Ignite Your PowHER

Thrive with PCOS

April 30, 2021 Jennifer Roelands, MD
Ignite Your PowHER
Thrive with PCOS
Show Notes Transcript

Let's talk about a subject near and dear to my heart, PCOS. I have suffered from PCOS since my late 20's when I had difficulty conceiving. In fact, I have had it forever but did not know until then. Very similar story to a lot of women.
PCOS is not well understood and often goes underdiagnosed. And then it is discovered women are often offered a birth control pill only. That is because most providers do not understand the disease. And do not get educated about natural solutions to the problem.

In this episode I discuss:
1. What are the symptoms of PCOS? What are the signs?
2. How do you know if you have PCOS?
You can take my FREE QUIZ if you are curious.
3. How to get a diagnosis.
4. What to do if you do not want to be on a birth control pill. What are the natural solutions for PCOS?
5. How diet and lifestyle shifts can help you reverse the symptoms of PCOS.

Are You Ready to Reverse Your Symptoms of PCOS and Take Control of Your Life!?
My 7 Day PCOS Challenge is here to help you do just that!

This episode is sponsored by Modern Fertility. A wonderful company that offers testing delivered to your door. The most comprehensive fertility hormone test you can take at home to be proactive about your fertility.
Use this link and get $10 off of your order. 

FREEBIES FOR THIS EPISODE:

FREE QUIZ: Do I have PCOS?
 

FREE RECIPE GUIDE: 7 Day RECIPE Guide for PCOS

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Unknown:

Hello, Dr.

Jennifer roelands:

Jenn here. For those of you that don't know me, I'm an OB GYN with over a decade in women's health. I'm also a health coach, and trained in integrative medicine, I help women with hormonal chaos balance their hormones without the birth control pill. So through diet, nutrition, lifestyle changes and mindset work. And today I want to talk about a topic that's super near and dear to my heart PCs or polycystic ovarian syndrome. It's near and dear to my heart, because I suffer with this particular disorder. I've had this my entire lifetime, as we know PCs is a lifetime disorder but didn't figure out this diagnosis until I was struggling with infertility. I tried to conceive my second son, and just struggled with trying to get pregnant, even though I knew those answers on how to get pregnant. And finally, I was given a diagnosis of PCs. So in this three part series, I'm going to talk about PCs and we're going to dive into what are like, why do you need to know about PCs? How do you know if you have it, how to change it, how to change your life through nutrition, lifestyle and mindset work, instead of being on the birth control pill. I'm not opposed to the birth control pill, I prescribe it every single day. But I think there are women who want to find out the root cause of their illness and really treat their PCs more naturally. Because the birth control pill can make everything look good can make everything perfect. And so if you want to get down to why you have PCs, and how to change and how to feel better than we need to talk about natural solutions. So first, this is part one, we're going to talk about what is PCs? And how do I know if I have it? So PCs stands for polycystic ovarian syndrome. It is called a syndrome, which means we don't know exactly what is the reason why people have PCs and what is the actual cause. We think there are a lot of things that contribute to someone having PCs, but the actual cause there's not one single reason why someone has PC less. So that is why it's called a syndrome and not a disease.

Unknown:

So

Jennifer roelands:

polycystic ovarian syndrome is extremely common is actually something that I see every single day in my clinical practice, about one in five women will be diagnosed with PCs. Unfortunately, it takes years for those women to find out they have PCs, because oftentimes the symptoms mirror other kind of GYN problems. So it sometimes could take three to five years before someone ever gets their diagnosis. And more commonly, I see women in my clinic who are struggling with irregular cycles and infertility. And this is how we find that

Unknown:

particular

Jennifer roelands:

problem. So pcls in general, is characterized by certain symptoms or signs that you see on a patient or in a client. So the most common signs that you see are weight gain, unexplained weight gain about 70% of PCs, patients will have excess weight, or unexplained weight gain. The second sign is evidence of male hormone excess. So here's the tourism. So having here like along your chin, having hair along your belly button, having the male pattern baldness, and cystic acne, I actually didn't wear foundation for reasons. So you can see these lovely little acne scars from years of PCs. Prior to actually figuring out I had this problem so you can actually see that's that cystic acne that's that real deep. Let's see if you can see a little better. Yep, like deep acne that's underneath the skin that's painful. And last for a long time. It's not that superficial one that you know, sometimes you pop and goes away in a day or two. It's kind of deep cystic acne. That's how you know it's truly hormonal acne. The other signs are irregular cycles. And so irregular cycles can be as short as less than 21 days between periods or as great as over 35 days, sometimes PCs patients, I actually had a patient who had a cycle once a year, which is definitely abnormal. The normal range of menstrual cycle is 21 to 35 days. So if you have cycles that are over 35 days, you might have PCs. This is what we call all all amenorrhea or irregular cycles that are not frequent. The other signs of PCs can be women who have insulin resistance, so maybe they're pre diabetic, or they're very close to becoming a diabetic and so they have evidence of insulin resistance. Some other signs of PCs are clearly infertility. So someone who is struggling to get pregnant and has been trying to figure out why her cycles or her are irregular, not oscillating could have PCs. The other less common symptoms and signs can be hair loss. Hair loss can be associated with other disorders like thyroid problem. But hair loss and usually sitting at the hair along the part and you can kind of see I have that thinning of my part. And it's kind of that male pattern hair loss, just like there's male pattern, excess hair growth, like along the chin or you know, the little hairs here. But you can also have thinning of the hair in a male pattern as well. And that's a less common sign. So now that we kind of explained some of these signs and symptoms that you can see in a patient, let's talk about the different criteria for diagnosis. So there's actually several different ways to diagnose PCs, there are three different criteria, three different diagnosis criteria. So there's the Rotterdam criteria, there's the NIH criteria, and there's also androgen excess and pcus society criteria. Now, different providers have different reasons for why they chose that particular criteria, and not one is better than the other. It's just a matter of how you make this diagnosis in general. So on the second video, or second part of this series, I'm going to talk about the actual testing done for PCs, what are the actual lab tests that are done and ultrasound that are done to confirm the diagnosis, but I did make a guide to help you talk to your provider. And that will be on my website that you can find the actual guide called How to Talk to your provider. And what it has in there is the actual tests that should be run to diagnose PCs, it's a way that you can help talk to your provider about what you need, because sometimes that conversation is hard to get started. And so I made this cheat sheet for you that you can take with you and literally say I need these tests. So that is available on my website and I will make a link to that particular freebie. And then you can just pick up that and take it with you. So besides the actual three different ways you can diagnose PCs, the different NIH Rotterdam or androgen access society, that diagnosis is made by finding a high androgen state. So high androgen state can be found by not only bloodwork, which I will mention on the next video, but it also can be found by clinical evidence of seeing those signs on a patient. So that's called here citizen. Here citizen is actually the physical signs of seeing high androgens. So the acne that I mentioned along you know, you could see kind of along here, and then also that the chin hair, the excess hair along the belly, the thinning of the hair on the top of the excess hair, that's an A male pattern state, then those are actually physical science called here's autism. You can also see high androgens in the bloodwork. So we're looking for testosterone levels and D hga, both of which they're elevated as far as the female normal range than those can make a diagnosis of high androgen state. The other thing that you see is oscillation dysfunction, and oscillation dysfunction can present in a different different different ways. First is that the cycles are irregular, so the cycles can be very far apart. So remember the definition of menstrual cycle is from the first day of your period till the next day of your firt. The second part of a PCs diagnosis is obvious Satori, dysfunction, or you are not oscillating. And there are several ways that you can prove that this is the case. The first is that if someone is having a regular cycles and their cycles are greater than 35 days apart, they're just not ovulating. That is definitely meeting criteria for ovulation dysfunction. The second would be that you do a population predictor kits. So if you take an ovulation predictor kit, and you do that over the counter, I recommend modern fertility. It's a fantastic company. It has great ovulation predictor kits, they're very reliable, and very easy to use. I will also have a link to that if you would like to check that company out. And then basically the third type of actually looking for abila Tory dysfunction is you can do a day 21 progesterone level, day 21 day 22 somewhere around there, there should be a peak and progesterone indicating that you are related that month. And if you did not have a peak oscillation of progesterone that's greater than 10 then you definitely have abila Tori dysfunction. And that can help you put together the diagnosis of PCs. The third criteria or the third that is part of some of those guidelines is ultrasound. So ultrasound you can see on ultrasound, something called polycystic ovaries. So on the ovary you can literally see these small little cysts that circle the circumference of the ovary, and they look like a string of pearls. Hence why it's called polycystic ovarian syndrome. Because they're very small cysts, usually not more than a millimeters in size. And there's usually multiple of them. And they look like what you would see as a string of pearls along the outer edge of the ovary. Now, that is not required for making a diagnosis on some of those guidelines that I mentioned. But it does help you if you do see it, then it does help solidify that this person probably has PCs, there are not a lot of reasons why someone can have the string of Perl appearance on their ovaries. So putting together the most common themes of diagnosis essentially are, you're going to have evidence of high male hormone, so hyperandrogenism

Unknown:

to

Jennifer roelands:

oscillation dysfunction. And then three, you may or may not see polycystic ovaries on your ultrasound. So now we've kind of talked about essentially, how do you know via PCs, right? You look for these signs, you get tested by your provider. And again, those particular tests are in the second half of this talk. And then you're going to talk to your provider about what do we do now? Right? So most providers, including ob gyn, and especially ob gyn will offer you a birth control pill, because that's what we're comfortable with. That's what we're used to in medical school. And in residency we're taught, the question you ask is Does somebody want to? Are they actively trying to have a baby or not. And if they're not actively trying to have a baby, then you offer them a birth control pill, because we know that the birth control pill will regulate hormones, the birth control pill essentially provides a perfect environment, it tells your body exactly what it should do in a 28 day cycle. Essentially, I don't want to say this in a derogatory way. But it masks those symptoms, right? It tells your body that in the 20 day cycle, we should do this. The problem is that most women want to figure out why like what is the root cause of their problem? How can they fix their PCs naturally, and not rely on a birth control pill. And so that's where I come in from the health coaching perspective. Because I have been trained in nutrition and I have been trained in alternative options to help women who do not want to be on a birth control pill who want to free themselves from being on a lifelong birth control pill. That's what happened to me, I was on birth control till I was 29 years old, got off birth control, conceived my first son without a problem, and then tried to get pregnant by second and realized that I had a serious problem. It was well over a year before I figured out I had something was wrong. And I had been using a birth control pill nearly my entire reproductive life at that point, and didn't know I had a problem, because everything seemed perfect. So how do we so how do I counsel people on what to do? So natural solutions for PCs, you got to focus on two big areas, one inflammation. So inflammation is the worst thing for PCs, if you have high inflammation in your body, it is difficult to lose weight, it is difficult to get your cycles regular it is difficult to deal with all the other hair loss especially, and then the acne portion. So inflammation, we have to address inflammation. The second part is insulin resistance, which is a key component of pcus. So addressing insulin resistance, basically PCs, you're essentially kind of a pre diabetic state, you have a high level of insulin resistance. And unless you dress this in your diet, then you will always be working against yourself. So as you gain more weight, then essentially that insulin resistance gets worse. This the sugar is stored in your fat, which then leads to estrogen dominance, which causes this cascade we're just continues and continues and continues. If you've ever spoken to a woman with PCs, you know that this is the biggest frustration is the waking that they're doing everything right, they're exercising, they're eating appropriately, but they still gain weight, or can't lose the weight that they have. So you have to get a control of your insulin resistance. So through goat group coaching options, and through my courses, digital courses, I try to help women address those two big problems, inflammation and insulin resistance. gcls is a difficult disorder to diagnose because it's a syndrome, which means that we don't really know why people get PCs. We don't really know what the actual cause of PCs, which is evidenced by women who get not diagnosed for several years. They oftentimes go through and see multiple providers because they don't fit the perfect picture of what we assume PCs is. And that's because there are multiple ways to diagnose it. There are three different essentially societies that say these are the rules for diagnosing someone with PCs. The first is the Rotterdam criteria. This is the oldest guideline set. Essentially, the Rotterdam criteria says you really only need to have high androgens, which can be made by either a blood test or physical signs from have we talked about her secure citizen, you also need evidence of irregular cycles or cycles where someone is not oscillating. And then the third criteria is ultrasound evidence of pcus. So on ultrasound, and this is a badge and an ultrasound looking at the uterus, the ovaries, the ovaries were pilled appear to have these String of Pearls effect. They have these small tiny little cysts that dot the rim of the ovary, and so they look like a string of pearls on ultrasound. And this is because the ovaries make these small, tiny little cysts and they don't be ovary does not release an egg is it? Avi latorre dysfunction and so you get this kind of appearance on ultrasound. The second guideline is something called the NIH guideline. And in this guideline, the NIH said, We don't need to see evidence of PCs on ultrasound, because not all women do have that. In fact, only about 60% of women you'll see pcus looking ovaries on ultrasound. So they dropped that third criteria altogether. The last set of guidelines is actually by the androgen and pcus society. And what they actually add to the mix. As they say, well, you need evidence of high androgens either by blood work or by physical signs. You also need evidence of not oscillating or odd dilatory dysfunction. And this can be seen by say irregular cycles. It can be seen by FSH level this irregular, it can also be seen by not getting positive ovulation predictor kits, meaning you're not ovulating using the standard over the counter option. You can also see it by doing a day 21 progesterone level. And if your day 21, progesterone indicates you did not ovulate, then that is evidence of Aviles iv latorre dysfunction or an oscillation. The third thing they put into the mix that's different than the other two guidelines is they say, well, you have to exclude everything else. So you need to make sure they're not diabetic, you need to make sure that they don't have a thyroid problem, because that's maybe why they have irregular cycles. So I like this last guideline, because there are sometimes these things that overlap. So for my life, I was diagnosed first with a thyroid dysfunction, so hashimotos thyroiditis, and that gave me irregular cycles. And once that was fixed, I kind of had regular cycles for a while, but then it kind of defaulted back. And that's because I also have pcus. So you have to be able to fix the underlying causes first, because there may be women like me who have multiple problems. So I like this particular guideline because I think it's important to exclude other reasons that someone could have irregular cycles. So talking about diagnosis in general, so we talked about high androgen state, you can do it by looking at physically at the patient and seeing that they have actually, you know, cystic acne, hair growth on the chin, hair growth on the lip, on the belly, thinning of the hair, hair loss, those are physical signs, but you can also do it by bloodwork and what you're doing is looking for levels of male hormones or androgens, those are typically higher in males, although females also have male androgens. Right, we have androgens. So the two tests that are frequently done as a free testosterone level as well as a d h EA. And what you're trying to do is figure out what is the testosterone from both the ovaries that produce testosterone and the adrenal glands that produce testosterone? Is there any evidence that it's elevated for the normal female ranges, and I'm not going to mention the actual values because everybody has different labs. And so some labs have different lab values depending on which type of lab that you use. But you are looking for male androgens or excess male androgens, that are out of the range for the typical female patient.

Unknown:

So those are

Jennifer roelands:

the tests and that and I mentioned that on the last segment that you really want to talk to your provider about getting that test getting the test done. If you have irregular cycles, and you have evidence of male hormones that are elevated by physical signs, you definitely need to make sure that they're ordering tests looking at your D h EA as well as testosterone levels. For the diagnosis, once you actually evaluate the blood tests, you can also evaluate whether or not they're obviously mean if you're interested in trying to have a baby. So if you struggle with infertility, and you think you have a diagnosis of PCs, the other tests that are extremely important is your Lh level or luteinizing hormone and also fasting sugar level. And insulin level, because that helps to determine what how much insulin resistance you actually have. Because sometimes you can try to fix population by using certain oscillation, induction medications. But if you don't fix the underlying cause the insulin resistance, remember I talked about my natural solutions for PCs are addressing inflammation and insulin resistance, then you're not going to actually fix the problem. And that you can still be working hard on trying to oscillate. But if you don't fix that insulin resistance, it's just not going to happen. It's incredibly important. This is why a long time ago, the one thing that people are, I would say a lot of times in a traditional setting either ob gyn or primary care, someone gets diagnosed with pcls. And they're automatically given a medication called Metformin. Metformin is a diabetic medicine, it's actually meant for diabetes. But what we know from our studies is that Metformin is used to increase insulin sensitivity. So it helps women who have insulin resistance to actually use their insulin more effectively. And it works. And it definitely has good data to support that Metformin will help women with PCs regulate their cycles, and then improve their fertility. The problem is you never really address the insulin resistance, you're essentially fixing it right, you're finished fixing as if someone was diabetic. And so for short term answer of trying to get pregnant right away, it could be a great solution. But for a long term trying to actually get your body back into order and fix your insulin resistance, you need to use a different solution. Because Metformin is not a long term solution, it is most effectively used with Clomid, which is an ovulation medication. But again, these are all things that you need to talk to your provider about, depending on where you are in your reproductive health, right if you're interested in trying to have a baby, or you're just working on your long term health goals. So we talked about the PCs diagnosis with bloodwork, we talked about looking for signs of narcissism, on ultrasound, your provider may or may not order an ultrasound depends on which guideline they think is the right way to make a diagnosis. If you do get an ultrasound, I would definitely suggest getting an ultrasound if you're trying to have a baby and you're struggling with infertility, because it can give you other information that could be helpful for trying to conceive. So why do we care? Why do we care about getting tested for PCs? Why do we care about PCs? in general? Why do we need to know that answer? Well, the short answer is if you have polycystic ovarian syndrome, you are at higher risk for heart disease long term, you're at a very high risk of developing diabetes. If you had gestational diabetes, when you were pregnant, and you have PCs, you've got an 80% chance you're going to get diabetes. And there are ways to can prevent that developing diabetes is not only just about your genetics, it's about turning on those genes to ultimately become diabetic. So you should care about it if you have PCs, because you are at higher risk of all these other metabolic disorders, high cholesterol, high blood pressure, diabetes, heart disease long term. So fixing the way that you live, and ultimately changing how your disease is will prevent these things long term. There are certainly people who have PCs under control, who do not develop diabetes, or heart disease or cholesterol. And so that's why you should care. That's why it's important to make sure that you address the root cause of your problem and not just mask it with a birth control pill. So on the next segment, what I want to talk about is what are the natural solutions for PCs, we've talked about what it is, what you do to get tested, how you should get tested, and what tests you should ask your doctor for. And then the third segment is really going to be about let's start with some natural solutions. Let's fix those two things, I think that are important inflammation, decreasing your inflammation and fixing your insulin resistance. So I'm going to talk about on this next segment how to do that. Join me Then let's talk about the natural solutions for PCs. So we need to address the two big root causes, right? One, insulin resistance. So insulin resistance if you don't know essentially, Insulin is a hormone that's secreted from the pancreas that helps the body digest glucose break down glucose for it to enter our cells for the body to then use that glucose or sugar for you know, normal bodily cell functions and so on. Insulin resistance means that your body doesn't effectively use the sugar, that essentially your, you know, the cells, which are little tiny components in our body need that sugar to live and to thrive and to repair itself. I use this analogy in the clinic all the time, insulin resistance. So if I had a hamburger and somebody else had a higher burger, generally, the body would take the food that I ate, the pancreas would secrete insulin, insulin would tell the cells in my body that I needed to take the food that I broke down in my intestine, and I needed to absorb the sugar into the cell so that it could be used for normal cell function, regeneration repair. But if I have pcus, essentially, the cell doesn't allow that sugar to be used effectively in this, it doesn't allow it to come in to the cell very effectively, versus someone who does not have pcls. They'll metabolize that hamburger in, say, two hours. But for me, that sugar will still hang around in my blood system, because it was not actually used effectively by those cells. And unfortunately, when that sugar hangs around in your blood system, then it can be stored into fat, your body can say, well, we have excess sugar, so we should just kind of store it. In fact, well, that causes more fat to be made, right, and then you just have this essentially avalanche where then your pancreas says, Well, we must need more insulin, let's make more insulin, but the body stores it as sugar. And so you're constantly at this battle against yourself. So it's harder to lose weight. When you have PCs, it's

Unknown:

also harder to

Jennifer roelands:

stabilize your weight. Sometimes it's hard to manage your blood

Unknown:

sugar

Jennifer roelands:

and to balance your blood sugar appropriately. And so the better getting the handle on insulin resistance is resistance is incredibly important. And the way that I feel is important to do this is by having a normal healthy diet. The key to decrease in insulin resistance is a having a diet that works with your body and not against your body. So women with PCs should actually have a diet that's a moderate carb, or low carb option. And I hate to use the word low carb because people automatically think low carb means keto. I'm not a big fan of keto for women with PCs, I like low to moderate carbs. And that's really referring to you know, 52 could be up to 200 grams of carbs a day, it depends on what you need. That's why working with a provider or a health coaches extremely important to figure out what your body needs. But overall, the diet should be an anti inflammatory diet, it should be focused on nutrient dense foods. So foods that actually deliver these micronutrients you need for your body, and also food that is going to help you decrease your inflammation. So an anti inflammatory diet is predominantly plant based. But not it does not eliminate animal proteins. It focuses on lean proteins, mostly organic proteins. The other component of anti inflammatory diet is that you should be eating the rainbow. So when you look at the plate of food, it should have more colors due to vegetables on it, and should be predominantly vegetables on your plate and less meat. So you should not have a bigger piece of meat and a couple of veggies as a side it really should be the opposite that the main course is your vegetables and then the meat is the protein source on the side. The other thing is important is important to an anti inflammatory diet is to make sure you know which foods work for you. So that's where that I came up with for me is I found out that me and gluten do not get along. I love gluten, but I do not my body does not absorb it well, and it leads for me to terrible constipation, pain, abdominal pain, foul trouble, like it just doesn't work. So the third component is really trying to figure out what foods work for you Do you suffer from bloating and constipation and digestion issues because those foods are not ones that absorb well, along with the anti inflammatory diet to decrease insulin resistance. Women with hormone problems often have poor gut health. We do not absorb things very well causing leaky gut. And when you get a leaky gut, you absorb things even worse. So when your gut leaks, then whatever you eat, essentially, those nutrients are not going through into your blood system to be used in your body. They're actually just not being absorbed well. So focusing on gut health is super important. And sometimes you can do this by using prebiotics, or probiotics or both. So that's a component of gut health that really needs to be addressed. So as far as insulin Resistance, you need an anti inflammatory diet, and you need to focus on gut health. I also am a big fan of intermittent fasting, there is a lot of good evidence, especially if you're overweight, if you're a pcus patient who is overweight, that intermittent fasting can be extremely helpful for starting the process of losing weight, but also for maintenance. And I have a whole video series on intermittent fasting you can check out, which will talk a little bit about the data behind intermittent fasting and the different types of intermittent fasting. So the other component of helping naturally solve PCs, or naturally reverse some of those symptoms of PCs, because you will always have PCs, if you have it, is inflammation. So there are lifestyle and mindset changes that need to happen to decrease your inflammation. This is something I did not appreciate until I hit 40. After I hit 40, I found out that it doesn't matter what routine you're used to have a lot of times that needs to be modified, because it's harder to lose weight, just age related. And so what I realized was the lifestyle shifts were so incredibly important that if you have high levels of stress, either physical stress, like you're not sleeping, emotional stress, like anxiety, or depression, your cortisol, which is your stress hormone goes through the roof. And when it goes through the roof, you essentially preserve all that sugar, you're in a fight or flight mode, where you take that sugar and you stored in fat. So then essentially, it's like all the work you're doing with your nutrition and exercise

Unknown:

goes by the wayside.

Jennifer roelands:

Because if you are stressed out, you're not sleeping, you're not consuming enough water, you'll never lose weight, you have to put some effort into lifestyle changes. So decreasing inflammation by decreasing stress, both physical and emotional stress. The last thing I'll mention is that mindset, you know, a lot of times we don't as doctors, and as patients, we kind of blow that off and go. It's just that woowoo kind of science, nobody believes in mindset. I don't know why people talk about it. But you know, it not only helps with stress to deal with your mindset. But the other important part is, is that a lot of times you don't really think about how mindset affects your what you eat. So for example, if you're like me, and you have four kids, and you're running around everywhere, picking kids up taking them to soccer, running them to the next activity, you often will eat just literally standing up like shoving food into your mouth, like and then you run off to soccer and you realize you really didn't eat enough. So you come back and you eat at eight o'clock at night and try to figure out whatever's leftover on the plate on the table and consume that. Well. That's like the worst thing you can do. And you're not practicing what the term is called mindful eating, where you're literally sitting down to eat and saying, This is time to eat. I'm going to sit in a comfort, calm environment, consume my dinner, and this is my dinner, and I'm eating at a normal hour that people eat dinner. I have literally coached so many women on mindful eating. And they just from that one simple step, we're able to lose weight. It's amazing how much that is part of this. And it's something I have to practice every single day because I'm busy as an OB GYN and mother of four. And you know, I have to literally think about it and say to myself, this is dinner, this is my time for dinner after that I'm eating nothing else. So it's this mindset work that is incredibly important. I do have a blog post on mindful eating. Check it out if you're trying to learn a little bit more about what I mean. And if you're curious about what it means, please head over to my website and check out the mindful eating blog. So lastly, I just want to say you know I've mentioned these three segments, which is about PCs. There's so much more we can dive into and I have a PCs freebie to kind of summarize everything so please check over to my website well, woman MD and you'll find out more information about it. Thank you