for anyone listening, like, you could probably already use your existing blood work to look for clues. Yeah. So, well, clue number one is weight gain around the waist.

So that apple shaped obesity is weight gain is pretty classic. Yep. So are things like skin tags are pretty, and I think they actually form because insulin, hypers, you know, insulin is high, insulin is a growth hormone. So you start getting growth like skin tags and fibroids and, you know, things like. that. So also triglycerides are typically high with insulin resistance. Yeah. And ALT, the liver enzyme ALT, especially if the other liver enzymes are not high. So this is fatty liver. Basically, fatty liver is downstream from insulin resistance. It can be because of other things, too.

But it's both sort of fatty liver is both caused by insulin resistance and causes insulin resistance. It's part of the process. Yeah. Yeah. Okay. So what let's help. Let's address the woman who's going through this process. She's listening to this. She's like, okay, I got to get insulin resistance under control. But when the waves of depression and anxiety hit, we know the brain is trying to recalibrate itself. We shouldn't be drinking alcohol. What, what are, what are other tools that we have? Like, where does cannabis fit in? Where does THC fit in? Where does Sammy? Like, what, what can we do to help? help women as their brain is recalibrating, knowing that they need to make sure that they're

handling insulin resistance. For sure. So I have, in my book, I call it the basic action plan for brain rewiring or brain rechialibrations. So pretty much I always start with magnesium and torring. We have these beautiful magnesium torring powders in Australia, New Zealand. I haven't really been able to find something quite equivalent in North America, but those two nutrients plus accessory B vitamins and zinc can really support the mitochondria, support the hippocampus, and the brain, you know, support gabber receptors. So let's talk about progesterone. We've talked a lot about estrogen. Yeah. Actually, progesterone, and the reason I'm segueing to this is because of the brain. So progesterone, the hormone we make after ovulation and with,

pregnancy. It's quite a special hormone that is not that easy to make and we don't make that much of it normally, but what we do make is quite precious. And it acts on GABA receptors in the brain. So progesterone arguably, and there's quite a few papers about this, has a regulating effect, a calming effect on the brain and helps to regulate the HPA access, the hypothalomic pituitary adrenal access. And so losing progesterone, Even in the early phases of parimenopause, that's where the migraines, anxiety, sleep disturbance typically comes from. So with my basic action plan, it's kind of got multiple prongs. The first is just go in and support the GAVA receptors.

Just give them what they need, you know, magnesium and torring, shantiglycine. I do talk about CBD oil for paramedopausal sleep. There's at least one study on that. That could be straight CBD or mixed with phyllis. THC for sleep. And then all the other things that you can do for brain health. So getting outside, supporting circadian rhythm, eating protein in the morning and, you know, giving your brain enough amino acids and breathing exercises.

And I'm a big yoga fan. Yoga is one example of kind of movement, synchronized with breathing that helps to stimulate the vagus nerve. We can harness the vagus nerve to have a calming. effect on the brain we can cut alcohol especially like it's much much easier to cut alcohol if you are on magnesium and touring and some cdadi oil and some anxiolytic herbal medicines to help reduce stress regular movement so those are all those are the basic yeah so what i what i yeah what i hear and i want i'm hoping people caught this um i really feel like the way our health care system

has trained us is there's one pill for one symptom. And my own menopausal journey has taught me, that is not the case and that you need an arsenal of things to work on and know when to pull these tools out. But what you're even elevating that to the place of like, if you supplement with these, with these key nutrients that will support GABA receptors and keep, and we can also chat about how do we keep progesterone at its best, then you're going to not need to turn to the alcohol as much because you're dealing, you're working in alignment with what your body needs as it goes through this recalibration, which I love. Absolutely.

Yeah. Yeah. So what can we do? So we open up, I love all those nutrients. Is there a way to maximize progesterone production as it's plummeting through menopause? to a point. I mean, eventually, no. Eventually, it's gone.

Like, you know, but the way I talk about it, I have a chapter in my book called cycle while you can. Like, as long as you can still ovulate, do it. Because that's how you make progesterone. So that usually requires removing an obstacle to ovulation. That's the way I think about it, which I'll point out contraceptive drugs are a major obstacle to ovulation. And there's no progesterone. in any form of hormonal birth control, then, you know, the next kind of obstacle to ovulation would be a thyroid, like thyroid disease. So if you have a thyroid disease, then adjust that,

and that will enable you to ovulate and make more progester. And if you have, again, insulin resistance or like a PCOS type state, then correct that. And you can regain some years of ovulation and progesterone. For some women, at some point, it can be helpful to take progesterone. So I have personally taken progesterone. I'm happy to disclose that. You know, certainly all my patients do, not everyone, but it can be for sleep in particular because progesterone capsules, and we're talking now body identical progesterone in the U.S.

it's most easily obtained as prometrium. It is for the, well, it's usually tranquilizing and sleep promoting. There's the, about one in 20 women have kind of a different reaction to it, which we can go into our lead for another interview, but it's most of the time it's yeah it's quite calming and so a lot of my in my book a lot of the writing i've done about potentially taking progesterone comes from professor geraldine prior do you know have you heard of her do you know her she's at university of british Columbia she's got an organization called the Center for menstruation and ovulation research i'm actually

on their scientific advisory board so she's a clinician an interchronologist and a scientist and she's done dozens of studies over the years on progesterone. She's a big fan of, you know, for those women who need something, support through the paramedopause transition, and she totally acknowledges that not everyone does. But she's a big advocate for progesterone alone. So progesterone without estrogen and real progesterone and using it for the brain to support the brain to promote sleep and also potentially lightens periods quite dramatically, which is another thing that can be going on with with perimenopause.

So progesterone is sometimes part, one of my recommendations for my patients. If I can see they need something because of the slate, because of the migraines. Yeah. So progesterone GABA is a big part of the brain recalibration. Okay. I bring something else into it. Yeah. So are there like one thing that I've discussed is that there, if you look at certain foods

that help with progesterone production. What I find is so interesting is they're not keto foods. If you like dive into food sources, you're looking at squashes and potatoes. And there's some evidence around citrus fruits that can actually help with production of progesterone. Do you feel like that's, that's accurate? Yeah, I don't think there's any foods. I mean, of course, we all of us have a baseline kind of chatter level of

progesterone. It's one of our hormones that's kind of there everywhere. but in a very small level. But the levels of protesterine that we were used to from our reproductive years, I don't think there's like there's no way with food to replace that. It's either coaxing your ovaries into ovulating if they can still do it. Talking them into that. Talking them into it.

Hey, you've got some eggs down there. Come on. Yeah. Come on. Let's take it. A few more months of cycling. Or taking it potentially. Yeah.

Okay. And what about stress? So, you know, we know when cortisol comes up that that can tank down, tank progesterone. So do you think for the menopausal woman that stress is going to be, contribute to the loss of progesterone? Yes. Probably not because of that pregnant alone progesterone steel thing. I don't think that's actually that, that's actually not quite what's going on. But certainly stress can impair ovulation. So it all comes back to if you were trying to make your own progester on, it all comes back to can you ovulate? And for how long, like, like, by for how long, I mean, um, the duration of the luteal phase, if you're listeners know what I mean,

like that post ovulatory phase, like when we're young, that should be about 14 days. It starts to shorten as we get older. So we're just making fewer days of progester on every cycle. You can track that with basal body temperatures to try to understand if you're ovulating. But the postmenopausal woman, she's got less progesterone. So it's just, it's just the re- what I'm hearing is it's the recalibration is where we get caught the most. Yes. So the brain is trying to get used to its new lower hormone state. And again, like circling back to the beginning of our conversation where, you know, arguably menopause evolved is natural, is normal.

Women were even traditionally quite healthy for, you know, several decades post-reproduction. brain can recalibrate to that. I mean, children have healthy brains with low levels of hormones. I think the brain is fantastic. It can get back there. It is a change, though. It's quite a challenging change. And one thing that I'll just differentiate between progesterone and estrogen is that

producer is interesting in that it has less, it's less addictive. Estrogen is actually quite addictive. And in what way? In terms of the brain. Like if the brain gets used to, it will really feel, you know, the drop in estrogen kind of arguably more dramatically,

which is actually just why. The reason I'm using this as an example is, Professor Pryor makes this point, you can take progesterone through the perimenopausal years and then just stop at any time. Like, you know, eventually your brain's like, that's fine. Like I'm good without the progesterone.

But if you take, If you get on, this is one thing about hormone therapy, actually, if you get on estrogen therapy, you will, and you eventually want to come off, you will have to taper it down. Because if you just went from a sort of higher dose patch to nothing, you would 100% go into, like, hot flashes and the whole thing. Like, so in that sense, estrogen is addictive. Right. I want to say, just want to thinking of it actually on terms of brain and mood.

And I really want to make sure I touch on another aspect that's going on. it's high estrogen and histamine. So especially in the earlier phases of paramedopause, like I think I said earlier, estrogen can be spiking up to three times higher than during our 30s and, you know, earlier. Like it's so a lot of that's to do with just the drop in, it's sort of increasing FSA and, you know, stimulating the ovaries to make more estrogen.

And when estrogen is high, depending on the immune system of the individual, that can stimulate a histamine response. So a lot of the, again, what I see is, so histamine would be. Yeah, explain that so people know. Yeah. So high incidence, so this would be mass cell activation. Mass cells release a lot of inflammatory compounds, actually, including heparin, which is why histamine and muscles play a role in heavy bleeding, because there's a lot of

mass cells in the uterine lining. But there's mass cells everywhere, like in the gut. And then, and when they release histamine, histamine is a neurotransmitter that causes, you know, fluid attention, anxiety, sleeplessness. So I've had a number of patients and readers give me the feedback that they actually feel like the high estrogen, high histamine is a big factor in their sleep disturbance. Interesting. menopause as well, which is why antihistamines can work quite well for, well, they do work for sleep, but, you know, for calming for mood, for some of the dialed up premenstrual mood symptoms. Migraines also have a histamine component.

So that's definitely something that's going on for some women during these. And what's, is there a natural solution to histamines? Yeah, well, my number one thing is, well, no alcohol. That's another place where alcohol is not friendly, is it activates. you know, releases mouse cells. No dairy. So we can talk about this a little bit. You know, I think I would estimate that amongst my patients about one in four,

one in three are fine with totally fine with Caz dairy, like no reaction at all. I think it's the maybe more like two out of three people seem to be reacting to some extent. And I think it's a lot to do with the A1 casein and the, um, the kind of opiate, you know, about this, right? The little peptide that it forms in certain people in their gut. Some people don't form it at all. So some people, that's why some people are just, I can imagine. Like some people are fine with cow's dairy and think, what's the big deal?

Like, you know, it's 100% fine. And some people get a strong inflammatory reaction to dairy. And part of that is by the mass cells, which is why I, yeah, dairy free or at least trying a few months, cows dairy free or avoiding A1 casein specifically, is one of my go-toes for heavy periods and pre-menstrual mood symptoms. And that can be quite a game-changer. Yeah. What if I do sheep or goat?

And what if I do raw or I do A-2 cows? Yeah. So sheep, goat, and A-2 are usually fine. So none of those have A1-Casein. So, yeah, I usually, with my patients, sheep or goat, or even like butter is fine, or potentially like sort of a heavier cream, like the more fat there is, the less protein there is. So the less room there is for the A1 casein to be there. And but and I would think with raw it doesn't, it really doesn't matter because you still got the A1. No, like raw goat might be

the best. Oh yeah. So it just depends on the animal, right, whether they're make. And a lot of my understanding is a lot of dairy farmers at least down under are quietly all switching to A2. They didn't want to kind of acknowledge some of the research around A1 casing being inflammatory, but they must see the writing on the wall. At some point, most probably dairy will not be inflammatory once it's all switched over. And the rest of the world, my understanding is, you know, in some parts of the world, most even cast dairy is A2. Explain the difference just real briefly because I think when I first learned A1 versus A2,

I was like, what? There's different milk coming out of different cows. Like, isn't it all milk? I think the listeners might need to know that. Right. So it's just, it's just the presence of, it's only Holstein or what we call down under Frisian cows, only that breed, which is unfortunately the main dairy breed. They make A1 casein in the milk is actually quite a recent evolutionarily.

It's actually only in the last, you know, several centuries that it's sort of been bred selected for for whatever reason and cows. And so, yeah, basically A2 animals are just, well, like I said, like you have to be a cow to make A1 case in for starters. And then not all cows make it. So what they do is the farmers just genetically test. They can tell from a gene test if the cows make that or not. Yeah. Yeah.

And I'd like to say here in America, we're switching to A2, but I don't know. I am seeing it more in the grocery stores. So you guys, if you're listening, go to your grocery store. a lot of people will there are a lot of options now for eight two that are in there um it would be great if everybody switched over so yeah love that yeah it's just got a simple change and i see quite dramatic results with patients sometimes just making that change yeah amazing amazing well i have about a hundred and eight thousand more questions for you but um i just want to respect your time and i think we got to bring you back because this is you know hormones is i i can never talk about

it enough. I think it's really interesting. And, you know, with menopause, what I found going through the whole experience was just women aren't talking about it. And I, and I love what you said today about the need for women, postmenopausal women to the community. And how primal, like that alone, I would hope would help women see that going through this process as smoothly as you can, because the world needs you on the other side of it. It's so true. It's a beautiful way to put it. The world needs us.

Yeah. It's always been like that. As long as we've been human, we have been very important members of the group. And we still are. You know that intuitively. I mean, you just look around it. You see like women in their, you know,

50s and 60s just getting stuff done. Like, seriously, taking care of business kind of thing. Yeah. It's very limited. They're less, they're less, less tolerant of, you know, adverse behaviors. They don't worry as much. Like, I'd rather hang out with a 60-year-old on most days than a 30-year-old.

So, I mean, just saying, depends on the person. It depends on the person. Yeah. Let's, I want to finish up with five questions for you. Okay. Okay. And some of them are unique to you. Some of them are just, we ask everybody in gathering some good information.

The first one, I'm really gathering, I love books, and I'm gathering a book list, like a book club of all of our guests and what their favorite books are. So if you had one to two books that you were like every person, it doesn't have to be women-centric, every person should read this book. What would it be? It could be hormonal related to. Yeah, that's a good question. I mean, I think I'm going to mention again, I mentioned it earlier, the slow moon climbs. I'm a huge fan of that book. If you're at all interested in human evolution or women or, you know,

this is the one that reframes basically makes the argument that human longevity evolved because of menopause. Oh, my goodness. I don't know in terms of other books. I read a lot of books on, I read a lot of fiction. Oh, yeah. What do you read? I'm currently reading.

I'll say that because it's called Hamnet. It's about Shakespeare's wife and his children. So it's a sort of historic fiction. I also read a lot of books on paleontology and biology. That's because I was a biologist first. Oh, you know what? I would say one, I mean, this is just, this is a great thing about these rapid fire questions. You just don't know what it's going to come up.

But the book that comes to mind is called The Hidden Life of Trees. And if anyone's interested in the natural world, it's by Peter, I forget his last name. It's a German forester and it's translated. It's one of those books where I feel like if you. you're interested in the natural world. There's kind of a before and after reading that book. Like after you've read it, you can never look at forests the same.

He basically is kind of arguing that there's a degree of consciousness, I guess for trees, which is quite beautiful. I'm putting that on my list. I love that. Okay, if you could go back to your 20-year-old self and you could give her hormone advice. Oh, right.

What hormone advice would you give her? Yeah, to flow down. Take maybe just stress less. Just stress less. Yeah. Yeah. I mean, I guess in retrospect, I think, yeah, I had more time than I, I don't know, I was always quite a type A kind of really worrying about things and trying to get things done.

And in the end, you know, from the perspective of 30 years later, probably a lot of that didn't matter. I should just kick back a little. Right. Yes. I would probably tell my 20-year-old self the same thing. Yeah. So, yeah. Okay.

In the pandemic, we've had a lot of, you know, bashing of 2020 and 2021, but there's also been a lot of real gems for people. And you've been in New Zealand. The lockdowns have been big. But there were gifts that people had. So what are some of your a haas or gifts of the last year, year and a half? Well, for me, again, the thing that comes to mind is just prioritizing what's important. Like I, I guess, the thing I've done. I can, I think I mentioned this. I live in New Zealand, but I traveled to Canada this year to see my parents who are still alive, thank goodness, and, you know, my immediate family and some friends here. And so just prioritizing that over almost anything this year was just made me realize that that some of those relationships are, those relationships are very important. So true. So true. I would, I would agree overall family, you know, I've always prioritized family, but I feel like they took a whole other level of like honoring over the last year and a half from everything

from my children to my parents and just how precious time with them is. So I would agree. Yeah, because I went from this mode of I'm sure we all were in 2019 planning all just international, you know, speaking engagements. I've got this and this and ticking off all these things to like the like this year I said to my friends like I've got a singular like one goal in 2021, which is to get to see the people I love in Canada. Like, like nothing else matters. I just let all the other, some of the work things just fall away. It's like, I can't. I have to just do this one thing. So that was, that's important. I love it.

Okay. If you could define health, what, how would you define it? Like, one thing that I've been thinking about is that we tend to think of health as like a noun, like, or like a destination, but I look at it more like a verb, like it's an action. I think if we're all trying to get healthy, well, what does that mean? How would we define that? Well, I guess in simplest terms, it would be, you know, having the ability to do what gives you joy to do. And of course, that will change over time.

And that sort of does change. Like, if you've got some people have particularly health challenges that they may never totally overcome. But like, they're still looking for maximizing. you know, what, what they, the amount of joyful, like, you know, existence that they, they can. And so, although I, and this is a good question because I've talked about it with my audience a little bit. Health is not a destination. Because if you think of it as, as perfect health, if you're always going for perfect health, you're never going to get there, actually.

Yep. Amen. Then if I've had patients, I'm sure you've had the same where actually trying to achieve some kind of perfect health becomes their life work. which is actually really sad to see because then they're not doing the other thing. So sometimes I say, you know, even to myself or to patients, like, I think you're good enough. Like, this is pretty good. Like, you're good. Like, you can go, like, in my case, it's like, I'm healthy enough to go on a walking holiday or, you know, to travel to see my family.

And I certainly, I don't, I'm not perfect, but I don't need to be perfect. Yeah. So it's like a state is what I hear. It's like when you're in a state of health, the joys you want and, the joys you want in life, whether it's vacationing, connection with people, exercising, you're able to do all that. And without discomfort, without anxiety, depression. But when we look at it, like, something I'm trying to get or something where I'm trying to go, that's where I think we constantly set ourselves up for failure.

Is that, would you agree? And it's anxiety producing, too, because you're just always worried about, I could be healthier. I could be doing this thing. It becomes this lifelong self-improvement project, which is, yeah, not a good place to be. Totally agree. Okay. Last question.

If you had one message for the world that you could get into everybody's brain, what would that message be? Wendy, that's hard. I know. It's okay. You can pick one today and your message can be. I would just say, honestly, I would just say life is short. I mean, that sounds a little pessimistic, but like life is precious.

and the life that we have and at the time we can spend with our companions, we talked about that a little bit, but also, I guess, more broadly, I guess, speaking from a biologist, like life is precious, like the biodiversity, the plants and animals that we were so lucky to be on the planet with. I'd like to see some of them stay around. I mean, I guess I would like to see a lot of the conservation. I mean, I think climate change is important too.

I'm just saying, but in terms of the conservation message, I'd like a lot of it to kind of shift to promoting biodiversity because that's what's the health of the ecosystem, right? It's lots of different health and plants and animals. Yeah. Hey, resetters. I just want to start off by saying thank you so much for all your wonderful reviews

and those of you that have left me comments on iTunes. I just greatly appreciate your thoughtfulness and how much you guys are in. enjoying these episodes. And it seems like you're enjoying them as much as I am enjoying doing them. One of the things that I've learned in just interacting with so many people is that we've really lost the art of deep conversations. And for me, the Resetter podcast stands for having meaningful conversations with people

who are thinking about health, about life, about mindset in a way that we may not be getting on social media or in mainstream media. And so I just want to say, give you guys a shout out and just say thank you for participating in this process with me. Because as much as I absolutely love delivering the information to you, I love even more knowing that it's impacting your life. So please let us know if there's anything we can do to make this podcast more customized to you, to make it better.

We are now officially in season two. and we are working to bring you the best conversations that health influencers have, that mindset changers can give, and to really deliver you something that you're not able to get anywhere else. So from the bottom of my heart, as I always say my YouTube, from the bottom of my heart, I am deeply appreciative of you. I am deeply grateful to be on this journey with you, and let's get healthy together.