Ep. 483 Menopause, Mood & Inflammation Insights with Dr. Aaron Hartman

I am delighted to have Dr. Aaron Hartman, the founder of Richmond Integrative and Functional Medicine, joining me today as my very first guest in my podcast studio! 

In our conversation, we dive into the common mood issues women experience during perimenopause and menopause. We explore the immune and inflammatory impact of hormonal changes, the role of protein and key supplements, and the importance of comprehensive nutritional support in preventing chronic disease. Dr. Hartman also highlights the effects of hormone fluctuations, stress, and nutrient deficiencies, as well as the importance of gut health, hormone optimization, and personalized treatment plans in addressing chronic inflammation, trauma, and environmental factors such as mold. 

This conversation with Dr. Aaron Hartman is full of insight, wisdom, and practical guidance that every middle-aged woman deserves to hear.

IN THIS EPISODE, YOU WILL LEARN:

• How societal expectations exacerbate women’s stress and mood issues

• Dr. Hartman shares his foundational approach to hormone optimization.

• The value of breath work for managing dysautonomia and trauma

• Environmental mold and mycotoxins, and their impact on our health

• The link between Lyme disease and autoimmune disorders 

• Immune system changes menopausal women experience and the protective benefits of estrogen 

• How protein is essential for proper immune functioning, and the benefits of supplementing with whey protein and collagen

• Addressing inflammation to help women avoid heart disease and cancer

• Trace minerals in bone broth and benefits to menopausal women maintaining optimal health

• Potential impact of long-term fasting and low-calorie diets on appetite and overall health

Bio:

Dr. Hartman's journey with functional medicine started when he & his wife adopted their first daughter from foster care. She has cerebral palsy & countless dietary issues. They went from specialist to specialist and, even as a physician, he felt let down & confused. His daughter's health struggles forced him to confront an uncomfortable realization: Our current healthcare system doesn't have all the answers. His wife, however, refused to give up hope. She ultimately pointed him to functional medicine. His daughter & other two kids began to thrive. After years in family practice, he felt called to make a dramatic shift.

He now helps patients identify leverage points in key areas of their lifestyle & health that harness their body's remarkable power to heal and begin living the vibrant life they deserve. He has become the go-to doctor for difficult and complex cases in central Virginia.

As a clinical researcher, Dr. Hartman has been involved with over 70 clinical studies. He is the founder of the Virginia Research Center and currently serves as an Assistant Clinical Professor of Family Medicine at the VCU School of Medicine.

In 2016, he founded Richmond Integrative and Functional Medicine.

---

“90% of serotonin, your zen neurotransmitter, is made in your gut, and 75% of all neurotransmitters get made in your GI tract.”

– Dr. Aaron Hartman

---

Connect with Cynthia Thurlow  

• Follow on Twitter

• Instagram

• LinkedIn

• Check out Cynthia’s website

• Submit your questions to support@cynthiathurlow.com

Connect with Dr. Aaron Hartman

• Richmond Integrative and Functional Medicine

• Made for Health Podcast

• YouTube Channel

Transcript:

Cynthia Thurlow: [00:00:02] Welcome to Everyday Wellness Podcast. I'm your host, Nurse Practitioner Cynthia Thurlow. This podcast is designed to educate, empower and inspire you to achieve your health and wellness goals. My goal and intent is to provide you with the best content and conversations from leaders in the health and wellness industry each week and impact over a million lives.

[00:00:33] Dr. Hartman, such a pleasure to have you as a first in-person podcast guest.

Dr. Aaron Hartman: [00:00:38] I'm super excited to be here in your amazing podcast studio.

Cynthia Thurlow: [00:00:41] Thank you. Thank you. And we were talking before we started recording about some of the anomalies that you have the opportunity to see. And I think as a triple board-certified physician, you are in a very unique perspective to see not only common issues that your patients experience, but also some of these anomalies, these things that maybe some of us saw in a book during our training. Yes, back when we were in training, we saw things in books. Nowadays everything is online. In terms of working with middle-aged women, which I know that you work with quite a few and I have publicly disclosed that you are also my personal physician. I know that there's a lot of focus on this bidirectional relationship between our gut and our brain. And when we're speaking specifically to the microbiome and the changes that are occurring in women's bodies as they are navigating perimenopause into menopause, how commonly are you seeing mood issues, anxiety, depression, obsessive compulsiveness that get triggered at this stage of life when their bodies are having fluctuating sex hormones and other types of issues that can go on?

Dr. Aaron Hartman: [00:01:49] Man, it's more common than not, almost 80% of the time, maybe it's a part of the story. The way I explain to a lot of people is, and if you're a female, you've raised kids, you have a career, how many moms in their mid-40s to 50-ish, how many are now doing 20 to 30 things at a time? And so, you're running on cortisol, you're pushing and pushing it. And so, when all of a sudden, your estrogen starts to get wonky, progesterone goes down, your testosterone goes down many times actually even the pregnenolone, which is the primary memory hormone, which often is not looked at, starts going down, like how would you feel you're going to have loss of tolerance for life, you get anxious easier and quicker. Your threshold for getting upset- 

[laughter]

[00:02:36] -whatever that might be in your household looks like goes down. So, all of a sudden, you're triggered quicker and easier. And then when you have that triggering event, it takes longer to calm down. So, it's a pretty, I want to say universal, but it's unusually common. I was actually talking with my wife who you're friends with and in their group it's like this common thing where no one told us this was going to happen. No one told us that all of a sudden, we weren't going tolerate life and things would go crazy. And I don't want to say things want to go to crap, and I think the common experience is you get to this stage and unfortunately, it's happening younger. 

[00:03:20] It used to be, 46 to 52, now it's, 43 to 45. And then you have some women who start losing their progesterone and testosterone in their mid to late 30s. So, it's a pretty big age range to see stuff based on your experience, your chemical exposure, how many children you had, fertility issues, PCOS and endometriosis, all things hormonal, which are the new normal can affect that. But to have some mood imbalance, I don't want to say it's universal, but it's too common, it's too common. 

Cynthia Thurlow: [00:03:58] And it's interesting because I feel like what I have experienced is this general irritability, whether it's a function of the estrogen dropping and our people pleasing tendencies go along with that, but I have no filter anymore. I think it's a source of endless embarrassment. And it's something that my girlfriends and I laugh about is I almost can't not tell people what I think. Whereas before I might've been more restrained, I might have thought more about what they would think of me. I'm very polite about it, but my kids sometimes will be like, don't do it, please don't do it. We're in a store and I'm like, “But if you just could have asked it in a different way or providing constructive feedback maybe when it isn't necessarily appreciated.”

[00:04:37] But I look at it as, it's this dual-edged sword of, we're getting to the affectionately, as people call it, the I don't give a shit anymore. It's just you're much less inclined to be people pleasing and what I see as an overall gestalt of irritability and it could be, also this sandwich generation. We've got kids who are older, our parents are getting older. You may be in a position where you have more work responsibilities or home responsibilities, and you just feel like there's not a break in sight. And that is certainly what I hear a lot of my girlfriends experiencing. I have some friends who are empty nesters now or open doors, depending on how you like to rephrase it. I have others who maybe started a little later. Maybe they have elementary school kids that they still have at home, but they're kind of in the stage of life that I'm in. And so, I think it’s so much of that experience is how our perception of the aging process in general. 

Dr. Aaron Hartman: [00:05:28] But yeah, those are all true things you said. But that's also the concept of that. I think we're just exposed to more these days since not to make this conversation political at all, but I have patients who are coming to me now that are unusually anxious and their stuff is going on. And it's like, well, I recommended to a couple of them, Jonathan Haidt, The Anxious Generation remove technology, right? But that's how we got here in the first place. And they feel this like, “I have to stay engaged in order to somehow-- somehow, they're going to prevent the dealing what's going on in the world right now. And it's like social media, it's news, it's podcasts. Again, this is something my wife educates me a lot about, what women in the mid-40s think about. But evidently in her age range, like murder podcasts are a thing. [Cynthia laughs] Yeah, she goes to bed listening to these things. 

Cynthia Thurlow: [00:06:20] Interesting. 

Dr. Aaron Hartman: [00:06:21] And for her, it's like control. If I know how bad things happen, I can [crosstalk] better protect my family. I'm like, “Wow, that's kind of okay.” [Cynthia laughs] And in her world and her people she talks to, that's like a thing. And I'm like, “Okay, I don't think that's helping your anxiety level, [Cynthia laughs] but if that gives you a sense of control, then.” But it's like all these things that when you're 20 and 30, not a big deal, but all of a sudden, what used to be your superpower that enabled you to grow life in the womb and raise it and not sleep. Because the reality is women still today bear the brunt of all that. By the way, you have to have a career and you have to have all these things and all that kind of stuff. It's like, oh my gosh, how do women do it for 20 years? 

[00:07:08] And then you lose that superpower. And it's like the cortisol is there. And the women in my practice who have the hardest time are my type A executive types who their expectation is, “No, I need to keep on firing all cylinders. The hormones cannot stop.” And that's where it gets a little tricky. Because the cortisol, you start checking numbers, you see the cortisol, it's off the chart. It's crazy high. 

Cynthia Thurlow: [00:07:29] Well, and it's interesting, we become much less stress resilient. And that is certainly something if I reflect on where I was 10 years ago, worked for a big practice in Northern Virginia. My husband was traveling a lot. My kids were 10 years younger, they were 7 and 9. I was just in a very different place. But I was doing all the things that I tell women not to do. Super intense exercise, because I didn't know any better then, too low carbohydrate, probably not enough sleep, not managing my stress proactively. And I reflect on what my life looks like now. And it is 180 degrees different. Last night I put myself, I was in bed at 8:45. I was like, “I'm tired, I'm going to bed.” Were there things I could do? There's slides I have to finish for a presentation for next week. I was like, “No, I'm going to bed.”

[00:08:11] And I think for a lot of women that is a hard thing to learn, that you have to adjust so many things about your life that maybe in many ways were great for you especially if you were a type A conscientious go getter. That all of a sudden everything that got you to where you are, you're like, “Oh, wait a minute, those things don't work anymore.” That's a lot to adjust to. 

Dr. Aaron Hartman: [00:08:31] It is. And when your body's changing and your hormones are changing and then you realize the nutrient deficient, this is another thing about the hormones. People don't realize nutrient deficiencies, magnesium deficiencies that 80% of the population has, depending on what study you look at, maybe these numbers sometimes are hard to just grasp. But maybe up to a 100% of Americans have insufficient potassium levels, who doesn't have a low vitamin D level? who's Selenium [unintelligible 00:08:58] minerals, trace minerals, molybdenum-- lithium levels. You need lithium for mood stabilization. You're supposed to get this from the natural spring water we consume. Like, who does that anymore? And all of a sudden, all these things that build up over decades, and then your superpower goes away. 

[00:09:14] And this is one of the things I see in patients I do hormone optimization versus hormone replacement therapy with, is that, yes, you're now off on this, but you have to build all this foundation back. And if you just replace estrogen and progesterone and bring the cortisol down, you won't see the same benefits if you don't-- In Virginia, I see so many people with basic iodine deficiencies. It was supposed to be gone. We were supposed to fix that with iodized salt. I see it routinely. And it's like, how is your thyroid going to work? How are your other hormones going to work if your iodine, one of your essential halides is deficient? 

[00:09:51] And so a lot of what you have to do is not just-- before you do this, actually, you need to replace what's lacking [unintelligible 00:09:57] gut, which started this whole thing. Because your serotonin, which is your Zen neurotransmitter, 90% is made in your gut. 75% of all neurotransmitters are made in your GI tract. I'm actually reading it right now. I got nothing else to do so I'm reading a textbook. [Cynthia laughs] I'm actually reading a textbook of Dysautonomic Medicine right now. And I realized there's five parts to your nervous system. Yeah, there's the sympathetic, parasympathetic. There's a noradrenergic. There's the sympatho-adrenal, which is basically the brain connecting to your adrenal gland and then your enteric nervous system. 

[00:10:36] And we always just clump them together like, “Yes, they're part of the autonomic,” but they are actually their own systems outside of the sympathetic and parasympathetic gut. And 80% of the interaction between your brain through the vagus nerve and your gut is actually sensory back to the brain. And so, your gut health, when you get anxious, oh, my gosh, my gut's messed up. We used to say 30 years ago, you're anxious, and that's the reason why you have IBS symptoms. Well, now, probably that's not the case. It's primary an enteric nervous system thing where again 5% of dopamine made your GI tract. And that's the reason you're feeling anxiety, most likely not the other way, which is exact opposite of what I was told in medical school 20 some years ago. 

Cynthia Thurlow: [00:11:25] Yeah, no, I think everything really originates in the gut microbiome. I think that is, especially after just writing this book and understanding what is changing in the terrain, especially with these shifts in sex hormones, in particular, estrogen, that's probably the hormone we know the most about and its interconnectedness with immune function. And so, when you are working with women at this stage of life, and as you astutely mentioned, you have this foundational approach to ensuring that their trace minerals, their micro, macronutrients are all optimized before you're adding in hormones. And I think that's pretty unique. And especially because I have the opportunity to connect with so many experts on the podcast, I think it probably is a huge differentiator between yourself and a lot of others that are just slam bam, thank you, ma' am. It's a terrible way to explain it, but you go to see them, they give your progesterone, maybe some testosterone, some estrogen, they send you on your merry way, and you're not feeling better. 

[00:12:20] And much of that can be attributable to a constellation of issues that I'm sure we can unpack. But I do think that if we're not dealing with things on a very foundational level before we start adding in hormones, things will not be optimal. 

Dr. Aaron Hartman: [00:12:34] Yeah, and you mentioned the gut initially. If there's a thing called the estrobolome, which is the metabolism of estrogen, and there are bacteria in your gut that actually create these enzymes, and if they're out of control, your body naturally detoxifies estrogen. Your liver takes it, puts it in bile, you put it in the GI tract, and you're supposed to defecate it out. If you have too many of these bacteria, and you can actually measure this in a stool test with a β-glucuronidase level being elevated. If that's high, then all of a sudden, this female most likely has estrogen dominance. Do you have fibrocystic issues? breast tenderness, history of fibroids, endometriosis type issues. And all of a sudden how many people is that?

Cynthia Thurlow: [00:13:19] A lot. 

Dr. Aaron Hartman: [00:13:20] Lot. And so, if this is elevated, that's a simple fit. I mean, you have to work on the microbiome, but you can literally use calcium D-glucarate as a part of your-- Now you need to fix the gut and other things. But all of a sudden there's little bio-hacks, so to speak, that you can use to address that one small piece of your body's ability to detoxify estrogen, which if you don't do it the right way and if you go down the wrong pathway, you make too much 16 or the 2, 2, 4, 16 Yeah. But all of a sudden you might be taking something good and turning it into something bad, which, I think it was 2018, 2019, some research came out showing that women on bioidentical hormones, if you're diagnosed with breast cancer, it's less aggressive. 

[00:14:03] So, all of a sudden now is-- were we wrong for quarter of a century, are actual bioidentical hormones breast protective? Well, literature is now going that way and it's actually us doing oral dosing, super high doses, including synthetic progestins like medroxyprogesterone, which we know causes tumor in lab rats. And then the initial group that the Women's Health Initiative was women 65 was the average age and a lot of them were smokers. So, it was kind of like all these things--- in medical school you shouldn't smoke and take birth control pills. But when we did that big study in Canada, we left smoking women on oral hormones in. And we’re surprised-- surprise, surprise that you saw clots and breast cancer and no one ferreted that out appropriately. And we went down this pathway of-- I was actually talking with Dr. Jenski about this. 

[00:14:52] He's another physician in the practice and-- I almost steal his phrase but he says he's becoming a medical feminist because it's like we've literally neglected all these little nuances. You know, the idea of radical mastectomy for small cancers, that was standard of care till the last 20, 30 years. And like, there's a lot of things we've done that have neglected, let's say, adequate care or optimal care for women, particularly in this age range. 

Cynthia Thurlow: [00:15:19] Yeah, well and it's interesting, there was a podcast with Peter Attia and Dr. Rachel Rubin. I don't know if you've heard about, but even my husband listened to this entirety of this podcast. So, she is, I believe, a urogynecologist. And she was saying that if men's penises shriveled up and fell off, there would be a vaccine against this. And so, she was making the point of saying, “Yes, over the past 25 years we have made some decisions that have not been in the long term best thought process for women of this age group. But it's also a part of this, and I dare I say this terminology, medical patriarchy, which in many ways in terms of looking at women's healthcare, women have accepted many things.”

[00:16:02] I think that our generation of clinicians, younger generation, will demand better care for women. But I think in many instances, the Women's Health Initiative is one of many examples where women's long-term health needs were like this knee jerk reaction of “Oh my gosh, these rates of cancer go up. But we're looking at an unhealthy population, obese, diabetic, hypertensive, previous smoking history, ten plus years into menopause. It's a very different population of women than when it's initiated. HRT is initiated earlier.”

Dr. Aaron Hartman: [00:16:33] But also doing it by mouth, oral-

Cynthia Thurlow: [00:16:35] Yes, very different.

Dr. Aaron Hartman: [00:16:36] -which goes to your microbiome. And a lot of the metabolites are made through your liver because of the way it's metabolized you have to dose it higher. So, you're dosing milligrams versus-- you’re dosing really high doses, 3-4 mg versus micrograms. And all of a sudden, it's like, well, maybe too much by mouth to your liver. We figured this out with men and testosterone, methyltestosterone used to be a thing we used to do by mouth. And then oops, liver cancer. And it's like, well, maybe is it possible that estrogen and progestin might used-- that never occurred to anybody that maybe doing those by mouth might have some bad-- Now it's interesting for progesterone because actually doing progesterone by mouth-- And this is the unique-- when it's actually better, it will turn into allopregnanolone, which actually is very calming. So, it can actually help with sleep. And one of the metabolites from oral progesterone is breast protective.

Cynthia Thurlow: [00:17:30] Yes. 

Dr. Aaron Hartman: [00:17:30] So, all of a sudden, it's like you want to do that, but you don't want to do this. And so that's where it gets a little nuanced. And I still have patients coming to see me who other practitioners are giving them sublingual estrogen. And I'm like, “You still swallow out of that.” 

Cynthia Thurlow: [00:17:45] Yeah. 

Dr. Aaron Hartman: [00:17:46] Yes, you do get-- [crosstalk] 

Cynthia Thurlow: [00:17:46] First pass effect.

Dr. Aaron Hartman: [00:17:47] And it's one of those things where the people learning stuff routinely on a weekly, monthly, yearly basis. I think a lot of it, just what you mentioned to my-- like, “I learned this. I didn't figure this out on my own I learned this from other people and I just pieced it together.” So, I think it's just the way you keep this-- Things are changing. I tell people all the time. You can't hold anything I say to me more than like three to five months because [Cynthia laughs] you might come back and I'll change because I'm just always learning. 

Cynthia Thurlow: [00:18:16] And I think that's the case that, that evolution of a clinician, that you are not practicing the way you did in 1995. It's very different than the way you practice now. I tell people, I'm not the same nurse practitioner I was 10, 15 years ago. And I'm grateful for that because of that learning process. What I find interesting is I'm starting to see some clinicians that are using oral estrogens to protect bone and brain. There's like an undercurrent of discussions ongoing about this. And I'm sure that there might be a particular patient that's appropriate for, but it seems like that is starting to become a thing in terms of wanting to get serum levels to a certain amount. I know you and I have talked about this separately. 

[00:19:01] It's like trying to help women understand. Is it more important that we treat for symptoms, symptoms we experience in perimenopause and menopause, or are there thresholds we need to meet to be able to protect bone, brain and heart health? And that's where I feel like there's a lot of nuance right now. And I don't per se think there's necessarily a right or wrong answer. I think that clinicians are trying to figure out what is the best offer for each patient. 

Dr. Aaron Hartman: [00:19:28] Well, I think that's the key, is for each patient, you have to individualize it. If someone comes in and has sleep apnea and they are prediabetic and they're really stressed out and they're 52 and they've been going through the change recently, then you can give them a lot of oral estrogen, which I've seen locally in some of the clinics, and you will cover those symptoms and they'll feel better for a year or two. But if you don't deal with all the other stuff, then there's a whole thing-- thing called estrogen receptor-- in nature this is one of the things that makes sense, but why isn't this not common talked about? 

[00:20:04] I was taught by experts in the field that when you are cycling, there's a period, five, seven days a month where all your hormone levels except for testosterone, will go down. 

Cynthia Thurlow: [00:20:18] Yup. 

Dr. Aaron Hartman: [00:20:19] And all your receptors kind of reset. That it's not a true type of tachyphylaxis, but you get a hormone resistance. If your estrogen's all is high, your testosterone's all. We see this in professional bodybuilders and people that have used testosterone after a while, like that 800 level, 900 level just doesn't do it for you. Now you need a 1000, now you need 1200.

Cynthia Thurlow: [00:20:38] You're chasing that high.

Dr. Aaron Hartman: Yeah. And so, what happens is if you don't take a break at least three to four days a month, then what happens? You develop this tolerance. And how many people doing the oral stuff aren't taking that little break? And the answer is, as far as I know, that's the norm. And so, there's all these little nuances to it that, that's the reason I like to use the word hormone optimization, not replacement, because the ideal is to make it optimal for the person in front of you. And if you have thyroid resistance, if your reverse T3 is elevated, if your TSH is 4, which is normal, and your free T4 is like 1.0, which is normal, which is low normal.

[00:21:18] All of a sudden, all this other stuff downstream is not going to work quite as well for you because you're in a relative, not quite technically, subclinical hypothyroidism. But for some of my patients, if their thyroid's off like a point or two, they feel it.

Cynthia Thurlow: [00:21:32] Well. And it's interesting because I reflect on what I've learned working with you and then what I've learned through continuing education and talking to other experts. And that three to four days a month of a break of oral progesterone. For me, it's Friday night. I'm like, Friday night, I know, it's like, Saturday is usually a less stressful day. So, if I don't get my progesterone on board-- And what I've come to find is that by being conscientious about the day of the week in which I hold my oral progesterone, my sleep actually isn't bad. And I think it's because I've learned, like, what are the other things I need to tweak? But I also do it on a night where if I don't get a stellar night of sleep, it's not as big of a deal, as opposed to a regular Monday through Friday workday.

Dr. Aaron Hartman: [00:22:15] And one thing I'll say, since you brought it up, I didn't mention that I see you anywhere-- [Cynthia laughs] So, I still haven't mentioned that. [laughs] But that's on you. I didn't mention that you broke the confidentiality there. But the thing is that you have-- And you're not alone where the oral progesterone, there's some women, based on microbiome issues, that they can't tolerate. 

Cynthia Thurlow: [00:22:35] Yeah. It's the progesterone resistance. 

Dr. Aaron Hartman: [00:22:36] Yeah. And they have issues with it. And you have to do topical. And then some of those women, I've noticed, I have a few of them, it's interesting, their skin absorbs it so well. I'm giving them these ridiculously low doses of topical. And sometimes it's like, “This is just 10 mg of topical progesterone. This is like nothing.” And yet their levels are high when we do their testing. And so that's where, again, back to the individual isolation, personalization. Like, just because this is the textbook best thing for women, it might not be the best thing for the person in front of you. 

Cynthia Thurlow: [00:23:08] Well. And progesterone resistance, from what I understand, is a real entity. I know that when I interviewed Dr. Lindsey Berkson, she was mentioning that sometimes she recommends women use it both transdermally and then also intravaginally to get their progesterone levels where they need to be. So, if there are women listening that have experienced taking oral estrogen and they're edgy, they feel anxious, they just don't feel good, you might be someone that is exquisitely sensitive to progesterone's effects. And I always say, “I'm so sorry,” because progesterone is one of my favorite things I look forward to taking right before bed because for me it helps fall asleep. I feel very relaxed and that's exactly the mode that I need to be in prior to falling asleep.

[00:23:51] When we're thinking about testing and I touched on this in particular. When you are working with a new patient, you're working with a middle-aged woman, what are some of the low-lying fruit tests? You mentioned some of them, some of these co-factors, some of these vitamins, minerals that are so important, iodine in particular. But where does gut testing, stool testing fall for you? Is that a very important kind of first step when you're working with someone that comes to you that is trying to optimize how they're feeling? They're not feeling as good as they did in their 20s and 30s, but they know that there are certainly options out there to optimize how they're feeling and to improve, whether it's energy, sleep quality, vitality, loss of muscle, loss of libido, all these different constellations of symptoms women experience.

Dr. Aaron Hartman: [00:24:45] For me, it depends. So, if someone's coming in and they're like “I'm an optimization patient.” Yeah, that's one of the first things I do because it's gut's super important. But the person comes in and they're like having anaphylaxis and weird skin things and they're having a bunch of chronic fatigue and they just got over long COVID and they pulled a tick bite, tick off their body, Yeah, you know what, your gut's a mess right now. But this is going to confuse the picture because you're going to get this 12-page report back with a lot of little things on it that are going confuse you and then we're going to go down this rabbit hole. 

[00:25:17] Let's do like I know that gut is foundational, but that's where I think working with someone longitudinally where you don't have to do everything in one visit. And it's also like reading the patient, developing a gestalt, let's say. Actually, I'm reading another Jonathan Haidt book right now called The Righteous Mind and its really interesting read because I'm sure if you're familiar with his work, but the idea is that what he's discovered is intuition is actually more powerful than our prefrontal cortex stuff. The analogy he uses is the man on the elephant, and the man is our consciousness. I'm thinking, I'm going to do this. But the elephant actually is your intuition, which is actually the beast of burden. And a lot of times-- and then there's other neurobehavioral research that most decisions are emotional.

[00:26:05] And then you try to convince yourself that's the right decision. There's this interesting thing where they had these patients that actually had damaged amygdalas and those are the-- limbic system was dysfunctional. They could make it like, I made a decision, but they couldn't actually do it. They could say, this is what I'm going to do. This, this and this, but the ability to actually go through requires that emotional component. I lost my train of thought, where was I going? 

Cynthia Thurlow: [00:26:34] So, we were referring to when we're dealing directly with-- [crosstalk]

Dr. Aaron Hartman: [00:26:38] Oh. Yeah. So, with the gut testing. So, it depends on where the person's at in the whole thing. And so, if they're like in a place where they're just 100%. I'm just here for personalized precision medicine. I want you to optimize me then. Yeah, we're going to do hormones, we're going to do salivary hormones, we're going to do cortisol, we're going to do the three-point cortisol in addition to the gut test and then all the nutritional stuff. One thing I think is commonly overlooked are fatty acids.

Cynthia Thurlow: [00:27:02] Yes. 

Dr. Aaron Hartman: [00:27:04] Because I think C15 is just now coming into public consciousness, I could talk about that for a long time. I think that's a great example of how following government regulations and recommendations has resulted in a nationwide nutrient deficiency. You know, low fat.

Cynthia Thurlow: [00:27:23] Yep. 

Dr. Aaron Hartman: [00:27:23] We did that for 40 years. Removed dairy, which is the primary source for C15, and 30% of the population is deficient. Oops, how many times do we do that? But the point is, fatty acids and all these hormone receptors we've talked about all sit in cell membranes. If the membranes are dysfunctional, then all of a sudden when something binds onto that, it's not going to quite work. And so, you need your omega-3s and 6s balanced, and inflammation's all the rage. If your 6s are really high or your 3s are really low, you can have a similar inflammation presentation. And so, balancing those saturated fats, which actually are the main things that stabilize your cell membranes. If you don't have adequate. it's crazy. 

[00:28:08] I'll see people routinely who when you do a fatty acid analysis, have low levels of saturated fats in their cell membranes. These are essential for a reason. We call them essential fats. And so all of a sudden, people like, “I want my hormones adjusted.” It's like, you need more behenic acid. You need more of these other saturated fatty acids. You DHA is super low. No wonder you have issues with cognition and thoughts. So, that's where putting all these things together but the basic thing-- if anything's pretty good with you, yes, the gut test is one of the first things I do, but that tends not to be my experience. My experience is patients that come in with their undiagnosed dysautonomia and all these other kinds of things. And I'm trying to do things even more foundational, which maintain blood flow to your brain so you don't feel like you're going to pass out. That's even more basic than gut, I think.

Cynthia Thurlow: [00:28:59] Remember one of our first conversations we had? and for listeners, Dr. Hartman and I are friends and our spouses are friends, and we were out to dinner, and [laughs] you and I were talking. You looked at me and it was like we were having a conversation, and you were like, “Do you have a high arch palate?” And I was like, “What?” And you were noticing things, anatomically, you were looking at me. And I think you probably are someone that has this constellation of hypermobility, dysautonomia and gut issues, which that trifecta is me in a nutshell. But you were one of the first people that actually put those things together for me, and you touched on the term dysautonomia. 

[00:29:41] So, let's talk about this, because I think things like POTS, which I saw a lot of in cardiology, this postural orthostatic hypotension, which can be quite significant and profound. It's a continuum. And so, when you introduce the “You might be dysautonomic,” I was like, “No, no I'm not one of those patients, because I saw the extremes.” But the irony is, when you started having that conversation with me, it made me realize, like, why have I always craved salt? Why am I one of these people that's always had, low blood pressure, but my pulse rate and my blood pressure didn't coordinate together. So, let's talk a little bit about dysautonomia. And you have my permission to interject some of the things that tipped you off that I might be one of these patients. 

Dr. Aaron Hartman: [00:30:27] It's gestalt. [Cynthia laughs] There's a great book by Malcolm Gladwell. It's called Blink. It talks about how experts think, the whole 10,000 hours kind of thing. Whether you believe it or not, the idea is you get a feel after a while. And that's back to the whole intuition where you get this gut feeling. It's not emotional. It's actually based on the sum total of your life experience. And then the goal is figure out why you had that feeling. And that might take months and months and months to figure out. And then you're like, “Aha.” And so, you get this feeling. I get anxious. I'll be sitting down, and all of a sudden anxiety-- overwhelming anxiety comes over. And then I can't calm down for a long, long time or sometimes I'll be sleeping or I'll be laying down. 

[00:31:07] All of a sudden, my heart starts to race, I feel it while I'm laying down. I'll wake up. I'll be sleeping and wake up in the middle of night, like water ache, maybe a little panicky or a version of that, severe version like you mentioned, Gulf War vets. Vets will have night terrors where people will actually have these horrific dreams that will give them poor sleep. There's different nuances to it as far as the face, looking at people's faces, it's amazing. If you start looking at people's facial structures, your head's big, your mid face is a little smaller, your chin's a little smaller. Well, and if you look from someone's side, you should have the top teeth and bottom teeth come together. One of the things that Weston A. Price, which discovered-- this is a dentist that traveled the world maybe 70 years ago, he realized that based on nutritional status, people would not need dental, would not need orthodontics done.

[00:32:05] They'd have really wide palates, wide wide dental arches. Their lower jaw would be set forward. And one of the things you see in starvation, your body preserves your brain. The next thing it preserves your mid face. And the last thing it preserves is your lower jaw. So, one of the first things that happens is people actually develop smaller jaws, smaller airways, solely from nutritional deficiencies. Now where the hypermobility comes in. And so, you can look at people's faces and kind of see that if you look for it long enough, just like the whole finger things. If you look at people's fingers, not me. But you can tell if someone's fingers are longer than- [crosstalk]

Cynthia Thurlow: [00:32:42] My finger--

Dr. Aaron Hartman: [00:32:42] -the palm. It's like, “Huh.” And then you did that and your fingers went backwards a little bit. Or you lean your arm back and then it goes back. Or you're standing, I see this at a church a lot with a lot of young ladies that would be standing up. And my wife like, “[unintelligible [00:32:56], just stop diagnosing people.” [Cynthia laughs] But they'll stand up and their knees have this little backward curve. And you're like, “Huh, these are all stigmata, let's say of hypermobility.” And then you start asking questions, or people in my case just tell you a story.

[00:33:11] And you start hearing all these mood, anxiety, sleep kind of stuff. I can't handle the heat very well, I get overheated really quickly, or I can't do sauna because I just don't do well in the sauna or when the weather changes, those fronts come in, I feel- I get migraines, I feel exhausted. I'm like, “Your nervous system is not dealing with something very well.” And your nervous system regulates everything else. And then you get this gestalt. And then when you do an exam on someone, you do a Beighton score. You actually get your number. And then you look in the mouth because you have someone in your office. Or even the question, like, “Did you had orthodontics for teeth? How many teeth have you pulled? If someone had four to five teeth pulled to make them fit in their mouth, the mouth is too small.

Cynthia Thurlow: [00:34:03] Yeah. Wait, did you ever ask me how many teeth I've had pulled?

Dr. Aaron Hartman: [00:34:05] I think I did. I think I did put in your chart somewhere. I don't recall off the top of my head.

Cynthia Thurlow: [00:34:08] Yeah, no, it was four adult teeth. 

Dr. Aaron Hartman: [00:34:10] Okay. 

Cynthia Thurlow: [00:34:11] Eight teeth total. So, they pulled four baby and four adult teeth for braces.

Dr. Aaron Hartman: [00:34:15] So, that just means your dental arch wasn't big enough. And if you go to the Lötschental Valley in Switzerland back in the 50s, which was still Europe, but it was this remote place that-- the Vatican, actually, the Swiss Guard preferentially came from this place. Really tall, and when Weston A. Price was there, he saw one cavity in every three to 400 teeth. So, they're basically cavity less. No tuberculosis, which was unheard of back in the 50s. I mean, tuberculosis was still the rage. But part of that was nutritional and da, da, da. But the thing is, they had wide palates and he has pictures of the dental stuff. And so all of a sudden, if these are small and the thing that okay, so what? Sleep apnea, mild sleep apnea.

[00:35:05] If you're getting disruptive sleep, it's going to affect your hormones, it's going to affect your cortisol. So, this is how this all plays in. And with dysautonomia, if your nervous system doesn't feel safe, it's dysregulated, it's having a hard time maintaining your blood pressure. Even if life is great, even if there's no issues at the home, even if you're getting eight and a half hours of sleep at night, you're still going to have cortisol and this fight or flight because your nervous system is stuck. And this is actually where some of the whole cell danger response stuff comes in play with Robert Naviaux work, which is taking this big picture down to the level of the mitochondria. 

[00:35:44] And that's what the cell danger response is. It's this thing where literally your cells get stuck and they can't appropriately repair themselves and turn over. The fancy term is senescent cells, of zombie cells or whatever you want to-- The term is for the day, but that's the concept. And those cells get stuck, which is a part of chronic Lyme, part of long COVID, a part of a lot of chronic illnesses. And the nervous system is one of the mechanisms that tells these cells, “No, you need to die, so go ahead and donate your parts to the rest of the cells, or no you're strong, you need to replicate.” When you lose that, these cells get stuck and they actually are stuck in this inflammatory-- It's called a proliferative physiology, where they sit and they release cytokines or inflammation.

[00:36:30] Now all of a sudden, your nervous system and dysautonomia is programming mitochondria. And this sounds all cool, but what do you do about this? That's where breathwork comes into play with our colleague Sachin Patel.

Cynthia Thurlow: [00:36:41] What was one of the things you told me not to interrupt you? You were like, “You need to do holotrophic breathing.” And I fought it and fought it and fought it. And in September, I did it with Sachin at an event and I walked up to him and I said, “You need to understand that my internist has been telling me to do this for about a year.” [laughs] And it was cathartic. And actually, it is what kind of, I think in many ways, I've been able to track my HRV improvement since that time. And so, for anyone that's listening, you can look this up on YouTube. It doesn't necessarily take a lot of time, but it is profoundly powerful. Sorry to interrupt.

Dr. Aaron Hartman: [00:37:15] I actually interviewed him and we talked to Sachin about this couple weeks ago, I think, when it came up. But I have actually some patients who are trauma therapists. And it's interesting to have people who have-- It’s like what you've gone through kind of draws you to help others with a similar kind of thing. And one of them, in her own personal journey every week, part of her own personal work is her breathwork. She does the holotropic-- psychedelic breath work. And at the end, she's like, “I have memories that I had no idea I was there.” In many ways, I prefer it over talk therapy, cognitive behavioral therapy. I have so many patients who have horrible histories and they come back from the therapist triggered. They come back and it takes them days to calm down from there. And, like, “This is not helpful. This is actually solidifying your traumatized nervous system.”

[00:38:04] That's one of the reasons why psychedelics have become really popular is because it allows you-- through the default mode networks and almost to disassociate your consciousness from your subconscious mind, to have a reset and actually help you with that in a way that doesn't require you to get triggered. Obviously, that's to be done the right way and you have to have-- it gets a little more than we want to talk about here, because that can be done the wrong way too. [laughs] 

Cynthia Thurlow: [00:38:29] Yes, yes. And that is what I think has given me pause. I was speaking at an event and did a podcast with a person who will remain nameless. And they were saying, “Oh, you really need to do this ayahuasca journey. You've got to do this. It's so powerful.” And I was like, “No disrespect to anyone who's done that” and that might be the right decision. But I think for me personally, with my trauma history and a very high ACE score, like there probably has to be something a little more gentle. I think my physiology needs a little more gentle approach. 

Dr. Aaron Hartman: [00:38:58] Well, that's where things like just body work, myofascial work can be very calming. Obviously, breathwork, EMDR is one of the newer techniques. There's a thing called Porges’ work, which is some of the counselors would do. And it's almost like taking some of the-- the body keeps the score concepts like you hold trauma in your body and allows you through realization like, “Oh, that's the reason why I get this pelvic pain or that's the reason why I get this certain abdominal pain or I get tight or I have these headaches that your nervous system clamping down and it's actually somatized previous trauma. And so, it allows you to take that and disassociate to a certain degree consciously, not through drugs. And then it allows you to work through it.

[00:39:43] And because it's focused on your body, it doesn't have anything to do with the triggering kind of stuff. So, there's a lot of really cool ways to work through it. In my conversation with Sachin, I actually agree with him on a lot of things. But this is one of the things we actually had concordance with is like your breath work is an easy way to get there and you can do longer two-hour sessions that actually act like disassociative and using something natural, your breath through hyperventilation, breath holding to actually cause this disassociation. And then it puts you in a safe place where you can actually do some processing, some work. You don't have to have necessarily, mother ayahuasca-- [Cynthia laughs]. And it's one of the things with that kind of stuff is that, if you do it the wrong place, the wrong way, that can cause its own trauma. And if that happens, then you're really kind of--[crosstalk] 

Cynthia Thurlow: [00:40:32] You're in trouble. 

Dr. Aaron Hartman: [00:40:33] Yeah, yeah.

Cynthia Thurlow: [00:40:34] You're really in trouble. 

Dr. Aaron Hartman: [00:40:36] And if you're asking this question, I'll answer for you. How many people do I see get 60% better. The hormones are better, but they're not quite stuck. And we wash and repeat. Look for mold again, look for Lyme again. Did we miss a concussion? Okay, we looked at your hormones again. I do that two or three times because I need to do that just because there's not a test for this, so to speak. And then it's like, maybe you're not healing because of the cell danger response because of trauma. And sometimes it takes that for people to get buy in, to go down the route of whether it's primal trust or dynamic neural retraining. There's so many things out there, it's just find what resonates with you and what you'll do.

Cynthia Thurlow: [00:41:17] Well, I think that's key because I know for a year to your credit, you kept bringing up holotrophic breathing. And I was like, “No, no, I don't need that.” [laughs] So, I found it to be really powerful. And I think sometimes when we're ready to do that type of work, it'll avail itself to us. I think one of the things about trauma that I have found so interesting is that when I was in my training years ago, trauma was really thought of as murder, rape, suicide that's trauma. So, I didn't think that I had any trauma in my life because, it turned out pretty good. I'm like, how bad could it be? But now that I understand the extent of what growing up in chaos and turmoil or drug addiction, parental drug addiction, those kinds of things, the net impact that can have on you long term. What I found interesting is while I was writing my book, which will be out next year, one of the things that really stood out was looking at people with high trauma scores, so high ACE scores, adverse childhood events, anyone can go online and take that, it's a pretty short test. And earlier menopause, it was the-- [crosstalk] 

Dr. Aaron Hartman: [00:42:24] At least one of the-- I wasn't familiar with-- [crosstalk]. 

Cynthia Thurlow: [00:42:26] No. So, the research from that has shown that women like, as an example-- [crosstalk] 

Dr. Aaron Hartman: [00:42:30] [unintelligible [00:42:30] got you.

Cynthia Thurlow: [00:42:31] if a woman is sexually abused as a child, and then she goes on to have a family and one of her kids get sexually abused, like she will go into menopause eight years earlier. So, the effect of whether it's epigenetic changes or just the growing up in that chronic, high sympathetic, dominant state over the course of a lifetime. But looking at trauma as a proxy for earlier menopausal transitions, I thought was interesting from the perspective of these are things people aren't talking about. It's like first of all, perimenopause, menopause are having a moment, thank God, because I think it's important to have those conversations. 

[00:43:08] But understanding that my childhood experiences probably contributed to going into menopause earlier than the average person does. And I thought that was really interesting, selfishly. And then I was like, “Oh, I've got a lot of friends that this makes a lot of sense.” Why some of them were 47, 48, 49, going into menopause earlier than conventionally. 

Dr. Aaron Hartman: [00:43:28] Well, the just basic statistics that 25% of women have had some kind of trauma, physical, sexual, emotional abuse 10% of men. And this is like the official, anybody--[crosstalk] 

Cynthia Thurlow: [00:43:39] People who have disclosed. 

Dr. Aaron Hartman: [00:43:40] Yeah, yeah. And this is like in the room, like everybody agrees this is trauma. This is not like questionable trauma. 

Cynthia Thurlow: [00:43:44] Right. 

Dr. Aaron Hartman: [00:43:45] The big ‘T’ trauma versus little ‘t’ trauma. But what got me down this pathway actually was from adopting our kids and our first daughter child with special needs and this is where like my spidey sense, my radar started popping up. It was just for my wife, she was a pediatric OT who worked with kids with special needs. And you would see in this world if your child's tooth falls out three or four times a year and they almost suffocate, like that's traumatic. If you have to take your kid to the ER for the third time this month for seizures, that's traumatic. And all of a sudden, in the special needs world, it's like every mom probably has little ‘t’ trauma of some degree just- [crosstalk]. 

Cynthia Thurlow: [00:44:26] Absolutely.

Dr. Aaron Hartman: [00:44:26] -dealing with these kids with special needs. Then my mind started to think, “Huh, there's water torture, which is like dropping water on someone's head and you go insane.” And I was reading some World War II books and reading about, I think it was the Battle of Verdun where basically it was like you get through these little planks up to the front and if you fell off the plank into the mud, you couldn't pull people out. They would just sink throughout the day. And so, the guys coming back at the end would find the people that sunk like to hear and they'd literally gone insane throughout the day because they knew their end was coming and their slow is sinking in the mud. And you're going to suffocate to death.

Cynthia Thurlow: [00:45:00] Right. 

Dr. Aaron Hartman: [00:45:01] So, just that the guys are coming back and seeing their friends who had lost their minds and it's like, okay, that's an extreme short-term stressor. Then kid with special needs, like is there a lot of small ‘t’ trauma just floating around the air that we're ignoring because it doesn't fit into the nice mace box, and again, 25% and 10%. So, if you add all this stuff in, maybe we all got something going on. 

Cynthia Thurlow: [00:45:27] No, I think for each one of us and I will be the first person to say I will be in some form of therapy for the rest of my life to continue to fine tune the things that I grew up within. And it's not to suggest, I think parents do the best that they can, period. And so, I'm grateful that I'm who I am because had I grown up differently, I wouldn't be the person that I am today. But I think from a lot of perspectives that trauma is oftentimes an undealt with entity, whether it's the time constraints of traditional allopathic medicine, which I know you worked within. When I met you, you were still kind of had your feet in both, the allopathic, functional integrative world and came fully over. 

[00:46:06] But I think about a lot of our colleagues that are still in a system where they just don't have 30, 60, 90 minutes to spend with a patient to unpack some of those things that can take a long time for a patient to feel like they have the trust and rapport to be able to share that information. 

Dr. Aaron Hartman: [00:46:21] Yeah, it's just hard. We have this thing connected health we're putting together and one of the resources for people is like how to talk to your doctor. Because the reality is if every primary care doctor in the country went functional tomorrow, we would not have enough people doing this. When you first met me, I was taking care of about 2,800 people with my patient. Now I'm like about 300 and I'm busy because people got a lot of stuff going on. But the point is like, if everybody went to functional, we would need probably 10%, 10 times more people than we have now just to be at the same place we're at now.

[00:46:59] And so the reality is people just aren't going to-- the average person that’s going to be hard to have access so to create resources that people can actually get stuff and trauma is just a part of that, like addressing those kinds of things, addressing the stress. And if you don't, it's going to affect people's healing journey, which we all have a healing journey we need to go on. 

Cynthia Thurlow: [00:47:18] Yeah, no. So, I always like to express publicly how grateful and appreciative I am because you have encouraged me gently to deal with my stuff. Like gently, “Okay, we're going to bring this up again. Okay, eventually it's going to sink down and I'm actually going to move forward with it.”

Dr. Aaron Hartman: [00:47:31] Its just doing too much stuff, that's all. 

[laughter] 

[00:47:34] Let your life slow down, stop reading books and doing podcasts.

Cynthia Thurlow: [00:47:38] Yeah, exactly. 

Dr. Aaron Hartman: [00:47:39] Work on yourself a little bit. 

Cynthia Thurlow: [00:47:39] Exactly. Just scale back on everything. One thing that I think I've learned about an enormous amount of information on from you is mold and mycotoxins. And I think for a lot of people, especially people that are not part of that 25% that are just more sensitive to mold and this kind of chronic inflammatory response, let's talk about how this can show up in middle age. Again, we know there are buckets are getting filled and filled and filled, and then middle age, sometimes that bucket overflows and then it becomes problematic. But when you're working with someone and considering environmental contributors to why they're inflamed or why their hormones-- they're struggling to get their hormones properly optimized. Optimized is a better word than balance, because balance is elusive. Help us understand, we also live in a very humid part of the United States. So, mold is always in the forefront of my mind. But how has that evolution come for you as well as a clinician? 

Dr. Aaron Hartman: [00:48:37] Great question. The way I'd start it is like there's two sides to this coin. One is the chronic inflammatory response syndrome, which is the innate immune system activation, which in that world, that includes, chronic Lyme, that includes post concussive syndrome, that includes Pfiesteria, ciguatera, Red Tide, recluse spider bites, breast implant illness, vaccinosis, vaccine related. So, it's a big tent, but 80% of that tent is mold-- water damaged buildings is more appropriate term because that includes bacteria and other things. So, that's one thing. But then there's just mold toxicity that just falls into the good old fashion. We're exposed to lots of toxins and chemicals. So, there's the people who get the immune system dysfunction and then there's just getting exposed to mold like in our food system and our coffee and the grains. I just did on myself a, a fancy toxin test and had lots of mold in my urine. All my SERS markers are fine, but I'm like, “Yeah, I've been eating a lot more grains in the last couple-- [crosstalk] 

Cynthia Thurlow: [00:49:42] Peanut butter. 

Dr. Aaron Hartman: [00:49:43] Yeah, whole nuts, because [crosstalk] nuts, [Cynthia laughs] nuts in general. But the point is that, so those are two different things. And like, how's this evolved with my practice? I was brought into this kicking and screaming. When I first finished my functional training, I was like, “I'm not going to deal with those crazy Lyme patients because they are crazy, but if you were chronically ill and your brain was on fire, you would be a little crazy too, right?” And then, I'm not going to deal with mold, because the same kind of thing. And I think, Dr. Ackerley, she's a psychiatrist in Maryland. When I first did monitoring, and what brought her in this world was bipolar patients who were getting better when she treated their mold, and for her, I was like, “Oh.”

Cynthia Thurlow: [00:50:25] Wow. 

Dr. Aaron Hartman: [00:50:25] But I wasn't going to do this and so I got pulled in kicking and screaming because I started seeing like, “Well, this sounds like what I heard about in that lecture. No, I'm going to ignore it. [Cynthia laughs] And then three patients later, three patients later it sounds ah like another one. And so, I was like, “Well, let me just do the basic testing.” And it took me a couple months to realize. Is this really everywhere? Is the literature true? Maybe 23% to 25% of the population has this gene. Half the buildings in the country have some kind of water damage. If you take those numbers, this is an undisclosed epidemic. And so, I got pulled in kicking and screaming. The same thing with Lyme. I don't want to deal with this, but when I moved, came back from Florida, we got in the military, had a patient who I checked and they had positive Lyme. I'm referring to the infectious disease doctor. And I called them and they're like, “Well, we don't take referrals for this because there's no Lyme disease in central Virginia.”

Cynthia Thurlow: [00:51:28] Oh, boy.

Dr. Aaron Hartman: [00:51:28] Yes. This was 2008. So, this was a bit ago. But Lyme's been around for a long time. And so, I was like, “Well, I could just shoot.” And then the primary care, family medicine side of me, I'm like, “Well, I guess I'll have to figure it out myself” right? And I literally got pulled in this kicking and screaming. And then you start looking around, realize, like-- In the East Coast from basically central Virginia up, it's all red. And you start looking at the CDC data that there are more cases of acute not chronic and not reactivated, but acute Lyme in our country than there are breast cancer cases every year. So, this is more common than breast cancer as far as cases.

Cynthia Thurlow: [00:52:10] Right. 

Dr. Aaron Hartman: [00:52:11] Then all of a sudden, like, if you can't take care of this, you're not going to be able to take care of a lot of your patients. So I just got pulled kicking and screaming, and then the whole dysautonomia thing, I'm like, I'm not-- [Cynthia laughs] That's another rare thing, Ehlers Danlos. I'm not going to see Ehlers Danlos patients because they're way too complicated because they have chronic pain and they dislocate this and that and the other, and they get their neck slides and it compresses their spine and all of a sudden-- it’s just really super complicated. And you realize it's a spectrum. And yeah, EDS is uncommon, but if you see enough people, you see it. But hypermobility, again, maybe 20% of the population. 

[00:52:46] And something I want to say now is if you start reading, the mast cell literature, maybe 20% of the population in Germany has mast cell activation syndrome, okay. Then the gene thing here for mold, chronic inflammatory response syndrome. Then the data. And the data is interesting from kids, for adults, because it changes-- because kids get old, they get a little stiff. But 20% of kids have this. 13% of college students, they don't grow out of it. We're not looking at it, but these are all kind of the same numbers. And then there's this thing called the pentad, which is five things you always look for. And it's gut issues, autoimmune issues, dysautonomia, hypermobility, and mast cell activation syndrome. And that's called the pentad super syndrome.

[00:53:36] If you see one of those, you have to look for the other four. Then all of a sudden, it's like, “Well, oh, my gosh.” Like these complex patients and how's all these play into hormones? If you have one of these things going on and your hormones are a wreck. But you got to do this stuff. And that's where it's like the layers of the onion and so I got pulled kicking and screaming into this. And I like it. It's cool. But initially it was not like I wasn't looking for this. 

Cynthia Thurlow: [00:54:03] Yeah, well, and it's interesting. When I worked in Northern Virginia, so I worked for a large cardiology group and we saw a lot. I mean, that's the number at least at the time, number one county in our state endemic for Lyme. So, we saw a ton of Lyme, but it would show up in weird ways. Like we would have an 18-year-old in the ICU with complete heart block, which means their atria and their ventricles were not communicating, which was fixable. But we would see Bell's palsy. I mean, we just saw a lot of unusual presentations, but got to a point where we were forced to be looking at tick borne illnesses. 

[00:54:35] I think the one that I always found more concerning, which is now more popular unfortunately, is Lone star tick, because in cardiology a lot of patients you need to refer to surgery. And when you have Lone Star tick, a small percentage, I don't know what percentage, but it's a small percentage, will go on to develop a mammalian meat allergy, which listeners are like, “Why is that important?” Because there's a lot of Heparin as an example, is a drug that's derived from porcine, so it's derived from pork. So, if you have an allergy to mammals, you cannot get certain drugs. And so, we would have patients who desperately needed bypass surgery who couldn't get bypass surgery because they had this mammalian meat allergy that would send them into anaphylaxis and no one would touch them because of this.

[00:55:17] So, I look at tick, I have a healthy amount of respect for tick borne illnesses. And I think if you live in most of the East Coast as a clinician, you have to have it as part of your differential if you're talking to patients, because it is so incredibly common. But a lot of people don't get diagnosed when they have early-stage symptoms. It's oftentimes when it becomes diffuse and chronic unrelenting. I have a family member that has chronic Lyme and it has been incredibly humbling to watch their journey. 

Dr. Aaron Hartman: [00:55:47] Yeah. And it's part of the issue is the testing. The recommendation from the CDC is you do antibody dot blot test, which in half of people that are later found to have Lyme. It's negative. So, the screening test is falsely negative half the time. And people who have this like that's a horrible screening tool. So, I never use that. I'll just do a Western blot test. But then if you use a Western blot and I don't want to say lab names because I don’t want to get-- these are like big national lab names. I don't want to get in trouble. But there's a certain lab locally, there's two of them that I work with. One their Western blot testing is not that good. So, I use a different one that's even better. But that one's two of the bands were taken out when they had the Lyme vaccine. So, you might have like, it's this weird thing where that you have to have five bands and three bands IgM and it's like you roll the dice and you break the bones and look at the [unintelligible 00:56:39] [Cynthia laughs] and if you have like a high-risk band, the question isn't like why do you have that? 

[00:56:47] If it's a 41, sure that could be, your Epstein Barr or whatever reactivating or other things. But some of them like a 90, if it's positive then that means a tick bit you and had some piece of that in it. And then there's a whole thing where well, it has to be attached for 24 hours to 48 hours or you won't get it. It's like “No”, like if the tick actually was attached to another animal, was feeding, fell off, attaches to you, you get it, you can get it within some of the literature looks like maybe an hour. All right. So, really quick. And my anecdotal personal story was is I had my-- live in the country, have a little farm and covered my mouth, I'm covered from basically here to all the way down. And I was in some tall grass and so I know where I got the tick. Went to Whole Foods and I was on my T-shirt on there like four hours later and I had like a little “Oh, what was this I saw?” So, I pulled it off the next day I got a round red thing.

Cynthia Thurlow: [00:57:39] Oh really? So that's unusual. You get that typical bullseye. 

Dr. Aaron Hartman: [00:57:42] Yeah, well, so you know me, Cynthia. I'm going to do my herbs and my [unintelligible 00:57:46], astragalus and I'll do a little petunia and all kind of stuff and resveratrol. And it got bigger. So, I doubled my doses up, and it was getting bigger. So, on day three, it was like my whole arm was red.

Cynthia Thurlow: [00:57:58] Wow.

Dr. Aaron Hartman: [00:57:59] So, I was like, “Okay, let me just take some doxy.” Oh, I'm going to take some doxy. Next day, I was gone. I was like, that was erythema migrans. That was from a tick. And it was on there for maybe the longest it could possibly be was six hours. 

Cynthia Thurlow: [00:58:14] You know, it's interesting. This is probably 1994-1995. I was at a friend's house. She was getting married. We were outside in New Jersey. I got bit by, presumably, a deer tick. And I'm one of these people my entire life. I get bit by a bug. I have this exaggerated response. And so, long story short, I don't know, the following week, I'm seeing my internal medicine doc, and she looks at me, she goes, “I know you came in for something else, but I want to talk about that.” She probably saved my life. I mean, at that time, I didn't have enough of an appreciation for Lyme, but I was put on, I think, six weeks of doxy. 

Dr. Aaron Hartman: [00:58:47] Oh, nice. 

Cynthia Thurlow: [00:58:48] So, that swelter. But I always say, like, with profound appreciation. But I have to be grateful that I have been one of those people my entire life. I have these exaggerated-- which is probably part of that histamine mast cell degranulation issue. I probably been one of these people my entire life. I was like, I probably saved my bacon. Because how many people get bit, don't have that reaction, and then, it's like a year or two later, a couple years later, they develop some sequelae. And what's interesting, and I'm sure you can probably speak to this, is that the type of microorganism the spirochete that Lyme and coincidentally, syphilis transmitted same ways, actually, through saliva. transmission and sex and everything else. They're very hard to treat. They're elusive, they're smart. 

[00:59:37] And so for a lot of people, they assume that they've taken a cycle of antibiotics and that has cured them. And in many instances, it hasn't. So, if someone's listening, they've been treated for Lyme appropriately. What would be some of the common sequelae if they haven't either been on antibiotics long enough or maybe they needed a longer course of duration? What can be some of the common things that you see in clinical practice? 

Dr. Aaron Hartman: [01:00:02] Well, a lot of those things are going to be like that pentad,- [crosstalk]

Cynthia Thurlow: [01:00:04] Yep.

Dr. Aaron Hartman: [01:00:04] the stuff, autoimmune, gut issues, neuropsychiatric. Particularly, if you have things like Bartonella, you can have dysautonomia going on with it. So, you develop a lot of things. Autoimmune problems, sometimes strangely enough, you know we used to use like doxycycline, the tetracyclines back in the 70s and 80s were actually used to treat different connective tissue disorders. Rheumatism, rheumatoid before we had some other fancy medications, hydroxychloroquine, Plaquenil, which also is used for Lyme and tick borne-- [Cynthia laughs] And so the question is like were these autoimmune expressions actually just undiagnosed tick-borne illnesses. Lyme disease is like the great imitator.

Cynthia Thurlow: [01:00:51] Yeah. 

Dr. Aaron Hartman: [01:00:51] Just like tuberculosis used to be the great imitator before. Well, syphilis and tuberculosis were head in head depending on what era you're in. And now tick disease, Lyme disease is the great imitator. And to your point, it's the same. It's a spirochete like syphilis. And that was one of those things that you might notice a little ulcer. If you didn't then 30 years later you went mad- [crosstalk]

Cynthia Thurlow: [01:01:11] Yep. 

Dr. Aaron Hartman: [01:01:11] Or developed cardiac issues-

Cynthia Thurlow: [01:01:12] Syphilis. 

Dr. Aaron Hartman: [01:01:13] or had an aneurysm or whatever. And so, and it's really interesting, when I was doing my training with Dale Bredesen who's a big Alzheimer's researcher at the Buck Institute, he's written a great book about this if you have any love when you're out there with cognitive decline. But it was a small study, like maybe 20 to 30 people. But a third of the Alzheimer's patients and this is all postmortem, they're dead, had spirochetes on brain biopsies.

Cynthia Thurlow: [01:01:42] Wild. 

Aaron Hartman: [01:01:44] And that's part of his thing is like infections, certain infections can be part of someone's slow decline again, think being sucked into things I didn't want to do. In my career, I had several patients who'd have massive attacks, let's say of Lyme disease in the middle of the winter here. And one of them was actually an EDS patient, Ehlers-Danlos patient going through a very stressful relationship. This happened to her like a couple times while I was taking care of her where she had a major issue with her husband, big stress. And then she'd come in with all of these red multiple erythema migrans like all over her body and she tests positive for Lyme,-

Cynthia Thurlow: [01:02:26] Wow. 

Dr. Aaron Hartman: [01:02:26] that would respond to doxycycline and it’d go away. And then now what I know is that Lyme likes hypoxic or oxygen-independent tissue. So, it likes connective tissues like joints.

Cynthia Thurlow: [01:02:41] Yeah. 

Dr. Aaron Hartman: [01:02:41] Well, if you have people that are a little loosey goosey, that are stretchy, they don't have lymphatic issues, so they're going to have more tissue hypoxia- [crosstalk] 

Cynthia Thurlow: [01:02:48] Interesting. 

Dr. Aaron Hartman: [01:02:48] -which is just part of the pain and other issues with hypermobility. So, all of a sudden it makes sense that subset, it's going to be harder to treat their tick borne illnesses because particularly with Lyme that likes low oxygen tension tissues, they're going to have even lower oxygen tension tissues. But the point was Lyme in my mind is like Epstein Barr. It's really interesting, some of the COVID stuff, people getting COVID and this isn't the published literature, getting reactivation of Epstein Barr, CMV, as well as Borrelia burgdorferi, Lyme. And so, it was already there [laughs] to be reactivated. And so is Lyme for some people, kind of like mono, acute mono,-

Cynthia Thurlow: [01:03:28] Yeah. 

Dr. Aaron Hartman: [01:03:28] -you have the chronic and you have reactivation. Is Lyme the exact same way? And the answer is I clinically see that all the time. And there's literature to support that. 

Cynthia Thurlow: [01:03:35] It's so interesting. So, when you're in this immunocompromised state, it can reactivate latent viruses, things that have gone dormant in your body. And I find this intensely interesting, especially because I feel like in the groups that we run and programs that we do and questions that we get for the podcast, women will say, “What in the world is going on with my immune system in menopause? Why all of a sudden is my immune system taken such a hit? And we know that estrogen plays this very protective role. And with the loss of estrogen, which is a normal function of aging, if you live long enough. Do you feel like women in your practice that are taking hormone replacement therapy tend to get sick less often? 

[01:04:16] And the reason why I'm asking this is that it seems like it's this burgeoning field of trying to figure out, where do we need to replace or optimize hormones to find, where's the sweet spot that they're going to confer the most benefits? There's a lot of attention, appropriately so, to heart disease, bone protection, brain protection. But I also think now, appropriately after writing this book, how important immunity is in this stage of life, especially as we're getting older. Because I feel like there's a lot of fear mongering around immune function in general. And then you throw in the loss of hormones and it becomes this precipitous shift and change in our ability to fight off infections.

Dr. Aaron Hartman: [01:04:58] I mean, having balanced hormones is anti-inflammatory, so it's anti-inflammatory state. And as you lose those hormones, particularly estrogen, as women age, you can actually track. It's a commonly known thing in internal medicine. Your sed rate goes up as you age, your fibrinogen or your clotting goes up as you age. And so hs-CRP tends to as well which is a molecule made by your liver. It's antimicrobial peptide, actually.

Cynthia Thurlow: [01:05:28] Oh.

Dr. Aaron Hartman: [01:05:29] Yeah, CRP, it's antimicrobial peptide. So, if you see an elevated CRP, the question is, where is the inflammation? But then once you do all your magic and you treat this, that and the other and do the probiotics and look for stuff if it's not coming down, the question is there an infection somewhere? Like a root canal is not better? Like reactivation Epstein Barr, Lyme and hormones are a big part of that. Women when they have-- Just after have a baby, you see more autoimmune diseases after delivery, and I had several patients with horrible, horrible lupus. Actually, one of them had chondrocalcinosis and she actually ended up passing away from her lupus that was pretty bad early on in my career, but she felt her best when she was pregnant. Her immune system was balanced. Her lupus went into a relative remission when she was pregnant. So, we know that 100% makes sense that when you go through a change of life and your hormones come down.

[01:06:24] Now the tricky thing about is if they come down in a balanced fashion and they're all equally lower, you're not going to feel the same way as if you're estrogens having estrogen dominance. It's a relative dominance. It's not like high compared to a 20-year-old. It's like high compared to your progesterone.

Cynthia Thurlow: [01:06:39] Right. Which is in the toilet. 

Dr. Aaron Hartman: [01:06:41] Yeah, yeah, exactly. But 100% is going to affect your immune system 100%. And your arthritis, there's a type of-- multiple patients with this type of degenerative arthritis that postmenopausal women get, particularly in their hands. And it's like a rapidly progressive, over years where you'll get just almost like, what's the term for it? 

Cynthia Thurlow: [01:07:05] Contractures, when they get the ulnar drift. 

Dr. Aaron Hartman: [01:07:08] Well, we will. Those are all things related to the severe. But it's got a name for it. It's basically a rapidly progressing arthritis in the hands. Not rheumatoid, and especially prominent in women with low estrogen. So, it occurs in menopause. It's kind of like your hands version of lichen simplex chronicus, which is the thinness of your vaginal vault. And it's interesting that that's a hormone thing in postmenopausal women. But the thing is you have to know the person's tell. Some women it's going to be, I don't think as well, anxious. Some women, “I got my cold sores, Now I'm getting apthous ulcers and there's a thing called Behcet’s, which is this weird kind of thing where you get bowel pain and vaginal ulcers and potentially mouth ulcers.

Cynthia Thurlow: [01:07:53] Ouch.

Dr. Aaron Hartman: [01:07:53] I know it's. Yeah. That's another rare thing I've seen in my career because that's what happens, and hormone related, right. So, your hormones are super important, but the way I say it, they're icing on the cake. When you're 9, 10, 11, 12, living the best life, you didn't necessarily need all this stuff. You do a lot of development through it. And where were made was to kind of edge into this nurturing stage where we pass on our genes and we pass on our memes. We go into a nurturing stage for like the next generation. It's just a part of living. But with all the chemicals in the environment, which are neuroendocrine disruptors that mess up your hormones that are driving their obesogens, they drive obesity. Microplastics is all the rage right now. But it's crazy to think that, something like 60% of crowd on plaques will have microplastics in them.

Cynthia Thurlow: [01:08:44] That is terrifying. 

Dr. Aaron Hartman: [01:08:44] It's crazy. Yeah, it's crazy. Petroleum that’s what's come to the public consciousness now is the idea that food dyes in our food system are petroleum distillates, brilliant chemists can take oral and turn it into blue, green and yellow. And why do marshmallows have a blue dye in them?

Cynthia Thurlow: [01:09:06] Makes no sense. 

Dr. Aaron Hartman: [01:09:08] When we were in Italy a couple weeks ago, I was looking at stuff. I'm like, “The marshmallows here have no blue dye in them.” [Cynthia laughs] It's like, why? And all these things actually affect our hormones, affect our immune system. So, it's one of those things that hormones are important piece of it. But you have to look at all these different layers and how they all interplay. And that's fortunately, unfortunately those are individuals I work with, and you have to work through all these layers of, okay, if you're hypermobile, do we treat your sleep apnea? People that are hypermobile need more-- This is like your world, the protein world. Women going through this phase in life need more protein for lots of great reasons. If you're hypermobile, multiply it by 1.5. Like you need more.

Cynthia Thurlow: [01:09:45] I take more protein than I'm already eating, amazing. 

Dr. Aaron Hartman: [01:09:48] Well, what you need to do. And you can talk to your doctor about this some time. [Cynthia laughs] Because this will probably escape my mind whenever. But at some point in time, you go in and get a urinary organic acid done. It looks at your amino acids, and that's where you see are you getting accurate protein? And if those are still low in your urine, that means your body's holding on to them, right? Because excess stuff you pee out. And so all of a sudden, it's like, whatever you're doing is not quite enough.

Cynthia Thurlow: [01:10:13] When we're talking about nutrition, I think one of the greatest corundum’s that we're in right now is, obviously I'm known for intermittent fasting, and I share with my community that I'm doing a lot less fasting to make sure I'm getting in three meals. Because one of the things you challenged me to do is to gain 5 pounds of muscle, which is meant, wider feeding window, more food. And I've been doing that diligently for almost a year. Having said that, a lot of women struggle and probably men do as well. They really struggle to get enough protein into their diets. Because I know you talk about nutrition with your patients. Do you have any like sneaky ways you get in extra protein?

[01:10:52] We can talk to patients about larger portions, we can talk about a whey protein shake. But what are some of the things that you have found to be effective when you're talking to your patients about their protein needs? 

Dr. Aaron Hartman: [01:11:02] I'm not sure if your experience has been this experience but when my wife was doing this and she was getting accurate protein, feeling great, losing weight, doing all the things that you write your book and tell your people to do, it was hard. Like every day was counting-

Cynthia Thurlow: [01:11:18] It’s a job.

Dr. Aaron Hartman: [01:11:18] -macros and weighing stuff. And she's not a professional bodybuilder. How old's my wife now? Now 47-48.

Cynthia Thurlow: [01:11:28] A young. 

Dr. Aaron Hartman: [01:11:29] Yeah, yeah, young. They're just trying to get enough so she feels good so she loses weight, so she sleeps well and all that kind of jazz. And so, hormones of balance, you know and it's hard. And so how do you do that with food alone, which I'm a big food forward, getting all the appropriate stuff. I think the trick is supplementing with a good quality collagen and whey protein. 

[01:11:48] I think that's the trick. And because if you're using steak alone to do this, you're going to drive your cholesterol up which is not always bad. And so, I have some patients who-- one of them thinking about particular, who may be listening to this, [Cynthia laughs] who has high performance. She's actually a 50-year-old ex-gymnast. Is there ever such thing? No, [Cynthia laughs] but it's like she felt her best when she was doing a carnivore thing and she just needed lots of protein. It made her cholesterol look horrible and that was a big stressor for her. But she felt absolutely amazing. And so how do you do that without making your-- And of course if you have gut microbiome issues, lots of endotoxins or saturated fats pull that over. So, now you're going to drive up your hs-CRP and your toxins--

[01:12:38] So, it's all balancing act and checking labs for this stuff to make sure that you're not hurting people is important. That's where I think just using good quality whey protein, a good quality collagen, and the devil is in the details. They have these, how many grams per scoop are you getting? And if it's like, “Oh, that's 5 g.” I'm like, “Okay, so that's, you need at least four scoops.” So, getting a product where you can just put it in and mix it up with whatever you're drinking or your smoothie. But typically, you probably, and if you want to get acro protein, you probably need two of those scoops. 

Cynthia Thurlow: [01:13:13] That's typically what I do. It's like, I'll get 40 g of protein. And I'm like, “Okay, check the box.” And even with me being fairly sensitive to dairy, I can do whey protein a couple days a week without issues. Just a clean protein that has limited ingredients. One thing that a lot of patients share with me at this stage of life, maybe early 40s, is that they don't feel as hungry. Now I always think about like what's physiologically changing or going on that may be contributing to that. And I definitely think, this progressive loss of muscle mass, the sarcopenic issue that becomes of issue north of 40. What has clinically been some of the contributing reasons or have you seen this clinically in middle-aged people that just tell you I'm just not as hungry as I once was. I know that I need to eat enough protein, but I struggle because I don't intrinsically feel that deep hunger like my teenagers do.

Dr. Aaron Hartman: [01:14:07] Yeah, that's something I have not personally ran across a lot of because in just my clinic and the people I talk to is just different world for many reasons. As the older I get and I've studied different healing traditions, I tend to just say, “Listen to your body and trust your intuition.” If you're healthy and there's a saying in the Korean culture, it's basically, forget the Korean phrase, but you eat till you're 80% full. The assumption is with the statement you're saying that you don't have elevated CPK enzyme levels, your inflammatory markers aren't off, your nutrient status is good, you have a well-functioning GI tract and all those things. I'm going to say listen to your body. I don't see those people. [laughs] 

[01:14:53] I see the people who are like, they might not have an appetite because they have inflammation. That's part of when you have elevated cytokines. If your IL-6 is elevated, that's the average cancer patient dies from malnutrition. And so, in those patients, part of the sarcopenia and inflammation is elevated IL-6 and TNF-α. And there's people literally don't want to eat and they end up dying. They've been basically eating themselves from inside out. [unintelligible [01:15:20] metastasis and stuff like that. So, is this lack of hunger, like inflammatory condition. Again, those are the people I tend to see. And so, I'm going down these pathways of checking cytokine levels and stuff. If it's just, you're healthy, you're doing great.

[01:15:35] I know I need more protein because I read Cynthia's book and listen to Cynthia, but I feel amazing that it's like, well, I'd say listen to your body, maybe do an organic acid test, look at your urine, because if you're getting adequate protein, you should have-- the urine amino acid testing will tell you that. And then if you did a urine amino acid with organic acid, then you'd also know what your metabolism as well. That's one of those things where it gets a symptom. It can be a symptom of like, I don't need more. It could be a symptom of badness. And that's where what's their weight look like? If they're overweight, that's an issue. If they're underweight, that's an issue. And that's where-- that question, it's a lot more nuanced than, simply, well, then suck it up and eat more protein [Cynthia laughs] or listen to your body. Because it depends on the situation. But that's would be my basic thoughts.

Cynthia Thurlow: [01:16:27] No, no. And that's helpful because it gave me something to think about that I had not considered before. When people come to me and say, “I'm just not hungry.” And especially, the camp of people that have been doing OMAD for five years and it allowed them to lose 50, 60, 70 pounds.

Dr. Aaron Hartman: [01:16:40] What’s OMAD.

Cynthia Thurlow: [01:16:41] One meal a day. So, someone who's been eating one meal a day for years and years and years and suddenly they're like, “Wait a minute, I'm not hungry for more food.” So, now you're telling me I have to eat more food. And I think that is different than what you were speaking to. But certainly, I see a lot of people that have been over fasting, over exercising, not eating enough food for a long period of time. 

Dr. Aaron Hartman: [01:17:05] That's a totally different situation right there. That's helpful information. Your hunger, let's go to some dysautonomia stuff. Like basically this part of your hypothalamus controls your temperature. It controls your hormonal cycle stuff, your hunger. And so, if you've been doing a one meal a day for years, you're going to rewire your brain a little bit so it can be-- And you're doing that, the question is what's the reason? Now there's a lot of medical reasons why you might do that. Dr. Wahls, her whole thing is around that and I mean she's treated her multiple sclerosis. So that's amazing. It's certain situations, I think it comes down to like there's a diet that's amazing for everybody, that's portable for you, vegan. 

[01:17:52] There's some people that's amazing for if you're hypermobile being vegan when you need tons of protein and trace minerals, those are the people who come see me five years later and we have to work through a lot of their health issues. Carnivore is amazing for some people and that tends to help. That tends to-- hypermobile patients who've had tons of micronutrient deficiencies, a GAPS diet. Autistic kids had a kid with acute demyelinating encephalomyelitis, ADE, it's super rare thing. And basically, his mom used that diet with some things to actually help his brain to heal.

Cynthia Thurlow: [01:18:26] Incredible.

Dr. Aaron Hartman: [01:18:27] So, there's so many types of really cool diets that work in different situations. But if you're doing just one meal a day for like five years, then that is a stressor. And if you've been doing that for five years and you're cycling age, that's a high cortisol state. Maybe you just reset your midbrain and that's a bigger issue. So, probably that person I would highly recommend getting in-depth nutritional evaluation. Look at your fatty acids, look at your omega 3s, omega 6s, your long chain fatty acids, your C15, which is all included in the testing. Now, I won't say a basic, but a big fatty acid test. Looking at your amino acid levels, looking at mitochondrial function, glutathione. I would be curious if those people's glutathione levels are low.

Cynthia Thurlow: [01:19:14] Yeah, well, it makes a lot of sense and it's interesting that bio-individuality piece is really key. Like one of the things, I've learned working with you that I always gravitated towards lean protein, lean fish. And it's because the way that I'm a hyper absorber. So, no wonder why if I ate a really fatty meat, I just felt sick, nauseous, my gallbladder is healthy. And you said to me, you probably have always gravitated towards leaner meat, chicken, fish. And I was like, “Yeah.” But I didn't understand why, now I do. My body just soaks it up like a sponge. So, now you got me on Zetia and I don't do that as much anymore, which I think is certainly very helpful.

[01:19:53] One thing I'd love to do, I'm thinking this might be part of these, quick round easy to answer questions, towards the end. One food you recommend most often.

Dr. Aaron Hartman: [01:20:06] Bone broth. 

Cynthia Thurlow: [01:20:09] Bone broth. So, if someone has issues with like histamine, do you have to kind of-- [crosstalk] 

Dr. Aaron Hartman: [01:20:14] What you said, [Cynthia laughs]

Cynthia Thurlow: [01:20:16] That's where my brain went. 

Dr. Aaron Hartman: [01:20:17] You're getting tricky. You're getting tricky on me. Like just the one thing-

Cynthia Thurlow: [01:20:21] One thing, super nourishing.

Dr. Aaron Hartman: [01:20:23] -that were deficient in there. And I know you're a big fan of certain mineral supplements for your fluids and stuff. And like we have a nationwide epidemic of micronutrient deficiencies, particularly in these rare earth minerals and these trace minerals. And, how do you know it's- Think about a cow. Where do cow bones come from? Where's the calcium and milk come from? If you eat grass, you vomit. Your cats eat grass, they vomit. Your dogs eat grass, they vomit. Cows literally, take that ferment it, suck out-- And they eat 16, 18 hours a day. And they concentrate that into their structures, into their body. And then you get the ability to basically get that without eating like, I don't know how many tons of grass, right?

[01:21:12] And so, who eats organ meat anymore? We do it low fat. And now there's a whole thing with processed meat that's coming to one of the podcasts I listen to that they're talking about now, [unintelligible 01:21:34] grow meat and incubator and it's going to be the next big thing to solve world hunger. I'm like, “What kind of broth?” That's like the whole growing plants and like water with fertilizer. It's like you make green plants, but they don't have all this information from the soil and stuff. But what's the single source for a lot of stuff. It's bone broth. And it's expensive, you buy in the store. It's easy to make. And you can make it in soups. The soup, you just drink it. It's really easy. 

Cynthia Thurlow: [01:21:57] That's one way you can get some protein in your diet if you're struggling. When we talk about trace minerals, can we identify for listeners what you're specifically speaking to? Because they might be like, “Okay, I know you know, potassium, magnesium, sodium, all are very important.” What are the trace minerals?

Dr. Aaron Hartman: [01:22:11] So, there's trace minerals like zinc, manganese, copper, molybdenum, then there's rare earth minerals like lithium, strontium, barium, silica. So, there's things you need like 8,000mg a day of like potassium. There's things you need like 30mg a day of like zinc. There's things you need like 500mcg a day of like iodine. And there's things you need like picograms of-- 

Cynthia Thurlow: [01:22:39] [laughs] Really tiny. 

Dr. Aaron Hartman: [01:22:41] And then the thing about is if you don't get this stuff, you get these weird diseases, but we don't really know what it does. And that's the cool black box. I learned about this from raising cows because I wanted my cows to be healthy. And I learned that cows that are fed grain, which only has about 60 of these trace rare earth minerals in it, tend to get certain illnesses. 

Cynthia Thurlow: [01:23:04] Interesting. 

Dr. Aaron Hartman: [01:23:05] And when you take a grass-fed cow and you supplement them with kelp. And Joel Salatin is a guy who I actually learned this from. And one of the things that happens is cows that are raised organically will go blind-- they'll get eye infections and go blind.

Cynthia Thurlow: [01:23:18] Wow. 

Dr. Aaron Hartman: [01:23:18] It’s organic farm because you can't use antibiotics. You'll see blinds cows. He's like, “Oh my, that hasn't happened to me.” I was talking about this 10 years ago, so maybe 30 years at this stage. I haven't had a cow go blind in 20 years. All I do is supplement them with kelp.

Cynthia Thurlow: [01:23:33] Wow.

Dr. Aaron Hartman: [01:23:34] And that was where I was like, wait a second. Because then with goats and horses they have certain deficiencies you have to supplement with. And so, these are the things that cows get when they eat grass. And we don't know what it does for cows, but we just know they need it. 

[laughter] 

[01:23:50] Right? That's so many things, right? 

Cynthia Thurlow: [01:23:53] Herbivores, yep.

Dr. Aaron Hartman: [01:23:54] And where do humans get that stuff from? Where are you getting your lithium from? Well, maybe you're getting it from your lithium supplement or you're getting it from eating something that concentrates it for you. 

Cynthia Thurlow: [01:24:05] It's so interesting. Thank you for clarifying that because I know that'll be a question. What's one test every woman over 40 should consider. 

Dr. Aaron Hartman: [01:24:13] One test. I'm only allowed one. [Cynthia laughs] That's going to depend on the week you asked me that question. 

Cynthia Thurlow: [01:24:21] Okay, well it's-- [crosstalk]

Dr. Aaron Hartman: [01:24:21] So, today [Cynthia laughs] it's going to be fatty acid analysis. 

Cynthia Thurlow: [01:24:27] Okay. 

Dr. Aaron Hartman: [01:24:27] Which is a trick answer because it's actually 20 different things in one test.

Cynthia Thurlow: [01:24:31] And what is the test? So, I know we didn't want to talk about tests, but I'm sure we'll get asked like, what is your preferred test?

Dr. Aaron Hartman: [01:24:37] I use Genova for that.

Cynthia Thurlow: [01:24:37] Okay. 

Dr. Aaron Hartman: [01:24:38] They have a really affordable. It's like 150 bucks for a fatty--

Cynthia Thurlow: [01:24:41] So when I see you tomorrow, we're going to be ordering this test. 

Dr. Aaron Hartman: [01:24:43] Of course. [Cynthia laughs] We probably already have done it on you, to be honest with you. It's probably buried in the stuff that we overwhelmed you with.

Cynthia Thurlow: [01:24:50] Yes. And what is one thing you wish more doctors understood about inflammation in middle-aged patients?

Dr. Aaron Hartman: [01:24:58] That it's more than just a symptom that can also cause disease and don't blow it off. You asked me one thing [Cynthia laughs] that's more than just a symptom. It's just something else is going on and it can show up as a mental health issue, joint aches and pains, fatigue, brain fog, it can affect your hormones and so if you ignore it, it's like, what did I just describe? Like how many people? You know, like tons. And it could just be inflammation that can be worsened by fatty acid deficiencies, nutrient deficiencies, gut issues, your chronic infection. So, appreciating that inflammation, it’s inflammaging, it's makes you age quicker and it's more than just a symptom and don't ignore it.

Cynthia Thurlow: [01:25:52] Oh, thank you. This has been an invaluable conversation. Please let listeners know how to connect with you outside of this podcast. Information about your practice. I know you're not currently taking new patients, but you have providers in your practice that are taking patients, learn more about your work and get access to your podcast. 

Dr. Aaron Hartman: [01:26:12] Sure. Yeah. Well, my website, richmondfunctionalmedicine.com is the hub for everything. If you Google my Name, Aaron Hartman, M.D. It will take you there. I am starting actually a Precision Medicine Clinic, which is my way of trying to take everything I've talked about and just like I've done with my daughter [unintelligible 01:26:26] individuals. And that's hopefully launching here in the next couple of months. I actually have a book that's coming out called-- I actually finished my third edit of it today. So, Becky's looking at it and adding some things into it. But that's called Uncurable. It's actually my daughter's story. [crosstalk] Anyway, the healthcare system and how it changed literally my entire career, like what I'm doing. 

[01:26:48] I'm here right now because I adopted a girl that the doctors wanted to put a feeding tube into and refused to do that. And it's led to this totally different-- But if you want to learn more, the podcast is Made for Health, which is on our website, richmondfunctionalmedicine.com, YouTube channel, all the kind of things. I'm just trying to educate people about all this stuff because I feel like, if I believe what I say I believe, then 80% of chronic health issues, heart disease, [unintelligible [01:27:19] percent of cancer can be prevented by diet, lifestyle alone and people knowing that, it can literally change their health trajectory.

Cynthia Thurlow: [01:27:26] Incredible. Thank you again for your time today. 

Dr. Aaron Hartman: [01:27:28] Thanks for inviting me. 

Cynthia Thurlow: [01:27:32] If you love this podcast episode, please leave a rating and review. Subscribe and tell a friend.

Tune in