The Gut-Hormone Connection Every Woman Should Know | SNH Podcast #137

[MUSIC] Hello, and welcome back to the Smarter Harder Podcast. You're home for one-cent solutions to $64,000 questions. I'm your host again. Today, my name is Dr. Scott Scher, and it's a pleasure to be back with all of you. So today's podcast was a fun one with Dr. Christine Marin. Christine's actually in neighbor. She lives locally and she's a family medicine doctor. She has a virtual functional medicine practice that focuses on menopause and parimenopause. And Christine is actually going to be speaking at our health optimization medicine and practice symposium. Happening October 17th and 18th here in Boulder, Colorado. Check it out at homehope.org. And so Christine and I had a great conversation. Let me give you a quick bio of her before we get started. So she is a board certified physician and founder of a virtual functional medicine practice here in Colorado, Michigan, and Texas virtually. She was introduced to functional medicine after struggling with pregnancy complications and recurrent miscarriages. Now I'm mother of three, and she's crazy like me getting people everywhere to camp this summer. She devoted her professional life to helping others address the root causes of symptoms, to restore health, prevent disease, and get their life back. She earned her medical degree at the Chicago College of osteopathic medicine, a Midwestern University, and later moved to San Antonio, Texas. The train on one of the nation's premier family medicine programs at Christus, Santa Rosa Hospital. She spent some time in Tucson, sitting with Andrew Wile at the University of Arizona, integrative group over there. And Dr. Wile's known as the father of integrative medicine. She was later introduced into functional medicine to address her own concerns. And she has her own functional medicine practice now virtually working with people in Colorado, Michigan, and Texas. And so I've known Christine for about a year and a half we met at an event in Boulder, and she's super smart and really, really good when it comes to parrymenopause and menopause. And we talked a lot about, you know, various things in this podcast. But we started off talking about the gut microbiome and parrymenopause and menopause. And many people don't really understand the connection here. So we talked about how estrogen plays a huge role here. How the estrogelome or estrogelome plays a huge role over here as well. Leaky gut and intestinal percent permeability with hormonal changes with the variations in progesterone and estrone. We talked about the lack of bifidobacteria malactobacillus that happens as hormones are changing for women starting in their forties and how keystone species otherwise, like acromansia, can also be modulated and changed, hydrogen sulfide or rotten egg smelling gas, and how this has effect on the gut as well as insulin resistance. Then we also went from there to talk about different types of parrymenopausal symptomatology or spectrum, one from a variations in estrogen and one from a more of like a low estrogen dominance, where you have the latter category in people being more high cortisol and have higher A1C's interestingly enough, even though they're not insulin resistance. We talked about unmasking. When you have your hormones changed during menopause and parrymenopause, you can unmask symptomat symptoms and autoimmune conditions like Hashimoto's thyroiditis or other autoimmune conditions as well. Gut dysbiosis and how you manage that. We also talked about HRV in detail, excuse me, HRT. I've heard HRV is related to your heart and HRT is hormone replacement therapy. How she does it, what kind of testing she does, how she tests things over time, and the idea of how you can modulate not only hormones, but also her whole framework looking at root causes as to why hormones might be need to be looked at sort of of course, but secondarily to looking at heavy metal exposure, toxins exposure, vitamin, mineral nutrient, co-factor deficiency, and other things like mindset, exercise and things like that. So this is a wide-ranging conversation with Dr. Christine Marin. I really enjoyed how she broke everything down, talked about the subjective aspect, things, the clinical aspect of things, the testing aspect, and how you can really work on this as a clinician and as a patient or as a woman going through parrymenopause and menopause, how to kind of navigate some of these things. So I hope you enjoyed this podcast with Dr. Christine Marin. Don't forget that you have our home hopes and posing him coming up. October 17th and 18th. You can check it out at homehope.org. Christine will be speaking. Now without further ado, this podcast with Dr. Christine Marin. Christine, how are you? Don't great. I know you're only like five minutes away down the street in Lewisville today, right? So yeah, we only talk virtually though. That's how it goes, right? As clinicians and as busy families with lots of children, it's a challenge to get out of our house or to get out of our house other than taking our kids to summer camp, right? So that is exactly right. We will see each other in the car. Yeah. So Christine, it's really good to see you. So those of you who don't know, so Christine and I, Dr. Christine Marin, thank you for being here. We are neighbors. We actually met at an event here in Boulder relatively recently, about a year ago, I would say, right? And you have a you happen to have the last name. That's the first name of one of my daughters. So I'm saying your name appropriately. I know that you can get it kind of butchered as a result of, you know, various reasons, depending on where you are from the country and what kind of accent you want to put on up at Dr. Christine Marin. And I know you have a fantastic platform and I wanted to bring you on for a couple of different reasons. First of all, to talk about, you know, gut health and menopause is I think it's a really interesting topic and many women and men, of course, and clinicians don't really know about the connection here. So we're going to go into detail. And I'm also excited that you're going to be speaking at our health optimization medicine and practice symposium on October 17th and 18th here in Chautauqua at in Boulder, which thank goodness is one conference that we don't have to travel for. I know that traveling is difficult for the both of us, but we do it often for work. And sometimes we, our kids get to come along with us as well, right? Yeah, I'm just glad it's not in Vegas. Oh God. Yeah, I'm going to Vegas next week for another conference. It hurts my soul. I know. I know. Yeah, we did our last symposium in Vegas right before A4M in December and that was just a bad idea overall. So, okay, so today, Christine, I want to talk about gut health and menopause. And so maybe you can frame it for us a little bit before we get into specific questions. Not something that people would typically think about when menopause is happening, right? We know that, you know, that hormones are changing. Tell us a little bit of what's happening in the gut as menopause is starting, as pairing menopause is starting and then how this potentially has like a bidirectional relationship between our hormones and how they may be coming down fast or slow depending on what's going on in the gut itself. Yeah. So, everyone knows that paramanopause and menopause is largely about hormones. And my message is it's a lot more than just hormones. There's huge changes that happen all throughout the body. And one of those primary changes is in the gut microbiome, which, you know, as emerging research shows us is really important for all sorts of downstream effects from inflammation, autoimmune disease, food sensitivities, you know, you name it. So, what we now know is that during paramanopause and menopause, a woman's gut microbiome indeed changes along with hormones. And the thought is declining estrogen leads to decline in intestinal diversity. And that really affects a lot of things, including permeability that we'll talk about. But we see that a woman's gut microbiome plateaus around age 40. And there are six differences in a gut microbiome. So, the male and the female gut microbiome look very different. A female gut microbiome has a lot more diversity until she reaches menopause. Compared to menopause, so compared to menopause, it's much more diverse until the age is. Exactly. Yeah. And then it starts to decline from 40 on. Largely because of hormonal changes. And as that happens, you know, when a woman reaches menopause, her gut microbiome is much like a male gut microbiome. And that has a huge effect on the way that she metabolizes hormones. So, there's this very interesting bidirectional effect where hormones are affecting the composition of the gut microbiome. And in turn, the composition of the gut microbiome is affecting the way that we balance the metabolized hormones. Is it just estrogen that we're that we're considering here? Or are there any other major hormonal implications here like progesterone or even testosterone, which might have an implication on the male side too? Yeah, they definitely play a role. I'm not aware of any really great research on testosterone with regard to females. I think there is some limited but with males, but I don't know it as well. There is, you know, progesterone, you know, players role. I think a really great way to look at this is just in pregnancy. You know, we see when women are pregnant, they have really high amounts of progesterone and estrogen. And we know that women also have slowed debt motility related to the high progesterone, progesterone, and relaxes everything. Yes. And so, it definitely plays a role in the gut. I think it doesn't play as large of a role as estradiol or at least the research doesn't show that. But yes, I'm sure they all play a role. And I'm sure testosterone plays a role. We just don't quite understand it yet. Understood. And so from a diversity perspective, what's what's happening here? As far as the microbiota species themselves, do we have a sense of what changes or what are the major changes overall and how maybe estrogen has a role here? Yeah. Bifidobacter lactobacillus species decrease. And then we see increases in some of the dysbiotic species. We also have see a decrease in acrimansia. So with that dysbiosis or loss of diversity, as I explain it to my patients, it's like, you know, you have a parking lot and you've, you know, all these parking spaces are now empty and are filled with the bad players, which could be bad bacteria, but also might be yeast or fungal overgrowth. Sure. And a really interesting one in paramanopause is that women often get overgrowth of the species that produce hydrogen sulfide, which hydrogen sulfide is can be toxic to the endroad. or the cells of the colon. So that is definitely an overgrowth that some women will experience, but I think it can be really all over the map. - Gotcha. Let's talk about hydrogen sulfide. What is it famous for? - I mean, hydrogen sulfide SIBO and rotten egg smelling gas. - Yes, that's what I think of. I think of very, very bad smelling gas. - Yeah, that gas, lots of bloating. It causes a lot of inflammation and it can also disrupt metabolism. So it's associated with weight gain. - Is it associated directly with insulin resistance as a result? - Yeah. - Interesting, interesting. - Yeah. - And so I know with bifidobacterium lactobacillus, like those are the two most common species in the gut overall, correct? - Some of the most. I mean, if we look at keystone species, right? Acrimancy is a big one. Bifidobacter lactobacillus. I mean, E. coli, you're gonna, yeah. - Gotcha. Yeah, I think of, when I think of bifidobacterium lactobacillus, I think a lot of the GABA-ergic nervous system oftentimes, because I know that bifidobacterium lactobacillus are very correlated with GABA production in the gut as far as I understand. And that how that regulates the biggest nerve and how that regulates brain function related to the GABA itself. Do we think, I mean, there's a lot of things that are happening during menopause, of course, right? But is that potential, another cause of why? Maybe there's more irritability, there's more, there's more sort of glutamate toxicity kinds of symptoms related to the metabolic. - I would definitely think so. I always think it's kind of like this vicious storm. That's one of the reasons. You know, there's a lot of different reasons, declining estrogen and imbalance in estrogen and progesterone. Hisdemines also a really interesting one. We see increase in histamine during parimenopause. So, you know, progesterone pretty much universally declines in parimenopause and progesterone stabilizes mast cells. And mast cells release histamine. Also, you know, some women experience these really high estrogen spikes in parimenopause and it's high relative to progesterone, which can destabilize mast cells on the flip side. Low estradiol can affect the immune system, which can not be favorable for histamine. So anyways, histamine can cause a lot of issues. You know, typical kind of stuff as hives or allergies or, you know, allergic rhinitis or something like that. But it can also cause headaches and irritability and anxiety because it's also an excitatory neurotransmitter. So I think that's a piece of that puzzle too. Yeah. And then like women aren't sleeping as well. I mean, I think there's just so many different reasons why women might feel more irritable during this time of their life. And progesterone's going down too as well. And progesterone is gonna work on the GABA system at the same time. So histamine intolerance or histamine sort of increases comparatively. This is all related to estrogen dropping. Is that correct or is that other reason? Yeah, it's related to really related more to progesterone dropping and to an imbalance between estrogen and progesterone, which is what people usually refer to as estrogen dominance. But if you have too much estrogen relative to progesterone, it's sort of like you've got both problems. You've got low progesterone. So progesterone stabilizes mass cells and then you've got high estrogen, which is releasing more histamine. Or on the flip side, you might also be, I talk about two types of women in paramanopause. One type is this woman who has low progesterone and these chaotic fluctuations in estrogen. So it'll be like, hi, low, hi, low. And that's what most people talk about in paramanopause. However, there is a type two and I see this a lot clinically and she is a high performing female who has low estrogen overall. And she doesn't really ever experience those big peaks. She just has low estrogen and low progesterone overall. And so that affects the immune system, low estrogen dial, I mean, estrogen dial is really great for us. Estrogens are really wonderful, wonderful hormone. But when we experience low estrogen, you know, women have a lot of symptoms related to that. Yeah. So interesting, there's two sort of major types. I'm sure there's probably crossover two where people might start one way and go another way too, right? And there's never one or the other in clinical medicine I like to say. Yeah, totally. I mean, what really, what everybody talks about in paramanopause is that type one, where it says very chaotic estrogen and it's not balanced by progesterone. What I'm talking about is this type two because most of the patients I see are high performing women who have really suppressed a lot of their HPA access. Part of the interruption, this episode is brought to you by Health Optimization Medicine and Practice Association, a nonprofit organization training practitioners had to optimize health rather than treat disease. For this episode, check out our Home Hope Symposium happening October 17th and 18th at Chautauqua in Boulder, Colorado. We have two days of speakers. Dr. Christine Marin is one of them. There'll be CME credits. You have Dr. Christine Marin, Dr. Chris Shade, Dr. Elizabeth Yurth from Boulder, Longevity, Thomas DeLauer, Dr. Abbot Hussein, yours, truly Dr. Scotchur, Dr. Ted Atchakosso, and more. So check it out at homehope.org and come join us for this symposium in beautiful Boulder, Colorado in October and now back to the show. A lot of the women I see are very, you know, they've disconnected a bit from their body and pushed through. They've learned how to like perform and push really hard. They might be like a lot of them used to be athletes or they're still athletes, but they're athletes when they're younger or they're CEOs or they're just like really kick ass moms, but they perform really high and they often disconnect from their bodies and just push, push on. Culturally it's reinforced too for women to sort of do that and just perform and not be really connected in our bodies. Right. So just be sort of the woman of the people, like everything you can do everything kind of woman, like you can do. She does everything for everyone. She's super reliable, you know, to go to her because she's gonna get the thing done. I mean, I speak from experience. Yes, yeah, I got that sense and that's a, I totally understand. What is the relative proportion of women that are in those categories? Do you think sort of population wise? Do you have a sense of that? It sounds like many of your patients fall into the second category, but do you have sense? Yeah, it's hard. It's hard to say, you know, there's really no data on it. In my patient population, I would say it's about 50/50. I mean, I still, I definitely see those women who have those high spikes in estrogen. So the type one woman who I'm talking about with a high chaotic estrogen, she often has like really heavy periods. She's that woman who enters paramanopause and just is like, you know, it's like a murder scene and she often gets like an ablation or something like that, but it's because estrogen proliferates the endometrial lining. And so wouldn't we have an opposed estrogen proliferating the endometrial lining coupled with low progesterone? Women tend to have really heavy periods. There's also, you know, moodyness and some inflammation and breast tenderness and stuff like that that goes hand in hand with those symptoms. Women on the low estrogen side tend to just be a little bit more flat. Their periods are often scanned or very light. So that's a good way for listeners to just kind of determine like what category they're in. Often with low estrogen will have like dry skin. Sometimes later in the game, there can be vaginal dryness or discomfort with intercourse, low libido for sure. Yeah, it's interesting how you frame it. So the second group that you mostly see are mostly these sort of high performers that have really kind of just pushed and pushed. What is the, what's the physiologic reason for? Like they're pushing and pushing, they're coming out of their body. Why is there estrogen lower? Do we have a, do you have a sense of that compared to? Yeah, it's HPA axis. It's stress. They often have other markers that show me they're under a lot of stress or sometimes that they're under fueled. That's another thing I look for. So along with low estrogen, sometimes they'll have low leptin. They'll have a high reverse T3. So it's like, I always say the body, your body loves you. It's, it's trying to compensate. It's trying to reach homeostasis. And in an effort to do that in a woman who's under fueled and performing at a really high level, she tends, you know, that reverse T3 goes up as like this body's mechanism of like, hey, I'm putting on the breaks for you. So you can slow down, slow that metabolism down. So you don't need as much. And she often will gain weight as a result of that because her metabolism slows down. But these same women are often, yeah, it's this whole mix because the same population of women is often really low carb. And so I talk about this a lot in my practice because I want them to actually eat more carbs. So it's really good for their gut microbiome and for their hormones, for this specific type of woman to eat more carbs. She often actually has a hemoglobin A1C. That's a little like borderline, like maybe 5.6. It's like, for years, I was like, what's up? Like, yeah, all these patients have, you know, this kind of borderline blood sugar where it's just sort of puzzling. And I mean, they're not overweight. They might be like five or 10 pounds higher than their ideal body weight, but they're not obese by any means. But they just have this surprisingly elevated blood sugar despite a very healthy diet. But what I find is they're eating really high fat inadvertently many times because they're gluten free and like really, you know, on their health kick trying to do their best. But they have limited carbs a lot. And they're eating a ton more fat than they thought. And sometimes they're under-eating protein. Oftentimes they're, you know, prioritizing protein kind of depends where they are. But the typical pattern is under-eating protein, under-eating carbs, over-eating fat. And you're still seeing a mild insulin resistance. Yes. I think it's more driven by stress than insulin resistance. I think these patients don't truly have insulin resistance because when they start eating carbs, their blood sugar comes down. It's more of a stress response. It's their body like, ooh, I got to stay in survival mode, you know, bring up that blood sugar. It's driven, you know, by cortisol for sure. So the cortisol level is elevated. And that's increasing the blood sugar. It's not necessarily And we know this, we know carbohydrates actually decrease our cortisol response. Right? And so this makes a ton of sense. And this, you know, it's relatively close to home as I think about it. And so it's very interesting that, and so when you start putting them on carbohydrates, they tend to feel better. They tend to have, you also know to send them at their age. They tell me like, you know, in the afternoon, so many women are, you know, suffering through fatigue and just like slogging through, especially when their moms, you know, come home and they're just like, all you want to do is take an app. It's really hard to mom when you're super fatigued. Anyways, they start eating more carbs and women are like, oh my God, my energy is so much better. Yes, your energy is better. Like you need more carbs. Now we're talking, you know, good, complex carbs with fiber. You know, I always encourage like your carbs should have fiber, though some of the pretty high performance athletes can do great on simple carbs after workout actually. Yeah, simple carbs such as like, what would you say? What would you say? I mean, you know, what's my favorite? Yeah. Juice would be okay. I mean, this honestly, if I'm totally transparent about simple carbs, I have a really hard time with them myself. I have a performance coach and she's like, eat rice cakes. Those, that's your simple carb rice cakes. And I'm like, ah, not really. I don't know about that. They don't taste very good. Yeah. I'm usually more of like when it comes to carbs. I, yeah, I have a hard time. I do complex carbs. I personally do like a lot of fruit and oats and potatoes. Um, yeah. So I mean, rice would be a more simple carb juice, you know, would be a more simple carb. Um, right. Yeah. We also know that carbohydrates before bed tend to help us relax and get that cortisol up. Of course, all down. Excuse me, right? And they can help people sleep better. So, yeah, super interesting. Yeah. It's such a nuanced conversation because there are, you know, there are also, I mean, I also have patients in my practice who are truly insulin resistance. And they, they do tend to be on the more overweight slash obese side. Uh, you know, we know insulin resistance is goes hand in hand with paramedic paus and menopause and decline estrogen. I mean, that's a whole thing building muscle. All that super important. But for many of the like high performing females who are lifting weights and running or walking or doing whatever and really active, those are the patients who usually need more complex carbs and, and maybe simple carbs. If you could figure out how to do that yourself, I don't know. Gotcha. Gotcha. Okay. Well, there's one word that I wanted to ask you about with the gut. That is relatively new for people, even clinicians called estrobalome. Yeah. And I think we've kind of discussed maybe parts of this already. But if you can just maybe define that word. And I know we have a lot of these ohms now. We have the metabolism. We have the epigenome. We have the proteome and, uh, et cetera, et cetera. What is the estrobal, uh, the estrobalome is my favorite because it is the microbiomes specialized unit for handling estrogen. And I think it is so cool because the estrobalome secretes beta glucoronidase, which is an enzyme that helps us to regulate estrogen, reuptake in our gut. And so back in the day, I used to look at this test because you can get markers of it on a stool test. Yep. The beta glucoronidase. And if I saw, hey, high beta glucoronidase, you know, I'd use something to kind of counteract that. But now I look at it differently, almost like reverse T three. It's your body trying to maintain homeostasis. And so your body is so smart, the estrobalome is so smart that it can help regulate that estrogen level. And so, you know, if you're going through a menopause and you have a really healthy, healthy gut microbiome, it'll help you hang on to a little bit more estrogen. Or if you need to get rid of estrogen, it'll regulate that way. But once you've got dysbiosis that that homeostasis is broken. And so what happens is women who are going through menopause tend to have worsening symptoms if they have dysbiosis because of that broken mechanism. So they lower, even lower estrogen levels. So they have a less reuptake right as a result. Yeah. And then estrogen more, you know, high estrogen states like endometrial cancer. This is one point that I really love. But your risk for endometrial cancer is related to your gut. Through the estrobalome. So if you're hanging on to more estrogen and you're not able to extrude it as much, you're going to be at higher risk for the unopposed endometrial proliferation that happens with estrogen. And so you always want that balance between estrogen and progesterone. I always say it's very guineaing. And part of that balance gets affected by how you metabolize and balance things through your gut microbiome specifically. You're a strobalome. And so, so basically gluteuronidases and enzyme. You talk a little bit about how that works. And so that people understand what's happening. I know it's sort of a conjugation, like thing where estrogen can either be recycled or it can be excreted. And what are the some of the things that that we're doing? Let's zoom out and we'll look at estrogen metabolism. So there's three phases of estrogen metabolism. Phase one happens through our liver through COIPM's ends. And so we can look at this through a Dutch test and see if people are going down this pathway toward forehydroxy or for OH. That's the quote bad pathway. We don't really want a lot of that. That can lead to DNA damage. There's also a 16 hydroxy pathway. That's a little bit like indeterminate. We don't know for sure. A lot of people think it's related to growth like fibroids or cysts or the 20H, two hydroxy pathway, which is favorable. So you really want to go down that two hydroxy pathway. That's why we tell people to eat broccoli, like e-crisiferous vegetables. That's really good for phase one metabolism. That is also why we use a supplement called dim. It helps with phase one metabolism. So just to be clear, dim is a tricky one. I wouldn't go by dim right like if you're listening, don't just start dim. You don't want to use dim if your estrogen is low. It will make it lower. Dim can be a really great tool if you're on HRT and you want this like little bit of extra encouragement to go down the two hydroxy pathway. So I like to use dim in my patients who are taking HRT. And also if you have hydrogen sulfide over growth, cruciferous vegetables might kill your gut. So that's where like eating a ton of broccoli and cauliflower and onions and leaks and garlic, like if that is causing a ton of bloating, a lot of women don't tolerate that because they need to first address their gut health. So phase one, CYP enzymes, cruciferous vegetables, dim. Phase two goes through COMT methylation. And so that's where like magnesium can be really helpful, some B vitamins. Okay. And you know, depends on what your stumps look like, but you know, COMT plays a big role here. And then phase three is really in your gut. And that's when beta glucuronidase comes into play. And that's where your microbiome and your astrobolo makes a really big difference. And so if you're making up a lot more beta glucuronidase, you're going to re-uptake the estrogen in your gut. If beta glucuronidase is low, you're going to get rid of estrogen in your gut. And that's where sometimes we'll use calcium deglucurate as a supplement to help with that. So there's like I take dim detox, which has calcium deglucurate and dim in it. But now I'm sort of questioning, do I want calcium deglucurate? I'm not really sure. Yeah, as you were saying earlier because it peaked my interest because I do a lot of stool testing as well. And I do see the beta glucuronidase enzyme elevated. And when I do, I'm like, okay, well, they're likely, you know, there's inflammatory process going on, likely dysbiosis. But you also think about the liver as well. And sort of, again, the re-conjugation, not only of estrogen, but other toxic things as well, right? And so typically, I would give calcium deglucurate for this, but it sounds like it's more nuanced. It's not your first go-round depending on the person and how they're kind of presenting to you. Yeah. Now, I mean, I really think of it differently than I did a couple of years ago because I used to just give them calcium deglucurate. But yes, now I'm really thinking about like, well, what's the homeostasis here? A good, okay, so good analogy too is like sex hormone binding globular. When we see sex hormone binding globular and go up, my immediate reaction isn't, let me bring that thing down. It's, why is this high? How is this affecting your hormones? So what's the mechanism? I mean, often, you know, sex hormone binding globular and will be really high in a woman on birth control pills. So it's like a whole other, we should talk about birth control pills. Sure. Sure. But yeah, so a woman, you know, on birth control will have a SHBG that's really high and it's her body's way of trying to protect her from the high synthetic estrogen she's getting in a birth control pill. Part of the interruption, this episode is brought to you by Troscriptions. Make us a precision-dosed physician formulated and pharmaceutical grade formulas in the form of a buckle trokey. For this episode with Dr. Christine, check out our trozi. Trozi is our comprehensive sleep formula. It contains eight different ingredients that are going to help modulate the GABA system. Serotonin, melatonin and work on relaxing you, calming you down, helping you fall asleep, stay asleep and wake up feeling rested. During perimenopause and menopause, sleep can be a big issue related to estrogen changes, progesterone changes as well because progesterone works on the GABA system. So check it out at troscriptions.com and save 10% on your water by using code pod10@checkout. Now back to the show. Got it. Are there any other, I mean, looking at SBG is a particular marker? Are there any other reasons why you see it potentially being elevated and not in women that are on birth control? Are there other sort of instances or SBG? Yeah. Yeah. I mean, pregnancy is one. I mean, any high estrogen state, birth control pills, sometimes oral estrogen, oral estradiol will increase that. Not always. I tend to not see those high, high SBG in women who are on HRT, biochemical HRT, just more on birth control pills. It's going to also be high, really high performance athletes tend to have a high SBG. I was saying that too. My husband's a cyclist. Yeah. I've got some other athletes who have a high SBG. Is it a vegan vegetarian diet that will increase it too? Yeah, I'm not sure. I'm not sure. But I do know it could be an inflammatory marker as well in the sense that if the at least with if you're holding on a more testosterone Typically, right? Is your binding more that's typically what's happening is that there could be an inflammatory piece that could be a gut dysbiosis piece But I think you brought the the birth control thing maybe we should talk a little bit about that So I wanted to talk to you about testing and and corrections and things like that but before we get there a Lot of women around the paramedic paul's a time frame or being prescribed birth control pills Maybe they have been on them when they were younger and then they've been off for a while And maybe they've been on the whole time some people have been What is your sense of the role of birth control pills at all during this time frame or is it completely Misguided and we should be looking at like an HRT focus instead or what's your sense? Yeah, I definitely look at an HRT focus instead of birth control pills. So Birth control pills come with risks and they come with a lot more risks in older women right and every time I Get on stage and lecture somebody comes up to me and says I was the woman who got the blood clot on birth control pills in my forties because That is the answer that paramedic paul get when they Paramedic paul women get when they go to the doctor and say yeah, my hormones are off like typically They're offered a birth control pill now obviously some women do need birth control pill if you need contraception I would really advocate for Avisectomy in an ideal world if that's not an option and IUD is a better option. It's not perfect, but it's definitely better than a birth control pill Right, so birth control pills have side effects the worst of which are Stroke and blood clots right. Yeah, they also cause low libido and changes in mood They shut off our ovaries and when we're trying when we're going through paramedic paul We're not we don't want to shut everything down right you want more ester dial so it seems very Unfair to me. Yeah, that women are not offered HRT and it's scrutinized to this higher level So I've had women tell me also I can't take factor or I can't take birth control or I'm sorry I can't take HRT because I had factor five light and so factor five lightens associated with You know increased clotting risk especially if you're homozygous, but there's so many people like I don't know probably 50% of the population has like a snippet Factor five lighten, you know if they're Really, really common. Yeah, and we never counsel women on factor five light and when they go on birth control pills ever even if she's 40 right I don't know anybody who's testing for factor five light and I mean I am but I am not also not prescribing birth control pills So the point is there's just a lot more scrutiny around HRT which has a lot of benefits long term like ester dial transdermally will not increase your risk of blood clots It will often improve sleep improve cognition the gut health piece is really interesting so Birth control pills can also mess with your gut microbiome. That was my next question You know lots of other stuff too like alcohol and Exercises great for your gut alcohol and antibiotics and birth control pills are bad for your gut So you know if birth control pills mess with your gut microbiome and increase dysbiosis HRT actually does the opposite this is emerging research. We don't have awesome research on it yet, but it's coming out and I will bet on it for sure, but HRT can be really helpful for the gut microbiome and here's another one that I love is an Estardial improves intestinal permeability so the tight junctions are better with ester dial which is so cool and that doesn't happen with synthetic Estrogen yeah, it's like a synthetic derivative of estrogen. It is not you know ester dial So if a woman goes and gets her hormones tested and she's on birth control pills There's like no estrogen and no progesterone that comes up Of course, but what does come up is the thing we can't test for which is this synthetic Ethinal ester dial whatever is in her birth control pill and so you know It just looks like her hormones are flatlined But she's got a lot of this synthetic estrogen derivative in her blood. That's shutting off her ovaries Got it. Wow. And so I mean there's a time and place like for some women who have really bad endometriosis like there might be a time and place for birth control I'd never say never kind of thing sure You know, there's a place for it, but it is not a good treatment for women who are concerned about Paramount of puzzle symptoms and want better sleep better sex better performance better cut microbiome better energy Better married. Yeah, a lot of it. I mean so the synthetic estrogen is themselves then have a propensity to increase your your gut Junction leaking. So they but but if you're taking but oh, but the but like estrogen itself is protective against them So when you're going through paramedic pause you actually have an increased risk of leaky gut as well that yeah I mean estrogen Disrupts your gut or I'm sorry a birth control pills disrupt your gut microbiome which the downstream effect is a more leaky gut or increased Intestinal permeability whereas HRT helps your gut microbiome and Estardial works directly on your tight junctions. So it improves your intestinal permeability and Might balance out those big estrogen peaks or fix the low estrogen that some women have and Progesterone can help with the mast cell instability and a lot of other things Sure, I mean this is I think a good segue to talk about treatment, right? So I mean I think we've you've kind of laid out the The argument and I think a very good one that HRT is is something that maybe all women during the penny paramount menopausal time frame Maybe all not everybody maybe but I want I want to kind of delineate that a little bit So let's talk about HRT a little bit how you think about it in paramount appausal What kind of testing you feel like is helpful and what kind of testing is not helpful and And then maybe talk I mean we can also talk about the GI part of it like the testing there that you do As part of your work up and how that maybe Over time how you how you look at things we can we can break all that down But we can start with that framework. Yeah, so hormones so in the paramount appausal woman I test hormones a lot of clinicians don't the metaposte society doesn't recommend that you do So just be aware what I do is not what typical clinicians do But I see a lot of value in it It's just dependent on when you do it and how many data points you get So I like to look at day three to five hormones when they're low and see like what's your estrogen doing at this lowest point And then do it again in the loodial phase so after ovulation and see like what's estrogen doing and then you can With more data points like I at least get to markers, but I like to get more Especially when it comes to estrogen The argument against testing estrogen is that it's all over the map with your cycle, which is true It's all over the board, but that's why you get more than one data point It's also why you can do daily testing so there's some upcoming test like Dutch test will do a cycle map There's also a test Proof it's called in power. I literally have it on my desk here. I haven't used it yet But it also will do you know give you that kind of Data so you can see you know what your levels look like throughout your cycle So there are ways to do that but so when you're doing it like with data points throughout the cycle is it You're doing it daily throughout the cycle like something like the Dutch test or this other test Yeah, the Dutch cycle map is you pee on a card basically every day of your cycle and then you can see the path You know that happens. I mean we know you know in the first half of your cycle Estrogen's gonna start to increase and then it increases enough where you get this LH surgeon You ovulate and the second half of your cycle the corpus leadium makes progesterone so it's increasing progesterone And so in a paramedic pausal woman I would say almost like pretty much universally Paramedic pausal women have this decline in estrogen And I say paramedic pauses like the invoice inverse of puberty, you know puberty is happening hormones are all over the map But they're like increasing and paramedic pauses They're all over the map and decreasing and sometimes they're just low overall right So you know doing testing will help us identify that and will help us identify also like does a woman have really low estrogen Or is it all over the map and then symptoms are really the most important and the amount of flow Like how have your period is can be a very helpful indicator of what's going on for women with the IUD It can be trickier because we don't really know sometimes they're not ovulating very often. They're not ovulating Um So I'll check I'll check their labs like 10 days apart, but you know symptoms are a huge part of it Of course labs are not the primary way to test for paramedic pausal There is no definitive test for paramedic pausal But it I think labs are critical and also because Uh, I have coined this term the unmasking effect in paramedic pauses and what that means is paramedic pauses The time when any underlying health condition gets unmasked and so it's really important to look not just at got health But also at thyroid Sometimes we see we see a big increase of autoimmune disease in menopause And you know part of that's the unmasking effect and so You know as we're looking through labs I like to get really comprehensive labs So we understand is this the picture of a woman who has low leptin and a high reverse t3 Maybe she also has subclinical hypothyroidism. She's got low estrogen low progesterone Um, you know and nutrient deficiencies. We're looking at methylation magnesium What's her b12 and folate and all that kind of stuff and then or we might see this picture of somebody who's actually got really true insulin resistance Her insulin is high. This is not my typical patient, but I still see them for sure But you know she has high insulin and you know, maybe she has high cortisol too. I mean that can happen We see you know both sides of the coin there I'm looking not just at estradiol and progesterone in the labs. We'll get DHA pregnant alone progesterone estradiol and then testosterone We haven't really talked about but a woman who has a woman has testosterone. Yes, the reference range Goes for free testosterone. Literally is like zero to five. It really depends on the lab But I'm like what why does the reference range go to basically zero? It's like point two. That's crazy So it's a zero at the point. What is how is that okay? You know a woman's estrogen like if you were to measure Unit per unit estrogen versus estrogen or I'm sorry, estradiol versus testosterone. A woman actually has more testosterone than estrogen. - Yes, I know that's good. - You know, a lot of times that's forgotten about, but I'm definitely looking at free and total testosterone, SHBG, the full thyroid panel, thyroid, antibodies, all that kind of stuff. So I think really comprehensive testing is important, though on its own, it doesn't really identify paramanopause. And there's some better diagnostic tools that we can use like a Dutch cycle map and things like that that are forthcoming. - I understand. - So that's testing. What's the next part? - Well, that's the first one. I mean, I asked a couple things about that, because that was really comprehensive. The, I think the idea of unmasking is really interesting, and I wanted to just take a minute to talk about that, because I think maybe you can describe what that would look like in a clinical perspective, right? Because I think giving some examples for clinicians out there, I've seen this in my own practice over the years, but maybe some people haven't. So tell me what that looks like in some of the patients you've seen over the years and what that might. - Yeah. - I mean, so many 40-something women are having a bit of a health crisis, and they're not getting a lot of grade answers. They're getting birth control pills and acid blocking medications. And part of the reason behind that is because as we lose hormones, we lose resilience. Any of the underlying health issues we have, we can't ignore them anymore. They just become to a point where you can't not look. They're gonna, you know, cause symptoms. So a lot of the women I see are struggling with an autoimmune disease. Hashimoto's is super common. Some things other things like inflammatory bowel disease or something like that. They are often struggling with hypothyroidism in addition to low hormones associated with parietal menopause. So estrogen progesterone testosterone. Other hormonal kind of symptoms, I mean, it's tricky. Like, you know, there's other things that come up for sure between endometriosis and things like that. But there is, you know, any kind of underlying issue is coming forward and then gut health is a huge one. Like we see worsening of IBS symptoms, worsening of IBD symptoms, bloating, you know, all that. So the symptomatology around parietal menopause and menopause immune said there's like 50 plus symptoms. The reason for that is because of the unmasking effect. It's because there's all these other stuff going on. And that's where back to what I said at the very beginning, it's not just hormones. It's so much bigger than just hormones. Hormones play a really important role. But when I approach in my clinical practice, I have a three-pillar framework. So number one is address the root cause. And often that's related to gut health. But sometimes it's also like autoimmune disease inflammation, toxin exposure, mold exposure, heavy metals, whatever it might be. Number two is optimized hormones. And so that's optimizing, you know, your sex hormones, your thyroid hormone, insulin levels, cortisol. And number three is building resilience. And so that's where I work with patients to really like dial in good lifestyle habits, like a protein centric high fiber nutrition. Strength training, walk, movement, sleeping, you know, which definitely there's like crossover between paramedics and hormones and sleep and even root cause issues and sleep. Stress, peace, mindset, and then low-talks living. - I love it because I think, I love that you're, I love the order of that. And I talk about this all the time with patients as well. I work a lot of, with a decent amount of guys doing hormone optimization, right? And what I always talk about with them is that we can't mess, we can't start working on your testosterone, your growth hormone, your thyroid, et cetera. Until we work on some of those, you know, quote unquote, root causes, like under underlying foundational biology, your vitamins, your minerals, your nutrients, your toxic load, because that's gonna have a huge effect on your hormones as well as you've already described. - Yeah, totally. - Yeah. One thing I wanted to ask you about with HRT and looking at labs, and you mentioned, like getting a baseline or trying to get, you know, with data points over like multiple months. As you are working with somebody and doing HRT, is it something that you're doing from there, you're rechecking labs over time, or is it something that you're just kind of looking symptomatically and how they're feeling depending on what kind of data points you saw initially? - Yeah, no, I'm a lap girl. - Okay. - I like labs. - Cool. - I also am a risk versus benefit girl. Like what is the risk of getting some blood work? I mean, there's really not. Let's get some data. I mean, we're right, there's some financial risk, but we can mitigate that. - Sure. - Sure. - Yeah, so I like to look at labs, and I like to use labs to titrate their dose, you know, so just like we do with thyroid. And really, this brings up a good kind of point too with thyroid. I mean, if somebody has hypothyroidism, we give them thyroid medication. If somebody is paramedic and deficient in estrogen, we can give them estradiol, you know, and then you look at labs to balance it. I can't use FSH and LH, like you use TSH for thyroid. - Sure. - But we can look at estradiol levels in the blood work, look at progesterone, we can talk through symptoms, we can understand bleeding and what the flow looks like, what your cycles look like, all that kind of stuff. - Cool. And so, I mean, maybe just a couple notes on controversy here, a little bit, just for those that are listening, and many of the people that are listening already have, a pretty good framework of understanding HRT and why it could be helpful, but why is it still so controversial, Christine? Why do you think it's still at that level? I mean, it seems like it might be changing a little bit, sometimes I think it is, and then other times, I'm like, no, nothing's changing. - So HRT or testing or both? - HRT, I would say both. - Yeah, HRT, I think HRT maybe is the bigger of the two, right? - I mean, largely it's because the Women's Health Initiative study that was published in 2003 is big media blitz, time magazine, all the things, causes breast cancer, it doesn't cause breast cancer, it can grow, it's proliferative. So estrogen, if you have an underlying breast cancer, could grow it, so you need to be careful about that. I always get mammography before I start patients on HRT. - Okay. - I wish we had a better option than mammography, and there are some coming up, you know, - Yeah, there are. - I'm really curious about, but that's what's accessible, that's what we've got right now. That said, endometrial cancer or uterine cancer is a risk, and so women need to be really cautious about that. That's why we always use progesterone with estradiol, however, as we talked about with beta-glucaronidase, like that will depend on your gut microbiome and beta-glucaronidase and your astrobalome, because you might be somebody who needs more progesterone and less estrogen if you're, you know, hanging onto it. So, you know, that balance is really critical, but yeah, I mean, the Women's Health Initiative just was a huge step back in Women's Health, because doctors just stopped prescribing it, or stopped prescribing it and talking about it. I didn't learn anything about it in residency. I mean, I was a family medicine resident. Did you learn anything about hormone replacement? - No, no, there was nothing. I mean, I was in, no. As a internal medicine doc, there was, there was talk about the Women's Health Initiative and how, you know, that HRT, that's actually when I was in medical school or residency, that's when they started taking everybody off HRT, because they thought I'd increased their risk of the cancers, the strokes, the thromboneblism, things like that, but they were using all the synthetic progesterone, yeah, so-- - Yeah, yeah, so-- - Yeah, the other big, huge piece is like, if you look, they've, you know, the reanalysis, I think was in 2013, 2011, the reanalysis did not get anywhere near the press, that the original, you know, data got, but the reanalysis basically showed like, "Oh, actually, I think the estrogen arm "was protective against breast cancer, "but nobody's really talking about that." But the hormones that were being studied are very different than the hormones we use now. So, premonit, premonit was, you know, from a pregnant horse's urine. And while, honestly, I think it's better than nothing, if you need estrogen, estradiol, transdermal, bioidentical estradiol that we use now is very different. And same thing with progesterone, what was studied in the Women's Health Initiative was a synthetic progestin. What we use now in HRT is a bioidentical micronized progesterone, very different risks. There's a French study looking at potentially that progestin was associated with maybe a slight increase in breast cancer risk, but the reality is we just don't have a lot of really awesome data. We do have some data, and, you know, it's a risk-benefit decision. I mean, it's not right for every single person. We should talk about vaginal estrogen, side note. - Sure, go for it then. - Yeah. - Yeah, but it's just, it's really under, doctors are undereducated on it. There's just not a lot of awareness around it. And that's why they're more comfortable prescribing birth control pills, because they're educated on that. They've used it for years. They're very comfortable prescribing it because they've always done it. But HRT is just different. They're not comfortable prescribing it. They don't really know how I do think it's changing, but I kind of live in a bubble of like, - Sure. - There's a lot of hormones in my world. - I understand. Do you want to talk briefly about vaginal estrogen? - Yeah, vaginal estrogen is a really great tool. It's one of my favorite things to prescribe to any menopausal woman. But I think, you know, one thing that doesn't get talked about is as women go through menopause, they actually experience a change in their anatomy. So the vulva changes, and they can get certain kinds of things that will decrease sexual function over time. So it's a really big deal to maintain your anatomy. And also it's a great tool for helping prevent UTIs, but also helping the urinary bladder. So I've had patients go on vaginal estrogen, and now they're able to sleep through the night, 'cause they don't have to wake up to pee. It helps tone the urethra, and it's very low risk. It's like you could actually use it if you had breast cancer. However, women with suspected or confirmed gynecologic cancer should not use vaginal estrogen. But outside of that, it's like a really safe, simple intervention with no money behind it. So you might not learn about it. - Yeah, got it. - Yeah. - So you're making commercials. - Right. So typically you'll have people on an estradiol patch along with vaginal estrogen together, or is it some people that you'll just do vaginal estrogen? estrogen on its own. It depends if you're not a good candidate for estradiol transdermally or systemic. I would argue that the vast majority of women should be using vaginal estrogen at least. Got it. So you can use them together. I use them together all the time. So local vaginal estrogen versus systemic estradiol. Yeah, you could use either. You could use them both together. The pharmacy will sometimes give you some pushback. So we have to explain to the pharmacy. Yes, we meant to do that. Yeah, I understand. Yeah. They're very different. Yes, I understood. Okay, so let's go a little bit along the side of gut testing, GI testing and how you think about probiotics, prebiotics, just what's your framework there? I know this is kind of a big area that you plan. So what can I testing you typically do and what do your major interventions? So my favorite three tests would be a sebo-broth test because bacterial overgrowth is very common. There is also one that tests for hydrogen sulfide, the triosmart one. So I like to do that sometimes depending on the patient. I'll do urine organic acid testing a lot. I like to look at that first page, especially when it comes to fungal overgrowth. So a lot of times patients are dealing with fungal overgrowth, which is really what people call candida or yeast. And I'll do stool testing as well. So that triad tells me a whole lot about what's going on with a gut microbiome along with talking to a patient and understanding what her symptoms look like. But from there, we can look at is there dysbiosis? Is there overgrowth of fungal species? Is there overgrowth of clostridia? Is there H. Pylori? Maybe there's a parasite. I just had a patient last week who has been struggling with digestive issues for a couple of years. We identified on stool testing that she had clostridium difficile. And so I centred a question, go test this at Questlet's just make sure. Indeed, she's got cdif. But in the conventional realm, I think nobody was checking for that because she wasn't the typical patient who would have cdif. But there's all these different collection of whatever got infection, whatever flavor you have, and you could have several. Sometimes I get patients who are like, oh crap. Literally. No pun intended. Yeah, no pun intended. What crap. Yeah, that sucks. But we got you. Like I'm not your year. Let's go. So I use a combination of prescriptions and herbals. I like to, my gut framework is like remove and replace. So remove the gut infections. So that might be prescription medications like syphaxin or antifungals. Also likely will be some sort of herb. You know, remove things like gluten and alcohol, some of the gut irritating foods, remove also processed foods, things like that. I don't generally put people on like a really restrictive diet. But you know, if they have histamine issues, we might limit some, you know, things like sour crout and alcohol. Right. So just depends. You know, remove. I also, you know, talked to my patients a lot about just the psychology and the emotions behind it all. So remove that like self criticism or that self critical voice. I think that's a really important point to and remove toxins because those are going to disrupt your gut microbiome as well. Yeah. And then you know, certain. Yeah, totally. Yeah. And like that's a whole other story. Like Xenoestrogens in your environment. These are bad estrogens. Estardial is a good estrogen. So, you know, good and bad. But most of the the negatives around estrogen are related to, you know, chemicals and plasticizers that resemble estrogen or interconductor chemicals. So, so you know, when we're talking about gut, though, like, you know, remove those big offenders and then replace digestive enzymes. Some women need more digestive enzymes or they need some more digestive support. Those same women who have like disconnected from their body and have low hormones tend to have low digestive enzyme function and lose stomach acid. Makes sense. Yeah. Because they're super stressed. So replace enzymes. Sometimes replace stomach acid, replace hormones HRT. That's a big one I put in there. Of course. Yeah. Yeah. That's sort of the framework I use and then, you know, re-enoculate. I like to use sport form probiotics. I'll, you know, potentially layer in pre prebiotics later on. But you don't use a ton of prebiotics. Yeah. No, no, patients eat more fiber. Yeah. Eat more fiber, you know, whole fruits, things like that. What's your take on selective versus non-selective prebiotic fiber? There's a couple, a little bit of controversy there. Like in a sense, if you have like some of the new, like some of the products out there for some of the companies that you and I like will have these sort of selective prebiotics versus non-selective, you take like a case of fiber or a psyllium husk or something like that. Do you have a major distinguishing aspect of how you think about it clinically or not really? I don't. Can you score me on that? Well, the idea with the pre-selective, the selective fibers is that they're supposedly only allowing certain types of bacteria to grow compared to the non-selective ones which are letting everything grow kind of deal. So in general, I have something that has bacterial overgrowth. If I'm going to put them on anything, it's going to be more of like a selective prebiotic fiber, something like, you know, we would use from like, you know, make a prebiotic or something like that from like microbiome lab or something like that as opposed to putting them on a case or a psyllium or something like that. But I think it's it's still controversial. I don't really think we have a good sense of whether that really matters or not, but I tend to, I tend to be similar to you in the sense of trying to get it from the food, but also not overdoing it on fiber as well, especially if they have bacterial overgrowth and foul overgrowth and things like that. Is I do worry that you're going to get this sort of, you know, the response that, you know, maybe everything will grow even if we're trying to, you know, remove that. Exactly. Yeah. Yeah. I mean, the first thing most people do when they have a gut infection or when they have gut symptoms is eat more sourcrow. Yeah. Take a probiotic. Yeah. What's the other thing they do? I mean, those two things, yeah, eat a lot of yogurt, right? All of those things can actually be the opposite of what you want to do. Like if you're somebody who has a lot of histamine issues, you're going to worsen that. If you're somebody who has bacterial overgrowth, that traditional probiotic is going to make it worse. So, you know, this is where like if you've tried those things and you're discouraged, that's where working with a clinician can be really helpful. The other big one is like, they're like, I took out gluten and I didn't feel any better. Mike, great. Unfortunately, we have to do a lot more than that. Like we've got to take all the logs out of the fire. And that's the same thing with hormones and HRT and paramedicos. Like I started or menopause, I started HRT and I don't feel better. I'm like, great. And we do all this other stuff. You know, we got to address like you've unmasked all these other issues. So we need to address all the under other underlying issues. Right. The unmasking is a big part of it. And I think it's a huge important piece that you mentioned there, which is the framework that you use. It's not just about HRT. It's not just about looking at even the quote unquote root causes. It's all looking at things together and then working with clinicians as we do knowing that everybody is going to be different. And I think this is a gripe that I have and you do as well when you see online advice about adding implemented foods or starting this sleep protocol. From somebody that's not a clinician that doesn't see people and that gives you advice. It kind of drives me crazy. I'm sure it drives you crazy. So we have to do with patients. I mean, other side of it's saying, I need this. I need this. I'm like, no, you don't. Yeah. One of the things I see is people who are on very restrictive diets, you know, because they've read a book and that's honestly, it's like, that's the easiest thing to give somebody if you're writing a book and you want to give them like an easy win, you give them a special diet. But like, we don't, you know, it's a special diet. There's, it doesn't have to be that complicated. Eat real food and more of it. And if you have got issues and autoimmune disease, don't eat gluten. And, you know, don't eat ultra-process foods and, yeah, like limit alcohol and, you know, I mean, I don't think we need to follow like a, most people don't need to follow, you know, autoimmune paleo or are some of those really restrictive diets. It can cause a lot of stress. Again, they can. Again, I mean, there's a time and place. Like, this isn't a never say never kind of thing. Of course. Yeah. Yeah. I love that. I love that. That's more of your framework overall. And I think a big thing that you kind of gave me today as a, as a little good nugget there is these two different types of women that are going through paramedic paus and that the change in hormones, like very different. And especially because I know a lot of the high performing type as well. And like the mild insulin, you know, resistance and quotes, the elevator cortisol. So that was really cool. Christine. But at the end of the podcast, which we're at the end now, I ask everybody the same question. And you may have already, you've already discussed a lot of things that might apply here. But the question we ask everybody is what are three ways that we can all live smarter, not harder. And that's the name of the podcast, the smarter and harder podcast. Yeah. And so, and this could be in anything you discuss today or it could be in other kinds of things that you think that might be helpful. But are three simple tips that you think all of us can do to live smarter, not harder. I love this question because I think about it often in terms of strength training, like you'll see me in the gym three or four days a week, lifting weights. And you'll see me resting in between those days and trying to take it easy. So think when it comes to building muscle, that's really key. As we age, it's key to our, you know, metabolic health, it's key to feeling strong and more confident. I think it helps with emotional health. I think it helps with obviously your structural, you know, framework and joint pain and things like that. But anyways, smarter, not harder, like lift weights three or four days a week. Okay. Make sure you're getting rest. Okay. I think the diet piece is another one. Like smarter, not harder, eat more protein, eat more fiber. You don't have to be on a super restrictive diet. There's definitely some foods to avoid. Alcohol would be a big one. I think a lot of people I see are, you know, they're gluten-free, they're dairy-free, they're sugar-free, they're like, Yeah. A lot of like whatever they're not eating any grains, but then they drink a lot of alcohol or a decent amount. Maybe it's not even a lot, but it's a glass of wine every night. Wine has like zero health benefits. So don't fool yourself. I mean, if you want to have a drink, everyone's going to go for it, but like that's a smarter, not harder concept right there. So if you want to have like a like a bonus or maybe you're done, that's cool either way. We can leave it there. I'll call you later if I think something. That sounds great. Those are great. Overall, I think the rest part is such an important piece too that many of the people that are listening to the clinicians and the people that are just go, go, go, and it's hard for us to all rest and many of us are type A. So I think it's great that you mentioned that as well. So Christine, thanks so much for spending some time with me today and going through your expertise, which is super cool. And I'm really excited again that you're going to be speaking at our symposium, the health optimization medicine and practice symposium, October 17th and 18th here in Chautauqua in Boulder. It's a fantastic place. The leaves will be changing. We're going to have two days of speakers. Christine, you're speaking. Dr. Elizabeth Yerth from Boulder, Longevity. She'll be there as well. We're going to have Thomas DeLauer who's coming from California. Good friend is a great educator. We're going to have multiple other great speakers as well. You can check it out at homehope.org and Christine, tell us where we can learn about more about you and I know you are taking patients. You have a virtual practice. Tell us a little bit about all of that. Yeah. So I see patients in Colorado, Michigan and Texas. My website is dr. Christine Marin.com and I mostly on Instagram at dr. Christine Marin.com. Awesome. You rock Christine. So I hope you have a good day going to your concerts, picking up all of your children and all the things we talked about before. We'll try not to forget anyone. Yeah. That's that's always a question with my fourth, but you know, that's that's, you know, that's the breaks of having the fourth kid. If they eat, if they get to where they need to go, you know, it's a blessing. That's why I am who I am. You know that I was the fourth. Oh, I didn't realize that. Yeah. I was the little one who took care of herself. I love it. Well, you have a great day and hopefully I'll see you non virtually in person soon. Sounds good. Thanks. Thanks so much for tuning into the episode of the Smarter Not Harder Podcast where we give you one-cent solutions to $64,000 questions. This episode was a fantastic one with dr. Christine Marin. We talked about Perry Menopause, the gut, the estrobolo, which was a new word for many of us. How to test, how to correct, how to think about things in a framework, nutrient gut optimization, hormone optimization, and so much more. If you like this podcast, don't forget to like and subscribe below. So you never miss an episode and check out our home hopes symposium. Go to homehope.org and check us out. Come join us October 17th and 18th in Chautauqua in Boulder, Colorado, a beautiful time of year. So many different great and amazing speakers. We hope to see you there. Take care.