Is Your Thyroid Hurting or Helping You with Izabella Wentz

Today on Midlife Conversations, I've got my friend Isabella Wentz. Now, she's a pharmacist by trade, but she's a best selling author. And I specifically wanted to have her on today to talk about thyroid. This is her expertise, Thyroid and adrenals. She's got a very real story around this. And I know us, me included, you listening. Thyroid is a big topic, especially in midlife. And I have a lot of my own personal questions. I myself have low thyroid. So I've got questions for you about that. People listening. We hear hypo hyper. We don't. I don't. I want to get to the bottom of what the difference on all of that is. How we can treat things. When do we need medications? When do we. Can we treat things naturally? What can we do naturally? So thank you so much for being here today.

Hey, Natalie, it's so good to be here with you. Thanks for having me.

So let's start. Let's back up. How did thyroid become such an interesting topic to you? When did this become of interest to you?

So, full disclosure, I was never interested in thyroid health during pharmacy school. I just thought it was like a very boring condition with very few drugs for it. Right? And it wasn't until I was in my 20s and had already graduated from my doctorate program in pharmacy, where I learned that I had Hashimoto's thyroiditis, an autoimmune condition that leads to an underactive thyroid. At that point, I had been going to doctors like almost every year trying to get a diagnosis because I had chronic fatigue, I had palpitations, I had hair loss, carpal tunnel in both arms, acid reflux, irritable bowel syndrome. Just like a long laundry list of symptoms where every few months I felt like I would get a new symptom. And so getting the diagnosis, I was initially very excited and relieved. And I thought, okay, great, I could get on medications and all of my problems will go away. Being a pharmacist, that's kind of what I thought before, before I was educated right by life. And I did start on the medication. Unfortunately, it was not a miracle cure. Thyroid hormone, it helped a little bit, but then I was still stuck with most of my symptoms. And so I really got into the world of thyroid health, functional medicine, root cause medicine, in an effort to heal myself and recover from a whole host of symptoms. And that's how I became, I guess, a Hashimoto expert slash human guinea pig, just really trying to get myself better.

Can you have one with the other? Is any if you have low thyroid, can you have that and not be Hashimoto's? Can you be Hashimoto's? Not low thyroid? What's the difference? And how. Where do they come together?

Such a good question. So Hashimoto's is an autoimmune condition. This is what it means, is basically the immune system has recognized the thyroid gland as a foreign invader and has launched an attack against the thyroid gland. Generally, people will have elevated thyroid antibodies. The two to test for are TPO and TG antibodies. And these can actually be elevated for 10 years, sometimes 15 years, before a change in thyroid function can happen. Now, in those 10 years, people might experience anxiety, they may experience mood swings. They can experience multiple miscarriages. These are the people that are going to their doctors and they're saying, I don't feel good. Something is off. I just don't feel well. But they're sort of told that it's in their heads or their hypochondriacs. Oftentimes only one test is done for their thyroid, which is tsh. Now, TSH is an indirect measure of thyroid hormones. It essentially is a test that becomes elevated when our body senses that we're not. We don't have enough thyroid hormones on. On board when we become hypothyroid. Hypothyroidism is oftentimes a consequence of Hashimoto's. So when you've had Hashimoto's and this damage to your thyroid gland for a prolonged period of time, eventually your thyroid gland won't be able to make enough thyroid hormones, and then you will become hypothyroid. Now, here's the interesting thing. Most people think that Hashimoto's is like a rare and exotic condition. It sounds like a Japanese sword fighter. It's not. It's very, very common. And 90 to 97% of people, women with hypothyroidism, they actually have Hashimoto's. But there's a good chance they've never been tested for it because their doctors didn't do the antibody tests.

Whoa. Okay, so that. That's wild because. Yeah, I feel like some people either know when they're talking about that, or they've never heard of it. So it's like a. It sounds like it's not often tested for. So how. How could you. When you have just low thyroid, what else could be causing that if it's not Hashimoto's?

Generally, it would be. In developed, developing countries, it would be an iodine deficiency, rather uncommon in developing or in developed countries like the United States, like Australia and Europe. And then if you had your thyroid gland removed or if you had had radioactive iodine done to your thyroid gland, that's going to be a chance that's going to lead you to have hypothyroidism. That's not autoimmune.

And that's why some people take iodine supplements, thinking they'll fix it that way. What if you are not lacking an iodine? What other reason could you have low thyroid?

Honestly, it's generally going to be Hashimoto's. 90.

Hashimoto. Interesting.

Yeah.

Okay. So it's interesting. I think a lot of us have been told different things. Like I'll tell you, I was told I don't have Hashimoto's, but I do have low thyroid. I don't have iodine deficiency. So that's interesting. So you're saying if you have been told you have low thyroid, it's either in your research and your studies, it's either iodine deficiency or Hashimoto's or if.

You'Ve had your thyroid gland removed, removed, treated by radioactive iodine. Those are going to be the majority of the cases why people would have hypothyroidism.

Okay. So why would they give. Where is the thyroid hormone come into play? Like when they say go get T3 compounded or where does that play? Is that. And is that what they did for you initially?

Sure. So when you lose the ability to make your own thyroid hormone because you've had your thyroid gland removed or because you've had Hashimoto's for a long time, it's generally going to be a really good idea to get on replacement thyroid hormone.

Okay.

And so this could be something like levothyroxine, which is known as T4, or it could be Leo thyroidine, which you mentioned, which is known as T3, which is the more active thyroid hormone.

Okay.

And so either, you know, any, anybody with any kind of hypothyroid condition could generally benefit from thyroid medication if.

And what is the downside to doing that? Is there a negative to taking those medications and is that what thyroid medication is? Are you talk about a replacement than for the T3 or the T4 there?

I don't think there is any drawbacks to thyroid hormones if you need them. Right. So if you don't have enough thyroid hormone, getting more from a bioidentical tablet, this is going to be helpful, not harmful to you because the hormones are just what would be made inside of your own body. The Trouble that arises for many people is that they might take something like levothyroxine, which is T4, the standard of care, and they may not convert it to the more active thyroid hormone, which is known as T3. And so people will say, okay, I'm on thyroid medication, but I'm still gaining weight, I'm still losing hair, I'm still fatigued, I still have brain fog. And it's because they're not on the right type of thyroid medication. And then there's a whole bunch of other things that are. Could be interfering with your proper utilization of thyroid hormone in the body. And then there's the whole reason why, like, why do you actually have that inflammation in your body that's leading to the autoimmune response? And. And so from my perspective, you oftentimes have to take a holistic approach. So really get the person thriving, feeling, well, feeling human, feeling like they have a brain and having, you know, gorgeous hair and lots of energy, right?

Yes. And I want to talk about some of this holistic approach because I would assume whether you're taking medication or supplements or not, you still should take this holistic approach. So I'm going to ask you about that. I do have a few more questions about the medication because this is the thing that women tend to get super confused on. So when you say a T3 or T4 replacement, or you name those, are those. Is there a difference? If you could explain the difference between the bioidentical or the synthetic, like, what's the difference there? And what do you suggest for women? And is it kind of the same as if you're doing regular hormone replacement, where bioidentical mimics more natural in your body, where synthetic and any. Do you see any favors towards one or the other there?

Yeah, absolutely. So Synthroid is. Is the medication that is most commonly known and prescribed for thyroid issues, hypothyroidism. And this is a synthet thyroid. Like, we pharmacists nerd out about that a little bit. Yeah, this is. This contains the T4 thyroid hormone. Generally, when you take that internally, your body has to do the work of converting the T4 into the more active thyroid hormone known as T3. On paper, this happens really, you know, consistently all the time in a petri dish. This happens consistently in the human body. It doesn't always happen. So a lot of times people may not convert that T4 to T3 properly. And T3 is like, what our body really needs to have that energy. And so many times people might advocate for more of a naturally derived thyroid hormone. This is generally derived from, like, thyroid glands of pigs.

Okay.

This would be something like an arm or thyroid. And this will have T4 hormone in it as well as T3 hormone. So that it kind of. The conversion is kind of done for you already, and people can just take that. And a lot of times people do feel better as far as their energy levels, their ability to have a faster, better metabolism, so, you know, lose more weight without doing it. They have better brain function. Typically, they'll say their hair is. You know, their hair comes back again. Because a lot of women will struggle with hair loss, even though when they have hypothyroidism, even though they're on synthetic thyroid hormones. And then there's also another medication known as Tyresin.

Okay.

This is a synthetic version of T4. The interesting thing about it is it's in a gel cap and there's also a liquid version of it. And that actually tends to be better absorbed than some of the tablet formulations because thyroid hormone absorption can be very finicky and things like coffee can interfere with it. If you have an H. Pylori infection, if you have sibo, if you have any kind of gastritis, lactose intolerance, whole long list of reasons why you not may not absorb the medication properly from the tablets. So this is an also an option. And then there's also the option of a standalone T3 medication that can be synthetic. Then there's also compounded T4 and T3 medications, which could be made in various ratios. And, you know, generally what I tell people is you want to work with a practitioner that's well versed in all of these therapies.

Yeah. Fortunately for you.

Yeah.

And it's very confusing. I know. I'm just trying to dive. You know what's so interesting? Every time I go down a road of a. Of a topic like right now, thyroid with you, and I could take gut health with another guest or. It's so interesting because it seems to me that most Western medicine lumps everything into. Especially for midlife life. It's just. Oh, it's menopause. It's just. It's just normal. It's just aging. And sometimes there's like a really simple answer. I mean, it feels complicated, but it's really simple. Like it's your. You have a low thyroid or you have really bad leaky gut. Like there's something that is there and fixable. And I think we as women get to start speaking up about this because when we're Told by our doctor. Oh, it's just your age or it's just menopause. You just have to accept it. That doesn't feel good because everything you described, losing hair, brain fog, gaining weight, that could. That gets sucked up as. It's just menopause.

Oh, absolutely. Another interesting thing is that not. Not a lot of people realize, but the. One of the peak times that women may have new onset thyroid issues is going to be during perimenopause, Right?

Yeah.

And so you're blaming menopause for that when it's actually your thyroid. And so puberty, pregnancy, and perimenopause, they're like the three peak times in a woman's life. Okay. And women are going to be five to seven times more likely to have thyroid issues than men. These things can go undiagnosed for decades sometimes, unfortunately.

How is thyroid. Is it. And is it connected to estrogen dominance? Because some of the things you explained about low thyroid also could be described as estrogen dominance. How are those connected? Are they.

Absolutely. There's a big connection with estrogen dominance. It can be a potential trigger for shifting the immune response so that you become more likely to have an autoimmune response against your thyroid. It also changes the how we bind our thyroid hormones, making them less available to us. So it can be something that, you know, maybe, maybe your body and your thyroid gland was holding on and kind of releasing enough thyroid hormone, but with that estrogen shift and that progesterone shift. Yeah, you kind of shift the scale and all of a sudden you become hypothyroid. When, when, before you were kind of getting by. Right.

Okay, so talk to me about the. I want to ask about adrenals and how this falls in, but before I. I don't want to forget the part about what are some natural things that we can do to help support this? Like if somebody does not want to take anything or they don't want to, should anyone just be adding iodine in or is that dangerous to do? And then what natural things should we be doing?

Generally people will say, you know, they'll do a search for low thyroid and it'll be like, take some kelp, take some iodine, do some seaweed. I don't recommend doing that because iodine is a Goldilocks nutrient, and so it can be helpful if you're deficient. But if you have Hashimoto's or an autoimmunity, then that can actually. Your tolerance of iodine becomes very small, so you can actually overdose yourself and High doses of iodine can actually trigger Hashimoto's. It's kind of like your thyroid gland needs to process iodine and when it's already kind of struggling, you give it that iodine and it can kind of flare up the whole system and produce oxidative stress.

We don't want to do that. So don't self treat with iodine.

Yeah, it's. I've seen a lot of people unfortunately get into trouble with that just by reading stuff on the Internet, you know, Google it. Yeah, yeah, it sounds good in theory, but there's a lot of other factors to consider. The things that do help a lot are going to be things like getting your blood sugar imbalance, eating more protein and fat throughout your diet. This is one of the very first things I recommend, a gluten free diet. About 80 of the people I worked with feel better going gluten free. So they have less pain in their body, they have more energy, less brain fog, they tend to lose weight. You know, these gluten free diet works almost as well, if not better than some thyroid medications in my experience.

And I would think any autoimmune you would want to be gluten free and also dairy free. So do you suggest dairy free with this too?

Dairy free? About 80% of the people do feel better dairy free. It's something that I, I feel like people struggle with because dairy is in so many different things and there's, there's a lot of different thoughts about dairy and some, some may be beneficial, but generally I'll say just give it three weeks and see how you feel off of it. Even like people are like, but I, I'm dairy free, but I use a little bit of creamer and I'll be like, okay for three weeks. Let's just give.

Because that's a little tiny bit, triggers it. Yeah, yeah.

And they'll be like, oh my gosh. I didn't realize it was triggering my joint, joint pain or some of my digestive issues and brain fog. So it is something that I do recommend doing that elimination diet, the gluten free, dairy free and then also soy free. These are the three biggest food triggers I've identified in people where I've had some people just do that for three months and they're like, okay, my thyroid condition is in remission now. I have normal thyroid function again.

Wow. So it actually can go back up to normal levels by just doing those things even without that support of those medications.

In, in some cases it can. There's also certain supplements that can actually get a person balanced with the early stages. Like, okay, somebody's been hypothyroid for a long time and their numbers are just super high or elevated, generally a Tsh above 10. Then I would say, you know, you could want to get on medications if you're trying to have a baby, if you're super symptomatic, but if you're kind of in that gray area where the, where you're just like maybe starting to be hypothyroid. Selenium, 83 micrograms and then myo inositol and 600 milligrams. Using those two together produces synergistic effects for reducing the autoimmune inflammation against the thyroid gland and potentially normalizing thyroid function. So this is something that can, like these two nutrients in combination can bring about a remission in the early stages of Hashimoto's and a return to normal thyroid function for some people, not everybody.

Yeah. What about adrenals and how is that connected to thyroid? I know adrenals is definitely connected to estrogen dominance and cortisol, weight gain. So how does this tie in with thyroid?

What I've seen in people that I've worked with is generally if they have a thyroid condition, they have some degree of adrenal dysfunction. And whether that is cortisol that's too high or cortisol that's just bouncing all over at the place at the wrong time of day, or cortisol that's too low, they're going to be presenting with that. A lot of times I'll see women will get started on thyroid medications and they'll say, I feel better. And then in a few weeks time they'll say they just crashed. And they're like, I have more fatigue, I have more brain fog. What has happened? And so thyroid hormones can impact the clearance, of course, cortisol from our bodies when we don't have enough thyroid hormone on board. This can keep more cortisol in our bodies to compensate. When we get normalize the thyroid function, this can mean more cortisol gets cleared out, which can then reveal an imbalance. Like some people might have, you know, good levels of cortisol because their body is hypothyroid and keeping that cortisol around. But once we get them on thyroid hormone replacement, then that cortisol deficiency can manifest itself. And these are generally people who have a history, long, long term history of trauma, inflammation in their bodies.

Okay, and how do we know if we have adrenal fatigue? I feel like that gets thrown around a lot like adrenal fatigue. And people think if they're stressed or adrenal, how realistic is that to a lot of people? I know you said with thyroid, they have some level of that. Um, but in general, do you think adrenal fatigue is a. Is a more common problem than we recognize? Is it over diagnosed? What's your take on that?

I think it's not necessarily a diagnosis. It's kind of what happens to the body when it gets stuck in a chronic stress state. And I think a lot of us have been stressed out, especially in the last few years. I feel like a decade ago maybe it was not that common. But lately I. I'm like every other person I see. They have symptoms of it. So generally speaking, if you're feeling overwhelmed, if you're feeling anxious, if you have that, like you're just feeling edgy and irritable all the time, have trouble sleeping, have trouble waking up in the morning, these are some signs and symptoms that your adrenals are not producing cortisol at the right times a day in the right amounts. And so that's what I would trigger that. Consider that adrenal dysfunction, where you're really out of alignment with the circadian rhythm and you're not feeling energetic and calm and productive during the day, and you're not feeling sleepy at night.

So it's kind of like a backwards. You don't feel in line with how you should be. How. So if it's less diagnosed and more a feeling, like more. How do you feel more? What's coming on with you? How do you. Is there. Should we all be treating it if we just think that way? And how do you treat it? And is there any, like. I guess that there's a lot of. There's just not a lot of clear information. That's why I wanted to have you on and ask you these questions. There's not a lot of clear information about it because you'll get a standard answer from a doctor. Either they're going to go extreme and go take a Xanax and just tell you to chill out that way, or they just say, oh, go meditate. It's like too general. Or it's too like, whoa, that's a drug. So what do we do? How do we start managing that? How do we start working on that?

So generally, most of the people I've worked with, I will ask them the question, what happened in your life before you got sick? And they'll say, I was going through some period of Extreme stress and stress is at the root cause of adrenal dysfunction where your body just loses its ability to adapt and handle stress. Part of what we need to do is we can replenish the nutrients that are typically burned out during a stress response. This would be like B vitamins, vitamin C, magnesium, electrolytes, kind of like very general things that people don't realize how helpful they can be. I've had people who have menstrual cramps and it's like that's magnesium or hormonal issues. Magnesium can help you with that. Anxiety and sleep issues. That's just getting a little bit more magnesium into your body or you know, pain in your body can be helped by electrolytes as all kinds of cramping. So this is generally when I would start people off with just giving them that and then focusing on some kind of way to shift your body into more of a relaxed state.

So any tips on that? Because I think we as midlife women hear that and then it's like, but, but how, but how? Because you get all these thoughts and these things going on. So. And I feel like that actually can make you more anxious even thinking about I have to relax and not be anxious. So any tips you have on that?

Definitely. I recommend going through and making a list of things that make you feel better and making make you feel worse. For a lot of women that I've worked with, things that make them feel worse are being over scheduled and over committed. Things that make them feel better are going to be spending time in nature, doing crafts, doing arts, hanging out with friends and picking out some of these things that make you feel better. I call them pleasurable activities and trying to incorporate them into your day to day life. That is going to be a great way to shift from that. You know, midlife, you're probably taking care of your children, your elderly parents, your career, your home, and you've got an endless to do list. I'm speaking from experience too, right? Yeah. And so really finding that opportunity to do things for yourself that are pleasurable, just a few minutes a day can shift you into that, into that like parasympathetic, relaxing, healing state. Out of that like fight or flight state that people get stuck in when they have adrenal dysfunction.

So what do you do? I'm actually, I would love some actual like practical, like what would you recommend doing? So like this is the situation, people, you get wound up and I can speak from experience because I've been there many times. Wound up, you're in a Sense of something's urgent. Something. And if, you know, you're in a stress ball moment, right. And it's urgent, and you. We think. I think people think that you have to just keep taking action. I got to. I got to handle this. I got to handle this. I got to handle this. Which is the opposite of what you're saying. So what do you actually do to interrupt that? Because I know you're human, and that has to happen to you, too, sometimes, and it might feel like it's urgent and time sensitive and all the things. So do you catch yourself falling down that road and, like, how do you interrupt yourself? Or what do you. How do you actually ensure that you can get into that parasympathetic and do what you're practicing and talking about?

One of the things I do is I have, like, a nighttime ritual. So I do an Epsom salt bath in the evenings, and that replenishes my magnesium levels, and that kind of helps me.

Okay.

Become more present. I do grounding as well. So if I have a particularly tough day and everything is like, just, you know, you have your own business crashing and, you know, like, your child is sick from school and whatever is going on, just taking a few minutes to step outside, get grounded, you know, take a few deep breaths. And, you know, for some people, they'll do, like, mirror affirmations and just try to remember who they are.

Yeah.

Just take that opportunity to really slow down your breath.

So will you literally interrupt yourself and say, okay, I'm in this mode. I need to get outside, take my shoes off, and ground. Like, will you seriously. Will you interrupt yourself and do that?

If I'm overwhelmed, I will be. I'll stop what I'm doing and I'll just go outside. I'll go for a walk. I'll go for a hike. I'll go for a nature walk. I'll go swimming in my pool. Whatever I can do just to get out of my head. The. The idea is to use your physical body or to use your hands, too, to get out of your head. Some people will create art or play a musical instrument. I'm not particularly gifted at any of these things, so I'll go for a hike. And that. That.

Yeah, that actually makes that fully clears my head to go for a hike. But I sometimes am guilty of. I feel too busy to go do that. So I'm always like. And I catch myself, and then I go do it. But I want to work on that too. And I know people listening want to work on that too. And that's why that's helpful to hear those real examples so we get to all hold each other accountable. When you're feeling like you're spinning, it's. What is that action you can take to interrupt that? Because if we don't interrupt it, we do create these other problems. And having adrenal fatigue, having the low thyroid, all these other issues we're creating are not making aging any better. It's making it worse if we do that.

Absolutely. And the beautiful thing about going for a hike is when you move from left to right. Right. You move your left leg and right leg. That actually gets your different parts of your brain activated or so. And so then whatever problem you have, you can kind of process it a little bit better. So it can actually. I don't know if you've had these experiences where I'm like, oh, my gosh, everything. I'm just overwhelmed. I don't have time for everything. I have to do everything. And then I go for a hike, and then I kind of figure everything out, even though I wasn't thinking about it.

Yeah. I know that my team really does not. Like, when I get in my mode of, like, a lot of things, and then I'll go for a hike and everything feels more clear, and I leave a calm message. And it's like, why did I waste their time with all this other stuff? So I understand exactly what you're talking about. I think we can be a lot more focused and really on point and be a lot more clear when we've taken that time to do those things, too. So how are you with things that naturally create a stress? Like, I'm going to bring up the elephant in the room, like the cell phones. I mean, I'm assuming you're pretty good about probably not having your cell phone with you at all times. Or maybe I'm wrong, but I think this. Do you have habits that you put in place to avoid getting distracted and into stress of other people?

So I used to be really good about my cell phone. I would just keep it in a separate room for most of the day, and I would just do whatever to do throughout the day. Then I had a young child, and it was, you know, I was taking pictures of him. So I kind of got addicted to the phone and, you know, breastfeeding. And I'm like, what am I going to do for 30 minutes every two hours? And I had to create some really healthy boundaries around my cell phone. And so that is keeping it away, but yet I keep it the volume up in case somebody calls and needs me. Like right now my son is at preschool and I can't necessarily put my phone in a different room in case something happens. You know, I'm still a parent, so I just keep the volume.

That's smart. You just keep the notification on. So that explains. It takes away that I have to have it on my hip. But you know that you're reachable if something's important.

And I uninstalled social media from my phone. Wow.

Wow. That you can only check it like from. If you go online, like actually onto your computer.

Yeah, yeah. Because that ended up being just something that you can get really easily sucked in.

Oh, for sure.

This is interesting. And this. Or, you know, this is scary. This. And you end up just going through and getting on the phone and. And that for me personally, I was like, you know, it's hard to be present as a parent.

Yes.

You're having, you know, like a one on one relationship with your phone. Sure. 90 of the day.

What do you want, people, before we wrap up? I want to like, I want to kind of tie this in a nice bow. What do you want women to know that have been told that they have low thyroid? What do want them to know for? Like, where should they start when they've been given that information?

Definitely start by empowering yourself and educating yourself about your condition. There's a lot more that can be done than what your typical endocrinologist might say. I've heard of women that have been told they have hypothyroidism and there's like nothing that they could do about it. They're just, you know, I was in my 20s and they were like, okay, well you're not going to, you're going to be losing hair because that's what happens. You're going to be gaining weight because you're getting older. And they just tell people all of these things that as though they were inevitable and that's not necessarily the case. So you can actually thrive whether you have a thyroid condition or not. There might be things you may need to address, like your vitamin levels, that there are some reasons that led you to have that inflammatory response in your body. And there's some consequences of the hypothyroidism that you may wish to correct. And a lot of the symptoms are completely reversible. So like let's say brain fog. Carnitine generally will. Will help with that. Carnitine production can be impacted by hypothyroidism. Vitamin D. Getting your levels up can help you feel better, resolve any kind of depression that's related to hypothyroidism. Selenium is amazing for hair loss and anxiety. So there's a lot of different nutrients. There's a lot of triggers for thyroid conditions. And I do encourage you to become your own advocate and get empowered on all of the things you can do so you can feel amazing.

Fantastic. Now Isabella has a bunch of books out and her most recent one. Can you tell them about your most recent one and where they can find it?

My most recent book is Adrenal Transformation Protocol. You can find it on Amazon, Barnes and Noble, wherever fine books are sold. And it's a four week plan to overcome some of the stress symptoms like brain fog, fatigue.

Who doesn't need that? We all need that. We all need that help. Thank you so much. And where can they find you on social? Even though you're only on it on your computer, she still does post some good stuff there. Where can they find you? Where? Instagram. Is that the main place you want them to go?

Isabella Wentz. PharmD is on Instagram and then I'm still on Facebook under thyroid pharmacist. Isabella, Dr. Isabella Wentz. So people can find me at both places and I do answer comments too.

So thank you so much for being here. Thank you.

Thank you so much for having me.