Episode #61: Could Gluten be Causing Your Symptoms? with Dr. Peter Osborne

Hey beautiful, it's Dr. Tabatha. I want to share something with you that I believe God is doing right now in women's health. We're in the middle of a massive movement and most people don't even know it. Every single day, 6,000 women in the U.S. enter menopause. That's over 2 million women a year, and by 2030, that's more than 1.2 billion women worldwide. So here's the thing, most of these women feel exhausted, bloated, anxious, disconnected from themselves, and the medical system is Doctors are handing out prescriptions and quick fixes, and no one is helping women heal from the root cause of their issues. That's where Fast to Faith coaches come in. As a certified coach, you'll be equipped to help midlife women balance their hormones, heal their gut, regain their energy, and reconnect their faith, the foundation that so many of us have been missing. And from a business standpoint, woo, this is one of the most lucrative untapped opportunities in the entire health coaching world. The global health coaching industry is expected to reach over $33 billion by 2023, and midlife women are the fastest-growing, highest-spending demographic in that space. Most importantly, these women stay with their coaches. They invest deeply because they are desperate for lasting transformation— body, mind, and spirit. So if you've been feeling that pull and that whisper that you're meant to do more, This is it. Now is the time to rise, to serve, and build a purpose-driven business that not only changes other women's lives but transforms your own in the process. Because when you help one woman heal, you help her family, her marriage, her faith, and her future. That's the ripple effect that we're creating with Fast to Faith. So join me, click the link to come watch this webinar. It might be the one thing that really moves the needle for you in this Next season. I can't wait to see you in there. Hi, I'm Dr. Tabatha, the Functional Gynecologist. I'm a board-certified OB-GYN and functional medicine physician. I've embraced the world of functional medicine and wellness through my own personal health journey, and I'm super excited to share my wisdom and unique perspective as it pertains to women's health. So if you're struggling with hormone imbalance, weight gain, period issues, anxiety, insomnia, you name it, Then you've come to the right place. I want to be your functional gynecologist. So welcome. Hi ladies, I'm super excited for this episode because I am interviewing a powerhouse of a doc. He is one of the frontiers of the gluten-free movement, and he was there from the beginning. He's been in diving deep on the research. He wrote one of the bestselling books called No Grain, No Pain. And his work, along with others, has just made a huge impact on my life personally and Hundreds of my patients. So I'm like super honored to have him here today to talk about gluten and why it's a problem for so many people because it still feels, from the conventional medical community, like this is woo-woo or there isn't science behind it, when in fact there's tens of thousands of scientific articles and journals.

Yeah.

Validifying the issues with gluten and the diseases that it causes. It's just that it takes time for new information and science to be accepted by mainstream medical society, especially when there isn't a medication to fix it, right? If you aren't— if it's not being backed by the drug companies, it's not going to be pushed into the medical marketplace. as something that needs to be paid attention to. So, you know, in my mind, there's no controversy, there's no question. Like, the evidence is clear. It's been going— they've been studying it for over 30 years and the evidence is overwhelming. And I will tell you, living with the issues myself— so today we're going to talk about what does gluten even cause? Gluten causes a multitude of symptoms, and it's not just gut symptoms. It does cause irritable bowel syndrome and bloating and digestive issues and feeling like you're 9 months pregnant after you eat and all of these things, but it doesn't have to. For me personally, it causes severe depression. It causes low back pain to the point where I can't function. It causes Rashes, eczema. I also have dermatitis herpetiformis, which is like a little bubbly skin rash that looks like vessels and it itches really bad and it is not comfortable. I have multiple issues with gluten. I have brain fog. You know, those are just the big ones. And so I see this every day in my patients. Gluten affects Different people in different ways. And not everybody, so not everybody has a gluten issue, but unfortunately, a large part of our population does. And so it's important for you to consider that when you are dealing with all of these symptoms and trying to figure out what's going on with you and you're not getting the answers from your doctor, like— I'm exhausted. I don't want to get out of bed. My muscles hurt too much when I exercise. That was a big one for me, is I would exercise and it would feel great, but then I would be down for like 2 or 3 days because my muscles were so fatigued and so sore, like I had way overexerted when I hadn't. So that's another issue people deal with. So if you're already diagnosed with any kind of autoimmune issue or chronic pain issue, then this episode is for you. If you have symptoms that you don't have an answer for, this episode is for you. Or if you know someone who's struggling, this episode is for you. Like, I really think this information just is important to get out there and share. So share this episode with everybody you know because it's super important. And Dr. Osborne is the man. Like, he knows his stuff. Like, hopefully, you know, he uses a lot of big words and you can understand it, but he does an amazing job because he uses a lot of analogies. He breaks things down, makes it easy to understand as best as we can. So please stay and listen to this episode. It could be life-changing for you or someone that you love. Honestly, It has given me my life back. I struggled to function and now I'm thriving. I'm loving life, enjoying life, doing everything I want to do. And it's because I gave up gluten. I mean, that's not all of it. We're going to talk about what else gluten does and how we have to replenish nutrients and everything else, but that was the key to getting my life back. So Please listen to this episode. But first, I need to sing his praises. So let me just tell you about Dr. Peter Osborne. So he's originally a doctor of chiropractic and pastoral science, but he's also an expert in functional nutrition and he's board certified with the American Clinical Board of Nutrition. He's oftentimes referred to as the Gluten-Free Warrior. He is one of the most sought-after alternative and nutrition experts in the world. He has the honor and privilege of sharing some of the world's most well-known, internationally recognized stage experts: Dr. Alessio Fasano, Dr. Russell Jaffe, Dr. Steven Gundry, Dr. Joe Mercola, Dr. Yudhana Schofield, and Dr. Josh Axe. He's one of the world's leading authorities on gluten sensitivity. He lectures nationally to both the public as well as doctors and many other nutritionally related topics. He's the founder of Gluten-Free Society. He's the author of Gluten-Free Health Solution, the Glutenology Health Matrix, which we're going to talk about, is a series of digital videos and ebooks designed to help educate the world about gluten. He's the author of the international bestselling book No Grain, No Pain, published by Simon& Schuster. And it was printed in 5 languages and turned into a PBS special that aired nationwide. So that's pretty impressive. So because of his work with gluten, Dr. Osborne was invited to speak at the Harvard Faculty Club with functional medicine advocate and New York Times author and TV icon Suzanne Somers. That's pretty cool. Because of his passion to educate the world About the relationship between gluten and autoimmune disease, he founded, financed, and hosted the Autoimmune Revolution 1 and 2. That's a free online educational series featuring over 40 of the world's leading experts on autoimmune disease and nutrition. Dr. Osborne has been a featured expert in a number of documentaries, including Betrayal, Autoimmune Secrets Revealed, and the Netflix series Afflicted. Dr. Osborne has served as the executive director and vice president for the American Clinical Board of Nutrition. He was also an adjunct professor at HCC and Texas Women's University, teaching nutrition and neurophysiology to nursing and occupational therapy students. He currently serves on the advisory board for Functional Medicine University. Okay, so he has been featured in or on Netflix, Fox News, CBS, PBS, the New York Post, Muscle and Fitness, celiac.com, The Gluten Summit, RadioMD, The People's Pharmacy, The Journal of Gluten Sensitivity, and many other publications. So I'm like super honored that he is here talking with me today. Amazing, amazing, accomplished man who has helped give me back my health and so many of my patients. So I'm appreciative of his work. So let's talk to him. Let's dive in. Here we go. Well, welcome, Dr. Osborne, to the Functional Gynecologist Podcast.

Well, thanks for having me. It's a pleasure to be here.

Oh my gosh, the pleasure is all mine because you are one of the reasons that I reclaimed my health. And so I just want to thank you publicly for all of the amazing work you're doing because it's changing people's lives.

Well, that's amazing. Thank you for sharing that with me. I didn't know that. I'm always thrilled to know when people have a success in their health and it was in part caused by some of the knowledge and information we put out there. So that's amazing. Thank you.

Yeah, it's been quite a journey for me. I had Hashimoto's diagnosed at 18 after I had my daughter. And, you know, I'm still amazed that I got that diagnosis so long ago, you know, that I had a doctor who was smart enough to actually test my antibody levels, but that's kind of where it ended, right? I got the Synthroid and then I was sent on my way. And so I went decades of eating a ton of gluten and all these inflammatory foods and creating so much pain in my body with my lifestyle. And, you know, when you start— when you came out with No Grain, No Pain, it was like, oh my gosh, aha, that makes so much sense. You know, my favorite food was ice cream cones. So you got the dairy, you got the gluten and the sugar. It's like the trifecta of evil, right? That's right.

Yeah.

Yeah. And so I had to reinvent my whole life, but what a world of difference it makes. And now, like, all day long I'm prescribing getting off gluten. So I need you to talk to my listeners and tell them, like, what Is the problem with gluten? Why does it cause inflammation and pain? And, you know, where does this all stem from?

Yeah, I think there are— you know, if we're talking about gluten, gluten is one thing and then grain is another thing altogether different. Um, but if we're just gonna— let's just start with gluten, I think. Keep it simple.

Yeah.

You know, gluten, gluten by definition, if you're reading a food label, gluten is actually a protein called gliadin, which is found in wheat, barley, and rye. But that's not the actual definition of gluten, like the botanical definition. That's actually where I— where I stumbled upon plant research, because none of my patients, after they were going gluten-free, they would get better, and then they'd hit a point where they weren't getting better anymore. And what, what I traced that back to was they discovered the gluten-free junk food aisle in the grocery store. And so they were really just replacing wheat, barley, and rye with corn, oats, and rice. predominantly. And so when I really started looking at why that was happening, I came across some really old work by a Dr. T.J. Osborne, who's considered the plant chemistry doctor. He's the father of plant chemistry, and he actually is who isolated gluten in the beginning. It's a— basically, it's an alcohol-soluble fraction protein that is found in all plants, but predominantly all seeds of grass, right? So if we're looking at gluten in and of itself, what gluten actually is, it's the protein. Found in the seeds of grass. So that's wheat, barley, rye, oats, corn, rice, sorghum, millet, teff, triticale, etc. That's when I asked, okay, well, if all forms of grass seed have gluten in them, why are we just focusing on wheat, barley, and rye? And the reason why was those were the staple grains primarily in the European area when Dr. Thomas— or Dr. Dicke, who was the original discoverer of what caused celiac disease back in 19— early, late 1940s, early 1950s. He actually wrote his paper on the cause of celiac disease, and he identified his pediatric patients during World War II where grain was rationed and not available in the hospital. They all went into remission, and he wrote his paper on that. Those were the staple grains: wheat, barley, and rye. Then at the University of Alabama Birmingham a few years later, this was 1952, They discovered gliadin. They isolated and fractionated out gliadin, and this was a study only done on 10 patients. I think it's important to understand like where this all comes from. 10 people decided that what we were gonna call gluten for the next 70 years, even though it's not actually accurate, right? So they isolated gliadin and said gliadin is a part of what causes celiac disease. In 2010, a group of Australian researchers discovered 400 forms of gluten that weren't previously discovered. 40 of them were more toxic than the gluten found in wheat, barley, and rye gliadin. So, so this kind of led me to just hitting the books, hitting the researchers, asking, calling them up, asking them questions. You know, I investigated. There were some researchers in South America that were studying corn gluten, and they were finding all kinds of crazy things. Corn gluten causing the same type of damage that wheat gluten caused in celiac patients. They were finding direct nitric oxide, which is a form of inflammation. It's a marker for inflammation, but they were measuring nitric oxide in the colon of celiacs after being being exposed to corn and finding that it was lighting them up. And they went on to discover that the corn gluten actually interacts with the HLA-DQ receptor, which is that antenna on our immune cells that recognizes gluten as an enemy. They found that corn gluten activates and aggravates that receptor more than wheat gluten, right? So here we are in the US today with our labeling law that was just created a few years ago that says it You know, to call it gluten-free, you have to have no wheat, no barley, no rye, down to 20 parts per million. So you could have 10 parts per million and still call it gluten-free, and it's still going to contain some gluten in it, although fractionated. But it doesn't take much gluten to create an inflammatory response. As a matter of fact, some researchers have found that only one breadcrumb, which is 20— the 20 parts per million rule— can cause inflammation for as long as 2 months. So, you know, you take that person who's cheating only once a week, right, the cheat meal. right, or cheating only once a month, right, and they're struggling to get better. This is what I was running into in my practice was people were struggling. They were getting better, but then they were plateauing, and then the inflammation would rebound back, and then they'd have more problems. And I actually named it gluten-free whiplash because what would happen is they go gluten-free, they'd have a good period of reprieve, and then boom, they'd whiplash back and have many more symptoms of autoimmunity. And so what we started— as we started collecting this evidence and this research, We realized that if we were looking at strictly the plant definition, the botanical definition of what gluten is, that you can't just isolate wheat, barley, and rye and say only those grains are dangerous. Gluten is found in all forms of grain, and most— if we look in the research, most of those forms of grains have been shown to cause inflammation in people with gluten sensitivity. Not all of them, not 100% of the time, but again, the struggle here is when you look at other research that says— on celiac patients that showed them going on gluten-free diets for up to 5 years. One study showed only 92%— or not only, only 8% had recovery of villous damage after years of a gluten-free diet. Another study showed, I think it was like 58% had recovery and 42% didn't. So there's all these research studies that show that almost half or more of the people going on a traditional gluten-free diet— I call that wheat, barley, and rye-free, traditional gluten-free— Don't respond effectively all that well and continue to have persistent damage and inflammation. And that just wasn't acceptable to me in my practice. So that's what led to, you know, what I, what I call today the true gluten-free diet, which is a completely grain-free diet. But, and then there are more rules to the true gluten-free diet, but that's, that's the biggest one. It's that you've got to cut grain out if you really truly want to cut gluten out, because all grains have some form of gluten. And many of these glutens have what's called homology, meaning that the structure of the protein is very similar from one gluten to the next. And so if a person's reacting to one, there's a greater likelihood they're going to react to the others. And that they may not react to the others as aggressively as they act to one kind or another kind, but they're still reacting. And if we're trying to heal years of autoimmune-induced inflammation, we've got to put out the fire, right? And if we don't put out the fire and that fire keeps burning, it's just going to cause inflammation that migrates through the body. It'll, it'll make its way to the thyroid, it'll make its way to the liver, the joints, the skin. And the average person with one autoimmune disease over their lifetime will develop 6 more. And, you know, that to the tune of, if it's celiac disease, you're at a fourfold increased risk for death if you get gluten exposure. And if you have a generalized autoimmune disease, you're going to die 10 years earlier than your counterpart who doesn't have autoimmune disease. And on top of that, the quality of life you're going to live is going to be quite miserable as you get older because the damage accumulates and it really can wreck your life.

Yeah, and I'm definitely not willing to accept that. You know, I, I have Hashimoto's, I have Raynaud's, I have dermatitis herpetiformis, and it's like, it's a slippery slope. Like you said, one thing starts and leads to another. So you made a lot of important points. I think it's super important to not just switch out gluten for your gluten-free junk products. So that's really important. So I was clear on what I needed to do because I already had a diagnosis. But what about other people? Should everybody be gluten-free? Or who should be thinking, I need to go no grain, no pain?

So I think everybody should be no grain, no pain. Everyone. And but that's not because of gluten. Not everyone is gluten sensitive. I don't believe that. I don't think we can make that statement. The research Doesn't show that to be true, and there's a long history of humans eating grain as a staple food. There's also a long history of celiac disease. A lot of people don't realize that 2000 BC was the first description of celiac disease. It's not a new disease. It's not only because of glyphosate or genetic manipulation or genetic hybridization of grains. It's been here a very long time, and people have been reacting to it for a very long time. But I can't say that we could scientifically argue that everyone 100% is gluten sensitive. That being said, why would I recommend everybody go grain-free? Because if you look at the way grains are grown today, first of all, grains account— in the United States account for more than 50% of the total caloric intake of the diet. Now, that has never been true in America, in American history or world history, that even though grains have always been grown and used as food, they've never accounted for the quantitative level that they account for today. And you have to understand, what is a grain? A grain is a seed. Okay? What do seeds— what is their job? What is their design? Mother Nature, God, what is the intention? The intention is perpetuation of the species, right? So you have this inanimate object whose sole purpose is to allow their species to propagate and survive. They do not want to be eaten into extinction. Okay? They don't have the ability to pick up a gun and shoot you or shoot your enemies, shoot their enemies. They don't have the legs to run away. They can't— they don't have arms to fight back, right? But they've developed chemical means to protect themselves. And some of these chemicals— I'll give you an example of one of them. It's called an amylase-trypsin inhibitor. It's a protein found in wheat and other grains. And this protein can actually shut down your pancreatic enzyme production. So the grain has developed a chemical warfare against predators to prevent its being eaten into extinction so that it can propagate itself, right? So it wants to come out of your poop. Undigested because your poop is a fertilizer, right? So when it hits the ground, you've got the seed, you've got fertilizer, you've got the ground. We can propagate the species and continue to survive. So it's designed mechanisms to shut down and hinder your digestion. That's one reason why avoiding grain as a primary staple food is a good idea. But there are there are plenty of other reasons. You know, there certainly is glyphosate as one of the issues. Most grains today, even if they're not genetically manipulated grain, they're still sprayed with glyphosate. For example, corn is double sprayed with glyphosate on the average commercial farm, sprayed in the beginning, and it's sprayed again at the end to dry out the crop so that it desiccates faster and they can harvest it faster. Beyond that, they spray the seeds with different hormones that are pesticide residue that act like hormones. Many of them act like estrogens. And so, you know, we have, you know, we have in our society today kind of a the largest degree of sexual confusion that we've ever seen. I, you know, whether— I don't— whether you're homosexual or not, I'm not— this is not my judgment on lifestyle. This is just my observation as a scientist that when you pump boys full of estrogen, then you alter their ability to have male characteristics, male sexual characteristics develop as effectively. We see this in animals, right? We see it in frogs and fish and salamanders where you dump these chemical pesticides you actually get literally chemical castration of the males. The males turn into females. That's been known for 30 years. So many of these pesticides act as pseudoestrogens or chemical estrogens that can affect the health of a male or a female. For females, too much estrogen, estrogen dominance, and a host of problems that come along with that. For males, it can create issues as well, including certain types of cancer. So you've got— that's one of the fundamental components of grain. the way they're sprayed, the way that the chemicals are used with them. Then you also have the fact that grain, if you use it as a massive staple food, is a— is too great of a degree in the diet of omega-6 fatty acids. So the ratio of omega-6 fatty acids in most humans should be at least 4 to 1 omega-6 to omega-3, and some would argue even more closer to 1 to 1 ratio. 6 to 1 or 6 to 3 is omega-6 to omega-3. A 1 to 1 ratio And at the very least, a 4:1 ratio. Grains are the opposite of that. Grains are very, very high in omega-6 and virtually have no omega-3 at all. So what they've done, and I see this in my patients all the time, their omega-3, omega-6 ratios are through the roof. We're getting ratios in people that are 40:1, right? And what does that do? That promotes inflammation. It's not that omega-6 is unhealthy or bad. It's that when the ratio is skewed, the body uses inflammation more aggressively than what it should. It's kind of like if I'm, if I'm using a wrecking ball to tear down a building, right, the wrecking ball is the right, is the right piece of equipment. If I use a nuclear bomb instead, I'm not just going to take out the building, I'm going to take out the city block and potentially even the city. That's what happens in people's bodies when their omega-6 to omega-3 ratio is that high, is they're just overexerting the inflammatory response. So their, their body's naturally producing inflammation to break down old tissue so it can repair and bring in new tissue.

Yeah.

But when you have a hyper-aggressive inflammatory response because of an omega-6:3 ratio abnormality, it just makes you more prone to chronic inflammation. So those are some— I mean, there are plenty of other things that we could talk about, but those are some big ones that why would we want to go grain-free. Those are several reasons why.

Yeah, well, I think those are awesome reasons, and I just think back to childhood when we would use vegetable oil for everything and deep-fry biscuits to make donuts, and it's like, wow, the Omega-6 levels must have been through the roof because all those vegetable oils are so toxic with the omega-6s as well, you know. And I think that's a lot of our processed food that we're giving our kids—granola bars, you know, all that fake food. Oh my gosh, that's such a good point. So talking about food and nutrition, you know, I want you to talk a little bit more about how. Having a gluten issue can induce some nutrient deficiencies because I think a lot of the complaints I see in my patients, like they're feeling anxious, they're feeling depressed, they can't sleep, they can't lose weight, I'm finding that they're nutrient deficiencies, you know. And like you say, you can't just get rid of the gluten and expect to feel better if you are depleted from that process, right? You have to then go and Replenish everything that it's destroyed from you.

Yeah, if you're gluten sensitive, think of it this way. Gluten is like the nail that pops your tire. You roll up in your driveway, you roll over a nail, you pop the tire. Okay, that's gluten. Gluten's the nail, the tire's your body. You can take the nail out of the tire, in essence remove gluten from your diet, the tire still popped, right? The damage is still there. The damage that was created by the gluten is still done. And in the— so the state of the vehicle is still undrivable. So we have to do the work. What is the work? We have to do the work to repair the tire. And that work is jacking up the car, you know, taking out the wrench and undoing the lug nuts and, you know, pulling that tire off, patching it, or whatever needs to happen, right? There's a lot of work that goes into that. The work— the workers that your body uses to heal. So like, you know, the tire analogy is you're doing the physical work, but your body uses vitamins and minerals.

Mm-hmm.

and nutrients as its workers. Those are the— they drive the enzymes and the coenzymes that allow the body to chemically repair itself from damage. So if eating gluten, right, did the damage in the first place, it's also important to recognize that eating gluten causes malabsorption and vitamin and mineral deficiencies. That's part of the damage gluten causes, is it damages your ability to digest.

Uh-huh.

Nutrients from the food that you eat. So not only can it damage your tissues, but it can damage your ability to get nutrients from the food you eat. So here you are, you're beginning a gluten-free diet, your body's malnourished, right? And it's damaged. What does it need to heal the damage? Nutrients. What don't you have because you've been eating gluten and not getting enough of? Nutrients. So vitamins and minerals are super critical for the healing process. So one of the things that, that can be done, and I would encourage anyone in your listening audience to talk with their doctor But don't just talk to any doctor about this. You've got to talk to a functional doctor who's trained in nutrition. If you go to a general practitioner and say, hey, I want you to check my nutritional levels, look, there's an art to this. It would be like going to a mechanic who specializes only in BMWs and saying, hey, I want you to fix my Hyundai. They may do an okay job, but it's not going to be great. A BMW is a very fine-tuned machine that requires somebody with a great degree of knowledge about it to fix it. Well, your body is a fine-tuned machine that requires somebody with a greater degree of knowledge about nutrition to be able to help you assess your nutrition properly. And you have to understand, the average doctor going through medical school has less— receives less than 7 hours of nutritional education. And you could probably vouch for me on this one. Most of those 7 hours are not pro-nutrition. They're anti-nutrition, right? They're teaching how nutrition is not important. Okay, and and don't worry about it because you've got medicine. So so you don't want to go to a doctor who knows nothing because it's important methodology and how you test for nutritional deficiency as a as a practitioner is extremely important. And if the doctor doesn't know what they're doing, they're going to order the wrong tests that give the wrong information or they give limited information, and you're not going to get better. So there there's an art to that. So find a good functional doctor who understands nutrition, who's had postgraduate training. To a much greater degree or much greater level. And that's where you can engage in that and say, hey, look, I want to get my nutritional levels checked. My favorite way to do it, you know, as far as methodology is concerned, is using a type of technology called lymphocyte proliferation. And lymphocyte— what lymphocyte proliferation is, it's a fancy word. Lymphocyte is a form of white blood cell. It's a type of white blood cell. And the reason why I like to use this technology is because white blood cells have a 6-month lifespan. So when we're analyzing your nutritional content inside of your white blood cell, we get a 6-month average of your nutritional status. It's kind of like running a hemoglobin A1c test to look at blood sugar. You get a 3 to 4 month average of blood sugar. Well, we want an average of long term. Why don't we want a serum test? Because a serum test is a reflection of your last meal. It's not a reflection of your nutritional status. It's a reflection of what you ate most recently. And what you ate most recently might not be a reflection of the comprehensive nature of your diet. So we want something that can give you a better kind of window. Think of it almost like a serum test is like a snapshot of a movie. A lymphocyte proliferation test is like watching the whole movie, right? You get the whole plot. You get the antithesis, the thesis, everything.

Yeah.

You get all the actors, the characters, all of it. And so when you have that type of information, then you can sit down and you can say, okay, where is this person lacking? And now you can teach them, and you can help them understand these are foods that contain more zinc. These are foods that contain more B12. Whatever they're deficient in, you can address it with diet, but you can also, if you need to, address it with proper supplementation. And sometimes that's what's necessary. I've seen it time and time again where people without supplements failed to recover. And that's not to say that a person has to be on supplements for the rest of their life. That's just saying that when you're in a hole. When you're in that hole of that pit of illness, sometimes you need a rope and a pickaxe to dig yourself out. Well, think of those vitamins as the tools that you might use to dig yourself out of that despair of being in that pit of illness. And so sometimes it's necessary, and there's a lot of research too that shows that people that go gluten-free oftentimes still struggle to heal because they're so low in certain nutrients. And so, so just to me, it's, it's a gold standard. If you're, if you're a gluten-sensitive individual and you're not having your doctor check your nutritional status twice a year, you need to.

Yeah, I see that all the time in my patients. I mean, they just can't heal until we get their levels up to functionally optimal, you know, and their primary care doctors oftentimes will freak out because they think the levels are too high or they're on too much. And I'm like, just trust me, I promise, you know, because I can attest, like, as you were Yeah. As you were saying, as a conventional doctor, I was trained to understand the levels to prevent major disease, right? You take this much vitamin D to prevent rickets. You take this much vitamin C to prevent scurvy. But that has nothing to do with optimal function or people who are trying to live with disease like autoimmune and stuff. So conventional medicine has no idea, unfortunately, what kind of levels we need to be at. And so, like you're saying, you have to find a provider who is functionally trained, nutritionally trained, to really understand that and help you get back to where you need to be. You know, I see that all day long in my practice, so I love that you're pointing that out. What are the most common vitamin deficiencies we see with gluten issues?

There's 5 of them, and this is 20 years of research. I'm going to publish this Soon as I get some free time. But I've got extensive data on testing people with celiac and gluten sensitivity. What the research shows is that iron is number one, vitamin D, vitamin B12. Those are the kind of the 3 main ones in most, most research studies that have done this. But what's the flaw in the research studies on this arena is that most of the research studies are using serum values, right? So they're using the very same, almost like inaccurate values to measure Which nutrients are potentially problematic. My experience is number 1, vitamin D, hands down vitamin D deficiency is the top. Number 2, vitamin B12. Number 3, iron. Number 4, zinc. And number 5, omega-3. Those are the top 5 deficiencies of essential nutrients. Now we get a whole battery— there's 40 different essential nutrients, so we get a whole plethora and battery of of different things. And I'd say that those are the top 5 I see on the most, most commonly. But it's also very, very random, right? So like the average person I see that has a longstanding inflammatory process as a result of eating gluten and lifestyle has on average at least 4 deficiencies, the average one. But many of them have 15 or more, like, like, so, so, so like the average is 4, but then we have some with like have, you know, 15. They light the whole test up, like they're just deficient in most things. And so I would say this is why I recommend people get tested, because you— I mean, the best thing that you can do as a person watching this, if you don't have a functional doctor and you're not working with anyone, is take a multi, take a fish oil, make sure you're taking vitamin D. And my recommendation on vitamin D is 6,000 units a day. It's not toxic. It probably won't even move your vitamin D up all that much if you're inflamed. But, but 2,000 is not going to do anything. It's like spitting on a forest fire. You're not going to do anything with 2,000 units of vitamin D, which is what most doctors kind of hover around in their recommendations. And then take a, take a good probiotic because a lot of the research shows that probiotics aren't nutrients per se. We know that gluten causes Lactobacillus and Bifidobacterium deterioration, and those are the 2 primary species of gut bacteria that help you make vitamins. They help you digest your food. They do something called immune crosstalk, which is where they They talk to your immune system and help your immune system understand what is dangerous and what is not. So those are things that, in my opinion, everyone should be doing if they're gluten sensitive, if they're not working with a doctor and they just want to get nutrients in them. Beyond that, again, that's what I said earlier, is get tested twice a year, every 6 months.

Yeah, I can't emphasize the vitamin D issue enough. I'm up in Michigan. It might be better for you down in Texas. But wow, up here people are hanging out in the 20s and 30s if they're lucky, you know, and their doctors are like, yep, you're good, you're fine. I'm like, no, no, no, we're not fine at all. So I usually tell people like 60 to 80. Is that what you recommend?

Yeah, I'd like to see anybody with an autoimmune problem, I like to see them between 70 and 100. Yeah. While we're getting through that. Once they're past and beyond that and their autoimmune problem is, is no longer a major issue, as long as we're keeping it over 50, there are 2 things that I recommend around vitamin D preventatively if you live above 28 degrees latitude, which would be your, your neck of the woods. In Texas, it is a little different, but it's— we still have people, they don't go outside, right? So, right, we have the sun, but they—

Lather up with the sunscreen.

Yeah, it's, it's to do what's called a vitamin D therapy. When you come into the fall, sometime— best done sometime in September, October. And the way it's done is it's 150,000 units of vitamin D for 3 days, followed by 100,000 units of D for 3 days, followed by 50,000 units of D for 3 days, and then you're done. And what that does is that'll push you right through the winter. That'll keep your vitamin D status hefty all the way through winter. You might consider repeating that therapy kind of toward the end of winter. Depending on where you live, again, if you've got a longer winter where March is still winter, like in Texas, March is not still winter.

Right.

But what that does, what's interesting about vitamin D is, number one, you really don't get a whole lot of it from food unless you love liver. Liver is a pretty good source of vitamin D, but liver has so much vitamin A in it, they kind of compete with each other for absorption, so you don't— it's not the best source of pure vitamin D. Mushrooms have some vitamin D, and that's okay too, but beyond— and some of your fatty fish like mackerel and sardine will have some vitamin D in them as well. But beyond that, there's not a lot of vitamin D from food selection. So if you're not capable of getting out and getting into the sun living up north, vitamin D is critical. What they're finding with COVID you probably followed this, but there was a recent article published. I want to say it was JAMA or New England. I don't remember which journal it was. But they found 9 out of 10 COVID deaths were— could have been prevented. The thought is it could have been prevented if the person had adequate vitamin D status. And if you look at most of this, you know, most of the success with treating COVID has been if the person gets adequate vitamin D early enough, then their level of severity of progression is not really an issue. So vitamin D is one of the most potent antivirals and immune-supporting nutrients known to man.

Right.

And it's not even really technically a vitamin, it's a prohormone.

Right.

And that's one of the reasons why it's so powerful. So, it's one of the things that you can— that anybody can do, but I would recommend living north, you've got to make sure, and you can go to your doctor and have them check your 25D level, that's what the test is called in the blood, and that's a good marker of vitamin D status. But, um, you got to keep those levels up, especially in the winter months.

Yeah, so important. Oh, can't stress that enough. Probably you need to be 5,000 units a day or above, right?

So yeah, so like if you were— let's say you were at 50,000, or not 50,000, let's say you were at 50 in your blood, like your 25-OHD test came back and you were at a 50. If you took 5,000 units a day, it would probably go down through the winter. You probably wouldn't see it go up. It would probably go down into the 40s. If you took 6,000, you'd probably keep it somewhere around the same level. So that's a kind of a— think of that as a maintenance level.

Mm-hmm.

And if you took 8,000 to 10,000, you'd see it climb. You'd see it climb up into the 70+ range. If you— but again, most doctors are like, go to the store, go to Walmart, you know, pick you up some vitamin D. And most of those pills are 400 international units to 1,000 international units. Again, that's not going to touch your vitamin D level. It's not— even those— even the D2 that many doctors prescribe, there's a vitamin D2 that it's a 50,000-unit capsule. It's not the same thing as D3, by the way. But taking that once a week isn't going to elevate your vitamin D status, like especially if you're inflamed. What we're learning about people who have chronic inflammation is they have a greater need for vitamin D because vitamin D is almost like a— it's like a fire truck. It helps put out the fire. And so the more inflamed you are, the more vitamin D your body needs to combat the inflammation. So what happens is in the beginning stages of inflammation, if you're You're not figuring out why you're sick, you need more vitamin D to symptomatically help you get through that. And then as you get better and as you get better, you'll find that you need less vitamin D through the course of the year and that sunshine is capable of providing you with what— with predominantly what you need, provided you get out in it.

Oh, that's so, so important. I love that. Okay, so such good information on the nutrients. I want to go back to gluten for a minute because when people first come to see me, you know, and I start talking about gluten being possibly being an issue because they have chronic joint pain or fatigue, you know, other issues, they say, oh, I don't have any GI symptoms. Oh, my bowels are fine. Can you speak to that a little bit? Like, do we have to have GI symptoms?

No. There's 2 terms in the medical literature. that were created more than 30 years ago that were designed to help catch this. Okay, there's celiac disease, which is the gluten manifestation in the small intestine that causes gastrointestinal symptoms, typically diarrhea and intestinal pain. But then there's a term we use called non-celiac gluten sensitivity, NCGS. Now that was coined by Dr. Marsh. Dr. Marsh is the doctor who actually created the biopsy classification criteria to diagnose celiac disease. So he kind of knows what he's talking about. So he made this term non-celiac gluten sensitivity because what he was seeing was he was seeing people that were reacting to gluten even though they didn't have a positive biopsy. They didn't have the gut inflammation or the gut damage. And, and then shortly after that was coined, another doctor, a researcher out of the UK, Um, Oxford University, Dr. Marios Hadjivassiliou, and I don't know if I mangled his last name pronunciation or not, but, um, but he has been doing research now on gluten as a neurotoxin. And in his research, they actually are doing MRIs of the brain. What they're seeing is people have smaller brain sizes and, and, uh, lose their white matter over the course of gluten exposure, even in the absence, the complete absence of any GI symptoms. So he's seeing people that are developing a condition called cerebellar ataxia or gluten-induced ataxia, which is a dizziness and a vertigo-type symptom. We also know that gluten can damage the thyroid without damaging the gut. We know it can damage the skin. We know it can damage the muscles and the joints. Think of gluten as an equal opportunity destroyer. It affects the gut in some people, but in other people, it affects other tissues. There's another term, and I don't like this next term, but it is part of the medicine, it's part of medical literature, and it's called silent celiac disease. The reason I don't like it is because it confirms that it's celiac disease when in fact silent celiac disease just means you're developing symptoms outside of your gut that aren't celiac disease, and so they call it silent because you don't have the gut problems. That's not silent celiac disease. That's gluten-induced disease, right? If we really wanna call it what it is, that's non-celiac gluten sensitivity. And so, but non-celiac gluten sensitivity, some of the researchers who coined that term did a study where they followed people's biopsies Over long periods of time, and what they found is at certain levels of disease, they had no gut symptoms or gut problems, but they saw damage in the skin, or they saw damage in the thyroid, or they saw damage in the brain, etc. And so they kind of tracked how the biopsy is actually very misleading because you can have somebody— I actually had a patient one time, 19 biopsies, 19 of them.

Oh my God.

And over a 30-year period of time, right? And the 19th one was positive. The first 18 were negative. It took her 30 years to get a diagnosis.

Ugh.

And so if you don't have a gut problem, but you have an autoimmune disease, I will just simply say this. The number one known scientifically validated agreed-upon cause for autoimmunity is gluten, period. Now, there are other causes for autoimmunity. There are other contributing factors. Gluten's not the only. But it's the most well-studied, and it's the most universally scientifically recognized cause. So if you've got Hashimoto's, dermatitis herpetiformis, non-alcoholic fatty liver, autoimmune liver disease, if you've got rheumatoid arthritis, lupus, scleroderma, dermatomyositis, any of those, you should get tested for gluten sensitivity because there's a really great likelihood that you are gluten sensitive and that it's a big, big trigger In terms of your autoimmune condition. Yeah, exactly.

Like Dr. Alessio Fasano says, you just need 3 things to happen, right? You got to have that dang gluten trigger. You got to have a leaky gut and you got to have the genetic propensity. So what testing would you recommend they get?

Genetics. And I've done extensive research here. Extensive. We've looked at every kind of test you could imagine to look out for gluten. Here's the problem with biopsy. First of all, the training of the GI doctor. When GI doctors do biopsies, typically they take 4 samples. That's a pretty typical, uh, done biopsy. Um, Dr. Peter Greene at University of Columbia, Columbia, who runs the, the celiac research facility there, says you need 6 to 8 biopsy samples to be able to get a good idea. So most doctors, when they're doing a biopsy, are only doing 4 samples, half the quantity that might be necessary to actually isolate or identify the damage. And that's even saying if the damage is in the gut because the damage might not be in the gut. So the biopsy is good in the sense that it will— when it does identify villous atrophy, which is the hallmark that we're looking for, that flattening of the villi, then it's accurate. But it's not accurate per se for gluten because here's the thing, what else causes villous atrophy? Parasite infection can cause villous atrophy. Soy allergy. can cause villous atrophy. Other food allergy can cause villous atrophy. So a biopsy by itself, all by itself, is not a great measure to determine whether or not somebody has a gluten issue, but it is a tool that some doctors use. It's an invasive tool, but again, you get a lot of false negatives. So it's one of the reasons why I don't like the biopsy. The other are the blood tests. There's different blood tests that measure the antibodies. So for example, there's a— there's an antibody called anti-tissue transglutaminase. There's another one called anti-endomysial antibodies, and there's another one called an anti-gliadin antibody. Now, the problem with antibody testing is that when doctors run antibody tests, usually they first should— they should do this, but they don't always— they don't determine whether or not their patient has an antibody deficiency in the first place. So like, many people have an IgA deficiency or an IgG deficiency, and so if we're using an antibody that's IgA or IgG to detect the reaction to gluten, We may not see it if they're IgG or IgA deficient, right? So you can get a false negative in that way.

Yeah.

That's, that's one flaw. The other flaw is anti-tissue transglutaminase, as an example, may not be positive in somebody with Hashimoto's. Anti-tissue transglutaminase is a very specific marker for celiac disease, but not so much for the non-celiac gluten sensitivity varieties of illness that gluten can contribute to. Same thing with anti-endomysial antibodies. They're more specific for celiac, and they're not so specific for the other conditions associated with non-celiac gluten sensitivity.

Uh-huh.

And then— so you've got antibodies. The other flaw is the gliadin antibody. Gliadin is the name of the gluten found only in wheat, barley, and rye, so it doesn't list the antigens or the glutens that are found in corn and rice and sorghum and some of the other grains. So it's only specific for wheat, barley, rye.

Okay.

And understand that to date, there are estimated about 1,000 different forms of gluten. So if you run an antibody test looking for 1 of 1,000 different forms of gluten and you get a negative, it doesn't mean they're not reacting to some of those other forms. So those are problems with blood tests that, again, they're tools that can be used. They can provide some insight, but they're certainly not— I wouldn't call them definitive. This is why I recommend genetic testing, genetic testing of what's called the HLA-DQ genotype. There's 2 HLA-DQ genes. There's an HLA-DQ alpha 1 gene and an HLA-DQ beta 1 gene. And so these 2 genes, when combined, form the antenna that sits on the surface of our white blood cells called the HLA-DQ receptor. HLA stands for human leukocyte antigen. Leukocyte's a white blood cell. So, so this is a— think of it as an antenna on the surface of a white blood cell. So white blood cells here, the antenna sticks up off the surface, and the job of that antenna is to recognize friendly from foreign. So that the immune system doesn't attack good guys, but it also knows which bad guys to attack. Like, that's the purpose of this antenna. So we can look for gluten patterns on that antenna. So if a person has different, different alleles that we know are associated with gluten sensitivity, and we can pick up on that, then we know that they have the genetic predisposition to react to gluten. So what, what activates the genetic predisposition? Exposure.

Right.

Right? So we can talk about predisposition all day long. It's kind of like somebody with an MTHFR. What puts— MTHFR mutations don't mean the person is sick. MTHFR mutations mean that if that person gets in an environment where they're dealing with a ton of toxic burdens, they're gonna get sick faster, okay? So it's a lot like that with gluten. The gluten antenna, we can recognize whether or not a person has a genetic predisposition.

Right.

And so then from there, it's just a matter of exposure over time. The more exposure over time that person gets, the more likelihood they're going to develop an autoimmune process related to gluten induction. So, so genetic testing really gives us an insight. And then there's another— this isn't ready for lab yet, but there's another series of stuff that's coming out. We're learning more and more about it, and scientific literature is reporting on it. But there are other parts of the immune system that are called the innate immune system, which is kind of the immune system— think of the innate immune system as the immune system we're born with. Think of the humoral immune system as the immune system that grows and adapts and develops as we get exposure to different things in our environment. Well, the innate immune system, we're learning now that gluten actually engages the innate immune system too. So it's always— in the past, it's always been thought that gluten only engaged the learning immune system and didn't engage the innate immune system, but now we're learning that there are these receptors in our GI tract called TLR7 receptors, toll-like 7 receptors, and that gluten engages these receptors to produce an inflammation that leads to leaky gut that opens up the permeation of the gut and allows for all the garbage in your poop to leak into your bloodstream and make you chronically inflamed. So, so there will be tests, I'm certain, that will come of this new science and this new research, but to date it doesn't exist. So the best way to really know is looking at genetics. If you know the person's predisposition then you can basically alter their diet to match what their genes want, right?

Yeah.

So as opposed to saying, oh, let's try this gluten-free thing for 6 weeks and see if it works for you. Look, understand that those of you listening need to know this. Going gluten-free the right way is at least a 12-week learning curve. You don't wake up tomorrow and you're gluten-free because there's so much you don't know that you don't know. And so that you have to dedicate your time and your energy and your effort to understanding what gluten means and where it's found and where it is found in a hidden fashion and how it can be snuck into foods and the tricky terms that food manufacturers will put on labels to hide it. Those are all things that have to be learned. You have to understand that it can be found in lipstick. It can be found in cosmetics. It can be found in lotions and soaps and shampoos, and you can get exposure to it in those ways. Actually, most unique way I've ever seen anybody get exposure to gluten consistently after changing their diet was that they worked next door to a bakery, and they shared the same air ducts. They were breathing in wheat flour all day long coming over from the bakery, and they weren't getting better. And it was inflaming their airway. And so, you know, we had to get them out of that environment. When we did, they made a full recovery. But my point is—

Wow.

There's a lot of different ways gluten can be sneaky and can get into your diet or your lifestyle. And so it requires a good degree of learning to kind of educate yourself about it. And so nobody is going to— this is just my experience, not nobody. Most people won't dedicate the time, effort, and energy into something they're not certain about. Right? If there's a level of certainty, psychological certainty that this is the move I need to make that is the right move, that yes, I'm gluten sensitive genetically, if I do this, there's a very real potential that my thyroid problem might improve. Not, not, I'll try it and if it works, great, but no, scientifically we know this is the case. So it gives the person the ability to make a decision to dive in.

Right.

All the way, as opposed to, you know, what I like to call piecemealing or playing around with it, because you can't play around with it. Remember, 20 parts per million is enough to cause inflammation for 2 months. So when you dive in, it's all your— you know, it's hands and feet, everything goes in if you're going to be successful at it.

Yeah. And I don't know about you, but I've seen people who have the standard antibody testing for celiac, you know, maybe 5, 10 years ago, it's been ruled out. And they're coming to me and we're doing all that testing again. And now they're positive because autoimmune disease develops over time. It's not something you're born with or have or don't have, right? And so that's why I think genetic testing is important as well, because just because you were— you didn't have it last week doesn't mean you don't have it this week, right?

That's right. And your genes won't change. Right, right. Unlike your lab— your lab work can change, but your genes will not change. They are what they are.

Yeah, exactly. Oh my gosh, you've— we could just go on for hours because I, I mean, there's just so much to talk about. But I think it's good for people to have like a basic idea that, okay, if I'm struggling with all these random symptoms, my conventional doctor hasn't figured it out, maybe this is where I need to start. So, you know, I think everybody should just read No Grain, No Pain, do the 30 days. But like you're saying, if you're not all in, if you want to know for sure, like find a functional provider and get tested, right? And then think about your nutrient deficiencies for sure. Oh my gosh. What, what else do you want to leave my listeners with? Like, what is the biggest thing, you know, that you want them to know?

I think, I think the most important thing that anybody can know as it relates to improving their health is that it's not up to anybody to heal you. It's up to yourself to take responsibility. And, and the first step in taking responsibility is admitting that if you're sick with a chronic inflammatory illness, you have to first admit that it's your fault. And, and I don't say that to be crude or mean, uh, or demeaning. I say that because honesty is the ultimate love, right? And we can lie to ourselves, you know, but lying to ourselves only misleads us. It takes us down the wrong path, right? The road to good intention, when we give half-truths because we don't want to hurt somebody's feelings, that's good intention, right? The road to good intention, you know, good intentions are fine, but the road to hell is paved with them, as the old saying goes. And so truth, it's starting with self-truth. Like, look in the mirror and say, okay, I'm inflamed because there's some things that I'm doing. And maybe it's your fault, but you don't even know why And that, like, so that's the first step is first recognizing that there are things that you're doing that are at odds with what your body wants you to do if you're inflamed. And so it's your fault, but it's also your responsibility to try to start beginning the process of figuring out what it is that you're doing and what it is that you could do differently. There's 7 fundamentals that I have seen repetitively in 20 years of practice. These 7 fundamentals that I have seen mold and shape better health Time and time again, the first fundamental is diet. What you eat matters, right? You can't get healthy eating food that's not— it's just, sorry, that, that, that's a deal breaker, right? Number 2, sunshine. Sunshine's a nutrient in many ways. Vitamin D is one of them. Melatonin is another. You know, sunshine is a very, very critical nutrient your body craves and needs it. Quit hiding from it. I know the dermatologists are all telling you to lather up with SPF 55 or 100. But the reality is any SPF higher than 8 will block your vitamin D production, and vitamin D has now been linked and causally linked—not not associated with, but causally linked—to 19 forms of terminal cancer. So ask yourself: you're trading 19 forms of cancer for the fear of skin cancer, and actually we now know sunshine doesn't cause skin cancer; sunburning repetitively does. Right? Big difference. It's kind of like water causes drowning, so don't drink it anymore, right?

Right.

No. So, so sunshine is a second factor. The third factor is sleep. Love yourself enough to get good sleep. Your body heals between 10 PM and 2 AM, but you need more sleep than 10 to 2. So sleep further on, more on the, on the north side of it and more on the south side of it. Sleep's fundamental to health and, and life. Love. Is a fundamental. Surround yourself with positive energy. Surround yourself with people who care and love about you and that you care and love about, right? We need that. We need that tribe. That's a very, very important component to driving good health. We also need exercise. Your body is physical. In this physical world, we have to move it. There's an old adage, use it or lose it. It's very true. Your muscles work and your bones work on Wolff's Law principle, and that principle is they will grow and they will form based on external force and pressure. If you do not exercise, they dwindle, they deteriorate. And we know that when your muscles deteriorate, it's one of the first signs of a weakened immune system. And there's actually a name for it in medicine, it's called sarcopenia, age-related muscle loss, and it will make you sick and it will kill you. So exercise is very, very important. Clean air and clean water, right? So, so, you know, I'm a conservative at heart in all ways, like conservation of the environment as much as conservation of of my life and everything else, right? So, um, be politically active by helping preserve cleanliness of your air and water. And that is— part of that means filtering your air and water. But the other part is don't just filter your air and water. Like, you know, contact your local, uh, your local representatives, you know, your state representatives, and demand that we have good laws that help protect our environment. Because at the end of the day, this planet has to last. And if we poison it too aggressively, we're going to be in trouble. So clean air and clean water are also fundamental. So those things, right? So we're backing up. We've got food, we've got sunshine, we've got exercise, we've got clean air, clean water, we've got love, and we've got— what did I miss? Sleep. Sleep.

Sleep.

So—

I can attest to that as an obstetrician. Oh, Lord. I mean, that almost killed me, lack of sleep. So it is beyond necessary. I say it should be a non-negotiable. You need to sleep like it's your job. You need to show up every night and do your job, right?

Right. That's right.

Yeah. Oh my gosh, such good information. You are a wealth of knowledge. You are just— you are changing us for the better. Thank you, Dr. Osborne, so much for all your work.

Oh, you're welcome. Thanks for having me. I really appreciated you sharing this with your audience.

Yeah. Well, stay in touch and hopefully we can connect again. Okay?

Okay. Sounds like a plan.

Awesome. I hope you really liked that episode and found it super interesting and not too heavy on the medical terminology. I know it's hard to talk about about that stuff without using all those words, but I feel like Dr. Osborne does an amazing job with his analogies and just explaining it so that everybody can understand it. So I hope that you, you know, got something out of that because, unfortunately, I think gluten issues are more common than conventional medicine wants to admit. I see it every day in my practice. I I live with it myself. That's just life. So I really want you to check out Dr. Osborne's masterclass he's got coming out in the beginning of January. So it's called Glutenology Health Matrix. It's going to be a multi-day masterclass where you're going to learn all about gluten, the issues that it can cause, and more importantly, what to do about it, how you can reclaim your health and feel better. So that is going to be a free masterclass. I have the link in my show notes, so definitely sign up for it. And my understanding is you don't have to watch it at that one time, so it's, you know, going to be easy for you to watch it whenever it's convenient for you. And it's free, so why not do it? I mean, he's just a wealth of knowledge. I just His brain's pretty amazing. I mean, he reads something and it's like photographic memory. He, he, he understands things inside and out like nobody else. So such a good guest. Okay, so follow Dr. Osborne. Those links are in my show notes. I would love it if you would hit subscribe if you're finding value out of this, because that lets iTunes know you want to hear more and see more, right? Or let YouTube know if you're on YouTube, or send me a review. I want to hear what you're thinking. Send me your questions. I want to know what episodes you want to hear about. So I am here to serve you. Follow me @DrTabatha. That's T-A-B-A-T-H-A, no I's, just A's. And let me know how I can serve you. So I do this for you, and I appreciate you letting me be your functional gynecologist. So go have a kick-ass week, ladies. I love you.