The Estrobolome Explained: How Your Gut Bacteria Control Estrogen and Mood

All right, and we are live. Exciting. Today, uh, it's going to be a good one talking about the Estrabum. But before we get into that, let's do some introductions and some quick disclaimers. My name is Cole Cy from one of the co-founders of MedMatrix, charge of patient education, and I'm joined with the spectacular Dr. Rose. Dr. Rose, um, why don't while we're waiting for people to roll in here, why don't you give a kind of brief overview of your licenses and experience? uh especially around the estrabolo. Okay. Um I my name is Sasha Rose. I am a naturopathic doctor and I'm also a licensed acupuncturist. Um I have been working um with um women's health for 20 years. I've also been working um a lot with people in general including women on digestive health and gut health. And I am fascinated by this topic of the estrobolum because it really um in a very real functional way ties these two things together kind of our estrogen metabolism as well as our gut microbiome and gut health. So for me, this is kind of like the joining of two topics that have interested me for quite a long time. Okay, great. So before we um get into it, quick legal disclaimer. What we're talking about today is not medical advice. This is for educational purposes only. So let's set the foundation here. What is the estrobolum? Yeah. So the estrobolum um I kind of think of it as the estro biome um because it's a a specific part of our gut microbiome. So organisms or microbes in the gut that are in charge of estrogen metabolism. Um and kind of the the recycling of estrogen, how much exposure the body has to estrogen. So technically it's a group of gut microbes. Okay. Why why is that important? Why should anyone care? Why should we care? Yeah. Um because if there is um an imbalance in the in that in the that aspect of the microbiome, if there's inflammation, if those um microbes are not kind of if there's too many of them, if they're just not in the right balance, if there's there's a specific enzyme that we'll get into later, if that is too high, then there's going to be more estrogen in the system than is optimal. And that is going to contribute to things like PMS, um, PMDD, which is a more severe form of PMS. It's premenstrual dysphoric disorder. Um postpartum depression. Um really heavy menes, really heavy cramping, um acne. Um and there's even a link to our neurotransmitter balance including serotonin, dopamine, GABA, and that's going to um directly affect our mood. So things like depression, anxiety, um mental health in general. So, it's pretty crucial both to hormonal health, neurotransmitter health. Um, and it's really this it it really brings in the liver detoxification pathways, the gut microbiome, and estrogen. Um, and how well estrogen is kind of broken down, recycled, eliminated. Okay. Gotcha. Why is it important to I guess let's first let's set some more groundwork here. What is estrogen metabolism and why should anyone care about it, especially a woman? So estrogen um is made in a woman who is pre- menopausal. So her ovaries are she's still cycling every month. Um estrogen is made in the ovaries. It's also made um somewhat uh indirectly in the adrenal glands. And there's actually even some estrogen made in fat tissue. Okay. So, we need estrogen, right? We need it for fertility. We need it for um bone mineral density. We need it for mood regulation. Estrogen really actually can be like both relaxing and energizing when it's in the right amounts. Um women who cycle will usually agree with the statement that sometimes their mood is the best. they feel uh most like in control of their lives and their emotions. They feel energized right around midcycle. So, you know, like in a 28 day menstrual cycle, really kind of like right before ovulation, around ovulation, that's often like moodwise when a woman's going to feel the best. That's when your estrogen is kind of the most stable. Um, so we need estrogen from everything from our joint um and connective tissue health to mood regulation to our skin health. I mean, it's crucial, right? So, however, when there's too much estrogen in the system, that's when you get some of those conditions that I mentioned earlier like PMS, PMDD, acne, um depression, like your um there's it's called estrogen dominant symptoms. And so really it's about the right amount of estrogen and a woman's level of sensitivity to fluctuations in estrogen. Okay. So women who have because I guess define PMS. What is PMS? Premenstrual syndrome. Okay. Where so essentially it's like PMS becomes a problem when it affects your quality of life. Like your your PMS is so bad that like you it almost ruins your life. I mean, I've heard women come to the practice who've experienced that. Yeah. So, so there's there's there's every woman who again is cycling, there's a premenstrual time, right? It's like the week or so, you know, it can be one to two weeks before a woman actually starts her period. And some women skate through that. They don't know their period's coming. They they're, you know, they really don't feel anything different than normal. A lot of women feel everything from a change in their digestion to really anxious, really depressed, really lethargic, um he heavy breasts, tender breasts, low energy, like everything is just off. And for a lot of women, it's not just like the first the couple two days before she bleeds. It can literally be like two weeks before she bleeds. Like it's significant. Like half of the month she's debilitated. So that's that's PMS. So it can be both emotional and physical. Gotcha. So how do we fix how do we fix that with estrobolum? How do we fix PMS with estrobolum? So it's really this connection with the gut. There's three pieces. There's the estrogen metabolism. There's the liver deto like the liver pathways or liver detoxification and the gut microbiome. So the quick answer to your question is we address gut health and liver health. And if we optimize that then her um estrogen levels should be more stable and her sensitivity to the estrogen in her body should be more stable so that there's less of the fluctuations. there's not too too much and not too little estrogen. And so all of those things, physical, mental, emotional, should be not, you know, again, relative throughout the the cycle should be not these like huge peaks and valleys. Okay. So there's So what's the connection between constipation, right, not pooping and bad PMS symptoms, depression, um all those like estrogen symptoms you were talking about. So often times um so in so in a healthy individual female who is having um regular bowel movements the um the the connection here is that the estrogen is produced um again by the say primarily by the ovaries and it locks into the estrogen receptors throughout the body does its does its work and then it is goes to the liver like in the blood travels to the liver gets basically conjugated like kind of bound up by the liver into a form that can then pass into the gut and that's where the microbiome that's where the bacteria is. There's a specific enzyme called betaglucaronidase. And if that is in the right levels in the gut that's produced by the gut microbiome, then the the estrogen metabolites stay in their conjugated form. They pass out through the stool and they're eliminated. Now, say she's not eliminating. Say, say she's backed up, then that there's more like there's a higher likelihood that that beta glucaronidase enzyme is going to be elevated and it's going to basically be deconjugating the estrogen. So, it's going to undo the work that the liver did and now you have estrogen available again and it's going to go it's going to basically be recycled once or twice. So it's it rather than kind of getting bound up and passed out through the stool, it's in the system longer than it should be and then and exposed to estrogen receptors and then you get again all those symptoms that I mentioned with premenstrual symptoms as you know as well as yeah mostly gotcha. So let's So you go to a conventional doctor, you're having maybe depression, acne, um constipation, there's an issue with the estrobolum. Do they even address that? So no, definitely not. And I think that um like the term estrobolum is new to me. like I knew about the connection, I knew about the importance of liver detoxification, I knew obviously importance about gut microbiome and estrogen metabolism, but kind of like tying it together with this term I think is relatively um new and certainly not acknowledged or understood within conventional medicine. So um conventional medicine um again we often talk about how things are very compartmentalized in conventional medicine as opposed to um it's not a holistic medicine. It's not looking at the whole person and kind of making the connections between the gut and the mental emotional health and your periods, right? It's all separate. It's the gynecologist, the the um therapist, the psychotherapist, and then the gastronurologist. We are kind of stepping back and we're looking again at how how these really are tied together. So, you know, there's there's way more to do for an individual like looking root causewise, peeling away the layers than an anti-depressant, oral birth control, and mirac often. Yeah, I mean, that's basically what it is is that they're covered up. So, some women are not going to respond well to oral birth control. It's going to make things worse mood moodwise, right? Um sometimes it will help, but it's certainly not addressing the root cause, which is really um balancing the gut microbiome, making sure that the liver is doing its job in terms of um kind of doing that conjugation piece of the estrogen. And um it's just adding in basically like birth control is just adding in more estrogen. It's not figuring out what's happening with the existing estrogen. Is it getting is it getting metabolized correctly? Is it getting eliminated correctly? So over time either it's the those um quick fixes. they might they might help. They might, you know, help the symptoms, but they're not getting to the root. And usually it's not sustainable. Um, and it's, you know, the gut issues are still going to be there. They're just going to, it's just going to kind of snowball into um, usually other aspects of the woman's physiology. Sure. Okay. So, with the rest of this webinar, should we take it more in the direction of treating like actually fixing the gut? because it sounds like, okay, woman comes in with estrogen, an estrogen dominance problem, you're you're really going to be looking at the gut, right? I'm going to be looking at all of it. Yeah. So, we're going to be looking at um so the other thing that I just I also want to make sure of So, we're going to be looking at all of it. We're going to be looking at hormone levels. We're going to be looking at ideally what does her gut microbiome look like? What's the level of inflammation at the gut level? And um you know how well it does it seem like her liver you know we can check her liver health and we can kind of also just indirectly glean how well she's kind of detoxifying. If she has other signs or symptoms of not really detoxing adequately um uh like acne can be a can in addition to kind of estrogen dominance that can kind of be a sign that you're not really detoxing well. Um, so, um, we're going to look at at all of those aspects, but the thing that I the point that I wanted to make was that it's not necessarily that a woman had like her estrogen is too low or too high. It can often be the fluctuations in estrogen that cause issues. So it can be if you look at over the span of a woman's life, it's often like during a month when she's cycling, it's often the drop of estrogen or it's at its highest run when she's ovulating and then it drops between ovulation and men and that's when the woman is most symptomatic. After a woman has a baby, the postpartum period, her estrogen is really high during pregnancy and then there's a sudden drop with childirth. That's often when women can even can be suic, you know, to the point of suicidal postpartum depression and anxiety. Wow. Perry menopause, it's the drop and the fluctuations in estrogen. She might still be making, she is still until she's actually menopausal, her ovaries are still producing estrogen, but they're fluctuating and there's a tendency for there to be less. And so all of these things, whether it's the monthly period right after a baby, um, and then actual pmenopause, that's often those are often the hardest times in a woman's life. Hm. And a lot of this is driven by estrogen. Just like the way estrogen really affects the way that a woman it's basically because estrogen can both be it can um it kind of has this direct impact on um neurotransmitters. And so when estrogen is out of balance, you're going to see more inflammation in the gut and and that's going to affect your serotonin, which is like your relaxation neurotransmitter. So 90% of serotonin metabolism is in the gut. And if if there's inflammation, if the estrogen is out of whack, then your serotonin is going to be out of whack. So how does estrogen that's important? How does estrogen affect your neurotransmitters? Like how does estrogen play such a key role just your psychological, you know, you just being you feel? Um, so it's kind of neuromod, it's like it modulates neurotransmitters. So, there's estrogen receptors in the brain and if um when there's a stable level and a decent level of estrogen, it's basically going to increase serotonin production and receptor sensitivity. Um optimal levels of estrogen are going to support dopamine, which is like your motivation, that kind of reward and mental focus part of um mental health. It's going to enhance GABA activity, which is more like your relaxation, anti-anxiety. Um there's this other neur I guess it's a neurotransmitter. It's called brain derived neurotropic factor or BDNF. And that's responsible for learning, memory, emotional resilience. So again, if you think think of estrogen as kind of being a regulator of all of those neurotransmitters, um and when it's stable, there's going to be mental clarity, emotional regulation. and they're going to feel like they can handle stress better. So, um, when, as I said, like when it kind of makes sense then that when there's that rapid drop in those, again, whether it's the premenstrual, postpartum, permenopausal, you're more likely to get things like irritability, anxiety, depression, brain fog, poor focus, like things that I'm sure you hear when you talk to to new patients calling in all the time, like those are new female patients, like those are super common. Mhm. Um, so let's talk about fixing that. Like what I don't know if you have an example of like a recent patient you saw like how did you actually help them take control of this and balance their estrobolum? Um, yeah. So well, you know, I ask everybody about gut health and how regular their mouth movements are. So um, um, let me think of a very specific person. Um, the way that I usually work with people is that I I I like to work uh on several systems at the same time. So, it's just my style is that I, you know, I usually am wanting to work on the root cause while I'm also providing things that I know are going to help make them feel better today. you know, I don't if I can if if possible, I don't really want my patients to have to wait six, nine months before they actually feel better. So, um a um I can't think of a very specific patient, but because this happens, I think more like with most per menopausal women that I work with. Um so, this is a hypothetical person, but it's a very common scenario. Um so, woman who is 45 um tends towards constipation. So what that means is that it takes a lot of work for her to have a bowel movement every day. She's often bloated um meaning doesn't really matter what she eats, she's just kind of bloated. Um and she has to like really hydrate really well. She whenever she travels, she has a hard time going to the bathroom. She um kind of needs that cup of coffee in the morning to have a bowel movement. So, her tendency is to not really go that often. She's still cycling and the 10 days before her period, it's miserable every month, right? Like irritability. She can't stand the sound of her husband chewing. She can't sleep. She is both depressed and anxious. Her breasts hurt. She feels like she's like even more bloated than usual. Um, everything's just off, right? Um and she gets her period, things are better. First half of the psych of her menstrual cycle is is pretty good. Um often will be is often this hypothetical patient is often on um you know wellbutrin or um another kind of you know anti-depressant and she feels like it h she's not really sure if it helps. You know she's been on it for 20 years. she is kind of afraid to go off of it. Um especially because of how she feels premenally and um she's just kind of tired of feeling this way, right? Like kind of not herself. So my suspicion is that basically there's an imbalance in the gut and the and in the estrobolum and that she is not really metabolizing estrogen well and that one is that she's parmenopausal so her levels are fluctuating and she's not really kind of handling that estrogen the estrogen that is in her system she's not really handling it Well, largely because of that gut environment and the fact that um that the levels are just changing really kind of erratically throughout the cycle. So, we're going to bring in some things to help her have regular bowel movements. That might be dietary. That might be increasing dietary fiber. That might be eliminating certain foods that might be constipating for her. For some people it's dairy. For some people it's gluten. Um, and for some people it's other it's other things. Sometimes that takes a little bit of trial and error. Um, maybe we'll do some magnesium, maybe we'll do some insoluble fiber. Um, basically get her to a place where she is going more regularly. Um, we're going to support her liver, right? We want to make sure that that um that her liver is doing its job in terms of conjugating the estrogen and getting it ready to be eliminated through the stool. So there's a really old-fashioned tool called a castor oil pack and that's a topical application of castor oil. You do it actually on top of your liver. Um I'm happy to kind of share that patient handout with anybody who's interested. It's something you can just buy the supplies at a health food store or online and it's a really safe healthy way to kind of promote a healthy liver detoxification. Um, so we get that moving and maybe some additional neutrauticals, botanicals that are going to support the liver and then we work on stabilizing her estrogen. So maybe it's a bioididentical estradiol which is the strongest form of estrogen that we provide so that she can kind of have a little at least some steady level consistent level of estrogen throughout the month. Um we might add in a little progesterone which can also help with those premenstrual symptoms because it has especially the mental health the mental ones it can have like a calming benefit. Um, yeah. So, that's just kind of without going into like the initial testing and the additional tests that I would want without being too specific. Well, I was thinking with the testing I I didn't go into like, you know, what I found on the on the gut the GI map gut panel. I just Yeah. Okay. Gotcha. So, like let's say you did some more functional testing with like a GI gut panel. What type of things do you think would show up and are you looking for on this type of test? So, I'm on that test. I can see specific species in her gut microbiome. So, I can see like are they kind of are the the the beneficial bacteria? Are they in the right ratio to one another? Are they in the right amount? Uh betagluconidase, which is that enzyme I mentioned earlier, which is produced by the estrobolome. Um, I can test those levels. Is that too high? If that's too high, that's showing me that there's probably too much recycling of estrogen in her system. Um, I can tell levels of inflammation at the gut level. And higher levels of inflammation again are going to interfere with the serotonin production that's going on at the gut level. That's going to interfere with the gut microbiome. And so, you know, we can see how much of a need there is to reduce inflammation systemically and gut-wise. Um, so that in combination with like, you know, the blood tests, um, and looking at hormone levels among other things is like a great, it's really good information at least to start with. Okay. Totally. Uh before I ask kind of a question going deeper into what you just said, I I want to ask a more general question that I think a lot of people are probably hear but they don't fully understand like what actually is the gut microbiome? Because you hear it all the time online, the gut microbiome, your gut so important, but like what actually is the gut microbiome? The gut microbiome. Yeah. So it's very specific um species. They're sometimes bacteria, but they're not always bacteria, but they're they're always anorobic, meaning they don't require oxygen to live. So, they're anorobic organisms that are basically living um in the lining of your small intestine and somewhat your colon as well, your large intestine. So, they're basically these live organisms that we need to survive. They have very important functions. um everything from immune health to actual digestion to hormone metabolism as we're discussing um to regulating levels of inflammation. So there's a term that we sometimes or I sometimes throw around called dispiosis which means it's an imbalance in the gut microbiome. So some of those microbes are there's too many some there's not enough. It's not it's it's not optimal. We can guess at dispiosis based on somebody's symptoms, bloating, diarrhea, constipation. Um, and that oftenimes we can kind of kind of be somewhat accurate on that. But um unless we do one of what like the GI map is or there's another lab that we use where they call it a gut zoomer which is really looking specifically um at a readout of the different micro microbes. Um it is basically guesswork unless we do that. It's not something that you're going to see on a colonoscopy. It's not something that Colagard is going to show you. um you really need and it's not something that the standard stool test that your conventional medical provider is going to um order for you when they suspect blood in the stool or even sometimes a parasite. That's a that's a different stool test that's often called there's like a it's basically one that's for blood and then there's one that's it's called an which is ova and parasite and that's specifically looking for parasites. Um, so that's not that's not a comprehensive diagnostic stool analysis. Okay. So the gut testing that you would get in functional medicine at a clinic like Med Matrix is actually far different from what you would get in a normal doctor's office. It's much more comprehensive. It does not take the place of a colonoscopy. I send people out for colonoscopies all the time. I think it's one of the best screening tools we have in modern medicine. This does not take the place. It's different. It offers different information. Please elaborate for those who are just joining. A colonoscopy is um for screening purposes. You know, now um usually insurance is going to pay for it after the age of 45. Um it's a great screening to rule out um cancer. uh they can detect polyps, precancerous polyps, and those are going to be removed during the procedure if they are detected. Um it's also great if we suspect that somebody has inflammatory bowel disease. Inflammatory bowel disease includes Crohn's um and ulcerative colitis. So, so again, if there's blood in the stool, mucus in the stool, um some really intense pain, a colonoscopy, you know, that's really the way to diagnose those inflammatory bowel diseases. Um it can a colonoscopy can show us um diverticuli. So, these these kind of pockets um uh within the from the colon that can become infected. That's what diverticulite diverticulitis is. Okay. I'm not going to be able to see any of that on a um on a GI map or a comprehensive stool test. What I can see are inflammatory markers. There's one in particular called Calrotectin. If that's high, I'm going to maybe suspect inflam inflammatory bowel disease, but it's not diagnostic. Okay. And then what let's talk about some more testing because I know a lot of people are interested in that. Um what about Dutch testing? I think is one of the names for like just the more comprehensive sex hormone testing, not just the you know blood like what's the what's the real what's the what's the truth about those types of hormonal tests for men and women. So yeah, so those can be helpful. I don't think it doesn't make sense for every woman to get a Dutch panel just right off the bat. um that is testing for what we call sex hormone metabolites and some of the Dutch panels um uh also test for cortisol cortisol metabolites and another adrenal hormone which is DHEA. Both of those are made in the adrenal glands and and the Dutch panel is it uses saliva to test um for cortisol and DHEA and then urine to test for the sex hormone metabolites. So what you get hormone metabolite wise is you get these kind of breakdown products of testosterone, estrogen and progesterone. And um it is considered to be it is more comprehensive than a um than a blood test. It's often used we often order it if a woman is having issues with her cycle. she's not having her periods. They're extremely irregular. Um maybe there's extreme, you know, PMS. Um infertility sometimes, maybe in that par menopausal window, but it's also used once a woman is on bioididentical HRT and we want to see how well she's kind of responding to the therapy. um using the Dutch test, especially if it's kind of we don't really understand why she's not responding as well or she's having kind of unusual responses to bio identical HRT, we might order a Dutch panel instead of um the standard blood test. Okay, gotcha. So, yes, so it's so I guess I would say it's definitely valid. I think sometimes it's overkill, right? Um because often times we can tell a lot by the blood test in combination with what the woman is reporting back, how she's what her baseline symptoms were, signs and symptoms were and now what her what are her signs and symptoms now that she's been on hormone replacement therapy. What and and again to you know what's happened with her gut health has has that shifted as well? Like usually clinically we can make some pretty accurate assessments. Okay. Gotcha. So, I'm going to ask a question that might sound dumb or might be a dumb question. There are no dumb questions. Cole, what So, with with estrogen, we're talking about the importance of metabolizing estrogen. What about your other hormones? Do you need to metabolize your other hormones? Like, what happens? The hormones just they all get they all get broken down, right? Like they basically they're produced. they lock into their receptors and then they are in the blood and they need to circulate back through to go through the liver get conjugated and eliminated. It's a good question. Um they all they all need to go through that process. Um we don't necessarily see the complications I guess that we see with with estrogen, right? You don't really hear about like progester progesterone dominant symptoms or testosterone like it just doesn't seem to be that was my follow was like okay so if you're having gut issues and you're not detoxing um and like what about your other hormones like are you now right having issues otherwhere it's a good question I think we don't really see it that much we don't really see um a level of sensitivity to those other hormones In theory, yes, it's it's happen. You know, you're not really it's not you're not really eliminating the way that you should. I think that um I don't know honestly like I don't know betagluconidase for example specifically is in charge of um deconjugating estrogen metabolites. I don't know of an equivalent enzyme for these other hormones. They they might be there. We just don't we don't it's not kind of part of our testing um at this point and clinically we don't really see issues like we do with the estrogen dominant piece. Okay. That I'm aware that I'm aware of. Okay. All right. Um another dumb question coming your way or possibly dumb. Um with Oh man, I'm forgetting my question. Um, oh, okay. Here was with Okay, so we're talking about detoxing, right? And the importance of having a daily bowel movement in order to detox. Let's say I'm stocked up, right? And I I my I need to detox. I take a laxative and I have to take a laxative most days to have a bowel movement. Is that not still effectively detoxing? Like is pooping while taking a lacting while taking a laxative having the same detox effect as just having a normal bowel movement? if that question makes sense. Yeah, I think it's a good question. So, you're not really helping your liver at all, right? You're not really changing the pathways in the liver. So, if in terms of the liver kind of doing its job, conjugating, making sure you need like bile. So, you need so all of that is important. It's that we call it the hippatic um part of the digestion, right? Um, so just taking a laxative is often there's different types of laxatives, but oftentimes you're one you're just kind of um one form is where you're just kind of forcing muscular contraction of the smooth muscle of the intestine. So you're basically artificially stimulating muscular movement and that movement. A more common form of a laxative is um osmosis using like basically you're drawing water into the colon which is then going to make you poop. um you're you could become dependent on it where basically the your own system the intestines kind of forget how to do that themselves and once again you're not really getting to the root cause of why there's lack of motility why is the person stopped up and so you're not going yes you you are eliminating but you're kind of eliminating the final product. You're not really helping the liver. You're not helping the bile production where that and the gallbladder is involved in that part. you're not helping and that those detox pathways are happening in the gallbladder and liver. The laxative is literally addressing the very end of the digestive system, just the colon. So, no. No. Okay. Gotcha. Okay, then. All right, guys. Um, all you wanted you just wanted a one word answer. No, that was perfect. Thank you. That was excellent. Made a lot of sense. All right. Um, yeah, we've had a lot of people. We've had like a couple hundred people tune in so far throughout the show. So, we got about uh just about 20 hanging out with us right now across platforms. Um if you're join joining us now um or you've been with us the whole time. Uh we're going to have a couple minutes to do some Q&A here. If you want to comment any questions um if you're so brave, we'd love to answer them. Um but while we're wrapping up here, let's Dr. Rose, why don't you kind of explain um what a what would a personalized healing plan at Medatrix look like for someone with estrogen dominance, PCOS, um endometriosis, beginning with gut restoration look like and moving into like hormonal repair? Yeah. So, we start with baseline, right? So, we start with some of the baseline blood work that we get right off the bat. Um, and a real comprehensive look at gut health. So, I'm always asking everything from heartburn all the way down to do you have hemorrhoids? So, top to bottom of the gut. Um, and then also extensive questioning around a woman's cycling, how she feels throughout the month. Does she have symptoms at ovulation? Again, physical symptoms, emotional symptoms. So, really trying to get a real sense. Um, if it seems like we want to do a gut panel, a a comprehensive gut panel, we'll do that. We'll get an actual readout of her microbiome, inflammatory markers, etc. Um, and then we customize, right? We personalize everybody's plan. So, there may be if um if we need to help with detoxification, support the liver, maybe we'll do a castor oil pack. Maybe we'll do some botanicals that can optimize um the the liver's job. Maybe we'll even add in some ox bile which is basically helping with that step between the liver and the um the intestines where the microbiome is. Um a high qu you know nutrition-wise high quality fiber in the diet. I will very commonly prescribe insoluble fiber a little even if a woman says she eats you know tons of vegetables in her diet. Um there's rarely negative effects from taking a dietary fiber. Um these are just examples. And then depending on where she is in her cycle, what um you know may make sense for her, we might add in some bio identical hormone replacement if it seems appropriate. We might do some what we call like adrenal adaptogens um to help with the anxiety and the stress resilience. We might bring in some help to balance the neurotransmitters. There's some peptides that specifically target neurotransmitter balance. There's again we might we always are going to make sure that she's not deficient in vitamin D, B12, iron, magnesium. Um so pretty comprehensive I would say. Yeah. Awesome. All right. Well, we appreciate it. Thank you everyone. Oh, we got a comment here. Um, this explains me 100%. Well, uh, yeah, it's why we're here. It's why we do what we do. We want to help patients with real healthcare, treat the root cause. Uh, I had recently gotten my blood test. I don't know if that was with us or another, uh, practice, but happy for you figuring this out. Um, real quick, guys, we do have a special thing for um, people who've joined us on the webinar. Um, if you book with this live link that I was just commented, you would actually get $200 off as a new patient. Uh, and you can book your discovery call through that page. Um, so that is that just went live for you there. Um, and then Oh, awesome. Yeah, she's this patient said with Med Matrix. Well, talk to your nurse and uh get a $100 credit because I imagine you got $100 discount, but this one's 200. So, see if you can get an additional $100 credit. ask your nurse. Um, and then yeah, this you can get this $100 discount for another um hour. I believe it expires at 7 p.m. So, if you're listening to this live and you're want to speak with our team and see if we can possibly help you, um, definitely click that link and just schedule a free call, see if we can help. Um, and then yeah, other than that, that is everything for tonight. Dr. O, do you have anything to add? No, I just I I find it such a fascinating topic and I think like the more that we can spread this information and let women have a different perspective on everything from PMS to acne to permenopausal symptoms. Like the more enlightened women out there, the better. Awesome. We love it. And more enlightened men, too, right? Yes. Don't forget the men. Yes. Awesome. I feel more enlightened. All right, everyone. Thank you so much for joining. Um, if you enjoyed this episode, uh, don't forget to, you know, share, like, subscribe. We're trying to put out more and more educational content as we go along. And, uh, yeah, Dr. S, thanks for joining. Bye, everyone.