Episode 48: Gut Health, IBS, SIBO, and Menopause: What Clinicians Need to Know with Shefaly Ravula, PA-C

We dig into where traditional gastroenterology often falls short—and how functional medicine can fill in the gaps. I’m joined by Shefaly Ravula, PA-C a Physician Assistant and Functional Medicine Certified Practitioner, who shares how her background in GI and nutrition evolved into a more personalized, whole-person approach.

We cover common clinical red flags, what to do when patients have “normal” GI tests but still feel terrible, and how to blend diagnostics with nutrition and long-term strategy. We also explore how menopause impacts gut health, the nuance around HRT, and why patient education is everything when it comes to sustainable results.

This episode is packed with insight for healthcare professionals and curious listeners alike who want to better understand the gut-brain-body connection.

What You’ll Learn in This Episode

• Red flags that may point to deeper gut dysfunction (chronic bloating, constipation, diarrhea)
• How microbiome stool tests compare to SIBO breath testing
• Why antibiotics, low FODMAP diets, and gut supplements only offer temporary relief
• The connection between IBS and SIBO—and how many are misdiagnosed
• How functional medicine combines traditional diagnostics with root-cause care
• The relationship between estrogen, motility, microbiome health, and inflammation in menopause
• Why HRT decisions should be individualized, not one-size-fits-all
• How pelvic floor dysfunction and trauma can influence GI symptoms
• What providers can do, even in short visits, to screen more effectively

Timestamps:

00:00 Introduction to the Episode

00:12 Meet Shafaly Founder of Precision Gut Health

00:55 Episode Overview: Key Topics and Takeaways

02:32 Dr. Mary's Approach to Whole Body Healing

03:17 Shafaly’s Journey into Functional Medicine

06:13 Challenges in Integrating Functional Medicine

14:31 Understanding IBS and SIBO

18:30 The Role of Testing in Gut Health

24:09 Antibiotics and Gut Health: A Complex Relationship

29:11 Patient Advocacy and Navigating the Medical System

32:27 Chronic Constipation and Structural Issues

33:04 The Multifaceted Nature of IBS

33:56 The Role of Trauma in IBS

35:01 The Importance of Personalized Medicine

40:43 Challenges with Restrictive Diets and Antibiotics

46:16 Menopause and Gut Health

50:31 The Controversy of Hormone Replacement Therapy (HRT)

57:41 Conclusion and Contact Information

You can find Shefaly below:

IG: @precisionguthealth

https://precisionguthealth.com

If you are a health or movement professional and want to stay in touch with future episodes, webinars, courses, events and more. Subscribe to my email list here

I’ll see you in a week!

Transcript

0:00

Welcome back to TMI talk with Dr. Mary. Today we're gonna be talking about the gaps between traditional GI care and functional gut health management and how to bridge them into practice. And in order to understand this better, I brought on Shafai Ula, who is a PA and a functional medicine certified practitioner. She is the visionary founder of Precision Gut Health, a virtual telehealth practice on a mission to unlock the secrets of gut health. Nutrition and longevity at the heart of her practice lies a powerful fusion between functional medicine, culinary nutrition, and a profound commitment to digestive and metabolic optimization using a deeply individualized approach. She's dedicated to guiding patients towards a future where gut health and longevity are intricately intertwined, and where vibrant health is not just a destination, but a lifelong journey. In this episode, you're gonna be walking away with practical red flags to recognize such as chronic bloating and diarrhea. Even if you don't know that much about gut health, then that way you can refer your clients to somebody to get help clarity on testing, we're gonna be reviewing how the differences between a standard microbiome stool test versus SIBO breath testing. We're gonna be talking about the insight on bandaid approaches, so why antibiotics, low FOD bat diets and gut healing supplements. Can sometimes help temporarily, but it won't fix the root cause. Next we're gonna be talking about the IBS and SIBO connection. Why many patients are labeled as IBS, but have actually been undiagnosed, as with sibo. And how to start thinking beyond the symptom suppression. We'll be also talking about the realistic view of functional medicine. It's not all about being anti-medicine, it's about combining conventional diagnostics with a personalized root cause. Approach to truly help people heal. And finally, we'll be talking about menopause and gut health, which is also a bonus dive into how declining estrogen levels impact gut motility microbiome health and overall inflammation. And why HRT decisions should be patient-centered and nuanced. So why does this matter as clinicians? Well, you'll be better equipped to a spot when something. That the patient might seem as normal, is actually not normal. You'll be able to ask better questions and know when to refer for deeper workups, and this helps empower your patients so that way they can understand more about their body. So thank you for listening, and now we'll jump into the episode. Welcome back to TMI talk with Dr. Mary where we dive into non-traditional forms of health that were once labeled as taboo or dismissed as Woo. I'm your host, Dr. Mary. I'm an orthopedic and pelvic floor physical therapist who helps health. Movement and rehab professionals integrate whole body healing by blending the nervous system into traditional biomechanics to maximize patient outcomes. I use a non-traditional approach that has helped thousands of people address the deeper roots of health that often get overlooked in conventional western training. And now we are gonna be starting our next episode.

mary: 3:08

Welcome to the show, thank you. So nice to be here. Love the space. Yeah. We're excited to have you. Thank you. And we'll just dive right in. Sounds good. Okay, so what inspired you to create Precision Gut Health? It happened because of my background. So I have a background in, so I'm a pa. And had an, a first job out of school that was in, strangely, a very unique niche in bone marrow transplant in Seattle. And but around that time my, my father had a heart attack and he was only 54 and he was very thin and lean and vegetarian. And I hadn't learned anything about nutrition, so I was so confused, yeah. Wait, why is this vegetarian, thin, young man having a heart attack and he survived and all that, but it really led me into this path of nutrition because I just felt like, okay, this is not making any sense. And, they don't teach any of this. I got into nutrition and then I, we moved here to Austin and I couldn't find a job. In the field that I had already been trained in, which was this bone marrow transplant. Very unique field, but the job I found was in gastroenterology. And so I started in the GI world, but at the same time, on the side, I'm sitting here learning about nutrition and cholesterol and cardiology and nutrition for cardiac health for my dad. It didn't apply to gi, really directly at the time. And then, yeah. And then I actually, for a period in my life stayed home and with my kids, I wanted to be a stay at home mom for a little while, but it ended up being a long time. Yeah. And I ended up teaching cooking classes, to keep myself busy for fun. But that turned into a career and that was where that old business that you might be familiar with, chef's Kitchen was born from. So I had this little culinary business, which was a nutrition business to a, oh, I, it was culinary medicine, so it was like initially Indian cooking. And then I'm like, wait this doesn't jive with my dad's health history. He grew up eating this way. It didn't fit into my nutrition plan. We weren't eating it every day. So it really morphed into food as medicine, a lot of more healthier cooking and really global cooking, honestly. Yeah. And then I went back to gi. After I'm like, oh, my kids are older and I miss, being a pa I miss using my medical brain. So and so that's what I did. I went back to gi same group, different location different, a little bit of different people. Great experience. And then the pandemic hit and then. That kind of broke that whole thing apart. But I will say while, right before I rejoined being at Austin at the GI practice, I I started studying functional medicine because I had been studying nutrition and I'm like, oh this makes sense. Like it's just a pathway to functional medicine a lot of times in integrated medicine. So I thought, I'll bring that to gi. I'm like, why not? Take what I've learned. I had just done the GI module at IFM and I'm like, I gotta bring this to the practice. And it is just, was just hard to do for many reasons. We don't, we can go into that if you want to, but very hard to do, I would say, because the insurance companies dictate us. That's really the main reason. There's no way, in those like five, 10 minute sessions, how are you gonna teach somebody about gut health, and there's so much, I've just seen so much disconnect in just like in, in modern medicine. Yeah. And actually acknowledging the gut brain. Connection. The connection. Yeah. Yeah. You cannot deny like it is there, yeah. And you can feel it too. Yeah. I know that brain fog is one that I'll get if I eat certain foods that flare me up and it's a direct correlation with all the serotonin in the gut too, that's produced. Yeah. Is it like 90%? Yeah, 80. Yeah. 80. 80, 85. Yeah. Yeah. And that instead we put people on SSRIs instead of, and we didn't know that, definitely when I was in school, but we didn't even know that, weren't taught that in the continuing medical education courses that we took to keep up our license, so there's been a lot of new science, which you have to really stay up to speed on. And so I think in the conventional path, sometimes you don't stay up to speed on some things. Sometimes you're just, staying within your specialty. And I. I see how it happens. Yeah, absolutely. I see how it happens.'cause you get into your niche and you're in there. Yeah. And you go in day in, day out. But the reality is it is hard because we have five, 10 minutes appointments and people tend to blame the physicians. It's or the practitioners. And it's listen it's a shit show. I mean it's, and the amount of, it's a system. Yeah. It's a, that's messed up. It's a system. And then people blame the faces that they see when it's like, Hey, no, this is a multi thing. Yeah. And so it's so important that we talk about, yeah. What are some things that people can do even, and we'll dive into this later. Yeah. But just knowing what we can do to help restore our gut health. Obviously modern medicine is wonderful for like colonoscopies, and doing all these other tests To help us when to. Rule out major things. Yeah. But how many people get all these tests and say everything's fine. Yeah. And they're having all these symptoms. So it's a, it's, I love to, I feel like I bridge the gap between conventional Traditional, yeah. GI and modern, holistic, integrative gi And that I think is where I shine because both are important, just like you just said. And it's not an and or situation. It's a, or whatever that phrase is. It's not a or it's an and. Yes. Thank you. I always mess up phrases. I got you. No, I do that. I do that too. So yeah, I wanna I do wanna comment on the. You know what to say in five or 10 minutes.'cause I can, there are things you can say as a clinician or a provider and you can do them with some caveats and nuances that you might want to say at the same time. But let me ans finish answering your question, which was, how did I get to Precision Gut Health? Because right after that, after the pandemic, I was like, oh, I really need, I can't prescribe another PPI where there's no, finite end to it or I can't, I just can't keep giving people Bentyl for their IBS and I can't. I just was I could, I just needed more for my patients and so I was like, should I open this little practice? And I decided not to.'cause I'm like, I. I don't know how to be an entrepreneur. It's scary. Yeah. So then I got handed this job, like somebody, the urologist said, Hey I can't get to where I'm at with functional medicine in my practice where I want to be, you know this urologist, but I want to have functional nutrition and medicine. Can you bring, can you do that piece for me? So instead of me being my own entrepreneur, I did it for them, which was a great learning experience. And I got back into male men's health, which is metabolic health, which is cardiovascular health and also hormone health. And I got to do that. And still, lots of GI people were coming our way. And then finally I said, okay, I'm ready to do my own thing.'cause I really missed, I wanted to bring the culinary aspect and the nutrition aspect more to it. So now we have a big nice little they go together. Yeah. They go together. Gut and nutrition exactly. No, that's what's the cool piece though, is that not only are you're blending all of it together and you're definitely onto something. There's no doubt in my mind I know it, but you're, I think you're a trailblazer, right? And so what that, in my eyes, it just means that you're one of the first people to be talking about this in this capacity that I've seen doesn't mean people aren't out there. Yeah. But in that, when I was just talking about this with somebody earlier today, it's just in that there's a bit more of an uphill Yeah. Battle with that because you're going against a lot of different things that have been in systems for decades. Yeah. And yeah. I can't imagine what it must be like being you and being like, yeah, here's some medicine, knowing that somebody with IBS needs so much more. Because the gut. With, especially with history of people with history of unprocessed trauma and how like chronic fight or flight, we know we literally hear the saying, I'm sick to my stomach. Yeah. That's a saying. Yeah. And butterflies in the stomach too, like that is you know that there is a gut brainin access connection. Yeah. A hundred percent. If we've been talking about this for a long time. The other piece of it too that I think is fascinating is that we almost, and then we treat like the dentist oh, this is nothing to do with our GI tract. Oh no, yeah let's remind, remind people of the tube that goes from the mouth to the anus. It's a tube. Yes, exactly. And then we say dentists over here, GI over here. Yeah. Mental health over here. And sometimes even liver is separated from GI because you do have hepatologists that are fellowship trained in hepatology but then you're like, wait, the liver is connected. And then hormones. It's so all connected, which makes it very difficult for a new provider to this. F type of thinking, or for a patient too. We have, we will, I think in the future, come to a place where it's all embraced again. I don't know. Sometimes I like to study the history of medicine because, not that I have really studied it, but I've read certain things about like when did evidence-based medicine come into play? I think it's, it was about 150 years ago. It wasn't that long ago. And then Eastern Medicine is like 33,000 years. Yes. And it's we act like modern medicine. Yeah. Is it? Is it? And I'm like, like you have yeah. You have not been row. And it's like midwives delivered babies before. All the time. Yeah. That's what the job was. And and then also nutrition used to be a GI doctor's job before the colonoscopies and endoscopies were invented. Not only nutrition, they were doing a lot of physiology. But if I saw an old gastroenterology textbook from the fifties how'd you find that? It was at a silent retreat that I do, and it's said a some house in the hill country and there were all these old medical books and I was so fascinated and there was not a lot of talk about acid reflux in the table of contents. Really? Yeah. I took a picture. I was like, there's not a lot. SIBO was not mentioned. Sibo. We know SIBO for your listeners is small intestinal bacterial overgrowth, which has a big overlap with irritable bowel syndrome. And by the way, this month is IBS Awareness month and today SIBO Awareness Day, SIBO only gets one day, but it's quite a dis, quite a condition I would say. It's very. Troublesome for a lot of patients and can be long lasting for some what if somebody's listening to this, right? So if a practitioner or a provider or somebody is listening and they're working with patients that are dealing with gut issues, and that can be physical, pelvic floor, physical therapy. That can be, honestly, anybody with back pain, we need to be looking at gut health too. The rectum is right there by the sacrum. True. And then you've also got any pressure right there is gonna be pulling, pushing onto the back as well. Constipation. Yeah. All of those things. Yeah. And so what are some things that they can look for in in their clients and maybe help direct them in some capacity? Because in the physical therapy world, we're really not trained a lot on SIBO and IBS and I've done my own training more on IBS. But sibo, there hasn't been a ton of stuff that I've seen Yeah. To help practitioners navigate that. Maybe differentiate the two uhhuh and then what could be a way that they could, obviously they can follow you on social media and a hundred percent and send your way, but also what are some things, so IBS is irritable bowel syndrome, not to be confused with IBD, which is inflammatory bowel disease. So IBD is more like Crohn's colitis, those are definitely different physiologies, different conditions. IBS used to be, and still is a diagnosis of exclusion in the conventional GI space. So it's like somebody that's comes to you in the conventional space that has had blood work maybe from their primary care and then they come to you because the primary care is referring them to you or they come to you on their own and they're like. I just have abdominal pain or I have constipation, I have diarrhea, I have gas, I have bloating. That's usually, I would say those are mostly the symptoms that somebody would have with IBS. And after a careful analysis exam, maybe a colonoscopy or endoscopy in some individuals might be indicated if that nothing is found. Excuse me. And there isn't pathology, the word for finding something organic.'Cause really what they're looking for in a colonoscopy would be making sure you don't have Crohn's or colitis.'Cause sometimes that IBS can look like IBD in some cases. But let's say all the workup's negative then, and you still have abdominal pain, gas, bloating, diarrhea, constipations, or some, one or two of those things, they might label you with the diagnosis of IBS. But there's no test per se for IBS. However, there are a couple of tests developed by Dr. Mark Penal. And he does, he's a, he does present data every year to the annual GI conference about IBS, and he talks about a test that he's developed. It's not routinely used. It certainly wasn't routinely used when I was in practice in that space. But I do wanna say that there is an, like I said earlier, and a big overlap with the sibo. And so those symptoms can look like SIBO as well and vice versa. So there's a Venn diagram for both. I don't know. There's a lot of, there's quite a, there may be a few of us in the SIBO world that do believe that a lot of IBS is SIBO and that they just don't know it yet or haven't been tested properly for it. Now, some people might have gas and bloating in some of the diary constipation. And you might get a a quick, not a quick fix, but you might like address fiber maybe, and maybe that would help your constipation. Or you might hydrate or you might do a squatty potty or you might work with someone like you work on your pelvic floor pelvic pelvic, maybe you have pelvic floor dys. I always pronounce that wrong. Maybe you have gut brain access stuff, but there's stuff that could be slightly simpler than having to go down the rabbit hole of, oh my God, do I have SIBO or not? And so I would say people come to me. By the time they've already been diagnosed, often with IBS or SIBO or both, and they've often had a treatment and it's not gotten better or it's come back. And that is when it's a very nuanced approach. Like you've got to really do the right testing, look for the right gases, look for the root cause of why you got it in the first place, address motility of the gut address, gut, brain, nervous system, all the stuff that you do too. So it can get complex. Some SIBO does come back. There's a percentage of SIBO that does, can be recurrent or refractory. So did that answer your question about Yeah, I would say, I'm wondering to. The thing that's confused me about SIBO is people are given antibiotic for it. Yeah. But don't antibiotics like just destroy the gut. Great question. Yeah.'Cause I've always been confused by that. And then what are, what is the way they distinguish between SIBO and IB Bs IBS is exclusion, but I know, are there some tests for sibo, right? I know there's some tests from that. Yeah, there's some great tests. Yeah. And so what, yeah. What are those tests? As well. Okay. So I like, let's maybe start question with the test and then we'll ask, answer the antibiotic question'cause so with testing, so you know, a lot of people have heard about the microbiome testing companies out there, Genova, gi, FX, et cetera GI Map. So those are tests that go look at. Your microbiome, maybe 20 or 30 sp species. They're looking at virus, they're looking at yeast, they're looking at parasite, they're looking at overgrowth. Or, and so overgrowth can mean overgrowth of just your good stuff, like your good keystone bacteria. You want that imbalance too. You don't want that to be too low, too high. But it's also looking at pathogenic overgrowth. And they are very sensitive tests for some of these organisms. Or, we're looking at the DNA, like of h pylori in that test. We're not doing a true gold standard h pylori test. So it's a very sensitive test. So it's picking up stuff. When I look at those tests, I'm, by the way, so those tests are not SIBO tests. Okay. Those are stool, microbiome stool health tests, if you will. They're looking at, like I said, the microbiome population. They're looking at digestive enzyme production. They're looking at, s one one factor that helps with estrogen detoxification. They're looking at whether you have fat maldigestion, because you can look for something called tcrt. So a couple of those tests you can do with a GI doctor or using insurance, but sometimes your insurance company doesn't cover them. You get a lot more information doing these tests, but they're also not a game changer of a test necessarily. They give me a picture of the patient. They give me a map. I'm not treating any one bacteria, I'm not treating any one test in that, big GI map. I'm looking at the pattern of what I see and then I'm taking that with the story of the patient. And then I'm also taking that with okay, what are their dietary restrictions? What is their family history? What are their other labs like? It's a big picture that we're looking at and it's a lot of work. Yeah, that's what I'm saying, even from an outsider perspective, where with gut health it's. We help with the nervous system, we help, we teach people with exercise and movement and mobility and like gut motility in that sense. Yeah. But there's this whole other piece of the microbiome, right? Yeah. And then understanding these things that I think so many practitioners outside of GI and maybe even in GI, that are unaware of Yeah. These other tests and how to manage this. And and then we get, one of the things that, the questions I had sent you before the podcast was how like gut health is this whole trendy thing. Yeah. And now everybody is treating gut health. And I think that there, not everybody, but there's a lot of unqualified people out there saying these protocols and things like that, that I think can be very harmful. Yeah. If in, in the wrong hands, right? Yeah. And so you can, so in that, yeah, it's so many different things. And so what. But then, so then what is this? Are there specific, was it the test that you were talking about? So that one's just a more basic, like I was saying, the microbiome test, but it's not a SIBO test. Okay. And then there are there's SIBO testing. Okay. And that is breath testing. I was gonna say. I thought. Yeah. And what they're doing, what those tests are trying to capture is how much of the gas is, how much of the gas is being produced by the overgrowth, by the bacteria. How do they know? What is it, do you know? Like specific Yeah. You basically have to drink a substrate, a particular type of sugar. Excuse me. I feel like I need to take a sip. No, go ahead. Of my strawberry expensive drink, but it's delicious and it looks really good. Strawberry nut milk. Oh my gosh. With chaga mushroom in it. That's so fun. Maya Papaya always like coming. Got a little bit of sweet in it and a little bit of sweetness. Maya's can I have some, I didn't bring my water, but do you want some water? No, I can wait. Yeah, I've got that. Thank you. My gosh. If okay, so yeah, you have to drink a particular type of sugar just to see what is happening with how much of the bacteria is fermenting this and what's happening with the gases that produces, it's a little bit more, yeah. And it's a pain in the butt of a test. And honestly, there is nuanced way to do the test too. I don't always, I have my own directions for patients to do it and my own substrates that I like for specific scenarios. So again, it's an art, and I know you mentioned unqualified professional people that may be doing this, but. I wonder if it's more that they're not looking at the person. I think this is a very personalized thing. This is why I'm a high touch clinic, where I only have a small number of people because it, that's it's involved, and I have to do, I wanna know all about you. I wanna know your prenatal history. Everything like every input into your body and into your person and into your mind goes on my timeline. Because it can affect your gut health for sure. It's not just about, oh, I had a CI was born by C-section, or Oh, I had lance antibiotics. There's more to it than that. There are other types of CBO tests as well. They're all breath tests, but they're different companies doing them. And there are multiple gases. It's not just one gas that we're looking for. We now know there are three gases that these organisms, these overgrowths can produce. And there's different types. And so depending on the type, you might have a different treatment protocol. Afterwards. So I answered your question about the SIBO testing. Oh. And then my question was the an like the antibiotics? Yes. Okay. So how is that,'cause there's so much on, on antibiotics Yeah. And how that affects the gut as well. Yeah. So why would, yes. Great question. So you may, have you also heard of the low FODMAP diet? Yes. Yeah. So I view a lot of these things as band-aids. SIBO is a manifestation. It's not necessarily it is a diagnosis and it, but it is really a result of something going on. And SIBO causes symptoms and they can be pretty bad. And typically it's. A belly that's getting more and more distended throughout the day. Belly being bloated feeling bloated, trapped gas, but it can also have abdominal pain. That's very significant. I have a patient, been working with her for quite a while, and she's I've, you've fixed my pain. You fix my pain. I never had anyone fix my pain. I went to multiple doctors, but she still has bloating. So we're working on that now, but the pain can be really bad. The malnutrition can be really bad. There can be weight loss, there can be systemic effects with, rosacea, rashes, joint pains, brain fog. And then there's a whole long list of other root causes that can cause it. Besides that, that can get a little bit. It was like two pages of root causes. To answer the question about the, so why the, why do antibiotics work? They work because there's this massive overgrowth of these bacteria. They're just going crazy. And anytime you eat something and they're like having fun, they're just like eating all, they're just like, oh my God, I'm just enjoying and I'm growing and I'm building, and I'm building, building. And I like, and they're overpopulating. So I like that analogy of the grass, like a grass, like a lawn. You have good soil and if you have good soil, you have good grass growth. But sometimes you'll have some weeds, but the weeds can overpower the grass if the soil's not great, and so then you have to kill the weeds. But by killing the weeds, you're not really addressing the root cause. So the antibiotics are the weed killer, but you have to address the soil. So antibiotics help. I. People with sibo, different types. There are very specific types for different gases too. And then there are herbal antibiotics that you can use that work very well. They just take longer. Which ones are those? Oh, there are many. But you could think of oil of oregano is a big one. Or I've seen that they're like concoctions of herbal medicines. They can be, put into capsules and sold by some of the higher quality medical grade supplement companies. But I would encourage nobody to go do this on, it should be guided.'cause you can feel pretty sick. Yeah. You don't wanna, yeah, you don't wanna, yeah. And then you don't, and if you're a practitioner listening, you don't, we don't wanna just be telling people to take this stuff. Because we are not, ordering the test. Yeah, exactly. And you're also, and are these tests, are they ordered through Western medicine? The SIBO breath test is Okay. Some people do. Some still don't. Some still don't. Oh, Uhhuh. Yeah. So when they go in, they're basically what given a colonoscopy then, and then an endoscopy, and then you're clear. So there's nothing, is that kind of the standard? So then they're like maybe an antispasmodic something to help with their constipation. If they have constipation, something to help with their diarrhea. If they have diarrhea. Those, sometimes I've seen conservative things like, hey, drink some water, have some fiber. Maybe take MiraLax, Metamucil that I, that they are doing in the conventional GI space for sure. But sometimes patients are miserable and not having a bowel movement except for once a week. Ugh. In that case, we call it rapid relief. I do rapid relief in our practice too. Sometimes I'm like, you gotta take all this stuff. We gotta get you feeling better. We got you sleeping. We need to, we've gotta clear people out. You've got,'cause they're holding and that uhhuh and then they releasing all the estrogen too and Yep. Hundred percent get, and the cholesterol dominance. And then the cholesterol, you've gotta clear it out. But. Yeah. That's why I think this blended approach is so important. Yeah.'cause the reality is people are gonna need medication. Yes. I'm not gonna not take medication. If I need to take an antibiotic, I'm gonna sit and be like, do I actually need to take this? I'm gonna question it. Yeah. And I'm gonna see, I don't wanna unnecessarily take it, but hey, the issue is that we're not just like blindly doing things. We're looking at it, okay, hey, this medicine's gonna help me, but why did I get sick in the first place? Yeah. Yeah. So treat the symptom but not the cause. Yeah. And that's the issue I think in Western medicine so much, is that we treat symptoms. Yes. Yes. And there's not a root, which is so interesting to me.'cause I'm like, don't you think insurance companies, like they would benefit from everybody feeling better, they's benefit from I don't know. F cash flow. Yeah. Lots of patients, lots of procedures. The insurance companies, then they pay out more. Yeah, I think I'm not, I'm definitely not an expert there, but I just think that I, yeah, I don't have an answer for that. There's, it's just, it's so interesting to me.'cause you would think preventative, that's another podcast episode maybe that has to do with. Culture demand. I don't know, if patients demanded it more, but I don't think patients, we also have this hierarchy in the medical system, like patients get gaslit, so then they don't sometimes speak for themselves or vouch for themselves. But there, that's a fine balance too. I don't think patients should go around disrespectfully yes. Yes, there's a balance. There is a balance. If you go in and you're bossing your practitioner around, get out of here. Yeah. Yeah. It's more of. Hey, what do you think? I've read this. I feel strongly about this. What do you think? Do, are you very against it or do you have any comment on it? What would you do if you were in my shoes? Yes. Those are the kinds of questions to be asking the provider. Yeah, but you do have to go in, you have to be your own advocate, but you, at the same time, you can do it with a respectful tone. And honestly, if they're not, if they're gaslighting you or not open, you gotta find someone else. Totally. Yeah. But that's the thing that sucks though.'cause that takes so much time. I'll tell my patients, and if you're all listening and you have patients as well that are, they're experiencing this is just knowing that, hey I'll prep them. Do your research before. Come up with your top three questions. You've got five or 10 minutes. Like you do the work ahead of time. Yeah. And you get in there and then they have the information.'cause otherwise there's just no, there's just no time. There's just no time for that. But what it, are there clinical symptoms that are differentiating between SIBO and IBSA lot? Or they look the same? They can look similar. IBS may not always be. I don't think, I don't see. Plain IBS anymore. But that's because I'm looking for a lot more and finding a lot more. But if I go back to the years of conventional GI that we did it, there are many people that come in and they're like, I'm a little gassy. I'm a little bloated and I have ment, just every other day. And because they're in my o in our office and they're seeking you out, you feel like helping them. And a lot of times they were helped by medication and maybe a little fiber, try this, come back in six weeks and if they don't come back, you don't know what happened. So you don't really know if they went and found someone else'cause they didn't get any better or you don't know if they did get better. So you just don't know. But then if they come back and maybe they're a little better. It's hard to say. There are people that can be helped from just a little fiber or a little hydration or a little meditation or a little squatty potty action. Good bowel hygiene, good eating hygiene is what I call it. Those are little things that can work. And maybe you don't have sibo. Maybe you, maybe it's really honestly just fixing some lifestyle things and diet a little bit, I also, I've seen from the pelvic floor P PT side, people forget how to poop. Yes. So they push through their belly instead of down. And they're like, it's not going anywhere. So you're literally like aiming out through the belly button. This is also for giving birth to people, push through the belly instead of down and we almost forget like the physics of it. And then people forget. We'll do, anal biofeedback as well to be like, Hey, contract, contract the anus, relax. Contract.'cause they'll do the opposite. And so isn't that what the pelvic floor dys synergia is? Yes. Okay. Yes. So the, that, that happens a lot with people that I've seen with chronic constipation or chronic diarrhea. And the other thing too that can happen that I've seen with bloating and constipation is more so constipation, but is rectocele. Yeah. So the bladder pro, the rectum prolapsing into the vagina. Yeah. Yeah. And so I've seen people's, their symptoms improve with just putting a pry in there and pushing the vaginal wall up. So then the rectum has to stay more in its place too. Yeah. So it's like there's so many things that are even structurally. Structurally, yes. Then you've got the nervous system, then you've got your diet. Yeah. And then you've got whatever bacteria, whatever is happening. And. It's so many multifaceted. The physician that wrote the Body keeps the score when I listen to that book,'cause I'm gonna be full audience. I am an audible person. I try so hard to read the books, but sometimes it's just easier. I'm the opposite. I can't do Audible. Yeah. It depends. Weird on the day. It depends on the day. I wish I could get both audible and the visual just for if you're. You wanna actually read? Yeah. But anyways, it was so eye-opening for me because this was several years ago and he was the first in my eyes to correlate IBS with the history of trauma. Yeah. And how much of that though, is it, I've heard people say Hey, it's actually the nerves Yeah. Around the gut. And so hard to say. I what? Hard to say that it's not. Hard to say that's not true. But it can't be like, yes, it can be, but I feel like there's this trend happening right now where people are relating everything to trauma. Yeah. I, and not actually treating the physical side of stuff too. Yeah. So there is, like I'll get people in chronic pelvic pain, but, yes, the nervous system is a piece of it, but what about the labrum, right? What's going on in the hips? What's going on in the lower abdomen? How's the back'cause a referral from the lumbar spine? Is there thoracic spine moving? Yeah. How are they walking? Yeah. So there's all these different components and so I feel it can be harmful to just blanket statements. Just say, oh, it's due to trauma, when there's still a physical body to be treated. Yeah. Yeah. I don't, I think blanket statements should be a sign in medicine or science aren't anything really. Yeah. I think there's not a lot of blanket stuff we can say. There's no blanket supplements. I could even say maybe fish oil, but not for everybody. Like I, there's no blanket diet. I'm very diet agnostic in our practice. Yeah. You can come to me on the carnivore diet and you can come to me vegan and we will tell you and figure out whether that's right for you or not. But that's based on your biochemistry, your labs, your family history, what you're dealing with, what's your GI tract like. All that stuff. Yeah, I don't know. I agree with you. Like I, that is true. I'm seeing that trend as well. I'm seeing it and I believe it has a massive component, right? I, the way that I look at. Unprocessed trauma is it's the fuel to the fire, right? So there's already a fire and then you're adding gasoline to it. Or you know what some of the researchers have said? It's like it's festering. Like that is the thing that like sets it off. Yeah. Yeah. And then we're predisposed to these other things. But then I go, okay, so say I, he heal my trauma. I work through it and I process my trauma. And then I eat McDonald's every day. Yeah. Do you, you see what I'm saying? And maybe I'm not traumatized. Yeah. I bucket and you tip the bucket at some point. And that is a big core tenet of functional medicine is that you, I. You could be on the same. This is why we do that timeline in our practice of people let's, where did we tip the bucket? What are the factors that tipped the bucket? And sometimes we don't always know, but there's always, there's often a time point where the bucket was tipped, but we don't really know how much percentage of the trauma at age five affected the GI tract at age 40.'cause maybe menopause happened before that too. And you had estrogen completely wiped out from your system, from all the receptors of the body. Maybe before that you had, abdominal surgery, maybe. So everyone's map is so different. So different. And that's why it's so important that we encourage our patients to know and advocate for themselves. I feel what I've seen here is just not just here, like I'm saying like in the us. I don't know if it's like this in other countries, but basically we've just blindly go to practitioners and ask them for answers. And where I'm trying to go is let's get people to start understanding their bodies intuitively. So they can ask the right questions. Because if you add in, if. A very well un like a, a patient who is, who understands their medical history, who can say, Hey, I know it started at this time. This is, these are some other symptoms I have. So starting to get our patients to correlate Yeah. These things even before they see, yeah. Because if you go in maybe to a GI doctor and you're like, Hey, every time I eat this, I have these symptoms, right? Or every time I experience this, I have this. And so you're almost doing, they're almost doing their own little experiment. Or research study, end of one. Yeah. Yeah. And so that way it's so much more consolidated. So by the time they go into that practitioner, they're like, Hey, I notice I have these symptoms with X, Y, Z. And so even people knowing their own anatomy and being like, oh, what's going on? Even, if you have bladder pain, is it your bladder or is it Yeah. Or is it your uterus?'cause they're right there. Or is it referral from lumbar spine or do you notice it with different movements? Do you notice it with emotional stress or for certain foods? And so getting people to Yeah. Know all of those things.'cause the patients their own advocate, but they don't know the power because we've had this hierarchy Yes. The hierarchy of the medical system for so long. And I just keep shouting this from the rooftops, is that evidence-based medicine is the practitioner, the patient and research. Yes. It's all three. That's a great phrase. Yeah. It just try it though. It makes me bonker and also just, I'm not against, I'm not, I'm thankful for EBM, but it, we get one endpoint. We don't EBM, evidence-based medicine. Sorry. Oh, sorry. The mic. I just remembering the course was EBM that I took in grad school. So luckily I just said it and I'm like, I'm weaning from caffeine. Everybody to my brain is a little foggy and well who says EBM? I don't think anybody does. I don't know why is said that you're just like, ebm. I'm like, Hey, okay, I'm gonna, I was like, I don't wanna pretend like I know what clearly we just said it anyways. So was it was the name of the semester course, and it was like, it's great. Yes. But let's also start thinking outside the box. And no one is gonna argue in Western medicine that we treat the patient in front of us, so we treat the patient in front of us. And that's not necessarily a trial. So it's an informed decision between me and you. Yeah, what we had looped back to before is one of the things that you said, like in that 15 to 10 minutes or five to 10 minute sessions to say, this can be any clinician. This can even be people in the fitness world or physical therapy world, wherever. What are some like little things that, that you can just steer them in the right direction. So I don't want people thinking out there that they, that having GI issues is normal. Ah, okay. So a lot of people live with chronic diarrhea, constipation and constipation, chronic diarrhea, excessive gas and bloating. Malodorous, flatts, marou acid. Smells like rotten eggs all the time, ugh, those are the worst belching. I know. Belching incessantly not being able to sleep because you have acid reflux. I just don't, you, you should, you or your, the provider that's listening, just let them know, Hey, this can be likely restored and reversed. Or at least looked at and evaluated appropriately from a root cause. Perspective. I was gonna mention one thing and I we were briefly talking about the antibiotics. Si I do think that's a bandaid still. I hopefully that came across No, you said that. Yeah, you said that. But so is a low FODMAP diet. It's, that is classically used in conventional gi we gave it out all the time. Go on a low FODMAP diet. You've got IBS try that. Maybe they, maybe we would try fiber or maybe we would try hydration, or maybe we tried some, something like Metamucil or something for constipation for the patient. Or, and then sometimes we would say, or maybe if they later on we'd say, try a low FODMAP diet. Here's a handout. First of all, it's a really hard diet. It's very complicated. Once you get the hang of it, it's not that hard. But you have to follow these rules and they don't give you any guidance in some GI practices. They just give you the handout. And what happens is a lot of people go on that and then they don't go off of it because it makes'em feel good. If that's you and you're listening. That's not a great thing. You don't wanna be on that restrictive diet for that long because you are then ultimately harming your diversity of your microbiome. It's just a bandaid. Same with the antibiotic you mentioned. Okay. Doesn't the antibiotic wipe out the bacteria? It does. So that's why it's a bandaid and it's gonna make you feel better. But you, there are things that need to be take done in sequence in our, like the way we do sibo that will help you restore your gut function, your mucosal repair, your butyrate production, and then ultimately give you your microbiome back. Yeah. So that you don't get it. I know it's, it sounds complicated, but No, I think it makes sense. So basically like the top two things that you would tell a practitioner or a coach or somebody that's working with patients in healthcare or experiencing a health related issue with their gut. So the top two things that you said. What are the top two things that a provider can tell their patient. To maybe help di direct them in the right direction. Okay. Is what you're saying? Yeah. Related to gut health. Related to gut health. It's really easy for me to say oh, the one thing would be tell them to eat fiber. No. What you, what I was going to was you had said, number one, tell, letting them know Yeah. That's not normal. And number two is restrictive diets can be harmful long term. Oh yeah. Would you say those to me, those are two good things to say. But I, it's hard to just limit it to two. I know. I'm just saying Would, are there others? Yeah. Would you say three? I would say I was gonna say, you might think that I might answer the question by saying tell everybody, get on 35 grams of fiber a day because that's what you should do. Okay. But, yes. Ultimately, that's a great place to ultimately get to. But if fiber bothers you, that's a red, that's a flag. Something's going on. If fiber bloats you up, you can't tolerate it. It's doing something to you, giving you diarrhea, giving you constipation, bloating, reflux, huh? What's going on? Yeah. Okay. Yeah. So basically the top three things, okay. You would tell a practitioner that's working with a patient that has gut issues would be number one to know that, hey, acid reflux or gut symptoms are not normal long term. Number two any, oh my gosh, I can't even get my words out. Any restrictive diet long term is not sustainable and it's not healthy for your microbiome. And then number three, fiber is not necessarily something that. Everyone can tolerate, but that doesn't mean that you ultimately should avoid it. Yes. It's the sim it's the signal. Yeah. It's basically saying, Hey, something's going on. Yeah. Yeah. And let's look at this deeper. Yeah. And now that being said, there's are people out there that are like not doing lectins and maybe on a, on various kinds of diets like the autoimmune paleo diet and avoiding grains and low like carnivore, which is no fiber. I'm not saying there's anything wrong with those. I just think that they, there are some of those, like the carnivore diet can be probably a therapeutic diet for a while because it's, there's something, why is it working for you? Why is it making you feel good? Because you probably have some inflammation there. So anything that's not the carnivore diet that's maybe excessively inflammatory to you is bothering you. Always ask why? Yeah.'cause I know a lot of people with IBS, they can't eat raw veggies. Yeah. And that's fiber right there. So that makes sense. And that's because a lot of the times that's that overgrowth happening. So they can't eat the veggies because the veggies make the bacteria really happy and you know what I'm saying? And the bacteria are like, oh, I love this. Let me give more gas and ferment this, these carbohydrates, and then you feel badly. So it's more because of that, most likely is what I tend to think. But still, no, I think it's, there's so much we don't know about the microbiome still, so there's still so much we don't know. Yeah. There's still so much evolving. Yeah. And it's being patient with the system and it's science, it's constantly evolving, constantly learning. I love this phrase I learned actually recently. I'm not. A know it all. I'm a learn it all. There you go. Just to, to dive in a little bit on menopause if practitioners are working with somebody going through menopause, can you explain how menopause. Menopause, I said menopause me, meno, me meno. How does gut health affect is affected? How is it affected by menopause? I got this, I get this question asked and I don't answer it very well every time because I still feel like hrts a little bit of the wild west. Totally. And and that's because it's, we're back in it and it's relatively new. Menopause is trending now for good, for great things, all good things, but I just don't know. I don't think we know a lot other than we know that we are depleted with these really crucial hormones that are all over our body. And including the gut and, brain and everywhere. And so wh the, why do we get depleted at such young ages is the question. It's not fair because we do live longer now. And so it's almost and I'm digressing a little bit, but I'm, I don't think it's, menopause is not fair. Oh yeah. To I mean it, I'm trying to embrace it like, for people, my patients, for myself, et cetera. But it's harder and harder to embrace it when you're like, oh, so you only wanted me on this earth to have a baby. And then goodbye. You don't need your hormones anymore.'Cause people will have the most pristine bowel movements, no GI issues, not a single problem. And I know this'cause I have family members and I've done their stool testing. Pristine. Nothing wrong with it. Menopause. Comes and they're like, huh, I'm a little con. I'm not constipated. But things are a little sluggish. They're a little slow. They don't come out. Yeah. That could be okay. Maybe the bucket's tipping for something else. Maybe something's about to happen. I don't know. Or maybe we blame menopause. Honestly, I've seen a whole cassia stuff. I've seen a DHD symptoms just flare up like crazy. I've seen anxiety. I've seen pain with sex. I've seen just loss of interest. I've seen depression. I've seen gut issues. Yeah. And with all the estrogen receptors on the gut too. Yeah. You're saying you're seeing this related to menopause, right? Oh yeah. That's, yeah. Exactly mean, that's, but they'll, it's all over. They'll come in and then they think they're crazy and I'm like, no, you're not. You're really not. There's a lot, there's so many things going on, and now there's a big menopause movement, which I think is great. But there are also this, a whole there side of just like over pushing like the hormones. Like I'm a person where I have, I had never been able to tolerate any hormones before and I'm like almost dreading, not dreading, I don't wanna say I'm dreading, but I'm worried about going through menopause because I believe I might be in perimenopause currently. And that's, I think it's happening younger for me.'cause I went through chemotherapy five years ago or six years ago. And I guess my point is that not everybody can tolerate hormones. And and there's still a lot I think that can be done in my experience to help. So I'll say it's interesting because I'm a, I am a food is medicine person and all that, but I'm also a longevity person. And if we know that these hormones affect our longevity in the sense of improved bone health, heart health and cognition, it's really hard to say, let me do this naturally. So I'm torn about it philosophically, but I also know that the science is there for these, for estrogen, testosterone, DHEA for all these to be really great things that we should have not been deprived of at these early ages. And we are. And so now I think we're all dealing with okay, do we go on these or not Now? Yes, there are great. All kinds of things. Herbals, supplements, natural things, maca, co black, osh, blah, blah, blah for perimenopausal symptoms, but that does not affect longevity. So I think there's a big difference between symptoms. And what's your target goal here? You're saying longevity'cause of like bone health? Yeah, muscle mass, things like that. Yeah. Yeah. And, but there are some people especially people with the history of breast cancer. Yeah. There's debate on whether or not people can go on that, but then there's also if you play this out, if you, if. Don't go on estrogen. There's also this thing about cancer that I feel like pisses me off in the medical community is it's let's just get people let's just make sure that their cancer, there's some evidence that maybe shows X, Y, Z. So let's just remove this completely from this person. Yeah. But let's roll this back now let's look at their quality of life. Yeah. Yeah. So if I know, if I'm a, if I, if somebody's told, Hey, don't go on estrogen, it could increase your breast cancer risk to come back. What are we say this person develops severe anxiety and then their bone loss and then they fall and break their hip. So there's this, okay, they might live like Yeah. Longer with without cancer, but what's their quality of life? Yeah. So there's this, fear is there for cancer. Yeah. But which I. Of course, but there's the number one killer in the world is heart disease. Yeah. And what men and women, what's estrogen receptors on the heart? Yeah. Yeah. So just look at the statistics of Yeah. Worldwide cause of death and cause of mortality. That doesn't mean I don't, I do understand where those providers are coming from. Oh, I get it. But how about a more informed decision making process with the patient? Like with the patient, let them decide Hey, this is it's more likely that hey, this is the risk. Yeah. But then this is also your more more the like your quality of life. Yeah. And you get to decide. Yeah. Yeah. That's my issue with it is it like, but I do think we can blame the, the WHI study and all that on some of this. Oh my gosh, it's horrible. Probably the next generation of med students are going to be more well informed and not that, not more well informed, but they will be. Able to look at the longevity piece a little bit more and maybe then have those discussions because, that study for the people that don't know, it was probably the worst thing I think for women ever Uhhuh. Yep. Yep. And it basically said that breast cancer was caused by estrogen, but they gave it to people. It was like 10 years after menopause. Yeah. And it was lots of problems in the study. So many issues. And so we've got, we still got so many people scared of estrogen now. And I'll say, Hey, there's no and actually maybe some people don't know this'cause I didn't even know about that study until I went to pelvic health. Into pelvic health. Oh, really? Yeah. Okay. So it wasn't well in the, it's not as well known in like the Oh, general physical therapy world. Yeah. So if you are a physical therapist or a chiropractor or a practitioner that works in the field, people are scared of estrogen because of the Women's Health Initiative study. But this study was extremely flawed and it scared a lot of people not to get estrogen. Yeah. People and practitioners. Yeah, and practitioners.'cause like even in training our, my good friend so we all were, in the medical field, med, med students and PA students and we're all friends and ones in ob, GY none of this was talked about. Like you just didn't, no one talked about menopause first of all, but it was a cult cultural mindset to be like, oh yeah, that is just not a thing you don't do. HRT. Period. So everything's changed from when we all went to med school, pa school to now. So I just, I would be curious to hear like you should have a medical student on Yeah. Or like a resident. Yeah, that's a good idea actually. Yeah. But I think the thing that frustrates me about now, we've almost swung so much to the other side, the other direction. Yeah. And Hey I'm pro whatever people wanna do. Yeah. But that's what I was say, alluding, like saying before is that now we're just like over pushing it without letting, without addressing all these different populations and. It is, there are plenty of people on HRT now that are having problems like postmenopausal bleeding. Okay. What do we do with that? How do we adjust the hormones? Do we adjust the progest? Do we adjust the estrogen dose? Do we, or like hair loss. I'm not trying to scare people from HRT, but I'm with you. Like it is a nuanced approach. It is. And that is why I think it's still a little bit of the wild west because there's different deliveries. There's different testing, saliva, urine serum. How it overwhelming and the testing the testing's hard too.'cause it's if somebody's on or a birth control, how do they test that? And then I've had somebody on and come on here and talk about the Dutch test. Yeah. Because that's supposed to be helpful for that as well. And so then you can get tested for that. But not a lot of practitioners use the Dutch test. Yes. It's a pretty expensive test and it takes a long time. To review it unless you do them every day, which, yeah. And so then people are going and they getting their blood work done and they're like, oh, things are normal, but they're symptomatic. And so then I've seen so many times people are given hormones and they're not monitored. Oh, that is the conventional way. They're, I had somebody Yeah I was, I the symptoms they were having, I said, we need to, is anybody, so I'll ask people, and this is important for practitioners, is are they doing routine follow-ups? Are you being tracked? Are you just blindly giving this? Yeah. Because that will cause a lot of issues. And then people think it's the estrogen, it's the dosage. Yeah. But then they come back to you and say we're, I went back to my doctor and I said, can we check? And they'll say, no, serum checking doesn't make any sense. So it's really tricky. You could still, I think the Oprah special was good. It was really like just getting the word out and people, I think it's great. It wasn't not, I, the people I watched it with had already gone through menopause and two of them and the third one had tried HRT and felt like, oh my God, I had so many side effects. I got off of it. And then that show convinced her, even though I've been talking to her to consider going back on it. So honestly, I think it was great for lay people to start the discussion. I don't think the discussion was thorough. It's only was an hour. There were so many, like I said, all these nuances that I'm talking about that need to be addressed. And so I think, she plans to have podcast episodes about it. Great. I do, they did focus on the cognition a lot. There was a neurologist there, so I feel like they were really talking about I was like brain gut, but they were talking about brain, gut, vagina. Access. Yeah. That, and then there's another piece too where, okay. HRT, but I've seen it where people like they're experiencing vaginal dryness and pain with sex because of the decrease in estrogen in the vagina. So even local estrogen, I'll tell people to get that a lot. And then sometimes I'll come back and be like, my practitioner wants to know the dosage. Yeah. But it's just so interesting to me that then they're coming back and then asking a physical therapist, I'm like, oh my gosh, I don't prescribe these things. But yeah, it's just, it it's all very new. It's, I think still so very fresh. It'll be different in 10 years. Yeah. It's crazy. Yeah. But thank you so much for coming on. For sure. Such a great time to talk with you. I love talking about all this. We could probably talk another hour about, I know. I was just like, oh my gosh, I don't want take your time anymore. In summary, we went over IBS, we went over sibo, different things to look for as a practitioner, when to potentially get more testing. And so understanding how western medicine. And how, and incorporating that into looking at the person from a holistic perspective and encouraging our patients or clients to really advocate for themselves and get to know their bodies so that when they do go into Western medicine, they go into these five or 10 minute appointments that they can really ask these direct questions and get some help from that standpoint. Yeah. And yeah. And then how menopause can affect the gut as well. The gut. Yeah. Yeah. So tell them how they can reach you. Oh. So Precision Gut Health is our website. Instagram Precision Gut Health, Facebook Precision Gut Health, TikTok, precision Gut Health. Okay. It's all precision gut health. Actually, we started as precision metabolic health because I really, oh, I did remember seeing that Uhhuh. And then it's, that's a mouthful. And I don't think people know what metabolic means Exactly. Yeah. And I was like, oh, marketing agency that I hired basically told me that's not gonna work fo. And it, and it. Because it's just a mouthful. And I still do metabolic health. I do a lot of lipids and cholesterol and things like that. We do a full chemistry panel if you're in the state of Texas. It's a very like, comprehensive blood work panel that's a really good starting point. That can give us clues to nutrition, to all inflammation, to blood sugar regulation, cholesterol, all the things. I love doing that. That's important to get your blood work done properly, comprehensively. Great. Cool. I'll put all that info. Okay, cool. And the link below. All right. Awesome. Thanks for having me. Thank you.

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Thank you so much for listening to my podcast. It would be a huge help if you could subscribe and rate the podcast. It helps us reach more people and make a bigger impact. I would also love it if you could join my email list, which is LinkedIn, the caption for podcast updates, upcoming offers and events. You can also find me on TikTok, YouTube and Instagram at Dr. Mary pt. Thanks again.