Episode Transcript
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Kate Scarlata, MPH, RDN (00:20):
The Gut
Health Podcast will empower you
with a fascinating scientificconnection between your brain,
food and the gut.
Come join us.
We welcome you.
Hello, friends, and welcome toThe Gut Health Podcast, where we
talk about all things relatedto your gut and well-being.
(00:40):
We are your hosts.
I'm Kate Scarlata, GI dietitian.
Dr. Megan Riehl (00:45):
And I'm Dr
Megan Riehl, a GI health
psychologist, and today wewelcome back a friend to our
show, Dr.
Brennan Spiegel.
He is the Director of HealthServices Research at
Cedars-Sinai in Los Angeles andleads the Cedars-Sinai Center
for Outcomes Research andEducation, where his team
investigates how digital healthtechnologies from wearable
(01:07):
biosensors and smartphone appsto virtual reality can
strengthen the patient-doctorconnection, improve outcomes and
reduce costs.
He developed one of the largestand most widely studied medical
VR programs, helping establishthe emerging field of medical
extended reality, which appliesimmersive technologies to
(01:28):
conditions such as pain, anxiety, depression and IBS all things
we care about on this podcast.
Dr.
Spiegel has authoredbestselling medical textbooks,
has more than 270 peer-reviewedarticles and has been featured
in all the major news outlets,including New York Times, Forbes
and The Wall Street Journal.
He's also the author of VRX HowImmersive Therapeutics Will
(01:51):
Revolutionize Medicine, whichwas named by Wired as one of
2020's top science books.
Today, though, he will besharing his insights on
groundbreaking hypothesesrelated to gravity and its
impact on human health,including digestive health.
Kate Scarlata, MPH, RDN (02:08):
So we
are so glad to have you back.
We're a fan of your work andthe way your brain works,
especially me.
Well, I know Megan too.
I'm obsessed with the wayyou're doing.
Dr. Brennan Spiegel (02:17):
I'm a fan
of you guys too, so thanks for
having me.
Kate Scarlata, MPH, RDN (02:20):
So we
are glad to have you here.
We are going to be talkingabout Dr Spiegel's new book
called Pull, which is going tobe released October 7th, and I
have had a preview and it's justvery insightful, intriguing and
novel and a must read forreally anyone.
Don't forget to check out.
We had him on for episode 13,where we talked about the vagus
(02:42):
nerve and virtual reality forgut health, so check out that
episode as well.
So welcome back, Dr.
Spiegel.
Dr. Brennan Spiegel (02:48):
Well,
thanks so much for having me.
And hey, you know, the vagusnerve has to do with gravity too
.
So who knows, we can bring itall back to gravity.
Kate Scarlata, MPH, RDN (02:55):
Oh, yes
, let's bring that in.
So we know that gravity doesn'tjust keep us on the ground.
It shapes our bodies, minds andeven our emotions.
And in Pull, dr Spiegel revealshow this invisible force
influences everything fromdigestion to depression and how
building gravity resilience canhelp us find balance, stand
(03:15):
stronger and live longer.
And I just want to interjecthere because you know I have a
lot of questions about your bookand this paper that you put out
.
With Gravity and IBS, we're alldealing with gravity, but it's
about having good gravityresilience.
So can you just quickly talkabout that before we get into
(03:36):
myth busting with you?
Dr. Brennan Spiegel (03:38):
Yeah,
absolutely.
Well, thanks for that startingpoint.
Because if you take a step backright, gravity was here long
before we were and it'll be herelong after we're gone.
So it stands to reason thatevery part of your body, not
just the gut, even themicrobiome inside the gut, every
tendon, every organ, every bonein your body, even your brain,
(04:00):
evolved to manage thisfundamental force of physics.
And so the better we do atmanaging it, the more resilient
we are to it, the more we thriveand survive.
And so that's the idea behindbiogravitational medicine.
It's like a fish is to water.
You know, a fish swims in water.
It doesn't, I assume, knowanything about the water, but it
(04:24):
survives and thrives and isdesigned to move through water.
And that's the same with us togravity.
It's almost so obvious that itdoesn't need to be said, except
that so many of our chronicmedical conditions are a result
of gravity intolerance.
So some people can manage thisforce better than others, and
we'll get into the details.
And gravity resilience is howwell you stand up to gravity,
(04:47):
not just physically, there'syour gravity fortitude, your
strength, also the inner pumpsand hydraulic systems, including
the gut, the cardiovascular,the lymphatics, how well you
pump up against gravity to getthat blood up to your brain.
So we don't pass out talking toeach other right now, but also
your nervous system, inner earand your brain itself are all
(05:08):
managing gravity.
Kate Scarlata, MPH, RDN (05:10):
All
right, so you've done this
before.
We're all about myth bustinghere at The Gut Health Podcast,
so can you bust a myth regardinggravity and gut health?
Dr. Brennan Spiegel (05:20):
Yeah well,
gravity.
In general, we tend to think ofit as a pull.
In fact, that's the name of mybook.
It's Pull.
That's how we feel it.
(05:40):
We feel like we're being pulleddown to the earth, but in fact
it's almost of relativity.
The idea behind relativity isbeing pulled down is the same as
being pushed up.
Now what does that mean for us?
Well, it means that in a way,we can think of the ground
beneath us as buoying us up,pushing us up, and we can
(06:00):
leverage our relationship togravity almost like a trampoline
.
Right when I run, for example,when I run marathons, I use
these almost barefoot shoesbecause I want to feel the earth
push into my foot and bound meup into the air.
So it's an interesting pivot.
I mean, if you think, right nowyou might feel like you're
(06:21):
being pulled down, but if youchange your mindset and think,
oh, actually the earth, thechair, the feet, the pressure
beneath my feet is pushing me up, it's a reverse mindset and
that has mental implications,not just physical.
So that's a myth.
It's actually not a pull, it'san upward acceleration against
us.
Dr. Megan Riehl (06:38):
Yeah, that
makes me think about like
grounding exercises that I'll dowith patients, or when we kind
of think about the power of yourfeet and feeling that support
underneath you, and that'ssomething you know, if you are
an individual blessed to havefeet, that you get to have that
sensation of grounding.
So that's a great myth, and youknow.
(07:01):
Let's kick this off a littlebit more broadly and tell us a
little bit more about gravityand how it may impact our gut.
Tell us a little bit about thatpaper that you published and
you certainly dive into it andpull as well.
Dr. Brennan Spiegel (07:18):
Yeah.
So I'll start with a story.
I saw a patient in clinic justa few weeks ago maybe a month
ago who had been diagnosed withirritable bowel syndrome young
woman and she had had persistentabdominal pain and diarrhea and
bloating and nothing really hadbeen helping.
So I went in to see her with mystudent and I shook her hand
(07:41):
like I do with all my patients.
I said hi, and the first thingI noticed is her wrist was
really clicky as I was shakingher hand, and that can happen.
But to me that was the firstclinical clue that there
actually could be a gravityintolerance explanation here.
So what does that mean?
Well, her wrist was clicky, itwas particularly clicky.
(08:02):
So after I said hi and so on, Iasked her could you bend your
pinky back for me?
And she was able to bend it wayback beyond what I can, which
is about 90 degrees.
She went way back.
I thought well, that's a clue.
And then I asked her can youtake your thumb and touch your
forearm with it?
Actually bring it all the waydown to your forearm?
I can't do that, not at all.
(08:22):
She easily did it.
She was double jointed in herelbow.
She can touch the ground easilywith her hands without bending
her knees, and I thought wait asecond.
She has hyper mobility and whenthe joints are stretchy,
oftentimes the interiorsuspension systems are stretchy
too and it turns out the gut ishanging off a suspension system,
(08:44):
almost like I don't knowornaments on a Christmas tree or
something like that, or amarionette on strings.
If the strings are stretchy ona marionette it's going to
collapse onto the ground andwon't be animated.
We ended up doing an x-ray ofher belly, first flat and then
standing up, and we observedthat almost 90% of her bowel
collapsed, all the way down intothe basin of her pelvis.
(09:07):
Turned out she hadEhlers-Danlos syndrome, which
sometimes can mimic IBS, acondition where there's issues
with collagen in the body, thestretchy protein that keeps us
connected, and for her thetreatment was abdominal
exercises, hypopressiveexercises where you suck your
belly in and hold it tight.
(09:27):
Lower back, she had a lot ofback pain, the anti-gravity
muscles in the back and so onSwimming, so she can be
horizontal rather than verticalwhen she's exercising Tilt table
therapy she had a gravityintolerance.
So that's just an example togive you a sense of the physical
ways and when that happens thegut compresses down.
(09:49):
It's almost like a garden hosethat gets kinked and it gets
backed up with water.
So she had bacterial overgrowthas a secondary consequence of
this accordion-like compressionof her intestines because she
was intolerant to gravity.
She also got lightheaded whenshe stood up too quickly, which
is another form of gravityintolerance, and you need to
(10:10):
drink a lot of fluid and getenough salt within limits to
maintain the pressure to getyour whole body moving with its
circulation.
So that just exemplifies what Imean by gravity intolerance.
And there's so many otherstories we could talk about, but
that one to me illustrates itwell.
Dr. Megan Riehl (10:26):
Yeah, and some
of these common comorbidities
that our patients areexperiencing that may go
misdiagnosed for a really longtime.
You might be looking down thewrong rabbit hole.
Kate Scarlata, MPH, (10:37):
Absolutely
.
And just you know I'm again afan like that.
All those clues that you foundjust by assessing, to know to
look for those things I don'tthink is standard of care.
And yet we know people withconnective tissue or
hypomobility joint issues oftenhave digestive problems.
(10:58):
So maybe we should bemonitoring those telltale signs
that you were, you know, werevery tuned into, which is so
amazing.
So let's think about astronauts.
They've been studied andobviously they're not exposed to
the gravity we are here onEarth and we know that there's
effects to their digestion andcirculation and mood.
(11:20):
And with that recent episodewhere the astronauts were stuck
up at the space station for evenlonger amounts of time, I
wonder if we learned even more.
But how can you know some ofthis science influence how
health strategies orinterventions for us down here
on Earth, where we are exposedto a lot of gravity?
Dr. Brennan Spiegel (11:40):
Yeah,
you're right.
So up in space, and we callthis microgravity orbit.
So there still is gravity up inlow Earth orbit, but it doesn't
feel like it because they're inwhat's called parabolic flight,
so they're always fallingtowards the Earth, which makes
you feel like you're floating.
But, boy, astronauts get abunch of gut issues.
They get a lot of issues, notjust the GI tract.
(12:02):
So they get abdominaldistension, can get bloating.
The microbiome changes in space.
Serotonin signaling, which is aconsequence of the microbiome,
also is abnormal in microgravityorbit.
They get kidney stones, theyget headaches, they get
infections.
So you'd think, why would youget a viral infection in the
(12:25):
International Space Station,which is scrubbed clean?
Well, the immune system startsto let its guard down and latent
viruses like, let's say, herpesor varicella zoster will come
out.
So it can affect all parts ofthe body, including the
circulatory system.
So there's this Goldilocks zoneof too much gravity or too
little gravity or just right.
(12:46):
So astronauts have too littlegravity and they get a whole
bunch of issues, whereas onEarth some people may experience
too much gravity.
Now, gravity doesn't change onEarth, of course, but our
relationship to gravity canchange depending upon the
decisions you make and the wayyou're built and all these other
things we'll talk about andwhat I like to think about it as
is.
We are born of this earth.
(13:08):
We came out of it.
We're a process of theevolutionary history of this
planet.
So what that means is our bodyis designed to take in all the
data from the world, literally.
The grounding exercises we talkabout are about feeling the
floor, interpreting it throughour nervous system and then
(13:30):
creating a mental model in ourmind physical and mental about
where we are in relation to thisplanet like Mother Earth.
Okay, so we can learn fromastronauts, first of all, that
we're born for this planet.
It's going to be challenging toget to Mars without simulating
gravity, and in high altitudesIBS is more common.
Colitis flares happen onairplanes, for example.
(13:53):
We could talk about all thesethings because that's a
gravitational effect too whenyou go up into the upper
atmosphere and in the book PullI talk about a lot of these
examples, especially with highaltitude.
So a bit of a rambling answerbecause there's so much to
unpack there, but it's a greatquestion.
Kate Scarlata, MPH, RDN (14:08):
No,
it's interesting.
Dr. Megan Riehl (14:10):
You know, as we
make this pivot to thinking
about, certainly it affects ourinternal organs and our physical
health.
Your book talks beautifully andI love that it incorporates the
mental health effect of gravityas well.
And in fact, if you don't mind,I just wanted to kind of
(14:31):
highlight something from yourbook that you shared and
research really showing thatadopting an upright posture can
have a measurable effect on ourmood and how we physically hold
ourselves against gravity caninfluence our emotional state.
You wrote and so tell us alittle bit about your
perspective on gravity anddepression and mood.
Dr. Brennan Spiegel (14:52):
So think
about what it would feel like if
you're on a bigger planet rightnow, with more gravity, more
pull on your body.
Getting out of bed would bedifficult.
You'd be exhausted all day.
Your shoulders would literallybe slumped over, you'd be
staring at your toes.
You would not have the energyto engage with the world.
(15:15):
You would feel physically andemotionally down.
Even the language that we use.
I feel down in the dumps.
Right Down in hell, right Up inheaven.
I feel high, literally high.
Okay, serotonin exploding in mybrain from a psychedelic.
You're high, okay.
Church steeples point to thesky.
(15:37):
We look to the heavens forinspiration.
Up is good and down is bad, andthat's not just a metaphor.
It turns out our brain literallyhas a verticality to our
neuropsychology.
It's born into us from birth.
Even little babies know andthere's been really interesting
experiments to show thismisinterpreting the force of
(16:06):
gravity, especially in theinsula, which is a part of the
brain that's taking in all thisdata about gravity and we get
confused about what the actualamount of gravity is and we feel
too much pull and it bringsmind and body down and, in a way
, anxiety is almost like you arefalling and depression is fall
in in.
So on a roller coaster peopleget butterflies.
(16:29):
That's their gut telling themlike you're about to die, like
we're not supposed to fall 20stories.
Some of my IBS patients do notwant to go on a roller coaster
because they feel those gutfeelings all the time.
It's almost like a metaphoricalfall.
That's what anxiety is isyou're going down and what's at
the bottom?
This is kind of poignant.
Well, in some traditions it's agrave, which is a gravity box.
(16:54):
It's a word derived from theword gravity.
We do not want to fall down andend up in a gravity box.
So when we're falling we feelthe gut feelings like we do on a
roller coaster.
So that's a big introduction tothis whole notion of mental
gravity.
Dr. Megan Riehl (17:08):
Yeah, and so
how might some of your proposed
gravity-informed approachesdiffer from traditional mental
health interventions?
Because, you know, I think somepeople are really going to
gravitate toward these conceptsand really take them as new ways
(17:29):
of thinking about how they'reemotionally feeling.
So give us some ideas.
Dr. Brennan Spiegel (17:33):
Yeah, yeah,
so you mentioned standing up
straight.
So, given everything I justsaid, this is to be clear no
panacea for depression, right?
People, as you would know aswell as any of us, you know,
with severe depression you can'tjust say, oh, stand up straight
and it goes away, that's right,so no.
But you know, amy Cuddy hasdone a lot of work on these
power poses and literally juststanding up straight, your spine
(17:54):
is a chassis that holds up allthe viscera in your belly.
Standing up straight opens upthe abdominal cavity and, just
from a gut health standpoint,can help with digestion.
If you're always hunched overall day long in a seat with your
shoulders, you know, curledforward, you're compressing the
abdominal cavity.
But there's something deeperthan that.
There's something aboutliterally defying gravity, using
(18:16):
that upward push of gravity tospringboard you up into the
world.
So you're standing strong andthis has effects on the brain,
even if it's subtle it's not thesame in everybody.
That can give you a littlesense of empowerment, even
smiling.
Smiling is up and frowning isdown.
Okay, so our body language upis good.
When we're excited, the eyes goup, everything moves up.
(18:39):
So that's just one simpleapproach.
But then we also use virtualreality, to simulate rising up
without literally rising, and docognitive behavioral therapy in
environments where you'refloating up into the clouds or
you're floating in heaven.
These are also very interestingways to leverage this
verticality of our psychology inways that are hard to do in an
(19:03):
office setting, let's say.
Those are just a couple ofexamples.
Dr. Megan Riehl (19:06):
Yeah, and so
tell us a little bit more about
serotonin and the gut andgravity and what is the
connection here?
Dr. Brennan Spiegel (19:16):
Yeah, so
most people think of serotonin
as sort of a happy chemicalthat's in the brain and it is
that it can help elevate mood.
Just think about that wordelevate, that's anti-gravity,
we're raising up mood and it'slow in depression.
But we spend a lot of timetalking about brain serotonin
(19:39):
when in fact 90 to 95% of thebody's serotonin comes from the
gut.
And I'm going to guess this hascome up in a lot of your
discussions over time on thispodcast, but it's always
surprising and it turns out weneed a microbiome to create
serotonin, which is one reasonwhy among many, infants and
(20:00):
little babies can't walk.
Yet they don't have serotonin.
They're busy forming theirmicrobiome to kickstart
serotonin production, which isvital to stand up.
It primes your muscles,serotonin, and it primes the
cardiovascular system so thatthe pump and tubes can push
enough blood up into your brain.
In an upright stance, of course, the gut itself is moving in
(20:24):
all direct, no matter if you'reupside down, you can digest food
because of serotonin, and soserotonin is a gravity
management substance and if wehave an abnormality in the
microbiome serotonin complex,we'll call it.
One could see how you might getlightheaded or dizzy or have
(20:45):
abdominal pain or get someswelling in your body.
Ankle edema from low return ofblood or lymphatics,
baroreceptor reflex, which is asystem in your body that tells
you if you're standing up, toincrease your blood pressure
quickly and not pass outserotonin.
The inner ear, the vestibularsystem that keeps you from
(21:05):
toppling over serotonin.
So this is why people on SSRIs,who withdraw quickly from SSRIs
, sometimes get very dizzybecause their relationship to
gravity has literally changedBecause the serotonin levels are
changing so rapidly in theinner ear that you've lost your
relationship to the planet.
It's extremely disorienting,depersonalizing, derealizing.
(21:27):
So serotonin is very profound.
It's not just a happy chemical.
Dr. Megan Riehl (21:32):
And you know it
highlights this bi-directional
relationship between whathappens in the gut and what
happens in our brain and why wesee these comorbidities of
anxiety and depression in highprevalence with some of our
gastrointestinal conditions likeIBS, as well as inflammatory
bowel disease.
So, again, giving us differentways to think about targets for
(21:56):
treatment.
And you're certainly right thatstanding up straight is not
going to be the end all cure forsomebody with major depressive
disorder.
But I do think you're giving usa tip and a trick for, you know
, if you're just having a hardmoment, if you're having, you
know, a really busy day, I wouldthink of some of that from a
mindfulness-based perspective,of taking a couple moments to
(22:19):
have a deep breath, but also situp straight, open the chest,
pull the shoulders back, putthat head up toward the heavens
and there is some science tosupport that that can help with
then grounding yourself andmoving back with maybe a little
bit more motivation, a littlebetter concentration and energy.
Dr. Brennan Spiegel (22:39):
And, if I
can add, there's also a therapy
called flotation therapy orflotation rest therapy, where
you get into a flotation tankfull of Epsom salt, so it's like
being in the Dead Sea in Israel, and you get into this nice
sort of dark room, the water iswarm to your body temperature
and you literally just float.
(22:59):
It's an anti-gravity experience, and evidence shows this too
can be helpful for depressionand for mood elevation in
general, and there's beenfunctional MRI studies in the
brain showing that it can changethe perception of time.
In the same areas of the brainthat are managing gravity, which
is a process calledgravisception.
(23:19):
It turns out we have anothersensation called graviseption,
which is your ability toperceive gravity, and flotation
therapy can help reset yourgraviseptive processes.
So that's just yet anotherinteresting approach that I talk
about in the book.
Dr. Megan Riehl (23:35):
That sounds
great.
Let me float.
Dr. Brennan Spiegel (23:37):
Yeah, I
mean I'm ready to do it.
Kate Scarlata, MPH, RDN (23:38):
Dark
room.
See you later, right.
Especially young moms out there.
Right.
I think, that's an automaticboost to the mood.
So let's talk.
I kind of mentioned gravityresilience in the beginning and
I know that there are somepeople that are less prone to
having good gravity resilience.
So I want to talk a little bitabout who are these people that
(23:58):
are less resistant to gravity?
And then, what is gravityresilience and how can we get
more of it?
Because clearly, you know, thisis vital information for some,
for all of us, but maybe somepeople more than others.
Dr. Brennan Spiegel (24:11):
We're all
too sedentary and we know that
sitting is the new smoking.
That's a meme that's out thereand there's so much research now
that shows that the strongeryou are, the longer you live.
The lighter you are, the longeryou live.
And, of course, the types ofcalories that you take in are
(24:32):
all important and we're going to, I'm sure, talk about this.
And so why is that?
Well, because that helps youfight gravity better.
As we age, gravity doesn'tchange, but our relationship to
gravity changes.
We become a little bit weaker,we become a little more frail.
We start to get literallypulled down to the earth.
Kyphosis, or lower backcurvature, starts to come into
(24:54):
some older individuals.
So the way to become gravityresilience to start off with is
to become stronger.
So I use a standing desk.
I'm standing right now.
I typically although not rightnow wear a standing desk.
I'm standing right now.
I typically although not rightnow wear a 20 pound weighted
vest.
All day long I wear ankleweights 20 pounds on each ankle.
I use a balance board toconstantly practice my balance
(25:16):
while I'm working.
Sometimes I step in place at mydesk and it turns out that
there's something else in thebody called the gravitostat.
It's like a thermostat in yourbody for weight.
If you suddenly put a lot ofweight on your body all at once,
not gradually over months andmonths, but all at once, the
(25:38):
bones feel the compression andthey say to the body, to the
brain, essentially hey, thingsgot heavy, like gravity just
changed.
We need to increase metabolicrate, we need to lose weight and
in fact there's research thatyou can lose four pounds in
about four weeks just by wearinga weighted vest all day.
(25:58):
And now there's this new trendof rucking.
Where you run around, you knowyou might see people with
weighted vests or backpacks.
Running comes from the military, mainly.
Very effective.
So this is one way to becomemore resilient, is just to
strengthen your body.
Kate Scarlata, MPH, RDN (26:13):
Okay,
so what about conditions that
are?
You know, you mentionedhypermobility.
What are some other conditionsmaybe that would make someone
less gravity resilient?
Dr. Brennan Spiegel (26:23):
Yeah, maybe
that would make someone less
gravity resilient.
Yeah.
Well, you know, lower back painis a form of gravity
intolerance, just starting withthe most common condition,
because we can get into POTS andmast cell activation and a lot
of these conditions that I knowyour listeners care about, and
those are forms of gravityintolerance too.
But if we just start with lowerback pain, that is a form of
(26:44):
gravity intolerance.
You know, we originated asfour-legged creatures and it's
only in the last about 10% ofour evolutionary history that we
stood up and as we stood up,all the systems had to reshift,
including the gut.
Hanging down, the back suddenlyhas to port around the sack of
potatoes.
We got a sack of potatoes inour belly.
It's the gut, and some peopleare better at carrying around
(27:07):
the sack of potatoes.
We got a sack of potatoes inour belly it's the gut, and some
people are better at carryingaround that sack of potatoes
than others.
And it turns out there's a fewways we do it.
Lower back, strengthening thatback, pulling up the diaphragm.
Diaphragm is the top, like theceiling tack that pulls up that
sack of potatoes.
The mesentery are thesuspension cables on the inside
that, if they're caked down withtoo much fat tissue cannot work
(27:28):
well.
The gut can get sort of tangledup, compressed.
You stand up straight, strongback, everything pulls up.
Not only does the back getbetter, but the gut gets better.
A lot of people with IBS haveback pain.
Why is that?
Way higher than the generalpopulation.
It's because the back and thegut are so closely connected
that they are completelyinterrelated in terms of how
(27:51):
their physiology and anatomyworks.
So those are just some examples.
Now I mentioned posturaltachycardia syndrome.
That's where people get verylightheaded and dizzy when they
stand up quickly.
Some people call that beingallergic to gravity.
Headed and dizzy when theystand up quickly.
That some people call thatbeing allergic to gravity.
You know mast cell activationsyndrome.
You have a lot of histamine inthe body, blood pressure drops,
people get lightheaded,tachycardic, their heart starts
(28:12):
to go quickly.
Those are signs that yourneurophysiology is not managing
the force of gravity.
And if we measure not just theheart rate but the heart rate
variability, the beat to beatvariations in the heart, we can
see that it's off in people withthose syndromes.
It's also off in astronauts whodon't have gravity.
(28:37):
These are all gravitymanagement systems and we can
see similar abnormalities inastronauts, as we see in some of
these people who have posturaltachycardia syndrome, for
example.
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Kate Scarlata, MPH, RDN (29:43):
I'm
just thinking about, like core.
What kind of exercises?
What else, so we get theweighted vest and standing more,
standing tall, being stronger,yeah, what else.
Dr. Brennan Spiegel (29:56):
So I really
like I'll come back to those
hypopressive exercises becausethere is evidence that this can
help, especially with low backpain, pelvic pain and abdominal
pain.
So the idea is you suck in yourbelly like, pull up your belly
towards you, almost like you'retrying to take that sack of
potatoes in your belly and pullit up, suspend it up into your
(30:17):
chest, hold it, relax, take adeep breath and then hold it and
relax and if you do thatroutinely you get much stronger
diaphragm, which helps bolsterand strengthen all the
connections inside.
It's not just about the gut andit's not just about the muscles
.
It's about the connectionpoints between the spine and the
(30:40):
bones and the gut and theviscera.
This is called tensegrity.
That's a term that meanstensile integrity and the way I
think about that, it's like atree can bend in the wind but
not break.
We want to be resilient,meaning we can bend but not snap
.
(31:01):
This is why Tom Brady was themost durable quarterback ever in
the NFL.
He wasn't the biggest guy.
He actually learned tostrengthen his inner connections
and become physically resilient.
He changed the way quarterbackstrained, using resistance
training and bands and notnecessarily just bulking up.
Gronkowski was a big guy whohad ACL injuries and shoulder
(31:23):
injuries.
The biggest guys in the NFLoften get injured and they're
out, because it's not just abouthow big and strong you are,
it's about how theinterconnection points are
moving together as one seamlessunit.
We have seams in our body andso part of this hypopressive
activity is not just bulking upthe abs, which you do with
(31:44):
sit-ups, but strengthening thediaphragm, the tendons and all
the connection points on theinside to bolster and hold up
the gut and the entire core.
Kate Scarlata, MPH, RDN (31:52):
And
it's not talked about.
Right, it's not talked aboutthat much really.
Dr. Brennan Spiegel (31:56):
No, not at
all.
Dr. Megan Riehl (31:58):
I was thinking.
You know, we do work withpeople in the psychology space
on resilience from the emotionalstandpoint, and we have
research that shows that thosethat are more emotionally
resilient have better outcomes.
We see this research ininflammatory bowel disease, and
so it is a modifiable factor.
(32:19):
I always like to stress forpeople that even if you feel
like you're not the greatest,you're not the most resilient,
we can work on that.
And similarly, from aphysiological standpoint, it
sounds like it is something thatis modifiable and we can really
work on that too.
Dr. Brennan Spiegel (32:34):
That's a
great analogy, and I think it's
more than an analogy.
Sometimes we think we're justtalking in metaphors, but
actually mental resilience hasthe exact same concepts as
physical resilience, and reallywe've talked about this in my
last podcast.
Mental and physical are, in away, one in the same, and so I
think about the body as anextracranial extension of the
(32:57):
brain.
The brain is in this controlcenter and it sends out and it
comes right out of the skull andit forms in this seamless way
into this entire apparatus thatis our body, that is informing
our brain at all times.
So we talk about resilience.
It's physical, it's mental.
These are just words that weuse, but what it means is you
can bend without breaking,whether it's mentally,
(33:19):
physically or both, and this iswhy study after study shows
physical strengthening, exercise, cardiovascular fitness all of
these things improve mentalhealth.
Kate Scarlata, MPH, RDN (33:31):
That's
right, bend without breaking
people, let's do it.
Dr. Brennan Spiegel (33:35):
That's
right, exactly.
Kate Scarlata, MPH, RDN (33:37):
So
should we talk about diet and
how?
Dr. Brennan Spiegel (33:41):
Of course.
Kate Scarlata, MPH, RDN (33:41):
Hello,
yes.
Dr. Brennan Spiegel (33:42):
We cannot
do that.
We got to get you in on this.
Kate Scarlata, MPH, RDN (33:45):
I want
to get in on this.
I've always been a littleobsessed with serotonin.
There was a researcher at MIT,Judith Wurtman, that did a lot
of serotonin and dietrelationship research early in
the 1980s, and so this issomething I've kind of tracked
throughout time.
But I know you have this stack10 and you talk about how diet
(34:06):
can enhance serotonin levelsthrough use of tryptophan rich
foods.
So let's chat about that.
Dr. Brennan Spiegel (34:13):
Yeah,
absolutely, and I'd love to hear
your thoughts about this.
So we just got finished talkingabout exercise and
cardiovascular fitness, how itcan improve mental health.
It also can improve serotoninbiology, so you can boost
serotonin through theseactivities.
But in order to boost serotonin, you have to have the substrate
for serotonin available, andthat's tryptophan.
(34:33):
So tryptophan is an amino acid.
It doesn't get manufactured inour body.
We need to ingest it throughour diet.
So thinking about how to enhancetryptophan levels in the body
through the diet is the ideabehind what I call the STACK TEN
diet.
I kind of just made that upbecause it just sounds good.
But no, the way I think aboutit is try to stack my diet with
(34:56):
10 foods that are all known tobe rich in tryptophan and I'd
love to hear your thoughts aboutthis, Kate, because every food
isn't necessarily right forevery person.
But you know salmon and seedsthat would be the S.
You know turkey, of course.
You think about people get allsleepy on Thanksgiving and some
people think that's because oftryptophan, which can lead to
(35:17):
serotonin and then to melatonin.
So these are all part of thebiology of tryptophan.
The A is avocado, I have toremember.
The C is chicken, and thenchickpeas and chickpeas, I hear,
are a little controversial forsome people, but chickpeas, K is
kidney beans, and then that'sthe STACK, and then the 10 is T
(35:37):
for tofu, E for eggs and N fornuts.
So I'm sure there are manyother foods that have tryptophan
in it, but that's how Iremember the key ones.
Kate Scarlata, MPH, RDN (35:47):
Yeah,
no, I'm with you on that.
I mean, not everyone's going tobe amenable to all the
different choices, but I thinkthat's what's nice about having
a variety of differentselections for different people.
Dr. Brennan Spiegel (35:58):
Right, yeah
, yeah.
Are there any other foods thatcome to mind that I should be
including or that you recommendfor serotonin or tryptophan?
Kate Scarlata, MPH, RDN (36:05):
You
know, not really.
It was interesting and I haveto look back at this Judith
Wurtman.
But she had some carbohydratesthat she pushed without having
the protein, so it was likealmost she had more of a dietary
pattern.
That made it different and I'llpull that research and attach
it to the show notes.
You know, again, this is backfrom the 1980s but these are
(36:31):
really tangible things that mostpeople can include and may not
be including enough of.
So I you know, I'm in agreementwith your list.
I think it's great, great.
Dr. Megan Riehl (36:37):
Well, nobody's
asking me, but I mean, ice cream
really gets my serotonin going.
But that just didn't make thelist.
Kate Scarlata, MPH, RDN (36:43):
It did
not make the list so.
Dr. Megan Riehl (36:45):
I will stick
with-.
Dr. Brennan Spiegel (36:46):
It gets the
dopamine going for sure.
Kate Scarlata, MPH, RDN (36:48):
There
you go.
Dr. Megan Riehl (36:48):
Yeah, there you
go Well it's always fascinating
to think about, you know again,just different tangible ways
that we can address this,whether it be food or our
emotional health or physicalhealth.
It's nice to have differententrance points for this our
emotional health, our physicalhealth.
It's nice to have differententrance points for this.
And you mentioned the rollercoaster a while ago and this
(37:13):
sensation of butterflies in thestomach, and I always think too
about those butterflies beingattached to our gut instinct and
tuning into that and havingsome ability to listen to what
our body is telling us.
What does that make you thinkof?
And what else might we takeaway from kind of those
sensations in our body?
Dr. Brennan Spiegel (37:33):
Yeah, so in
the book I talk about how I
used to ride a lot of rollercoasters and for me I really got
the feeling in the gut and Iremember once riding on the
Colossus, which used to be thebiggest wooden roller coaster in
the world, at Magic Mountainhere in LA, and at the end of
the ride you know they usuallytake a photo and on the way out
they show you a photo.
So I was with my friend, Chris,who ended up becoming a
(37:56):
Broadway dancer, like a reallystrong, robust guy, and I am
next to him curled over in aball, white, knuckling the rail,
looking like I'm absolutelydying, and he's got his hands up
in the air and he's smiling andhe's not even holding on.
And I realized we were havingdifferent experiences and
(38:17):
reactions to this gravitychallenge.
My belly ignited and his didn't, and so if we had an MRI
scanner, our brains would lookvery different.
In that moment my amygdala,which is this sort of almond
shaped emotion center that wehave in our brain, would be on
fire, just going crazy, and hisprobably would not.
And so in the book I talk aboutthat and I even talk about this
(38:39):
guy, Alex Honnold, who isfamous for free soloing El
Capitan in Yosemite.
He's an incredible rock climberthat got all the way up the
side of this rock face withoutany ropes.
And you think, well, how doeshe manage gravity?
Because at any nanosecond hecan fall to his death?
Well, it turns out when they doMRI scans of his brain, his
(39:00):
brain is like the opposite ofsome people with chronic pain or
IBS or fibromyalgia Hisamygdala silent, nothing like
just quiet, Whereas if you lookat the amygdala and the related
connections to people withchronic pain, it's the exact
opposite.
It's like he has an inversebrain.
He is the ultimate gravityfighter.
(39:20):
He's not going to be worriedabout going on a roller coaster
for sure.
So this is just telling usabout our neurophysiology and
how we're all a little bitdifferent and how, something
like anxiety.
When I think about gut feelings,I'm thinking well, why are you
having those gut feelings?
There could be a purelyphysical explanation.
Like you know, you have aninfection in your gut or colitis
, but sometimes it's almost likea ventriloquist throwing its
(39:43):
voice.
It's like the amygdala.
It's the brain throwing itsvoice into the gut and it's your
brain talking through your body.
That's why I said before, thislanguage is imprecise.
It's all one system, but wethink about oh, the brain talks
to the body.
Well, the body is the brain,the gut is the brain.
It's all connected.
There are seams that are reallyseamless, and so it's like a
(40:07):
ventriloquist, though, and I saywell, why do you feel like
you're falling right now?
Next time you have gut feelings, think why do I feel like I'm
falling, why am I falling?
It's an illusion.
You are not falling.
You're literally not falling.
Your brain feels like it'sfalling.
You are misinterpreting gravityright now and your relationship
(40:30):
to the planet.
You're not falling.
You're not, and that's atotally different way of
thinking about a gut feeling.
Dr. Megan Riehl (40:36):
You know, it
makes me think.
Over the summer I was with myfamily and one of my children.
We were out tubing on a boatand one was really hesitant,
didn't really want to get out onthe tube, was seeing it zipping
around and going up in the airand over the waves.
And this is one of my moregentle children, a little
quieter, a little more in tune,Whereas another child of mine,
(41:00):
who happens to be the youngestand the only girl, was on that
tube in a matter of seconds andwe are literally zipping fast.
Her little arms are up high inthe air.
She was having the time of herlife and it just.
I think, also when we thinkabout personality constructs and
how we approach children too,my parenting style is a little
(41:23):
different with each one, andthat just made me think about
that in terms of again thoseinstincts of one having that
kind of yellow red flag go upand the other is like green for
go, let's go.
And that, I think, is also alittle bit of what we're talking
about here, the pull to make adecision.
Dr. Brennan Spiegel (41:41):
How we
raise kids now, helicopter
parenting, controlling ourenvironment.
We're all controlling ourenvironments more and more to
try and exclude threats.
200 years ago, where I'mstanding right now in LA, this
would be chaparral.
There would be not much outthere.
There'd be farmers trying tojust make it through the day,
like 200, not 2000 years ago.
(42:03):
200 years ago, no one wasworried about helicopter
parenting their kid.
I'm guessing, I don't know, Iwasn't alive, then, but if you
think about what I'm saying herein terms of gut feelings is we
don't want our kids to fall,sometimes like literally like oh
no, he fell down, oh baby.
Oh, you know we do that, it's anatural instinct, I mean listen
, I do it with my kids too.
But if you do that so much, youliterally learn that you are
(42:27):
hardwired into your neurons.
I don't want to fall.
If I fall, I'm going to gethurt and die, and it's not just
physical, it's an emotional fall.
Every little thing that goeswrong becomes some kind of
catastrophe, and if you'reraised that way you know I have
it in me too Then you start tomisinterpret things around you
(42:49):
as catastrophic threats and youfeel as if you're falling.
And I think that's one reasongut feelings are so common and
anxiety is so common, not tomention social media and all the
other factors.
But my point is like we'rechanging, as a species, how we
think about managing threats,and it's been so rapid, in such
a short period of time, becauseof technological advances in our
(43:11):
civilization, that we bear noresemblance to the people we
were just 100, 200 years ago.
So that's something we need towrestle with no-transcript
(43:52):
you're learning aggression.
They're practicing graviseptionexactly I almost feel like
arrested.
Graviseption is the underliessome of the mental health issues
that we deal with.
If you don't allow a developinglife, whether it's a human or
an animal or whatever, to learnhow to balance.
And it's not just physical,it's the mental-physical
(44:13):
relationship to this planet.
And we are so advanced in ourmental capabilities that we can
transmute those physicalphenomena into mental phenomena
and then have our own mentalgravity map in our mind's eye.
And if that's off a little bitand you're misinterpreting your
relationship to this planet,what could be more upsetting to
somebody than feeling as ifyou're literally not born for
(44:36):
this planet?
Right, you can see how, if youfeel like you don't belong on
this planet, physically,emotionally, it's too much
gravity you can see how thingscan get really dire.
But it also has implications.
If you rethink about what thatmeans and how we can reverse
that and how we can try tostrengthen the body, strengthen
the mind flotation therapy,vagus nerve stimulation, tilt
(44:59):
table therapy, elevatingcognitive, behavioral flotation,
meditation I mean we can go onand on.
That's to me the whole bigpicture about how to reverse
this graviceptive mismanagement.
Dr. Megan Riehl (45:11):
Yeah, so for
some of these people that are
thinking about you know howthese factors impact anxiety,
depression, attention deficitdisorder, kind of
neurodivergence, PTSD.
You just listed a whole newrealm of therapies that I think
are a little bit in theirinfancy in terms of applying
(45:34):
them in larger research terms.
But are there any clinicaltrials underway looking at some
of these things for mentalhealth conditions?
Dr. Brennan Spiegel (45:42):
Not near
enough that I'm aware of.
There's a guy named LachlanKent who I talk about in the
book, and he's in Australia andhe's a neuroscientist who coined
the term mental gravity andhe's written some really
fascinating papers about thethings I'm talking about.
So a lot of what I'm saying isinformed by his work.
So I really want to be clearabout that and you know, he has
(46:04):
laid out a framework that Ithink is ripe for examination
and there's very few peoplethinking like this right now.
But I think there's somethingmuch bigger, much bigger story,
and it's so fundamental.
I think what happens is we getcaught up at the wrong level.
You know it's important to knowwhat peptides do or what this
does or what this microbiomedoes, but when we get down to it
(46:24):
, in all of physics there areonly four forces, fundamental
forces.
One of them has to do withstars, so it doesn't even apply
to us.
One of them has to do with ourbodies not exploding instantly.
Okay.
So once we don't explode, okay,that's the nuclear forces we're
only dealing with two thingselectromagnetism and gravity,
(46:46):
and that's it.
So what we're talking abouthere is so fundamental that
everything, everything that weexperience and feel in this very
moment talking, boils down tothose two forces, and we're
talking about one of them today.
So, if we understand and workour way back up, physics came
first, biology second and thenpsychology emerged, and it's a
(47:09):
through line from the physicsall the way through to the
psychology and then even tosociology and politics and all
of human civilization.
And I believe serotonin is amaster key near the base of that
, that is, transmuting thephysics and allowing us to
transmute physics into biology.
And that's what's happening atthat base level with serotonin.
Kate Scarlata, MPH, RDN (47:28):
So
interesting and so zoomed out.
You know, I think you know toyour point we get into the
little microcosms of health anddisease and we're not really
zoomed out to this level andmaybe we need to be more so, you
know, really to be able to takecare of our patients better and
to live better.
One of the areas that arereally like been hot on this
(47:48):
podcast has been IBS and smallintestinal bacterial overgrowth,
and you alluded to these shiftsin gravity impacting the gut
microbiome, the impact ofgravity on just the way the gut
collapses on itself and canincrease risk of SIBO or small
intestinal bacterial overgrowth.
(48:09):
Can you just get into the weedsa little bit with IBS and SIBO
and the gut microbiome andgravity?
Dr. Brennan Spiegel (48:15):
Yeah, yeah.
So the example I talked aboutearlier with Ehlers-Danlos
syndrome is a really clear oneto me because it's so physical.
Right, you have the suspensionsystem and the cables are
stretchy and then you know thegarden hose gets kinked and
whatever analogy the marionettecollapses and then things back
(48:36):
up and off you go and you knowthe first thing is just to come
back to that.
That is underdiagnosed.
So I routinely find flexiblejoints in my patients and
there's been one study thatshowed almost 50% of people with
unexplained abdominalcomplaints in one study had over
hypermobile joints.
I'm not saying that's theexplanation for everybody, but
it's absolutely worth testing ineverybody, Everybody who has
IBS.
Pull your pinky back, put yourthumb over and if it's stretchy
(48:59):
go talk to a doctor.
They can make a diagnosis, theycan do the x-rays to see if you
have that collapse.
So that's a really clear one.
But you know we can go back tosome of the things we talked
about before, just back strength.
I mean, sometimes what I say topatients is hey, I think you
need to lose weight, I think youneed to strengthen your back,
and here's why.
And then I go through the wholediscussion.
(49:20):
I show them a picture of theabdomen, the cross section, I
say look how close your spine isto your gut.
In fact, that suspension systemthat you have, it ties in right
about L4, right about lowerback.
That's the place where you arehoisting up the sack of potatoes
.
So when I explain it that way,it all starts to come into play.
But then I explain how the gutmicrobiome requires that your
(49:43):
functional stack we have thisstack, this again sack of
potatoes it needs to be moving,it needs to be fluid, needs to
be fluid, needs to move thingsthrough so that bacteria don't
back up, the gas, doesn't form,get trapped.
So this language is veryhelpful to motivate weight loss,
exercise and core strengthening, and I keep coming back to
(50:05):
those ideas.
And the microbiome is right inthe middle of it, generating
serotonin and the diet and thetryptophan and all that.
But it gets so interesting whenyou look at high altitude.
And why in the world does themicrobiome change?
Or serotonin, we don't actuallyeven know.
But you know, guess what?
Those bugs in our body.
They also evolved alongsidewith us at sea level and so
(50:29):
they're not designed to be up inthe high mountains or in space
either, and they are also livingorganisms and we don't even
really understand how theychange in relationship to this
fundamental force.
And with this little bit on this, we came out of the seas, this
buoyant world where gravity isthere, but it's not that
(50:51):
important.
We think life came out ofhydrothermal vents hot, dark,
gassy places, kind of like a gut, kind of like the colon and
what happened is, as I see it,we co-evolved.
As we had to crawl out of theocean in these amphibious forms,
Serotonin biology became veryimportant, which meant we had to
(51:13):
bring a microbiome with us.
So we gave it a hydrothermalvent.
It gave us serotonin.
We then were able to stand upand deal with this force of
gravity that hit us head on whenwe came out of the ocean and we
symbiotically evolved with it.
So, yeah, it makes sense thatif we're going to be affected by
changes in altitude, then sowill the gut microbiome, but
(51:36):
it's a big mystery still, likeexactly how.
Dr. Megan Riehl (51:39):
So interesting,
well, so why don't we take this
opportunity to have a littlebit of a speed round with you?
Dr. Brennan Spiegel (51:46):
Okay, let's
do it.
Dr. Megan Riehl (51:47):
All right,
you're ready to go?
VR or building gravityresilience.
If you had to pick just one totransform healthcare, which has
the most potential impact?
Virtual reality or gravityscience?
Dr. Brennan Spiegel (52:01):
Gravity
science, for sure, I mean.
It gets to what we've beentalking about.
It's fundamental.
I think VR can help us managegravity, but gravity science, I
think, is literally at thebottom of all of this.
Kate Scarlata, MPH, RDN (52:12):
Okay,
so interesting.
So are you a morning bird or anight owl?
Dr. Brennan Spiegel (52:17):
Oh yeah,
I'm definitely a night owl, for
sure, I stay up late, stay upway too late.
I wish I can get up earlier.
I just I struggle with thatsometimes.
Dr. Megan Riehl (52:26):
All right,
would you rather travel the
space or the deep ocean?
Dr. Brennan Spiegel (52:30):
Speaking of
well, it's kind of like do you
want to go up or do you want togo down?
They're both incredible and Ithink we need to learn a lot
about the ocean, but I would gointo space for sure.
Yeah, I would definitely.
I'd feel pretty good aboutgoing into space.
Kate Scarlata, MPH, RDN (52:47):
Okay,
yeah, I'm with you on that.
He's going up.
He's going up.
Dr. Brennan Spiegel (52:51):
Let's go up
, up and out.
Kate Scarlata, MPH, RDN (52:52):
What's
the strangest gut fact you've
ever shared at a dinner party?
Dr. Brennan Spiegel (52:58):
Oh wow.
I am known for telling lots ofstories at dinner parties, so
I'm trying to think about thestrangest.
It may not be ideal for apodcast, but I have fished a lot
of things out of people let'sput it that way.
So I have shared, veryanonymously, some stories about
(53:19):
things that have come out ofpeople.
Yeah, I think almost every GIhas those stories.
Dr. Megan Riehl (53:23):
I think so.
Yeah For sure.
What's worse?
Sitting too much social mediaor poor diet?
Dr. Brennan Spiegel (53:31):
Oh God,
that's so tough.
All of those are really bad.
Yeah, I would say, you know,sitting too much using social
media, with a high BMI, I don'tknow.
I think probably of those,probably sitting too much in the
(53:52):
end has the greatest effect,but they're all interrelated.
Kate Scarlata, MPH, RDN (53:55):
Yeah, I
agree with you there.
Dr. Brennan Spiegel (53:58):
Yeah.
Kate Scarlata, MPH, RDN (53:58):
Before
we wrap up the last time you
joined us, you were wearing aweighted vest.
There it is.
Dr. Brennan Spiegel (54:03):
Yeah, I
don't have it on right now
because it's kind of weird.
But yeah, I'll be putting it onlater.
Kate Scarlata, MPH, RDN (54:07):
And
standing at your desk, which is
amazing.
So what are you up to thesedays for your overall health and
well-being?
Dr. Brennan Spiegel (54:15):
Yeah, I try
to do that really every day,
you know, not just for like anInstagram reel, but actually to
do it, and I found that veryeffective.
I'm training for the marathonagain.
I got injured and I realizedlike my gravity resilience was
undermined, so I'm trying tostrengthen my body and I run in
these barefoot shoes so I'mgetting my strength back in my
(54:37):
feet and my legs.
I'm also trying to be a littlebit more thoughtful as I get
older about what are the rightexercises, so that you know I
don't break my body in half andfocus more on tensegrity, which
is that idea we talked aboutearlier, where the seams between
the organs within the body needto be strengthened.
We need to zip ourselves upfrom the inside out, and so I
(54:58):
haven't done enough of that yet.
But that's my goal for nextyear is to start working on my
physical resilience maybe moreyoga, for example, and Tai Chi
and these sorts of things.
Kate Scarlata, MPH, RDN (55:09):
Okay,
let's work on those seams.
People, let's work on thoseseams.
Dr. Brennan Spiegel (55:12):
Seam
resilience, yeah, leads to
gravity resilience.
Dr. Megan Riehl (55:15):
We'll see how
your yoga practice is going the
next time you come back and joinus.
Thank you so much for coming onand giving us a really new
perspective on something that'scertainly universal but
invisible, which is gravity.
We're all dealing with it andso, friends, if you enjoyed
today's episode, don't forget tocheck out Dr.
(55:37):
Spiegel's very new book Pull,and if you missed his first
interview with us, go back toepisode 13 for a deep dive into
the vagus nerve and virtualreality.
It was a really fun talk anduntil next time, thank you for
tuning in.
Take good care of yourself,others and especially your gut.
Dr. Brennan Spiegel (55:55):
Thanks for
having me.
Kate Scarlata, MPH, RDN (55:56):
Thank
you for being here.
October 7th, Pull be on thelookout.
Dr. Megan Riehl (56:01):
Thank you for
joining us as we grow this gut
health community.
We hope you enjoyed thisepisode and don't forget to
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You can also follow us onsocial media at The Gut Health
Podcast, where we'd love for youto share your thoughts,
questions and experiences.
Thanks for tuning in, friends.