Welcome to the Dr. Gundry podcast. Well, you know, one in every 10 women suffer from endometriosis, a complex, lifelong, and often incredibly uncomfortable disease. And unfortunately many women go years without receiving a proper diagnosis and are left in the dark about ways to manage their condition even if the diagnosis is made.  What we're about to share today could help someone you love or you might even be living with them right now or it might be you. That's right. My guest today says that there is hope for all women with endometriosis and that for many life altering surgeries and medical procedures may not be the only answer. She's Jessica Merman, a sought after speaker host and women's health advocate. She's also the author of the new book, Know Your Endo, an empowering guide to health and hope with endometriosis. Today Jessica will share her unique story navigating life with endometriosis. She'll also share how diet, movement, and effective stress management can help women across the globe manage their symptoms and take back control of their body. Jessica, it's so great to have you on and great to see you again. I know. I'm so excited to be here. So you've actually gone from being on the verge of a hysterectomy to finding ways to manage your symptoms from home. You know, that's amazing. Tell us a bit about your health journey and why you decided to write the book. Yeah. I, you know, I wasn't diagnosed with endo until I was around 28 or 29 years old and it's really common with endo, right? Most people, the average time is 10 years for diagnosis, eight doctors for diagnosis. So I wasn't really even searching for the endo diagnosis because I had never even heard the word before and it wasn't until multiple trips to the emergency room and now I know I had cysts that had ruptured that I had an ER doctor say, hey, this might be something else. I'm going to connect you with this doctor and then that doctor connected me with a gynecologist and I was finally able to get diagnosed. But a tricky thing is, and this endo is just because you have a diagnosis that doesn't mean that you automatically feel better. It's just an answer. And I really went into a pretty dark place after my diagnosis, not because of the diagnosis itself, but because my pain didn't get any better after having the initial surgery. And you know, I'm sure we'll explore this, but you know, there's two different types of surgeries for endometriosis. There's ablation and there's excision and I didn't know that there was a difference. And so I was just, I had multiple surgeries was not getting any better. My doctor gave me hysterectomy and hormone therapy as a solution and I was going to get the hysterectomy before a friend sent me a link to a website that talked about whole foods, more plants helping manage pain. And I want to be clear that food and movement and all these things that we're going to talk about, it's not going to be able to stop the endo from growing. But the key to all of my work and for myself is to have more good days than bad because with endo, it can be pretty brutal some days. So let's stop for a second. You and I know what endometriosis is. In fact, believe it or not, I personally operated on endometriosis as a thoracic surgeon. I've operated on women who had endometriosis at the top of their lungs and they actually popped the hole in their lung from their endometriosis and their lung collapsed. So can you believe it, a thoracic surgeon operates on women's endometriosis. But let's have you tell everybody listening what the heck is endometriosis in layman's terms perhaps. So endometriosis is when the type of tissue that lines your uterus grows onto the outside of your uterus. So as you mentioned, in some severe cases, it can grow onto someone's lungs. It can grow onto your appendix. Bowls are a huge issue for a lot of people with endo. It grows onto there a lot. And so what's interesting is that with endo, the Hallmark classic symptom that you see everywhere is painful periods. But not everyone with endo has painful periods. In fact, a lot of people that have it on the diaphragm, they're experiencing shoulder pain and breathing issues and they're not even having painful periods. So I think that definitely lengthens the time of diagnosis because we're having all these other types of symptoms that aren't even connected to or what we don't think is connected to a gynecological disorder. Yeah, I think that's a very good observation. So this is tissue that would normally be stimulated every month by the hormonal cycle to get ready for an egg to implant inside your uterus. But for unfortunate women, this tissue can, if you will, leak outside the uterus and end up in all sorts of crazy places. Right. And yeah, as a general surgeon, you're right. We've operated on women where you mentioned it grows up underneath the diaphragm on top of the liver or on top of the stomach and they present as if they're having a gall bladder attack or they present with, oh, you've got an ulcer in your stomach or you've got a cancer in your colon and, you know, as general surgeons, we go in there and go, oh, look at that.  And it's, you're right. It's very frustrating. I don't want to interrupt you, but it can do so many things to mimic other things that, as you know, one of my missions is empowering women to get listened to. And this is one of those things where women are not listened to. So that's why you got this forum. So what happened?  And you finally said, maybe not. Well, I didn't say and maybe not because I did not have any faith that anything would help me. When my friend sent me that link to changing my diet, I was pissed off of even attempting a diet change. I thought, I'll try this for a couple of weeks. It's not going to work. I'll just get the hysterectomy anyway. And, you know, at that time, and this is something else that's important to mention that you'll see on top hospital websites that a treatment for endometriosis is a hysterectomy. But if you just remove the uterus and you don't actually excise the endo, that's not going to solve the problem because that endo is outside of the uterus. So I'm so, it's one of those sliding door moments where I think if I hadn't just tried it, even tried it in anger to make these changes, I probably would have gotten the hysterectomy and I don't know where I would be right now. I could be in the same amount of pain as I was before. Yeah, that makes a good point, just taking out your uterus if these little seeds of endometrium are elsewhere, that's not going to solve the problem. Right. And that's the issue is there's so much misinformation out there about endometriosis where they're saying a hysterectomy is a treatment, and this is happening in 2021, doctors are telling patients to get pregnant as a treatment. A baby is not a treatment for a condition, it's a very, this is why this work is so important to me because I think when we talk about these things, so many people don't understand what the symptoms even are. So 90% of people with endo experience GI issues, like if you're having GI issues, you're not going to your gynecologist, you're going to a GI specialist. So it's so important to know these symptoms and so you can kind of look down this list and say, wow, check, check, check, this might be something that I need to talk to my gynecologist about. So why don't we go with that, you and I have both kind of touched on that. What are the common symptoms that often get missed or get misdiagnosed? Right, so painful periods is obviously the classic symptom, not everyone with endo has painful periods. Painful sex, urinary issues, meaning retention, urgency, frequency, painful bowel movements, painful urination, fatigue, fatigue is probably one of the biggest ones and I mention this so often because I want every person with endo to hear this, that so many people don't know that fatigue is a symptom and they just think that they're lazy or unmotivated, but when you have that much inflammation in your body, it's going to get fatigued if we're not able to manage that inflammation. For infertility is another huge symptom of endometriosis. A lot of people with endo can have children, but a lot of people that don't experience painful periods, they're not diagnosed with endo until they start having fertility issues. And does anybody know why endometriosis per se can prompt infertility? Are there theories? Yeah, I mean I definitely explore those in the book and it's interesting because with endometriosis there's so much that we still don't know and there's just a lot of theories happening. There's five different theories as to why endometriosis happens and we still just don't know and I think most of the doctors that I spoke to and interviewed for the book, everyone just believes it could potentially be a multifactorial situation where it's some genetics and some immunity. We don't know the cause for some of these things. So I do, the book really explores these in depth because, but it's a weird thing to say in depth because it's also saying we're still not sure. Got you. The diagnosis number one is just a starting point, but why, how do you make the diagnosis? What finally prompts somebody to go looking for this? Well I think that, I think that one, if you're able to be a great advocate for yourself and push and push and push, I think second if you find a doctor that is really listening to you or even mentions the word endometriosis to you, I get frustrated sometimes because when you go to a gynecologist's office you have a pamphlet on breast cancer, STDs, ovarian cancer. There is no pamphlet on endometriosis, at least in all the doctors' offices I've been to and this is happening to one in ten women. So I think that getting to the point of the diagnosis is one thing, actually getting that diagnosis is another because it can't be done via blood test, MRI, ultrasound. We have to go inside, look at the inside of your body with the microscope through your belly button and for some that is not a possibility whether it's through insurance or time off work. And so getting to the point of the diagnosis is one thing, getting the diagnosis is another and then what do you do after that? I think that we haven't touched on it yet but the mental health impact of this is huge and just receiving the information that you have in Do that comes with so much more than just the physical pain. Gotcha. You mentioned in the book about a BBC study which I've actually looked up and that's a fascinating study so speaking of mental health aspects, can you talk about that? Yeah, so they interviewed over 13,500 people with INDO and nearly half said that they had had suicidal thoughts and that is a significant number and I think so many people that I've told about that study say why do you think that is and I think there's a lot of contributing factors. I think it's waking up and living in chronic pain every day. I think it's not having your pain believed. I think the financial toll of INDO can be huge. So I think it's so important I think with mental health to get the help you need, ask for help and to start to develop tools that could potentially calm the issues that you're having.  How do you differentiate endometriosis pain from garden variety menstrual pain? Yeah, well one of the doctors that I interviewed for the book Dr. Goldstein who is an INDO surgeon, she said to me it's if a leave and motrin and these types of things are not doing anything for you, we have an issue because I think a lot of people that have painful periods maybe they even take the holistic route and down a bunch of turmeric and a bunch of anti-inflammatory but it might help them a little bit. When you have INDO generally with the painful periods, it's knocking you out and I think this is without any sort of management practices or a great surgery but yeah it's debilitating and I think what's tricky is that so many people with INDO have a parent or a grandparent or an aunt or a sister that also have INDO so those are their period role models. For myself, my mom had terrible period pain and so I thought well that's normal when you have your period. So I went for a very long time thinking that this is what it is. You just have painful periods that might black you out at some point during the day. So yeah it's significant pain and I think the fatigue again is a huge component of it. I think it's a great point. This does run in families that we don't know if it's quote hereditary but it definitely runs and so you may be or our listener may be in a situation where her mother said oh yeah every month this is going to be painful and that's the way it is and I got through it and you'll get through it and it's part of being a woman. So where do you just go beyond that and seek out more information? I think by listening to a podcast like this I think seeing the word and thinking oh my gosh maybe it's not normal to not be able to go to work on my period. Going I remember in high school I would go home from school the first two days of my period like clockwork every time. So I think you can get to a point where you say I can't do this every single month for the rest of my menstrual cycle that's not a life to live and I think so many of us with endo I think we really really hit rock bottom before we're able to start to dig ourselves out. Yeah I think another thing you mentioned that I think really does deserve attention a number of my patients with endometriosis one of the tipping points for them was painful sex and oh my gosh yes. Yeah and that you know somehow it became they were advised that well you know that's just a part of it and you know get over it or live through it and that's not what's supposed to happen and it was actually that that they kept saying well you know I want to participate in this part of our relationship but this is ridiculous this is horrible. So that sex isn't supposed to hurt right. Right but you know what's interesting is not interesting it's horrible when I was when I first started having sex in college I went to a doctor and I told her that I had painful sex and this is before I was diagnosed with endo and she said I just needed to relax more in bed. So for a very long time until I was diagnosed I thought it was a prude I thought I just needed to relax more there was something wrong with me and I do think that's a great point I think that when it comes with endo we sometimes miss out on so much of our life like having sex going to birthday parties going on vacation that we get to a point where like I'm not able to see my friends and family because of this like this is this is interrupting my career my relationships something has to be done.  Definitely and I and I always share the story I interviewed a woman Lynette in my book that wasn't diagnosed until she was 53 and at that point her organs had fused together and they had to take out part of her colon so this isn't something that's in our heads this is infiltrating our bodies creating a lot of pain and discomfort and like you said I also like to reference that it can spread to your lungs and have your lungs collapse if I think if you were to tell a person it doesn't have to be a man this could make your lungs collapse all of a sudden they're listening because it's not just about periods anymore. So now we know that this isn't just in your head although in a way it gets into your head because this anticipation of you know every month here it comes again so help us help help help our listeners and viewers how do you deal with this from a psychological standpoint well I definitely practice a lot of stress management tools and those really help me calm my body and it's not meditating twice a day I mean my stress management tools are everything from doing Legos with my son to doing puzzles to taking an edible and watching TV in bed I mean there are things that I enjoy that help me calm my body down because you know in my book there's a whole stress chapter and as we know increased stress can increase pain so it's so important to me to make myself a priority and if that means you know I have a sauna blanket that I get in every couple of days a week I really make the time to care for myself and I think that I didn't do that before and I think it's hard to do that when you have a career and kids and a family but if I don't make my stress management a priority I'm going to be in bed and I've had to learn that the hard way so I think stress management is huge for me movement is huge for me and in the movement chapter I love that chapter so much because moving your body with Indo is so important because we're so clenched and hunched and protecting ourselves at all times that we're really tightening up those muscles and joints even more and that's just increasing our pain so I'm not out running marathons I'm jumping on a trampoline I'm using a foam roller I'm doing gentle Pilates and that was a huge mindset shift for me because I think when we look at social media there's people climbing ropes and flipping tires and we think that that's what we have to do to move our bodies but we can do it in a way that works for our body what about people who say well it hurts so much during this time that movement hurts me so I avoid movement which definitely I mean in the book I talk I'm sure you're familiar with these studies of the pain avoidance model the fear of pain increasing by moving and they did a study with people that had a lot of chronic back pain and by avoiding that movement we just continue to avoid it because we're afraid that it'll increase our pain and over time it actually will increase your pain by avoiding it so like I said there are days when I'm in pain and I bring my foam roller in my bed with me and I roll out I will put my legs and butt up against the wall and I just do whatever I can to move my body in a way that I can do it and that might just be stretching and I'm okay with that now and I I really have adapted more of a pacing mentality as opposed to this black and white all or nothing all right any other techniques that are important for you know the the mental and physical adaptions that you need to do yeah I mean I also talk a lot in the book about self-compassion and Dr. Kristen Neff who's really pioneering that work and to be clear you know when I first learned about self-compassion I thought it was standing in front of the mirror and saying that you're beautiful but really what self-compassion is is retraining your brain to say I'm here to care for you and her work is so compelling because it's really showing how just waking up and saying what do you need today we can really rewire our brain to care for ourselves better and so I do a lot of self-compassion instead of beating myself up because I look very tired or I can't move my body I say what do you need right now and that might be a little bit more blush it might be my loosest pair of pants and it has really changed how I take care of myself because beating yourself up doesn't help anything sounds like our former senator from Minnesota from Saturday Night Live because I'm good enough and I won't go there but so you know can you you can just look in the mirror and work on this huh well but to me it's not looking in the mirror and saying I'm great self-compassion is laying in bed and asking yourself what do you need right now and for me the mantras and things like that they don't really always impact me so being able to just ask myself what I need and then doing that that's what's helping me okay so you're a busy mom uh how do you get through this when your kid needs you and you really don't want to do that what where's the where's the motivating factor well I definitely have a supportive partner which helps but I also you know and I never put this burden on my son of me having my period but I also make him very aware of what periods are and when it's happening and we do something where it's on the first day of my period we he gets to watch cartoons in bed with me and it's kind of a fun thing he'll actually say did you start your period today because it's it's something now that we get to do together and so you know and I wrote in the book there's times when he's eating breakfast and I'm laying on the floor foam rolling next to him because it's a way of us still connecting but still caring for myself so I think you know I really have a lot of people that reach out to me a lot that fear parenting with a chronic illness and and I understand that but I think what's so cool is is that we can also show our kids making yourself a priority and really prioritizing your health because if we're able to do that we're just going to be better parents and I'm not saying it's always easy but I find that working those things into our life and sometimes doing them together it's really been helpful all right let's shift gears let's talk about food you know you and I both know the power of food so when did you first make the connection between your endometriosis symptoms and your diet well it was that link that my friend sent to me about the power of food and endometriosis and there aren't a lot of studies out there to show that there is a link between endo and whole foods or more plant-based foods but we do have a lot of studies that show lower inflammatory foods can help inflammatory conditions so I've had pretty prominent doctors tell me that my story is anecdotal and there's no studies to prove it I don't really need a study I'm able to get out of bed I know that changing my diet has changed my entire life and I think that there's a basic logic to the fact of I have an inflammatory condition and I eat lower inflammatory foods and it's completely changed my life and I didn't like doing it in the beginning it was very very difficult because my diet was pizza and candy and frozen meals but I slowly made the transition and after I did that there was just no turning back yeah how how long once you kind of started this transition how long did it take for you to notice a difference I mean it was pretty quick because like I said my diet was candy and soda and frozen meals so I wasn't going from smoothies to better smoothies I was at the bottom level of eating healthy so I definitely noticed a change and I would say the biggest change for me was just feeling more awake it was just having less fatigue in the beginning it didn't necessarily knock out all my cramps but it made me feel actually alive again and wanting to be able to function in the world so I think it kind of helped mainly with my mental health because I was able to get out of bed which meant I could move my body again which meant my depression was a little bit better it was really a domino effect but you know I'm not even sure how long it took I just know I instantly felt so much better and and I think it's also important to note that like I said food is not going to stop your endo from growing it is a management tool I still even with a great diet and still moving my body I still have pain sometimes I just had a giant cyst that they found a couple years ago but I still am continuing these practices because it helps me get out of bed every day and live my best life with endo yeah that's actually most of my patients with endometriosis come to me because either they they've noticed that the plant paradox has worked for them and then they they want to learn more or they come to me with chronic fatigue and it's actually from their endometriosis and that's how we get into it and oh by the way you know eating elect and limited diet has made a huge difference for them yeah yeah so I and we see the same thing actually with other chronic inflammation conditions like chronic Lyme a lot of us believe that you know once chronic Lyme sets in all your you're dealing with an inflammatory condition and reducing inflammation is the key to making that work go away right so you got any favorite lectin free foods or recipes well for those of you who are watching I think in the plant paradox cookbook several of your recipes made a appearance if I remember correctly well one of my favorite recipes in your cookbook was it's sauteed greens with coconut milk and a little bit of vinegar it just really kind of tangy greens I mean that's one of my favorites that I have at least once a week so yeah I mean I I really keep it pretty simple in terms of how I eat and I think the know your endo not everything is lectin free but it's definitely low lectins to if you're going lectin free there's definitely swaps that you can make in there great all right so you say in the book that there's no specific endo diet that works for everybody but so how do you how do people you know figure out what works what doesn't work what's what's your guide I mean it's it's definitely trial and error I mean that the title of that chapter is called good foods and the mission of that book is for you to find foods that don't make you feel bad it's really that simple I don't want to lay out this is the endo diet that will work for all because I'm sure with your own patients some people that drink coffee don't feel an impact at all where other people it completely destroys them the same thing with eggs I can't eat eggs they immediately give me extreme issues where other people are able to eat eggs just fine so I think that what I like to suggest is is to really get down to the basics of whole foods like let's it first start with eliminating the big I call them the big be eyes the big inflammatory's and then kind of take it from there because I think something also that we have to think about is so many people with endo have significant GI issues and SIBO is a huge condition for people with endo so you might see that garlic is anti-inflammatory but garlic for you might make you feel worse so we really have to start to really think about how does this food make me feel and sometimes we don't necessarily always like the answers like I don't like that sugar makes me feel bad I used to love candy but I came to terms with the fact that it doesn't make me feel great and so you know last night I actually went to a birthday party it was outside at my friend's house and everyone is drinking wine and feeling great but for my endo alcohol is a no go for me and it kind of took me a while to come to terms with that but last night it felt kind of good to just pop open of sparkling water and just be able to enjoy it without the stress of wanting to drink but know what makes me feel bad it can take some time to find peace with that yeah a good good point you've got the top 10 tricks to make your grocery shopping less stressful what give us a few of your top 10 best tricks well I came up with the top 10 pantry ingredients that's really my goal is to have a list of 10 ingredients that you know if you have in your fridge you can make a meal in 20 minutes or less so for me some of my top 10s are nut butters veggie broth nutritional yeast these things that I know if I've got these ingredients in some veggies in the fridge I can whip something up quick because I think that when you're starting to change your diet and you're starting to change other things in your life you just need to make things simple like I for one never really cook so I wasn't starting out with very elaborate 20 ingredient meals I needed to start very very basic and the thing that helped me most was having this top 10 list so when I got to the grocery store I didn't feel overwhelmed with all the other things that I could buy good advice you know in my first book years ago Dr. Gundry's diet evolution there's some very fascinating research that most people end up having five meals that they just rotate and it's always the same five you may experiment with a bunch of much of stuff but most people end up with about five meals that that's basically all they do and I think it's actually not something that you should feel bad about you should say these these work for me and you're right they're usually very easy which is yeah half half the fun part of it it's a reason why I don't think I ever want to write another cookbook it's like I gave you all my favorites here we are that's right no no more questions right all right all right how did the tools that you talk about in the book how did implementing those tools change your life and what have you noticed when other people have implemented those tools oh my gosh it's I know you get all these emails all the time and you actually are a physician so you're getting to get the face to face interaction but I think that one of the things that I get the most feedback on with these tools is people just sharing that they don't feel as alone and and understanding that there isn't one exact plan for everyone because I think that that we look online and we read so many books that this is this prescriptive this is the way for all and I think a lot of people that message me say I feel seen I feel heard and I also feel like I can make choices that feel best for myself and I think in my own journey that's what's happened to me I really thought that I had to do it a certain way but I feel so much more light and I feel so much more free doing it in my own way and not really caring what anybody else thinks about it perfect in your book you talk about celebrating your wins you know I think that's really important to do no matter what we're going through and people know in my office when they reach some little milestone they get a gold star actually sometimes on their forehead they wear it out so what tips do you have for people to celebrate their wins if you're not going to give them a gold star well the celebrate your wins I actually in the intro of the book last year pre-covid I had to celebrate your wins party at my house and every person that walked into the door got a stack of post-it notes and they had to write down a win that they felt proud of and I think that we sometimes judge ourselves for feeling proud of things that we've accomplished so I think with Indo sometimes it's especially hard to think of our wins when we're in chronic pain we think well I can't do this I can't do this I can't do this I think it's so important to think about what can you do so a win for me you know this week is I moved out of my house and it didn't knock me out the way that it might have before because I was implementing my stress management tools while I was doing it maybe not as much as I'd like to that was a huge win for me I started on Instagram on Wednesdays we share an Indo win that people send in and one of my most favorite ones that someone shared the other week is that she said instead of working 40 hours a week I'm now working 36 hours a week and I'm taking those four hours to care for myself and be with my family and that's a huge win for her they don't have to be I ran a marathon it can be really simple things that are big to you all right so you mentioned Instagram where with where can women with Indo find a sense of community or connect with others to share all about this yeah so I have an account called know your Indo and it's a very very great community of people there's also I also share a lot of other Indo accounts and I think you know what I love about know your Indo is is that we do share a lot of information and facts but we also share those wins that we're talking about and I think that we need to protect ourselves sometimes when we're looking on Instagram because there's a lot of sadness that comes with Indo and if you're constantly just seeing accounts that are sharing these devastating statistics and a lot of sadness it's not always best for the brain so I like that on my account and others that I promote we have a nice balance okay so uh go to go to your account on Instagram what's it called just know your Indo okay yeah and do you have any other places people can find you yeah you can find me at jessica mernan.com and I'm also Jessica Mernan on Indo I mean Jessica Mernan on Instagram and then always thinking about Indo and yeah you can and then know your Indo you can buy it wherever books are sold okay and please like we say please go to your local bookseller if at all possible because they've been devastated and they're open now so go buy there okay and I actually have because I do want people to shop more local I actually have a signed copy option that you can get at my local bookstore blue bicycle books and it's so exciting they had some of the biggest pre-orders that they've ever had for a book and I think it's offering that signed option is kind of a fun way to get people to shop local all right can't get a signed option with Amazon no you can't so if you're in the Charleston area go to blue bicycle book store and they have it there's an online option too I have it on my website where you can buy from them online as well and can they get a signed copy online yeah I went in and I signed hundreds of them so they're ready to go all right you heard you heard it here first all right Jessica it's great to see you again and thank you for coming on the show and good luck with the book thanks so much thank you bye bye okay it's time for our audience question this week questions come from PJ LeBlanc on YouTube who says what about cheat meals cheat days let's say I am following your diet but once every week or two I would like to eat a good old pizza from the local pizzeria will doing so ruin everything or is it acceptable well here's the deal with that everybody cheats including yours truly and I've actually posted from Italy on some of my cheats I see how 80% of my patients have autoimmune diseases and that's kind of who ends up with me these days if you have an autoimmune disease cheating will set you back almost always it's and I've documented this on myself I can have a weekend cheat and activate markers of my autoimmune disease and then I clean up my act and a week later they're gone and I can do this at will do I want to do this no but I do it in the interest of science so and I see this so many times with my autoimmune patients who have gone into remission they're doing great and they go well I'm fine now I'm cured I can relax I can let down my guard and almost invariably their autoimmune markers come right back up many people absolutely positively notice when they cheat and that oftentimes is what keeps you on the straight and narrow I'll give you a great story real quick my wife and I recently moved and one of our traditions in moving houses is we get to have Mexican food which we usually don't eat quite frankly and it's just been a tradition for many many many years so we decided to have Mexican food I took I kid you not eight of my lectin blocking pills before we went my wife said oh I don't need it well need us to say I did great my wife two hours after the Mexican food with her tortilla chips etc was in agonizing pain and I said don't look at me you know what you do that for and so luckily these things come back to bite you oftentimes so I guess that's if you have an autoimmune disease please please please don't cheat it's going to bite you if you don't have an autoimmune disease and you're eating elect and free you'll probably notice from the most part that you really didn't enjoy that pizza as much as you thought you were going to and next time make a cauliflower crust pizza from the plant paradox cookbook and you'll still like your pizza and it will like you back great question time for the review of the week this review comes from rubber wilbur on youtube who says I've lost 120 pounds since may of last year on the plant paradox and I've got 40 more to go this eating lifestyle is the only thing that has healed me from bed she has a binge eating disorder bed I like it I haven't craved junk food in over 12 months now wow that's absolutely amazing you rubber wilbur you remind me of a truck driver and his wife they're both truck drivers who are long-haul truck drivers they live in their truck and they both have collectively lost over 200 pounds on my program and they're such an inspiration because they literally follow the plant paradox program while living on the road in their long-haul truck and they've pulled it off and they come in to see me they drive their big rig into our parking lot and they come and see me every six months and so good for you you can do this no matter what your circumstances are no matter you know what drove you to eat in the first place and thank you so much for sending in the review and I really appreciate it you know it's reviews like this that help us reach a bigger audience for our transformative health message so if you haven't already please rate and review us on apple podcast and while you're there feel free to drop in any health questions that you have or let me know of your success i'll be sure to answer your questions in a future episode and you know why i'm doing this because i'm dr gundry and i'm always looking out for you we'll see you next week before you go i just wanted to remind you that you can find the show on itunes google play stitcher or wherever you get your podcast because i'm dr gundry and i'm always looking out for you


How long has SGI not been around? There is no modern hardware system that is simple, understandable, but also powerful. And it is understandable from top to bottom. I don't know about you, but many years ago when I... They essentially forked UNIX in the early 70s, about 1973-74. The NetBeasty system today is a direct descendant of that line of development. On the other hand, you have modern features. The first thing you'll notice if you boot it on your laptop is that it will boot not into text mode, but into a graphical console using the full resolution of your display. And that graphical console is accelerated. So NetBeasty these days has well-working graphics drivers for things such as NVIDIA cards, Intel integrated graphics, whatnot. And so even your text console has these. You have ZFS, which is a big deal. It's a new feature in NetBeasty 9. It has a few limitations. It's not quite as powerful as in FreeBeasty, but you have ZFS. You can have LVM, the logical volume manager.  If you want to use it as a server, that's good. You have support for a lot of programming languages, like Go, for example, supports NetBeasty. Well, Maya just did a talk in the Go dev room about porting it to more architectures. There's CC++, obviously. Ruby, Python, Perl, Raku. You name it, OCaml. It's all there. And it also makes a surprisingly useful desktop OS these days. You have a bunch of desktop environments such as Mate and XFCE available. You have browsers such as Firefox and Midori. You have like Gimp and LibreOffice. It's all kind of there. And with the graphics acceleration, you can install Firefox. You can go to YouTube, YouTube works. That was not the case a few years ago. Here's an example for a desktop usage. Somebody from Japan running NetBeasty on a laptop with an internal digitizer display and just drawing casually on it. Also, NetBeasty is kind of, I feel, one of the systems that's most at home in the cloud. First of all, there's at least three different hypervisors. There are now, on the system, you have Xen, which has been there for a long time. And it's really kind of enterprise grade.  The main machine is called the DOM zero. And then you can run guest domains in it. And for example, running NetBeasty, running Windows, running whatever you want. That works. There is a new hypervisor in NetBeasty 9 called NVMM that is very intriguing.  It's very elegant in how it's written. And it also was written in a few weeks time, apparently. And it's kind of similar to KVM and Linux. Essentially, it provides you, the way it's implemented now, it provides you with an accelerated QMU. So you can run your guest in regular QMU and set the accelerator to NVMM and you get native-like speeds. There's another hypervisor called Hexim. It also plugs into QMU. That's a sort of multi-platform thing. And it's used, for example, in Android Studio to run, to power the Android emulator. So that also works on NetBeasty these days. Then if you want to run NetBeasty in the cloud, we have official images for AWS, AMIs for both Intel platform and ARM platform, 32-bit, 64-bit. The ARM ones are fairly intriguing also but the ARM offerings from AWS are cheaper and faster. So that's something to keep in mind. There's other cloud providers where it also works. There's some people are using Vulture, some people are using Scaleway, which also has cheap and high-performance ARM stuff. It's all there. For Google Compute Engine, we have the staging script here that works well. And finally, I think what I would like to emphasize is it's also an OS that has a fairly welcoming community. This is a picture from the package source con 2019 in Cambridge. It's sort of the group picture about half of the people there are developers, I think. And I think there's been some sort of generational change in the NetBeasty project over the last few years.  And nowadays, there's been a strong influx of younger people. And as a result, the system has modernized quite a bit, which is nice. So it's a community that is living and that renews itself. And yeah, I like it a lot. Then I think maybe my favorite point, my favorite thing about NetBeasty is the package tree. It's called package source, written PKG SRC. And it has more than 20,000 packages, plus if you count the work in progress ones, that's another four and a half thousand. And package source cannot be used just on NetBeasty. It supports about 18 different OSes and architecture. So whether you run a Mac laptop, a Chromebook, a Linux server, you can use package source on all of these, which is really cool. And the way it works for a user is that there are quarterly stable branches. The last one is called 2019 Q4, because it was released at the end of the fourth quarter 2019. And so these remain stable for three months. And during those three months, when there are security updates or build fixes or things like that, they're pulled up into the stable tree. Then there are like build bots that build binary packages for certain architectures from this branch. And they run in a loop. So every time there's like a security update, all the stuff gets rebuilt. That depends on it. And you can use a package manager called package in. It's sort of like apt get in a way to keep your system up to date really easily. However, if there are no binary packages, for example, you're, I don't know, using the latest current or on a weird architecture of some sort, like on your VEX or whatever. It's no problem. You can easily build stuff from source. Here's an example. If you want to build Firefox, which might take a while in your VEX, you just change into the directory for this particular package and type make package install. And it'll automatically do whatever is necessary, like find out what the dependencies are that need to be installed first, download the source code, build it, build a package, install the package and so on until something fails or you have a working Firefox. If you're using that, like if you don't, if you're not depending on binary packages, but using building stuff from source, there's a tool called package rolling replace. That's kind of useful whenever you do an update of your package source tree, like say updating to a new quarterly release or something like that. You just run package rolling release dash U, like update, and then it'll automatically find out what packages you have installed are outdated compared to what's in the repository, and then rebuild them in the correct order. So like the things that are lower in the dependency tree come first. So you can do that once. It'll also take a while, and then you have up-to-date packages. It's really nice. Compared to if you add ZFS in the mix, if you have your package directory under ZFS, you can do a snapshot before you start and if you're scared that things might go horribly wrong, if they do, you can just roll back that snapshot. It's really nice. Also, I found that package source is one of the easiest ways of actually creating your own package. There's a tool called URLToPackage where you give it a download URL to the source and it'll start building a skeleton for you and then you just fill out stuff. It's really easy, and there's sort of a gateway drug to becoming a package source developer. There's a staging repository called package source whip work in progress. It's really easy to get an account for that. You don't have to become like fully a NetBSD developer or anything like that. You just send a mail to the owner of this repository and attach a public SH key and then you're in, more or less. So package source whip is several things. It's kind of a testbed. It is, if you're a contributor, but you're not a developer, it's a way you can put, say, a package that you make changes to. You just commit it into whip and it's a lot easier than attaching a patch to a mail or something like that because you can actually review it. Some people, like, when they start working on a new package and they realize, like, I won't finish this today. This is not building correctly or something. They still commit what they have into whip and then others can continue on that. It's also, like, it's really good. As a user, you should know the packages that are in there might be slightly broken. Typically, there's a to-do file if they are and so if there's a to-do file, you should read that before you install it. Anyway. And now I want to take a little break and do a tiny retrospective on my talk from last year. If you remember that, that was called an update on NetBSD. It's kind of similar to this one. And back then, I was actually talking about NetBSD 8, which was the all-new release back then. And NetBSD 8 is now stable and 9 is coming up. It took over a year from the time when the NetBSD 8 branch was cut from the development branch to the release of NetBSD 8.0. And it was kind of a long time and a lot of people were kind of nervous about it. And I realized when preparing this talk that it's almost as long already for NetBSD 9, but I think we're really, really close. Unfortunately, it's not there yet. So the branch from the development tree at the end of July 2019, you might remember that the middle of July 2019 was when 8 was released. Basically, as soon as we were, as we got rid of one better branch, we created another. And I think the same is going to happen after 9 is done. And I actually asked Martin Husserman, who is the release manager for NetBSD, if I could announce this release at Fostam, if we would have a release. And he was like, no. However, there's a release candidate number two that he promised me would be released now. It is also not really... But it should be any day now. So there's a release candidate one that is from late November and release candidate two is coming because there were some bugs fixed since then. And I think if I were you, if I were starting with NetBSD, I would start with NetBSD 9, whatever state it is in at that point. As I said, ZFS and NVMM are sort of the big new headline features. I talked about the accelerated graphics drivers earlier. There was a big update to those. So if your graphics card is less than three years old, then you may want to install this. And then in terms of the hardware support, there's a lot of improvements in the ARM architecture. It's called EVB ARM evaluation boards with ARM architecture, but it's really all sorts of things, including laptops and stuff. In particular, EVB ARM now has 64-bit support. So on a Raspberry Pi, for example, you can install it in 64-bit mode and you get a bit more performance. It's really nice. For developers, you have a bunch of sanitizers, both in the kernel and in the user land. So you can run your code against UBSAN and ASAN and TSAN and whatever their names are and find bugs. There have been a bunch of bugs found in NetBSD itself, obviously, and fixed.  Our security folks are particularly proud of this thing called kernel ASLR, which does full randomization of all the kernel addresses to make exploit development more difficult. And it does that by adding another stage between the bootloader and the kernel. So it loads something called a pre-kernel that'll load the actual kernel, rejigger all the stuff, and then start it. So that's kind of nice. And now, you know, maybe I have convinced you now that NetBSD is a cool operating system, so I want to address the question like, what are you going to run it on? Of course, you could run it on the laptop you already have or the desktop you already have, which is probably an AMD64, I guess, like a 64-bit Intel or AMD CPU. But there's also more interesting machines. Most of them incidentally running ARM. So here's one that you probably all know, the Raspberry Pi, $35. Reasonable performance, doesn't blow anyone away really. And you have wireless LAN, you have Bluetooth, you have a bunch of extension thingies you can install, I don't know, LEDs on the bus. It's a cool hacker toy. You know, why not buy one of these and use NetBSD on it? You may wonder why I showed the Raspberry Pi 3 and not the 4, which is because the 4 doesn't quite work out of the box. So there is this thing here. You have to download an image and then untar this file on top of the FAT partition for people who are looking into the, like, this is more for reference if you're looking into how to get it working. But the Raspberry Pi 4 works with this. Here's another one that I'm very excited about and a lot of other people as well, I think. The Pinebook Pro. I think they might have a presence here at FOSSTEM. They might have a stand outside. The Pinebook Pro is a laptop running an ARM processor and it is $199. So it's really cheap, but it is really high quality as well. Its predecessor, the Pinebook without the Pro, it's more like a netbook if you remember those. But this one here is like superb keyboard, great build quality. It's really a notebook that doesn't have to hide behind the Apple stuff or whatever. It's $200 and it will run NetPCD natively. So here's one of our developers, Jared McNeil, who are making some publicity for this. So you see display, backlight control, SD card, NVMe, USB Wi-Fi audio, and I don't know what DVFS is, are all supported. So you can download an image there on armbsd.org or on the NetPCD site and just write it onto a SD card, put it in the Pinebook Pro. Superb. And that's really all I have. Thank you very much. Do you have any questions? Yes. What is the minimum amount of RAM you need to run ZFS decently? The minimum amount of RAM for ZFS. I think technically it's one gigabyte, but if you have less than four, you might not be super happy with it. Yes? Does this support hardware acceleration or the Pinebook Pro? Hardware acceleration on the Pinebook Pro. I'm not sure. I don't think it does. Yes? What would you say is the performance of that new hypervisor compared to older ones, especially compared to Beehive? What is the performance of NVMM compared to Beehive? Maybe the question should be why didn't you... Why does it not Beehive? I think the reason why it's not Beehive is that it was easier writing this from scratch than porting Beehive. And it's really very minimal. I don't have any performance data compared to Beehive. I don't know. So as far as I know, Beehive is free BST only. Is that correct? Andy Lumos. So the question was what is the glue language of package source, saying OpenBSA has a lot of Perl, FreeBSA has a lot of Lua. Package source is a lot of make. Like the main control file for a package is a make file.  For example, we have wrappers around the C compiler and around the linker and all of that, and they're written in C, so you don't lose too much performance. That way, even if a build system is behaving badly, we can be sure that the arguments we really want to be there are sort of injected into the command line. That's what the wrappers do. Any more? Yes? Can you do GPAU pass-through? I don't think you can. I think the display is always emulated. You might be able to do it with Xen, but it's hard to get right, I think. But you might be. Yes? All of them, really. It's as generic as KVM, and because you have QMU, you get emulated devices for things like network, or if the guest OS has proper guest support, you will get non-emulated devices. All right, thank you very much.


Hello, my name is Dr. Nishant Yagnik. I'm head of neurosurgery in Manipal Hospital Gurgaon and today I want to tell you about a disease that we have specialized in the treatment of and that is brain tumors now We specialize in the treatment of brain tumors with endoscopes and microscopic surgery with minimal or no Futures and minimal or no head shape See we try to go beyond The treatment of just brain tumors to try to rehabilitate you in your life as best as possible Which means that we don't want you to go back to your office and have the stigma that you've been treated for a brain Tumor we don't want you to go back to your family and You know roam around the car you're in your trips and in your vacations Always wondering or always being judged for the scar on your head or the fact that you know You've had your head shaped so seeing this we are now trying to achieve a much higher level of Resolution from something that used to have very difficult treatment So to conclude at the end of the tunnel there is a very good light right now Brain tumors and number of tumors are curable. They are curable for the rest of your life They are often curable with very minimal disruption in your life And without the stigma that they once used to have Thanks to the advanced techniques that we have at our center that we have perfected at Manipal Hospital Gurgaon. Thank you


Heavy metal contamination is a serious global health concern, especially in developing countries. Conventional remediation methods can be costly and generate toxic byproducts, so there is a need for an environmentally friendly solution. Bioremediation using microbes and their extracellular polymeric substance, EPS, is one promising option. EPS is a complex mixture of high molecular weight biopolymers, including proteins, polysaccharides, uronic acids, humic substances, and lipids. These polymers have an anionic charge, allowing them to bind positively charged heavy metals. This article reviews the biosynthesis of EPS, its ability to sequester heavy metals, and the current research on its use in bioremediation. Challenges associated with commercializing EPS are discussed, along with potential applications for its use in detoxifying contaminated environments. This article was offered by Pratima Gupta and Batoldi Wan. We are article.tv, links in the description below.


Hey, what is going on everybody? My name is Radii and in this video I'm going to talk about tips that can help you create a responsive website with ease Coding a responsive website can be a relatively complex process Luckily for us, the many tools and techniques that can help us improve the process and write clean, fast, unreliable layouts that scale Let's look into some of them starting with planning Trying to figure out how things will fit on different screens as your code can be time-consuming Ideally before you start developing the layout you should have a high-fidelity prototype That includes mobile, tablet and desktop views. A high-fidelity prototype is a realistic representation of the website that you want to build. It is an interactive, clickable version of the design You would also want to have different states for inputs, buttons, images, errors and so on Additionally, it would be nice to have the design of the pages such as 404, No Results, FAQ Policies and so on. That is the ideal scenario. Now, let's talk about CSS There is no set of rules on how you code your website I personally like to start from mobile, work in my app to tablet, desktop and so on When I say mobile, don't be confused by wrapping everything into a mobile media query I start with the base styles first and then work my way up This way I'm getting the foundation of the elements that I need and then I can use media queries to progressively enhance them as required. For those of you who don't know what media queries are they look like this and they can help us write tailored stylesheets for desktop, laptop, tablet and mobile screen size. Speaking of media queries, I feel that the fewer you have the better. Essentially, it's less complicated. Three media queries should be good enough but of course if you need to add more then go for it And as I was talking about using less media queries, you can also use something called queryless grids, a way of creating layouts that change depending on the size of the screen without using media queries. The most often used for responsive of design where the layout is optimized for any screen size. One of the benefits of using fluid grids is that there is no need to specify how many columns should be in a row or in total. The main advantage of using fluid grids over traditional grid based layouts is that they allow more flexibility and adapt well on different screen size. To achieve fluid grids or queryless grids, you can use Flexbox or CSS grid. The next point I want to talk about is avoiding fixed widths and heights. Fix widths and heights are bad for responsive web development because they can be difficult to create a layout that is flexible across different screen size. It could result in writing more media queries to ensure that your layout is somewhat flexible. So I would avoid them whenever you can and instead try using properties such as max width and max height instead. And the next point I want to talk about is building reusable blocks. You can think of everything as its own little component. If you develop a search bar, make sure that the search bar is responsive so it fits pretty much any reasonable section of your layout with a simple copy and paste. This way you can save time by not having to create new elements or modify elements for every layout variation. And now let's talk about responsive typography. Responsive typography is a technique that allows the text to be readable on any device. The use of relative units in web development is a great way to ensure that the layout is responsive and adapts to different screen size. And it is important for us to understand how to use units such as M, REM percentages in order to create responsive typography. As you might know, typography is probably the most important part of a website because it can make or break its design, usability and accessibility. Typography should use M, REM or percentage units for font size instead of pixels so that it can scale with the size of the screen. You can also use modern CSS techniques such as using the Client property and of course you can use media queries to make sure that your typography adapts well on different screens. So basically always use relative units such as M, REM and percentage. Okay now let's talk about responsive images.  To do that you can use the following snippet using max width of 100%. This allows the images to scale within the parent width. Even when we want our images to be responsive, you should always try to add the width and the height property to avoid rendering issues. You know the little jumps sometimes when you refresh the page. Additionally you can use the picture HTML5 element to define different images for different window size. This is not only great for performance but it also gives you the opportunity to adjust your content so it's useful and legible on all screens. As we are on the topic of images let's talk about scalable vector graphics. SVG is an XML-based markup language that can be used to create two-dimensional graphics. SVG images are more compact than other formats such as JPEG, GIF, PNGs since they don't use any compression algorithm. This means that SVG images can take up less storage space on your website which means faster loading times and less data usage. The advantages of using SVG in the web design are scalability, flexibility and lightweight. You can use SVGs for pretty much everything from logos, backgrounds, icons and illustrations. One great thing about SVGs is that they can be animated. My favorite way of writing CSS is by using the SCSS preprocessor. You've probably seen me using it on pretty much most of my videos. The preprocessor is a program that processes the SCSS code before it gets compiled. It's used to write CSS in a more efficient way. There are many benefits of using SCSS preprocessor over pure CSS. It helps with writing efficient and clean code. It prevents better support for variables, mixings and other features. It allows developers to create their own custom function. And last but not least, it's faster. The next and the last thing I want to talk about is using CSS methodologies such as BEM. BEM starts for block element modifier. It is a CSS methodology that helps developers to create robust maintainable websites. The methodology is based on the idea of separating website code into blocks and elements. Blocks are the names of the sections or module, while the elements are individual parts of a block. This methodology was developed by Andex in 2009 for internal use, but it was later released as an open source tool for others to use. It's super popular among front-end developers and it makes it easier to maintain large web projects in many different stylesheets. Alright, so you might be wondering what's next for CSS? How can CSS help us write better responsive web layouts? We have CSS container queries coming up and CSS sub-grid. Okay, one thing that I wanted to mention before we end up this video is that if you're struggling with the stuff that I said today, don't worry. You can always use a framework such as Bootstrap or Tailwind that will help you out to create good responsive layouts. If you like this content, please give it a thumbs up, consider subscribing to my channel and I will see you in the next video.


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Colombia Heights is one of DC's most diverse neighborhoods and home to a growing population of Central American immigrants. Most arrive in the U.S. fleeing violence and extreme poverty, but determined to build a better life. Dedicated to helping them adapt and thrive in their new home is a local nonprofit organization, Garecin. What this organization does is help integrate immigrants, recent immigrants into the new community, but also understand the underlying causes of why they had to come to this country in the first place. For minor campos, a Salvadorian immigrant coming to this country was his only choice. From seeing what our families go through in our countries, all the poverty, that's what makes people like us come to the United States. Now, Mr. Campos seeks Garecin's help to obtain a work permit and driver's license both critical for his job and his family. We need a driver's license to be able to get to work, to be able to work hard and earn the daily bread for our children. Garecin will help Mr. Campos through his application process, though the DMV system is already backed up and has several loopholes for undocumented immigrants, which for many Latinos raises a key political issue. Both the administration and Congress need to put in place policies that truly protect people that are fleeing violence, because that is part of the value system of the U.S. The Latino community now looks beyond election day when the president is set to announce his plan on immigration reform. For the U.S. Service, Washington, D.C., I'm Noelia Valero.