You’re Not Really Bloated!

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We've had it wrong. I'm Debra Atkinson, and you're listening to Flipping 50. I started this podcast over a decade ago to answer questions about fitness and menopause and beyond before you know to ask them. The goal: to help accelerate your results with the science and the practical application of proven protocols. While living your best life. There's no more powerful health influencer in the world than a midlife woman. It's not just you, but it's the 3 generations that you influence. My unique 40-year career, including being a university senior lecturer in kinesiology, an industry subject matter expert, an international speaker, to founder of the first and the only exclusively made made for menopause and beyond fitness membership in the world. Every week I interview experts behind the science of optimal hormone balancing, fitness, and longevity, and share answers to our community's questions so you can have the vitality and the energy you want, need, and deserve.

Yeah, we've had it wrong.

You heard me right.

You're not really bloated. In this episode, my guest explains what bloated is. And isn't, and how your hormones and your gut interface happen, and why adding protein might not be the thing you want to do right now. My guest is Shefali Ravulia. She is a PA and the visionary founder of Precision Gut Health, a virtual telehealth practice on a mission to unlock secrets of gut health, nutrition, and longevity. At the heart of her practice lies a powerful fusion of functional medicine, culinary nutrition, and a profound commitment to digestive and metabolic health optimization. Using a deeply individualized approach, she's dedicated to guiding patients toward a future where gut health and longevity are intricately entwined and where vibrant health is not just a destination but a lifelong journey. I think you're really going to like this one, especially if you're plagued with any of the gut disasters like bloating, constipation, gas, diarrhea. And you may have a different word for bloating by the time we're done. Shefali, thank you so much for joining me today.

I'm so happy. Like I just was telling you, I, I, I'm in— I feel like I'm in Hollywood. Like, you're the first podcast I ever listened to 9, 10 years ago when I was 40. So this is really, really cool. I'm— it's I'm, I'm honored.

Well, this is really, really cool for you to tell me, so thank you so much. I too am honored, and no pressure, no pressure at all. All right, everybody here likes to dirt. We like to know the background. Why are you doing this? Gut health? Why gut health? And, and did you always see yourself in medicine? Did you know that's where you were going?

No, I went to college Well, I picked a biology major because you kind of have that sort of cultural emphasis of education in being Southeast Asian Indian. Like, yo, you gotta be pre-law or pre-med. So it was kind of like, I kind of felt like I had to be a science major, but I really, really enjoyed the liberal arts as well. So I actually didn't know, and I was trying to decide between med school and PA school in college, and being a PA at the time was not that well known. And I, I remember, uh, getting a lot of information about the PA profession, which I really wanted to do more because of the flexibility that I perceived that I would have. Um, that being said, I think you can totally be a physician and have some flexibility too. You can just make your life— I mean, you can go after things now, you know.

So cool, I love it. Why the gut? What?

Oh yeah. That's a circuitous path. So I'll try to keep it short. Cut me off if you need to. So I, my first job was away. We moved, uh, my husband and I, we got married young. You know, I met him in med school, PA school. We went to the same one and we graduated at the same time and he's in residency, um, which is what pulled us to out of Texas to Seattle. And I just found the first job I could get. I was supporting him as a resident and I worked in bone marrow transplant of all, you know, very, very unique niche, but also gave me a lot of great internal medicine, hospital care experience. And then when we decided to move back to Texas, there was no job in bone marrow transplant and hospital care. So I found a gastroenterology job. So I worked in conventional GI for a long time, off and on. And that's what I just got good at the gut, like, but from a conventional point of view initially. And then my foray into culinary medicine and cooking and structuring, like I became a stay-at-home mom for a little while and explored that led to functional medicine and nutrition. And, um, and then I tried to bring that back to a conventional GI practice, like what I'd learned. And it was challenging, you know, it was hard to be able to give everything that I wanted to in just, you know, 20 minutes, even sometimes even 30 minutes, you know. Um, and so I, I left, um, during the pandemic and decided I got did a little bit of metabolic health and functional medicine in a urology practice where I actually picked up a lot of cardio metabolic men's health, women's health, hormone health. So very different from gastro. But there was a reason for that that pulled me in is because my dad earlier, many years ago, had had a heart attack. And so I kind of got into cardiovascular health, nutrition, really starting from his health, honestly, because it didn't make sense. He was like super thin, vegetarian. I didn't learn anything about nutrition, you know, or heart— cardiac nutrition in school. And so, I really ended up learning a lot of things. But then, I ended up going back into gut health, bringing it all full circle. So, yeah, we do gut health, but we also do— once that's restored, we can work on things like hormones and lipids and, you know, other things that are important.

Love it. I want to come back to that actually. Eventually I want to come back to that. But the one question I think is, you know, I imagine my listeners, what would they ask you? Like if they had you locked in a room and you couldn't get out, what would they, what would they want to know before it was all over? And I think a lot of people want to know, why am I bloated? A lot of midlife women, you know, it's like suddenly, and nothing I do works. First of all, what is bloating? What causes it? And, and what is the difference between bloating and distension?

Ah, thank you. You were— you, you took it out of my mouth. So there's a big difference, right? Like, yeah. And I think a lot of people come to me saying I'm bloated, and then we have to really ask a lot of questions to figure out, are you— is it bloated? Are you flatulent? Are you gassy from above? Are you— or are you distended? And that bloating and distension is different in the sense that bloating can be related to hormonal health, water retention, things like that. And it's more of a sensation of feeling the gas, trapped gas perhaps, and just an discomfort, an overall disease. It can be related to constipation, but not always. And then distension is going to be actually the physical, uh, which— what you see. So, and I often will hear progressive distension during the day. So they wake up in the morning, their belly's flat, and then they eat something and it's just boom, they look pregnant. And then gets progressively worse during the day. And by the evening they're like, oh my God, I just look so pregnant. And then to the point they start watching their foods and sometimes restricting foods for sure.

Okay, and let's— we have to unpack all of that because I think, um, what I've noticed in terms of fasting, you know, I don't know that a lot of women really buy into fasting for the longevity and the autophagy. I think they will say they do, and with all due respect, listener, I, I got you, but I still think a lot of times we're defaulting to fasting because all it allows us to do is avoid the foods that cause the discomfort, and we haven't figured out the real solution. So we feel so much better when we avoid them.

Yep, yep. And I think it still needs to be personalized because you can be a faster— and there are different kinds that I like to use, not, not just one kind for every person, right? It's really catered to the person. Um, So you can, it's just that, yeah, unpack like why, maybe have someone help you figure that out, be thinking about why. And really, like, if you're fasting, I would say most of the time you probably want a pretty good gut because if you do have GI issues, symptoms, constipation, diarrhea, bloating, acid reflux, et cetera, belly pain, distention, uh, greasy stools, you know, too much undigested food in the stools, um, urgency. I mean, this is like a laundry list of GI symptoms, right, that I asked about. But if you have some of those, that needs to be addressed first.

Okay, so I'm gonna play devil's advocate because I think a lot of women will be under the belief that if you fast, it's going to improve your gut microbiome. So it's almost like a selling point that, oh, this will fix your gut issues. Talk to me about that.

So it depends what kind of fasting are we talking about, like fasting mimicking diet or alternate day fasting or 16:8? I think, like, I, I don't know that we really have solid evidence. We have a lot of solid evidence besides the fasting mimicking diet. Um, And some other ones too, but I think— I guess it would depend on what kind of fasting that would help the microbiome. I think that's a difficult relationship to make, like, as a generalization, I think.

So you, you're in favor of fasting mimicking diet, or—

I do really like it. I do really like it because of a couple of reasons. It's doable. It's in a 5-day, you know, 5 days. And I like that there's a lot of good scientific literature behind it for specific outcomes. Now, we're not saying, oh, it works for everything. Like, it has shown visceral fat reduction, waist circumference reduction, certainly autophagy and the benefits of autophagy and longevity. And then, you know, it's always in trial. There's always trials, small trials for various other things. But one reason I'm a fan of it is that it is doable. And, in midlife women where we're all hearing about protein and a muscle-centric movement, it can be a little tricky to get as much protein as you need if you're fasting every day on even a 16:8. Most of my women that come to me like that are Right. They're struggling with like, okay, I can't get the fiber and the protein in. Like, how am I going to do that?

Exactly. Yeah. And so just for listeners who are not familiar with the 5-day fasting mimicking diet, we should probably go back to square one. So sorry about that. If you're listening and you're like, what are you talking about? So, Shefali, do you want to explain? This is Dr. Valter Longo's, you know, Prolon program. I would find— I would be hard pressed to think that somebody here listening hasn't seen an ad yet. But that might be true.

Yeah. Yeah. Yeah. And yeah, it's a company.

Yes.

You know, keep that in mind, but you can, I know people that can do a homemade version. Um, I do think people should do it under some guidance. Um, but let me back up. It's a 5-day, um, it really is a package. Like, so you're like, you're probably thinking, oh my God, she's a fan of processed packaged foods. And I'm not, but I think that the benefits here can outweigh the— there's some benefits here. Um, and the food, so you get a 5-day kit and it's got like a very strategic day-to-day, um, you know, packet of meal. There's like soup packets and a bar, a couple of vitamins, and you're supposed to do like day 1 as is, day 2 as is, day 3 as is, day 4, day 5. And, uh, you know, people just really like love it. One, for clarity, brain fog, a little bit of weight loss, um, and then that's how they feel. But then the, the objective data is sometimes laboratory evidence of biomarkers that improve. And also we know about the longevity. So, um, that's what it is. It's meant to— it's called the fasting mimicking because it's It's letting you eat a little bit, basically.

Yeah, yeah, yeah. And, and I would say a lot of people love it because it's like the decision-making is gone. Yeah, like you don't have to think about what you're going to eat, it's all done for you.

Yeah, yeah, yeah. Decision fatigue is a real problem in, in our— yeah, in any kind of diet or non-diet culture, like just like even meal planning culture.

So true. So talk about this. So in relationship to who we've talked about bloating and tapped into that a little bit and talked about the food-avoiding issue. And because we don't want to be bloated or distended or whichever it might be, talk about elimination diets or the elimination phase of a diet. And I'd really like to unpack that because I think we're— we've done it so long, we've also gotten it wrong so long, but I'll let you take that.

Yeah, so I would say in, you know, functional medicine training, functional nutrition training, naturopathic training, we all learn about the elimination diet. I, I think we all could say safely that we feel like it's meant to be therapeutic, meaning not long-term. So therapeutic to give us clues, to give us some answers as to what is bothering us. And I think I like using it sometimes, depending on what the patient wants, because again, it's, it's, it's, it's free. It's cheap. It's free, like you don't pay for it. But it's harder sometimes for some people. So, but I— it's useful. Like, it's— I don't want to say it's a detox really, because technically, you know, it's not really quite a detox, but it's more of a Let me figure out my food sensitivities, my food triggers, or let me reduce my inflammatory burden. Depending on if you were somebody that went into it on the standard American diet, let's say you were, you know, working 80 hours a week, couldn't exercise, drink sodas all day, some processed food, you're wired and tired and you're eating that way. If you go on a elimination diet, those are the people that have the usually more profound results. Versus someone that's already eating healthy. I get a lot of those. I get the healthy eaters, you know, organic this and trying to hydrate and taking my creatine and doing everything right, but I'm still, you know, what should I do? Because I'm— often they either have abnormal labs like high cholesterol or, you know, prediabetes, or they have their gut patient, they've got issues. Those are the people we don't necessarily need to do an elimination diet. Up front. Um, and we may try different kinds of therapeutic diets, like, you know, maybe the low FODMAP, maybe the SCD, maybe the low fermentation. I mean, there's a lot to pick from.

So talk about it's only meant to be done on a temporary basis, it's meant to be therapeutic. And I think this is where things go wrong. I've, I've experienced this. We used to do this a lot, like I used to do it a couple months out of the year, and then it got so, so popular. We were doing it practically every month for a couple of years. But what I would notice is people would be like, well, I feel so good, I don't want to reintroduce those foods. Like, they didn't want to do the actual testing. The reason that we, we took these things out so that we could bring them back in, and they're like, no, no, I don't want to do that. Like, oh no, we're in trouble here.

Yeah, yeah, I know. It's, it's a real fine balance, and I think Now I feel like that wouldn't be as— so you tell me. I feel like now that the microbiome is everywhere and you can now test your microbiome, which a lot of people do, and yeah, that may or may not be necessary, but you see the importance of a healthy, diverse gut flora. Yeah. So you— I think most people probably realize that some of those foods— sure, maybe not pro-inflammatory gluten, dairy, which, by the way, is not It— you don't— everyone doesn't have to take that away, um, you know, by any means. Um, but, you know, we want to bring in some of those other foods sometimes because I, you— I guess the issue is hypocaloric restriction is not always the way to go for, number one, caloric restriction if you're also not trying to lose weight, but also your, your polyphenols, your nutrients that come in some of these varieties like that you can't really replicate in um, easily in a supplement.

Yeah, so true. You know, we do inside of our membership one of the challenges that we do, and we kind of bring it in regularly so they're not all exercise, but we do a, like, a food diversity challenge. People struggle with that, and they realize, you know, that every week they're eating the same thing over and over and over. Like, oh yeah, I eat a lot of vegetables. But it's the same ones, right? Over and over. It's like, oh, we're not getting it. There's no diversity here.

Yeah, yeah, that's cool that you do that. And I think we all need reminders. I'm a provider, I know all this stuff, I still need the reminder. There are ways to keep things interesting in the kitchen, or, um, you know, whether you eat out a lot or not, like, you can. So this is what we do teach, that, um, you know, trying to keep that diversity, just reminding on every session note, like, Hey, let's do this, or let's try this now. Um, thinking about colors is awesome because that can help the variety, you know, make a different color this week than next week. I— yes, we all want all the colors, but you know, you're working towards this.

So good. Okay, talk about this, because in talking about digestion or talking with women who are primarily our audience The inability to digest or break down, you know, may sometimes cause the gas or the bloating or the discomfort. Talk about stomach acid because it's a, it's a topic here we discuss. We talk sometimes about betaine HCl. We talk about what's the difference between that and, say, using digestive enzymes. Can you, could you talk into both, and when is one appropriate versus the other? How do you feel about adding stomach acid or, or the need to do it?

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Yeah, so with this very strong conventional GI background where most of— I think a lot of people now know that, well, they can get gaslit at an allopathic doctor sometimes when you talk about certain things that are not quote-unquote evidence-based. I was very skeptical of hypochlorhydria as a thing because I was not trained on it. All— it's just not addressed yet. Patients would come to us daily saying, oh, I feel better on apple cider vinegar. Apple cider vinegar. And we'd be like, okay. And, you know, it's not like we said stop the apple cider vinegar. It's just that we didn't— in that mindset, you're not often thinking, oh, you know, they make— they feel better on the apple cider vinegar and they're taking a PPI. So fast forward now. Yes, it is. It's, it's an issue with aging, with stress, with multiple other Scenarios that can cause low stomach acid, a big one is chronic use of PPI too. However, it's still a, it's still a balance. Like, some people do need that PPI.

It just dawned on me, for listeners who don't know, do you want to describe PPI?

Yes, sorry, I'm so into that. PPI is a proton pump inhibitor. So a lot of the common drugs like Prilosec and Nexium, and, um, some, you know, they are now over the counter and And on the bottle, it's meant to be used for 2 weeks, but a lot of the times your doctor may tell you to continue. And honestly, since I'm— if you're listening, I can't tell you to stop it because I don't know what your endoscopy looks like or your family history or, you know, there are scenarios where one does need perhaps a long-term PPI use. However, there is a holistic sort of integrative, I should say, approach where you have an ability to be able to work your way off of a proton pump inhibitor, or you can help supplement, you know, if your doctor approves and is okay with it, with a little bit of natural way to pump up and prime the pump with maybe bitters in your diet, bitter drops, you know. And yes, the digestive enzymes, we see them very helpful for people. We can't always explain why because we're not all testing, especially in the conventional setting. You know, they just started testing for things like sucrose deficiency and some other unique sugar deficiencies in a conventional setting. But before, I mean, even SIBO wasn't really recognized, right? So it's coming along, it's evolving. I hope I didn't confuse the listeners. Do you want me to go further on one of those topics?

No, I think that was really helpful. And then come back again to, you know, the use of apple cider vinegar or or betaine HCl? And when is that the— or why would that be more appropriate or less appropriate than, say, just trying digestive enzymes?

So both pancreatic enzyme deficiency, like, um, where— or hypochlorhydria. So both of those phenomenons— so hypochlorhydria is more from the gastric stomach cavity an issue there. And then beneath that is where you have this complicated, really beautiful interaction between the gallbladder, liver bile coming into this and helping the pancreas secrete enzymes. And there's a beautiful north to south, kind of really incredible process that the human body does for digestion. And it is a north to south thing. And so if you don't have enough stomach acid, You then can have blocks in the system underneath it. Okay. So a reasonable place to start if you have bloating is, and if you don't have severe, you know, ulcer disease or, you know, severe heartburn, you could try something like apple cider vinegar and you work your way up. You know, you dilute like a teaspoon in a little bit of water. See how that goes. If it's burning, you know, for a long time, you know, that's— you'd want to talk to your doctor about that. Um, again, I can't give you medical advice and I haven't seen your endoscopy, but generally speaking, that's not an unreasonable approach. Um, a more conservative approach is to do some, um, bitters, um, which won't really directly affect your, your gastric cavity and cause burning. Um, and then, uh, let's say you try that and you've kind of worked your way up. By the way, you do this before meals, um, typically. Um, Digestive enzymes, you could try those. And I know there's so many out there. There's gluten ones, there's dairy ones, there's general ones, and it's hard to navigate. Everybody— I would say some people react to some and some don't. And I feel— I find that a lot of people now just go on their own and get digestive enzymes just to see. And that's, you know, that's probably okay if you feel a bit of a difference, that's probably okay. But at the end of the day, do you really want to be taking these things without knowing, um, like indefinitely? Like, I don't know that we should all be taking all these supplements indefinitely without understanding your own body as much as you can and your own biochemistry and biology.

Yeah, that was such a great point. I love that. Talk about which comes first here, the, the chicken or the egg kind of thing. When we're talking gut health and changes in the gut versus hormone changes, you know, I mean, they're probably like one affects the other. Which of those, which of those happens first? Or is it, is it impossible to say? Or is it we don't even care, it doesn't even matter?

That is such a hard question, but I'll tell you that in these, you know, functional medicine or integrative medicine programs, you'll see the speakers, the guest lecturers fight over which one's more important sometimes. Like, I— hormones, gut, you know, or mitochondria, or, you know. And so everyone has maybe, maybe a little bias, but I would say most people are starting in the gut and restoring gut function. Um, Yes, things wreak havoc, happens through menopause.

Yeah.

And that is hormonal, as you know, it can happen kind of all at the same time. And I— that's when I'm not sure exactly why that happens other than estrogen is declined, progesterone is declined. And so you have sometimes different levels of cortisol, different levels of DHEA. So you've got a lot of low production overall of some of these. And so you— and then if you're constipated, you're not detoxifying your estrogens very well. Same with cholesterol, um, because we do excrete our cholesterol in our gut as well. That's more complicated than just that. So I don't think I really answered your question, but I do favor the gut.

Yeah, well, basically you pointed the picture. It is utter chaos. We all understood that. We get it. We get it.

We feel it, right? I mean, even people like very normal GI tracts, never had an issue with gastroenterology, eat everything, like no problems, and then they hit menopause and there's— they've got slowing down a little bit, you know, they're starting to get a little constipated. So, um, yeah, I wouldn't be able to say exactly, like, I don't know that we have the answer as to what exactly is going on. To cause that switch.

Okay, so next question. And I think I know this in regard to muscle, in regard to helping clients with their bone density, and simply with, I would say, energy sometimes and more cognitive function. Protein is so important. Where does it come in if we were talking purely today about gut health? How important is protein, or is it a part of the problem? And then likewise to hormones.

Yeah. So, before we were Precision Gut Health, we were actually Precision Metabolic Health because I had like a foot in the door with all this cardiometabolic stuff because of my dad's heart health history that I was mentioning. And then, I also worked in a urology practice, so it was a lot of male infertility, low testosterone patients. And, Oh, where was I going with that? I just lost my train of thought. You were asking me about protein. Okay. And so I think that that's how I got in understanding of protein in midlife and how muscle protein synthesis declines at an early age and you have to really work at it. But if you're a gut patient, meaning you have these GI symptoms that I've just described, some of them, all of them, even a couple of them, that's a bit of a different story. You have more lower-hanging fruit to deal with because I'd say a quarter of my practice is the longevity folks, like, you know, people that don't have gut issues, they're really seeking health optimization. They're like wanting to understand, okay, should I take creatine? What should I do for exercise? How should— how can I optimize my nutrient status? How can I optimize my body composition? That's about still a quarter or a third of my practice. And then two-thirds is this. So they look very different. Okay. And so these people with the gut, that's, we have to work on that first. And that's like, you know, 4, maybe 6 month process. And then they want to work on their hormones and their longevity and their metabolic health, because then I can address it more. But in those first 4 months, it's really hard for me to say and concentrate on protein. It's not like I say don't do protein, But if I'm on— if they're on a therapeutic diet with me, you know, like I said, a short-term elimination or a low FODMAP, or we're just trying to get them to eat and refeed their microbiome, I can't also tell them, okay, I need you to calculate your macros, do this, do this. It's just too much for them. You know what I mean?

Right.

It's a lot. So I honestly, I just meet them where they're at. If they're wanting to do that, then we can craft a plan, a nutrition plan with my health coach. That can address the protein needs for your age group for longevity and hormones and brain health. And but it, it would be complicated and a little bit hard to do.

Got it. And I think that's helpful for, for somebody listening who might be feeling the pressure of— and part of it I'm sure is me and what I see in my timeline, what I see coming and served to me because I'm so conscious of it constantly. But It is like a barrage of everybody telling you, "Eat protein, create a caloric deficit, eat protein, count your macros, use this app, that app. Here's what I eat for breakfast." I like, "Did I ask you?" I don't think I did. I don't remember asking you. But, you know, I think there is a lot of pressure. And I think when someone comes into a program or a membership, they right away feel there's that dual pressure of, "I got to I'm going to show them how many grams of protein I ate today. And it might not be the moment for you to be focused on that if you've got gut issues. So I think basically what you've said is, you know, which comes first, and know what your priority is. And I think a lot of times for, um, for some of you, we talk about ideally, would HIIT be great for you to help burn fat or visceral belly fat? It might. But if you're already exhausted right then not yet, not right now. It's just, yes, first though, let's do this first, let's do that. So thinking of it in terms of priority, that, that really helps to, I think, ease some stress on I'm supposed to be doing all these things and feeling incongruent or inadequate while you're trying.

Yeah, yeah, I'm glad you brought that up because I was gonna mention the other example is maybe not gut, maybe your gut's fine, but maybe It can be, like you just said, a workout, like a weight training workout with heavy weights knocks you out for 2 days.

Yeah.

You know, do you have other signs of HPA axis dysfunction, you know, which is kind of a term for the old term adrenal fatigue. We're kind of getting out of that phase of using adrenal fatigue, but it's, you know, your cortisol, and your DHEA may be not up to par, and you may need a different type of workout for a little while. So I think a good way to know, like, if you're a listener and you're not sure, like, what is my biggest struggle, um, do like an objective score, like an MSQ score, um, and, and, or have somebody do that on you, your provider, and that'll kind of help figure out, like, what areas do I need to work on.

Agree. So members, if you're listening, this is your you go to My Progress, right? And you're doing those subjectives and the objectives both together. So you're tracking those all the time because otherwise we're, we're shooting blanks, right? We're just going for an arbitrary number and it may not be a fit right now. I love that.

Yeah, I love numbers.

Knowing that, knowing that we're talking to women 40 to 70, roughly. If you're an outlier, it's okay, we see you too. Is there a question that I should have asked you based on your day-to-day? And what are the most common, common, maybe should I ask questions you wish somebody would say to you?

I— two things. Well, one's not a question. Okay, let's go with the question. What labs should I get?

Yeah.

Okay, okay, I just asked you what labs should I get.

I mean, unfortunately, insurances are dictating a lot of the ordering, so we can't quite blame, you know, the primary care doctor or the internist on this. Um, we, we do a Mark Hyman style function panel here. Um, look for a decently priced panel, but where someone can give you some guidance on it. Um, So, okay, basics are gonna be— should I use abbreviations here? Or, uh, well, I'll just say complete blood count, which is standard in an annual physical. Yeah. CMP, complete metabolic profile, standard in an annual physical. TSH, thyroid stimulating hormone, standard in an annual physical. And that's about it. Maybe a urinalysis. Okay. Um, sometimes we get a vitamin D, sometimes they don't. And then, oh, they get a basic lipid panel. But unfortunately, that just doesn't give me much information, honestly. With heart disease as the number one killer in the United States and the world of men and women, we cannot forget that statistic. That is always at— like, yeah, sure, I'll fix your gut, but I'm always thinking about your heart health. Always. Like, that you work with me and we restore the gut. Well, I want to know what your LP(a) is, what your ApoB is, what your small dense LDL is. I don't have to get that all the time, but you know, it's nice to get some of those once a year, you know, and then if you're fine, maybe once every 2 years. Some inflammation markers like an hs-CRP, a uric acid, and then it's not only about getting the labs, it's looking at them with the magnifying glass, right? So your range, like a standard range for somebody for vitamin D is like over 30. Um, but our windows in, in our field is, is much tighter for certain populations, like autoimmune patients. We do it here. Regular— everybody else, we do here. Same with, um, ApoB, Lp(a). Same with hs-CRP, all the thyroid numbers.

Like, you don't want to be compared to people who don't feel very good, right?

That's right. The majority of, you know, Yeah, the majority of us. Yeah, yeah.

And I think that just for listeners, I want you to make sure that you heard what you heard. And so it's both knowing what tests that you want, but it's also getting a good interpretation of those tests. What does that mean for you? And it's more, or it's beyond it coming back and saying, well, here's the norm, here's where you are. And it's a green dot instead of red. That's, that's just, again, you're being compared to a lot of people who test but don't feel very good. So your mother never ever ever looked in the crib and said, oh, I hope you're average. So, so let's just not go there. Let's just— we want optimal. You want optimal for whatever else is going on, how old you are, what you're doing. And that's really what she's saying. So it's not just about what test should I get, but it's like Who should I go over those tests with? That really also matters.

Yeah.

Yeah. And also even that person should be looking at you like as a person, your family history matters, your preconception history onwards is, you know, relatively important. Like, um, what medications you're on, what, you know, what supplements you take, like all of this matters. So it's nice to get that snapshot. But more than just a snapshot, I guess. I guess we're talking about a DSLR camera in those days versus a Polaroid.

Right. You really just dated us both. Every listener here got it. So that's, that's where we are today. Shefali, thank you so much for being here.

Oh my God, it was so much fun to talk about. I have so many other things to talk about. So, you know, there's always stuff to talk about. I love chat.

And where can everybody find you?

Oh yes, thank you. I'm on Instagram, although I'm not super great at social, but I, I always try, at Precision Gut Health. Same with TikTok. And then our website is precisionguthealth.com. And if you need any information and if you want to look to work with us in various capacities, that would be— you can just email us at info@precisionguthealth.com. Health.com. I'd love for your listeners to sign up for my free newsletter. It's got some good stuff in there, including like freebies and all kinds of good things.

So awesome. All right, we have all the links in the show notes, so if you're walking, you're lifting, or you're commuting, we got you covered. And we're always happy to hear that that is true. Thanks again.

Thank you. I, I just feel so honored to have been here. It's just so amazing to talk to Thank you.

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