Beyond Normal Labs: A Functional Medicine Approach to Your Health Data

Hi everybody, thanks for making it here. I know it's Thursday evening and it's dinner time, and I know how hard it is to sit for an hour on any week— weeknight, so I appreciate the time you took to be here. But this is one of my genuinely favorite things to do, is to increase awareness of functional medicine And try to get people to recognize what their body is saying. So grab a piece of paper, grab something to eat, grab a pen, grab any old labs that you have that you want to make sure you review or ask questions on. My goal in this webinar is to really have you feel empowered regarding your health, and also to leave the webinar with some practical insights into your health, something tangible that you could actually Apply right away. If you have questions in the webinar, put it in the chat and you can ask a question and my team will answer. And if we are meeting for the first time, my name is Dr. Shilpa Sayana. I'm an internist and a functional medicine MD. I practice in Sherman Oaks here in Southern California. And my expertise is mainly helping women and men in the mid, mid-age life, like 35 and above dealing with stuff like fatigue, bloating, brain fog, and hormonal changes. So just some ground rules for today's webinar. I really value kindness, so please only put— the chat is open for anybody to chat in there, so just only put kind comments or kind questions. I did get the most humanistic intern and residency awards All through my residency. So being kind is of utmost importance to me. So before I start, I just wanted to see who's showing up for today's webinar. So again, my name is Shilpa, and I am an internist here in Sherman Oaks. So if you could just put your name and where you're from in the chat, just so I can get a sense of who's here. And if you could also ask what you're hoping to get from this webinar, so I can make sure I touch on it. And I'll just look down to— at the chat to see if anybody puts in their name. So again, Shilpa. Excellent. Welcome everybody from everywhere in the nation, from Boston to Vegas, to all my LA people, Florida, San Diego, and a lot of them, a lot of the names I recognize as our patients. So I wanted to give you a sense of what this next hour is going to look like. This is really my efforts to give back to patients who may not even know who I am. I have— I run a small concierge primary care longevity functional medicine practice here in LA, and I'm so privileged to do that, and I'm so grateful for every one of my patients. But this is for others who don't know what functional medicine is or don't have access to this so that they can understand their labs. So there's probably a big chunk of people who are here like that, and And also our current patients. If you are our current patients, you can always message with questions after the webinar. And at the end of the webinar, this is my third time doing this webinar this year, and I'll tell you what inspired me to do that in a moment. But after, at the end of the webinar, I offer the ability to check people's labs and in a small group walk through what these labs mean over like a 6 to 7 week period. For our current patients, if you want to join that, you're welcome to. And there, we'll just kind of repeat your labs or use recent labs so you understand what they mean. And the labs are mainly around these 80 markers that we check on every initial patient. So I'm going to share with you what those labs are, what they mean, what the difference is between optimal and normal, and what this might look like in your symptoms. And if you guys see here, I have a new kind of logo, Ask Dr. Shilpa. Again, this is a new social media account I created just so people can ask me questions directly, whether they're dealing with health issues or want a functional medicine perspective who may not be my— our current patients. So why have I really created these webinars? So what happened is about a year ago, I was doing this, um, I did a 6-year program with myself and my teenage daughter at the time, uh, with a bunch of other mothers. And every time these moms would say, I'm exhausted, I have brain fog, I'm gaining weight, it just must be stress or aging. And I was like, it can't be stress and aging. Let's just check everybody's labs. And as a group, let's review it. And I was so surprised to find that so many of these women, my friends, had things like hormonal depletion, nutrients that were super low, and hormonal patterns that really showed that there was a lot going on in terms of inflammation. And a few of them had autoimmune conditions that were showing up for the first time in these labs. So they just mistook it as stress and aging. And when they went to their regular doctors, their doctors were like, It's medically unnecessary. You don't have a disease we recognize yet in conventional medicine, so we won't even monitor. Some of them just said, you know what, it's unnecessary. You don't have symptoms. And so I really created this as a mechanism for women like that to get the labs tested and be able to review it in a safe space. But for today, for those of you who are bringing their labs and want to kind of get something out of this, definitely jot stuff down. There'll be a Q&A at the end for you to ask specific questions. So put those specific questions in the Q&A, and if you have have questions along the way that I ask you, put it in the chat. And for those who have done this with me before, you know that always at the end of a webinar, because I'm grateful for your patience, I— we send a free supplement. So this is one of my favorites. It's inflammation support. It has boswellia, it has turmeric. It's a great supplement. And whoever stays till the end and we call a name will get it shipped to them. So when you say— who here in this audience have gone to their doctor and don't— they don't feel normal, but they may have things like brain fog, fatigue, weight gain, bloating, and have been told that their labs are normal? If any of you have had, can you just type normal in the chat?

Normal.

Okay, there's a plethora of you saying normal. So that's really what I'm trying to help. That's the whole point of this webinar, that normal doesn't mean optimal. And so I'll explain to you how, what the difference is, and so you can be empowered to understand what this meant, what this means. In March of this year, we did a an online group course like this at the end of a webinar. And I was so— as I was so taken aback as to how many women's labs, when they understood what their labs were and how they could approach it, felt so empowered to really take charge of their health and just didn't feel discounted and not validated. And they felt like discounted for many, many years. So again, the fact that you don't feel normal, there's something in your labs that needs to be looked at deeply.

Okay.

So who am I? So my name is Dr. Shilpa Sayana. I'm triple board certified in internal functional and obesity medicine, and I'm the founder of Sayana Medical. Working at Sayana Medical has really been such a grateful opportunity for me because I really help people understand the why. And I'll tell you kind of how I came to that. I started as an internist, did a lot of global medicine. Got sick myself, recognized there was something more, and then I discovered functional medicine. And functional medicine to me is what the why of medicine, and I'll explain that a little bit more. Just in terms of residency, I am an internal internist and a functional medicine doctor. So a lot of people ask, are you an MD? Yes, I'm an MD. I write lots of prescriptions as an internist, but my main framework of how I look at things is about the why, and that's where functional medicine comes in. So who am I? I was born in Zambia, which is in Africa. I grew up in Botswana, and I went— came to the East Coast, to Vermont, first to Pennsylvania, and then kept moving colder and colder to get my medical degree in Vermont. I was done with the cold, came to California, and have done internal medicine, global medicine, and now functional medicine and longevity medicine for the past decade. And so this is the— so how many here know the difference or have heard of functional medicine? I just want to make sure I am— I don't need to explain things that people have heard it. If you haven't heard of functional medicine, why don't you type no in the chat so I'll know how much to talk about? So a few, a few of you haven't heard of functional medicine. So functional medicine is really— it should just be all one medicine, like in Internal medicine, functional medicine should all be lumped up. But our conventional medicine system is so quick where we go to see the doctor and 15 minutes later it's like, here's the next prescription. So functional medicine is really taking the time to understand who you are, like what are your genetics, what have you been through in life, what are the patterns that keep happening, and how can we pattern interrupt so your symptoms don't keep happening? And so if you look here at this tree, it's really about what are things that are feeding your energy levels, how is your Hormones? How is your gut? How is your inflammation? And then when you have actual diseases, as it's in the internal medicine framework, when we recognizing symptoms that fit certain disease categories and we call them. But the the a lot of times functional medicine happens a lot earlier than when we recognize a disease process. And another kind of distinction you can make is what is the testing involved in functional medicine and internal medicine? So in internal medicine, you may go to your doctor for. Physical labs, and they may check your annual physicals. They may do some symptom-based testing, but it's really what is the root cause. And this is supposed to be an iceberg in the ocean. So it's really the tip of the stuff is what we look at in conventional medicine, unless you're really sick. But it's really what's going on underneath the surface of the water that's important, because that's probably causing subclinical symptoms as to why you feel unwell. So what are you going to discover today? So I just want to give you an agenda, and I put an alarm because I'm very known to keep talking. So I want to make sure that I give you guys an agenda, can be respectful of your time, and so you get something meaningful from this. So the first thing we're going to talk about is what's the difference between normal and optimal using the exact same test that you have. So some of you have your tests in front of you, and I'll explain some of those, and you can ask me questions about, about them. And it's all about looking at the reference range. Conventional medicine If it's within the normal limit, it's normal. And that's the quick medicine in 15 minutes. Functional medicine, if it's something good like vitamin D or B12, you want it in the top quartile of normal. If something is inflammatory like hs-CRP, which is an inflammatory number, or mercury, which is a toxin, you want it in the lower quartile of normal. It's very simple. A lot of times patients are like, well, you know, you're— my regular primary care doctor said these labs are normal, but you're saying there are all these things that are not normal about them. And I'm going to talk to you about what it's maybe normal, but it may not be optimal. And then the second thing I'm going to talk to you about is the initial labs we order for every single patient. So for my patients who are here, thanks for coming, but you have already seen these labs. And but for the rest of you, they will be new. And then I'm going to talk about common symptoms in midlife and what could their root causes be. And these are common things I get over and over again. And then I'll also talk about the last pathway, which is how to get these labs ordered, either through your own clinician or if you want to work with me after this webinar for 7 weeks. You draw the labs and we look at— we look at them as a group, which we've done a few times this year. And I'll explain what is your body really trying to tell you. But this last option, number 4, I should say that right away, is that that option is only for people living in California because I'm only board certified, right? I mean, only licensed in California for now. But that's for this 4th option. It's for them. But even if you are coming from another state, I hope you can understand Why you should be looking at your labs in a different way. So what are you going to discover? The difference between normal and optimal labs using the same results. And a lot of you have already said when you've gone to your doctor, they've said they're normal, but are they really optimal? So this is a caricature that I think summarizes this entire webinar. For those who have joined before, you've seen this before, but I really do like it because here is her poor lab. It's within normal. You could say it's definitely within normal. And the doctor's saying, you know, good news, you're in the normal range. However, it's so low that it's truly suboptimal. And you can see how she's feeling. She may be normal, but definitely not optimal. And that's how we'll look at every single one of these labs. So what are you going to discover? A lot of people who had responded to this webinar were like, what is the list of things you do order? So I just wanted to give you that right off the bat. So these are the labs I order for everybody above 35, just to really evaluate them for hormones and their long-term health. And I think so much of medicine is becoming this 3.0 medicine where some of you may have heard where patients are taking their health in their own hands, which is great, and really trying to understand what do they look like at age 85. And I ask this to all my patients, will you be able to get up from a toilet by yourself? Will you be able to go up and down the steps by yourself? And the key for that is Muscle.

Will you—

are you going to be strong enough to do these things? Because muscle is the true currency to longevity and inflammation. So if you can keep your inflammation low, you age slower. So that's where a lot of these labs are around. And so these are the labs that I order on everyone. And I'm going to have Alyssa, my virtual assistant, put it in the chat so you guys can have access to this, because a lot of you are here just to understand what are the labs that you should consider getting. You can get labs like this through Function Health. And, and I'll give you an opportunity to understand how you can get them through us. But these are the labs that are important to, to draw. But you can get this lab kind of list from ChatGPT or Claude or any AI. The thing is, why do you need to get these labs and how do they apply to you? And what are the patterns you need to start looking at?

Okay.

So to do this, we first have to understand what's happening in midlife. How many of you are less than 35? Can you put in the chat 35 if you are less than 35, and then if you are above 35, can you put in there above, maybe less and above? So I can just see that we talk to all the audiences. Perfect. So you all the right, right age category because we do have some patients who are less than 35. They generally are more sicker and require more of a functional medicine approach. But 80% of our patients are above 35. So what's really happening? In this decade of life, a lot of people are very surprised because there are a lot of new rules that are happening. Your body's responding in different ways than it did before, and that can show up in different ways. So it's really a lot more— it's a lot more inflamed. You're having a lot of stress because this decade of life, a lot of times my patients are having kids who are going to college and then the aging parents that they have to take care of. So even though their career may be stable, stress is definitely higher. They have nutrient deficiencies, mainly because of gut issues, and they're having— their hormones are changing. And the biggest hormone shift we see is testosterone goes down, insulin goes up. And a lot of patients are like, I never had prediabetes or high cholesterol last year, but this year I do. And what's really happening and how can we explain that? And to really be balanced, you actually have to— to improve any of this, you need to balance your hormones and improve inflammation. And a lot of it is actually focused on lifestyle. Another big difference between internal medicine and functional medicine is functional medicine focuses on lifestyle about 50%, supplements about 20 to 30%, and medications if needed. And so it's really important to focus on that lifestyle piece. So I'm going to go through some clinical cases. For those of you who joined me for a previous webinar, I— it was very didactic as to what things you should check and what those normal ranges look like. But I want you to be able to go further to understand patterns, because only when you understand patterns could you understand how This could apply to you, and maybe you will see yourself in some of these people I'll describe. None of these names are true, and these are a collection of patients I've seen over over the decade. So let's see. Before going to Allison, let me go here. So these are the symptoms. These are symptoms before jumping to the patients where you may not recognize as to why you have them more now. A lot of people kind of come with. Low and inconsistent energy. The afternoon crashes are more pronounced. They have gut or digestion issues. They're more bloated, craving carbs more, and brain fog, forgetfulness. They're like, "I came into this room and I'm not exactly sure why I'm doing here. What I'm doing here? I have the word at the tip of my tongue. I just can't remember it," and they just feel cognitively slower. Hormones and sleep are a big one, and we're going through some cases as to what those mean and what the labs show. A lot of people have trouble staying asleep. They may fall asleep, but trouble staying asleep. They may have irregular cycles, heavy. And then the hot flashes is something we recognize. And then skin appearance changes, and they have more maybe brittle nails, pain and inflammation. How many of you know of MSK, musculoskeletal syndrome of menopause? It's kind of a new term, and we recognize that during menopause, perimenopause, a lot of women seem to get injured really easily, and the hormones that are changing impact the flexibility and and lubrication of the joints. But now it's an actual term. And we understand why women may— this may happen in this decade the most. How many of you have heard of musculoskeletal syndrome of menopause? So this is pain, inflammation that's happening around this time. If you could put yes in the chat, that would be great. So I understand how many of you have heard that and how I need— if I need to explain it more. So, so some of you have heard it, some of you haven't. And, you know, we just—

we know.

And what's happening in this decade, a lot of women are like, oh, I'm 45, I want to take charge of my health, or I'm noticing belly fat, I'm going to go exercise. And they start exercising and exercising hard, and then they have shoulder injuries and they have rotator cuff injuries, they have knee pain, and they're just like, why am I getting injured so easily? And now it's a recognized condition that these injuries and this inflammation happens more around perimenopause, menopause time. And I'll explain as to which hormones may be responsible for that. With brain and mood, the word finding, we're recognizing more that what's happening in perimenopause and menopause is a neurological change. Like our brains were not the same they were 5 years ago. And we're seeing a lot of it has to do with estrogen receptors. Before we thought estrogen receptors were just in the ovaries, but now we're recognizing that estrogen receptors are all over the body and especially the brain. And so by giving women hormone replacement, we're seeing that maybe a lot of women get their brains back. All by reducing inflammation. So a lot of estrogen and testosterone and progesterone impact all these areas. But the biggest thing that's happening in midlife is inflammation. So here are some real stories that I thought would bring some of these points home. So meet Allison. Allison is 38. She just— and, you know, this one thing I wanted to kind of go back to Because a lot of— I think I skipped over it, which I think is very important to understand— is what internal medicine, the question it's asking is, do you have a disease? Functional medicine is asking, why don't I feel like myself? Because internal medicine is, do you have a disease? Do we have an ICD-10 code to diagnose this disease? At least we have some new ones in menopause world. But functional medicine is, why don't I feel like myself? Which isn't a disease, but people are having symptoms and the approach again is very different. So let's go back to Allison. So meet Allison. I have met many Allisons in my journey through medicine, but a lot of patients come through with the same chief complaint, and that's the CC. I just want to start feeling like myself again. For Allison, when I met her, she was irritable, hangry. She was gaining weight. She had heavy periods. Her husband knew exactly when she was pre-period because nobody wanted to be around her and she felt genuinely sad. She was like, I'm such an angry person during this time. I yell at my kids. I just don't have control. I'm so not like me. I'm such a sweet person for the rest of the 3 weeks of my cycle. So conventional medicine, her labs were normal. That's what they told her. And they suggested Prozac. I have nothing against medication, but I really want people to look deeper as to the why they may have these symptoms. So in a root cause medicine approach, we see this All the time, her progesterone was very low, and mainly due to stress. So when your cortisol is high, it eats up your progesterone, and the progesterone that should be there before your period is much lower than it should be. And you know, progesterone is the hormone of of calmness. It's the hormone most pregnant women have in abundance. They have their lovely glow, and when you're low in progesterone, especially pre-period, you can be all those symptoms: irritable, angry, and have heavy periods. So what we did for her is we really worked on her cortisol, her stress levels, and we gave her supplements to increase progesterone. But I think eventually she did progesterone. So Allison's like her, can do supplements to increase progesterone, work on cortisol, or actually take progesterone. So a lot of times you look at your lab values and you were like, well, what should my progesterone be? And I understand the frustration for so many women because they'll go to their doctor and be like, well, can you just check my hormones? And Sometimes a doctor will say no, and sometimes they will, but they don't tell them when is the correct time to test. And you want to test if you're cycling, you want to test around 3 to 4 days before your period. So mid-luteal phase, and you want a progesterone above 9 to 10. Even if you're on hormone replacement with progesterone, that should be your goal. And you always want to test these hormones so you know if they're truly working. So this was her cortisol. 27.1, and I want you to look at the range. So you see this range? The best time to check cortisol is in the morning before 10 a.m. Again, conventional medicine, when we think of cortisol, in my doctor friends' debate, doctor friends' defense, and in my defense of my previous doctor self, we didn't recognize optimal versus suboptimal. We just recognized, is it abnormal or is it normal? So if you look at cortisol before 10 a.m., it should be between 4 to 22. That's a humongous range. So we really want it to be optimal. What does optimal look like? Between 10 and 15. So poor Allison's cortisol was 27, and her— that high cortisol was impacting her progesterone. This is obviously high, but if your cortisol is 18 or 19, it's still too high, but you or your doctor may read it as normal. And things you can do to bring it down is Meditation, yoga, ashwagandha, magnesium, but really trying to understand why it's happening. So meet Isabella. She's another version of Allison. Again, she just wants to feel like herself again. She couldn't sleep. She had night sweats, hair thinning, normal periods, and she's kind of wondering, like, am I in perimenopause? Why is this happening? So went to conventional medicine. Labs were normal. Recommended Ambien because her sleep was so bad. A root cause medicine. She also had high cortisol, normal estrogen. So a lot of us are thinking if you're having night sweats, it may be because of low estrogen. So it's important to check these values and say, oh, my estrogen is normal, but I have— I'm night— have night sweats because of cortisol. Another good clue is if you cannot stay sleeping. If you wake up and it's between 3 and 5 AM, I would guarantee your cortisol is high at night. And if you checked it in conventional blood work and it looks good between 10 and 12 or 10 and 15 in the morning, I would recommend doing a salivate test, which is a more advanced in functional medicine to really see that cortisol is high at night. But you really want your cortisol around less than 10 a.m., between 10 and 15 to really feel good. And so for somebody like Isabella, really working on her cortisol, bringing that down so she can sleep well, and that usually resolves night sweats. High cortisol does cause hair thinning and does impact sleep. So here is a caricature just talking about your body genetically doesn't know the difference between you being chased by a tiger and you just having all these things to do. Take the kids to school, do your PowerPoint presentation for your boss, drive in LA traffic, figure out dinner. We constantly on the go, go, go, go. So our cortisol naturally is higher and our blood sugar is higher, insulin is higher. And this, this hormonal Framework is inflammatory to begin with. So I always tell patients like you need to help your body pretend that things are okay. Obviously, you want. I would love it if everybody could not pretend and just believe that things are okay. Have the time to meditate. Have the time to go have a bowel moment in the morning. Have the time to be quiet in the morning. But most of America isn't. So it's important to recognize that your body may feel very stressed, and it's continuous stress that makes your body inflamed. So your body would respond to this in the same way if it was under physical threat, even if you— and I see this a lot because we're in LA, we see a lot of high, high executive women and men and celebrity people, and they under— even though it's a good thing, they have like a promotion or they have this, this movie that they have to do, it's a very internally stressful event. So it's very important to calm your cortisol down so you can respond in a better way. And I see this also Also with like kindergarten teachers and everybody just kind of surviving. We're just in survival mode so much that our body doesn't recognize that things are okay and we're safe, and your cortisol can become normal. So what does a high cortisol state do to your body? Why I'm really talking about cortisol the most in these labs is that a lot of patients go to their doctors and then, can you check my hormones? Can you check my cortisol? And They may not be taken seriously. So I want you to understand high cortisol is obviously high, like we saw in Allison, but even suboptimal cortisol impacts your body. And so what kind of labs should you test for? You should check for your cortisol, a full panel of your thyroid, and that's 5 different tests, as you'll see in the lab test I shared with you: estrogen, progesterone, testosterone, and insulin. If you're a woman who's having regular periods, you want to make sure you're doing this mid-luteal phase, which is around 3 to 5 days before your period. And if you're a guy, you want to make sure you're checking these labs in the morning to see what your testosterone levels are. Insulin, and insulin is a very important hormone to check, and we'll talk about a case with that. But this is a lab order you want to make sure you're doing, and also make sure you're doing this in the morning before 10 AM. High cortisol causes this. This is the belly fat, and we see this more in our midlife, and, you know, especially if we've gone through a lot of stress. High cortisol causes a lot of anxiety, a lot of irritability, and so you really want to support your cortisol and make sure it comes down to normal.

Yeah.

So this is Zoe and she's 47. I've met so many Zoe's through my life and she just wants to start feeling like myself again. There is no ICD-10 code for not feeling like yourself, so it's not like medical necessity, but this is true medicine. She's not feeling well and her symptoms are insomnia, anxiety, and she again couldn't stay sleeping. She's gaining weight mainly around her belly and her thighs. She's having regular periods and she wonders if she's in perimenopause. And so, so many people go to their doctors and say, am I in perimenopause? And they're like, no, you're having regular periods. You're not in menopause. And that is correct. You need to not have a period for 1 year to be considered in menopause. But a lot of us are in perimenopause. I think the earliest patient I've seen, she was 35, ton of stress, just pushed her body toward aging quicker. And so you really want to see what, what, what labs will tell you if you're in perimenopause. And there are a few. And the one thing is what we discovered for Zoe Was she also had low progesterone? It's a common thing we see in our practice, and really we optimized her with the hormones. And again, she felt so much better. A lot of these women, when you get their hormones under control or balanced, they just like I feel like myself again. And it was something that they just kind of lost hope and didn't think it was possible. But it was it's actually not a very complicated fix. So these are someone like Zoe's labs. So this is an FSH. Follicle stimulating hormone, so it's your pituitary, your brain telling your ovaries make more eggs. And the higher the number, like above 100, you're in full-on menopause. The lower the number, like less than 10, you're fertile and can get pregnant. But when somebody's 29.5, they are in perimenopause, and even though they're having regular cycles, and we also know she's not maybe in perimenopause also because her progesterone is not optimal. So even though she's having regular periods. She's in perimenopause because the FSH is slightly high and her progesterone, which should be above 10 in mid-luteal phase, is 7. And her symptoms again could be things such as insomnia, anxiety, and weight gain. Because if your progesterone is low, you're left with estrogen, which can be a hormone that puts weight on your belly and your thighs. So important to check your labs and don't be discounted by your provider. If your provider is not willing to work with you, Work with somebody else who can at least check these labs. Now you know at least what to ask for. So this is Linda, and Linda just again wants to start feeling like herself again. She's bloated with everything she eats.

She's—

her hair is thinning and she's also fatigued. Her labs show they were normal. Her doctor said, I checked your thyroid and your iron and they were normal, and recommended she eat fiber. So functional medicine is kind of obsessed with the gut, and we check the gut in a lot of our patients. But you don't even have to check the gut. You can just check the conventional Quest Labs. They'll give you a sense of why she might have these symptoms. So what she found was she had very low ferritin. Ferritin is iron stores. It's also low for— if your ferritin is low means generally you have low iron or you have high amount of oxidative stress, which is inflammation at the level of your mitochondria, which are these tiny engines in each one of your cells that make energy. So her ferritin was super low. And when your ferritin is very low, you commonly— women and men present with hair loss or hair thinning. So a lot of trichologists, which are experts in hair growth, don't recommend you do anything with your hair until your ferritin is above 100. And for vegetarians and vegan patients, that's kind of hard. So we want to really work on her ferritin. And with a lot of my patients who are maybe vegetarian or vegan, but who actually eat meat have a lot of low ferritin, and it's mainly due to malabsorption. What causes malabsorption? Something called SIBO, small intestinal bacterial overgrowth. It's a breath test, usually takes 3 hours to do, and generally people have bloating with, um, if they have SIBO, and then sometimes they don't have any symptoms, they just are bloated. How many people in the audience here feel like you can resonate with any of the symptoms so far? Bloating, insomnia, anxiety, irritability, and hair thinning. If you could just type it in your in the chat, which one for you is the biggest one? And fatigue.

How many?

And all of the— all of you guys have many of them. And it makes sense because they all come together. And that's where you have to recognize the pattern and see why. Because you can be on 20 supplements, but if you have SIBO, you're just making expensive poop. So you really need to understand what to treat first. And the biggest thing to treat first is usually the gut. With the thyroid, you'll see on your lab order that there's TSH, free T3, free T4, thyroid antibodies. So when you check that whole panel, and the one thing conventional medicine doesn't do a good job of, we might check TSH and, and free T4, but we don't check free T3. Your free T3 needs to be above 3.2 to help with hair. Since hair is a popular symptom, let me just tell you the 5 things I think about When I hear a woman who have— woman or man who has hair loss, more for a woman. The first one is ferritin. Is it above 100? The second one is free T3. Is it above 3.2? The third one is DHEA. Is it above 70? The fourth one is hs-CRP, which is inflammation. Is her hs-CRP optimal or less than 3? And then the fourth one is her Her adrenals, like her cortisol. Is her cortisol optimal? So those are things I think about. But then beyond that is something called oxidative stress, which is the mitochondria. That's probably the 6th one to really think about for hair loss. And, you know, in terms of hair loss, just a quick thing I'll give you here is conventional medicine. You can do Rogaine, which is the topical gel, but you can— you should use the men's strength even if you're a woman, twice a day. And you can use oral minoxidil, which is the same thing like Rogaine. Problem with oral minoxidil, you will grow hair everywhere. So I have a lot of women who come in and feel like they're bears but feel like it's worth it. They might have to do more laser, more waxing. But if you have like light skin and light hair, then it's not a big deal. And then there's procedures like PRP, ProCell, but none of that is looking at the why. It's all Band-Aid medicine. So if you need a quick fix, those are the things you can try. So this is something I wanted to talk about the why. So what's happening in your body? And I'll just let this play. So this is one of my favorite ways to explain to patients that your body is like this container of wine. When the level of and your body is the container, the wine is the level of inflammation. When the level gets higher and higher, your your resilience reduces. So if you shake a glass with very little wine in it, very little of The wine spills out, but if the wine is almost to the end and you shake it a little bit, a lot of the wine spills out. And those are your symptoms because a lot of patients are like, "Well, I had mold exposure twenty years ago. Why is it showing up now?" Oh, I had SIBO ten years ago. Oh, I had this horrible stressful event two years ago. Why now? And it's the level of inflammation just keeps increasing and increasing until the body says, "You know, I can't," and the next stressful event. Just makes these things appear. A common trigger is pregnancy. Another common trigger is perimenopause, menopause, because your resilience just really reduces and a lot of these just increase. So for in functional medicine, we check each of these things. But the initial labs is what this webinar is about. Touches on a lot of these in terms of nutrients, inflammation, and hormones. So this is Jasmine, and she also she a lot of patients come with weight gain mainly around the gut, and she's. Working harder, I have a lot of patients who are Pilates instructors and strength trainers, and they're just like, "I am working really hard, but I'm not losing anything. I eat exactly the same. All I did is I turned 48." And conventional medicine said labs are normal. Her hemoglobin A1c is 5.6. Diabetes is above 6.2 to 6.4, and they told her it's just aging. And someone like Jasmine is generally in her late 40s. She could be in her mid 40s, and the TSH is normal. But so it said there's nothing to do here. Why don't you exercise harder and eat less? Or let's give you a GLP because that's where we are in conventional medicine. But what's root cause medicine? We checked her insulin. It was 15.

And that—

and the good level of insulin is ideally less than 5 or less than 8. And hemoglobin A1c of 5.6 is too high. How many of you have heard that Alzheimer's is considered type 3 diabetes? Can you just put yes in the chat? I'm speaking to a very educated audience. So for those of you who may not know, we really are recognizing the fact that blood sugar metabolism and keeping your blood sugar even is really important to protect your brain health. So 5.6, I think, is— it's too high, especially in functional medicine. We would like it less than 5.4. For those of you who have a family history of Alzheimer's or worried about your brain, a great book to read is something called Grain Brain by Dr. Perlmutter. And he really makes the case for the— when your blood sugar is higher, your brains are smaller. So for her, we really wanted to work on her insulin and work on her suboptimal thyroid. So we really treated her with the low insulin. We can put on supplements. My favorite supplement for insulin is berberine. Works really, really well. And then once we improved her gut health and normalized her inflammation, we could put her on microdosing GLPs. I get this question often. Do we use GLPs? We definitely do, but we really microdose, like 1.25, 2.5 milligrams of tirzepatide. That's my favorite. Now, there are lots of oral options available. And then a supplement that's similar to the GLP is Calocarb by Orthomolecular. I really like that supplement because it just naturally increases your GLP, and you don't actually have to take a medication. So for her, when we improved her insulin, She really was able to drop her weight. Biggest thing with weight, you have to have to check your body composition. So for any of our patients who are on any kind of weight loss journey, they have to come in and check body composition monthly because if we help you lose 20 pounds, but 15 pounds are muscle, we've completely failed you as a practice. So we really have to make sure you're preserving your muscle and preferentially losing body fat. And again, I told you before, as your testosterone goes down, your insulin goes up.

Yep.

So a lot of women, they're on supplemental testosterone to help them build muscle. And muscle is really important because the bigger the muscle, the lower your blood sugar. Think of muscle as a glucose sink. So if you are strong and have muscle, you can have more sugar because there isn't much of an insulin spike. So the hormones that help with metabolism are thyroid and testosterone. They have to be optimal. So TSH less than 2 is my ideal for patients. Testosterone for women, ideally closer to 40. And very important for testosterone is to look at something called sex hormone binding globulin, which is a long word, but it's a protein that binds up your testosterone. It's something that people rarely check, but it's important to check if you're on testosterone replacement or if you're gaining weight or not gaining muscle, because if your sex hormone binding globulin is high, that means your testosterone is not bioavailable. And so you really want to optimize testosterone, optimize thyroid, And we'll go through a male case in terms of what the numbers are. Fat storing. If you have too much estrogen, too much cortisol, too much insulin, it's very difficult to lose weight. There's lots of ways— lifestyle, supplements, and medications— that can work for this. But I would say the biggest lifestyle hack I will give you is you must eat around 30 to 40 grams of fiber if you are in perimenopause or menopause or postmenopausal or in andropause. So Fiber. Most Americans get 10 to 12 grams of fiber. So you really have to work on increasing more fiber. Why is fiber so important? It naturally lowers these 3 and doesn't help increase this, but it reduces these 3. So this is Eric. We do have 20% of our patients are guys, mostly the husbands of our female patients or people who are very motivated to biohack. And so he's 56. He just didn't think he was feeling normal. And actually, I've met a few Erics in our, in our practice, really feeling detached, unmotivated. Kind of wondering why. Went to his conventional primary care, told everything was normal. His testosterone was normal, but this is really suboptimal. We optimized his testosterone to a better number, and he really felt— he just, he told me, he's like, I was actually feeling clinically depressed and considering a medication. I'm finally back to feeling how I should be. And we also gave him Clomid to help with that testosterone. So this is his testosterone level. This is at 466. And post-treatment was 972, and he was like a different human, even the way he carried himself and how he felt. And I see this with testosterone replacement in women all the time. The confidence and the clarity is just pretty remarkable to see. And in this room, he was considering antidepressants, and here he's not feeling depressed at all. So if you have men in your life, or the couple men watching this, really think about ways to optimize testosterone. So natural ways is build muscle. Second ways is things like fenugreek, ashwagandha, stinging stinging nettle, tongkat ali, and then clomid and testosterone. So Janice is 52. She's wondering if she's kind of getting Alzheimer's. Her biggest root cause was inflammation, low testosterone, and really worked on treating that. And we really want to get the HCRP. Less than one testosterone, a bit higher, and she kind of was like, you know, I feel better, and she started building more muscle. And that's where checking that bioimpedance is really important. And then for Janice, actually, she this is Heather. Sorry, the next person. So she her big difference was she just didn't feel like her doctor was hearing her. She said everything was normal. It's just your age now that you're fifty-four. But she had you know she has low libido. She's super fatigued. So all her labs were normal. Checked iron and thyroid. But again, when you look at the labs they checked, they checked one thyroid. And just iron. But when we looked at her labs, the ferritin was very low. Thyroid was suboptimal, but she had very high mercury levels. That's the number one toxin we see in LA all the time is super high mercury, especially if you don't detoxify. And it's important to safely bring that down. We treated her gut, improved her hormones, improved iron, and she again felt like herself. So I just briefly wanted to touch upon toxins. And we live in LA, so we live in the most toxic city in the US, and everybody eats a ton of sushi. Toxins are metalloestrogens, so they mimic estrogens and not the good kind. So they can cause a lot of inflammation and growths. So it's important to check your levels, and it's one of the markers I put on the lab order. If you do function labs, they just do whole blood mercury, which is never high for anybody unless you're super toxic. You want to do red blood cell mercury, and that's what's on the lab. If you go directly to Quest, it's around $40. So if you don't be, don't be reassured if your functional mercury looks pretty good. And toxins mainly impact your brain and how you feel with anxiety and depression and your heart. So you really want to check red blood cell mercury, sex hormone binding globulin, and ferritin if you're dealing with any kind of toxins. And you really want to check for all these toxins, but at least start with the Quest one, which is mercury. And this is my last case, and this is Emma. Family history of heart disease, worried about her heart. Conventional medicine said she has high cholesterol. She doesn't want to take a statin. And so what we did is we did her particle size. Can you put in the chat and say size if everybody knows what particle size of cholesterol is? Some people do, but basically you want to look— so fluffy cholesterol is fine because it just bounces off your heart vessels. The tiny beanie-shaped cholesterol is the dangerous ones because they can cause damage to your coronary arteries, and then your body responds and makes a clot, and that's what causes a heart attack. About 70% of people who have heart disease or die of a heart attack actually have normal LDL. So we really obsess about cholesterol, but we should be looking at the kind of cholesterol and how inflamed we are, because a heart attack is really an inflammatory condition. So this was her.

We—

and it's important— how many of you have had— who are above 45, maybe I'll say 50 and be generous— have had a coronary calcium score? Can you just put C in the chat to let me know how many of you have had this? And if you don't know what I'm talking about, I'll explain.

Excellent.

So a lot of people have. So for those who don't know what it is, it's just a CAT scan. It doesn't have any dye. It'll tell you if I have a lot of plaque buildup, and how what it's measuring is calcium. And it's important to check that, especially if you have a family history of heart disease or you're above 50. It's a test insurance generally doesn't cover, but it's like 200 or 300 bucks here in LA. I highly recommend you do that because especially for women, you know, above 50, what's killing us is heart attacks. You want and you may present weirdly. You may have indigestion, and if you have indigestion and you're in Hawaii, but you know you had a normal coronary calcium score, at least you can be reassured that it's not your heart; it's truly indigestion. Because if and I had this happen to a patient recently, and she typed in ChatGPT, and they're like, "You need to go to the ER." And then she messaged me, and I was like, "You know, your coronary calcium score was normal within a year. It's probably indigestion." So I think it's a super helpful test to have.

And then this test.

I think is helpful. So this is a lot of patients again are coming with new diagnosis of prediabetes and cholesterol. So these are the things you want to check in the lab order and in your sheet. Homocysteine, super important to check. Conventional medicine, we don't. It basically resolves with good B12 and folate. So this is a Cardio IQ through Quest. So this is, this is all like until here is where we check in conventional medicine. So like Emma would have amazing, amazing cholesterol. But when you look deeper at the kinds of cholesterol she has, Moderately high risk. It's kind of on the tiny sides, and then she has small particles of her LDL. ApoB is slightly high. Lipoprotein A is slightly high. But if you look at her inflammation, that's high too. But this is the marker I want to talk about: this Lp-PLA2 activity, and that's showing inflammation on the cell, on on a cellular level, on the inner part of the coronaries. It's endothelial inflammation, kind of like. So if you have a high Lp-PLA, you really have to make sure you're risk stratifying your cholesterol. So work on your gut, work on inflammation. But another very important thing to do is consider a medication like Repatha or the oral version, which is a medication that is the only medication we know about that actually reduces plaque burden if you have a family history of heart disease. Again, I'm an internist, so I'm going to recommend medications if it's appropriate while working on the root cause and then hopefully getting rid of the medication. So, inflammaging. Great, I'm almost at time. So, inflammaging is concept in functional medicine. Basically, higher the inflammation, the quicker we age. So, like nature's kind of done with us. We've had kids. We haven't at age 40, 50, and then we slowly decay. So longevity medicine is the opposite of that. How can we reduce inflammation to prevent all these diseases? And so working on the gut, working on hormones, reducing toxic burden. Working on lifestyle, building muscle, having purpose, having community—all those things reduce inflammation. So this could be some of you. I don't think my doctor ever heard me. You know, everything is normal; it's just your age, and you have so many more questions. Please get a new doctor or come see me or come see a functional medicine person close to you. Don't accept that as as normal. Or is this you? I want to optimize my health, and I want to age gracefully. I have a lot of patients who are above 65 because a lot of times doctors just truly discount them. They're like, oh, you've lived a long life, you seem pretty healthy. But they want— they come to us for longevity and optimization because they want to feel younger and they want to be strong and they want to be the person at 85 who can go up and down those steps. So work with somebody who's going to— who sees that vision for you. So as you do. So if you said yes to any of these symptoms, I may be able to help you. And first of all, take those labs, get them done if you haven't already, and ask your primary care doctor too if they'd be willing to. And again, remember this image is that you really want your labs to be optimal, like here, if they're a good thing, not low or suboptimal, because just because they're normal doesn't mean they're, they're making you feel better. And they may be the result of how you're feeling. And then some quick kind of lessons I just want to repeat so people know. This is our roadmap, which could be anybody's. You want to really do some advanced testing. You want to prioritize what's important to you. Like, what are my goals? I want to build muscle. I want to lose weight. I want to work on brain fog, and then you want to talk about lifestyle, and then it's about the gut. Then it's about mindset and emotional balance. Sometimes it's maybe about quitting your job or meditating, or realizing that you need to have bigger perspective. Then it's about what your mitochondria doing, what's your toxic burden, and then you know hormone balancing really throughout it all. How do you feel better? You balance your hormones, you improve gut inflammation, work on toxic burden, and focus on lifestyle. And that's kind of a summary of what it is. But a lot of my patients feel like this, just like out of order, trying to understand why and really discounted. And they've been told their labs are normal multiple times and it's just not true. And again, you can definitely be in perimenopause or you can be in perimenopause if you're still having periods. So just test those labs and see where you are. And even if you're 36, 37, and again, could malabsorption be causing your symptoms if you have SIBO and low ferritin, or if you have low ferritin, definitely check your gut, especially if you're not vegan or vegetarian. We see a lot of patients with depression or anxiety, and if we improve their gut, what's always surprising is how much their mental health improves. So just think of that connection. And again, remember that just because it's normal, it doesn't mean it's optimal. And I'm sorry, I kind of went through the last few slides fast, but at the end of the day, you really have to understand why are you doing this. Like, you showed up for this webinar. I'm assuming you had a bunch of symptoms But what can you can take charge of your health and you can do something to improve it. And what is really your why? So what is your why? This is my why. This is this is my husband, my kids. I really want to be. I don't want them to take care of me when I'm old. I want to be independent and I want to be strong. And what is your why? If you guys could put some some things in the chat of why some of what some of your why is that maybe it's travel, maybe it's Run a marathon. Maybe it's garden. What are some of your whys? Why do you want to live till 85, 90? Perfect. I mean, these are all healthy, normal things that we should want. But really, for those of you who are in your 40s, 50s, 60s, now is the time we work on them. If you're already in your 80s, you can still get improvement. But for the vision of who you are going to be at 80, you need to start working now in terms of reducing inflammation and increasing muscle. And then my team who's on this Zoom just has a bunch of questions in the chat. Let's make sure we add them for the end. So be, be really cognizant of your why. Like, I have a gene that puts me— I have an APOE gene that puts me at risk for dementia. So I'm 6 times more likely to be demented than somebody who isn't. And so what can I do to improve that? I live in LA, so I live in a toxic stew. So I can reduce my toxic burden by improving my gut health, making sure I'm never constipated, eating enough fiber, using a sauna, and really building muscle. Do I love going to the gym? No, but I show up and I try and lift heavy because I'm trying to protect my 85-year-old self. So that's how you have to think. Your why has to be so clear so you do things that make you uncomfortable. So you show up to the gym, so you show up to your trainer, so you show up to saying no to the cookie You have to be clear on the why, and you have to have the vision of who you want to be. So when you are clear and you have the data, and so the mental innovations are like, I've tried this before and I just it's not going to work. But when you have the numbers and you see the shifts and you understand what the numbers are trying to tell you, it gets much easier to sleep better, have more energy, and feel less inflamed. I just want to leave with this quote before I tell you how to work with us directly: Is if you keep doing the same things, thinking the same thoughts, and feeling the same emotions. You'll keep creating the same life. And this is by Joe Dispenza. So if you're doing, thinking, and saying the same stuff, don't expect a different outcome. And this is my own version of it, is if when we only look at surface markers and accept normal as optimal, nothing truly changes. Real healing begins when we look deeper. We need to look at patterns, not just numbers, trends, root causes, and early signals. That's when you can really have better health outcomes. So how can we really help you? So I wanted to leave you with a few of these just video testimonials of some of the people we've helped recently. So this is Carla. My advice to women would be to not normalize their symptoms. I normalized many of my symptoms, such as painful periods, excessive bloating, acne, insomnia, just to name a few. And at Sayana Medical, I was able to get help to get to the root cause of these symptoms and eliminate them. So don't normalize it. You don't have to work with us. Work with someone and just look deeper. And so we already gave you these 80 blood markers. And again, it's kind of like function does a few more, but get these basic labs at least done. And I know a lot of times patients are like, well, my doctor said no. Or if I go to Quest, it's like $1,200. It shouldn't be that much. Honestly, when we do the cash price for it, it's markedly less than $1,200. But this is where our business of medicine is now. So what I'm offering for those people who can, who live in California, last time I did this, a lot of people were really disappointed that it wasn't for them who didn't live in California. But if you live in California, this is an offer for you. If you don't live in California but have a friend in California or can come by here for just a day so I can see you once and just establish a physician-patient relationship, then you're welcome to do this. But otherwise, until I get licensed in many states, you can just take this information and use it. Ask your doctor, look for a functional medicine doctor close to you, because that's really important. So we have a 7-week reset. Last time I think I did 6 weeks. 6 weeks felt a little bit rushed. And it's longevity reset. Basically, we check these labs as a group. We had a small cohort of women last time. It was fun. I love giving and pouring into them, and they really felt really empowered with the knowledge. And I will be there kind of guiding you through these, through the, through your labs. And it's helpful to have your labs labs so you understand how it works to you, and then generic labs. And then I'll just give— I'll leave you with this one.

I can say I echo the sentiments of Judy and Robin that these sessions have been enlightening for me. I mean, coming from a healthcare background, I thought I knew a lot, but like, just— yeah, I mean, there's so much, quite an eye-opener as far as, you know, labs and what the risks are. And yeah, like, I feel like sessions have provided not just educational content, but also, you know, you going through our labs together in each session, I think has been really helpful as far as providing direction and, yeah, like steps towards how to improve those areas. So I'm excited to implement some of these and see what my labs will look like in 3 to 6 months. Yeah, I I would really looking to improve. Yeah, so I feel like the sessions have really fulfilled their purpose.

So that is one of our pharmacy patients who just did the online group course with us in the beginning of middle of the year. So this is how you work with us. If Alyssa, can you just drop that the link in here while we also— I just want to go through what this looks like, and then I'll answer questions. And then we'll do the raffle. So basically, we're going to do these 80 panel labs, just Quest. So don't expect like the SIBO breath test, the gut test, the genetics, the toxins. That's you working with us one-on-one, and I'm happy to see you. But this is like, I just, I'm curious as to what's going on with my body. I know there's something wrong or something off, and I want to understand and be empowered. So we're really looking at deeper level of labs around hormones, stress physiology, inflammation, and nutrients. And the labs will be done here in our office in Sherman Oaks, or we could send you a link to do it at Quest. And who is this really for? It's really for people who want to lose weight, feel unstuck, feel metabolically stuck, which is kind of everybody unfortunately in perimenopause at some point, or you really want to understand what your body is trying to say. I love doing this because I love having impact, but it's a group usually of women. If you are a guy, you're welcome to join, but it's us looking through those labs and understanding what it means to you. What's nice is going through it in community. And realizing that everybody is a mirror of each other, and that has that has been really rewarding. It's not for you, a if you're sick, because you should come and see us individually because you may need a very tailored approach. And if you're looking for something that's quick, a quick fix, nothing is really quick in this decade. And if you're not interested in really knowing how, and some people aren't, they're like, "I'm too busy. Just tell me what to fix," and that's come and see me individually. But if you're somebody who you know likes to learn about labs, if you like to be empowered in that way, then this is really. For you, so again, it's not a diet. I'll go briefly with nutrition. I feel like functional medicine has created a lot of eating disorders by telling you to go on the AIP diet, the Gunvi diet, the no gluten, no dairy. It's just extreme, and I do think you know you should eat and eat socially, eat with joy, but eat with a lot of fiber, a lot of protein, and eat clean. So I'm not giving be giving any of these specific diets, but I'll give you my favorite prompts to put in AI. To create a diet that's good for you, and you will definitely be able to think about how to lose weight with that and reduce inflammation. But it's not really a diet program, and it's really about working on root causes and what your labs are trying to show you. So this is a seven-week hormone reset. You use this QR code, and if you if anybody's clicked on the QR code or is having issues, please type in the chat issues, and we will look at what they are. But it really is five live sessions with me. So we start on September 29th, and I've kept some free space in some of these visits because last time it was just a lot of information to these poor women. So September 29th we start. You ideally want to do your blood work before then, by by October sixth we want to have the labs to review, and my team will help you get those labs scheduled, especially if you're cycling. We really have to pick the time correctly, and then we meet five times. It says six to seven. Sometimes the sessions have lasted till 7:30, sometimes 8. I kind of end the didactic portion by 7, and then I'm open for questions for half an hour, and they usually are questions. So if you can, if you need to leave by 7, you can, and it's always pre-recorded. It'll always be sent to you. And then you'll— and so all the— this hormonal reset includes the labs, includes the sessions, and includes an app where you can talk to each other and talk to me and ask me questions. And I'll also give you a that'll be curated to the group as to what the lab is that's normal and what's optimal. So the next time you do this, you'll know to read your own labs. And that is a lab interpretation guide. And then the private group. And then if you need supplements, I recommend you get a discount for the state, the time you're in the course, and a little bit further. And you can, and you can keep those recorded sessions. And what we'll really be talking about, it's kind of like what I did today, but more What are your labs telling you? I did my generic Allison and Ashley and all these names I made up, but it's what are your labs trying to tell you and what are these 80 markers trying to show you? So we start with what this kind of a recap and what this means, and then this session, the second session, you'll have your blood work back and we'll talk about what this specifically means to you. And you don't have to share your blood work with everybody. Some women by the end of it were just very happy sharing because they recognized everybody else was in the same boat. And then the Q&A was very lively. A lot of people have questions and you can ask questions between sessions and I'll message on the app or we'll keep it for this visit. And then you really want to rewire stress. Stress and cortisol, as I kept talking about, is a big part of what impacts your hormones. It's a big part of what impacts brain fog, weight gain, and inflammation. So we really talk about that lifestyle first, supplements next, medications if needed. I can't prescribe on this because I'm not individually your doctor. But I can tell you what to ask your doctor, and you can always come and see us after. But you want to understand between lifestyle and supplements, a lot of people can get pretty significant wins. And then it's coming up with what is your personal longevity roadmap? What are your goals? You know, if one of your goals might be to exit, to make muscle, somebody else's goals might be to just prevent Alzheimer's. And what are those things you need to make sure you're doing to make sure that you have those outcomes and understand? Because in conventional medicine, And we don't have much on either front, but there's so much data and evidence-based things that you can do. And so I have one more. Yes. And so your bonus bundle. So this is for people who get it by Monday. They get these 3 things. What are they? So Relora is magnolia bark. It's one of my favorite supplements that drops cortisol and makes you feel less stressed. And it's just a bark. Inflammation support, which is what one lucky winner gets, is a supplement that really reduces inflammation. And a lot of people within the 6 weeks of the course on inflammation support, by the 3rd week, they're like, I feel better just by taking the supplement. They hadn't really implemented the lifestyle. So the inflammation support, very safe supplements. And then a continuous glucose monitor. I'm a fan of those, but it's not super accurate because it's not in your blood, it's in your interstitial fluid. But I think it's a good proxy. What was surprising for some women is they recognize that their blood sugar went higher When they were at when their boss walked in, and then commonly patients are like, "Oh, when I visit my mother-in-law, I recognize my blood sugar is higher," and that's good because you recognize high cortisol and high stress's impact on your blood sugar. So you may be pre-diabetic not because of your diet, but because of stress perception. So I'm a big fan of that. If you're scared of needles, we can help you put that in instead for two weeks. So this is the stuff you get by Monday evening, and I really want to keep the The list small. That's important to me because it's intimate. People can ask questions. So by Monday evening, we kind of will cap it and, you know, allow very few people in if needed after. But by Monday evening, you get these 3. I hope you can join me. I enjoy doing these courses, and I just feel like, you know, why I went into medicine is to have impact, and these group courses have really allowed that for me. So here, questions. My last slide actually just says questions. Yeah, and let's go through your questions. I'll have Veronica, my operations person, join us, and I will stop sharing so she can join me. Hey, Veronica, and we can ask questions from the chat. Yeah. Great.

Okay, so you guys can send your questions on the Q&A chat. That way I can populate them. I do see a couple already coming through, and we can go ahead and start from there. Okay, so the first question is—

I know, I think there were a bunch before also. I just didn't capture all of them. So when you have a chance to scroll, but go ahead.

Okay, so could someone take this course even if their biggest concern isn't hormones? For example, they're struggling with weight, fatigue, sleep, and brain fog, inflammation, or just don't feel like themselves.

Yes, you know, even though you don't recognize it, there's definitely a hormonal component with that. And you know, when we think of hormones, we always think of sex hormones like estrogen, progesterone, and testosterone. But I want you to broaden your vision. I think you probably have adrenal issues. That's cortisol and thyroid issues. Think of your adrenals as the grandmother, thyroid is the mom, and the sex hormones is the grandchild. And you really need to focus on mom and grandmother to get improvement. So I think your adrenals are part of it. But yes, short answer, and keep me short, Veronica, is you can definitely get benefit from it because it's just not sex hormones.

Okay, so the next question is, um, just a reminder, guys, Questions, please put them in the Q&A so they can populate and I can grab. I do see some coming in the chat. If we can keep them in one place, that'll be helpful. Okay, next question is, can you remind me who is this program ideally for and who is not?

Okay, so it's ideally for really anyone who is looking to optimize their health. Ideally, somebody who's above 35. And to all, it's also fine for men and women, but it's not for somebody who's on dialysis because a lot of supplements you cannot use. It's not somebody who has active cancer because it's not a lot of supplements you cannot use. So it's really for someone who is going through the symptoms we described in here and are generally feeling okay otherwise, or just curious as to what's going on in their body and they want to kind of dip into understanding the Okay, so the next one is, why do you recommend taking progesterone only on days 14 to 28 instead of every day? Good question. So 14 to 28 is really for women who are still cycling. So if you still wanna have your period, you wanna take it 14 to 28. If you're not having your period anymore, or if you feel really good on progesterone and you're in your 40s, then you can definitely take it every night. But some women still wanna have their period or are still thinking of fertility. So you, you wanna keep the progesterone just to 2 weeks where it naturally should be higher than it, and it's not higher, and that's why we're on progesterone. Great.

Okay, next one is, how do you detox from mercury?

So you detox from mercury— a lot of you are going to be very sad— is you really need to cut out your fish. So sushi, especially tuna, have a lot of mercury. Um, a lot of people who are vegetarian have high mercury. Not a lot, a few, mainly from air quality if they're poor detoxifiers. But how you detoxify from mercury, the first thing you can try and do on your own is high fiber. Never be constipated. Use a sauna. Then try and do some sort of chelation, which is usually with things like charcoal or a binder. I would be careful of using a binder without checking your cortisol, because if your cortisol is not optimal, then you will have side effects.

Next one is, Dr. Shilpa, for the person listening tonight thinking everything you describing sounds like me, but I have no idea where to start, is this meant to be the first step?

Yes, it'll kind of give you a good idea of what's wrong or what may not be optimal. And then you can say, okay, this is what I need lifestyle, this is what I need supplements, this is what I may need medication. And then you can, you can see if this, it just gives you a foundation. And, you know, the entry point, I know you, some, for some of you may think it's high, but it's really not because our concierge patients, the investment is much more. So it's a good place to start and say, oh, I understand why.

You keep talking about normal versus optimal. Why does the difference matter if I'm still having symptoms?

Especially if you're having symptoms, it matters. If you're not having symptoms, Then it's really like you don't even need to be here. You're doing well. But if you're having symptoms, it really matters as to what is to get your labs optimal because if they're just normal, then your symptoms will continue. And it's really understanding like what are your symptoms and how do they marry to the to the lab so you can recognize the pattern.

Are fiber supplements an okay way to get daily fiber amount or should it come?

From food, you know. Go ahead. Food. What are the top recommendations? Fiber is one supplement in the United States we all are low in. But top recommendations would be a bowl of raspberries and an avocado a day. Between those two, you'll likely get to close to twenty. My favorites are chia, flax. Add it to like Greek yogurt. Put it overnight. It's super easy. Add some berries and eat them in the morning. But if that's too cumbersome, then you could do a fiber supplement. And the problem with most fiber supplements is they don't have enough. Even our, like, lovely powder out there only has 12 grams. You need to get to 40.

Is this course appropriate for someone looking to improve their gut health?

You know, we had a gut health this year, but I don't think you could really look at the gut without looking at this first level of hormones. And we did treat the gut in this course because we had to, because people's inflammation was high. They had all these symptoms of gut symptoms. So we just ended up treating it, and when we're treating the gut, we're treating for the wrong bacteria in the gut. So it's important to treat.

Is it possible to get pregnant during perimenopausal? Is it safe to get pregnant if you're taking hormone replacements?

It is possible to get pregnant when you're taking hormones, but ideally only want to be on progesterone because progesterone is that hormone of pregnancy, and you probably want to take it only between day 14 to day 28.

You include more than 80 lab markers in the program. What are you looking for that might help someone understand why they don't feel like themselves?

The biggest thing I would say, and this is how I even teach my providers, is look at their cortisol. If their cortisol is really low, meaning less than 6 or 7, that's the issue. The second hormone we look at is the thyroid. If the thyroid is off, look at that. The third one is inflammation, hs-CRP. So those are my top 3. There's always an answer as to Why?

What is the difference between the seven-week program versus working with you one-on-one? If we were to work with you one-on-one, can we participate in this program as a client? Absolutely.

So for those patients who are on here, hi Vashti, hi Usha, hi everybody. I see your names. You guys are all our current patients. You are all welcome to join this program. This is really for people who are new. You guys will be like educators to them as well. well, but with your experience. But for you who are already seeing us as patients, you can just bring your original labs and you'll come and you'll learn. You said to have like 5 Tuesday nights that are available. Just tell the team that you want to join and we'll make sure we include you in that group. For those who are new patients to us, um, and have a lot of symptoms and want to do hormone replacement therapy and need a prescription at some point, then come see us one-on-one and you can join the course As well, there won't be a charge for the course. You'll just be doing the program.

What if I don't know whether my problem is hormones, thyroid, insulin inflammation, stress, or something else? Do I need to know what's wrong before I join?

Hundred percent, you do not. This is the course for you because this will give you a good idea of where the issue is because we're checking all those things.

What about the woman who was eating well, exercising, and doing every Everything she's been told to do, but the weight still isn't moving, and she feels really exhausted.

Well, you're going to meet all your sisters because everybody in our in our practice, or a lot of people that practice, are very much like that. And this is what happens in this decade as your hormones change. They really allow insulin resistance and cortisol issues to happen. Great.

How often is the group offered? Next start date is September 29th.

And you know, was I clear about the course versus the patient? So if you're a patient of ours, you don't need to buy the course. Please don't buy the course. It's included in you being a patient. If you are not a patient of ours, you should become a patient and do the course, which would be included. Just, I just want to reiterate.

If this is a good program, how will I understand what my labs mean and what my body may need?

Yeah, so it's a group program. So we are doing this as a group. So we'll be like, this is what everybody's— and I'll look at all the labs before and say, oh, these are the ranges of cortisol we saw. If your cortisol is X, you should think about these things. If your cortisol is like this, you should think about these things. So it's really more educating you to be empowered to take those things. That being said, some women were just like, I want to share my labs. Can we— can we use me as an example to go through stuff? And we use multiple people because a lot of people had similar Can you say the top 3 tests again? Oh, the top 3 tests are hs-CRP, cortisol, and free T3 and TSH. So maybe—

How far out are you booking one-on-one new patients?

Uh, one-on-one new patients, I think we're about 10 days, but it is always like people who cancel. We all are busy women, stuff happens. So just ask the team and they could probably get you And that's initial. Just remember, it's two hours. So before doing an initial with us, you schedule a discovery call and you talk to our team member just to make sure you understand what it entails. And so if you could drop the chat for just the discovery call so that they drop the link so that they know where that is.

At the end of seven weeks, what do you want someone to know about their body that they did not know today?

I want them to know that their body's been trying to talk to them for a while and that it's fixable. Because so much of what we find, people just accept their symptoms. And to know that, you know, now what's off and I empowered and feel powerful because you can powerfully age.

What happens after reset? I'm trying to figure out the next step on my own.

Yeah. So after 7-week reset, we had a few patients who became patients because they were like, this This is what I'm looking for, but I need hormones, or I need to look at my gut deeper. And that could be the next step. Or, you know, you come and see us one-on-one. One-on-one, you see myself and my nurse practitioner. It's unlimited appointments. It's concierge style. So you message, we message, you do a set number of labs. This initial plus maybe gut and more toxin type testing. But it's really trying to understand who you are in that initial 2-hour appointment.

Is there an initial consultation?

Yeah, it's $450 and it's for 2 hours. People don't always believe me, it's for 2 hours. It really is for 2 hours, so please come for 2 whole hours.

Awesome. Okay, so the last question I have here is for the person watching right now who knows something needs to change but is thinking, I deal with it later. What would you say to me?

I would say deal with it now because, you know, a lot of women especially— I'm sure men on this call as well are investing into their kids and their families, and they have to recognize that they need to invest in themselves. Because if you are not strong and you're not healthy, you know, you will— you'll— you sometimes women are holding everybody else's lives together and you'll decimate all of that. So do it for them. Don't wait. Don't hesitate. Because the longer you wait, the harder it is to reverse disease. And I say this also because if you have one autoimmune marker You're three times more likely to get the second autoimmune marker within five years. Don't wait. Look now. Understand now. Sometimes, you know, a lot of patients who I meet who are already in their fifties and saying, "I wish I knew this when I was like in my thirties." That's really where we have to educate is women in their thirties and twenties is build muscle, reduce inflammation, choose healthy. Right? Awesome. If there are any other questions, you know, hopefully we'll have this next one at some point. But hopefully you can join. I hope to see many. if you're there. Remember, I'm trying to keep the group really small so it can be intimate. Existing patients, you're all welcome, but, um, make sure you try and show up for those sessions, and, uh, you'll get the recording as well. But you can always message us. I hope this was helpful. Okay, excellent. Um, in fact, was there anything else? Yes, everything can be done online. It was just a random question. We kind of see a lot of people virtually. You just have to be in the 2 hours in California or come to California once. And again, I'm sorry for everybody out of state. Excellent. Thank you all for joining and wish you a good night. Thanks for staying with me for this long.

Thank you.