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Josh (00:17.619)
So joining us today to talk about Guts and Gynecology is a board certified OB-GYN and Ketogenic Nutrition Specialist with a background in exercise, nutrition and health sciences. And one of our mottoes is that if you don't make time for wellness, you'll eventually have to make time for sickness. Dr. Jamie Seaman, thanks so much for being here.

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Dr Jaime Seeman (00:46.679)
Thanks for having me. It's my honor.

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Josh (00:49.159)
Oh, I feel so special now. That just, I'm gonna make my ego swell so much, I'm not gonna be able to fit through the door. So appreciate that. So Jamie, there are so many things that we just don't understand about the body that aren't really shown to us. Things that were kind of, we'll say they're watered down through the health and wellness and fitness space, especially when it comes to hormones and sex hormones and gut health. And there's such a strong link to it. So.

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I'm just going to hit you with one big question right out of the gate. This big ass umbrella question. How does hormonal and gynecological health impact each other?

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Dr Jaime Seeman (01:28.742)
Well, so our hormones are part of our endocrine system. So hormones either, and they work in a loop. So these are ways that we interact with nature essentially, right? So we have nutrient sensing pathways. These are sensing nutrients that are coming into our diet, they're sensing sunlight or absence of sunlight to set our circadian rhythms. They're sensing the availability to reproduce and eat, right? Because that is how

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we as a mammalian species perpetuate for the end of time, right, is we have to pass our DNA down. So, you know, our endocrine system and hormones, how they're related to our health, back to this big, huge umbrella question, is that the way that we interact with our environment, the foods we eat, the way we sleep, the way we deal with stress, impact our hormones. They do. It's really hard because most Americans want to come into my office and they want me to run a...

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a lab panel, they want me to check their hormones and they want me to tell them exactly what's wrong. But there's so many things that are moving the dominoes. The body is very humbling, honestly, because anybody that pretends that they know everything about the human body is a complete liar. Even in medicine, it's so much more of an art than a science. But the thing that I've really learned...

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taking care of a lot of patients is that you can't mess with nature. You know, you just, you have to give the body what it needs and a lot of times it's amazing and it's resilient and it's regenerative. But unfortunately, modern day world, it is not easy to be healthy right now.

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Josh (03:08.023)
Well, it's really interesting. So I mean, there's so much in the way of even agriculturally. If we look at our food, our nutrition, the soil is so depleted, we're not letting crops die in the soil and, you know, bio decompose and start to break down and the nutrients that the soil is so depleted of nutrients and void that everything we take in is void. So I mean, one could argue that our food that we consume is like 10% as rich in nutrients as that could or should be.

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And so when you're talking about giving the body what it needs and getting back to nature, is that what you're referring to as basic nutrition? Is it balance? Is it stress? Is it earthing and grounding? Like what sort of things does the body need to have a healthy, happy hormonal profile?

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Dr Jaime Seeman (03:46.194)
Well, it's thinking about the basic requirements, you know, for human life. And we have a requirement for protein, for amino acids. So let's just talk about macronutrients and then we can get down to, you know, thinking about minerals and vitamins and things like that, which are also very important. But when I say get back to the basics, you know, our food these days is very calorically dense and very nutrient depleted. So we're eating a ton of energy, but we're not really eating what our body...

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needs to function. I mean, when you think about just basic pathways in the liver just to, you know, metabolize our own estrogen production, we need magnesium, we need B vitamins, we need all these things, and they have to come through our diet. Our body only has limited storage capacity of even fat soluble vitamins, let alone water soluble vitamins. So when we think about things like macronutrients, for instance, you know, protein amino acids are a requirement for life. There is

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Dr Jaime Seeman (04:44.686)
to sustain being alive. Now, optimal is a whole nother debate, right? If you wanna be a super hard to kill human. Fat is an essential macronutrient to stay alive. Carbohydrates, we could call them non-essential. I don't think that they shouldn't be in the diet per se, but the modern American diet is so laden in carbohydrates, which essentially our bodies could produce enough glucose substrates through, or glucose through

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Josh (04:48.856)
Mm-hmm.

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Dr Jaime Seeman (05:14.018)
protein and fat substrates. But when we think of even just macronutrients in general, we're already way off base, let alone micronutrient content of our food. But you mentioned some other things. Yes, getting back to the basics. I mean, when you think about how we evolved hundreds of years ago, we didn't have computers, we didn't have beds to sleep in, we were outside so much more, we were getting signals from nature, sun, absence of sunlight.

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Josh (05:21.283)
Mm-hmm.

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Dr Jaime Seeman (05:42.922)
we were walking barefoot, you know, now we have orthotic shoes. I mean, there's the list could go on and on and on and on and on. But the modern technologies, the modern agriculture, I mean, everything about it, these are great conveniences, but there's a cost to absolutely all of these things. And the more that we consume and use them, you know, it does have an impact on our health and it can be detrimental.

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Josh (06:10.975)
It's really interesting. I find the slow degradation. I talk to people, I specifically work mostly on Facebook is where I run most of my business. And I see people all the time posting about, well, it's all downhill from here, just turned 30, joints already hurt, my body already hurts, my PMS is so bad. And we normalize this downhill decline after 30, 40 years old. I think it's because we're so nutrient deficient. It's not optimal, right? The difference that you talk about between normal and optimal.

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It is far from being optimal, but it's considered normal. And even over here to give you an idea, I'm in Calgary, Alberta, and of course, Canadian American healthcare standards are gonna be slightly different. In each province, each state might have different levels of the use for hormones. But for an example, they used to consider a healthy normal range of TSH between 1.0 and 4.5. They've extended that now to 6.5. They've added 67%.

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to the range of what they consider normal, which tells me the normal that they're using is based on an entire population of sick people. And now we're calling this normal, you're in this range. You're healthy. What are they doing?

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Dr Jaime Seeman (07:21.758)
Well, so most lab reference ranges are created by using statistical analysis. They look at something called two standard deviations above and below the mean. So you take a population of people, let's say you survey, when you're trying to figure out what is a normal TSH, right? You just go find a thousand people and you draw a thousand people's TSH, assuming that they're all healthy, right? So

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90% of those basically will fall between the 10th and the 90th percentile. So the vast majority of them and then you have these outliers, the really low ones and the really high ones and then those are the ones that we kind of say, oh, you know, what's going on here? Is this too high? Is this too low? It's the same thing we do when we're watching babies grow in utero, for instance, right? I want the baby to between the 10th and the 90th percentile, but that is the same thing as a lab reference range. That is looking at the, you know, ethnicity of the baby because it does matter if it's Caucasian or African American or Asian because we all...

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have different growth parameters, but it's the same thing. We're just looking for that kind of 10th to 90th percentile. And if it's above or below that, then that raises some red flags. So when you think about something like TSH, you're exactly correct. If we have a really unhealthy population and we're using that to garner what is considered a normal lab reference value, is it normal? Is it pathologic or not? There are some endocrine societies that have...

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that have argued to make TSH, you know, 2.5 being the upper limit. So anything above 5, 6.5, I would be concerned as a clinician. Yeah.

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Josh (08:47.639)
Should be very concerned. It's concerning to me that they're not concerned It's wild and one things we're not looking at and this is where I really like to segue as well is We're checking TSH to say well the body doesn't have enough thyroid therefore make more the body's just saying make more We're not checking. Is it a production issue? Is it a conversion issue? Is it an iodine issue? Is it a nutrient deficiency somewhere? We're not checking to see they're not doing reverse t3 And in t4 they're not checking everything just checking

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Dr Jaime Seeman (08:51.891)
Yeah.

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Josh (09:16.527)
one lab value of TSH and that's full stop, which I think is so ass backwards, which sort of leads me into another question. As a gynecologist, working in the OBGYN space, and let me get that just so I understand my terminology here because I didn't go to medical school myself. I work with doctors. I'm not a doctor. OBGYN and gynecology. Is there a difference there? Am I getting my terms right?

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Dr Jaime Seeman (09:40.955)
Yeah, so OB-GYN stands for obstetrics and gynecology. So an obstetrician is a doctor that takes care of pregnant patients, delivers babies.

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And a gynecologist is somebody that just takes care of women and women's health, you know, related issues all the way from young girls, um, all the way up to, you know, pass the menopause and beyond.

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Josh (09:59.948)
and you're an obstetrician.

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Dr Jaime Seeman (10:01.882)
I do both. So I'm a full-fledged OBGYN. So I have an obstetrics practice. I deliver babies, do C-sections, high-risk pregnancies, supernatural, amazing natural birth, you know, pregnancies and everything in between. And then I do practice gynecology. So I take care of just like basic well-women care, you know, teenage contraception, menopausal, hormone management, urinary incontinence, heavy bleeding, everything. So.

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Josh (10:03.267)
Oh good.

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Dr Jaime Seeman (10:30.346)
And most OBGYNs in the United States practice both. And then usually as we age, we start to really dial back on obstetrics because babies are born 24 hours a day and we have really messed up circadian rhythms because babies don't, they don't obey by, you know, Monday through Friday, eight to five kind of rules. Yeah, yeah.

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Josh (10:50.331)
Stupid babies should know better. All right. Well, let's dive into something here. So we talk about briefly about hormones and gynecological health and how things are connected. In my specialty, I specialize in inflammatory bowel disease. And there's a lot of questions still because obviously I'm not at OBGYN. And so I use a lot of caution or furrow. A lot of my clients that I work with who are dealing with either they're currently pregnant or they are breastfeeding.

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I will not work with somebody because what I do is a lot of flushing and detoxing and microbiome balance. We kill off a lot of bacteria, which leaves lipopolysaccharides and toxins and all kinds. I'm not getting anybody's baby sick. I don't work with women who are pregnant or breastfeeding. Can you walk me through, when someone's dealing with a digestive issue, something that is benign will say is IBS, all the way up to a diagnosed clinical disease like IBD, so Crohn's colitis. What sort of steps will you take with them to help them improve?

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their pregnancy, their baby can come out healthy, particularly that they're on biologics and on Remicade and Humira, different things that actually alter their immune system.

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Dr Jaime Seeman (11:56.989)
Well, the interesting thing about conditions like inflammatory bowel disease, Crohn's, and ulcerative colitis is any condition that involves the immune system essentially being overactive, they actually tend to get better in pregnancy. And that's because in pregnancy, it's an immunosuppressed state. So because you are carrying

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something inside your uterus that is half not your DNA, by nature's way, it suppresses the immune system so that your body doesn't attack the pregnancy. So there's this very delicate barrier between, you know, the maternal and fetal circulation and what is allowed to cross and what is not allowed to cross. But in general in pregnancy, it is very much an immunosuppressed state.

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And then after pregnancy, after the delivery, when the immune system turns back on, this is the most common time to see really sometimes awful flares of things like ulcerative colitis, Crohn's, lupus, you know, we could name a lot of autoimmune conditions. It's a common time for women to develop autoimmune thyroiditis. And that's because in pregnancy, even though there's this delicate balance, we know that there is a small amount of what we call cell-free fetal DNA. So there is...

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portions of the baby's DNA that do circulate within the maternal bloodstream. And this is, in general, why women are more susceptible to autoimmune conditions across the lifetime. Because of this, men never get exposed to this phenomenon. But essentially, a mother has parts of her baby's DNA. Now, they're cleared pretty rapidly after birth. So I've seen things on social media that they hang out. Like, you've got your baby's DNA in you forever and ever and ever.

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But in women in particular, they do tend to get better. Now, these patients sometimes though will come into pregnancies, specifically with IBD, they can be very nutrient depleted because their gut is inflamed. And so we want that to be really well controlled prior to getting pregnant, because there are a lot of things that are required to grow a human baby. There's a lot of parts and...

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Josh (14:02.991)
course.

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Dr Jaime Seeman (14:04.074)
I tell pregnant women all the time that the body really will take whatever it needs for that baby. So the placenta and the pregnancy are really team fetus. They're not team mom. So when it comes down to the, if there's only one of something, it will take it for the baby at the cost of the mom's health. And so that's unfortunately when you're thinking about somebody that may have one, two, three more pregnancies in a lifetime, it can really take an extreme toll on this person's body.

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you know, if they're chronically nutrient depleted. The inflammatory state, like I said, is actually somewhat dampened in pregnancy. So if they were able to get pregnant, you know, amen, that's a good sign. But unfortunately, infertility is on the rise too.

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Josh (14:50.923)
Yeah, I've seen a lot of that where women are able to get pregnant or prone to losing the pregnancy. There's a lot of touch and go there as well. We've had a lot of miscarriages due to their conditions, autoimmunity, nutrient depletion, all of that. We've seen it go a lot of different ways, but even those who are able to get pregnant, carry a baby to term, deliver, and then are breastfeeding, I've seen several women over the last few months. It's really strange. I seem to get these phases of clients sort of come in phases.

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where I'll get someone coming in for the first three months. It's just people who eat like raccoons. They kind of just put whatever garbage in their mouth they can find. They eat that and that's why their bowels are a mess. We correct their food. Then the next batch tends to be people with microbial issues. So we're correcting GI maps and we're dealing with that now. Then it's auto-immunity and there's so much in between. They come and go in phases. But I've seen a fair bit lately of women coming in who are now postnatal. They're actively breastfeeding. Some upwards of two years they want to breastfeed for.

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but all their IBD symptoms had come back. I'm a fan.

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Dr Jaime Seeman (15:48.497)
That's the new recommendation. Yeah, that's the recommendation actually. Yeah. Two years and beyond even. Yeah, it's so stigmatized. Yeah, yeah, they used to say one year and then, you know, or mutually exclusive, essentially, you know, the mom or the baby at any point can decide that they're done. It's a two-way street.

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Josh (15:54.167)
So really, beyond.

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Josh (16:08.355)
Right.

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Dr Jaime Seeman (16:10.058)
But now, yeah, they're really advocating for up to two years and beyond. You know, obviously the vast majority of the nutrition is coming from solid foods once the child starts eating, but there's still incredible things that come through the breast milk that can't come through food. So you're getting a lot of, you know, immunoglobulins, which is, you know, we've never been able to replicate those in baby formula. That's why it will never be the same as breast milk. So you know, there's still, I think, some benefit.

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The other really big one, really honestly, is the microbiome. So the baby is actually born with a sterile gut. Now, I say that very loosely because nothing is sterile. We used to think that the amniotic fluid around the baby, that the placenta was sterile. They were trying to figure out what the microbiome of the placenta was, but they kept saying, well, there's no way to get the placenta out of the uterus and into this bucket to test it without.

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Josh (17:03.407)
Right.

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Dr Jaime Seeman (17:03.87)
risking contamination, right? It either comes through the vagina or it comes through a C-section incision. So certainly there's risk of contamination, but they've definitely discovered that the placenta has its own microbiome, but there's a very, in somewhat of a sense, you know, there's not a lot of bacteria in the fetal gut because the baby is just swallowing amniotic fluid during the pregnancy, it's not eating food. But then what happens is the baby starts breastfeeding.

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the pH of the baby's stomach is very low. It allows the bacteria just from the breastfeeding and the immunoglobulins to go down and populate the gut. So within a few days, now the baby's microbiome is getting established. There's a reason that babies are supposed to come through the vagina because the oropharynx is, right? It's connected to the gut. It's the inlet to the gut. And so there's a reason that we're born that way. Those bacteria populate the oropharynx, the baby's swallowing it, now they're breastfeeding and they're...

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the mom is surveying the environment. So that's how our microbiome is initially established. So in the first two years of that baby's life, why breastfeeding would be encouraged, even if the vast majority of the macro and micronutrients are coming from solid foods is for that purpose. It's for the microbiome, it's surveying the environment, the mom gets exposed to viruses and things like that. She's passing those signals and that messaging onto her young essentially.

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Josh (18:21.539)
So I would say just from having met you now for 18 minutes and 23 seconds, that you are very holistically open-minded. I notice a lot of doctors that I speak with say conventional Western medicine, very clinically trained, very pharmaceutically trained, and it's almost like the body is a machine where you can cut parts out and plug and play and it just goes back to working as it should. And they almost treat birth in a lot of places like the States where it's all insurance-based. It's like a business. It's the business of birthing. Where it's, you know,

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pump milk as quick as you can, get a C-section done, all that stuff. And it gets to be a really messy process that from the little research I understand and know because I'm not an obstetrician is that there's a lot more to it than just clinical, get the baby out, clamp the cord, cut. The guy used to be a paramedic. We were taught right away, right? If you lift the baby up, you'll lose a lot of blood, make sure you bring it down, clamp, cut, snip, pop, it's all done. But there's a lot of arguments now being made for things like oral swabbing, like a

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Dr Jaime Seeman (19:01.945)
Yeah.

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Josh (19:21.263)
the vagina into the baby's mouth to get that bacterial inoculation. There's arguments to be made for leaving the umbilical cord attached for a longer period of time. What do you make of all that?

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Dr Jaime Seeman (19:31.173)
Well,

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You know, here's the thing is that people are not healthy these days. So I'm a huge fan of natural birth. I think it's amazing and incredible to watch it happen. Unfortunately, our patient population is not healthy. And so, you know, what we would like to be just normal natural birth, these people have a lot of risk factors for a lot of major problems. And unfortunately, in the US, we have one of the highest rates of maternal mortality across the world. Yet we have.

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the greatest doctors in hospitals, right? So where's the disconnect? You're right, there is some research being looked at with the swabbing. So we actually call that vaginal seeding. So when we deliver a baby by C-section, actually taking sterile gauze and placing it in the mom's vagina, and then actually swabbing the oropharynx, the issue with that is there, you're assuming that the mom's vagina has all...

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rape bacteria in it. But sometimes you can have bad ones too. So like E. coli groupy strepsis, you know, I have taken care of patients whose babies have died from these bacteria. I mean, these are I don't want to, although I am very natural. I mean, there's I mean, nature kills people too. And so you know, that's the problem is in medicine, it's first do no harm. So we never want to do something that you know, even if it's nature's way, right? Somebody could argue, well, that baby was supposed to come through the vagina.

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Well, now we've swabbed it and it died of e coli sepsis in the nursery. You know, that's a real issue. So you know, unfortunately, yeah, you don't want to lose your medical license or get sued right for millions of dollars. And you certainly as a human, you don't want to do harm to anything, you know, or anybody else's child for sure. So you know, we have to let science kind of play out and what we do inside of a hospital, right? We can't just be running our own experiments. So

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Josh (21:03.918)
I'm not kidding, that sounds like an issue.

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Josh (21:13.615)
course.

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Dr Jaime Seeman (21:23.362)
for a while when patients would ask about vaginal seating, the hospital would allow parents to just do it on their own. That's fine, you can do it, but the nurse physically isn't gonna swap the baby or whatever. And so I try to support patients and what they wanna do. There's even companies trying to make the perfect microbial solution that we could rub on the baby if it had to be born by C-section. So hopefully science advances in that way because we are able to save some babies that otherwise would have maybe...

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died by nature. But I do agree with you that there's still a lot of an intervention that happens, unneeded intervention, and there's certainly ramifications of that too.

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Josh (22:03.983)
So in the IBD space, right, and I'll use IBD as my umbrella to all gut disease. Like I firmly believe, and I've been showing clinically anecdotally, that there's a progression from IBS to IBD. For example, someone comes in, it's like the heel of a shoe rubbing without socks on. It gets a little red, gets a little flamed, it blisters, it gets raw and it bleeds. And so we're seeing a lot of people who started with historically what sounds, again, it's anecdotal, we don't have all the paperwork, but from the history they can give us, it sounds like they've had...

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IBS that started with maybe a gallbladder got removed. They developed other stomach issues and gut issues which led to IBS which over the last 20 years has now progressed to IBD. And now we truly do have some kind of autoimmunity going on. And so we're seeing a lot of these progressions. What do you make as somebody who's coming in, who's got some gut issues, maybe they're dealing with things like Candida or E. coli or C. diff or something who is actively pregnant. What do you do with them?

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whether it's a progressive disease or an acute onset of some kind of infection, how do you help them without compromising the health of the baby?

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Dr Jaime Seeman (23:11.662)
So like I said, most people's issues actually get better in pregnancy. The GI issues that actually tend to be exacerbated is because progesterone, which is really high in pregnancy, slows gastric emptying and slows GI motility. So we tend to have a lot more transit time in the gut. So patients have a lot more issues, usually with constipation as opposed to diarrhea when it comes to symptomatology. But in pregnancy,

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I like to say we control the controllable. So, let's clean up the diet as good as we can. We obviously wanna be using therapeutics and antibiotics and things like that very sparingly, especially with the baby in utero unless it's indicated. Sleep can be disturbed in pregnancy. The airway, which also contributes to gut dysbiosis. So women who gain excessive weight in pregnancy or come into pregnancy with

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airway issues, sleep apnea of pregnancy is a real thing. And because we have particular bacteria and or a pharynx that are related to our nitric oxide pathways, these women have less nitric oxide, which is a vasodilator. They start to create problems within their placenta. It contributes to the get dysbiosis. So we have to be thinking about all the different things. So it's not just their diet, it's their airway, you know, taking a look at their teeth. Have they been to the dentist? Do they have issues that need to be resolved there?

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You know, what other stressors do they have going on? Because even just psychological and emotional stress can impact our immune system and our ability to, you know, restore gut lining and all of these things. I mean, it's like, we really just want to like focus on food because that's what we put down that tube, but there's so many other things that affect it. So it's hard in pregnancy because we're already trying to take care of the basic things, let alone all these other things. So like I said, it's so much better to.

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work on these things in the year or two prior to getting pregnant in that preconception period. But unfortunately, a lot of patients don't come see us until they get that positive pregnancy test.

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Josh (25:11.095)
It's almost a little bit too late at that point.

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Dr Jaime Seeman (25:14.154)
Yeah, well, it's never too late. It's never too late. But and the first trimester too is, yeah, the first trimester too is brutal. You know, some patients can experience, depending on HCG levels, you know, severe nausea, a lot of, you know, blood sugar dysregulation due to the 30% increase in insulin from the pancreas. So the first trimester can be brutal for some for some women. And so this is a hard time to all of a sudden start making, you know, a lot of these changes.

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Josh (25:17.067)
Right, right.

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Josh (25:41.135)
So what would you recommend? And I'd love to circle back to non-obstetrics after this. Actually, I have so many questions, Jamie. I could probably talk to you all day. I'll just buy a month of your time and just let you lecture me. So when we're dealing with, say, prenatal care, when somebody's dealing with some kind of gut disease, obviously we're getting into food, we're getting into causation. What's the minimum amount of time if somebody's dealing with any kind of inflammatory condition?

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gut disease, dysbiosis, dealing with diabetes, anything. What's the minimum amount of time in general that you would like to give someone to prepare for a pregnancy, to get their nutrients back to balance, to get the hormones re-regulating, all of that?

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Dr Jaime Seeman (26:21.454)
I mean, I think you should be feeling good for a couple of months. You know, the menstrual cycle is on average 28 days. So I think, you know, the menstrual cycle too is also a really good indicator of what's going on. You know, you want to be having a regular cycle. It's very predictable. You're feeling well. Your energy is good. I mean, I think how are you feeling and functioning is such an important thing to ask patients, you know.

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the patient will always tell you what's going on. That's one thing you learn in medical school, but sometimes we're just too tied up at our check boxes, right? Click, click, click. But I think you should be feeling good for a couple of months, you know, and your partner should be too. I mean, we can't be letting guys off the hook here because we know that, you know, epigenetics of sperm and things like that play a major role in an offspring's lifetime risk. So this is something you wanna be doing together as a couple, but I think you should really be making a valiant effort to improve

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Josh (26:55.522)
Right, right.

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Dr Jaime Seeman (27:17.47)
everything that you can control about your health about a year out from conception because you know vitamin and nutrient depletion can change really quickly okay you can't just like do good for 30 days and oh I got pregnant now I'm good right we're so addicted to these like eight week plans 12 week plans like whatever it is this is like really thinking about a lifetime because pregnancy is one thing breastfeeding is very depleting you actually need more nutrients

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in breastfeeding than you do in pregnancy.

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Josh (27:49.119)
And that is something interesting I think really gets missed. My understanding is that medical school in general has very, very little focus on nutrition. Is that something you had to go out and learn on your own, get your own designation certifications? Is it something you rely on your, we'll say, standardized medical training for?

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Dr Jaime Seeman (28:07.65)
Well, here's the deal. In physiology, I mean, you take an entire year of physiology and anatomy, and then you do a full year of pathophysiology. So you're learning the pathology. Here's what's normal. Here's what's not normal. You're definitely learning about nutrition in bits and pieces through there, as far as how nutrients and things like that relate to pathology. But there's really, you know,

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every medical school curriculum is certainly gonna be a little bit different, but there's not, it's not like you're sitting in a classroom for a full year learning about nutrition. Now my background is very different than my colleagues. I have a degree in nutrition and exercise science. So I have four years where I sat learning about nutrition and exercise science. So very different than a lot of my colleagues that studied chemistry, biochemistry, biology, you know, whatever it is. But when we get down to the real world as a practicing clinician, in most states, the

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practice of a medical doctor is not to be giving medical advice. So to expect that doctors should know everything about nutrition, I don't know if it's fair, I guess, because in most states, you're supposed to refer to a registered dietician for these types of therapies. Where the system is totally broken is that we do learn that the first treatment for most chronic diseases is lifestyle intervention.

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all day long about the DASH diet and the Mediterranean diet and lots of different dietary interventions for manipulation of lots of diseases. So I think doctors do have somewhat of an awareness, but I think there's such a disconnect in how to apply that in the real world, when you're sitting across the clinic. And so I think most states expect that those doctors refer those patients out to a dietician of some kind.

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Josh (29:58.799)
Interesting. In your experience, do you find most doctors do refer out or is it something kind of just neglect to do?

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Dr Jaime Seeman (30:05.022)
Well, I think they basically say, you know, what I've been, when patients come into my office, and they say my primary care told me I have whatever, they're usually told the name of a diet, you know, eat the dash diet, eat the Mediterranean diet, go look at the Atkins diet, look at the South Beach diet. I mean, these are all things I've heard from patients coming to my office.

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Dr Jaime Seeman (30:30.898)
or they're referred out, or they're just told to clean up their diet, they're given very like, you know, general vague advice. The problem is, is that most insurance, some insurance companies, you know, in the US, when we have, you know, we're different than Canada, like you said, a lot of times, you know, it's not covered by insurance, you have to pay cash for these types of things. And the real honest truth is the people listening to this podcast are obviously highly motivated to take control of their health. But the vast majority of the patients we see

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They don't care. They want a medicine. They want the easy ticket. And so they hear their doctor say, they know, and it's not that they, I mean, they know, most patients come in and they're like, I know I'm supposed to eat healthier. I know I'm supposed to be making better choices. I know I'm supposed to be going to bed earlier, right? But like, how do you apply it? So, you know, I feel bad for doctors, honestly, because I do think that they all went into medicine because they really truly want to help people.

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but our toolboxes really just don't have the right tools and we don't have the amount of time that we need to teach these patients. And you're talking to some people that really actually don't wanna make these changes.

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Josh (31:36.511)
It's really unfortunate. In Canada, we get, it's incredibly demoralizing. Well, in Canada, yeah, well, I believe it. I mean, you get into medicine, obviously you love this. You have a passion for this. You wanna help people. You've done, from what I can sort of math here at the top of my head, 12 years plus of school to do what you do at the level you do it. Four years in nutritional sciences, probably seven years between medical school and residency and specialization, if not eight years.

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Dr Jaime Seeman (31:38.494)
It's demoralizing, honestly. Like it's, yeah. Yeah, it's moral injury, honestly, you know?

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Josh (32:06.135)
We're talking 12 plus years on top of your own experience.

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Dr Jaime Seeman (32:08.118)
And then I did an integrative medicine fellowship. So I think it was 26 years of school. My kids were asking me what grade I was in. I said, well, I went to the 26th grade. I presented at career day and looked at these fifth graders. They were like, oh my God, she's crazy. Yeah, yeah, you are.

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Josh (32:12.379)
Hahaha

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Josh (32:16.657)
Wow.

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Josh (32:23.103)
I'm going to be stuck here this long. Yeah. There's so much. I mean, in Canada, we'll get an average of seven minutes with your doctor. Now, I'm lucky I have a great doctor. I have a nurse practitioner I know like and trust. We happen to be friends outside of it as well. So I can definitely shoot her a text and get info. But for your general population, they're getting seven minutes or less with a doctor, which is enough time to come in, hear the chief complaint, attach it to a diagnosis or a condition to attach to medication, send them on their way.

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It's a very broken system.

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Dr Jaime Seeman (32:54.571)
Well, and we have requirements. So to be paid, you know, in the United States, there are certain requirements that you must meet for a certain level of care. And what a lot of people in the US don't understand is that when you come for an annual visit, you know, your annual preventative care visit, that is literally so your doctor can go through the boxes and say, okay, did you get your mammogram? Did you get your colonoscopy? Have you had your flu shot? What's your BMI? Oh, you smoke? Okay, don't smoke.

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I mean, that is like, um, you're due for your pap smear. Let's do your pap smear. I mean, we're just saying like, here's the preventative things that we need to do for you. We haven't even gotten into the problem. So that requires an entirely different visit. Um, and so, and most patients come in with like a laundry list of like 17 things that they want to discuss and they feel really, you know, shut down by their provider, but that's how that's the business of medicine, you know, we have to.

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keep the doors open, we have to pay the nurses, we have to do this. And a lot of it is based on this. They just changed our billing system that you can now bill on time, kind of like a lawyer does essentially. But that's the problem is that the structure, it's production-based, it's procedural-based, it's production-based. That's how we make money in medicine. And, you know,

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We went to school for a really long time and hundreds of thousands of dollars of education. I'm not saying that doctors shouldn't make a good living, but at the same time, there is that disconnect between outcomes and work, right? What if doctors were paid based on how healthy their patients were? I don't know. Be interesting to think about that, right?

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Josh (34:33.707)
That is a very interesting query. It's something I never thought about, but that is a question I'd like to put on a t-shirt for sure. It's almost like, there's an old Monty Python skit where the doctors are in there and there's a pregnant woman on the table and they're just looking at the computers and the numbers and the charts and they're completely ignoring this patient sitting in front of them, just treating the numbers. And it really is sort of indicative of where medicine sort of ended up or just treating the charts and the numbers and the, you know, getting things through for insurance purposes.

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Dr Jaime Seeman (35:02.614)
Well, and where they're trying to go with it is artificial intelligence. So they're trying to make it now where you probably won't even see a doctor. You just get on your insurance company's website and do your preventative care visit. And it's artificial intelligence. The bot is going to figure out what you have and haven't done. And I mean, you won't even be speaking to humans anymore. I feel there's some job security in what I do because I'm a surgeon, so that's a perishable skill. So you know.

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AI can't do surgeries and C-sections and deliver babies and not yet. Yeah. But that's the scary thing to think about is that we go through the checkboxes at some point here, there's going to be like a non-human doing that.

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Josh (35:33.499)
Not yet.

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Wow.

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Josh (35:46.839)
Yeah, I mean, I've seen the matrix. Robots can do babies. Like, I get it. So I do have a question for you. Non-obstetrics. Go back to gynecology. A lot of women coming in dealing with dysbiosis, they got all kinds of bacterial imbalances. Whether they have something as benign as bloat, again, all the way to IBD, we'll call it the spectrum. But a lot of them will develop UTIs, yeast infections, bacterial vaginosis. What's going on, and how does the crossover work? How do we get bacteria from a closed cavity like a gut?

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Dr Jaime Seeman (35:51.636)
Yeah.

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Josh (36:16.847)
closed cavity and air quotes all the way to a uterine cavity or a vaginal cavity. What's going on?

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Dr Jaime Seeman (36:23.564)
Yeah, so the genitourinary system, so, you know, anatomically speaking, the vagina sits right between the rectum and the urethra and the bladder. So they're all right next to each other. Like I said, nothing is sterile. So certainly, you know, these things are interacting, these bacteria interacting and mixing. The vagina...

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to protect the uterus essentially has a very low pH. So these things have similar but different microbiomes, but all in all, they're pretty similar, but the bacteria in the vagina that predominate are lactobacillus type bacteria that will eat up glycogen and glucose to make lactic acid. And so the lactic acid makes the pH of the vagina very low.

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And when the pH of the vagina is low, then that keeps other pathogens and other pirates basically at bay. And when it becomes perturbed is when patients have an increased risk of pelvic infections, vaginitis, endometritis, also urinary tract infections as well. So the vagina and the bladder are very much similar. The colon and the rectum tend to have a little bit different bug profile, but.

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but they're right next to each other. And when you have inflammation inside your gut, it creates whole body inflammation. We turn on something called the NLRP3 inflammasome. And when the body is busy trying to fight a fire, it's very distracted by, you know, doing all the normal nice things. One of the best analogies I ever heard was, I had somebody on my own podcast that has, actually is a dentist, but he has done a lot of work with the oral microbiome. And

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When we think about our gut bacteria, essentially, we think of it like a cruise ship. And so all the passengers on the cruise ship are the commensal bacteria. So these are just like our bacteria that are like along for the ride. And then we have some important players like the crew. So they gotta like drive the ship, they gotta make the beds. And so they're very, very important. And then...

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Dr Jaime Seeman (38:27.438)
pirates will come on the ship. So a pirate comes on the ship and these pirates are very dangerous. They will take over the whole ship. They will eat all your food. They will steal all your money and they are really hard to get off the ship. Nobody like, nobody's coming to help you. You're like in the middle of the ocean and your boat has been taken over by pirates. And so what happens is we make ourselves susceptible to pirates. So, you know, we start leaving the doors open. We're not watching from behind. Is there a ship coming to get me, right? I mean, this is just an analogy I'm using so people can kind of picture this in their minds, but

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Josh (38:56.623)
It's a fun analogy.

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Dr Jaime Seeman (38:58.539)
But yeah, when we start putting crappy foods down into our gut, we're not taking care of our airway, we're only getting four hours of sleep a night, we're super stressed, we're not recovering from our crappy stressful job and relationships. And I mean, the list could go on and on and on. No sunlight, no vitamin D is low. Like I said, all the dominoes are connected. So that's the real issue. And that's why patients get recurrent issues.

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One thing, I know you said you want to go away from obstetrics, but thinking about infertility and recurrent pregnancy loss, so like miscarriages, it is not widely known that problems with the vaginal microbiome and the endometrial microbiome increase the risk of pregnancy loss because these bacteria, although they start in our mouth, they go down our gut, they do populate our vagina and our endometrial linings and our bladders.

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And these pirates essentially make it really hard for an embryo to implant and grow. There's particular bacteria inside our mouth, Fusobacterium piriform minus gingivalis, which causes gingivitis. It's well known these things increase the risk of not only pregnancy loss, but if you get pregnant, preeclampsia, stillbirth, preterm birth. So it's a huge deal to think about. And that's why I'm just so passionate. A year out from even thinking about getting pregnant, you got to start cleaning these things up.

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Josh (40:25.535)
There's a really interesting process that I've used to help clients get rid of UTIs because obviously as we're cleaning stuff out, we're dumping all these bacteria into the system, they're getting filtered and they're putting through the blood, they're getting into the kidneys and they're getting into the urinary tract. We're ending up with UTIs and yeast infections I see quite often from women who are trying to balance out their flora in their gut or in the process of a cleansing, either a flushing to flush their liver and detox their cells and systems. Or if we're actually...

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killing off bacteria in the gut, very prone to UTIs and yeast infections. And there's actually a product, I'm not sponsored by Metagenix, they might sponsor me after this one, it's Ultra Flora Women's. Are you familiar with that probiotic they use? And so...

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Dr Jaime Seeman (41:05.929)
Yeah, yeah, there's a handful out there that I think are decent and good.

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Josh (41:10.367)
Well, these ones like you're talking about for vaginal microbiome, they are the lactobacillus. So it's the lactobacillus rooteri, as well as a lactobacillus rhamnosus. And we'll have them do UTIs and yeast infections. Take a tampon, a little bit of coconut oil, just so it can stick. You crack open a capsule of probiotic, insert, leave it overnight, and the UTIs gone in the morning. I had a client with recurrent yeast infections, which these bacteria happen to combat yeast, two days in a row, yeast infection was gone. Didn't need antibiotics, didn't need the canestin or whatever they use.

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And it's really amazing the role bacteria play in our health as a whole.

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Dr Jaime Seeman (41:44.938)
Yep, yep. There's lots of good products out there with these two particular bacteria that you talk of. And there's even studies that show there are less rates of colonization of group B strep and E. coli in pregnancy in patients that take those probiotics too. So these are bacteria that we screen for in pregnancy and sometimes have to treat at the time of delivery. And I see my natural patients are like, oh, I don't want to be tested for it. I definitely don't want to be treated for it if I test positive for it.

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And so these things can be really good to prevent colonization with these other particular bacteria too.

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Josh (42:19.023)
I had a question in my brain and it just fell out. Things fall out of my brain late in the day. And I realized this is late for you. Whereabouts are you from? Like I'm from Alberta right now, so we're about.

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Dr Jaime Seeman (42:23.038)
I'm sorry.

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Dr Jaime Seeman (42:27.526)
Yeah, I'm in Omaha, Nebraska, so like dead center of the United States. We have, uh, we have. Yes.

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Josh (42:32.276)
So you're on central time.

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So it's almost eight o'clock for you. So we appreciate you being here this late. You understand things fall out of the brain. But yeah, there's a really neat connection between all these different things. So what sort of treatment options would you give to women dealing with bacterial issues or any kind of dysbiosis, any kind of imbalance who are looking to clean up a UTI or a yeast infection or something else? What would you give them on a natural holistic way that's gonna be non-antibiotic, it's gonna be non-pharmaceutical intervention?

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Dr Jaime Seeman (42:41.339)
Yeah.

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Dr Jaime Seeman (43:06.47)
Yeah, so the tough part is sometimes patients have had so many infections, they've had a lot of antibiotics thrown at them that the normal, you know, microbiome is not there. So first of all, if there's pirates, we have to clean out the pirates. So sometimes Western medicine treatments are indicated in particular situations. And then after we do that, then we're trying to get the cruise ship back in order. We're trying to get the passengers back doing what they want to do, get the crew back in order. So

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like you said, probiotic supplementation, lactobacillus ruderi, there's other ones that I'll sometimes use. But we also have to think about how do we, once we get those players back in there, then how do we foster an environment that will keep them flourishing? So we have to look at their diet, we have to look at other issues going on. I mean, you guys will hear me say this over and over and over again on the podcast, but do they have good oral health? Do they have...

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You know, what other things could they be using? Women's products in particular. Women are marketed feminine hygiene products in a very harmful way. You know, women are sold this story that like the vagina sterile, it shouldn't smell, it shouldn't, you should have all these products to like clean yourself up and that's like telling, you know, basically making women feel really dirty.

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And a lot of these products can be super harmful. So I've found patients, you know, using a lot of particular products that are disrupting, um, their, their vulvar vaginal, urogenital microbiome. So, um, we have to figure out why the insult happened in the first place, how to get the good guys back in there and how to keep them flourishing. Um, and there's lots of different, you know, modalities that I'll use.

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Josh (44:30.553)
Mm-hmm.

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Josh (44:54.537)
So how do you feel about stuff? And I think I have the answer, but I'd love the audience to be able to hear this for themselves about some of these feminine hygiene products they have like vaginal steamers.

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Dr Jaime Seeman (45:04.07)
Yeah, it's like, I, it's really sad, honestly, like, because I've seen a lot of these products cause a lot of harm. Unfortunately, I've, I've seen dermatitis issues, I've seen them exacerbate vaginitis issues. Yes. And then people are like, told to do steaming and things like this. Women have to be really careful. I mean, if the microbiome in the vagina is good, you don't have to do anything to it.

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But it's like we always feel like there's something wrong and that we should be doing more. So if you're not having any issues, you don't need steam in there, you don't need jade eggs, you don't need special wipes and cleansers or anything like that. It's just, it's wild, it's wild. There's a whole aisle, there's a whole freaking aisle at Target.

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Josh (45:52.567)
It is a crazy market. I mean, they call it the pink tax. I mean, women are marketed to razors and more. I had a girlfriend, I went away on vacation and came back and just didn't recognize that she happened to have these razors. I had questions because I found men's razors in her shower, but they're better and cheaper. It's the pink tax, the cute fluffy ones from Venus they just charge more money for. So what sort of products would you recommend?

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Dr Jaime Seeman (46:09.934)
their men's rises are better and cheaper.

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Josh (46:22.839)
Let's say you got 30 seconds in an elevator and you're talking to a patient and they want to have better feminine hygiene, maybe avoiding things like bleach tampons and other things. What are some of the basic hygienic healthcare products that you would recommend they can either switch from and go to or just use in general?

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Dr Jaime Seeman (46:41.258)
Yeah, I mean, for menstruating women, like the low hanging fruit is tampons and pads because most of them contain tons of chemicals. Like for instance, they put scents in them. Like who needs it scented? Like it's just, that's just chemicals. Like it's just straight chemicals. So yeah, switching to something just like plain organic tampons, pads, panty liners, completely unscented. Like there are some really good brands out there. So look for those.

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Or you can think about like menstrual cups. So there's reusable menstrual cups. You can get medical grade silicone. You can sterilize them yourself just in boiling water and you can just use it over and over and over. Great for the environment. You don't have to keep buying all the pads and tampons. So those are great options too for people. But that's, I mean, for women who are having a period every single month, that's a lot of product, you know, that you're buying. And then just completely avoid the soap and cleanser aisle. Like there's no...

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you know, if you take a shower, that's fine. Just let, you know, use a very, just like basic soap, Castile soap, like literally, you know, but the thing is, is like our skin is made to protect itself. And so sometimes we're over cleansing. Like we are, you're washing your hands too much. You're, I know I'm a doctor, you guys, if they're visibly soiled, like wash them, okay? But we're cleansing too much. Like we just are, we need to like, we need to like

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Josh (47:56.903)
Hehehehe

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Dr Jaime Seeman (48:05.238)
back off and you know women are just really marketed heavily in all of these things. You know we just we never feel like we're doing enough and really honestly we're probably doing too much.

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Josh (48:19.619)
Let's talk about a basic healthcare plan, we'll say. So as a nutritionist, some of the things that I look at are like, well, you're getting whole foods, you're getting enough of the right foods. Personally, I'm on the carnivore diet. I've never felt better. I've got a lot of bacterial issues. I'm working on like Candida, H. pylori, provatella, like bacterial overgrowth issues. So I mean, that's why I'm benefiting so greatly, but I've been in keto now for about a month. I feel great. What would you recommend though for women?

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Do you lean towards the keto detox? Do you go to Whole Foods? You look at high fiber, low fiber, carb starch. Like what is your basic plan? You would give to say the 80% average who could tolerate it for basic feminine health.

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Dr Jaime Seeman (48:59.475)
Yeah, I mean, my plans are very individualized because I have the ability to check labs and do all these things. But I think in a... Yeah. But I think in the general sense...

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Josh (49:01.944)
course.

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It was a crappy question, so I apologize in advance.

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Dr Jaime Seeman (49:10.814)
you hit it, whole foods. I've never found a patient, you know, that's like, I'm just eating, you know, all these whole foods and I'm like a total wreck, right? Now we could go down into the rabbit hole, like you said, of carnivore diet plants, like, okay, now we're eating whole foods, like now we're falling in the spectrum. But for the vast majority of patients, get everything with an ingredient list out of your diet. Start there. Once you're doing that,

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then you can start to kind of manipulate, what plants do you tolerate? Do you tolerate fiber? Do you feel better with fiber? Do you feel less fiber? I personally eat pretty low carb ketogenic, pretty low fiber, a lot of meat, like very carnivore-ish, I would describe my diet, but I don't have any gut issues that I know of really. So I'll do some berries and I'll do some plants here and there. But I think for the vast majority of people, get to a whole food diet and then start to manipulate it because we definitely all respond differently.

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We'll have different DNA, we have different epigenetics, we have different methylation pathways, like what Josh feels good doing and what I feel good doing could be two totally different things and it doesn't mean that either one of us is right or wrong.

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Josh (50:20.775)
I like that. I think there's so much black and white in the health and wellness space where it's either all carnivore or all keto or all whole foods or all vegan. And we very rarely take a step back and look at the in between. It's like we turn food into politics. You're left or you're right. You're conservative or Republican. It just, it doesn't make any sense. And so we talk about a well-rounded plan going into what you feel you need. Now, if I understand correctly, you yourself are keto based. And so, okay. And how do you find that works?

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Dr Jaime Seeman (50:35.97)
Yeah.

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Dr Jaime Seeman (50:47.254)
Yep. I'm very low carb. Yeah. So I've been I've been pretty ketogenic and or low carb since 2015. So I started out very ketogenic because I had pre diabetes and hypothyroidism. And I wanted to fix my insulin resistance. So I was ketogenic for a long time. I mean, I'm talking less than 50 carbs a day. At some points less than 3020 maybe even down to like 10 grams of carbs a day. When I was carnivore.

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Josh (50:51.244)
Yeah.

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Dr Jaime Seeman (51:16.966)
Um, in 2018 is when I went a lot more carnivore. And then in 2019, 2020 kind of started to figure out like, could I add some more back in, but I was getting to a place from a body composition standpoint. I was like the leanest I'd ever been in my life. And as a woman, like you don't want to get too lean. So I started to see my menstrual cycle shorten and then knew I was getting too lean and so I started to add a few more whole food carbs back in a few berries, maybe a sweet potato, you know, here and there.

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And now I'm still very meat based. I eat a ton of beef and eggs, salmon, wild caught salmon, shrimp, scallops. I do some dairy as well, but I do have some plants and I've kind of played with my carbs. I've gone up to like, maybe 50, 75 carbs, but by all standards, I've been low carbs since 2015. I mean, when you look at how many carbs

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we use in a meal, you know, essentially. I still think that if you're eating a whole food diet, it would be hard to be eating more than like 150 carbs a day, which is still considered very low carb. And, you know, for exercise purposes, I'm very physically active. I do a lot of exercise, do a lot of heavy weight lifting. You know, the advantage of using, I get asked this all the time, you know, like the advantage of using carbs for performance.

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The studies would suggest like in a keto adopted state, like there's really not any advantage, maybe 10 or 15 carbs at most, which is still what like 45 a day. That's not much. So yeah, by all standards, I'm very low carb.

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Josh (52:53.091)
So what do you say to, I mean a lot of people say, well just even for the basis of trying to create progesterone, especially on your period, women are going to need 50 to 80 grams of carbs a day for progesterone production. But then there's, of course, if you're in ketosis, the gluconeogenesis, and you can actually make your own glucose. Do you cycle your carbs on and off around your period? Do you leave, are you basically the same all week or all month? What does that look like for you?

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Dr Jaime Seeman (53:21.49)
Yeah, so with the different hormonal fluctuations in the menstrual cycle, we do have a change in physiology. So when we have more estrogen in the follicular phase, we've got great insulin sensitivity. This is the time to be like going harder in the gym, going for PRs. You do have more insulin sensitivity, so you could be doing more carbs during this phase. And then after ovulation, when you're luteophasing and more progesterone, the gut is slowing down, you're feeling just more bloated.

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you'd have much more blood sugar instability, but your metabolism is up a little bit. So the heating effects of progesterone do ramp up the metabolism a little bit, maybe upwards of like 200 calories maybe. But the problem is, is this is when people feel crappy and they start eating emotionally, you know, like they need chocolate because they actually need magnesium or they need, you know, and so, or they need carbs because they're sensing this blood sugar instability that's happening. So,

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you could change your eating patterns. I honestly, I have a plan what I do and I just do that every day. I don't stray from that. I just think it would be too much. I already have to make a lot of decisions during the day and I just feel like decision fatigue. So I don't change mine, but I'm very in tune with my cycle. I know when I'm follicular phase, like I just ovulated yesterday, I know when I'm coming into luteal phase.

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Josh (54:33.634)
So you don't time your food to your cycle.

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Thank you.

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Dr Jaime Seeman (54:49.246)
And I know how to be resilient to what I'm about to encounter. I know my hunger is going to be up during luteal phase. So I'm going to make sure I take my meals. I'm going to make sure I'm not searching for snacks or going through a drive-through or whatever it is. These are what women are susceptible to. I know my mood is going to be down. So I'm not going to be doing things that are extra stressful and ramping my cortisol.

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I'm going to do more recovery. I'm going to do more breath work. I'm going to do more meditation. I'm not going to do high intensity. I'm going to lower it down. The studies would say your strength is the same, but I've argued this on social media with a few of the big fitness gurus as a woman, I will tell you the rate of perceived exertion is significantly different, follicular phase to luteal phase. Um, it just feels harder, you know, like if you can do a 40 pound dumbbell shoulder press like

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Day seven versus day 21, the rate of perceived exertion is totally different. And that's okay. That's okay. I think women just need to know where they're at in their cycle, kind of track it and kind of just take note of these things. And you can kind of find some workarounds. You don't have to change it. If you feel like you feel good, then don't change it.

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Josh (56:01.291)
Yeah, you're the kind of person where if we got into an online discussion, I feel like most people are going to lose. Not many people are in grade 26. So I think we done good that way. So Jamie, no.

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Dr Jaime Seeman (56:12.205)
Well, most people just aren't in tune with their bodies. I mean, that's the thing is like a lot of them are using birth control. They're not cycling regularly. They got no clue, you know.

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Josh (56:21.131)
Yeah, their periods are all over the place. They're having two and three periods a month, all kinds of crazy stuff. So I do have one last question for you. Is there anything that we missed or anything that you'd like to still talk about or go over, any words of wisdom you'd like to give to anybody listening?

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Dr Jaime Seeman (56:39.37)
Well, I think people will remain sick and tired until they're sick and tired of being sick and tired. I mean, it's the problem that we have in our world when it comes to our quote unquote healthcare crisis is that we don't have a level of self accountability. So, you know, we can sit on this podcast for an hour and talk about how bad the American healthcare system is and how doctors don't sit in nutrition classes. But honestly, in this day and age,

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that information is available to you. So nobody should care about their health more than you. And you need to educate yourself. You need to learn, you need to read, you need to find people in your life that are healthy and that you aspire to be and do what they do. You become the people you surround yourself with. It's not, this is like a well-known phenomenon. So, all I can say is for people out there listening, you know.

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because most of them aren't my patients, is be your own best advocate. You know, figure it out, figure it out on your own. Nobody's coming to save you.

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Josh (57:45.771)
I love that. I can't honestly think of a better way to wrap up an episode than that. So Jamie, thank you so much for your time, your expertise, just being here to share all this incredible amounts of knowledge. Could not have done it without you. So thank you very much. So I'm just going to pause.

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Dr Jaime Seeman (57:59.942)
I appreciate it, Josh. Thanks, everybody.