Functional Medicine Meets IBD Care At Vanderbilt with Dr. Dawn Beaulieu

When your scope looks great but your day still falls apart, something’s missing. We sit down with Dr. Dawn Beaulieu, a Vanderbilt IBD specialist certified in functional medicine, to unpack a root-cause approach that complements biologics and brings relief where patients feel it most: sleep, fatigue, bowel consistency, and energy.

We get specific about what functional medicine actually is—science-based, holistic, and individualized—then trace how Dr. Beaulieu integrates it into a busy academic IBD center. From the “functional medicine tree” and Five Rs to team-based care with dietitians and social workers, she shows how nutrition, hydration, and nervous system training shift the gut-brain axis. We talk real-world food strategies that work for sensitive guts, why ultra-processed ingredients and dyes upset the microbiome, and how to ramp fiber without misery. She shares outcomes from Vanderbilt’s group programs, where patients improved quality-of-life, sleep, and fatigue in about twelve weeks, with some showing lower fecal calprotectin.

We also tackle supplements with nuance: which nutrients many IBD patients actually need, how to choose third‑party tested brands, and why you can’t out-supplement a bad diet. Dr. Beaulieu sets clear lines on when medication is essential for moderate to severe disease, then explores where GLP‑1 drugs may help overweight patients alongside standard care. Access matters too, so we highlight ways to find certified functional medicine providers, piece together a local team, and use tools like HRV training and Nerva to build daily resilience.

This is a grounded, empowering roadmap for anyone stuck between “remission” and “feeling well.” If the goal is fewer flares and more life, these are the levers you can pull today—without abandoning the therapies that work. Follow the show, share this episode with someone who needs a nudge toward better routines, and leave a review to help more people find the conversation.

Links: 

• Find a practitioner- Institute for Functional Medicine
• IBD Learning slides "Functional Medicine and Inflammatory Bowel Disease" with Dr. Beaulieu- Crohn's & Colitis Foundation USA
• Podcast with Dr. Beaulieu on FMP Essentials
• Podcast episode with Dr. Beaulieu on The Dr. Mark Hyman Show

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Transcript

Meet Dr. Bolio And Setup

SPEAKER_01 0:00

Hi, I'm Alicia.

SPEAKER_00 0:01

And I'm Robin.

SPEAKER_01 0:02

And you're listening to Bow Moments, the podcast sharing real talk about the realities of IPD. This week we talked to Dr. Don Boglio. Dr. Boglio is a professor of medicine in the division of gastroenterology, hepatology, and nutrition at Vanderbilt University Medical Center. She is a gastroenterologist with expertise in inflammatory bowel disease and is certified in functional medicine through the Institute for Functional Medicine. We talked to her all about what that is. We talked to her about what that is. What is functional medicine? How does she incorporate functional medicine into her practice with people living with inflammatory bowel disease? And how she has built an entire functional medicine team at Vanderbilt. This was such an interesting conversation, and we hope you learned just as much as we did. Cheers!

SPEAKER_00 0:51

Hi everybody, welcome to Bowel Moments. This is Robin.

SPEAKER_01 0:54

Hello everyone. This is Alicia, and we are absolutely delighted to welcome Dr. Don Bollio to the show. Dr. Bollio, we literally you've been on our list of guests to have on the show, I think, since we started this show five years ago. So we are real excited to have you on.

SPEAKER_02 1:11

Oh, well, I'm excited to be here. Thank you for thinking of me.

SPEAKER_01 1:15

Of course, yes. And everyone will understand why you were top of our list to come join us very, very soon. But our first very, very unprofessional question is what are you drinking?

SPEAKER_02 1:24

At this moment, I have water on my desk. But if I could choose what I could drink right now, it would be a French 75.

SPEAKER_01 1:31

Yes, my favorite. It's my favorite cocktail. It does look like you're still potentially at work. Is that correct? I am.

SPEAKER_02 1:37

I've scoped all day, and it was either I could make it home in time or potentially be late. And I didn't want to be late for you two. So I stayed at work.

SPEAKER_01 1:45

Out of curiosity, when you're done scoping, are like your hands tired? Like it feels like it's a fairly taxing thing.

SPEAKER_02 1:51

It is. We get a lot of like repetitive motion injuries over time. And so because the wheels and the buttons and things like that, and we're always doing really fine motor movements. And so, yes, depending upon how many scopes you have that day and how old you are, it does get taxing over time.

SPEAKER_01 2:08

All right. Well, now that I've asked that random question, Robin, what are you drinking?

SPEAKER_00 2:13

I have a Giridelli hot chocolate. I mean, even though it's not cold here, I really just, you know, it's the winter months and I want it to be in the spirit. What are you drinking, Alicia? I saw a fancy glass.

Why Choose IBD And What It Demands

SPEAKER_01 2:24

Yes, we had a lovely bottle of champagne in the fridge, and I opened it over the weekend, but only had a glass or two here and there. And so, which I feel very proud of, Robin. You everybody should really give me congratulations. More than a glass. But I'm very proud of it. So this was the last little bit of the bottle, and it is still sparkling. Cheers. Cheers, guys. Okay. Next question for you is what brought you to our IBD community? What made you want to specialize in inflammatory bowel disease?

SPEAKER_02 2:49

So, yeah, so I am an adult gastroenterologist that specializes in inflammatory bowel disease and I'm certified of functional medicine, which I'll love to talk about today. But I came into GI after starting my internal medicine residency. I wasn't sure what I wanted to do. And I kept getting IVD patients on my inpatient service like over and over again. It just seems like I kept getting patients that had Crohn's and ulcerclitis in my inpatient service when I was a resident. And so that kind of got me interested in it. I had a really strong mentor in medical college, Wisconsin at that time. And I just loved everything about it. I love GI because I like doing things with my hands, but I also wanted to take care of the patients in clinic and also be in the hospital. Really kind of drawn to autoimmune disease. So I was kind of like toying between allergy and GI. And I did a rotation in both, but I really just liked IBD. I wanted to do adult medicine, but I like the idea of taking care of patients throughout their life, you know, and so I didn't want it to see a patient one or two times and then never see them again. But yet I didn't want to be an internist. And so IBD gives you that kind of the best of both worlds where I get to take care of my patients forever because unfortunately we don't have a cure. And so my patients are stuck with me until I retire or they move away. And so, but then also I'm to the point where like my patients are getting older, and so I see some of their kids. I also do screening colonoscopies and other endoscopy procedures. And so I kind of get to see patients all the way from their 20s till their 90s. And, you know, with all these great medications that we have out now, we I really get to change people's lives, like make a huge impact. And that was important for me when I chose my specialty that I just really wanted to make a difference in people's lives. And, you know, IPT gives me the privilege of being able to do that.

SPEAKER_01 4:37

That's a lovely way of putting it. And I agree, I think there are some other variations of doctoring that perhaps don't have as many answers and tools to be able to offer. A nice way of thinking about it is like, how are you going to be changing somebody's life? So that's lovely.

SPEAKER_02 4:50

Yeah. And I realized for some reason I liked things complex. Like if things were too simple, it kind of bores me. And so the complexity of IBD also really fascinates me. The spectrum of IBD is huge, right? And if you've got Crohn's disease, you're not the same person that next to you has Crohn's disease, and the same thing with ulstracolitis. And so, you know, it depends on the severity of the disease. It depends where the disease is. And so I really try to educate people because then, you know, somebody'll be like, Well, I have got IBD and I can do this. And I'm like, Well, your IBD is not the same as her IBD over there. So, you know, it's one of those things that you can't really compare across the board.

SPEAKER_00 5:26

And it's actually refreshing to hear a doctor say that they love the complexity of it because so many people like me, like you get to a point where doctors don't know what to do with you. And and knowing that there's people out there that do love the complexity of it and are there to help the more complicated cases, it's refreshing to hear.

SPEAKER_01 5:46

Yes. So you mentioned that you are also a functional medicine specialist. And that is one of the reasons why Rob and I really were excited to get you on the show because I don't think a lot of people know what functional medicine is, number one. So that's question number one to answer. And also, there's not very many people that specialize in functional medicine that also do what you do. In fact, I think you said you're the only person in the United States, maybe the world that has both.

Defining Functional Medicine Clearly

SPEAKER_02 6:11

That is an IBD specialist and certified in functional medicine. Yes. I'm the only one that I know of. There might be someone else out there, but the IBD community, as you know, is pretty small. And so there are a couple a handful of other gastroenterologists in the country and in the world, I'm sure, that, you know, work in functional medicine, but I'm certified through the Institute of Functional Medicine. And so I kind of started so, you know, it's been 16 years that I've been in practice now at an academic medical center. And it was probably maybe like five or six years ago, like I was really in it, right? It'd been like 10 years, and like we have all these great medications. We had multiple mechanisms of action of biologics, and like patients were still coming to me in clinic and still feeling one, feeling terrible and in remission, right? So I'd be like, Look, your colonoscopy is all better. And then they would look at me and be like, Well, I still have diarrhea. I'm still having abdominal pain. And then I'd be like, Well, no, you're not supposed to. Look, you're all better, you know, or I would have tried multiple medications and nothing was getting them in remission because unfortunately, nothing that we have out there works a hundred percent of the time. And so there's a piece of the puzzle that we're missing. And so I was really frustrated trying to figure out like what else that I could do to help my patients because I wasn't taught a lot of nutrition or you know, diet information in residency or fellowship. You know, we were always taught that it doesn't matter what you eat. And we know in 2025 that it's completely the opposite of what's true. And so I really kind of wanted to figure out like what I could do to learn to help my patients. And so that's when I kind of went down that functional medicine journey and I found the Institute of Functional Medicine. And it took me about two years to go through all of the conferences and training and get certified and learn everything that I needed to learn to bring functional medicine back to the IBD center here at Vanderbilt University Medical Center. And so functional medicine isn't really new, it's not like a new branch of medicine, but it's kind of like a way of thinking on how to treat patients. And so it is a holistic science-based approach to care. And we're trying to understand the underlying dysfunction or the root cause of the problem versus just treating the symptoms. An easy way to think about it is not by Crohn's, but if you think about hypertension, right? So hypertension is if your blood pressure is elevated, if you go to a traditional physician and you come and you get your blood pressure elevated after multiple times, they say label you with hypertension, they give you a calcium channel blocker, they tell you to come back in six months, and then that's it. If you go to a physician who's using a more functional medicine approach to care, you may also get that calcium channel blocker, but they're going to figure out why did you develop hypertension? When did this start? What are you eating? How are you sleeping? You know, what's changed in your life? We look back pretty much to where before you were born and kind of look out your entire timeline to figure out like what happened along the way to derail your health. And so, in addition to that, like we try like try to tailor all our therapies like to an individualized approach. So we don't kind of do like a one size fits all model. So even though everybody that comes to us here at the center has IPT, everybody has a different story that's kind of led them to where they are right now. So we need to figure out like what's going on and how we make that better. And even though I'm a gastroenterologist as a functional medicine provider, I believe that like everything in our body is like interconnected, right? So I'm not just looking at your GI tract, like I'm looking at your brain and how is your brain affecting your GI tract? Like how are your hormones affecting your GI tract? And every bodily system, how that kind of comes together. And the basis of all of this is like rooted in like nutrition and lifestyle choices. And so really it's a huge part. And so when I learned everything I could about functional medicine, I just realized how impactful this could be to our patients with IVD and what we could do to try to bring that to like traditional IV care. So I'm not replacing, I'm not substituting conventional IVD care for functional medicine, but I'm using it as adjunct care to get patients to where they want to be.

Integrating Function With Conventional IBD Care

SPEAKER_01 10:13

I'm curious. So before you went to get this additional training and afterwards, what changed in your assessment? So say I'm a brand new patient, I walk in your door, I say I've been having diarrhea, I'm having all these symptoms, I think I have inflammatory bowel disease. What was your assessment like before? And what was added to that? What changed kind of as you were doing an initial assessment with somebody, a workup?

SPEAKER_02 10:33

Yeah, I wouldn't say that the assessment before changed, right? Because IVD, you know, we diagnose IVD by clinical symptoms, endoscopic findings, radiologic changes, lap, you know, and we all of that is come together for us to diagnose IVD. And so, you know, functional medicine is more of a chronic care model versus like an acute care. And so if someone's coming in a flare and they're sick, you know, we're going to use the traditional medicine to diagnose them. But using functional medicine, we're potentially, I'm not going to just say, okay, here you've got mild ulcer colitis, here's your misalamine medication. I will see you back in six months. You know, once your colonoscopy is normal, then I'll see you back once a year, right? So like I do a lot more, and my team does a lot more thinking about like what we can do in regards to diet and lifestyle and changing how a patient lives on a day-to-day basis. One, to help the medicines work better and two, improve their overall quality of life, right? And kind of like make sure that all these downstream ramifications that we have from IBD, like dysplasia, fatigue, anemia, extraintestinal manifestation, so we can try to control inflammation on all levels. Patients will often come to me and not want to be on medicine, but that really depends on the degree of severity of their IBD, right? Like if you're gonna come to me with fung with fishalizing perianal Crohn's disease and you've had two small ball resections, like there's not a supplement in the world that's gonna make that better, right? Like you can't just change your diet. Like you have to be on a medication, but you can also do other things to help decrease inflammation in your body and kind of like improve your overall life, right? And so I think that's one thing that was always missing from a gastroenterologist. And I'm very lucky to work in a center where we have dietitians and we have social workers that work as well as coordinators and psychologists and things like that. But, you know, we have to be able to educate patients on what they can do at home because you know, patients literally see us 20 minutes every three to six months, right? How you live on a day-to-day basis at home is way more impactful than what you do with us when you see us in the office. So for me as a functional medicine provider, I really want to educate my IVE patients on what they can do at home and what they have control of to make things better for them. And, you know, people are always like, well, how does this work? And so, you know, as humans, we have genes, right? And we're passed down genes by our parents, which predispose us for certain diseases, right? And so we can't change the genes that gave us that presented with IVD, right? But we can change the things that affect our genes. And the things that affect our genes are environment, so how we live, like so our lifestyle choices and our biochemistry is affected. And those choices are nutrition and diet. So really focusing on lifestyle and diet changes with patients in addition to medications, I think is really important for the treatment of IBD.

SPEAKER_00 13:32

You mentioned that you have a team. Is there anybody else on your team that is also a functional practitioner? Has anybody else gone through the training with you?

SPEAKER_02 13:40

Yes, so I have two other advanced practice providers that are certified in functional medicine through the Institute of Functional Medicine and they support the program. I have two dietitians that work on the inflammatory bowel disease side, but then I've also had some training in functional nutrition. And then we have two now three social workers that work as wellness coordinators and do a lot of our kind of nervous system work. Patients with IBD, I've learned over time, are really affected by their brain, right? And so this vagus nerve work that we just don't really do. And so I we use our wellness coordinators to really work on that. So we focus on, we figure out what the patient needs. And so, for example, like we'll do heart rate variability, and so we do heart math to try to do that. We do a lot of breathing. One of our social workers is trained in yoga nidra. And so we do this kind of like multi approach where we have our functional medicine providers, we've got our dietitians, we've got our wellness mind, body, health coordinators to really work every aspect of the patient's life because that's really what you need when you're taking care of IBD.

SPEAKER_01 14:46

That's so cool. I love that so much. Like I want to know more about. I'm sorry, I'm a social worker. So I mean me like, tell me more about this. That sounds amazing. It reminds me too of a little bit of our conversation with uh Dr. Ali Navidi with GI Psychology, who was talking about disorders of gut-brain interaction, exactly what you're talking about, that sort of vagus nerve dysfunction that can happen and that can short circuit that they're having symptoms when perhaps their disease is in remission, but they're still experiencing symptoms of disease. And so that was that was a really fascinating conversation.

Building A Multidisciplinary FM Team

SPEAKER_02 15:17

Right? Like you don't realize like what you're thinking and how you're doing really affects your microbiome, and your microbiome is already kind of dysfunctional because of your underlying IBD. And so you really need to work on that. I mean, the majority of our neurotransmitters are like made in our gut, right? Which is affecting our brain. And so you don't really even think about a lot of that. And so for us, I think, you know, we have a good cohort of IBD patients that respond to medications but still feel poorly. And the answer to that is not to add more medications on top of that, right? Like, so you're gonna add your pain medicine on top of that and your benzo for the anxiety and your sleep medicine to go to sleep, right? And so in our society, we are so prone to just try to take a pill to fix whatever's going on, and then but you're not really fixing the root cause of the problem. And so functional medicine is all about trying to come about this puzzle of this human, right? And getting to the root cause of the problem. So if people aren't sleeping, why are you not sleeping? Right. If you aren't eating properly, why are you not eating properly? I mean, even little things like how you treat your food, we talk to patients about, you know, the relationships that you live every day, like a lot of people aren't getting better because they have a toxic relationship at home, which is driving all the stress and the anxiety and affecting your gut. And people are like, oh, it's just, you know, IBS or it's just in your gut. It's like, really, no, this is really affecting your microbiome. This isn't checked, you know, affecting the permeability in your gut, which is allowing things to go back and forth that aren't supposed to go back and forth. And so now you're super, you know, sensitive to all of these different foods. And so you can't eat this and you can't eat that. But, you know, again, like just trying to figure out the root cause of the problem and figuring out like which individual, what each person needs. And for me, also, I think patients often come and they just feel really helpless when they're given this diagnosis, like you've got IBD or you've got MS, and you just feel like your life is over and there's nothing that you can do, and everything is being done to you. And I really think that, you know, working with a functional medicine provider or using functional medicine techniques really takes back some of that power, right? Like, you know, I'm like there are things you can do, like you are doing things that are making yourself not well. So let's fix that. Like you have to take some responsibility and change what you're doing on a day-to-day basis. And it's hard, it's much harder than taking a pill or getting an infusion or taking a shot, right? This is something that we all have to work on that I work on and struggle with on a day-to-day basis.

SPEAKER_01 17:45

For sure. Yeah, I think that's a really important point. And I I have said that before as well. Like the more opportunities we have to give people a chance to make decisions on their own and to take pieces of power back in a system, especially our healthcare system, that basically disempowers people on a daily basis. I think the more that we're going to see improvement in people just because they're able to take more power and control within their disease state.

SPEAKER_02 18:08

So in this day and age, we can't just treat one thing. Like we can't just say, okay, well, we're gonna treat you with this biologic, which is gonna decrease inflammation in your gut without just working on every other system that we have in our body, right? Because it just doesn't work that way. Like the food that we eat, the air that we breathe, how we sleep, whether we do or don't exercise, like all of that affects our microbiome. I also find that fascinating, right? That's another reason why I like functional medicine. Like I'm fascinated by how relationships can affect your microbiome, right? Like the fact that, you know, I think there was like one Harvard study that showed that like if you have friends that are overweight and obese, like you're more likely to be overweight than if your family's overweight. Like, so it's like the relationships that you surround yourself, like, you know, like your our genes talk to each other, you know, even in close proximity. And so that's why it's so important to have a great support system within a disease like IBD, right? Or any autoimmune disease. Like you need your tribe, you need your support system for so many different reasons. And so, like, loneliness is a huge epidemic here in our country right now. I mean, it's so sad when I have patients who don't have anyone to bring them to their colonoscopy. Like, to me, that's like one of the saddest things, where it's like you don't have one person that can come with you for your colonoscopy and sit there for an hour, and people don't, right? And so that is also very impactful to your disease and how you feel and your overall health, right? And so all of these different things, and we don't think about that as patients a lot of times, like how all these different things are interacting our body and our health and our brain.

SPEAKER_00 19:47

Leach and I were just talking about just with our last interview. I mean, it people are lonely, but this disease is also isolating. Like for somebody like me who's had a pretty rocky road and has required like actual caregiving, you get to a point where you're like, you know, I'm just gonna drive my doctor's three hours away from me. I live pretty rural. I'm just gonna drive my three hours to my scope and get a hotel room and get a hotel room close to the hospital in Uber because I am not gonna inconvenience somebody I love one more time because it has been such a rocky road since 2020. So there's also that element of like, how much more can I put on the people around me? So it's the disease is isolating, the world has changed, and more people are alone and by themselves than ever before. And also like, I don't want to ask one more time. So it's kind of like the I feel like we've heard that from other people too.

Brain–Gut Axis And Nervous System Work

SPEAKER_02 20:41

Yeah, no, I mean that's a that's a real thing. But then also you need to realize like, think about how many times that you've helped other people, right? And how much you've put yourself out there and deaf things. And so, like, people will want to reciprocate that, right? They'll want to be there for you because then that way when they need somebody, they know you will be there for them, right? And so it's a two-your right. I get it. Like you're like, oh, I can do it. I just want to be able to do it by myself, but you just can't, right? And so, but you have to be that person to show up for the other person when you can't and be their support system. But like it's interesting to see for me, like when I have patients that sometimes just can't get in remission or can't feel better. Uh, there's a lot of something that's going on at home. And for me to figure out what that is so they can realize what it is and make that better, right? Because sometimes they don't realize what they're doing or who they're surrounding themselves. You know, sometimes I always say, like, you know, sometimes you have friends when you get around them and they just give you so much energy, right? Like when you're with your friend, it doesn't matter if you're tired or you're sometimes your spouse, sometimes, you know, and then you just have a lot of energy and you're like, oh my gosh, you're driving me, right? And then there's other family and friends that you have, like, and they just suck the life out of you, right? Like they're just literally like a dementor and they just Suck it out and then you just want to go to sleep, right? And so, like, that's how being around other people can kind of affect your vibe and how you're feeling. So you need to surround yourself with positive energy and people that kind of lift you up and give you that power versus suck you out, right? Just the same way as like when you go home, you don't want to stop by certain fast food restaurants just because you're hungry, right? Because that is going to not be good for your gut versus like going home, making your food. And so talking about diet and talking about nutrition is also very important for patients with IBD and from a functional medicine approach because a lot of times we don't realize there's certain foods that we're eating that are triggering our symptoms. And so, you know, figuring out that journey by trying to figure out which foods are triggering your symptoms is also really important in the trying to do that. And then also for IBD, like, you know, we use food as medicine. And so trying to educate people on being like, okay, like these are the foods that you need to be eating. You know, if you ask people how many fruits and vegetables they eat a day, they'll sometimes say zero or one. And then for IBD patients, it gets even a little trickier because we can't eat a lot of fruits and vegetables, right? And so trying to figure that out with the diet, the help of the dietitian, like how to get that fiber in your diet. So we're kind of getting it from all different angles, trying to like figure it out.

SPEAKER_01 23:18

Since you're talking about how like you're helping people look at the sort of everything that surrounds them, including potential energy vampires. Have you ever told somebody maybe you should get divorced?

SPEAKER_02 23:30

Well, as a provider, I don't think that's anything that we say you must leave your spouse, but we definitely try to get them to reflect on what's going on. And I have had patients that have left their partner and gotten better. I I mean, but yeah, I mean you have a lot of self-reflection, right? And so, like trying to figure out like what is going on in your internal life, external life, and like what triggered things to happen. You'd be surprised if you look back at like someone's timeline and we really dissect what's happened throughout their whole life. There are certain moments in your life that will trigger specifically a lot of times like autoimmune diseases, like some kind of stressful, traumatic event, some kind of crazy infection or severe infection, right? Like that is very common for IBD and for all autoimmune diseases. And so you can trace that back if you really think about what's gone on and do like a deep dive, like what we call your story or your timeline.

SPEAKER_01 24:36

It is really fascinating. And it's just even if this wasn't helpful to their actual like care, which it it obviously is, even just thinking about a person as a holistic person and getting that timeline of and learning about their life, I think would just be helpful for you as a provider to be able to say, how am I treating this person as a whole person, not just, you know, as the person living with inflammatory bowel disease? I think that's a beautiful way of looking at it, but it's especially helpful in this case. So that's awesome. So the dietitians you have working with you, sounds like there's training that goes along with this, and diet is a big component of this. Is this something that sort of naturally gets folded into dietetic type programs, or is there additional training dietitians can go through in order to get this additional piece to be able to layer into that?

Food As Medicine And Realistic Nutrition

SPEAKER_02 25:18

Yeah, so there's additional training that dietitians can go through to learn more about a functional medicine approach to nutrition. So, like the Institute of Functional Medicine has the training courses. There's one of my dietitians that we had before, she got her master's in functional nutrition. And so there's master's programs out there for dietitians. There's through like a forum. So different other formats online, yes, you can definitely get additional training. They don't really treat this in nutrition from like basic nutrition. I think as a whole, they're coming around to it more, right? Because like when you think about the old school dietitian, and I'm not trained in this, so if I misspeak and I offend anyone, I'm so sorry. But like they are real big about the plate, right? Like, here's your plate, and then here's where your carbs go, and here goes where your protein goes, and you need this. And that, you know, when I first started 15 years ago, the nutrition dietitians would talk about like, okay, you need bread. And I'm like, who needs bread? Nobody needs bread from the grocery store, you know? And I'm like, you need protein, you need vegetables, you need fruit, you know, and so they were big about that kind of like plate situation. And so I think they've moved they're moving away from that. And so for our IBD patients, like a lot of times we focus basically on like the big pictures, like the Mediterranean diet, right? So Mediterranean diet is what we like to encourage people to do. And then if they have the ability and they're not sick, that they need to have a very specific, you know, caloric intake or a nutrition intake, then we will do some different nutrition diet changes to kind of investigate like if what to identify like what their triggers are. But for you have to meet patients where they are, right? Like if they I live in the south, so they often will come into my office with a giant big bulb filled with soda and a bag from a fast food restaurant. And so my patients that know me well will sometimes will just do that just to trigger me, and just then they just start laughing when I'm staring at their soda. And I was like, You what did and then they start laughing because they know it's like one of my big kicks. I'm like, Can you just drink some water? Just drink water, and so really easy things that people are always like, Well, what can I do? I was just like, you know, water. You need to drink water. Most of us, a lot of us will not drink enough water in the day. And so, really drinking, you need to hydrate your cells. And so, replacing soda with that. I truly believe that IPD patients are very sensitive to any kind of processed food and fillers and artificial dyes and artificial colors. And you really need to kind of get that out of your diet. And those are simple things to do. But you would be surprised at how much we eat that's processed and full of artificial dyes and fillers and artificial colors. And all of that is very triggering to dysbiosis and affects your microbiome. And I think for IVD patients, it affects it potentially even more than someone who doesn't have IVD. So, really eating whole foods and cooking your food, going to the grocery store, eating organic when you can, but if you can't or it's too expensive, that's okay. But just really learning to cook your food. And we also educate patients like when they go to the grocery store, like try not to go to the middle of the grocery store because that's where all the bad, fun, colorful stuff is, but that's where all the processed food and fillers and dyes are. So you want to you want to shop the outside of the grocery store because that's where the vegetables and the fruit and the whole foods are. So we would work a lot with patients just starting there, getting them to a point where they're cooking their food at home. You know, of course, we're gonna eat out every once in a while. Of course, it's okay to have a soda or a French 75, right? But it's just not something that you want to do on a daily basis and you want to try to focus on how you're going to, you know, use food as medicine to repair your gut, because food can actually repair your gut, right? So the phytonutrients that are in our foods have like positive properties on our gut. And if you ask patients how many fruits and vegetables they're eating a day, you know, the recommendations are like seven to eight. And if you think about how many fruits and vegetables you ate today, I did not eat seven or eight.

SPEAKER_00 29:24

But I hear you say seven or eight, and I'm like, that is so much food. Like, could I eat that much?

SPEAKER_01 29:30

Yeah, we're talking about servings. So, like a serving of blueberries is not what I'm eating. I'm eating an entire large pack of it on my own. And that's probably not what you should be doing. A serving is like what, like a cup, right?

SPEAKER_02 29:41

Yeah, and the next thing you do, you're messaging me that your poop is black and I'll ask you how many bags of blueberries did you eat today?

SPEAKER_01 29:50

I I probably won't send you that message, but you know, now now that I know I can, maybe I will. And we just got into an interesting discussion with friend of the show, Stacey Collins, who is a dietitian that specializes in inflammatory ball disease, in thinking about working with patients, especially patients that come from diverse economic backgrounds, that like, how do you how are we working with these folks to help get what they need out of, you know, the grocery store, which especially price is increasing and increasing every single day because of lots of reasons. And so I do think I'm sure there's education that your folks do around like, okay, this is how you add to your diet, but in a way that potentially is also not gonna hurt you too much in the wallet category.

SPEAKER_02 30:27

Definitely, yes, we do a lot. My dietitians are great, like Julia and Sydney. Like they will go through and they've made handouts of things that you can get at like Aldi and Walmart and like grocery stores here around town that are, you know, that are options that patients can refer back to when they don't know what to eat or they don't know what to go by. We'll provide people with a lot of food plans and ideas of recipes and things for them to meet. So then that way they can, you know, start doing it on their own.

SPEAKER_00 30:54

One patient ed event, this is a long time ago. The dietitians did like a grocery store tour as like their education program. Like it was so great. I love that so much at Vanderbutton. I don't know if anybody is still doing those kind of programming, but I really thought that was so beneficial for the patients who were there, like to really just go through what to look for, where to shop, good substitutions. It was a really great program.

SPEAKER_01 31:19

I just think about the fact that like child of the seven late 70s, early 80s, right here. And like, you know, my mom worked and also I grew up in North Dakota where there's just not a lot of food variety in general, it feels like. And so, like, there's definitely stuff that like I don't know how to cook because I've never had it. And so I always get excited and I buy stuff and I'm like, what the hell do I do with this okra? Like, what? So it sits in my fridge and goes bad. And so I definitely think there's like probably a whole education that could be done around just like here's a new food to you. How do you actually do anything with this? Because I literally went to the farmer's market this past weekend, was like, look at all these pumpkins and gourds. And I came home with five of them. I don't know what to do with them. I don't have any idea. So what is wrong with me? Why did I do this to myself? And yet now I've got, and you know what's happening? My husband's going to get tacos tonight. We're not even eating any of these.

SPEAKER_02 32:06

Well, they're probably really pretty.

SPEAKER_01 32:08

You can put them in a bowl, they could be decoration. I know, but I want to eat them. I want to figure out how to eat them. It's just like now I have to go on the internet and figure it out, which means I'm too lazy to actually do this.

SPEAKER_02 32:16

Whatever AIU is your AI of choice, you literally need to stay in there, I have this many gourds and pumpkins. Give me a recipe that's less than five ingredients that I can make for dinner.

SPEAKER_01 32:26

Question getting getting back to actual discussions here. One of the things I mentioned to you is as I was researching your research, you have a whole paper on how functional medicine can assist people in things like quality of life and sleep and fatigue. So I'm curious, talk to us about that study. And are there some simple takeaways that are just kind of universal for folks with inflammatory ball disease? Or does it like it has to get folded into the actual assessment and kind of bigger picture of each individual person?

Study Results: Sleep, Fatigue, QoL Gains

SPEAKER_02 32:54

Yeah. So in 2019, we started using functional medicine as adjunct care to our IVD care here at Vanderbilt. So patients that were wanting to do functional medicine, they could enroll in these functional medicine programs. And at the time they were share group programs, and so patients with IVD would come together, and this was pre-COVID, and so they would be together in a room. Once COVID hit, we shifted to telehealth. And so we all did this through share group visits online, like a Zoom platform. And so they met every two weeks for anywhere between five to seven sessions, depending upon what the program was. And we went through a very standard education in that paper that I wrote about. We went through a very standard education of working on lifestyle factor modifications and we did a group elimination diet together. And so we did a group elimination diet where we eliminated like the most allergenic foods for four weeks, and then we reintroduced those foods every two days to see if we could identify food triggers. And then in addition to that, every time we met, we focused and educated on what we call the base of the functional medicine tree. So our functional medicine tree is this kind of picture a human as a tree, right? So the leaves and the branches are your organ systems and things like that. And the roots of the tree are what strengthen the tree and keep you strong. And so the roots of the tree are nutrition, relationships, exercise, sleep. So those kind of things. And so every time we focused on teaching patients about that. And so when we did that, we would also record their patient-reported outcomes to see how they did over the six-week time period. Oh, stress. Stress is the other one. Well, by doing that, we focused on that over like six to eight weeks and we tracked people over time. And by doing that, by the time we got to the end of the program, we looked at their patient-reported outcomes and we saw that their fatigue, their quality of life, and their sleep scores all improved in literally just like six short sessions, so like 12 weeks. And so to me, that kind of proves like how impactful like changing your diet and then also focusing on your sleep, your exercise, your stress, and your relationships and nutrition can affect your overall health. And that was what that paper was kind of like the first proof of concept, because I really didn't know what was going to happen. Like I literally was like, okay, let's do this and let's see what happens to how you feel. And I would tell patients, I'm like, you are we you are the first ones going through this. I have no idea what's gonna happen at the end. Hopefully you won't feel worse, but I'm betting you're gonna feel better. And literally every single person that started the program from start to finish felt better. And so it wasn't, and so then I'm like, okay, maybe that was a fluke and let's try it again. And so by then COVID hit. So then we shifted to share group visits, and it actually worked even better because in a virtual share group visit, you can be do this from your home, right? So coming to clinic every two weeks for six sessions is a lot of dedicated time. And so that's really not an option for a lot of people. So when we were able to pivot to a Zoom model, like patients were able to take do this during their lunch break when we had lunch sessions. They would do this sometimes. We do a five o'clock session and they could do it after work. And so that way it was able to like reach a lot more people. And so we've been doing it now since 2019 uh with our IV patients, and I've seen a lot of good come from all of it. A couple of years ago, I looked and I was wanting to see if their fecal cow protectant, which is their stool protein that reflects inflammation in their gut. I'm like, I know people are feeling better at the end of the 12 weeks, but are things changing in regards to their inflammation? And people's fecal cow is actually decreasing in that short amount of time by just changing your diet and your lifestyle. Now, whether that persists over time, I don't know yet, right? But I know from that initial session, by you know, doing what we do, we can actually change things from you know an inflammation level, and you're decreasing inflammation by changing your diet and changing your lifestyle. So for me, that proves that like doing this can you are actually helping, you know, your IVD. In addition to taking your medications, you can be working things at all fronts to try to decrease inflammation in your gut.

SPEAKER_01 37:09

Okay, so question about that. As you've been looking at the data, I know one of the things that came up, gosh, what it was a recent conversation we had. We got talking about like just the number of times that people get up to go to the bathroom at night and about how that affects sleep quality. I mean, Robin had talked about, like, you know, I got up X number of times and I was exhausted with her answer, quite frankly. So I'm curious, when you were going through this training with folks, you're looking at inflammation, but were you also looking at something like sleep hygiene?

Inflammation, Permeability, And The Five Rs

SPEAKER_02 37:37

Yeah, so we focus on sleep hygiene a lot, but you by by decreasing inflammation, people that were constipated would start pooping again, right? People that had a lot of loose stool, their stern their stools would form up. I've had patients tell me, be like, this is the first time I've had a solid bowel movement in my entire life, and their disease is in remission. So they should be having formed bowel movements, but but it's not that easy. So I think for a lot of IVE patients, and just because you're in remission, that doesn't mean you're asymptomatic. And so we have to figure out like why are you still having symptoms?

SPEAKER_01 38:10

Right. So it was that you saw also like for those folks that might have been like having to get up multiple times a night because of needing to have a bowel movement, those decreased because the inflammation also reduced. And that in addition to also teaching people how to be better about, you know, getting themselves prepared to go to sleep, probably also helps. Okay, interesting.

SPEAKER_02 38:26

Right, yeah. And if they were in remission and they didn't have significant inflammation, you can still have like increased intestinal permeability, right? And the foods that you're eating. And so we go through this whole program of like, you know, removing there's this thing called the five R. So we it's like a little kind of roadmap that we follow, but we want to remove any kind of triggers. And so that remove can be nutrition, like certain things people are eating if it's certain stressful situations, that kind of stuff. And then we want to replace with good things, and so we'll be replacing with good nutrition. And I think a lot of times when people have a lot of symptoms and are in remission, it has a lot to do with diet and lifestyle. When patients have active disease, diet and lifestyle can help decrease inflammation, but that's not the only thing that you need in moderate to severe disease. If you've got very mild disease, a lot of times we can get things better with diet and lifestyle and certain supplements. But if you have moderate to severe disease, that's like one of the first things I say. Like, this is not gonna be your be all end all. Like you need medicine and you have to be okay with that. And when people are not okay with that, that's another thing that we have to do a deep dive on. Like, why are you not okay with taking medicine? You know, you're okay with coming in with 10 bottles of supplements where you don't even know where that came from, but you don't want to take a medication that's been tested for the past 20 years. So there's there's something to, you know, get to the bottom of that mentality also.

SPEAKER_01 39:47

I'm glad you brought that up because that was going to be my next question. Is those folks that do come in that are are so adamant that they only want to do stuff that's quote unquote natural. And like you said, they come up with, you know, 20 supplement bottles. When somebody is in that case and and they're they really think that the supplements are going to be the answer, how are you working with them on like the supplements they are choosing? Because I'm sure there are supplements that can be extremely helpful to folks. Like you said, I'm sure there's a conversation to be had with people about when medication is needing to be used specifically because they're in just such a state of you know inflammation. But how are you guiding people into finding supplements that are safer and more effective and are more regulated, I guess?

Supplements, Safety, And When Meds Are Essential

SPEAKER_02 40:25

So yeah, so I mean, those lots of questions rolled into one. You're welcome. So yeah, so for me, I I do love supplements as the functional medicine provider. Like I will use supplements, but the first thing I always tell people is that you cannot out-supplement a bad diet. Like you cannot take supplements to replace your bad diet. So that's typically where we start with first. If patients aren't doing what they need to do from a nutrition standpoint, like we don't even talk about supplements because, you know, again, you cannot out-supplement a bad diet and you can't over-medicate a bad lifestyle, right? Like you can over-medicate a bad lifestyle. So, like all of these things you need to work on, right? If you want to use supplements or if I feel supplements would be a good thing to add to your care plan, if patients can afford it, I prefer recommending supplements that are practitioner prescribed. And so, you know, there are ones, there's certain companies out there that do testing on their own supplements and things like that. And they're the bigger companies where you either have to be a physician to prescribe them or you can get them through other, you know, avenues and online supplement providers and sites and things. Yeah, just making sure that they're reputable brands. And when I work with patients, like if they can't afford this, then we'll try to find an over-the-counter one that I know is like a reputable brand to replace whatever that I'm needing for them to have. From a nutritional standpoint, most IBD patients need some kind of vitamin D supplementation. They need a good multivitamin. A lot of patients with small bowchrooms need vitamin B and B12 supplementation. You know, so those are things that are part of our overall daily regimen that I work on across the board with patients. Like vitamin D is huge for immune health, right? And every IBD patient has low vitamin D. So really normalizing your vitamin D is one thing that you can do. And patients just don't take their vitamin D every day. So really doing that, you know, B12 and vitamin B, like we need these for our brain. If you're not getting enough vitamin B12, like that can affect your brain and your nerves and your nervous system. And so that's something that needs to be addressed in addition to like iron. You know, if you're bleeding or if you're not absorbing your food, your iron's going to be low. And so you need iron to make blood and other pathways in our body. And so these are things that I always focus on across the board with IVD patients, and we often need supplements for that. So I make sure that the ones that I recommend have either internal testing or third-party testing and are reputable companies. And there's a number of ones out there. For patients that want to just use supplements for their IVD care, we really have a conversation on is that even a viable option for you? And if it is for the patient, then we negotiate a plan that we're gonna try a, you know, a functional medicine only approach for the next six months. And then if things are not better, then they agree to start a medication. But there's a certain subset of patients that that does not work on. And I am just very upfront with patients. And if they push back, I just say I'm not the doctor for you because I'm not gonna watch you hurt yourself. So, you know, severe pan ultra colitis, like you're not gonna get better on a supplement right away. You need a medicine, right? Fistalizing Crohn's disease, perianal Crohn's disease, upper GI tract Crohn's disease, all of those phenotypes of IVE patients need to be on a medication. You're not gonna get away with just diet and lifestyle change in and adding a supplement or multiple supplements. So, really educating people up front. And I think when you do that, they understand. I mean, I would say 99.9% of people understand that. And they're like, okay, I get it. And so there's definitely different other like herbal. And like curcumin is a great supplement, L-glutamine, aloe ver, like for upper GI stuff, like licorice. And there's multiple things out there that we can use to help supplement what patients are doing on a day-to-day basis if they're willing to also work on that base of the tree.

SPEAKER_01 44:15

Super helpful information. Thank you. And also I'm going to give everybody the caveat that just because you said any of this out loud, it doesn't mean that people should start willy-nilly doing any of it without talking to their doctors.

SPEAKER_02 44:26

Correct. Because you don't know the medicines out here. Yes, for sure. Yes. I mean, a supplement is not, you know, you can overdose on certain vitamins, right? And so just because it's available over the counter might not be the right thing for you. And especially if you've got inflammatory bowel disease, it's you're it's very complicated. And you also don't want to be wasting money and flushing it down the toilet for something that's not either good for you or something that's not going to be beneficial for your disease. So you need to have a plan.

SPEAKER_00 44:54

Over supplementation can also affect your liver if you're doing this willy-nilly. Yeah. We check you.

SPEAKER_02 44:59

I mean, we got to be monitoring your liver functions if you're on a lot of supplements. You need to be checking your vitamin levels if you're taking vitamin supplements. So all of that needs to be monitored.

SPEAKER_00 45:09

My husband saw me like filling up my little pillbox this last week with like all of my bottles of supplements. And he's like, Are those all vitamins? I'm like, yes, these are all vitamins, babe. My dietitian and my GI have prescribed me all of these. And then when we check my blood, if something changes, then I can get to take one away. But right now I have everything that you mentioned: iron, vitamin D, vitamin B12, vitamin B1, thiamine, folic acid because I'm on methotrexate. And I don't know, there's like five or six vitamins that I'm on, but we're do my blood work like every three to six months to make sure that I still need them. And I used to be on higher doses of vitamin D, like a lot higher doses of vitamin D. And now I'm able to do like over-the-counter vitamin D because I don't need the higher doses. So that's great. I used to have to have iron infusions, and now I can just do over-the-counter iron. So like you just have to make sure that you're checking your blood levels to make sure that you're taking the right amounts of the supplements. And also, I can't say this loud enough, but reiterating what Dr. Dawn said, you can't supplement your way out of a uh out of a bad diet. Like you have to be able to, you should try to do food first. You should always try to do food first.

SPEAKER_02 46:15

Yes. But it's hard because, like I said, like it's really, you know, we need fiber to feed the good bacteria in your gut, and patients with IBD can't tolerate a lot of fiber. So I think that's where if you are working on nutrition, like I use I don't like the over-the-counter fiber supplements, but there's other things that you can kind of use to help focus on like gut healing blends to try to help the inflammation in your GI tract.

SPEAKER_01 46:40

A lot of times fibrous things are also more difficult for our folks to digest. And so when you are working with somebody to get additional fiber within their diet, and uh, you know, is there any ideas?

SPEAKER_02 46:51

Good question. This is something that I'm always searching for. So yeah, there are some supplements that are a little bit easier on your GI tract. Like one of them is a rabinogalactan, which is like a large bark supplement. For IVD patients, it's a little bit harder because any kind of fiber often will cause bloating. So we start really slow. And for me, again, like taking out the processed food, taking out this, and just doing that for food first, whole food approach, and then kind of see where we are and slowly, slowly increase. You know, maybe not people are like, I want to eat a salad. I'm like, you can eat a salad, but maybe just not the giant bowl of salad, you know, maybe you can just eat a tiny bit of salad for now and work your way up to the bowl of salad. But the problem is, is they'll be like, oh, I want salad, and they'll eat the entire bowl. You have a terrible night, you're up all night having diarrhea or vomiting, and then you're like, I'm not touching that salad ever again. And I'm like, I literally just wanted you to eat two pieces of kale. That's it. If you ate an entire bowl of kale.

Fiber Tolerance And Gentle Strategies

SPEAKER_01 47:49

Okay, this is a this is a big can of worms, though. With the rise of GLP1s and research that's showing that there are some additional benefits to folks in addition to weight loss. So that you know, there's the weight loss side of things, and there's, you know, it can be helpful with people who potentially have diabetes issues, but there are some additional sort of information that's coming out around how it may be helpful for some folks about inflammatory bowel disease or other autoimmune conditions. When somebody walks in the door, how are you layering in that conversation around a GLP one in addition to how this is going to work within a functional medicine lens?

SPEAKER_02 48:22

So patients are usually the one to bring it up. I'm usually not the one to talk about it. They're usually having the conversation with their primary care provider or a different provider, and then asking me if it's okay for them to take with their inflammatory valve disease. And so my take on it is if patients are overweight and they have some sort of comorbid condition, or if they're just overweight, I just say go for it because we don't know any reason for them not to. There's a clinical trial coming out, and I can't remember which company were their targeting a GLP1 with a biologic to kind of see if that helps, like optimizes the biologic and they get better outcomes. And so I've seen a lot of my patients who were overweight do so much better on a GLP1. And whether that's decreasing inflammation or just the symptomatic side effects of it that's helping, I'm not really sure. I can't say that it's decreasing inflammation because we haven't had a clinical trial from a GI standpoint, but I know, you know, it's we know it causes your gut to slow down. So if patients are having a lot of diarrhea, they will decrease having diarrhea, right? And so that's great. If patients are morbidly obese and they have perianal disease, like taking that pressure off their bottom with them losing weight, they do a lot better. When they're losing weight, some of the medications, you know, the doses of the medications because their drug level is getting higher, because maybe they've lost a significant amount of weight. So I think there's it's multifactorial what it can do for a patient, but I'm completely open to it. I don't prescribe it because it's outside of my scope of expertise and I don't know enough about it to prescribe it. But if I have a patient who's overweight and wants to try it, then I definitely don't discourage them. And then I am excited to see how it's gonna affect them. If patients are underweight, then definitely no, because I do not want them losing any weight whatsoever.

SPEAKER_01 50:09

No, I do worry about that just because I know in just conversations with our dietitian friends, but also like patients about how like RFID, the like disordered eating that can potentially can come along with being affected by food, being hurt by food because of your disease, you know, you and then use, you know, this is making people, you know, lose their appetite. I feel like there's real potential for there to be some psychological sort of ramifications to this or just nutritional ramifications, because we're already talking about a group of folks that like, you know, it's it's painful to eat, you know, you're already averse to eating, and now you like all of a sudden your body's like, you don't have to eat, you're you're cool. So it just feels like there's a potential for that to really cause a lot of pain.

SPEAKER_02 50:47

If that's the case, like the provider that recommended would know that and not recommend it, right? So if anybody has any kind of disordered eating or restricted eating patterns, we never talk about elimination diets or removing certain things from their food. We just want them to eat, right? But we might focus on if they're eating a lot of processed food or fast food and try to figure out how to like move patients away from that. When you talk about like functional medicine elimination diets or changing diets, like we never restrict people's calories. It's never about caloric restriction. A lot of times people will lose weight because they're removing the bad things that they shouldn't be eating in the first place. Um, but we really focus on more kind of like the quality of the food. And if the quality is good, you can eat as much of it as you want to, right? Because it's not going to affect you in that way. But I do think I think GLPs will have a place definitely for our patients that are overweight and if they have IBD and I have patients that feel better and they say that I they feel great, and I'm like, great, love it.

GLP‑1s: Where They May Fit

SPEAKER_01 51:45

If people are not as fortunate to be able to be able to see you at Vanderbilt, are there any tools that you know of for patients that might be able for them to be contemplating their functional medicine on their own that they can then also take to their provider to say, but I did this, you know, I I kind of did my functional medicine chart. Here's what you need to know.

SPEAKER_02 52:04

Yeah, I mean, there's definitely lots of functional medicine providers like in the community and around the world. And so you can look to see if there's anybody in your community that's certified or has training in functional medicine and see if that person can work with your gastroenterologist to try to figure out a great plan for you. Unfortunately, a lot of functional medicine providers are out-of-pocket costs and they don't take insurance. One of my missions is to bring functional medicine under an insurance-based model. And so there's not a lot of opportunities for that in the country. Unfortunately, a lot of people have to get their knowledge in like great podcasts like this or do their own reading. So there's a lot of things online for people to read. But I think piecing together just different multidisciplinary providers to be part of your care team. If you don't have like a one-stop shop, like find that dietitian in the community that really kind of knows what they're talking about, find a social worker or wellness coordinator or somebody to kind of help work with that mind-body nervous system regulation thing that you need to focus on and piece together your care team to get what you need, because unfortunately there's not. There's a lot of great apps out there that you can get on your phone to help with nervous system support. I've started using Nerva a lot for my patients and have started to have a lot of great outcomes. And there's things like that that you can, there's a lot of nervous system regulation and heart rate variability tools and breathing and yoga and meditation that you can use and learn locally and on your own. But unfortunately, there's not a lot of insurance-based functional medicine care out there yet. But I'm on a mission.

SPEAKER_01 53:39

If somebody were looking for a functional medicine provider, does the Institute for Functional Medicine have like a search tool?

SPEAKER_02 53:46

Yes, they do. If you go to the Institute of Functional Medicine, you can find a certified provider near you and put in your zip code and it'll pull up different providers. So to be certified in functional medicine, you don't have to be a medical doctor. You can be like an osteopathic physician, you can be a chiropractor, you can be a dietitian. And so there are other providers out there that can be have a functional medicine background and not be medical doctors.

SPEAKER_00 54:12

Thank you so much for joining us today. Like Alicia said at the beginning, we you have been on our list since day one, and we finally were able to track you down and get you on the show. We appreciate it. But it is time, unfortunately, for me to ask you the last question. And that is what is the one thing that you want the IBD community to know?

SPEAKER_02 54:28

I think right now, after the conversation we have, what I would say is that you have the power to make change and that you can do whatever you want. You know, you have the strength and the power within you to do whatever you want to do, and you can make change in your life and take back power from this disease that lives with you 24-7. And that as a physician, I'm out here rooting for my patients every day. And that if you don't have someone like that in your corner, then you need to find somebody.

SPEAKER_00 55:00

Snapped to that. We talk about that a lot on the show. Yeah.

SPEAKER_01 55:03

Thank you so much for your time, Dr. Bollio. It was such a pleasure to hear from you and such a joy to like kind of hear more about this. And my hope is that more people get excited about this and add this to their medical practice as well. So thank you so much for being on the show. Thank you, everybody else, for listening. And cheers. Cheers, everybody. Cheers. If you like this episode, please rate, review, subscribe, and even better, share it with your friends. Cheers.