Boost Your Hormone Health: Myths & Secrets Revealed with Dr. Christine Maren

It puts us into stress and survival mode. And when we are in stress and survival mode, our body down prioritizers or deprioritizes things like digestion or gut health, hormones, or reproduction, and immune system. [MUSIC] >> Everyone, thanks for tuning in to the first optimal podcast. Here with Dr. Christine Marin, really excited to have Ron. She is a functional medicine specialist in hormone optimization, as well as a number of other areas we're going to impact today, things ranging from gut health to as our bodies transition later in life, to PCOS, menopause, all kinds of fun stuff. I'm sure we'll get into today. But thanks so much for joining us. Appreciate you coming on the show. >> Yeah, happy to be here. >> So we were talking a little bit before we started recording. So you're based in the Colorado area. And just for those out there that are maybe just for the first time being introduced to you, can you talk a little bit about how you got introduced into the one or four-year of functional medicine and obviously pretty extensive in your education as well as your practice? >> Yeah, yeah. Someone asked me a question yesterday. That was a really good one. She said, what was there one moment in time that really puts you on this trajectory? And I was like, yeah, I was 18 years old, actually. And I was prescribed birth control pills because I had period problems. And 18-year-old Christine was like, and that doesn't make any sense. Like, why would I take birth control and suppress all my hormones? And so that really started my path toward women's hormones and a really more holistic approach. I ended up seeing an acupuncturist and integrative physician in the Boulder area. And got the help I needed, fast forward, a decade later, through medical school residency, lots of stress, and having babies. And those hormonal shifts can be really big triggers for women. Whether that's trying to conceive, miscarriage, pregnancy, postpartum, parimenopause, menopause, any of those big hormonal transitions tend to be triggering for underling health issues. And so that was certainly true for me. I had gestational diabetes with my first child, which was really surprising because I was eating like what I thought was perfectly healthy at the time. And I just had none of the traditional risk factors. And that really started me down, an nutrition pathway of like, what's going on here? I learned a lot, but it was really between my first and my second child when I had recurrent pregnancy loss that I started taking a very serious look at my health. And, you know, it's traumatic. I had a lot going on. I had finished my residency training in family medicine. So I'm a board-certified physician. You know, I have a lot of resources. I had a lot of training. And he didn't have the answers. And nobody else did either. Until I saw a functional medicine doctor. And I knew from that time, functional medicine, what was helping me personally, I already had a holistic mindset. You know, I already, I knew a lot about it in a greater medicine and had done training with like Andrew Wiles program in Arizona for a bit. But it was then I knew like professionally. This is what I have to do. This is the thing like easy, you know. So my personal and professional life is really collided. And I'm really grateful for that because I found the thing that I meant to do. You know, functional medicine has been my focus. Since then, I've had a functional medicine practice of my own for about a decade. And Colorado, Michigan, and Texas, all those places where I did my training, my residency, my husband did fellowship in Michigan. So they're there for a bit. And now we're back in Colorado. But, yeah, I mean, I have the great pleasure of helping people transform in a really meaningful way. Awesome. Now, does your husband work with you at the practice or is he? No, he's a spine surgeon. Yeah. He has a very different job. Got it. Okay. Yeah, I'm curious with your with your background and experiences. There's a lot of publicity, if you will, or content, or what have you about the medical field and his relationship with like nutrition. Because you mentioned something there about, you know, finishing residency and then getting into other, you know, trainings and such. I'm curious, what was your experience like as far as exposure to like nutrition going through like the medical pathway? And then what did you find outside of that? You know, I mean, from day one, I went to an osteopathic medical school. So I'm a doctor of osteopathic medicine. My husband also is. We met in med school. So, you know, a lot of people are, you know, MD and DO are actually quite similar, but our training is a bit more holistic. We learn more about like the muskosalital system, but we still don't learn a whole lot more about nutrition. And so nutrition wasn't really, it wasn't a big part of my medical training, but it was a big part of my own personal interest and, you know, think something I saw it on my own. But yeah, exposure wise, I mean, really pretty limited. Yeah, and I think I think it's still great that, you know, you meet just like any other profession, right? You meet people that stop right after they get that first stamp for approval, if you will, you know, and rightfully so. Like it's pretty extensive to go through medical school and accomplish those things and be out in the world of hands on, but then for you to go and get additional training on top of that to really round out your approach. I think is is really cool to see and, you know, definitely something I would encourage anybody who's looking at different practitioners just to see like what did they do, you know, after that to kind of specialize in that area. Maybe they're they're treating you with. So yeah, I think that's the special thing about functional medicine doctors actually is a lot of times if you find a physician who is practicing functional medicine, you know, they generally are people are physicians who continue to learn and are, you know, interested in like what's next and are there better answers than a birth control pill or, you know, whatever. Yeah, I'm curious just your, you know, as you mentioned, you and your husband both, you know, going through the medical education process and practicing for quite some some time now. Do you and you might not have an opinion as I don't know, but do you have any thoughts on where the medical field is potentially going to go? Do you think there's going to be maybe more regulation and or formal training around in like a med school, around more functional medicine practices or more of these intertwining of, you know, nutrition and other levers and maybe even peptide therapies or something along those lines. Do you think some of that is is possible in the near future or is that not really? I don't know. I mean, here's the thing, med school and residency, like it as long as a lot of hours. And it was hard, but it was like good education and it sort of is, it's seeing this other side of the spectrum. I'm seeing people who have diabetes and cirrhosis and cancer and the end stage of a lot of diseases, which are really significant. I guess what I'm trying to say here's I don't know how much room there is for that, right? Like especially with my husband straighting, he's hated orthopedic spine surgery. You don't, you know, if you're a surgeon, you just don't, you don't have a lot of there's not a lot of time for all the other stuff you have to learn. So I don't know. It also is something that I'm really like it's it's it's pretty far away from me now, you know, I don't I don't do a lot with medical, you know, like formal medical schools anymore. Sure. So I don't know. I mean, maybe, but I know there's a program in Arkansas that's like a little bit more holistic. I mean, there's some programs popping up for sure. And you know, that was part of why I saw an osteopathic approach because it felt more in line, more aligned with like, you know, my my philosophy at even at that young age. So I think, you know, there are some programs out there, like the Arizona Center for Integrative Medicine, great program. You could do residency through that program and get exposed to it. But it's I think you really have to seek it out. I don't, I don't know that it'll become the norm. Yeah, I just curious with the it seems like there's so many lack of a way of putting it like celebrity doctors or educators. If you, you know, under the that operate under the umbrella of functional medicine, if you will, or longevity or things of that nature. So just kind of curious what your thoughts were there. It seems to be more promised last, you know, five to 10 years. And you see was it Peter Tia was on 60 minutes. Yeah, yeah. It seems to be like more more more mainstream these discussions are happening. And I don't know. I think our world is really exposed to it. Like that's all I see, you know, that's all we see because that's our algorithm. Yeah. Is those. Yeah. That's true. That's true. Well, speaking of expertise and all that good stuff, so much we can unpack here. But I thought maybe we start with, you know, parimenta pause kind of when does it typically happen if I'm a if I'm a listener and what would I what would one feel if they think they're maybe starting to go through that transition of life and then and then we can kind of start there and start unpacking it from there. Yeah. Parimenta pause. I mean, it's in the news. It's also in my algorithm. So I feel like everybody's talking about my pause now, but maybe not. So generally most women will experience parimenta puzzle symptoms around late 30s to early 40s. So the average age of menopause for women in the United States is age 52. And parimenta pause is about a decade transition that starts before that. Maybe a little shorter for some women, but it really is Is this like a video? like inverse of puberty, right? So puberty starts, you know, and like young girls may be around the age of, let's say nine to 13, 14, 15, whatever. Now we're on the downtrend, right? So we go through parimenopause and we start to experience lower estrogen and lower progesterone, especially lower progesterone. Some women in parimenopause experience these big spikes of estrogen in relationship to low progesterone, which can bring on specific symptoms. Other women in parimenopause will experience just low estrogen and low progesterone overall. But any woman, if she lives long enough, will go through parimenopause and then menopause. It just depends on the age. And certainly we can, there are reasons why women might go through parimenopause on the earlier timeframe or through menopause on the earlier timeframe. And those include really common conditions like autoimmune disease and hypothyroidism. Smoking can really accelerate it as well. And part of what we look at in longevity medicine is how do we prolong our variant of aging? What can we do to delay that onset? Because having estrogen in our system and adequate progesterone is really helpful for longevity, mood, brain health, bone health, muscles, body composition, blood sugar. - Yeah, I'm curious to when this is happening. And I don't know if this is a black and white answer. Maybe there's some new, I'm sure there's some new oncis and percentages. But what hormone would you say is generally the first to go in women's health that you see? - Progesterone. - Progesterone. - Yeah, progesterone. Progesterone universally declines in parimenopause. Estrogen is variable. Like I was saying, it might be high in low, chaotic or it might just be low. But progesterone is, yeah, is always the first to check out. - And you, I guess I'll be paused for a minute. Just in case there's people out there that might not associate what that would feel like. Could you mind sharing a little bit of what that would, someone might be in there like if they're experiencing that? - So low progesterone can feel like anxiety, often trouble sleeping. Progesterones are really calming hormone. It might also look like heavy painful periods. So when women go through parimenopause, if they're experiencing really heavy painful periods, which is, I hear it every day in my clinic, that's a sign that you have too much estrogen in relationship to progesterone. So it really has to do with that ratio. It's very Yin-Yang. And if you don't have enough progesterone to offset the proliferative effects of estrogen, you end up with endometrial proliferation or a thick endometrial lining, which is the lining of your uterus that you slough off during your period. And so if there's other reasons why we can have heavy periods, like fibroids and things like that, but often it's this hyperestrogenism, which is really estrogen dominance, which is really just progesterone deficiency. - Yeah, no, it's, do you see any relation to, during that time in life, you mentioned progesterone going down. I'm curious if you often see estrogen clearing as problematic as well that's leading to some of the estrogen dominance. - Yeah, yeah, for sure. Yeah, so estrogen, I say, we need flow. We need estrogen to come in. Estrogen's really good for us, but we need to come in and come out or go out, right? And so there's three different phases of estrogen metabolism or detoxification phase one goes through the liver. Phase two goes through methylation. And so that's where nutrients like some B vitamins and magnesium is helpful. And phase three goes through the gut. So this is a really interesting correlation. How much the gut has to do with hormone balance? Because that's a real, it's a very well documented bi-directional relationship between gut health and hormone health. So your gut, well, first of all, just having regular bowel movements is important. If you're not pooping, you're not pooping out your estrogen. So women who aren't having a regular bowel movement need to look at that a little bit more. But what's also interesting is just the composition of the gut microbiome. And so the gut microbiome has the subset of bacteria that's called the astrobolo. And the astroboloam's job is to regulate those estrogen levels and phase three of that estrogen detoxification. And so astroboloam makes beta glucoronidase, which is an enzyme that can unpackage estrogen so you can suck it back up into circulation. So we first heard about this in 2011 in a paper called microbiome and malignancy. And so they were looking at a strobelem in relationship to cancer risk because women who had cancer, if they're sucking estrogen back up into their circulation, that's probably not what they want, not to say that estrogen causes cancer, but it's proliferative. And so for women who have cancer, you don't really want to have high estrogen levels to proliferate that. So yeah, I think it can go both ways like that astroboloam potential. If you're menopausal or parimenopausal, and you have low estrogen, that's a really cool way that your body can suck up more estrogen to protect you. And this might be why some women experience menopaus in a less significant way. Some women don't have really significant symptoms. On the other hand, if you have more estrogen-dominant symptoms and you have really heavy periods or you have endometriosis, you'd want to get rid of more of that estrogen in your gut. And so there's this switch that our body really intelligently can switch on and off, except if our gut is in a state of dysbiosis and we don't have the favorable bacteria in our gut, then that switch isn't really working so well. And that affects our hormone balance. - It makes a lot of sense 'cause that's with myself not being a practitioner, but having a family member go through that and they presented like low estrogen production but estrogen-dominant symptoms. And it was really strange 'cause back then, myself or even like some of the physicians who I was working with weren't exposed to like a precision analytics or something along those lines, like doing some kind of methylation or the Dutch task, things like that. And so it was just, you know, really I was curious to your experiences with that. So that makes a lot of sense because I think sometimes like just looking at the surface, oh, your estrogen's low, your aging, like just give you more, then it like multiplies those side effects that just can be really problematic a lot for women's health and they think, like, "Well, that just doesn't work for me." - Like they think that hormone therapy doesn't work for them? - Yeah, because it just kind of exacerbated the symptoms but that wasn't really-- - Yeah, totally. I mean, I have, like there's a lot of patients who start hormone therapy and they're like, "Gain change, I feel like myself, so helpful." And then there's a subset of women who try and for various reasons, they don't feel that good. And so that's when I really look at like, what's going on, well, I'm gonna look at it anyways, frankly, but we're gonna look at gut function but also thyroid. And so sometimes if women go on estrogen, if they have can borderline thyroid function, it can worsen that because of sex hormone binding glopulines. So yeah, it can be complicated. The other piece of it is like, I always layer in hormones and so we know when we layer in progesterone, how do you do with it? Do you tolerate it well? Most women love it, but there's certainly progesterone intolerance. And so I don't wanna guess if it's progesterone or estradiol or testosterone, which one is the side effect. So I do really layer them in one at a time and kind of assess from there. - And do you normally see, I'm curious, like with, and I know we're paying with a broad brush here and there's details, which is what, obviously you specialize in why someone should see you. But I'm curious to like progesterone application. I've seen different protocols for different people at different stages in life. Do you generally try to look at, I guess I have a couple of follow-up questions, but is it generally like a short term symptom relief? Like, hey, use this during this time of your cycle. Are you seeing that more as an application? Is that not a good application? Or are you seeing it just in a daily application to use, you know, kind of around the clock? - I think we're on the clock. - On the progesterone every night. - Yeah, I think it depends on the person. So for some women, they do benefit from nightly progesterone, especially if they suffer from a lot of anxiety or poor sleep. I didn't even mention this, but progesterone's is also anti-inflammatory. It can help stabilize mast cells, which are the cells that really is histamine. So for various reasons, it can be really helpful. If I have a patient who has a massively heavy periods, I might put her on progesterone every night. And then we might dial it up. It's a balance, because if you dial it progesterone too high, and you use it every night, it can interrupt ovulation. And so for women who have a regular cycle, we're not interested in messing up their regular cycle. There's also a certain women where I'll use it just in the luteal phase. So ovulation administration, nightly for two weeks, we've got a lot of options. And it depends. If I think the bottom line is really, it's progesterone helpful for you. Does it change your symptoms a lot? Does it change your life? Then we might use it nightly if it's gonna help you sleep. - Yeah, and this is again, another more nuanced curiosity. I have so selfishly, if you would might entertain me more, I got a few more follow-ups. But one being, do you see a difference in patient outcomes related to progesterone being applied with like a, I'm drawn to blank into terminology, but like an immediate release versus an extended release. - Or a oral, tack and death oral? - I'm sorry, yeah, yeah, oral. So like if they're, let's say they're having issues with sleep, especially during certain phases, you know, an identity. Yeah, there's some time. So the prescription I write the most often is for pro-metrium or micronized progesterone, which is in your regular pharmacy. And that's mostly, I mean, not always, but it can be a financial decision too, because it's not as expensive and it does have peanut oil, so it's not quite as clean, but it's not a bad option. I also will prescribe a compounded, sometimes a sustained release progesterone for certain women, especially those who have trouble sleeping. And so when you compound something, it is cleaner. There's not going to be peanut oil. You need to use a really reputable compounding pharmacy. You don't go into random pharmacy on the corner. Sure. You know, make sure you're using a really reputable compounding pharmacy. And then you could get a sustained release, kind versus a regular release. And for some women, yeah, I do use an extended release. I wouldn't do it. I don't do it in every woman. But yeah, we definitely, I have some patients who are on the extended release or sustained release progesterone. I don't know. No, appreciate that. And my other question is on kind of staying at the top, I guess, of the hormone cascades. When you notice, have you noticed this in blood work? I've heard this from a practitioner before. Admittedly, I haven't read this myself, so it might be complete. They just made it up. I don't know. But is there a relationship between progesterone going down and a woman's DHA levels? Is there-- Yeah. Yeah, I mean-- It's just to be a drop in DHA. Yeah, for sure. I mean, DHA is like at the top of that-- it's a precursor hormone. Sure. And so generally for women, DHA, it depends. It really depends on the woman. But sometimes it turns into testosterone, which is what the point is generally of using DHA. You just have to be really cautious about it in some women, because it'll cause hair loss. Can it cause more-- or can it give us more progesterone? Generally not. But low DHA would definitely be associated with somebody who had lower progesterone levels. And it's just not like a direct relationship, but-- Got it. Potentially. I would think, though, more, like with a really low DHA, like a really stressed out woman-- Yeah. --and somebody who's had chronic disease for a long time, those are tend to be the women who have low DHA. Yeah. No, and that's what I was curious about is if it's-- which came first as a low-- they had low progesterone, which caused their stress to go higher, which led to their DHA being low over the-- Yeah. And it was speculating. Yeah. So no, I appreciate walking through some of that. And then lastly, on kind of this high level of the hormones themselves, progesterone's first to go with the next generally B testosterone, or is it used to find more estrogen? It depends. I mean, as women go through paramanopause, they experience a universal decline in progesterone. And then the decline in estrogen takes a lot of years, you know, seven to ten years on our way down, sometimes chaotic spikes, sometimes not. It just depends. So-- but those are both, you know, the progesterone is produced by the corpus leutium of the egg that you ovulate. And so for a woman who is in her reproductive age range, she should experience progesterone the second half of her cycle, which is called the leutial phase. So that's between ovulation and menstruation. So your ovaries make estrogen. And so testosterone is made in the ovaries, but it's also made by the adrenal glands. And so we've got, you know, two places. So not every woman who goes through paramanopause experiences low testosterone. Some experience it sooner than others, especially if they have low DHA, and especially if they're under a lot of stress. But some women, you know, in their 30s have really low testosterone. But they'll have normal estrogen levels, or high low, high low, or whatever it might be. Because testosterone's the first one to decline, actually. I mean, in a 30 something, that's a possibility. And then, you know, if we're looking at like a 50 or 60 something, and I look at their testosterone levels, not every single one needs testosterone, some do for sure, but not everybody does. And it depends on symptoms, too, you know, like the lab work, especially for testosterone, only tells us so much. Sure. The lab reference range for testosterone is a big joke because it literally goes to like nearly zero. And that's considered normal. Yeah, no, it's interesting. Do you have any any sweet spots of what you generally to see for women's health relative to that with testosterone? Yeah, I mean, if I'm looking at labs, all labs have different reference range. So I'm aiming toward like the upper half or upper third of the reference range for free testosterone. So total testosterone. Sometimes people only check total. And that's a piece of the story, but it doesn't tell us what's bioavailable. And so there is another marker called SHBG or sex hormone binding globulin. And so for women who have a really high sex hormone binding globulin, they are going to bind up some of the testosterone, so they'll have less bioavailable. So what that means is so let's say your total testosterone is normal, but you have a really high sex hormone binding globulin. That means your free testosterone is probably going to be low because a lot of it's going to be bound. That same binding globulin SHBG will bind up free thyroid hormone. So it's there as a protective mechanism. You know what makes it go up really high is birth control pills. So hands down like every time a woman's on birth control pills or SHBG is really high. And it's her body's way of trying to protect her. It's sucking up some of that excess progesterone and estrogen. And also the bystandered is thyroid and testosterone. And I was talking to another guest about this. I'm curious to what you see related to that. So if we're talking specifically like SHBG, you know, being elevated from birth control, if you were saying that helping a woman navigate coming off of birth control is that a pretty quick adjustment. Does it take a long time for that to come back down and rest does it self-correct? Do you need to enter some intervention there? What does that look like? I mean, really you remove the offender in itself corrects most of the time. Not always, but most of the time. And it's a progressive decline. I mean, I can tell if I'll have like sometimes I'll see a patient and she'll be on birth control pill and her SHBG will be like, I don't want 150. And then I get her labs back, you know, let's just say 12 weeks later or something. And her SHBG will be like 80. And I'll I know that she's gone off her birth control pills because her SHBG has come down so much. It doesn't always happen like I would follow those markers ideally, you know, get some data. But yeah, I would say that definitely trend is that SHBG will just come down on its own. Is there anything you see out there as far as utility that you might implement or dietary or supplementary, you know, pharmacology, etc. for lowering SHBG if that still is a problem for somebody? You know, I more ask the question, why is it high? What are we missing here? Because I think of it more as like our bodies are so intelligent. Yeah. When there's a marker like that that's off, it's like rather than trying to make it go down and force it, you know, it feels like stuffing something into a box. Like let's try to figure out why it's high and work on that first. That said, I mean, there are certain supplements that can help and, you know, blood sugar regulation that can help. But yeah, my first instinct is really just optimize lifestyle and try to understand why this number is high. Yeah. No, I think you're obviously, you know, doing a great job articulating the difference between, you know, maybe that traditional medical care we're trying to get you just that relief, symptom relief right away versus like a root cause approach, which you're, you know, you're talking through, which is, which is great. I, so I appreciate kind of walking through some of that. I have just a ton of questions about gut health and similar topics you have. So I'm going to try to do my best to navigate in the same direction, but we'll see how I do. I did want to ask just to circle back to the gut microbiome and its relationship to, to histamine. I don't know if you might, you might have, you might know or I don't know if you guys are in the same network, but I had Michelle Shapiro on. She's a registered dietitian does a lot on specific with histamine, but that was really, really interesting conversation. But I wonder if you can kind of walk through, you know, that whole part as far as like paramedic haves, gut health, histamine, inflammation, that whole, that whole deal. I find a lot of people don't, sorry to ask a question, then make a statement, but I'm, I guess I'm going to stop myself, but I just find a lot of people don't make the connection of like this causes this, which causes this, cause this. I think that would give people so much hope if they can make that connection and stop thinking like this one thing didn't work. Therefore, I suck and I'm never going to get better and I just have to deal with it, you know. Yeah, I mean, I think the bottom line is like women's health is complex. We are all connected. All these systems, it's like a web, it's a complicated web and our healthcare model silos all of these systems off. And so you see your gastroenterologist and then you see your OB-GYN and you see like your endocrinologist, whatever it is. Like, I think it's helpful to have somebody who can look at this whole picture and this whole web and help you put it together. Like histamine is a good example of this because parimonopause is a perfect storm for histamine issues. And that is because the hormonal disruptions affect histamine and the gut microbiome changes can affect histamine. So hormone-wise, I mentioned progesterone stabilizes mass cells which release histamine. Estrogen when it's really high can lead to excessive histamine, but if it's really low, that can disrupt the immune system and make you more prone to histamine issues. So it's kind of a Goldilocks issue there. In terms of gut health, as we go through paramedicons, we see a change in our gut microbiome. And in terms of histamine, we see more histamine producers and less histamine degraders. So the gut microbiome plays a really big role in the way that we even metabolize histamine. There's also genetics like DAO and HNMT and some certain genes that help us kind of understand why some people might be more prone to histamine. And just to give the listeners a lay of the land here, like when we're talking about histamine, we're talking about sure the thing you know, like allergies, right? Stuffy nose, hives, itchy skin. But also sometimes histamine looks like things that we, excuse me, don't quite know, which is like migrants or headaches or palpitations. It's an excitatory, so histamine's an excitatory neurotransmitter, which can cause palpitations and excitability and trouble sleeping. This is probably part of the reason if you drink a glass of wine, you can't sleep or you have palpitations that could be histamine related. It can also cause a lot of, it's called visceral hypersensitivity, so that's just like a lot of cramping in your gut. It can contribute to bloating. I mentioned skin and allergy symptoms and all of that, but it's all often multi-systemic. So if you have a lot of different symptoms or let's say you eat sourcrout and you get a runny nose, like that's histamine. So, did I answer the question? - Yeah, yeah, no, no, I'm just following you, yeah. 'Cause when you were talking about the heart response, it flashed a memory too about like the relationship between histamine and pots. - Yeah. - Coming up in some of that and it's definitely, I know enough to be dangerous and say the wrong thing, but I've talked to some people that like yourself that have went definitely in the weeds and very hands on with some of those relationships and that's been pretty interesting to see like tying that into how the histamine's affect like blood flow changes, nervous and immune system, connective tissue and kind of the whole cycle there. So with gut health or let me take a step back. So obviously a lot of different tasks you can pull from, you can look at genetics, gut, blood, bubble, all the stuff. Someone comes into your practice. I wanna share with the audience a little bit about your pillars as you were talking about before we started recording, but then also maybe like what is usually, I say usually loosely 'cause I know it's gonna depend, but order of operation, like where do you generally find yourself leaning to prioritize testing as you start to navigate through a solution with people? - Yeah, I mean gut is the place I usually start. And simultaneously I will work on hormone optimization as we work through treating gut. At the same time we're working on improving or tweaking foundational lifestyle habits. So I have these three pillars that I've structured my practice on and number one is the root, like addressing the root cause and that's where functional medicine really shines. And where we really do deep dive on gut health, also nutrient depletion. I mean the vast majority of people could improve their gut microbiome and also have some sort of nutrient depletion, whether that's zinc or vitamin D or B2 or B12 or folate or whatever it is, maybe it's all those things. But really looking toward like strategic supplementation and also improving your gut. So you have better absorption than your trends that you're consuming. But really starting with testing, we're looking at gut health especially if somebody has autoimmune disease, digestive symptoms like loading or heartburn or cramping or whatever it might be like a loose stool or if they have food sensitivities. If they can't eat as much food or if they have skin issues, that's a big sign of gut stuff too. So address the root causes, pillar one, pillar two is optimize hormones. And so when I talk through optimizing hormones, we're looking at thyroid function, we're looking at progesterone, estrogen, testosterone, also insulin and cortisol. I mean there's all these, the symphony of hormones and those two things really talk to each other. And then the third one is really building foundational lifestyle habits and we're working on this at the same time as well. So really that's what kinds of modifications can we make to our diet so that we're nourishing our body, eating enough food and eating the right kinds of food, getting enough fiber, getting enough protein. Big advocate of strength training and movement. I could walk some more in my life. I'm going to do that this afternoon. But just really developing those habits around building muscle and moving our bodies. Low-tox living is certainly a focus of mine, but I always talk about progress over perfection because I myself have been in a place of hypervigilance where everything around me had to be claimed. But doing the things that'll move the needle, like filtering water, filtering air, avoiding blade plug-ins, things like that. And then really nailing down sleep. If your sleep isn't nailed down, we've got a problem. But sleep and hormones often talk to each other a lot, estradiol and progesterone, hugely influence sleep. And so sometimes there's this big crosstalk happening there. Of course, cortisol is a big one too. And then mindset. Mindset's a huge focus of mine. It's really encouraging women to show up for themselves. And I work with a lot of really high achieving badass women who know how to get things done. And often there's some subtle degree of self-sacrifice or self neglect in the name of being productive. So-- Yeah, no, I'm curious to kind of peel that back a little bit more with the high achieving women. And I'm curious to like, one, how do you define that? That type of demographic, if you will, when you're seeing them. And then what is usually maybe a common approach? I know there's going to be some nuance as far as how to start to unravel these things. Yeah. I mean, it's a hard one. And it's one-- I mean, I am her. She is me. It's all part of the weave. I'm part of this weave. We're so similar. And it's easy for me to spot because I also-- in my-- Hi, my name is Dr. Marron. Like I'm a high achiever. High achieving women-- there's a lot of cultural conditioning behind this. As we grow up in the United States, we are taught to put our needs last. We're taught to anticipate the needs of others. We are taught to be maybe hyperproductive. And this all depends. This depends on cultural conditioning and what your childhood experiences look like. Sure. Big trauma, little trauma. Those kinds of things really underscore this and really drive home. What's there? But a lot of what a girl learns in our culture is often her worthiness is centered around what she does and how much she produces, not just being inherently born worthy. Yeah. And so she grows up and she's conditioned to be a boss babe. She's conditioned around hustle culture. And she's good at it. The high achieving women are really good at playing this game. And that is why they become high achievers, right? They can play this cultural game and they won. They won the game. And at the end of the day, they end up exhausted and depleted and sometimes anxious or stressed or whatever it is. And that plays a role in their health. So I get on the phone. There's this specific archetype behind women who have autoimmune disease. She is always dependable, responsible, capable. It's just a double-edged sword. Because all of those things are great, right? The other edge of that sword is recognizing that it comes with the cost and that cost is often our health. And so what does that look like? By the time they get to my office, I usually know, the vast majority of them, about 95% of them, are already showing up for themselves. That's why they're there. They're showing up for themselves. They're like, OK, it's time. I'm going to work with this doctor. And they commit to it. We ask, I have a three month and a 12 month program. And so especially if they're like, yeah, I'm going to do it. 12 months, like I'm in. I know they're starting to show up for themselves, which is awesome. And I think as women, the way that I approach that is we're all individual. We all have our different stories. We just-- it's a pattern. And we all have a different curriculum but end up with this similar pattern. And so I'll just speak for myself in the way that I approach this with myself as just learning with great compassion to look at certain habits that I chose, like skipping lunch, because I'm working, which is still a default. I work. I work hard. And I like my work a lot. And sometimes, then I sacrifice my own nourishment. I'm like, OK, yeah, I don't want to do that anymore. So what do I want? And my best advice is for women to really look at what do you want. So often we talk about what we don't want. I don't want to miss lunch anymore. I don't want to be stressed out. I don't want to do laundry all weekend. I don't want-- whatever it is, what if instead you frame it, like, what do I want? I want someone to help me do all of my laundry. I mean, I know that's not something that everybody can do. Sure. Not naive to that. But whatever it is, that was me. That was my life. I want somebody to help me at my house, help me with-- I have three kids. I have a surgeon husband. I have a busy practice. And it was really framing my life. What do I want? How do I want to design my life? And then going after the life you want. So reframing your language and showing up for yourself, I think are the two most powerful places to start. - I'm curious like how long did it take you to get to that point where you're like, okay, I need help, want help, whatever the case may be, how long? - Yeah, it was a progression. And for me, one thing we didn't really talk about, like my own health journey, it wasn't just pregnancy loss, it was Hashimoto's and hypothyroidism and Moltoxicity. And the very dark time was when my house flooded and I already was in a place of hypervigilance with mold. And I had designed this house to be really safe. And then my toddler left the sink on and water went down the whole thing. It was just like so dark. And now I see it as such a gift because it was the thing that woke me up. It was the cataclysmic event that woke me up. And so I don't even know what your question is, but right now what I'm sharing with people is just, sometimes pain is the way in. - Sure. - And so if you're struggling with health issues or struggling with relationship issues or whatever it is, like pain is the way in. And from that time, I started seeing a therapist. I started seeing an acupuncturist. I started practicing nervous system regulation. I knew then like, okay, this is like, it's too much. The stress is killing me. It's not the, you know, like molecules of mold floating around. Like at the same time, let me be clear. It's not healthy to live in a house that's full of mold. - Right. - But I remediated. - Yeah. - And was there a little bit of mold in my environment? Yes, because there always is. And it's just really about building resilience and nervous system retraining. Because for women who are hyper vigilant or women who are really high achieving, like, I know you, I know you so well. We can do anything and we can get really like, we often get to this point where we're like, well, it's not working. So what do we do? We push harder. We try harder. We work harder because we get it done. And so, you know, for me, it was learning, how do I do these things with greater ease instead of pushing harder? How do I nourish myself and start a skipping work? How do I ask for what I want and bring somebody in who's gonna help me so that I have time to go work out and I have time to walk or whatever it is? - Yeah. - It's really about designing the life you want. - Yeah, I know I appreciate that because it's, it's something, you know, I've observed clearly I'm a man. So I don't know this to be 100% true, but it's just kind of little things I've picked up and I have two daughters and my wife and earlier in my career just working with women and women's health. But I'll just use my wife as the example. She grew up with where her mom was, you know, head of the, all the parent stuff and the neighborhood association and like, Miss Homemaker and that was awesome. And then as her life progressed, I didn't meet her till a little bit later in life, but she was a college athlete. So she was more that, you know, go after, go get it, you know, got into the business world. But then when we later in life got married and had kids, it was like, oh, well now I have all this pressure to be outside of the home to be superwoman. But for my, well, my mom demonstrated inside the home superwoman and it took some time for her and me to even understand like how she was viewing things to the best of my ability. So like, you know, even for asking for help or for putting her, you know, trying to put herself first what she would tell you even to this date still she struggles with, but still a much better job at this point. But I think it's just a lot of those, you know, as you mentioned before, like those societal pressures and I don't think there's any like intentional ill will there was just kind of how she grew up and then her, she happened to be pretty good at some sports. So that's like positive reinforcement in that and then it was like that translated the business and then it was like, so you kind of have these. - It's all subconscious programming. Like most of the time we're not aware of it, you know, subconscious and it's just this programming and until you shine the light on it, it's really just remains in the dark and has a lot of power over you when it's in the dark. - Yeah, no, for sure, for sure. That's why I was just curious to your journey and your accomplishments, you know, having the three kiddos and as you mentioned, you know, I mean, actually you're practicing sure it's your journey. - Most high achieving women are like, they're doing all right, but when you layer in motherhood and layer in children and then they're really taking over functioning in their life for various reasons. There's a lot there through like, you know, dynamics and partnership and like, for men who are listening, it's really helpful to let your partner know, like I would like to, how can I help you? I see you, yes, you like, you know, pushing yourself really hard, like how can I show up? How can I do this? It would be awesome if she could ask for that too, right? But it's hard for a condition didn't I know, I'm like men have their own conditioning. I'm not like men aren't without their own challenges. I really acknowledge that. But I think part of, you know, part of our societal, like subconscious programming leaves women in a place where they feel like they're, you know, it's a funny thing 'cause we're taught we can be anything, but we're doing everything. - Right. - And we don't realize it all the time. - Yeah. No, it's, I can work all last couple of years, even like some of the stuff. I'm definitely the typical guy and she's definitely the, you know, the mom you would think of where it's like, I go, how do you even think of these things? Like I'm like, even cross my mind. Like, you know what's Lane is, you know, blah, blah, blah, like whatever the thing is of, you know, the swim team thing and there's this so we gotta get it to the, I'm like, that is so thoughtful, like that never crossed my mind. - Yeah. - It's like, of course I love my daughter. - Women are great like that. - Yeah, and then conversely that's what I've been working and you know, we both, you know, been working together on as our communication of like, hey, those things, like this is my domain, like this is my space. Like just, just hand it off and let me own that. So I can at least take that off, you know, 'cause that's why I'm hardwired and so let me own those things. And so I think I think you just said communications key and we're all still trying to figure it out, right? So it's kind of hard of the process. But all right, circle them back a little bit unless there's anything else you wanna mention at. Sorry, I don't mean to shift. - No, I mean, we could go straight into gut health because you know what, it's like really interesting. - That's a good one. - Well here, let me just connect this because. - Yeah, thank you. All this stress in our lives is women, we get into this point where we're ramping up, ramping up, ramping up and then we're like, holy crap, my like plate is so full and I have so much weight on my shoulders and literally have headaches, right? And it puts us into stress and survival mode. And when we are in stress and survival mode, our body down prioritizers or deprioritizes things like digestion or gut health, hormones, or reproduction and immune system. And so that's why little kids, when little kids are under a lot of stress, they get a belly ache and it's like their blood flows going to their muscles so they can run so they can survive and away from their gut. So there really is like physiology and psychology are very much connected. What you say to yourself literally, these thoughts and feelings flood your body with different neurotransmitters and chemicals that influence your actual physiology. So don't forget that part. It's something that people neglect. I mean, we know in IBS, right? IBS there's like a stress thing, we know that. But really like the thoughts in our head, the stress that we have every day, it affects our gut and our digestive enzyme function and our gut motility and all that kind of stuff. So I see a ton of women with underlying gut issues and it's multifactorial. It's like all these logs in the fire, you know, stress is one of them. So is the gut infection or the food poisoning you had that was like the nitrous for developing an infection like post-infectious seabull, which is bacterial overgrowth. It might be the antibiotics you talk, which now give you a yeast infection in your gut. You know, you can get CFO, so small intestine fungal overgrowth. So there can be a lot of different reasons for you know, why these things affect your gut. It didn't even talk about the enteric nervous system, but your gut has its own nervous system, the enteric nervous system. So like this is one of the, I follow Joe to spend his work and do a lot of meditation and they came out with a paper recently showing how meditation can influence all of these different centers. And you know, gut coherence is one of them. So you know, that's, there's a definite like mind body connection. But nonetheless, having an underlying gut infection can really influence your hormones, but also your immune system. And so if anybody who has autoimmune disease, I'm looking at their gut because you know, we've got to remove and replace. So remove a gut infection and replace any digestive enzymes. We also remove some foods like sometimes that's gluten, sometimes that's dairy, sometimes that's alcohol. I don't like to do really restrictive diets most of the time. You know, because that's stressful. But sometimes we do that for like a short period of time. - Sure. Yeah, and I'm curious like when you go into say, gut health, I guess I have a couple of follow up questions, but I think maybe a first one to open it up would be, are there a couple? I mean, we're talking percentages. I know it's not black and white, but are there common themes you see when you're testing gut health of, hey, this typically comes up a higher percentage of the time. Is it dysbiosis? Is it, you know, some pathogen? Like what are you seeing typically? I'm just curious. - So a lot of dysbiosis, so dysbiosis for the listeners just is an overgrowth of bad bacteria. So when we talk about the gut microbiome, there's a ton of organisms. It's a rainforest. And first of all, let me like set the stage a little bit of hormone changes because men and women have very different gut microbiomes, and that's called sexual dimorphism. And so the male gut microbiome is less diverse than the female gut microbiome, but a woman's gut microbiome diversity starts to decline about age 40. So a plateau is age 40 and it starts to decline. Well, what is that correspond with? Perimenopause. And so in the last five years or so, we've seen studies coming out showing us how in menopause a woman's gut microbiome looks completely different. It looks like a male gut microbiome, less diversity, less astrobalone potential, more inflammation, more cardiometabolic risk, so heart disease, weight gain, diabetes, blood sugar, stuff like that. So the composition of the gut microbiome is really important. And as a woman, we want a lot of diversity in there. And then when you have this bad balance of bacteria, so too much of the bad bacteria and not enough good bacteria, that is a setup for things like intestinal hyperpermobility, which is just leaky gut. And so leaky gut is like, you have this hose in your gut that goes from closed to leaky. And imagine what your immune system might be seeing on the other side of that hose if there's little holes. And it's like leaking out the stuff that's not supposed to be there, essentially. And that creates a big immune response. Again, your body loves you. Your body's trying to protect you. But it really raises this question of what's going on with the gut microbiome. So the trends I see the most often are dysbiosis. I would say the vast majority of people have some dysbiosis. There's SIBO is really common too. So SIBO is too much bacteria in the wrong room. Basically, the party's upstairs and it shouldn't be. And when you have too much bacteria in the small intestine, instead of the large intestine, you start to have malabsorption of certain nutrients, gas, belching, loose stool, or constipation depending on the type of gas that's produced. It could be really foul smelling too. Sometimes cramping, but more like the gas belching bloating, I don't even think I said bloating, but bloating is like the big one. So SIBO is super common. One that's missed often by a lot of people out there are CFO. So CFO is small intestine fungal overgrowth. People might also have an overgrowth of fungus outside of the small intestine. That might be something like Candida, but it might also be something like Aspergillus. And Aspergillus is a fungus that comes from mold. And so if you eat foods like a lot of corn, has Aspergillus in it. A lot of grains that haven't been stored properly have too much Aspergillus. The FDA makes farmers test their grain for how much Aspergillus is in there. And if it's too high, I think it's made into dog food, sadly. Got it. OK. And so if we go to a high phase of any of the bad bacteria, as if you will, or bacteria is in the wrong area of the gut, is-- and you find that there's got permeability issues, et cetera, all that. Are you generally following some steps there, whether it's like a-- do you do like a kill phase, then like a restore phase? Like how do you kind of-- Yeah, I say I move in a place. So remove the infection, replace the digestive enzymes. And that really depends on the person. So we want to remove the gut infection, whatever. I mean, sometimes it's age pylori. Sometimes it's a parasite. But the first step is like, let's figure out what it is. So we can remove it. And at the same time, we should take down some inflammatory foods and sort of modify the diet in a favorable, doable way. So yes, I do treat certain pathogens with sometimes antibiotics and sometimes herbs, and often both. And usually also a spore-form probiotic and something like an immunoglobulin or something to support the underlying gut infection or the underlying gut immune system. At the same time, I'm looking at enzyme function. Do they have enough stomach acid? Have they had a colostestectomy or had their gallbladder removed? Do we need to think about replacing bile-- bile's antimicrobial, actually? And so if your gallbladder's been removed, that's a big setup for gut infections and for our bacterial overgrowth. We can replace it with oxbile. And then there's pancreatic enzymes. So pancreatic enzymes are sometimes low, especially in older people or people with celiac disease. And we can just measure a pancreatic elastase level. I do that through stool testing. But you can even do it at like a quest or lab core. Any traditional lab, they can measure pancreatic elastase. So we know older people have pancreatic elastase and sufficiency. And your regular doctors know what that is. But I think often missed, especially when I have an older patient, they'll have that. It's just something that regular doctors haven't thought about. Just hasn't been on their radar, I think. Got it. No, Annette, do you find a lot of-- is it primarily diet being the driver? I mean, obviously, we talked about hormones. And so I think it's important to earmark that for the audience that, hey, as you start to progress in life, as you just mentioned, this decline happens with our gut microbiome as well in women. But also, are you finding other maybe patterns in traditional US diets that are leading to this? I think it's really that bonfire effect, like all these different logs in the fire. It's going to take factorial. So antibiotics, stress, pesticides, ultra-processed foods, alcohol, lots of different medications. And I'm talking birth control pills and acid blockers, but really all the medications can change your gut microbiome. The big ones I see that are modifiable are women who have recurrent UTIs, especially around perimenopause. I can help you with that. You don't have to have recurrent UTIs get vaginal estrogen. That can prevent recurrent UTIs by 50%. There's lots of different things we can do. But I have a lot of patients who have-- they use antibiotics once or twice every year. That's a lot of antibiotics. And that is going to definitely impact the gut microbiome. And yes, you need them. I don't want somebody to have untreated UTI that then leads to kidney infection and sepsis and potentially really bad stuff down the road. But how can we go upstream to prevent the need for antibiotics? So vaginal estrogen or other ways to prevent UTIs. Sionus infections is another really big one. And so I'll use a nasal sinus remnants or something like that to prevent recurrent sinus infections. And I do this-- this is a really common trend in my patients. And they'll be like, I haven't had a sinus infection for a year and a half. I used to get them twice a year or whatever it is. So there's a lot you can do to prevent some of those upstream issues. And I think they're really important to address. But to your question, it's like-- I think it's just this vicious cycle pattern. I don't think I even mentioned stress with stress impacts that got microbiome. Like, there's a lot of different negative inputs to our gut microbiome. And so trying to avoid those, you can't remove them completely. But like, limiting those and then doing whatever you can in terms of choosing better foods, and particularly fiber, to encourage a healthier gut microbiome. Yeah, I see that a lot. And I think one of the questions I had, and you've already mentioned it, but I'd like to restate it, is what are-- because I see a lot of people that say, oh, no, my stomach's fine, especially more guys than women. But-- and it's not fine. But so I'm curious, what are some other symptoms, maybe, if someone's listening and say, oh, I think my gut's OK. Yeah. And they're kind of having it in a hog. What are other non-specific gut things that maybe might be the alarm saying, no, we need to look at it more. I mean, your gut microbiome plays a role in all of your systems. But some of the common things they see are skin rashes, let's just say, eczema is one. Also autoimmune disease. So if you have an autoimmune disease, like that might be psoriasis, or hashamodos, or chowgurins, or rheumatoid arthritis, whatever it is, autoimmune disease is a big sign. Food sensitivities, sometimes people are just like, oh, yeah, I can't eat that anymore. I can't eat that either. They just keep taking foods out. But if you're having multiple food sensitivities and food reactions, it's often a sign of intestinal permeability issues, or leaky gut. And then just really paying attention to your bowel movements. If you're not having a healthy bowel movement every single day, that's a problem. There's a problem there. And so sometimes it's constipation. And people think, well, for me, it's normal to poop every three days. Well, I would work on that. That could be a sign of methane predominant seabow, or dysbiosis, or something else going on. So those are the big ones. I mean, certainly mood is involved there. There's a huge gut brain connection. And so for people who are struggling with anxiety, depression, there's probably some association with a gut microbiome imbalance. It's not as clear as those other ones I mentioned. Hormone issues too. I mean, we talked about how hormones excrete, or help you metabolize, or rather gut health helps you excrete metabolized hormones. So you know, got my being playing a role there. I'm just trying to think like what else am I missing? Sometimes like blood sugar issues could be rooted in gut just because gut makes, if you have leaky gut, it creates a lot of inflammation. If you have a lot of inflammation that often drives some underlying blood sugar issues or autoimmune disease or whatever else. It also when we have an underlying gut issues, it puts us into an anabolic state. So sorry, catabolic state, we wanna be building, right? We wanna be in an anabolic state. We wanna be building muscle and repairing. And if we're in this process of trying to deal with all the trash, deal with all the garbage because our gut's inflamed and leaky, like that's not where we wanna be, especially for healthy aging. So it can even convey risk for aging, accelerate aging and joint pain. - Yeah, no, I'm glad you hit on all those because that's something I tend to see, I wanna circle back to question about food sensitivity, but I do wanna comment on that 'cause I tend to see it more in men as far as their approach to it. I'm good, I'm fine. Not as much as I'm excited. I think for whatever reason, maybe I'm getting, maybe I'm over what am I doing? - No, I think that's cultural conditioning. I've been less tuned into what's going on with their bodies a lot of times. - Yeah, and so, but some of the things like I've even seen in the combat sport community with athletes was like, their gut was such so trashed that I would argue their inflammatory response to their training was super super high. And I'm like, okay, like, yeah, you should be sore. You should be like a five on a skill from zero to 10, but you're at like an eight or nine. Like this is, or like, you know, some people would want, you know, this magic supplement or this magic peptide or pill or whatever 'cause like, yeah, my shoulder, you know, and it's like, well, okay, so it's gonna knock out some inflammation temporarily. You're gonna spend three to six hundred bucks and some, you know, whatever, you know. And then this is gonna be back in a couple months, in a month or two. - Yeah. - Like, so what are we doing here, you know, so trying to encourage that, like, the guests, there's, you know, those isolated, immediate care protocols to help you, but let's look at, as you've been talking about this whole time root cause and how do we look backwards to kind of fix this thing from the start. - Yeah, gut health is like, really interesting in the performance community. And it's definitely something to look at for sure. And there are like, like, toward a France, I don't know, there's like professional cyclists out there who are looking at gut health, but it absolutely affects performance. - Yeah. Well, and going back to, I did wanna ask you a follow-up question on your approach to food sensitivity. So I heard this in a practitioner and just curious your thoughts. So they were talking about, I was asking like, well, you know, they were talking about combining like gut health testing with some food sensitivity testing. And again, you could just, hey, these food just, I'm sensitive to, if you don't wanna have the means or wanna do like a sensitivity test. But the point they were kind of bringing up was the value in temporarily cutting out these food are more sensitive to will lower the inflammation which would help the gut heal or repair a little bit faster maybe, maybe I'm oversimplying this, but is there some validity to that in that approach? - Yeah, that's part of like, remove and replace, like remove the infection and remove the foods. That's why sometimes people will remove gluten and they're like, I took gluten out, but I didn't make me better. So now I'm eating it again. Like, well, 'cause you had to take gluten out and you also had to remove the infection and we had to replace some enzymes. You know, yet I gotta do all that stuff sometimes. It's like, just like if you have joint pain taking BPC157 is not going to be like this magic bullet. Like you got it, there's a lot of different things to kind of add in there. So food sensitivity, you know, it's like, I think you could go either way. Like if you're eating traditional American diet or standard American diet and you're eating ultra-process foods and you're eating a bunch of like, processed bread and processed dairy, your gut's not gonna be able to heal on that diet. So it is important to eat a real food, whole food diet. The other side of the coin is sometimes I see people who go to like an autoimmune paleo diet or you know, sometimes a low five-map diet. And hey, there's a time and place for that. They're just not long-term diets. And I tend to use a less extreme form of like an elimination diet. You know, I think Whole 30 is pretty darn reasonable. You know, it's like, I don't use that a ton, but that would be a good framework for people to sort of like, you know, if they're curious, you can start there. What I see in my practice is women will start an elimination diet. I mean, they'll start a Whole 30 and then they'll be like, I'm gonna do Whole 30 AIP and then I'm also low five-map and low histamine. Like they can only eat like if you, this doesn't, it's not like crazy common anymore, but I saw a lot, I've seen enough of this where women are just like, well, what do you eat? Like, and how does that affect our nervous system? Like if you can't, if you literally can't find food, that's like a big survival response right there. You know, you think of animals who can't find food. Like what happens? So it's a balance, but yes, I definitely think there's, it's important to take out some of the big offending foods and like for some people, you know, I don't do a ton of food sensitivity testing. I do a lot more gut testing because the goal is like, let's heal up your gut and remove some big offenders, like alcohol and gluten. But I do, I do it still, you know, especially on patients who are eating like all the foods and they haven't eliminated anything. And sometimes we'll see some stuff come up like they're sensitive to nuts, you know, and so sometimes we'll like take out nuts for a bit. But do you find that those foods can come back in a later date when it goes to bed? I used to have to like, I was, I could need eggs, I could eat dairy, I could eat gluten, I could eat nuts. Yeah, at my worst when I was like in Texas, yeah. And I eat all of those, I eat everything except for gluten and even then I just went to Europe and I ate gluten and I was fine. And I was like a big celebration because, yeah, seven, five, five, seven years ago, seven years ago, I would have like bombeted in my yard. Yeah, it's, it's, well, and I say this, how do I put it? So my wife and I, we joke, 'cause I guess I joke, but I think she does too. But she is, I'll say, like, you know what says, like less than 1% have these symptoms, blah, blah, blah, blah, she's the less than 1%. Yeah. And then her first go. No, no, but it's her, her mom and her sister. And so very, very, you know, probably started about 10 or 11 years ago. And that's how I started to just, you know, try to figure out, well, I'm just curious, like, why is it do that? Let's just try to figure this out. Of course, they don't want to figure it out. They're like, no, stop messing with me. Like I don't want to do any more tests. But my point in that was, I've noticed with her, it was like, high alert gluten needs to retest, but maybe she might want to consider retest, and that's her choice. But now, like, there's certain, there's a woman here who does like a sourdough bread and, you know, all whatever, better, not processed, et cetera, whatever. And she's found that she can have that. Yeah. And, but now, granted, she's cut out gluten a couple years ago. So now she's constantly introducing things back. And, and, you know, I think there's still some things from a protocol standpoint, because she's also on the flip side is the one that doesn't like to take supplements, vitamins, et cetera. So it's going to be a good balance. But no, I just, yeah, just kind of walking through that. I was just processing some of what you were saying there. Related to gut health, how to add things back into approach. And actually with that, I did have one more follow up question. And like the permeability part, are there any approaches you find that are pretty widely accepted as a good approach when it comes to gut permeability to help with that repair process, or tools that you use? Sorry, say it one more time. Are there any tools that you use? To help with intestinal permeability? Yeah. I mean, the big thing is removing the thing that's causing it, which is a combination of the infection and the-- sometimes it has to do with the mucus layer. It just really depends on the patient. But like, here's an interesting one. It's like, does HRT influence gut health in a positive way? And it might, I think it does. There are a couple studies showing it. We need more. But I would say yes, is the answer. And what I'm thinking through here is like, as a woman goes through paramedicoster, mucus layer gets thinner as well, and not just her gut microbiome. And so we want to build up that mucus layer again, and that protective layer and also work on the tight junctions. An estradiol itself plays a role on those tight junctions. So for me in my practice, sometimes, it's removed the infection, replaced the digestive enzymes, exercise, actually is really good for the gut microbiome. A fiber is really important for the gut microbiome. I'll use sporeform probiotics and immunoglobulins. So I like to use a lot of like zinc, invite them in A, and omega-3 fatty acids. Those are all known to improve the gut lining as well. But yeah, I mean, I think the biggest step there and the one that's the most often neglected is what's the underlying infection and how are we going to treat it. And if it's CFO or it's fungal overgrowth, whatever it is, there's got to be, we need to make that thing go away. And support the underlying immune system. So your immune system can clear that kind of stuff. When people are immunocompromised, which stress is a form of immunocompromise, that's when we're more at risk of getting certain infections. So I mean, there's no simple answer, right? No, no, I know I was gonna say I was looking at him. our time and I'm like, well, I could, - Yeah. - I could steal you for three hours. - That's a forever, I gotta go for my walk. - Yeah, no, no, I'll start the, I'll start the wine down here. I definitely, I definitely appreciate you joining the show and I'm sure our audience will as well as this comes out. Gosh, yeah, there's just so much more. So I wanted to just, for the audience out there, I do wanna share those you listening on the audio will have this in the show notes, but just for those on video, I wanted to share some of your resources here and then we'll do maybe an audio version of that as well. But so just Dr. Christine Marin on Instagram, Stephanie, I wanna encourage you guys to check that out. There's, like I said, even just, I had a list of stuff to talk about, but even just looking at your content. I mean, it's endless, great, great, great stuff. So I highly, highly recommend people check that out. And then as far as your link tree, anything you would point us to here that you think is just a great resource for people who are gonna introduce you. - Yeah, I mean, I think if you go up top, like we see patients in Colorado, Michigan in Texas and I do a lot of speaking too. So if you go to the press section, that's where we keep, like speaking engagements and all the podcasts I've done. And other sorts of, you know, articles, I write for different publications, like Forbes and Newsweek and stuff like that. So yeah, I mean, I have a ton of resources out there for people. It just, you know, I think my goal is to educate women so that they can advocate for themselves and so that they have more agency. And I will tell you, like these articles are 100% written by me and I have picked through them, like taken so much effort and attention and goes into writing these things. So yeah, there's a lot of really good content on there just to help women like figure out where to start and get some idea of what's going on. - Well, and good for you for not only all the extensive training you did even after med school, but also as you just mentioned, like to go through with the fine tooth cone, all your content, your information, you know, 'cause I think it's easy in today's world where let's use chat GPT or a ghost writer to kind of put a lot of that together. And I think it's important to still go through it and make sure everything's above board and aligned with, you know, the latest and greatest as far as what's out there. So yeah, I'll see you up. - And I think too, like my guess is there's probably women listening who are wondering who can help me with HRT. So hormone replacement, you know, for women who are in paramedic pauses and metapause. And while my practice, like I am a functional medicine trained physician, my practice has always been really focused on functional medicine. I'm also metapause society certified practitioner. So those two things are rather unique, honestly, like not, you know, a lot of people who are metapause society certified practitioners don't really know a ton about gut health, right? And a lot of hormone or a lot of functional medicine doctors don't really know a ton about HRT. So it's really finding, you know, finding a practitioner who can help you marry these things and work through them. But if you need help with gut health, it's generally functional medicine. If you need help with HRT, it's generally like a metapause society certified provider. - Awesome. When you other closing thoughts, tip suggestions, any of the good stuff as we kind of wind down the episode today that comes to mind. - I think the biggest one is just encouraging women like keep advocating for yourself. If you know something is wrong, believe that. Like, I can't tell you how many times I see patients who have been told like your labs are normal, you're fine. And, you know, most of the patients who end up in my office are the women who kept advocating for themselves saying like, no, it's not. So if you need permission to keep advocating for yourself, like here it is, keep going, keep advocating. You are the CEO of your health. It's important that you know all the different pieces and that you hire the different people in your life who can help you with all the little pieces that need to come together. - Yeah, no, well said. Well, thanks again for joining us. In today's episode, really appreciate it. And for everybody out there, as a reminder, all of the contact info will be in the show notes. But be sure to like, comment, subscribe, all the fun stuff to the podcast. But also, you know, sending your questions will gladly link you up with Dr. Christine and her ways again, contact with her or to get those answers that you're seeking out. So we're definitely welcome the comments section, reaching out email, whatever works for you DMs. If you have questions of any of the topics on the episode, we'll be happy to link you up with Dr. Christine. But thanks again, I know your practice is in life is extremely busy. - Yeah. - So appreciate you, appreciate you joining in. We'll see you guys, take care. (upbeat music) [music]