Hey everyone and welcome back to the Rose Cove.  I had some filming issues the last time but here I am.  So here was my breakdown for February. I guesstimated $2550. I don't think we're gonna get there. This is what I've paid off already. Let me zoom in just a little bit. So already I've paid Amazon which is through the first altar, Walmart, Canva, Insta, Inc. And as you can see I changed the date here. Apple, I don't think that's come out yet and my booth rent, I just go ahead and mark it out because I paid that weekly so I have to have some of the work so we kind of know that's going to be paid. Wayfair, they got $107. I want to say, I don't know why I have 107 on here but I did think I did pay Wayfair and I don't think I have one due which is the 25th. Shopify came out a little early. It actually came out on the third. So I've made a note for next month to move that and the community bank got 40. So I still have these things here to pay. Don't know how I'm gonna pay it. Oh, let me go back. I did make a payment to City Bank for $32 and Barclays, they got 100. They really didn't. They got 80. And T-Mobile, I have a payment coming up this week of 285 and we'll get into that during my weekly paycheck to paycheck. Navy Federal Credit Union, I have a personal loan with them. This was tricky because I'd only give them $100 every month. It's normally 96 but I'll end up giving them 100 to kind of pay it down. And I looked to go pay it, was going to pay it today but they have a total of 181. That is like my final payment. It will be late. I'll be paying that on tomorrow. And then we have car insurance, that's 206. And then my car note, I didn't have it broken up this month. It is actually due today as well and that is 36381. I will not have that until tomorrow, preferably. So with that breakdown, as you can see, I can't do any cash envelopes right now. I can't do any savings and it's really kind of bothering me but it's okay. I've already thought about kind of doing a little savings offline, like a $5 challenge or something. But right now, you guys, I just cannot financially contribute to any type of savings or anything. Also, I don't think I've been here since like January but I caught COVID in January and that threw my budget completely out of the loop. And put my finances in a definite chokehold. I think I did come back and I took like $700 out of some stocks that I had to help with the bills. So now I have nothing in my stock. So I do want to get back into gaining stocks and having those mature and things like that. But I really want to do my research on that. So nonetheless, let's hop right on in. So we're doing February 21st through the 27th. I'm laughing because y'all my income is just, I know that I'm busy tomorrow. That's all I can and then I may have three more clients for the rest of the week. It has been terrible to the point. I'm really considering just getting a regular job because I want to pay check. I want to know what I'm making and I'm too old and too big of an age to be out here guessing and paying my bills and I like to pay my bills on time. Nonetheless, let's put down here and honestly, I don't think I'm gonna make about $750 this week. I would love to make more. We'll come back in next week and see what I actually made. Nails, I so far don't have anybody. I'll put Zip Shopify. I'm going to put 40 already made a sale over the weekend, just one with my new releases. And then I'm going to be doing a sale on some other items that I have. So right now that's just 40. So we have a grand total of $790 for the week. So we know on the 23rd because they moved my card note for me back to the 23rd. That will be my card note. And that is $363.20. My loan, I'm going to pay that on the 21st. And that is 18102. Okay. And what else we got this week? Oh, on the 24th OT mobile, $285. I'm just writing down what I owe. I already know I'm going to be in a negative, but it's okay. The booth rent, I believe that is the 26. And then my booth rent goes up next month to 250. And that'll be 225. I'm going to check my monthly calendar to make sure I don't have anything that I'm overlooking. This is the 21st of the 25th, Wayfair. Oh God, Jesus Christ. And then Wayfair because I kept forgetting them because they got put on a different date that I'm used to. I was behind, like not behind, but I paid two payments late and they dropped my balance. So whatever you call it, what I would have. And I had over like 2000 and dropped me down to 500. And I wanted to pay off what I already had because I wanted to get a new like kitchen table. So now I'm just like, you know what, screw it. I'm almost to the point, I don't want to pay, you know, but especially these credit cards. I'm going to give them 50 for Wayfair. And then car insurance is due next Monday. I'm not going to include that. And I think it came out. Oh, also in the 25th, we have GoDaddy and that $7.41. And that is for my name. But down here in the notes, I'm going to make a note because I have to pay my PO box, which I think I'm just going to get rid of because I just can't afford it at this time. I'm going to put PO box. It's like, you just, I think it's $79. They went up as well. So let's do some math. Let's see what we can afford this week. And I really just hate coming always with bad news. I'm really crying, but I just can't help it. So we got 363. So we have a grand total of $1,111.63. Put that here. Hmm. 1111. Now, as you can clearly see, I'll be in the negative solicit track that $790. And this is really on the low end. So I'm in the negative, my $321.63. So this is what it is. I don't think I have a read. This is a read. Let me just trace this. $321.63. I am in the negative. So basically, I need to come up with $321. The only thing I would see that possibly I would not have is my T-Mobile. And it's a possible way I could get that pushed to next week. But I'm not certain.  But I definitely want to pay that this week. So we need to work on making $321.63. So my plan of action for that is to run a sale. I've sold everything that I can sell at my house, but I no longer use. But that would be it. My last resort is to go to Mr. Cart. Very last resort. Prayerfully, I'll get some new customers this week. But that is that. So I'm trying to come back on a weekly basis with my budget. I'm budgeting. I enjoy doing it, but I just get a little down about it when I don't have the funds. But this two-shot pass away has always been made. You know, like I said, some things are just going to have to be late. And if it's late, it's okay because at least they're not cutting in nothing off or coming to get anything. And I have these stickers here I got from Cocoa Mini's plans. I've been meaning to show them on my Instagram. Check her shop out. Cocoa Mini plans.  And I think I am. So I am going to put this down here in my notes. I need some more of those because I'm doing the best I can. So I hope you guys enjoy it. And I hope this video actually takes some action. Upload it. Thank you so much for watching. We still have to put this planner together, but y'all, I'm just barely making it. Okay. But I really do appreciate you guys stopping by. If you enjoyed today's video and you would love to see more content from me, do me a favor, hit that subscribe button. Also hit that notification bell so that you're notified whenever I come back with more videos like this. And I will see you guys in my next video. Bye.


Good, so I think this is sort of an appropriate time for me to give this talk because I'm going to be talking about how, you know, a lot of the things that work in single cohort analyses don't necessarily scale as we add more data as we try and integrate across different data sets. And so I'm going to give you a simple example looking at tumor normal phenotypes, but I think this, the general lesson applies to many things. So TCGA is sort of both a blessing and a curse. We've been talking all, you know, the last couple of days about all the really nice things about it, and it really shows this unprecedented data set to do lots of different things. But as you can see from this figure, you know, from a method standpoint, one of the really nice things that we've thought we wanted to do with this is to integrate across different data types and different tissue types to look at networks and pathways in the pancancer context. But you know, it turns out that this is actually a really hard thing to do. In our lab, we've spent a long time trying to do this, and you know, we get really complicated really quickly. The same methods don't work in one cohort as they do across many cohorts and in one data type integrating across many data types. And so I think part of it, part of the problem is that we need to think about this from a different perspective. So how do we get past this? Taking from a lot of the work that Google has sort of trumpeted in what they're doing, when we scale up, when we get to truly big data, often simple models will get you most of the way. So complicated models may give you better results, but they're going to be much harder to integrate with different data sets and much harder to put into production. Additionally, we need to really work on incremental and transparent methods. So I'm a graduate student. I don't have a full team of software engineers to check all my pipelines and make sure everything's all right. Doing these complicated analyses, it's really hard to find the bugs. It's really hard to do all the tweaks that's required to bring a project to completion. So the goal of this study is going to be relatively straightforward. We're going to look at the tumor phenotype, and that's going to be the mRNA, microRNA methylation data, and we're going to try and get at what is the scope of the events observed in specific tissue cohorts, as well as a pan-cancer context. And so we're going to do this by sort of going the opposite way that we normally do these studies. We're going to first look at what all cancers have in common, and then and only then we're going to look at what are specific to individual cancers. And so traditionally when we're talking about something like differential expression, in 2002 someone might do gene expression profiling and highlight a handful of genes in one specific cancer. Then a few years later we're going to do a couple of different cancer cohorts, and maybe a meta-analysis review will integrate these things and highlight those genes that are sort of ubiquitously turned on or off in cancers and those that are tissue specific. But this data set really allows for a unified analysis to do this sort of all at once with a shared data set. So sorry this isn't coming out too clear, but on the right we're going to start by defining a very simple model of differential expression. So this is an example of one gene profile across TCJ, so this is going to be about 8,000 patients. So here you can see that about 600 patients are going to have matched adjacent normal tissue samples. So the first thing that we're going to do is we're going to take this data and we're going to throw away about 90% of it. We're only going to look at the matched tumor normal samples. And then we're going to do something that's going to throw away even more data. We're only going to observe whether a gene has higher or lower expression in the tumor compared to the normal. And then finally we're going to count how often that happens across a given cohort. So this is, we're going to call this statistic fraction over express, and this is going to get at how often the gene is over expressed in a given context. And we'd expect that if the gene was under sort of random regulation, this would happen half the time. So there's a lot of advantages to this method that may not be obvious immediately. Anyone that's done pan-cancer analysis with expression data knows that tissue baseline, tissue specific baseline expression is really hard to overcome. So this is going to be, this is not going to be sensitive to that because we're not, we're only looking within paired samples and we're not incorporating the magnitudes at all. This test statistic is going to be much easier to interpret. It's a fraction from zero to one. And we're going to be able to carry this forward to integrative analyses and have a common baseline to compare across different data layers and different data types. So obviously we're going to have some disadvantages throwing away this much data. And those are going to be that we're less sensitive to the magnitude of differential expression and obviously less powered. But sort of in preliminary analysis, we found that this very simple metric, given enough samples and, you know, as we know in the future, we're only going to get more samples and actually compares very well to a paired T test, which uses the full data. And so we get about 99% correlation. And this is within one specific cohort. You can imagine if we were trying to carry this over to a pancancer analysis, we would have to look at things like tumor purity differences in the tissues. We would have to look at margin effects. All these different, all these different factors that aren't going to be that big of an issue in our analysis because our sole assumption is that our tumor sample has a higher concentration of tumor cells than our normal sample. So we're going to start out by trying to get at what, what's common across all different cancers. So we can apply this across the methylation data, the mRNA data, and the microRNA data. You can see that we get a full profile. 50% is our sort of random model. Immediately you can see a skew of microRNAs. So this data tells us that microRNAs tend to be overexpressed in this pancancer context. When we look into details, we see a lot of the players that we've seen over and over in these studies. We can see alcohol dehydrogenase, and then a number of the alcohol dehydrogenase are turned on, turned off sort of ubiquitously across all different tumor types. Additionally, we see a number of things that are turned on across many different tumor types. So here's microRNA 21, and you can see it's turned on in every different tissue type except for maybe any chromophilic cancer. We can carry this forward. So what we get here is we get a simple metric. We get a fraction of how often the gene is turned on or off across this pancancer cohort for every gene. So we can use this to do things like pathway analysis, network analysis. We see an enrichment of mitotic genes, and a lot of the metabolic pathways are turned down in tumors. Initially we can do functional enrichment. So this is on the methylation data. And we can see PRC2 probes have an enrichment for hypermethylation, whereas we see a decrease in promoter hypermethylation that's enriched in this across every different, across the full set. So promoters may be methylated to silence a specific patient tumor, but these things aren't generally conserved across many different cancers. So finally, we want to see how well this type of metric would replicate. We're able to get about eight microarray data sets for about 900 subjects. The data is not as good because these are older microarrays, but we do get pretty good replication. So we get about 76% correlation. So now we've sort of established what all cancers have in common. If we were to look without this knowledge in individual cancers, these are the things that we will get. But with this knowledge, we can go further into see what differentiates cancers. But first, we're going to look at, we're going to sort of explore another hypothesis. So we know that these genes that we see over and over again, these are probably genes that are associated with growth and proliferation because this is sort of common processes that we see in all different tumors. But we haven't looked at the levels. So now we want to bring back the levels and see is there differential usage of these genes and does it matter? So we can do this by using our fraction over express profile. So this is our fraction over express for 20,000 genes. And we can correlate this with all of our different patient profiles that we're going to normalize to the normal tissue expression. So you can see this is one patient with a matched sample. You can see in their normal sample there's not much correlation with this statistic, which is sort of by construction. Whereas in the tumor, we see a pretty solid correlation and what we can interpret from this is that in this patient, those genes that are always turned on in the cancers tend to have higher expression levels and those genes that are always turned off tend to have lower expression levels. So just as another sanity check for all of our matched patients, we see 99% of them have lower values for this correlation in the normal compared to the tumor. But you can also see that there is a pretty big spread of this correlation level amongst the tumors. So this analysis doesn't depend on the matched normal data at all. So we can apply this across all 8,000 tumors that have expression levels. We see a pretty big spread with some tumors such as colon and rectal cancer having pretty uniformly high correlation to this tumor growth signal. And others have a bigger spread and pretty low correlations. And finally, we can look at whether this is associated with outcomes and like many of these growth and proliferation signatures, we see a high hazard ratio of many of these tumors which have lower baseline correlation levels. And so the way to interpret this is a hazard ratio about 2. This is in kidney cancer and this means that patients with one standard deviation, higher correlation to this tumor growth signature are about 2-fold increased risk of death. And there's a pretty big effect size for many of these tissue cohorts as you can see down here. So now we want to really get at what are the differential pathways activated in different cancers. And we can do this by doing another very similar analysis. So we're looking at our breast cancer cohort. And here we have our fraction over express metric for all the genes in the breast cancer cohort compared to the same metric for all of the other tissues pool. So you can see that there is a pretty strong correlation between these two things, which is to be expected. So most things are shared between breast cancer and the rest of the tissues. But there are some genes off the diagonal and those might be interested to see what is turned on or off in breast cancer but not in different tissues. And so one of the first things that comes up, this is this gene right here, is MET, which we've been talking a lot about these last couple days. We can see MET has very high overexpression in kidney papillary cell carcinoma, which is to be expected. That's where we know it has clear oncogenic activity. A number of other tissues as well and these tissues that have the highest differential expression are generally the ones where we see familial germline mutations. So we know that it has oncogenic activity in those tissues. Whereas in breast cancer and in prostate cancer, we actually see a decrease in expression and the tumor is compared to the normal tissue. Additionally, a lot of what we've shown in TCGA is that not everything is tissue-specific. There are the genomic context matters. And so we can group by the genomic context and look for things that are differentially activated in different contexts. So here we're dividing based on the status of P53 mutation. And we can see, again, while most things agree, there are some genes off the diagonal. We can see that MCM8 has no differential expression in P53 wild-type patients, whereas it does have higher expression levels in the tumor in P53 mutants. Sort of in contrast, MDM2, which we know has a strong interaction with P53, is overexpressed in the tumor in P53 wild-type patients, whereas there is no differential expression in P53 mutants. So in summary, we've described a very simple metric for studying the tumor phenotype. And we've used this to define a list of differentially expressed genes, microRNA and methylation sites in this pancancer context. We've used these features to stratify patient outcomes and define both tissue and driver-specific changes in cancer. And I encourage you, so we're working on putting this manuscript together, but I encourage you to think about the specificity of results in these targeted analyses to really understand what is specific to a given tissue context or a given model, versus the general features of cancer as a whole. And with that all, I think this is the Eiderker Lab and open it up to questions. Very nice talk, thank you. I'm curious, why not assign a statistical significance score to your statistic, maybe by permutations? So we're using, you know, so our statistic is basically a coin flip, and the value is reported here.  These are extremely significant. We get significant at about 55%. And so in this realm, we're really more worried about the effect size than the p-values that we get on these things, because a traditional differential expression analysis has power with maybe 10, 20 samples. We're using 600. So we're sort of past the realm where significance matters. Anything that we're looking at is going to be very significant. Okay, so we are going to have a break. After a break, we'll have a workshop. But before that, I want to, on behalf of the TCGA project team, I want to thank Julia for taking the time to organize this productive scientific symposium. Julia, thank you. We also would like to thank Josh Shapiro, Jennifer, and the colleagues from the Capital Consulting for getting us organized. So we can have a hotel and we can have our slides. Also, we'd like to thank the TCGA project team, especially J.C. Carling for the work they do behind the scenes for getting this going. And finally, I'd like to thank my co-chair, Katie Holy. Where is she? For her excellent work. Thank you, everyone, for coming to this meeting and see you in the future.


Dr. Campbell, it's great to have you on. I heard about you through Christina Rice, who's one of our very, very good friends. Yes, I'm too. I was asking her for some good functional medicine doctor recommendations. At the time, Jessica was having some gut issues, so I wanted her to maybe work with someone or whatnot. And you came recommended very, very highly from Christine. That's pretty cool. Yeah. So I get a lot of questions. Actually, all of us get questions weekly, very similar ones. And one of the common ones that we get quite a bit, they revolve around functional medicine, what it is, how it's different from traditional medicine, how they treat people differently. So I'd like to start with a little bit of that. I guess we can start with the basics. What does a functional medicine doctor do and how are they different from a traditional Western medicine doctor? Yeah, that's such a good question. So I think typically people going through the conventional medicine system, they go and let's say they have a gut issue or they're bloated and they have, they're fatigued and they're gaining weight. So what typically happens is they'll run a very limited blood test panel and everything usually comes out fine. And then they start sending them off into pieces. So you need to go to the GI doctor, you need to go to a dermatologist, you need to go, whatever. They don't kind of look at the body as a whole. So with functional medicine, we realize that everything really plays off each other. So we kind of just dig into this other type of testing. We do do a really thorough blood panel and really like looking at the thyroid, just looking at more than TSH, looking at the whole thyroid panel, which there's like nine markers, more than just one. So that's kind of where we start. And we're looking at things like methylation. We're looking at what is your gut health look like? So we're doing different tests for that. I do a SIBO test, that's the small intestine bacteria overgrowth. And then also looking at a stool test, which is a large intestine, because about 70% of your immune system is in your gut. So if you're having autoimmune issues or you're having many different, even skin issues, it really pretty much stems from the gut. So we kind of look at that. We look at hormones, we look at cortisol, which is our stress hormone. And so we really look at things as a whole. We do all different types of testing that's not typically done at the regular doctor's office and put all the pieces together. And we realize that what you're eating plays a very big role in how you're feeling too. Because a lot of conventional medicine doctors, and not all of them, but a lot of them have no idea about nutrition and what kind of role nutrition plays in their health. And they'll say, gluten doesn't matter if you have a thyroid issue, you can eat it, that's a myth, and it's literally like, no, it's not, it's in studies. So I think that's kind of the difference. We're just digging deeper and we're using different, really like different parameters on what we call a problem versus what a conventional medicine doctor would. So an example is with the thyroid panel. The thyroid panel in a conventional medical system is very wide the range. And with functional medicine, the range is very tight. Oh, you mean like what's considered, this is normal. Yeah, like the number, right? So like your TSH, let's say you go to conventional medicine doctor and it's a 3.5 your TSH. When we see that as a functional medicine doctor, we're like, there's a problem there. And then we'll also have the backup of what is T3 and four and the thyroid antibodies look like, right? Well, they're just looking at TSH and they wait till you get to almost a five to call it an issue.   Functional medicine, we're looking at things in a tighter range. We're looking more thoroughly. We're working with diet. We're trying to reduce inflammation. We're talking about stress management, all the things that make you feel the way that you feel that's not that you know is not right. And we're really listening to you, number one, and we're catching things before they become a really big screaming issue. So what are some of the common offenders that you see? Like what's most common in your practice? What's most the underlying causes? Yes. Definitely gut health. So I think I can tell you I've worked with thousands of people and I do a SIBO, which is small intestine bacteria overgrowth. And then I do the GI map, which is looking at the large intestine for bacteria, yeast, parasites, viruses, that type of stuff. Those are almost always positive. Like almost everybody has SIBO.  That's like their go-to diagnosis. But it's really because of the bacteria it should not be in the small intestine. So that, and then usually, I see Candida, but it's, I think a lot more people think they have Candida than actually really do because I see bacteria in the gut more, like opportunistic bacteria in the gut more than I do see Candida. But those are like the biggest thing. And then definitely issues with the sex hormones and the adrenal hormones and basically mostly because of stress. Now, Dr. Campbell, do you think that the reason why you see so much SIBO is because there's a little bit of a selection bias, right? People are coming to you because they don't feel good. Right. Do you think SIBO is super prevalent in the general population or just in the population of people who suffer from some of the symptoms? I think because almost everybody is positive that I test, it's probably the population in general. And I think that people are told they have too much stomach acid and they're put on these proton pump inhibitors, which is like the worst thing you can do because we need that hydrochloric acid to stop that bacteria from going up into the small intestine. So, so many people have heartburn, which is one of the biggest signs of SIBO, and they're put on proton pump inhibitors, they're reducing that hydrochloric acid even more and then they're allowing more bacteria up into the small intestine. And so, they're taking these medications, whether it's Toms or something, a prescription. And it's like this vicious cycle of reducing the acid, feeling better temporarily, letting more bacteria in, increasing the splash up of the acid, which does not mean you have too much acid. And so, people are really, they're just misinformed. And I honestly think that the doctors are misinformed. They're just not understanding what's really going on and they're just leading people down the wrong path. What are some of the other symptoms of SIBO?   That's a really big sign that you have SIBO. You know, just, you know, a difference between, sometimes they're constipated, sometimes they have diarrhea, sometimes they have a mixture of both. That's a really big sign you have SIBO.  It's such a wide range of symptoms. You'd be so surprised what symptoms go along with SIBO. So what does a treating it look like? What does that protocol look like?  So here's the thing. So like back in the day of when people first found out about Candida, they starved the carbs completely, right? And I don't follow that method. I think you need a little bit of carbs because if you don't eat any carbs, that bacteria, it feeds on it, right? So it hides. So you're going in with antimicrobial supplements, right?  So it makes it harder to get. So you wanna eat a little bit of carbs, but just not a lot. You don't wanna eat too much to where it's like the bacteria is growing too much and the antimicrobials aren't working. So it's kind of this balance that you have to find. So they kind of hibernate because you're starving them. Yeah, it adapts to survive. Which means that you take an antimicrobial, doesn't touch it. Exactly. It's like you can't find it. So you need to eat some carbs, not too many. And then the worst part about SIBO is that unlike bacteria in the large intestine, it can come back. It's like once you have SIBO, you're kind of susceptible to SIBO, but there are ways to kind of manage it. So you kind of like aggressively kill it and then you work on just kind of managing it. And for some people it never comes back, but for some people it does. So you just, it depends on the person, what I'll kind of do with them. Is this because they never solved the root reason in terms of why they got SIBO in the first place? It's like sometimes people have, people have what's it like the lap band surgery or any surgery where you're going in, it's really leaves you susceptible to SIBO. And those type of people, you're just always gonna be susceptible. But if it's someone who just had like a minor hydrochloric acid issue, you can give them hydrochloric acid, you can get in there with antimicrobials, you can get them to kind of maintain, you know, something really important I like to talk to you about is like there's no one diet for everybody, you know? And some people do well with like lower carb long-term because they're more susceptible to building a bacteria. And so if they can kind of stand like a moderate to lower carb diet, they can really keep it at bay.  It really just, it depends on the person. I read an article about SIBO where the author speculated that certain infections or gut issues could cause either temporary or maybe even permanent paralysis of certain parts of the intestines. So you end up not moving food through properly or effectively, which causes the backup or the buildup of bacteria. And those are the people that tend to get the reoccurring. It's the trans at time. Yes, exactly. So, and the good thing about the testing we do is so it looks at hydrogen-based and methane-based. So basically what happens is you drink a lactilose supplement, it's like a little shot you take and that feeds the bacteria that's in there if you have it. And that bacteria will spill out either hydrogen or methane gas or both. So if you have the methane dominant SIBO, you're more likely to have constipation and slow transit time. So that's the people who you see having a harder time getting rid of it. And that's why you have to make sure when you're treating the gut that you're getting your bowels moving. I mean, and some people, you have to do like multiple things to get it moving and some people you don't. So the people who get their bowels moving the most are the people who are gonna have the most success. Now, is it different when you're treating the different types of bacteria? You said there was methane producing and then what was the other one? Hydrogen, yeah. Are there different antimicrobials for each one? So I've noticed that I do an original like more in-depth antimicrobial protocol with some actually prebiotics, sun fiber I use that actually helps, it helps to feed the bacteria so that you can kill it better. And then if there's still an issue, then I'll start using autron teal, which I really like. And that's a little bit more from methane dominant. And so that's something that you can keep them on longer term and they can kind of use it as needed. Like if they're feel like, you can really tell if you have it. So if you're feeling like you're reacting a lot and you'll start using your autron teal more and then if you feel like you're really good, you just stop. And some people will kind of go through that for months or even years. And autron teal is a supplement that has only three ingredients in it, which I like so you can really stay on it pretty long term. I've used it before. Yeah. I had good success with it. Yeah, they're a really good product. Now, in comparison, these natural antimicrobials, how do they do when you compare them to pharmaceutical antibiotics? Because I know that that's the traditional Western medicine treatment for bacteria is antibiotic, yes. So Ray Faxman and Neomycin is typically what people use. And the problem is, is number one insurance doesn't cover it usually. So people end up spending about $1,200 per round. And they have to do about two to three rounds to even really get to it. And there's about a 40% success rate. So I find that the natural antimicrobials actually work better. And there was a study that showed that. I actually read a study that compared natural antimicrobials to the antibiotics for SIBO. And it was slightly more effective, which I thought was pretty rare. Yeah, it is. Yeah, the thing you brought up about food in Western medicine is, it reminds me of a story where years ago, I had a family member who had cystic acne. And they were asking, trying to figure out how to solve the problem. And I told them, I'm just a trainer. I've trained people though for a long time. And because I've trained so many people, I've made lots of observations. My expertise is not gut health or skin. But I did notice through my clients, anecdotally, that eating certain foods or changing the diet did have an effect on their skin. And so one of those things was acne. So my cousin went to the dermatologist and said, hey, my cousin said that what I'm eating may be affecting my skin.  I mean, how frustrating is that? So frustrating because food is so inflammatory certain types of foods. And acne is inflammatory. And then certain types of foods affect your gut health and your gut affects your skin. And also one thing I really talk about a lot is the liver. If your liver is congested, think about all the toxins. We're breathing in, the stuff we're putting on our skin. Our liver can get taxed pretty easily.  So that's when you get acne, you get all these other inflammatory skin issues. And then you add inflammatory food to that. You're gonna have a problem. And I work with people with acne all the time. It goes away like that. The second I work on their liver, their gut, and reduce inflammatory foods, their acne is gone. Now are there markers that you take, because I know there's liver enzymes that we could test. Do those change? Is that what you're looking at? Or is it more based off of symptoms? So I think if your liver enzymes are elevated, it's actually like, wow, this is really a problem. Like I get to it before the liver enzymes are elevated most of the time because I think everybody needs liver support. And I'm one of them. Like I take liver support every day because we just were taking in so many toxins with everything we're exposed to. And I want my liver constantly pushing everything out the way that it should be. So I think that it's just really important to support the liver before it even gets to be something you can see on labs. Now the word toxins has become such a buzzword in the wellness space to the point where it's been parodied by the conventional medicine. They make fun of the fact that, oh, everything's toxins and you need to detoxify. And we've seen this in our space, like fat loss detox teas and stuff like that, which in our, we know fitness and health.  But what do you mean when you refer to toxins and what are you referring to? What are toxins that we're exposed to? I mean chemicals mostly. So like, let's say you're standing behind a bus, the exhaust that comes out of there and environmental toxins. Let's say you're living in a house and there's mold putting on products with phthalates and stuff that's really actually changing what your endocrine system is doing. Even touching receipts. I was talking to Ben Lynch the other day and he's like phthalates are in receipts. So like we're literally exposed to these chemicals all the time and they not only can really congest your liver but they start to change your hormones, your sex hormones. Well, we just did an episode actually on how to raise testosterone. And before we did the episode, we were doing some research and there were articles and these were by scientists and there's some studies supporting them. Talking about how, cause I don't know if you're familiar with this, but men's testosterone levels have been dropping pretty consistently for the last four or five decades. It's, this is a documented thing. And one of the theories is our exposure to these, what are called Xenoestrogens found in plastics and whatnot. Can you tell me a little bit about that? Yeah, so it's in plastics. It's in your beauty care, which men use to, like putting on lotion. Our skin is our biggest organ. And so what I'm seeing with men is they're actually, their testosterone is going down their estrogen pathway. So their testosterone is low and their estrogen is getting higher. So it's, in my opinion, it's because of all the things that they're putting in our products that are really, and in our food, you know, like chemicals in our food. And like I said, like you're touching something as simple as a receipt and it's just getting into our skin, which is affecting our endocrine system. And it's really changing hormones for men and women. What kind of changes are you seeing in women's hormones? I see women, a lot of women getting either estrogen dominance, which leads to a lot of things, you know, with histamine and with thyroid. You know, the estrogen being high causes so many issues. And then also then you have on the other side, PCOS, which is polycystic ovarian syndrome and women are getting really high testosterone. And then they're feeling aggressive. They're getting hair like men. They're, you know, everything's kind of changing. Their personalities are changing. They're having mood swings and they're gaining weight and they just don't feel like themselves. They don't even feel like feminine anymore. So it can really swing both ways and it just really depends on what's going on in there. How do you test that in women? Because I know that a woman's estrogen will fluctuate throughout the month. It does, yeah. And I know if you go to a conventional doctor to get your hormones tested, they just test you. They do. One day, right? And they don't even tell you what day to test. Okay. So is there a different way that you do? There is. Okay. So I really like the Dutch test. It's from, I, there's different companies that make it, I really like precision analytics and they tell you to do day 19 to 21 of your cycle. So they know where you're supposed to be versus a blood test, which is just snapshot in time. It doesn't matter where you are in your cycle and how can you really tell if you were high or low because your hormones are doing this, right? Throughout your cycle. So we look at it at the right time and then it's using urine metabolites which it kind of allows you to look at it more of a like an ongoing thing rather than just that moment in time because you're taking multiple samples throughout the day and then it puts it all in a graph for you and it's like, this is what you were looking at at this time of the day. This is what you're looking at later. So it's really thorough. And then it also breaks it down even further to what pathways your body was using to eliminate this estrogen. And then you know, like was that an inflammatory pathway? Was that the normal pathway? So it's really, really thorough and helpful. What does estrogen dominance produce in terms of symptoms? Weight gain, moodiness, sleeplessness, gosh, so many things. Well, you know, I talk a lot about histamine intolerance and estrogen increases histamine release in the body. So it can definitely give you, you know, a lot of people would be like, I'm itching or they'll have all these histamine reactions like right before ovulation or right before their period. And I'm like, that's because that's when your estrogen is highest, plus you probably already have estrogen dominance. Oh, okay. Yeah. So, and then even with your thyroid, like estrogen makes your thyroid cells more visible to the immune system.  So that's why people with certain disorders do really bad with estrogen dominance. Why would estrogen go up? Why would a woman develop estrogen dominance? And so, senaestrogens, like, yeah, from the products we're using. And that's why, you know, I talk about makeup and Christina does and we all kind of talk about makeup a lot because it really actually matters. And like, it matters just as much as what you're putting in your mouth. It matters what you're putting on your skin because you are literally changing your sex hormone levels with what you're putting on your skin. Is it regulated differently than food, makeup? I don't know. That's a good question, but you know, the way that food's regulated, I mean, I don't... It's not great. It's not great either way, so.  Right. Now, I imagine there's so much to look at with a client. Do you have like an order of operation that you go down like the list, like, okay, let's check all these boxes first because I would imagine throwing them all that at once it would be just like overwhelming and who's actually gonna actually follow through this. So do you have like an order or operation?  I'm like, let's not do like a baby piece of the puzzle and then a month later we'll try something else. I start first by taking a really detailed history and I have them fill out all these forms where I can kind of see what's going on and then I just keep it real with them. I'm like, this is what I think's happening. Let's test this, this and this. So while we're waiting on the test, like I usually will test the gut and test that Dutch test, right? So that's looking at their sex hormones and their adrenal hormones, their cortisol. And so while we're waiting on the test, they're starting on diet and I don't baby step them into diet because I don't think you need to. I think people are very capable of changing the way that they eat. If they feel bad. Yeah, as I say, especially when they feel bad. It's different from trying to get someone just to lose weight or build muscle. When you have somebody who has an issue, they're more compliant. And I would imagine being a functional medicine doctor and functional medicine not being mainstream yet, I would imagine a good chunk of your clients came to you as a last resort. They do, exactly, yeah.  I want you to cut all of these things now and they do it, they do it because they do it and it helps, especially with histamine intolerance. You cut out high histamine foods, you're gonna notice a difference in a week.  So they really, really pay attention to what I'm saying. So, and I start them with basically diet and based on what they have going on, never the same cookie cutter approach to anybody. And then I do the testing. So it gives them a good month to work on learning how to adapt a different lifestyle and eat differently and support their liver. I always start with liver support.  And then I'm like, okay, if I see gut issues and adrenal issues, I usually will start with the gut, but if their adrenal issues are screaming, like let's say their cortisol is like literally bottomed out. I'm like, we have to work on both of this together because your body's not gonna process the treatment as well as it could if you were addressing the adrenal issue also. Is that common or not common? It's more common for me to see, like I can work on it piece by piece. And I like that better because I'm not a big, like let's take 20 supplements at a time type of person, but I do have to give you what I have to give you. And luckily the gut is like a timeframe. We figure it out, we work on it as long as you do what you're supposed to do and you take your antimicrobials and the other stuff I give you, we can be done with it and move on and finish and then you get to the next step. And so I like to do it that way better, but sometimes I have to work on both because it's like so bad in all areas. And their adrenals aren't supported enough to handle the treatment for the gut. So I have to help them with that at the same time. Do you think this is something that's on the rise? Currently or we're just more aware of it now? I think that more people are talking about it. I think that people are more willing to learn because they're getting frustrated with the system, the medical system. And I think it's still very, very small in comparison to where it should be, but I do think it's on the rise. I mean, I think it's people are more open because they feel so bad physically and they just wanna get better. And so they're not getting better. Like a perfect example is people who take thyroid meds and I'm not against thyroid meds, I've taken them myself, but they're not the only answer. You have to take the thyroid med and then do the lifestyle changes or you're not gonna get better. So they're learning that it's like a concerted effort on multiple parts to really get better and they want their quality of life. So if you get in touch with that type of person, which is the ideal patient, it's your very successful. I feel like we're cortisol junkies now too. I mean, look at us, just what, two decades ago, there wasn't lines of people every morning at five a.m. waiting for coffee. Definitely not kids, it was like old people. There wasn't people taking all these high intensity group classes and addicted to training like that. I just, and our fast-paced life, I think has changed so much in the last couple of decades. I would think or speculate that we were on the rise. And it's funny because you talked about cortisol being on the floor, it thinks cortisol is so bad, it's the stress hormone, gotta keep it low. But you need a certain amount of cortisol and I would train clients and I could see that they were definitely in some type of HPA axis dysfunction, need to reduce the intensity and they're like, but I feel great after a really hard workout. I'm like, well, you got a little temporary boost in cortisol. Is that what's happening? When you talk about cortisol being on the floor, is it because their bodies become resistant over time, their bodies try to produce more and more and they're just not making it like they should be? So what are natural responses?  Well, with all the stress we have, even with technology, people on their cell phone all the time, that is constant stress on whether you're comparing yourself to other people. Whatever you're doing, that type of thing, get it drinking coffee, doing these high intensity workouts that your body's not really ready for, whatever it is that's keeping your relationship, whatever, keeping your cortisol high, high, high, high, high. Eventually you can't keep up with that demand. So that's when you'll see people actually start to go into low cortisol, but it actually, I see more high cortisol than I do low cortisol. It's more common in my opinion. And is that because they're in the thick of it? Yeah. Yeah. They're typically reaching out to me when they're really feeling symptomatic and but maybe it hasn't been five to 10 years. It's been like one or two, three years. And so they're really kind of, and a lot of people too, like I deal a lot with exercise intolerance and it's those people who have that high cortisol already and then they're hitting like a really heavy workout and their body's just like, no, because their cortisol is jumping. I've never heard that term exercise intolerance. So what does that look like? I can imagine what it looks like, but I'd like to hear from you. Yeah. So I had it myself and it can be different reasons that you have it. So I like to say probably the top three reasons. Number one is adrenal issue, whether it's too low cortisol or too high cortisol and I'll kind of go into that in a minute. Histamine intolerance because histamine levels being too high that aren't able to be broken down when you exercise, you release histamine.  And then there's something called POTS which is postural orthostatic tachycardia syndrome and that goes along with histamine intolerance. So it's when you change postures and it's typically from a sitting to standing position, you get dizzy. So if you guys have clients and you're seeing them do squats and lunges and burpees and they can't do it, that's usually POTS because their heart rate is down and then it's up and then it's down and then it's up and their body can't tolerate that. So if you're looking at it from an adrenal perspective, it's typically because either your adrenal, your cortisol is too high and doing exercise typically raises your cortisol. So they're just kind of over, it's like an overwhelming high cortisol. And one of the things that happens with the adrenals is you get dizzy or you get fatigued, right? Those are like big symptoms of adrenal issues. Or if their cortisol is too low, they're just really depleted. So they can't, they just don't have the energy for it. They're just really tired. So then that exertion is just bringing that on even more. And then again, you know, going into the histamine and then the POTS, those are the other reasons for it. But I stayed all the time and I had it myself. I mean, I used to take orange theory classes and go sit in my car for 45 minutes because I couldn't drive. Orange theory is the worst for people who would be in that particular situation. It was terrible and I'm like, maybe I should figure out what's going on. Well, it took us years, we all talk about this all the time, it took us years to figure that out for our clients. Well, the irony is too, what you start to piece together when you've been doing this a long time is the people that are most attracted to that type of a workout typically are the people that shouldn't be doing it. Because they have high cortisol because they're go, go, go, go, go, right? That's my personality. So I'm like, if I'm walking on board, if I'm doing yoga, Pilates, I'm so bored. I wanna be running, I wanna be doing. And then, and I actually in college, when I first experienced exercise intolerance, I was running all the time, like six and a half miles a day. I was training the gym for two hours a day. I was studying like crazy. I mean, literally at the gym at five in the morning and then school till from seven to five and then studying till 11 at night, literally getting up at four to study. Like it was nuts. And then I was exercising and I was gaining weight. And I'm like, why am I gaining weight? I've never gained weight in my life. I gained like 30 pounds. And I got shin splints and I had to stop running and I started doing Pilates and I started like getting smaller and smaller. And I'm like, but I'm not doing anything. I'm bored in this class, but I was losing weight because my body, the cortisol was adjusting correctly. About seven years into my personal training career, I had a client who was very similar. And I at this point started to piece it together and I had her replace two of her long runs with yin yoga. So if anybody's familiar, if you're familiar with yoga, yin yoga is the calming, relaxing, non-intense. You sit in a stretch or a position and you kind of chill there. And I thought because of the reduction in the calorie burn, she burned way more calories running that maybe we're gonna expect some weight gain. So I told her that. I said, look, you're gonna probably gain some weight but you need to, I think your body needs some rest. The opposite happened. She started doing that within a couple months. Her body started to burn body fat again, even though technically she was burning less calories through exercise. And that's when it all started to really make sense to me. The cortisol, high cortisol makes you gain weight, especially in the abdomen. People say to me, they're like, I'm gaining weight in my belly. I'm like, you have cortisol issues almost always. So I've also observed that. So there are healthy patterns of fat gain on women and healthy patterns of fat gain on men, correct? What would those look like? What would it look like, like healthier areas that women tend to store body fat versus areas that may be related to high cortisol or other health issues? I think men naturally store more in their abdomen, women more in their hips and thighs. So if a woman is storing it in her abdomen, that's kind of like not really going with nature. So then you're looking at, well, there's probably a cortisol issue there. Now at the moment, we're seeing a lot of news and media around veganism and more particularly, it's more about the health issues associated with meat or that meat is not good and you should avoid it. So you kind of see those two messages. And I know as a trainer that maybe for some people that'll work, but for some people that'll be disastrous in my opinion, are you seeing clients come to you because they've heard this, they follow the vegan diet and they're nutrient deficient or just not working for them? What does that look like? It looks like nutrient deficiency, I mean, at its finest. It's literally the worst labs I see are from vegans. Really? They're extremely nutrient deficient, they're losing their hair, their cortisol is not in a good place whether it's too high or too low. They're eating a lot of grains instead of eating meat. So they're not only, grains can be anti-nutrient. So they're literally blocking their nutrient receptors. So, and grains can be inflammatory. And the problem is that all these vegan documentaries, they're done based on meat that has hormones and antibiotics in it. And that's not the type of meat we're telling you to eat. We're telling you to eat grass-fed organic meat that is just more natural and they don't do studies with that. So that's where I find the problem.  So I have to kind of explain that to the people who come to me as a vegan.  You said anti-nutrients. I remember years ago reading about the difference between brown rice and white rice. And I was led to believe, because coming through the muscle building space or whatever that brown rice was better, right? So it's better for you, more fiber. And then I remember reading studies of how when children in certain parts of the world are fed lots and lots of brown rice, they start to become deficient in certain nutrients because of the anti-nutrients. Yeah, how does this work? What does that look, what does that do? It's the phytic acid. So I guess what happens is when you eat that, and this is why people soak, like they soak to try to get the phytic acid out. But if you don't, and even so, when you soak, you can't get everything out. But it's basically, it binds to the receptors of our nutrients. So those nutrients actually cannot get into and get absorbed into the body the way they're supposed to. And this is found in brown rice. Brown rice is one of them, yeah. More so than white, yeah. And other grains will do this as well. And beans and even nuts too, has it. So that's why you're supposed to soak all of that. Oh, very, very interesting. Okay. I wanted to kind of take you back to the whole acid topic, with stomach acid and heartburn. And this is something I brought up on the show many times and have talked to people actually who can identify with this a lot because this is something where we just think we're taking Tums or taking Prilosec or whatever these other types of over-the-counter drugs are gonna help solve the problem. But it becomes this chronic thing where I just, I'm always taking this pill now. This is like my new norm. And I wanted to, I wanted, if you could kind of take somebody who maybe feels sometimes they get heartburn, but when does it become a problem? How do you adjust your diet accordingly? And then what leads them to you at that point? So I think that there's definitely certain foods that can bring that on more. For some people, like acidic type of foods, like tomato or maybe high-fat foods. But really it's more that bacteria buildup in the small intestine that actually I see mostly brings this on. And so what it happens is, is it's not that your acid is too high. It's that it's low. And when you have low acid, it kind of causes this spit up of acid to come up and cause that feeling of the pain. But it's not that it's, it's like too high. You know what I mean? It's just, it's doing this. So you actually need more acid and you can actually test it. So if you take a digestive enzyme that has hydrochloric acid, the way you're supposed to do that is you're supposed to take it until you get heartburn. So let's say you start with two caps in a meal and after the meal, you don't get heartburn. Then the next meal, you would do three cups. So you do that until you get heartburn and then you back it down. And that is the dose that you need. So that's how you really know if you need this.  But I find very rarely that people have high stomach acid. It's actually low stomach acid.  It does. Yeah, that's one of the main jobs of it. And that's why you hear people talk about celery juice because celery juice has a lot of natural hydrochloric acid in it. This is where it's, this is where it's the relevance of that.   Just like, let's be honest, but, and you can take it in a pill, but it does have good natural hydrochloric acid in it. And that's why it can really be helpful for people who have things like Z-Bow. Oh geez. Well, that makes sense now. We make fun of celery juice all the time. I know. I don't make it because I'm too lazy. I just like, I actually don't have a stomach acid issue, but when I did, I took it in a pill form cause it's easier. But no, there are benefits for sure. So celery juice. What are some of the best foods in terms of nutrients, like nutrient dense foods that you would recommend to women in particular? Cause I know men and women have different nutrient demands. What are some of the ones that you're like, hey, these are probably some foods you should be eating. Okay, so here's the problem. So this is where it's so individualized. I love that answer. Okay, so let's take an avocado for a perfect example. Right, it's a very nutrient dense food. But am I gonna tell my histamine intolerant patients to eat it? No way. Cause it's one of the highest histamine producing foods. So it's hard to say that it's really hard to answer that. Definitely organ meats are really, really nutrient dense. So that's something that most people can tolerate more like real organ meat, not taking it in like a pill form. And mostly just because of the way it's prepared and like if it's frozen and then you make it. But it's, to me, it doesn't taste good. So like a lot of people aren't gonna eat that. But I think that really, if you're looking just for like a very neutral way to start, I really like, and I hate to say this because I don't like to identify with any particular diet, but paleo is a good start. And then you can adjust things from there. Because I like paleo because it takes out the big offenders, like the inflammatory foods, but you can adjust what foods inside of paleo work for you.  Bacon. Yes. Okay. Like in anything age, bone broth, oh my gosh, like this bone broth craze.  So it's really, really, really individualized. And that's why I don't write books for like the general population because there is no book for the general population. Everyone's different. So I look for this is what I've worked with. This is what I literally have seen with thousands of people that works for this specific type of person with their condition. And this is what I think will work best for you based on that. What are the symptoms of histamine intolerance? I know this is a topic you talk quite a bit about. You've brought it up now several times on this podcast. What does that look like for someone symptom-wise? It's gotta be so many different ways people respond. It is. And the thing is we have histamine receptors all over the body. So, you know, I say the biggest things are migraines, eczema, vertigo, flushing.  That's a big sign.  Is that genetic, the flushing or is that actually histamine-based? Well, it depends on where it's coming from. So like I have mast cell activation syndrome. It's really unknown exactly where that comes from, but basically what the difference between mast cell activation syndrome and just histamine tolerances. Mast cell activation syndrome is a, it's like, let me kind of go back. So histamine in the body is a great thing. We want histamine. It helps our immune system fight off pathogens, right? But with mast cell activation syndrome, we're signaled in the wrong way. So let's say it's hot out. Your body produces all this histamine. That's not a normal immune system reaction. So with mast cell activation syndrome, there's over 200 triggers. The littlest thing can trigger your body to think it's being attacked and release all these inflammatory cytokines, histamine being one of them.  That's what's supposed to happen. But then the problem lies when histamine builds up and it's not broken down because what happens normally is we have an enzyme that comes in once the histamine's job is done and it breaks down the histamine and it's gone and we're fine. With people who have histamine tolerance, that enzyme, it's called the DAO enzyme, it's not being produced in the right amounts. So you release this histamine because of a pathogen and then it's just sitting there and it's not being broken down. And one of the jobs of histamine is to dilate your vessels. So that's when you get these migraines which are dilated vessels, vertigo, that's dizziness dilated vessels. And then all these other issues that you can get, anxiety, panic attacks, hives, you know, a lot of people will eat and they feel like their throat's closing up. You know, it's really so random. Tachycardia, which is an elevated heart rate, you know, some people will eat and their heart starts racing. That's all histamine issues. What causes someone's body to not produce enough DAO? It's usually a gut issue. And it can be genetics because we have a DAO enzyme like gene. So it's, if it's enough of it's not being produced because you're born with a SNP in that gene. And so you just, it doesn't work properly but there's other, there's MAO, enzyme, HNMT. Those are all genetic SNPs that you can have that work against how much your body will break down histamine. But it can also be non-genetic. It can be, you know, gut issues because the DAO is produced mostly in the gut. So if you have all these poor gut health, you're gonna break down that enzyme, ability to break down histamine.  So that, you know, we have such poor gut health in at least the US, right? So that's why so many people are getting histamine intolerance. And I can't, I can tell you that most people don't know what histamine intolerance is. But when they're looking at my Instagram page and they're seeing these little things that I post and they're like, oh my God. That's me, yeah. That's what I've had. No one knew this. I can't believe this.   And it's really, the worst part is is you don't know what's going on. And nobody knows what's going on. You go to doctors and they're like, I don't know. How do you test for that or is it just based off of symptoms? So I really like to save people money on testing if I can. There's no great histamine intolerance test. Even testing for Mass Activation Syndrome can be a false negative. So the best thing to do is, in my book I have a yes, no, maybe list. The nos are like the biggest offenders, right? So I say, eat those no foods, whether it's for one to three days to seven days, however long it takes. If your current symptoms exacerbate or you get new symptoms, then remove those foods for about a week. And if you feel better, you have histamine intolerance. Could you also potentially test this by supplementing with DAO or taking an antihistamine and seeing if you notice any benefits and then saying, okay, I feel better. I took, you know, Zirtac or Benadryl or whatever. Well, isn't that what you did for your face, Doug?  Yeah. Doug, Doug. I just suffered from a histamine issue. Yeah, he just recently did. We couldn't even take him in public. His face was so bad. Well, it just so happened to happen right around the time we were doing all these live events. So, this is wonderful. Well, stress is one of the biggest causes of excess histamine release. Well, Lord knows I'm under a lot of stress here. Sal puts a lot of pressure on Doug for me. Sure it's me. He's all from Sal. But for me, it was just remove foods. That was the thing that did the most. Yes, and the thing with antihistamines is they actually, they're okay short term, but they actually decrease that DAO enzyme. So, you're better off taking a natural, like I put my patients on my natural histamine relief product that has like quercetin and things that they're not gonna reduce DAO enzyme and they're gonna also help to control the histamine levels in your body. Now, would what I say be a viable maybe test also? It's like, okay, let me take DAO, let me or take antihistamine. Wow, I feel a lot better. Let me go back off of them. Uh-oh, symptoms are back, might be histamine. Yeah, and DAO is a little tricky because it doesn't cross the blood-brain barrier, so it's not like, boom, I'm better. So, it can be good for more situational, like Ben Lynch has a good DAO supplement that I recommend in my book, and he says, if I'm gonna have it, because he and I have a lot of the same issues, and he's like, if I'm gonna have a glass of red wine, which is super high in histamine, he's like, I'll take my DAO enzyme, but it's not something you take every day. You take more of the histamine supporting, reducing like quercetin-type supplements daily, take those foods out of your diet, and then look for the underlying cause. So, definitely the gut, definitely it's looking at sex hormones and cortisol, and then really learning stress reduction techniques. You know, I talk through in my book, even though this is not my expertise, like I'm not a meditation expert, but I think it's important to find someone who is and to learn how to reduce the stress in your life, whatever it is, whether it's just being more social, learning to say no to things, you know, meditation, mindfulness training, whatever it is, do that, because that can be extremely helpful in this situation. And I like to talk about it as like a histamine bucket.  Well, your bucket's already full, so you're gonna react, right? You start working on those things inside that bucket, you're gonna be able to handle so many more foods at that point. And my purpose is to get you to live as normal of a life as possible. So that's why I really like to dig into those underlying causes, because I don't want you to have to eat a completely low histamine diet for the rest of your life, never have a drink again, never ever eat whatever your favorite food that's high histamine, but it's letting your body learn to be ready for it. Now with that example that example that you just used, is this why some people may see it expressed sometimes and other times not? Yes. Like because maybe that week they had very low stress, they were on vacation, but they had an avocado, it didn't bother them this time. But in the mix of high stress work week, you over consumption, and then in addition to that, that you bad sleep, and then you also have an avocado. Now you react. Exactly. Well, that makes it really difficult for a listener, right, to like try and like troubleshoot, do I have an issue or not, right? Because it could express itself in so many different ways, and it can come and go, because it's still president there, it's just not, it's not, you're not over filling the bucket. I like that. Because histamine is a part of the immune systems response to pathogens, does a histamine intolerance affect fertility?  You know, I don't know for sure, and this is why. I have three kids, okay? I have gotten pregnant with birth control on every single child. Oh, wow. And all three different forms of birth control, okay? So I cannot say, yeah, sure, you have histamine tolerance, you're gonna have trouble getting pregnant. Everyone is so different, but I know that it does affect your hormone levels, which can affect pregnancy. It definitely plays off your thyroid hormones, which can definitely affect pregnancy, but I have all of that, and I'm literally the most fertile person in the world. So like, I don't really buy into something like that for everybody. I think that some, and you can see like some people are extremely overweight, they eat McDonald's every day, they have, you know, bad relationship, but they've had seven kids, and then some people are really healthy and they do everything that they can, and they're trying and trying, and they can't get pregnant. So pregnancy is something I don't like touch because I think that it's just so individualized that it's really hard to say why people can get pregnant and why people can't. You mentioned the stress component earlier, and being a functional medicine doctor, you work with the whole person. How big of a role does mental state play on all of these different things? Because I can imagine, and I've had clients like this where they do everything that I tell them, but they're so neurotic and stressed out about it, but that it actually makes their health worse because they're counting macros and calories. I gotta do this many steps. I can't miss a workout, and it's like, okay, you need to loosen up because this is actually being, do you encounter any of that?  I think that people put a lot of pressure on themselves. They tend to do poorly with their health, like in general. And that's why I don't count macros. People always ask me, what macros should I be? And I'm like, I don't count macros because I think it puts too much focus on food. And I just like to say, these are the foods I do well with. These are the foods I don't. I'm gonna eat when I'm hungry. I'm gonna eat what I want out of the foods. I know we're gonna make me feel good. I'm gonna stay away from the foods that don't, but I'm not gonna be like calculating. It's actually hard to overeat when you do that. We talked about this before. When you eat healthy whole foods, especially avoiding ones that you're not intolerant to, it's amazing how the body's natural system is just gonna tell you when you're full, I've had enough. It's tough to overeat that way. It's crazy. It's so true. I don't think about food ever.  But I'm not like, ooh, did I hit my macros today? Because that's too much thought about food to me. And I don't want food to be a bad relationship psychologically for me. So personally, I just don't go with that. And some people do really well on that. They like that organization. They thrive on it. They feel good on it. I'm not against any of it. I think what works for you works for you. But I think that people with that type A personality, that they put too much pressure on themselves, they're beating themselves up if they eat something, they're punishing themselves in the gym because they ate off their diet, whatever. That is a recipe for disaster. Well, in our space, we've seen more eating, dysfunctional eating and eating disorders in the world of competitive- Can the super fit out? Physique, bikini, and they count macros and the disorders look, I mean, it's like you got people who are trying to fit whatever they can into the macros or if they go out of the macros, they lose their mind, they cut off relationships as a result of it. So we know exactly what that looks like with that dysfunctional relationship with food. And simply, I'll tell you what, the most effective thing I've ever done for clients was tell them, hey, avoid heavily processed food. And almost all of them lose a decent amount of weight just from doing that alone. It's that inflammation factor. And it makes you just eat less. You just don't eat. They actually have studies now that show that people will consume about five to 600 more calories a day if they consume heavily processed foods versus unprocessed foods, even when the macros are controlled. They actually did a study, it was a crossover study. It was a 500 calorie difference. I think the chemicals in there make you more hungry. They designed to do that. It's engineered that way, for sure.  What does the schooling or the education look like for a functional medicine doctor? What does the training look like in comparison to like an MD? The great thing about it is you can really come from any, as long as you have a doctorate or even like a PA can become a functional medicine, practitioner, I guess, maybe not a doctor. You typically start with something else, like an MD, DO, DC, nurse practitioner, PA, and then you realize you want to do something different and you start taking all these courses on it. So for me, I have my DNM. It's a doctorate natural medicine on top of a doctor of chiropractic. So what I had to do was 4,000 hours of functional medicine on top of my chiropractic degree. So then I got a second doctorate in that aspect, but I was able to do it just by doing, I did Chris Crusher's year-long course. I did many different year-long courses and then just all these courses that made up those hours. So it's really great because you can come from all different lines of training. And I think it's really people that who have been sick and who have not found help in the conventional medical field and then they start looking outside, whether they're a doctor or not, and then they get better and then they get a passion for it and they do whatever they have to do to get their whatever degree it is. And then that's when they start using it in their practice. Right, or you're in conventional medicine for so many years and realize how many people you haven't helped, right? But that says, I guess, as trainers, I feel like a lot of the motivation behind what we're doing right now is, for a decade I felt like I really wasn't giving people the right answers. We weren't addressing things like behavioral issues and relationship with food and stuff. We were talking about macros and training harder and how many calories does that burn and honestly, when we look back now, I think we all feel like we probably were doing more harm to the space and we're doing good, which is a lot. There's a level of guilt. Since now that the functional medicine space seems to be getting more and more popular, more and more people are looking for functional medicine, do you foresee it becoming more and more regulated or do you foresee it going the opposite direction? I know insurance is starting to pay for some of the testing I do, which is a good sign. They don't pay for my time. And I don't know that they ever will because I spend 30 to 60 minutes with each person. Average doctors visit is five to seven minutes, right? So, I know, like, what can you do in five minutes? Which is why they're not listening.  They're not listening because they're on a time limit and they have 40 other people waiting and they're just... They need that BMI. They're like, what prescription do I have samples of that I can give you that might help this, right? So, yeah, so I don't know. I don't know if they're gonna actually start figuring it out and helping people to be able to get the help that they need. But it's like, then you run into the issue with pharma, big pharma where then you're not gonna need the medication. So why would you do anything preventative? So it's all the political stuff. Oh, I couldn't believe it when I was at one point in my training career, I really started to specialize with clients who were in advanced age. And as I got better and more experienced, I would ask for a list of medications and I would call their doctor and actually talk to the doctor so I knew what to do, what not to do and that kind of stuff. It was just being a responsible trainer. I was always blown away by the number of medications that my clients took that they took because of the symptoms of other medications. It always blew me away. It was like, oh, I take this one for constipation. I'm like, oh, constipate, no, but this medicine makes me constipate. And this one's for the migraines that this particular one causes. This one keeps me up at night so then I take this sleeping pill and I couldn't believe the pages of medicines that were there to counteract the symptoms of the other medicines. It's a crazy, crazy system. It's sad, it's really sad. And people are very upset about it. And then that's also where people get that guilt about taking thyroid medication because medicine has that stigma now like because of exactly what you just said and I'm like, actually, thyroid medication is pretty benign. So it's actually worse for you not to have enough thyroid hormone than it is to take thyroid medication. Yeah, I wanna be clear. I'm not anti-medication. When needed, it's a God's end, but sometimes it gets out of hand and when you go in with, like we're talking about, let's say you have some skin issues and it's related to gut issues, but your doctor doesn't address this gut issue. So they give you a suppressive steroid maybe, an anti-inflammatory steroid to control your skin. That's when you start to see the problems. Now, as much as you love functional medicine and are in it and are helping people, what are some signs that maybe your functional medicine practitioner probably is somebody you shouldn't go back to? Oh, that's a good question. Yeah, because I know in our profession, obviously we talk about trainers that there's some signs and things you should look for whether or not that's probably- Yeah, who's just riding the bandwagon to make money versus who's truly helping people? So when people give you supplements based off your symptoms and so I see people coming to me they're on 25 supplements and they're all like single nutrient supplements. I'm like, who told you to take this? They're like, well, I was tired so I take this. It's like the same thing as the medical profession. It's the herbal version of it. It's exactly what it is. I'm like, what tests did they do? Oh, they didn't do any tests or they just did a blood test. I'm like, okay, nope. Wow. And I have a lot of people who come to me and they're with a functional medicine doctor and I'm like, well, why are you here? You're like, I asked them. I'm like, why are you here if you have a functional medicine doctor? They're like, I'm not getting better. And I'm taking this many supplements and I'm like, let's talk about everything. What testing have you done? None? Let's start there. Let's do some testing. What diet changes have you made? None? Let's figure out what diet you need to be on and get you on your specific type of diet. Take out the foods that are gonna affect you, may not affect somebody else and really individualize it. If someone's not willing to individualize it, stay away from them or if they're just gonna throw their supplements at you and especially their branded supplements which I have my own branded so I'm not against that. But if it's like, this is my treatment plan is just all my branded supplements and no testing. That is not a person who is really looking into what the problem is. It's like a trainer that doesn't do an assessment. So let's take you through a workout which there's a lot of trainers like that that are out there. Okay, speaking about supplements and I know you just said it's gotta be individualized and you wanted to do testing. Let's speak generally what are some of the most useful supplements or herbs that you use as a functional medicine practitioner? For example, we talked about cortisol issues. I know that Ashwagandha has been used traditionally to help people with cortisol type issues. Are there like your favorite five that tend to the ones that you like to work with and of course it depends on the individual but are the ones that are better than others? So I always try to use blends so that people aren't as least bottles and capsules as possible but then sometimes people are too sensitive for that. So it really depends on the person but always liver support to like milk thistle and acetyl cysteine are really good for liver support and then you can get into like the mushrooms and stuff but for some people they don't do well with that. And then yeah, Ashwagandha is really good. It's a really good neutral supplement. Some thyroid people don't do okay with it but most do like licorice can be great but if you have high blood pressure it can be a problem. So you really have to tailor it to the person. Quercetin I think is a very good neutral supplement that most people can tolerate because it has so many great benefits. Not only does it help to lower histamine but it's also a good antiviral. I really like monolorin. I think that's a great immune system support and it's a good antiviral just really antimicrobial in general and there's different companies who make different versions of it but I'd say those are probably your safest, selenium's great for the thyroid but you can eat Brazil nuts and get that as long as you do okay with nuts. So I try to do as much as I can with food but then some people aren't absorbing anything. Because their gut health is off. Yeah, their gut health is off. I just was speaking, we had someone here yesterday filming for our YouTube channel. He trains professional fighters and we were talking about supplements and they're now recommending creatine to fighters not for performance enhancement which is traditionally what creatine is used for but because they're showing that creatine actually can prevent the CTE which is the brain trauma that fighters and football players tend to get. I've also read studies of how creatine helps with heart health that's got antioxidant properties. Some doctors are recommending it to their older patients for strength and whatnot. Has creatine made its way into the functional medicine world yet? Yeah, it has. Ben Lynch puts it in his electrolyte powder and I actually take the electrolyte powder and it's a really good methylation supplement. Explain that, what do you mean by that? So methylation is a very complicated topic because it's basically adding a methyl group to something else to make it do its job. So it has so many functions but people most recognize it probably as helping you push toxins out. So basically if you're not methylating well which most histamine tolerant patients have methylation issues. But sometimes what you need to methylate which would be like the methylfolate or the methylcobalamin, the B12 folate B9, you can't tolerate that. It will give you anxiety. So he goes about it by using like Lutathione or creatine and that will help you to methylate but without getting the anxiety that the B vitamin is. Excellent, more benefits for creatine. Yeah, you have to get the right source. Like I maybe don't go to JNC. I remember years ago there was this big scandal because a lot of suppliers were getting their creatine from China and it had high levels of lead and heavy metals in it. It was like, that's not the kind of creatine you want to take. So looking ahead in your space, what do you think's coming along on the horizon in terms of new ways of working with people, helping people? Are there new things that you're interested in learning about moving up? Cause I know like histamine for example that's something that I didn't hear about maybe five years ago. Now people are becoming more aware. Is there anything like that moving ahead in the future that we should keep our eyes open for? Oh gosh, that's a good question. I mean, I'm always listening and learning, always looking out for something new to learn about and I think with functional medicine, gosh, you can never know everything. I think the newest thing is histamine intolerance. Gosh, I think with functional medicine, here's the thing. It's all the same in the way you approach it. Whether you have Lyme disease, histamine intolerance, thyroid issues, any other autoimmune disease, you gotta look at the underlying cause. You gotta look at the gut, you gotta see what the hormones are doing, you gotta see what's going on with the diet, maybe looking at viruses, maybe looking at heavy metals, stuff like that, you know, mold, whatever. But it's all the same. Every single person that comes to me, that's what I'm doing with them. No matter what they come to me for, I'm looking for what caused their issue. And it's great because we kind of have a formula. Like, you know, just look for these things and you might not be able to go, oh, that specific thing caused that exact symptom because it's usually like a couple of things together. But if you just use that formula on people who come to you, whatever they come to you with, you can typically get rid of it or at least really help them manage it. It depends, you know, what it is. What are some of the hardest things to identify? I would assume something like Lyme disease would be really difficult, right? Because there's so many false negatives. False negatives, the longer you have it, the deeper that bacteria gets into the cells. But you know, I think a lot of people have Lyme. I think maybe a big percent of people have Lyme. It's all about how your body tolerates things. So really it's not about getting to the Lyme necessarily, it's about getting your body to push toxins out well and your hormones to be balanced to help you tolerate things better, your gut health to be good to your immune system strong. So it's getting your body to tolerate whatever's, it's coming in its way as far as health goes. It's not like you have Lyme, let's kill this bacteria because it's really hard to do that. And a lot of people get really sick with Lyme treatment. And I'm like, how many rounds of antibiotics did you do?  I have a friend that went on for two years, antibiotics for two years and just completely erect her gut. What's the number one thing that you see misdiagnosed by Western medicine and then you get? Western medicine. Yeah, they misdiagnose it. Like they say they don't have it. Yeah, exactly. Lyme probably. And but then again, it's like, I don't know that they have Lyme either. I think and I am in no way a Lyme specialist because Lyme patients are some of the hardest people to treat. Because it's not like no one really can find like this diagnosis in them, you know what I mean? It's kind of like a whole bunch of things together that it could be like stress is like their biggest trigger for this and you don't even know what it is, you know? And it's the same thing with Mass Activation Center. The test can be negative and you can have it and then you can have these terrible symptoms that nobody knows. So it's really about getting people to learn how to manage the way that they take things in, the way that they think about things and their relationships and their social life and what they'll put in their body and what they'll put on their body. And then again, looking at the inside with the testing and then just trying to get people to a good place no matter what they come to you with. And would you say you get a majority of your patients already currently exercise? Or would you say more of them don't exercise? And then how often do you recommend or even talk about that? I do, I talk about it with everybody and I have such a wide range of people. So I have ex-athletes who like, they're just done with the adrenals, you know?  Or hormones, you know, definitely steroids and stuff. And then two people who are 60 and they don't, they're completely sedentary. So it really depends, but I talk to everybody about exercise because I do think it's important no matter where you are in your health. It's just that you have to do the right type of exercise for what you have going on. Right, so what you're talking to about with the athlete about exercise is probably completely different than that person who never exercises. Exactly, but you gotta move. Right. Like you can't just sit there.  But exercise is one of the most important things not only for our physical health, but for our mental health. So I don't think anybody should just not do anything. Yeah, do you recommend sunlight for people? I do. I talk about that a lot. I say, you know, during the day, if you're sitting in office and you've got fluorescent lights on with no windows, get outside or get by a window even. Like if you can do that, you know, go take breaks, go for a little walk outside.  And that makes a huge difference in what your adrenals are doing. Yeah, it's funny.  I'm like, no, sunlight's bad for you. Stay indoors, totally wrong. No, it's great for you. Absolutely. Well, thank you very much for coming on the show. This has been awesome. Thanks for having me. Yeah, I really appreciate the conversation. So people will find you through, well, we'll make sure we, in our intro, we mentioned some of the places they can find you, but where's the easiest place to contact you? Usually my website, DrBeckyCampbell.com or Instagram, just at DrBeckyCampbell. And you take patients virtually or do they have to be in person? They're virtual. Yeah, I do everybody virtually. All right, thank you very much. Yeah, thanks for having me. Great time.


future directions related to the terrorism. There are normally, which are mainly considered, the two perspectives about the future of terrorism and future related on the basis on the actions and the aims of terrorist activities. One view that is mainly recognized in academia that is given by the optimistic views of black and he has the perspective that the emerging innovations in technology and communication is narrowing the social distances among different cultures. So the making of diverse social attitudes, it is now various due to the modern communication and means of technologies. Now it is not limited to any social behavior or social pattern that it will be fixed there. So if communication and technological developments continue to happen at this rate, then the anger and hatred will not be limited to any society. People's behavior according to black, people's behavior will not be specified on the basis of areas. In fact, the developments in it will bring new trends in it. Such pessimistic views of enders and sendlers, they think that there will always be weaker parties in the governments due to presence of grievances which will compel them to carry on their terrorist activities. So in such sense, government will be unable to effectively coordinate their anti-terrorist policies. According to them, they have presented their perspective specifically in 2006. After experiencing the 9-11 incident and the war on terror, the experts of this field, they have their own perspectives. They think that it is not possible in the world that the existence of weaker parties will end. That is to say, if communication with the speedy people's interaction has increased, but it is not that the world will not be weak, or it will only be strong, or it will not increase its dominance, then until it is between the weak and the powerful, it will be difficult for the governments to tackle their activities. And in these two situations, terrorist activities will also exist. So the future direction for researching and studying terrorism must be kept on lines of comparative approach. Because we will have to see what developments are happening in the world, and permanently we will have to design a comparison if we want to understand the future dimensions of terrorism and specifically how and what type of terrorist activities the terrorists are planning. We do not have to see what communication is in the world. We do not have to see what is the weaker and powerful nature of relationship is. We have to understand the mindsets of terrorists. Their aims, objectives, and what type of strategies they can of in the future. We have to study all of them. And to study all of them, the most important thing is that there must be a separate categorization and combating mechanism of those who attack their own territories or foreign interests lying in their own territory. We have to see how people can attack their own people, whether they have foreign elements on their backs that convince them to attack their own territory and their own people. We have to understand that mindset as well. And then along with that, we have to see how modern technologies are coming. So all of these developments have to follow them and stop them. What steps will the governments take? Along with that, those sub-activities who are not limited in their own areas, in their own territories, to manage all of them, what steps will the society and the government take? That is, it is important to identify terrorists and their aims and objectives. And then we have to see who is mobilizing them for such type of anti-society and anti-state activities.


Okay, I think it's pretty much, hello my name is Dr. David Tomasi, I work as a psychotherapist in the Impeachment Psychiatry University of Vermont Medical Center and I teach for UVM Integrative Health. Okay, I think I could add the rest later. In order to understand mood disorder, depression and mental health disorders in general, it's important to understand two different parts of the brain. The first one is the prefrontal cortex right here, which is part of our frontal lobe that is responsible for our rational decision-making as well as analytical self. And in the other part, it's very interesting, is the limbic system here. More specifically, the part of the brain that is responsible for the fight-and-flight response, our amygdalae. We have two, one on each side of the brain. Furthermore, our hippocampal structure are also responsible for memory production and retention. So what we have noticed in the scientific literature and our experimentation is that these two parts of the brain need to communicate appropriately in order for us to perceive the world in a positive and nurturing way. Based on recent study, we know that while exercising, it's important for a general well-being and perception. Exercise also simulates the very same neurotransmitters that are involved in pharmacological intervention. What we cannot claim that exercise could possibly replace pharmacological intervention entirely, it's important to understand that serotonin, dopamine and even beta-endorphins are released and modulated by exercising. So not only the body feels better while exercising, especially in vigorous exercise, the body will also understand that it is feeling better. So it's the self-proprioceptive apparatus that makes us feel more connected with our deeper self, thanks to the release and modulation of these neurotransmitters.