Gut Health and Weight Management: Beyond Dieting

Welcome to The Perfect Stool: Understanding and Healing the Gut Microbiome. This is your host, Lindsey Parsons, and today I'm going to be talking about weight loss resistance in the gut microbiome and factors that may be at play if you're experiencing that problem. Before I start, I did want to comment on the fact that I am aware that I speak quickly as a recent podcast review highlighted. So I wanted to make sure everyone knows that you can slow down podcasts using your podcast app. Like in Apple Podcasts, there's a little 1x in the left-hand corner. You can change to 0.75x to hear a podcast at 3/4 speed. And that I also put my podcast transcripts out in blog format as well, which you'll get a link to a week after I publish if you're subscribed to my newsletter, which you can do at HighDesertHealthCoaching.com. But I will try to slow down. And if you haven't yet followed or subscribed to the show, be sure to do so. If you'd like to get my free ebook, Finding Your Root Cause Through Stool and Organic Acids Testing, you can get that by signing up for my newsletter at highdeserthealthcoaching.com. And if you haven't yet done my quiz on which stool test would help you get to your root cause, you can find a link in the show notes and take that. Now on to the show. If you've been struggling with feeling comfortable in your body, weight gain or weight loss resistance, and wondering if maybe your gut health or gut health issues might have something to do with it beyond the obvious regarding diet, I wanted to address that today. But before I go into that, I should mention that before I focused in on gut health, I worked with clients on sustainable weight loss without dieting, because I think it's really important that any lifestyle changes you make be sustainable in the long term. I'm not in favor of, nor do I recommend, low-calorie diets, Crash or fad diets, because severely restricting your food intake can disrupt normal bodily functions, doesn't promote sustainable long-term weight loss, and can result in muscle loss and a reduction in your basal metabolic rate, which plays a crucial role in calorie burning. And even worse, undereating often causes your body to store calories as fat. It is not recommended for individuals to consume fewer than 1,200 calories a day unless you're being supervised by a doctor. And I've often seen people on such low-calorie diets that started to lose weight only when they started eating more. I also rarely recommend long-term extreme diets like carnivore or ketogenic diets, perhaps with the exception of people who have diagnosed type 2 diabetes that's in need of immediate and extreme attention. I think that self-acceptance is very important at whatever body size your body naturally rests when you're eating a healthy diet 95% of the time and exercising regularly, getting good sleep, managing and reducing stress, practicing all of the health-supportive behaviors we all hear so much about. And part of that self-acceptance is consuming media that highlights and supports diverse body types and sizes and reducing exposure to media that exclusively promotes a certain body type or filtered or altered images of unrealistic bodies. I also think it's very important, especially if you have any disordered eating behaviors like binge eating, emotional eating, anorexia, or bulimia, to address the mental health component of weight gain, especially if you have a high level of adverse childhood events known as ACEs that are highly correlated with obesity. If that's part of your history, I'd recommend looking into trauma-focused therapies, which include modalities like somatic experiencing, AEDP, EMDR, and neurotherapy. If you've gone through therapy but only traditional CBT type talk therapy or cognitive brain training, I'd recommend you look into these other modalities in conjunction with whatever other interventions you're considering. That being said, research over the last 20+ years into gut bacteria has shed light on its pivotal role in regulating weight and weight loss. So you may have heard about early studies suggesting that a key biomarker in the microbiome of obese individuals was an excess of gram-positive bacteria in the Firmicutes phylum, in particular as it relates to gram-negative Bacteroidetes and a high Firmicutes to Bacteroidetes ratio, the two principal phyla of bacteria in the human microbiome. However, these results have been called into question. In a resequencing of the DNA from 9 of those previous studies, it was found that methodological differences in sample processing and DNA sequence analysis, interpretive bias, and confounding factors that weren't accounted for, such as exercise and altitude, which have been shown to impact the gut microbiota, may have been responsible for these results. Further studies in animals and then in humans over the course of 5 days have shown that the composition of the gut microbiota can change rapidly when subjects are fed different diets. In particular, one study showed that a 5-day animal-based diet increased the abundance of bile-tolerant organisms from the genuses Alistipes, Bifidobacterium, and Bacteroides, and decreased the level of Firmicutes from the genus Roseburia, as well as the species Eubacterium rectale and Ruminococcus brominae. Which metabolize dietary plant polysaccharides. What I believe is a more important factor to consider with regard to weight loss resistance and/or weight gain is lipopolysaccharide, or LPS, an endotoxin that creates inflammation in the body and is released by and is a component of the cell wall of gram-negative bacteria. Studies have shown that elevated blood levels of LPS are associated with prediabetes, diabetes, and obesity, while additional studies have shown that translocated gut bacteria are the origin of that LPS. One of the reasons beyond diet that many people end up with elevated levels of gram-negative bacteria, in particular from the Proteobacteria phylum, is use of oral antibiotics. As I've described in previous podcasts, antibiotics reduce the body's ability to produce butyrate, the primary food for the cells lining your colon, which comes from the fermentation of fiber in the colon by butyrate-producing bacteria, primarily from the Clostridium cluster of the Firmicutes phylum. In animal experiments, 3 days of oral antibiotics decimated the gut's ability to produce butyrate from fiber and increased oxygen levels in the colon, which is an alternate fuel source for these cells lining the colon. This oxygenation of the colon produces a wonderful habitat for gram-negative proteobacteria because they are facultative anaerobes. Meaning they can exist in the presence of oxygen. This can then lead to a vicious cycle where proteobacteria continue to dominate and the colon fails to recover its preferred hypoxic or oxygen-free state because of lack of butyrate, and the butyrate-producing bacteria that are obligate anaerobes are wiped out because they can't live in the presence of oxygen. What's more, a high-sugar diet in rats has been shown to increase proteobacteria, —one of the reasons for which I recommend that people eat a super healthy, sugar- and flour-free diet while on antibiotics. The domination of proteobacteria then creates a vicious cycle of high LPS in the body, promoting inflammation, blood sugar dysregulation, and increased weight gain. Likely because of this phenomenon, probiotic bacteria that restore the balance of butyrate producers and also mucin degraders like Akkermansia muciniphila which reside in the mucus lining of a healthy colon and live in symbiosis with the butyrate producers, have been shown to decrease hemoglobin A1c, a longer-term marker of blood sugar. The first product on the market of this kind, which contained 3 strains of anaerobic butyrate-producing bacteria, was Pendulum's Glucose Control, which has Clostridium butyricum, Clostridium beyerincki, Anerobacterium hallii and Akkermansia muciniphila. While it's not inexpensive, and a monthly supply will run you $177 a month via my Fullscript dispensary, which includes the discount I give my listeners, the company study on it showed a reduction in hemoglobin A1C of 0.6% and a 32.5% reduction in postprandial glucose spikes after 12 weeks. You can also get just the Akkermansia and the Clostridium butyricum in separate products that are more reasonably priced., which I'll link to in the show notes along with the glucose control. Because SIBO, or small intestine bacterial overgrowth, can also cause an overgrowth of proteobacteria, with Klebsiella, Citrobacter, and E. coli being 3 of the most common overgrown bacteria in SIBO, I've also struggled with an overgrowth of proteobacteria since I have post-infectious IBS, which is essentially autoimmune SIBO that keeps recurring because of poor small intestine motility. As a result, I've tried Butyricum, Pendulum's Colostrium butyricum probiotic, and have found that it is very effective in firming up stool, which is a good indication of butyrate production in my colon, which slows colon motility. I have found, however, that I can only handle half a capsule a day, as a full capsule led to downright constipation and sometimes pain and cramping. At a half a capsule, it's a perfect adjunct for keeping me in steadily perfect stool, along with Tributrin supplementation the preferred form of butyrate for supplements, which I have also found indispensable in the face of a likely lifelong recurrent hydrogen SIBO issue. In addition, direct supplementation with butyrate in various forms has been shown in animal studies to positively affect the function and metabolism of fat tissue, increasing insulin sensitivity and helping with body weight control. For humans, results have varied between individuals, and I personally only recommend butyrate to people who have loose stool or diarrhea as it will constipate you unless you use it at very small doses. Its success in weight control in animal studies is likely due to its help in turning around the vicious cycle of Proteobacteria dominance in the colon and the subsequent release of LPS. Because of its unpleasant taste and odor, as well as absorbability, the preferred forms of butyrate are Tributrin, which is what I put in my supplement Tributrin Max, which is a 750 mg capsule of Tributrin, or the Cicloc form, an alpha-dextrin fiber matrix butyric acid complex used in ProButyrate, which is only 300 milligrams a pill if you want a lower dose, which is more appropriate if you're starting with Firmstool, or Aurex, spelled A-U-R-E-X, if you want a powder. Both ProButyrate and Aurex are Tesseract products, and you can find all of these in my full script dispensary at a discount. If you do have firm but incomplete evacuation or a sense that there's more to go, I'd recommend starting a low-dose butyrate supplement like ProButyrate once every 3 days. Of course, along with taking probiotics or butyrate, I'd recommend increasing fiber intake through 5 to 9 servings a day of fresh fruits and vegetables—vegetables primarily—including 1/2 cup of beans, chickpeas, or lentils on a daily basis to feed the microbes you're working to restore in your colon. Another way in which gut health is connected to weight loss resistance is through low stomach acid. Because sufficient stomach acid is necessary for breaking down proteins into amino acids, if you have low stomach acid, you may become deficient in an amino acid called L-carnitine. L-carnitine is found primarily in animal foods, most abundantly in beef and lamb, as well as formed by the body from the essential amino acids lysine and methionine. Because of this, I often find vegetarians and vegans are deficient in L-carnitine as well. L-carnitine is one of two molecules necessary for bringing fatty acids into the Krebs cycle for production of ATP or energy. The other is vitamin B2 or riboflavin. While researching for the podcast, I also happened upon a study that showed that riboflavin supplementation at doses of 50 milligrams or 100 milligrams a day also increase butyrate production in the colon, coincidentally. So if you're struggling with weight loss resistance coupled with low energy, which happens when your fats are being stored and not converted into ATP, and you don't have a blood sugar dysregulation issue indicated by high fasting glucose or high hemoglobin A1c, you may want to check your fatty acid metabolism through an organic acids test and/or try supplementing with L-carnitine or acetyl-L-carnitine. To see if it will spark some weight loss. Typical doses are in the range of 3,000 mg a day for L-carnitine when there is a deficiency, some of which can be taken in the form of acetyl-L-carnitine if you're also struggling with brain fog or poor memory or other signs of low energy in your brain. And a B complex is often also helpful, so a good quality B complex with appropriate amounts and forms of the various B vitamins is the best choice if if you're trying to cover all your bases with fatty acid metabolism. You will be wanting to get at least 50 mg of B2 if you have an identified deficiency. And then on top of that, if you do eat animal protein, you could also start a trial of betaine HCl or supplementary stomach acid while you're eating animal protein to see if it will help you to digest it better. The usual way is by taking one pill with meals with animal protein for a couple days then moving to 2 pills per meal and up to 5 per meal until you feel reflux, warmth, or burning in your chest. Then you'll want to back down to the previous dose. Then you should start looking at causes for low stomach acid. First, maybe your sodium intake is too low. Salt, or sodium chloride, is one component of stomach acid. If you eat no processed foods and salt lightly, you're likely falling short of the Goldilocks level of sodium which is between something like 500 and 2,300 milligrams a day, although some sources recommend keeping it under 1,500 milligrams a day. And of course, it's better to choose a high-quality salt like Himalayan pink salt or Redmond Real Salt, or one of those good quality salts that have trace minerals, rather than just regular store-bought salt. If you have any signs of gastritis or inflammation of the lining of the stomach, like gnawing, aching, or burning pain in your stomach. And note, that's different from reflux in your esophagus, which can be from low stomach acid, or nausea, vomiting, a feeling of fullness in your upper abdomen after eating, trouble with acidic foods, or a known history of H. pylori or ulcers. This can also be at the root of low stomach acid. Healing H. pylori or addressing gastritis first may be necessary, as you don't want to add betaine HCl or digestive enzymes for that matter to stomach that's already inflamed. You can learn more about that in episode 34 called Upper Digestive Issues. Next, Candida overgrowth in the gut can also be related to weight gain and weight loss resistance, causing sugar cravings and hormonal imbalances. This can come about from overuse of antibiotics as well as a diet high in sugar and simple carbohydrates. If you have a history of heavy antibiotic use, have a white or yellowish coating on your tongue, crave carbs and sugar, have a history of yeast infections, are usually cold, have fungus in your toenails, or have brain fog. These are some of the key symptoms pointing to a possible systemic Candida infection. While Candida is a normal resident of your gut, an overgrowth of this yeast can lead to systemic candidiasis, where it forms hyphae or tails that poke out holes in between cells lining the intestines. Giving it entry into the bloodstream. The only reliable way I've found to assess Candida in the gut is through an organic acids test. The D-arabinotol marker on the Organixx, Metabolomics, or NutrEval tests by Genova is the most studied marker of Candida, but I've also had good results with the Mosaic, formerly known as Great Plains, organic acids test, which has a marker called arabinose. You can get some sense of how systemic and entrenched the Candida infection is by how high your level is on these markers. The reference range on arabinose tops out at 29, and for D-arabinotol, it tops out at 36. And I've seen clients with results in the 300s, just to give you some sense of how high it can go. Although I consider anything in the yellow or red on the organics or above the reference range on the Mosaic OAT to be treatment-worthy. To combat Candida overgrowth and facilitate weight loss, antifungal herbs and fatty acids are usually needed, often for as long as 8 months in more severe cases, along with binders like GI Detox to catch die-off at first and prevent severe Herxheimer reactions, which is when you feel like you have the flu as you start killing off bacteria and Candida with antimicrobials. And then often I'll add in a biofilm disruptor into the protocol often in the second round of antimicrobials. And note that I will typically change antimicrobials for each 2-month round in order to prevent any resistance to the products. For a lighter case of Candida that's less symptomatic, serum bovine immunoglobulins might be sufficient to reduce levels. After treating Candida, you can restore the gut lining by supplying essential building blocks for mucosal lining repair, like glutamine, and herbs like DGL, marshmallow root, aloe vera, and slippery elm, and nutrients like zinc L-carnosine. I usually add the probiotic S. boulardii as well for Candida, as it inhibits Candida's adhesion, morphological transition, and virulence. Along with that, I recommend a diet free of added sugar, refined grains, dairy, gluten, yeast, white potatoes, and for 2 weeks, fruit, after which time all fruit but bananas are okay. I prefer people follow this diet while on antimicrobials for as long as they can, knowing that realistically, if it will take 8 months of antimicrobials, they may not be able to persist the whole time on such a strict diet. If none of the above work for you, one more drastic method for changing your gut microbiome for weight loss may be through fecal microbiota transplantation, or FMT. FMT is the process of using a healthy stool specimen and transplanting it into the gastrointestinal tract of a recipient for the purpose of improved health. This counteracts the dominance of pathogenic bacteria in the intestines, ideally creating permanent changes to the microbiome. FMT from a healthy donor has demonstrated a remarkable 90% success rate in curing the antibiotic-resistant bacterial infection Clostridium difficile, or C. diff, which is a prevalent infection that occurs in hospitals in the United States, affecting over 500,000 Americans annually and causing 14,000 deaths a year. The transplantation of stool from a healthy donor introduces protective bacteria, overwhelming pathogenic bacteria, and offering a potential cure for illnesses originating from an unhealthy gut microbiome, like C. diff. Regarding weight loss, I do have to say that results are mixed and more research is needed to fully understand the relationship between FMT and weight loss. In one study involving 41 patients undergoing bariatric surgery in Finland, researchers investigated the effectiveness of FMT for weight loss. The findings from the clinical trial suggest that FMT did not demonstrate significant benefits for weight loss in patients undergoing bariatric surgery, although it's known that bariatric surgery alone changes the microbiome. In this particular study, there were no substantial differences in weight loss outcomes between patients who received FMT from a lean donor and those who received an autologous placebo, meaning they had their own stool put back in. While this study did not find evidence supporting the efficacy of FMT in enhancing weight loss in the context of bariatric surgery, It's important to note that the research in this field is ongoing and results may vary across studies. Other studies have shown more promising results. For example, one such study investigated the impact of FMT on weight loss in patients with obesity, considering clinical and microbial factors. The researchers compared mixed donor, non-intensive FMT with single donor, intensive FMT. Results indicated that 13.2% of patients in the mixed donor group achieved a weight loss of at least 10%, whereas no patients in the individual donor group reached this threshold. Despite engraftment in all patients, there were no sustained differences between the two groups, suggesting that intensive individual donor FMT did not induce lasting weight loss or microbiome changes compared to non-intensive multi-donor FMT. Notably, mixed donor FMT led to a durable increase in the abundance and diversity of butyrate-producing bacteria, once again pointing at butyrate as a key player in the question of obesity and the microbiome. The study also identified associations between weight loss and specific microbial changes. Higher initial amounts and reduction after FMT of Bacteroides dorei were linked to overall weight loss. While a weight loss of 10% or more correlated with increased amounts of butyrate-producing bacteria, including, including Anerostipes, Hadris, Collincella, Tanakei, and Roseburia hominis. These findings suggesting differential impacts of FMT regimens on microbial composition and weight loss highlight the value of personalized microbial-based therapies for obesity based on donor and recipient selection. This personalization could include matching donors with specific microbial profiles to recipients to enhance the success of FMT interventions, although the evidence seems to point more and more to butyrate and butyrate-producing bacteria as a key mover in weight loss. Additionally, the frequency and duration of FMT sessions, as well as associations with specific bacterial species, could be factors influencing the weight loss response. While these findings provide valuable insights, further research is needed to establish broader guidelines for the application of FMT in weight loss interventions. Another area in which the gut may be affecting weight loss is around gluten sensitivity. One randomized clinical trial aimed to investigate the effects of a gluten-free diet on components of metabolic syndrome. The results indicated that the gluten-free diet led to a significant reduction in waist circumference and improved glycemic control and triglyceride levels. Compared to the control diet. The findings suggest that a short-term gluten-free diet can positively impact some key features of metabolic syndrome, specifically reducing abdominal fat, improving blood glucose levels, and lowering serum triglycerides. Many individuals without metabolic syndrome may have slight gluten sensitivity, not to be confused with celiac disease, and this gluten sensitivity could lead to weight gain or hinder weight loss. Leptin, a crucial hormone in signaling feelings of fullness to the brain, plays a key role in regulating hunger and satiety to maintain a healthy body weight. However, individuals classified as overweight or obese often experience leptin resistance. This condition, characterized by high leptin levels without a corresponding cellular response to satiety signals, hinders the body's ability to manage hunger effectively. A study conducted by Swedish and Danish researchers and published in the December 2005 issue of BMC Endocrine Disorders suggests that grains, particularly those containing gluten, may contribute to the development of leptin resistance, potentially leading to weight gain and obesity. Whatever the mechanism is, I can tell you one thing from my own personal experience. I eliminated gluten because it's known to be a risk factor for autoimmune disease. And I was trying to reverse my Hashimoto's thyroiditis. Anyone with an autoimmune disease is recommended to stop eating gluten. As a result of being strictly gluten-free, I avoided so many breads, cookies, cakes, pies, etc. that I would have otherwise eaten, thereby making it much easier to avoid sugar, which of course is related to weight gain. And when I knew I'd be going somewhere with desserts that make me feel deprived, I'd make my own almond flour muffins with xylitol as a sugar substitute eat that instead. And I did, by the way, successfully reverse my Hashimoto's. I've had normal antibodies for like 3 years now and still have optimal TSH levels and have never had to take thyroid hormones since my diagnosis in around 2013 or 2014. So if you're looking to lose weight, I'd recommend going off gluten whether or not you have evidence of a sensitivity, because it's just present in so many processed foods that are so addictive. Or if you want to check whether gluten sensitivity is actually a factor in your weight loss resistance, you can try a short-term elimination diet for 4 weeks without changing anything else. Track on a weekly basis your weight, waist measurements at the belly button, and any other symptoms from gastrointestinal to skin to headaches, brain fog, etc., and check if you feel better off gluten. If you want to make it super objective, try to replace gluten-based foods with equivalent gluten-free foods, although I wouldn't recommend breads and desserts and regular pastas for someone trying to lose weight. Be sure to closely check your food, medication, and supplement labels for hidden gluten. Then you can try reintroducing gluten by eating a couple normal-sized servings in a day and evaluate your response over the next 3 days. Finally, I'll finish up with the more obvious interventions for weight loss, but with an eye toward developing and maintaining healthy gut microbiota. You want to incorporate plenty of polyphenols into your diet, which are micronutrients recognized for their antioxidant properties, disease prevention, and positive effects on the balance of beneficial gut bacteria. They're found in colorful fruits and vegetables, or products like Poly Prebiotic Powder by Pure Encapsulations. Great food sources of polyphenols include cocoa powder, berries, dried herbs and spices, hazelnuts, chestnuts, pecans, and red, purple, orange, yellow, and dark green vegetables, as well as beverages like green and black tea. Embracing these polyphenol-rich foods can contribute to a healthier gut microbiome and support weight loss. Fiber, along with polyphenols, is also recognized as a functional food that provides food for the fermentation of beneficial bacteria in the gut, leading to increased short-chain fatty acids like butyrate. Found in undigestible carbohydrates from fruits, vegetables, beans, legumes, and nuts, fiber serves as an excellent nourishment source for beneficial bacteria. Gut health is extremely influenced by fiber, evident in the distinctive gut microbiota of individuals consuming animal-based diets versus those favoring plant-based diets. High intake of meat, eggs, and cheeses with low fiber content results in an abnormal gut microbiome characterized by reduced fermentation. Additionally, individuals consuming substantial amounts of animal fat face an elevated risk of pathogenic bacteria, potentially linked to increased iron consumption. In contrast, those with higher intake of plant-based prebiotic fiber from fruits and vegetables exhibit an abundance of healthy bacteria in their guts. Note, however, that this does not apply to ketogenic diets, which bypass the traditional production of butyrate through fiber fermentation and instead produce ketone bodies like acetoacetate and beta-hydroxybutyrate and isobutyrate, a metabolite of protein fermentation, which also help with keeping the lining of the colon hypoxic or oxygen-free. That being said, I'm generally a supporter of an unprocessed omnivorous diet with adequate protein, which is basically 1 gram per pound of ideal body weight a day, including mostly lean animal proteins, at least 2 servings of fatty fish a week, limited saturated fats, but from high-quality pasture-raised sources like meat, butter, or ghee from organic pasture-raised animals. Dairy is okay if you have no sensitivity, again from pasture-raised animals, with priority going to fermented dairy like yogurt and kefir. And hard cheeses in limited quantities. Then healthy fats from nuts, seeds, avocados, and healthy oils like extra virgin olive, avocado, zero-acre oil, which is a fermented oil high in omega-3s that tolerates high-heat cooking, or flaxseeds or flaxseed oil, or walnuts in particular for omega-3s if you're not otherwise supplementing with omega-3s or getting them from fish. And then getting a rainbow of fruits and veggies with a minimum of 5 servings a day and preferably as many as 9 servings a day. And then for starches, the best choices are starchy vegetables other than white potatoes, so root vegetables, winter squash, sweet potatoes, yams, and legumes, quinoa, and other whole grains, brown rice, black rice, wild rice, or cooked, cooled, and then either eaten cold or only slightly reheated white potatoes and white rice, which are good sources of resistant starch, which functions like fiber in the body and in particular feeds those butyrate producers. Generally, to lose weight, most women need to stick to no more than 2 1/2 cup servings of these types of starchy foods a day, and men may be able to get away with a little more. And if your diet is very far from this, I'd suggest picking one area to tackle each week to move towards a diet like this so that the changes won't be overwhelming and will be sustainable. Well, that's all for now, and if you're looking for help with weight loss, I still work with clients in this area. Both from the food, mental, and lifestyle perspective through a weekly program that runs for 12 weeks, as well as incorporating testing and interpretation to see what's going on metabolically that might be impeding weight loss. If you are struggling with bloating, gas, burping, nausea, constipation, diarrhea, soft stool, acid reflux, IBS, IBD, SIBO, Candida overgrowth, gastritis, H. pylori, fatigue, or migraines and want to get to the bottom of it. That's what I help my clients with. You're welcome to set up a free 30-minute breakthrough session if you think you might like to sign up for a 3 or 5 session gut health coaching package or a 12-week weight loss program, or I offer individual consultations as well. You can find links for those in the show notes. If you'd like to support the show, you can make a regular donation on Patreon or buy vetted high-quality supplements from my full script dispensary or from links in the show notes to eVitamins, Bulk Supplements, or Amazon, or give me a 5-star review on Apple Podcasts. And if you're using Amazon for your Christmas gifts, whether they're supplements or not, if you use my Amazon link, that will support the show. To reach out to me in other ways, I have a Gut Healing Facebook group for asking questions, or I'm on Instagram, Pinterest, TikTok, and X. Links for all those are in the show notes or on my website, highdeserthealthcoaching.com. Thanks for listening, and here's wishing you all the perfect stool.