206. Dr. Pamela Smith: The Truth About Hormone Replacement Therapy—HRT, Menopause & Cancer Risk

Hormones influence far more than reproductive health. They affect your sleep, mood, metabolism, muscle, bone health, brain function, stress response, and how you age—yet hormone health is still often reduced to a handful of numbers on a standard blood test. In this episode, I'm joined by Dr. Pamela Smith, a physician who has spent decades practicing and teaching personalized medicine, to break down what women and men need to understand about hormone replacement therapy, healthy aging, and disease prevention. We explore estrogen, progesterone, testosterone, DHEA, cortisol, thyroid hormones, insulin, and one hormone many people have never even heard of: pregnenolone. More importantly, we discuss why hormone optimization should never be one-size-fits-all. Dr. Smith explains why two people of the same age may need completely different approaches, why testing before treatment matters, and how hormones interact with everything from gut health and methylation to toxins, blood sugar, bone health, and cancer risk. In this episode, you'll learn: Why hormone replacement therapy should be personalized to the individual The roles of estrogen, progesterone, testosterone, DHEA, cortisol, thyroid, and pregnenolone What women should understand about hormones and breast cancer risk Why hormone metabolites and methylation may matter How gut health and environmental toxins can influence hormone health Why fasting insulin can reveal metabolic dysfunction before diabetes develops How stress and cortisol affect blood sugar, cholesterol, blood pressure, and bone health Why genetic and advanced testing are changing personalized and preventative medicine We also discuss PCOS, menopause, micronutrients, glutathione, environmental toxins, therapeutic plasma exchange, genetic cancer screening, exercise, and the emerging tools that may help us identify disease risk earlier. The biggest takeaway from this conversation is simple: optimal health isn't about giving everyone the same protocol. It's about understanding your individual biology, measuring what matters, and intervening before dysfunction becomes disease. Learn more about Dr. Shah: Website: drshah.com https://drshah.com Clinic: next-health.com https://www.next-health.com/ Instagram: @darshanshahmd and @extend_podcast Learn more about Dr. Pamela Smith: Website: centerforprecisionmedicine.com https://centerforprecisionmedicine.com/about-us/ Thank You to Our Sponsors! Next Health: Your destination for cutting-edge health optimization - from IV therapy and peptides to hormone balancing and TPE. Explore more at next-health.com https://www.next-health.com/ Timeline: Timeline, powered by Mitopure, just dropped in price! Check it out using the link shop.timeline.com/DRDARSHANSHAH https://shop.timeline.com/DRDARSHANSHAH for 20% off when you subscribe!

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:03Dr. Darshan Shah?

  Welcome to Extend with me, Dr. Darshan Shah, a podcast dedicated to cutting-edge science, research, tools, and protocols designed to help you extend your health span. Having become one of the youngest doctors in the country at the age of 21, and trained and board certified at the Mayo Clinic, I've accumulated three decades of practice as a board certified surgeon and longevity expert. Over that time, I've discovered that a mere 20% of health knowledge yields 80% of the results when it comes to your health span. We're living in a new era where we are creating a new healthcare system, no longer focused on disease management, but achieving optimal health and vitality. Join me as I interview world renowned experts, offering you a step by step guide to proactively avoid disease and most importantly, extend your health span.

• 0:49Dr. Darshan Shah?

  Welcome back to Extend. I'm Dr. Darshan Shah, and today I'm going to be diving deep into the world of personalized medicine, longevity, and hormones with a true OG in the space, Dr. Pamela Smith. Dr. Smith is a powerhouse clinician. She started her career as an emergency room doctor at a trauma center before transitioning into personalized and functional medicine, very similar to my story. She directs the only program of personalized medicine in the world at Morsani College of Medicine at the University of South Florida, and she runs her own thriving practice. She's a prolific author who's written 17 books on hormone health and preventing cancer, and she has a brand new release.

• 1:32Dr. Darshan Shah?

  She spent decades in Washington DC, working with the FDA, teaching thousands of practitioners how to look at the root causes rather than just symptoms. And in this episode, she's also going to share her personal journey of how she overcame her own personal medical challenges using personalized medicine. We're going to talk about the intricate hormonal symphony from estrogen and progesterone to pregnenolone and cortisol, and explain why the medical system is finally shifting back to true personalization. Let's dive right in with Dr. Smith.

• 2:10Dr. Darshan Shah?

  Dr. Smith, really honored to have you on the podcast. Thank you so much for coming out here to join me.

• 2:15Speaker 01

  Very happy to be here.

• 2:16Dr. Darshan Shah?

  Yeah, so you're one of the people that have been practicing personalized medicine for 40 years. So you're one of the people that are like, one of the OGs of this space.

• 2:27Dr. Darshan Shah?

  Thank you for, you know, being early to this movement. And, you know, a lot of your books are on hormones and preventing cancer, all the things I talk about every single day to my patients here at Next Health, and I'm excited to dive into all that with you.

• 2:41Speaker 01

  It'll be very exciting to look at, truly. I just turned 72 last week. This is my natural color of hair, and I still run around the world teaching and have my own personal practice, written 17 books, the 17th one comes out next year. My goal is everybody, everyone can do that at 72 years of age.

• 3:03Dr. Darshan Shah?

  Happy birthday to you.

• 3:04Speaker 01

  Thank you.

• 3:04Dr. Darshan Shah?

  Here, here, I am is really excited to join you on the journey of me potentially also being this healthy as you are when I'm 72. So let's start the conversation off with this. Like you said, you're 72, hormone replacement therapy and just hormones in general were not talked about for probably most of your career until just recently in traditional medicine, right? And I, I just would love to get your perspective on the journey that you've had through your practice and your career on hormone replacement therapy and kind of where, where things are now versus where they were before.

• 3:39Speaker 01

  Well, thank you for asking because it is a very interesting question. I actually started out as an ER doc at Detroit Receiving, which is a level one trauma center, and was very, very thrilled with my job. I loved every moment of it, kind of an action junkie, but one.

• 3:55Dr. Darshan Shah?

  I said the same thing, you know, like I was a trauma surgeon for many years and I loved it. It was a lot of fun, but it does wear on you.

• 4:02Speaker 01

  It does wear on you, and one day I could not sleep. And so literally, I went to 11 physicians, and they all told me the same thing. Take a sleeping pill. I thought, this is absurd. All of a sudden, I can't sleep. There must be a reason for it. A sleeping pill is not the answer. And I was very lucky. I was invited by my friend to go to the very first longevity conference in the world, and there I was, second seminar, second slide. Women without progesterone frequently have insomnia. I tested myself and I ended up having no progesterone whatsoever, went to see a compounding pharmacist, had it made

• 4:42Speaker 01

  for me, and slept like a baby in four days, and honestly have ever since. I am a power sleeper. So it has really been the answer to many things in life.

• 4:53Dr. Darshan Shah?

  That's incredible. What an incredible story. So you had a personal experience that then convinced you that hormone therapy is the solution because it addresses the root cause.

• 5:03Speaker 01

  It does. And that's what I love about this kind of medicine, because I spent about five years transitioning. But when you look at a personalized medicine approach, it is looking at the cause of the problem, not just treating symptoms. And that is where the science is today, looking at the cause.

• 5:22Dr. Darshan Shah?

  Right. So when you first started practice, it was not uncommon for women to get hormone replacement therapy, usually in pharmaceutical form, right? And compounding pharmacy, I don't know how big of a thing it was back then, but it seems to me like, you know, the pharmaceutical companies kind of squashed the, the compounding industry for years back then. So how did you source your hormones? What was the state of hormone replacement therapy back then? I'm talking about pre WHI.

• 5:50Speaker 01

  Well, it was interesting because the pharmacist at the end of my block literally was a compounder. So that's what I grew up with. And I thought honestly, all of them were compounders until I went to medical school and discovered not all pharmacists did that. So I was kind of spoiled from the perspective of a personalized medicine approach to begin with. And once though you understand that looking at the cause of the problem is not the problem, you can't go back. You can't change it. You can't relook at things anymore. So it was an easy transition to look at this kind of medicine.

• 6:27Dr. Darshan Shah?

  Yeah. You know, why do you think there's so much controversy around compounding? I know you spent a lot of time in Washington DC, you're in front of the FDA a lot. There's, you're very involved politically with what's going on with the pharmaceutical industry and compounding pharmacies and peptides and all this stuff. Like, what do you think is the answer to this political problem?

• 6:51Speaker 01

  I think the answer, and the answer to the political problem, honestly, is that we should leave the practice of medicine to physicians, because they are the people who are trained to do this. And of course, in the FDA, there are physicians, MD PhDs, et cetera, but they have different areas of expertise. And I direct the only program in personalized medicine in the world at the Morsani College of Medicine at the University of South Florida. So it's just now getting into the educational component to medical schools. But the program that I teach is for people who are already out of medical school. They're already nurse clinicians, PAs, they're already nutritionists, et cetera.

• 7:35Speaker 01

  We hasn't really quite gotten into the medical schools and schools of pharmacy yet itself. So it's really a political issue because of education. We have to educate people because who can read all the science? Not anyone can read every single article every single day. And so I think that's where the problem lies.

• 7:57Dr. Darshan Shah?

  Yeah, very well said, very well said. So when you're teaching personalized medicine to these medical practitioners, how do you kind of define what that is? Just, and just for my audience, many of them are practitioners and also patients. I think they hear this term personalized medicine, and it sounds great. Like, I want, of course, I want personalized medicine. I want the medicine personal to me. But what does that really mean to you, having taught this for so many years?

• 8:22Speaker 01

  It really does mean personalized. To give you an example, I had two people who came in to see me, and they were friends. And when they came back for their revisit, because we ordered their different studies, they came back and we evaluated them and ordered what they needed personalized for them. The first person was very, very happy. She was thrilled. She went out the door. The second one was not so happy. We rarely get a complaint, but she came up to the desk and she said, I want what my friend has. I have to have what she has, exactly what she's taking. So I took her from the front

• 9:01Speaker 01

  desk back to my office and said, no, this is a personalized approach. Apparently, I didn't do a good job explaining to you. So let's start from the beginning. And I want to explain to you why this is the amount of estrogen you need. This is the amount of progesterone. For you, you don't need testosterone because yours is normal, and you do need just a baby amount of DHEA because it's just slightly low. But that's not true of your friend. And so I gave you what you needed and you alone. In fact, there's not a single person in my practice who has the same combination of hormones. And she was just not happy. And so I gave her her money back. I said, this is a personalized medicine

• 9:46Speaker 01

  approach, literally. Every patient does have something different, and apparently that doesn't need your needs, and that's fine. But that's what we do here. And literally, that is what I'm talking about. Every single person, like they do at Next Health, they get a different approach. Some people need red light therapy. Some people need therapeutic plasma exchange. Not all people do. Some people need hormones. Some people need gut health, and maybe amino acids, fatty acids, organic acids. It truly is different for every single person.

• 10:18Dr. Darshan Shah?

  Absolutely. And so, you know, this kind of old approach where people would come into their primary care or regular, you know, medical care doctor and say, you know what? I think I'm going through perimenopause or menopause. I've been given one prescription, same dose, same, and that's it, just estrogen at this prescription. I think that's one of the main reasons that we got into trouble with hormone replacement therapy for a while, specifically around, you know, the Women's Health Initiative and the negative press around that. Could you talk about that whole kind of like, segment of history and what happened? And why we're in the place today where hormone replacement therapy is considered controversial, right? Because in our minds, I don't think it's controversial.

• 10:59Speaker 01

  Oh, it's not.

• 11:00Dr. Darshan Shah?

  It's definitely not controversial, right? But I still have doctors and patients and doctors, believe it or not, doctors, I think is controversial. And so, yeah, how do we get here?

• 11:10Speaker 01

  Well, we got here because doctors don't really have time to look at everything. So let's begin with women and look at hormones in women.

• 11:20Dr. Darshan Shah?

  Yes.

• 11:20Speaker 01

  Most people don't realize that estrogen literally has 400 functions in the body. 400. So it is taste, touch, smell, hearing, skin tone. It lowers cholesterol, blood sugar, blood pressure, and is your memory. I mean, it prevents heart disease by 50%. But if you ask a cardiologist that, they do not know that. When you look at the idea of progesterone, women have to have that to balance estrogen.

• 11:51Dr. Darshan Shah?

  Right.

• 11:51Speaker 01

  And women without progesterone can be at any age, whether it's PMS, PCOS, PMDD, perimenopause, menopause, but they can have really bad symptoms like anxiety, irritability, insomnia, mood swings, depression, heart racing, bladder problems, gut disturbances. The things that people say, oh, I'm 40 and I have all of this. But it's important to have progesterone to balance the amount of estrogen in the body.

• 12:21Dr. Darshan Shah?

  Right.

• 12:21Speaker 01

  And a lot of people will arrive at the doctor's office when they're 42 years of age, for example, they have lots of estrogen still because they're still cycling, but they don't have enough progesterone. And that was me. But those women have a dramatic increase in getting breast cancer, as do I, because I actually have breast cancer on both sides of my family. So I am the last person that you would want to have what we call estrogen dominance. A lot of estrogen, not enough progesterone for balance. And then there's testosterone. People think, oh, testosterone's great, which it is. It is not just sexual interest, which of course is important, but it's muscle mass.

• 13:06Speaker 01

  It's memory. It helps with bone structure, the strength of bone. It has all these other functions in the body. But women that are younger, a lot of them do have polycystic ovarian disease and they have high testosterone. So we have to bring that down. Some women have normal and some have low. So for low women, we do prescribe testosterone. But honestly, I didn't start testosterone until six months ago. I got to 71 years of age, not needing testosterone, because my body made its own.

• 13:42Dr. Darshan Shah?

  Right.

• 13:43Speaker 01

  And that's what I mean by personalized medicine.

• 13:45Dr. Darshan Shah?

  Absolutely.

• 13:46Speaker 01

  Otherwise, I'd say, oh, you need testosterone, you're menopausal. Not the case for me. Everybody's different. And it's not just about those hormones, which are made in the ovaries, but they do balance with the adrenal hormones, the hormones that were made in the adrenal glands above the kidneys, DHEA and cortisol, the stress hormone. So DHEA does make estrogen and testosterone. So there's this nice interplay. And it does balance cortisol, the stress hormone, which you have to have. People say, well, stress is bad. You actually have to have cortisol to live. If you don't have it, you die in a week. So the goal is you have very perfect cortisol as well.

• 14:29Speaker 01

  And people forget that thyroid has to be optimal, not just normal, because thyroid is the conductor of the hormonal symphony. And then the hormone that is truly forgotten, pregnanolone. It's so hard to say and so hard to spell, but most doctors and patients have never heard of that hormone, which is the hormone of memory. I am convinced at this point that AI is not taking over yet. Because when I say onto my little cell phone, hey, Siri, pregnanolone, she has never ever typed it right so far. What she actually types is pregnant alone.

• 15:12Speaker 01

  She does. So she still has to learn it. But pregnanolone is really important because it helps with several things, but definitely the hormone of memory. And it comes from cholesterol. And that's where I do have a lot of discussions with my colleagues, for example, cardiologists and endocrinologists, because you have to have a total cholesterol of 140 to make pregnanolone, which also makes all the other hormones we talked about, except for thyroid. And sometimes cardiologists get the total cholesterol too low so that you don't make pregnanolone. And then people come into our practice, like they do into yours, and they say, I have brain fog.

• 15:57Speaker 01

  My memory's just not as sharp. I can't remember how to spell simple words like took. And really, it's just a question that their total cholesterol got too low to make that important hormone.

• 16:09Dr. Darshan Shah?

  That's so incredible. You just gave us a full primer on all the important hormones. And to your point, like, there's, there's quite a few. There's not an infinite number, but there's quite a few. And most doctors don't have time to test all of these, to talk about how do we modify all of these, how they all balance each other out. And it's a long conversation. Why, also the why, like, why am I deficient in pregnanolone or even testosterone? Right? There's so many reasons there as well. And I think that my original question to you is like, why do we get to this place? Is because, because there was not enough time and because there was this kind of knee jerk reaction, just prescribing unopposed estrogen, I think that caused a lot of problems. Right? But to your point, we now know, and the research is very clear, that hormone replacement

• 16:53Dr. Darshan Shah?

  therapy is beneficial for most people and people should be talking about it a lot sooner.

• 16:58Speaker 01

  Well, it's interesting when you say that because my first book came out in 2003 and it was literally this thin. It was 73 pages called HRT, The Answers, because that's all we knew.

• 17:10Dr. Darshan Shah?

  Right.

• 17:10Speaker 01

  The next book on hormones came out in 2010, which was about this thick. And then sitting here is the third book that came out, which is this thick. The references are online because they don't fit.

• 17:22Dr. Darshan Shah?

  Right.

• 17:23Speaker 01

  That's how much we now know just about women's hormones, where the science is. And that's really what you do at Next Health. That's what we do in our practice is we stick to the science and really it's a personalized approach.

• 17:37Dr. Darshan Shah?

  Yeah, absolutely.

• 17:42Dr. Darshan Shah?

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• 18:25Dr. Darshan Shah?

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• 18:47Dr. Darshan Shah?

  With DHEA and pregnanolone, you could test levels of these, obviously. And there's also, you can test for metabolites in the urine as well. And so is that part of your testing program is also testing urine metabolites?

• 19:00Speaker 01

  We do.

• 19:01Dr. Darshan Shah?

  You do? Good.

• 19:02Speaker 01

  We want to look at the urine breakdown products or metabolites because they're important when it comes to an increased risk in breast cancer in women and an increased risk in prostate cancer in men, because they're really the same derivation. So when they break down, estrogen breaks down into 2, 4, and 16 hydroxy estrogen. The 2 is the good one. That's the one you want, both male and female. You need a little bit of 16 for bone structure. And yes, men can get osteoporosis. So we do look at bone structure in men as well. And then you have the 4 hydroxy estrogen. The 4 is the bad one. You don't want any of that.

• 19:43Speaker 01

  That's the one that increases the risk of breast cancer and prostate because it causes mutations in the DNA. You do need a little bit of 16 for the bone. You don't want that to be zero. Too much does increase your risk of cancer.

• 19:57Dr. Darshan Shah?

  Got it. And why do some people make a lot of 4 and cause, have an increased risk? Some people, their levels of the 4 metabolite is pretty high. Why does that happen?

• 20:07Speaker 01

  The 4 metabolite, usually the most common reason is genetics and what their genetics really say. And of course, because I have breast cancer on both sides of my family, I broke down into the 4 hydroxy. But for most people, that is what is called a methylation issue. They are poor methylaters, which is about 50% of the world. So it's not a rare thing.

• 20:29Dr. Darshan Shah?

  No.

• 20:30Speaker 01

  And I, of course, am a poor methylator. And that's really important to look at because it's not just about hormones. If you're a poor methylator, you have an increased risk in not just breast and prostate cancer, but heart disease, stroke, bone loss, cognitive decline is really big. And so you do have to be a perfect methylator. The great news is we can help every patient perfectly methylate. The science is here that all patients can be perfect methylators, which is wonderful.

• 21:03Dr. Darshan Shah?

  Yes, and I agree. And I, since you said it, you can't leave us hanging. How do you become a perfect methylator?

• 21:10Speaker 01

  It really depends on the methylation test.

• 21:13Dr. Darshan Shah?

  Right.

• 21:13Speaker 01

  Because you can do a methylation test itself, where you look at all the pathways of methylation into something called transulforation, which ends in a very important nutrient called glutathione. And then on the other side, looks at the ability to detoxify.

• 21:30Dr. Darshan Shah?

  Right.

• 21:30Speaker 01

  So we can look at that. For me, I am methotetrahydrofolate reductase. I have that one as my SNP or single nucleotide polymorphism. For people out there who've never heard those words, in other words, I inherited a gene and part of that methylation pathway that doesn't work well.

• 21:50Dr. Darshan Shah?

  Right.

• 21:50Speaker 01

  And so I need methylated vitamins, which is a CH3 group, put on B6, B12, and folate. And then it makes me methylate appropriately. So honestly, I just take a specialized B vitamin twice a day, and it fixes this problem. And I have for 37, almost 38 years.

• 22:09Dr. Darshan Shah?

  Yep, and me too, by the way. So I think you said a few very important points there. Getting tested on the methylation pathways, that's a genetic test. There's not just one gene. I know people go out there and just get the MTHFR gene checked, but there's other genes as well. If you have a defect in this pathway at all, so you want to make sure you're checking the whole pathway with your genetic test. One of the solutions is to take a methylated vitamin. And so specifically the B vitamins. And these are sometimes called activated B vitamins or methylated. But it's very important to find a high quality vitamin that is specifically methylated, because that's what's going to bypass this pathway. And then glutathione as well, because that's the other part of this is detoxification with glutathione, right? Does that summarize all of that correctly?

• 22:54Speaker 01

  It does. That's perfect.

• 22:55Dr. Darshan Shah?

  Yeah.

• 22:56Speaker 01

  And equally is important that the audience should know is the other half of the population that are normal methylators should not take methylated vitamins.

• 23:04Dr. Darshan Shah?

  Yes.

• 23:05Speaker 01

  Because they can get 18 different symptoms, and they have an increased risk in all cancers, not just hormonally related, but all cancers if they take methylated vitamins when they don't need them. Like my husband, he's a very normal methylator.

• 23:20Dr. Darshan Shah?

  Right.

• 23:20Speaker 01

  And so he doesn't need all of that. It's important that everybody be tested.

• 23:25Dr. Darshan Shah?

  That's a really great point that I actually did not, was not aware of, that if you take methylated vitamins and you are already normally methylating, it can actually increase your risk of cancers.

• 23:38Speaker 01

  Absolutely.

• 23:38Dr. Darshan Shah?

  Wow, okay. What about glutathione? Do you take glutathione? Do you take the precursors of glutathione? How do you recommend people think about glutathione as a supplement?

• 23:47Speaker 01

  Glutathione is fabulous. For one thing, you need it if you're sick. So when people had COVID, for example, our office was really full because we were giving IV glutathione to everybody. Because COVID, people who have long haul COVID, people with chronic Lyme, et cetera, have low glutathione levels. And if you have those diseases, you're better to have an IV first, and then we can give it to you by mouth. And when I first started practicing this kind of medicine, they did not have liposomal form of glutathione. So everybody had to have an IV, or it didn't work. Now we have the liposomal form. So then you can take it orally or by mouth as well.

• 24:29Speaker 01

  But it's hugely important also for people as they age. I think people don't realize that the aging process, you have a decrease in nutrients. And so, for example, when you're 50, when it's really important to look at the idea that you get depleted in coenzyme Q10, a nutrient called alpha lipoic acid, both of which you cannot eat your way into. Of course, eating right is really important. Exercise is key. And also, you get depleted in L-carnitine, which is an important nutrient as well. And there's some specialized tests you have to do to make sure you can take L-carnitine. But starting at the age of 50,

• 25:12Speaker 01

  we'd give those nutrients to everybody because they're depleted by the aging process itself. And then we double the Q10 when people get to be 70. And equally is important, and I know you do in your practice and I do in mine, is we look at medicines that people are on. The different medicines they're on all cause nutritional depletions.

• 25:34Dr. Darshan Shah?

  Right.

• 25:34Speaker 01

  And that's important to replenish those nutrients. So for example, estrogen, which we've been talking about, depletes the body of B5 and B6.

• 25:43Dr. Darshan Shah?

  Right.

• 25:44Speaker 01

  So even if people are on birth control pills, they still need to take B vitamins twice a day to replenish those nutrients. And then, of course, Q10. Most of the medicines that people take after 60 cause depletion of Q10. From metformin for blood sugar, to beta blockers, to looking at not just statin drugs, but even hydrochlorothiazide, the diuretic. All of those deplete the body of Q10.

• 26:11Dr. Darshan Shah?

  Yeah, these are all very important, especially to your point, after you turn 50, because we're just not absorbing enough. We get depleted, and then we can't make enough glutathione or any of the methylating our, our B vitamins. All of this needs to be really looked at.

• 26:26Speaker 01

  It does.

• 26:26Dr. Darshan Shah?

  Yeah. And so one of the things we do is we measure a micronutrient test on people that actually measures intracellular levels of these nutrients as well. And I think that's been really helpful to show people kind of where we can target some of our nutritional supplementation.

• 26:40Speaker 01

  Well, thank you for mentioning that. Because truly, people don't realize, they go to their doctor, and they come back to me, and they say the following. Oh, my doctor told me I'm on too many B vitamins. And I go, no, no, no, no. Your doctor measured B12 and folate, the extracellular, the outside the cell. And I'm measuring the inside the cell, the intracellular, like you are doing in your practice. We measure those as well. Because that's really the important aspect is what's inside the cell.

• 27:12Dr. Darshan Shah?

  Exactly, exactly. So going all the way back to estrogen again, and specifically estrogen metabolites that can be dangerous to women and men. Another factor that I've recently been looking into a lot or talking a lot about is gut health and how that influences this same pathway. Can you tell me your feelings on that?

• 27:29Speaker 01

  Yeah, so when people ask me, is it all about hormones? It's honestly not all about hormones, as much as I love talking about them, which you can obviously see I do. But it's also about the gut.

• 27:41Dr. Darshan Shah?

  Yeah.

• 27:41Speaker 01

  If the gut's not healthy, just simply, you're not healthy. The gut has to be optimal. And it's not just you have reflux or GERD, or maybe you have a little burning in your stomach, or you have gas. You can have extra, meaning outside the system of your gut, outside the GI tract. You can have symptoms that actually come from your gut and cause inflammation, like arthritis.

• 28:08Dr. Darshan Shah?

  Right.

• 28:08Speaker 01

  That people think, oh, my gosh, I have arthritis because of X, Y, and Z. And honestly, it's coming from their gut.

• 28:14Dr. Darshan Shah?

  Uh huh, right, right. And also specifically with hormones, because if your gut health is not optimal, you can also go down the wrong pathways through what's called your estrobolome, which is now also metabolizing and detoxifying you from these estrogen metabolites. So this is something, there's a lot of research going on now, and people are looking at how do we influence our gut bacteria or microbiome to be better detoxifiers of estrogen as well?

• 28:39Speaker 01

  Oh, and it's not just estrogen, as you mentioned.

• 28:41Dr. Darshan Shah?

  Right.

• 28:41Speaker 01

  But it's really detoxifying other things as well.

• 28:44Dr. Darshan Shah?

  That's true.

• 28:44Speaker 01

  So when you look at the idea of toxins, a lot of that has to do with the gut. Because 70% of the immune systems in the GI tract or the gut.

• 28:54Dr. Darshan Shah?

  Yes.

• 28:55Speaker 01

  Also, the gut, you make B12. So you have to have B12.

• 28:58Dr. Darshan Shah?

  That's true.

• 28:59Speaker 01

  You make serotonin, the happy neurotransmitter. 90% is made in the gut. And in the gut, you make biotin for hair and nails and other things. So the gut does all of that.

• 29:11Dr. Darshan Shah?

  Super important to really take a look at the gut as more of an organ of health and for your entire body, not just, like you said, not just GERD and reflux and stomach aches, right? So, yeah. So going back to, you know, we talk a lot about hormone replacement therapy. I think one of the reasons that many women get convinced not to do it is they're worried about their risk of breast cancer. And I know you have personal experience with this, and you've written an entire book, How to Prevent Breast Cancer, right? And so I would love to hear your feelings on breast cancer, specifically related to hormone replacement therapy, who should have it, who shouldn't have it? And what are some of the tools that you give to people in your book on prevention of breast cancer?

• 29:52Speaker 01

  There's actually 18 different things that you can do to help prevent breast cancer. So it is a very preventable disease. And one of those is methylation, which we talked about. So there are many things that you can do to prevent it. But again, only 20% is inherited. 80% is environmental. So when you ask about who should take hormones, all women should take hormones, the ones they need, at the dosages that they need, made for them and them only, unless they have had a hormonally related breast cancer or other hormonally related disease, such as uterine or ovarian cancer.

• 30:31Dr. Darshan Shah?

  Right.

• 30:31Speaker 01

  Everybody else, honestly, should take hormones when they become depleted. However, people always think when you stop cycling, you lose estrogen. That is not true. Particularly if the patient is overweight, because estrogen is stored in fat cells. They may not lose estrogen until later. My best friend died at 72. She never needed estrogen because she weighed 300 pounds. So you have to give the hormones that that patient needs. But when it comes to breast cancer, the most important hormone is progesterone. Because when we start out looking at breast cancer, most women have estrogen. They just need the progesterone for balance in the younger women.

• 31:16Speaker 01

  That's not true, however, of PCOS.

• 31:18Dr. Darshan Shah?

  Right.

• 31:19Speaker 01

  With PCOS, those women have an increased risk in breast, uterine, and ovarian cancer. And we already know that when they're diagnosed at 16 or 17 years of age. So we can probably stop those diseases altogether if we work with people when they're 16, 17, 18, 20.

• 31:39Dr. Darshan Shah?

  Yeah, that's so true. And recently, PCOS got renamed, I think to P, yeah, PMOS, which, which signifies kind of a nod to, this is really just tied to metabolic disease as well, right?

• 31:53Speaker 01

  It is. And really, what people don't realize, and that's even OB-GYNs, is two things about PCOS, besides the fact they're hormonal dysfunction, meaning imbalance of hormones. PCOS is an autoimmune disease. So with autoimmune diseases, we always do three things. One, the patient is taken off of gluten. Two, we do a gut health test.

• 32:17Dr. Darshan Shah?

  Right.

• 32:17Speaker 01

  And fix their gut, because it's always abnormal. And three, we put them on low dose naltroxone that is compounded.

• 32:24Dr. Darshan Shah?

  Yes.

• 32:25Speaker 01

  And then the third thing that I'm writing about in my book that will be coming out next year on toxins is that PCOS is actually, the etiology or cause is toxin related. When I was in medical school 50 years ago, and it's hard to believe it's been 50, but it has been 50 years, I was told I would see four cases of Stein-Leventhal, which is PCOS, PMOS, and in my life, in my entire life, I see 10 cases a week.

• 32:54Dr. Darshan Shah?

  Right.

• 32:54Speaker 01

  It is the most common hormonally related disease in women prior to menopause. So it's everywhere worldwide. We can really help these patients because they do have an increased risk in becoming diabetic as well by starting when they're young.

• 33:10Dr. Darshan Shah?

  Right, absolutely. You know, it's so stark how much things have changed in 50 years, and I think is very closely related to the massive amount of chemicals that are poured into our environment from chemical companies, from fertilizer manufacturers, from glyphosate, et cetera. And in 50 years, you went from seeing four cases a year to now pretty much like a massive part of the population of women have some level of PCOS, PMOS, right? And so it's a big problem. And to your point, removal of toxins and avoidance of toxins is so critical. It's almost like, I would say, a lifestyle thing now. It's part of lifestyle medicine, is how do you avoid toxins in your environment, in your

• 33:55Dr. Darshan Shah?

  food, in your water?

• 33:56Speaker 01

  It is, but the important thing about it is that we've known that BPAs since the 1980s were a problem. We knew that microplastics were a problem, but it's only been recently that we've been able to get those kinds of toxins out of the body with therapeutic plasma exchange.

• 34:14Dr. Darshan Shah?

  Right.

• 34:15Speaker 01

  Because before then, we did a really good job of getting rid of lead and mercury, pretty good job of cadmium. We did a decent job in getting rid of fungus and things of that nature. But when it comes to BPAs and looking at microplastics, which are what we call endocrine disruptors, they change the hormones in the body. We had a hard time getting rid of those until therapeutic plasma exchange became available for this.

• 34:41Dr. Darshan Shah?

  Is this part of like a potential recommendation now for women with PCOS?

• 34:45Speaker 01

  Oh, it is. And I'm really very familiar with TPE because A, I'm a toxicologist, so I do have a master's degree in toxicology. But we did ER in TPE many years ago. We did it before Narcan came out, because when Narcan became available, we didn't need to do TPE. But when it comes to therapeutic plasma exchange, we did it then to get rid of toxins because we had nothing else.

• 35:14Dr. Darshan Shah?

  Yeah, yeah.

• 35:15Speaker 01

  We've been doing TPE in the hospital for people with very severe disease like Parkinson's, MS, et cetera, for 30 years. But now, in the last five years, it's come about that we look at it to get rid of toxins in the body.

• 35:31Dr. Darshan Shah?

  Right, right.

• 35:31Speaker 01

  Kind of a new indication.

• 35:33Dr. Darshan Shah?

  Yeah, yeah. And I think it's, you know, using these incredible technologies that we have locked up in disease care, using them, it's almost like too much too late, right? Like, let's use these technologies earlier. They're incredibly safe, they're FDA approved, and we can prevent a lot of these problems from building up over time.

• 35:52Speaker 01

  Well, we can. And starting in about 2017, people came into our practice that we couldn't fix. We did all of these modalities that we've talked about today, but we couldn't get them healthier. And part of it is because they had mitochondrial illnesses, diseases of the engines of the body.

• 36:12Dr. Darshan Shah?

  Right.

• 36:13Speaker 01

  But the other part of it is they were too toxic to even take hormones.

• 36:18Dr. Darshan Shah?

  Yeah.

• 36:18Speaker 01

  Yes, there are actually some patients who can't even take progesterone because they're too toxic.

• 36:23Dr. Darshan Shah?

  Wow.

• 36:24Speaker 01

  So we get rid of the toxins, and then they're able to take the hormones.

• 36:28Dr. Darshan Shah?

  Yeah, yeah. It's such an incredible world we live in now. And you do an incredible job of putting it all together, all these different aspects of how we take care of patients. Really, there is, hormones almost seems to be a common ground for, or a, like a point where everything just kind of comes together, right? If we can get your hormones right, we're fixing a lot of peripheral problems around that, such as gut health, toxin buildup, et cetera. And from fixing all of this, we get better hormone levels.

• 36:57Speaker 01

  We do. And people forget that thyroid is a really big subject.

• 37:02Dr. Darshan Shah?

  Yes.

• 37:02Speaker 01

  Because it does have to be perfect. They also forget that insulin is a hormone.

• 37:08Dr. Darshan Shah?

  Yes.

• 37:08Speaker 01

  Insulin's a hormone that regulates blood sugar. That also has to be perfect. But 99% of people never even have their insulin levels measured.

• 37:18Dr. Darshan Shah?

  Yeah.

• 37:18Speaker 01

  They just have their blood sugar measured, their hemoglobin A1C, and they don't realize what their fasting insulin is. If your blood sugar is high, it is a major risk factor for all cancers, including breast cancer.

• 37:32Dr. Darshan Shah?

  Yep, absolutely. Insulin's a hormone. We measure fasting insulin level on everybody. And it's a really great indicator, years before even your hemoglobin A1C changes to tell you if you have metabolic disease or not. And so, yeah, your hormones almost seem like, if you can get those right, usually everything else is probably going pretty well for you. And if not, we need to address all of these different aspects of your biology, including your toxins, your sleep, your exercise, your nutrition, your diet, all of it.

• 38:00Speaker 01

  It does, but it does start with diet and exercise.

• 38:04Dr. Darshan Shah?

  That's true.

• 38:05Speaker 01

  And I know you guys are big on exercise. I have to confess, I hate exercise. I really don't like it. It doesn't give me the high. It does a lot of people. But I do exercise because it gets rid of toxins, it maintains memory and focus. So even if people don't like exercise, they should have an exercise program. They did a study, and it looked at dancing. I happen to love to dance.

• 38:31Dr. Darshan Shah?

  There you go.

• 38:32Speaker 01

  And dancing is excellent exercise.

• 38:35Dr. Darshan Shah?

  Yes.

• 38:35Speaker 01

  So for the people out there who are not big exercisers, pumping iron, there's other modalities of exercising that you can do that are medically sound. People should realize, though, that you do have to exercise part of the time on the ground.

• 38:50Dr. Darshan Shah?

  Right.

• 38:51Speaker 01

  If you're just doing it on a machine, then you can still have bone loss. And exercise on the ground is the one that maintains bone structure.

• 38:59Dr. Darshan Shah?

  Yes, it provides kind of that force to the bones that creates the little stress to the actual osteoblastoclast that helps you create more bone. And that's always a constant battle against being sedentary all day long, which is a huge factor in why women are getting, women and men are getting osteoporosis.

• 39:18Speaker 01

  It is, along with hormones. And you're right, it does come back, because estrogen for women maintains bone, but it doesn't build it. Progesterone builds bone, testosterone builds it, and as the strength of bone. DHEA does all of the above. But if cortisol, the stress hormone, is abnormal, most people, men and women, still break down bone. And so maintaining a healthy lifestyle for everything, including decreasing stress, is a key component to life.

• 39:51Dr. Darshan Shah?

  Yes, absolutely. Do you do stress hormone measurements, cortisol measurements, like multiple times of the day through saliva measurements?

• 39:57Speaker 01

  Absolutely. Saliva testing is key when you measure cortisol. When a patient comes to me and they said they've had their cortisol measured, if it hasn't been saliva, then they haven't had the gold standard.

• 40:08Dr. Darshan Shah?

  Right.

• 40:08Speaker 01

  Because that is the gold standard. We do like to measure it at 8:00 in the morning, about noon, 4:00 or 5:00 PM, 10:00 or 11:00 PM at night. It gives us more information about the patient.

• 40:19Dr. Darshan Shah?

  Right. And so what are you looking for when you're measuring those four time a day saliva measurements of cortisol?

• 40:25Speaker 01

  You're actually looking at cortisol, which is higher in the morning, so it should be higher when you wake up. And then it declines with age, and it declines over time as well. Cortisol's an interesting hormone, because it is tied to everything else.

• 40:41Dr. Darshan Shah?

  It is.

• 40:41Speaker 01

  So if your cortisol's not normal, too high or too low, then it drives up your cholesterol, blood sugar, and blood pressure. And that's part of the reason why some people are 35, and all of a sudden they're discovering, oh, I have high blood pressure, my blood sugar's climbing, my cholesterol's gone crazy, when they didn't have that before.

• 41:00Dr. Darshan Shah?

  Right, yeah.

• 41:04Dr. Darshan Shah?

  This episode was brought to you by Nex Health, a health optimization and longevity clinic located in Los Angeles, Manhattan, and soon to be opening in Montecito, Nashville, Miami, and many other cities in the United States and Canada. Nex Health is the Apple Store of wellness, where you can optimize your health span and lifespan using cutting-edge technology. I actually founded Nex Health eight years ago to give my patients a place to go get extensive biomarker testing done and provide them with all the tools that I use to get my health in order. The longevity circuit in Nex Health using hyperbaric oxygen, sauna, cryotherapy, and LED light is a game changer. In addition, the doctors at Nex

• 41:45Dr. Darshan Shah?

  Health measure thousands of biomarkers and put into place a longevity optimization plan using advanced tools like ozone, plasma exchange, and peptides. Go to www.nex.health to check it out.

• 42:02Dr. Darshan Shah?

  What are your favorite methods to advise patients to lower cortisol levels in the day so that the cortisol and the stress is not affecting their biology?

• 42:12Speaker 01

  Thank you for asking. I really start with stress reduction techniques. So prayer, meditation, Tai Chi, yoga, qigong, exercise, massage, breathing techniques, acupuncture, red light therapy. All of those kinds of things are great modalities to really help the body relax. It's a key component. Everybody has stress. It's really about mitigating stress.

• 42:40Dr. Darshan Shah?

  Yeah.

• 42:41Speaker 01

  It is important to take a multivitamin because the adrenal glands that make cortisol use a lot of vitamins to make it. And then we do give things like adaptogenic herbs, ashwagandha, ginseng, rhodiola. Some people need calming herbs, chamomile, lemon balm. There's a lot of things we can do fortunately to help people de-stress.

• 43:03Dr. Darshan Shah?

  Yeah. You know, I'm looking at your book in front of me, How to Prevent Breast Cancer. You said there's 12 different things you can do.

• 43:08Speaker 01

  There's 18 different things.

• 43:10Dr. Darshan Shah?

  18 things.

• 43:10Speaker 01

  Yes.

• 43:10Dr. Darshan Shah?

  I think we mentioned a lot of them just in this conversation, right?

• 43:13Speaker 01

  We did.

• 43:13Dr. Darshan Shah?

  Are there another couple of them that stand out that we did not talk about?

• 43:17Speaker 01

  When it comes to helping prevent breast cancer, if I could choose just one thing, because there are many things that you can do, as you've seen, believe it or not, it would be toxins. It would be mitigating toxins. And right behind it would be blood sugar normal. Because in my almost 50 years of practice, I've only had one patient have a perfect blood sugar at the time of diagnosis of any kind of cancer. All of them otherwise have had a blood sugar above 90. Because a perfect blood sugar, just so everybody knows, a perfect blood sugar is basically, if you're under the age of 60, is 70 to 85.

• 44:02Speaker 01

  If you're above 60, it's 70 to 90. Otherwise, above that, it's insulin resistance. A perfect hemoglobin A1C at any age is 5.4. And a perfect fasting insulin is 6.

• 44:16Dr. Darshan Shah?

  Yeah.

• 44:17Speaker 01

  I have all of those numbers, but I don't have a gene for diabetes in my family anywhere. I have ones for breast cancer, heart disease, because I'm a poor methylator. I don't have that gene pool. So my numbers have stayed at 72. I just had them done last week. They are all of those entirely perfect.

• 44:37Dr. Darshan Shah?

  That's awesome.

• 44:37Speaker 01

  So that's going to decrease my risk of breast cancer and other diseases.

• 44:40Dr. Darshan Shah?

  Right.

• 44:41Speaker 01

  That's a really important hormone to look at.

• 44:43Dr. Darshan Shah?

  Do you help people that have blood sugar abnormalities and fasting insulin levels that are high, that don't meet those perfect criteria? If they don't have a diagnosis of diabetes, which is a hemoglobin A1C above 6.5, there's a lot between 5.4 and 6.5. Do you think those people are candidates for tools like continuous glucose monitors?

• 45:02Speaker 01

  Oh, absolutely. I think it's really key to start with those people because you have a 14, 15, 20-year window.

• 45:11Dr. Darshan Shah?

  Right.

• 45:12Speaker 01

  Where those people are quote unquote, pre-diabetic, insulin resistant, whatever word you want to use, we know they're going to become diabetic.

• 45:21Dr. Darshan Shah?

  Right.

• 45:21Speaker 01

  And we actually can stop that. In fact, an interesting study came out last year showing that if someone inherits a gene for diabetes and you do everything you need to do, exercise, eat right, take nutrients, hormones are balanced, and you do all that before the age of 25, and you continue to do it, you do not have to turn on the gene. That patient will never become diabetic.

• 45:46Dr. Darshan Shah?

  Wow.

• 45:46Speaker 01

  If you actually work with them when they're younger. I think we have a really big market that we miss in the pre-diabetic age that we have because most people don't say, hey, you're 37, your blood sugar's 95, that's a problem.

• 46:00Dr. Darshan Shah?

  Right.

• 46:01Speaker 01

  Because it is a problem.

• 46:02Dr. Darshan Shah?

  It is a problem, absolutely. Yeah, we check people very early. In fact, you know, sometimes someone will come in here 25, 26, and we still do our standard, what we call our baseline blood panel. And it has a fasting insulin, fasting blood glucose, and a hemoglobin A1C. And even in people in their 20s, sometimes we're seeing elevations in fasting insulin that are concerning. But we always say, thank God we caught it now because this does not need to turn into diabetes 10, 20 years from now.

• 46:27Speaker 01

  No, it does not. And that's what I love about this kind of medicine is that we look at that person and it's optimization of the numbers. It's not just high, it's normal. So let's give an example. Hemoglobin A1C, when I started practicing, perfect was 6.4. Then it went to 6.

• 46:47Dr. Darshan Shah?

  Yeah.

• 46:48Speaker 01

  Then it went to 5.7 now, and then optimal is 5.4.

• 46:52Dr. Darshan Shah?

  Right.

• 46:52Speaker 01

  So even the basic labs have changed over time in looking at the idea of what perfection is.

• 46:57Dr. Darshan Shah?

  Yeah. And we know it's, in your words, perfect because those are the people that have a very, very low risk of getting diabetes in the future, right? And so that's how, that's how looking at these numbers, 5.4 is very protective, whereas even 5.7 now is considered pre-diabetes. So you just have to aim for perfection or optimal, I think is the key message there. You know, one of the things I talk about also about this type of medicine is there is preventative medicine. We know preventative medicine exists, but this type of medicine is hyper preventative.

• 47:28Speaker 01

  Yes.

• 47:29Dr. Darshan Shah?

  Right? So we are checking way early. We're using tools and technology to make sure we detect any type of disease decades before it becomes a problem. I always say, you know, if you're going to get cancer, cancer's biggest enemy is being diagnosed as stage one, when it's still curable, rather than for many cancers, or you can at least talk about cure rates, whereas waiting for stage three or four and symptoms to develop before you look for diagnoses, now you're talking five-year survival rates, right? And so I think one of the things I really am looking forward to is this whole new world of diagnostics around cancer. And now we're changing our mindset there. Even with tools like AI being used for looking at mammograms, for example, how do you feel

• 48:13Dr. Darshan Shah?

  about the diagnostics for cancer that are coming on the horizon?

• 48:17Speaker 01

  All these diagnostics are great. Because now in oncology, our therapies really are very much related to your genomes, what your genes are. Taylor makes the therapy that you do, and they call that precision medicine in oncology. But we even do that when it's related to the heart. You can do genomics of the heart. And for example, you can have a gene for AFib. You, on the genomic test, if you have high blood pressure, we'll do that test to determine what medicine you need. Even if I'm going to give you a medicine, it's commonly on the gene, which one is going to work for you.

• 48:56Dr. Darshan Shah?

  Yes.

• 48:56Speaker 01

  And so we will actually use the genomics in traditional medicine, quote unquote, because we're giving a medication, we'll use their genomics to determine what they need entirely based on who they are themselves.

• 49:09Dr. Darshan Shah?

  Yep. We do this genetics test called the INVATE test, which, do you use that one as well?

• 49:15Speaker 01

  Yeah.

• 49:15Dr. Darshan Shah?

  It gives you many different cancer gene genomics, and it's been very useful because not only does it like tell you what you're a risk for, but it also gives people a little bit of a sense of comfort not knowing if they have like a mother and a grandmother that have had breast cancer, for example, they don't have the BRCA gene, right? And so I think there's some comfort that comes from it. But also, you know, we've seen quite a few people with the BRCA gene that we refer to the oncologist because now we know we need to be looking more carefully.

• 49:45Speaker 01

  Absolutely. And that is where the personalized medicine approach comes in because I want that patient to go to oncology. But is that patient a candidate for hormones? Someone with a broken gene actually is a candidate for hormones, done correctly. The trouble is, a lot of practitioners just give hormones.

• 50:04Dr. Darshan Shah?

  Yeah.

• 50:04Speaker 01

  They just say, hi, here's hormones. It's just like birth control pills, they're hormones too. And everybody should have hormones. But that's not the case. It really is testing beforehand and continuously testing to make sure that person has what we call a physiological dose. So it's kind of interesting what I do when I teach. I actually have asked the same question for 37 years on four continents to practitioners. How much estradiol does a woman make preludially when she's at the peak of health of 25?

• 50:39Dr. Darshan Shah?

  Hmm.

• 50:40Speaker 01

  Do you know what? No one's ever been able to answer that question, ever, in all these years. So if you don't know how much she's supposed to make when she's healthy, how do you know how much to give?

• 50:50Dr. Darshan Shah?

  Right.

• 50:50Speaker 01

  And so I think we do women a disservice and men a disservice when we give hormones and it's not a specialty area like you and I do where we really concentrate on hormonal therapy.

• 51:03Dr. Darshan Shah?

  Right, right. And to that point as well, I think a lot of people don't realize that their level of estradiol or testosterone production is different than other people's, right? And so you also want to get measured early so you know, at an early age, where were you when you were feeling your best, right?

• 51:21Speaker 01

  The perfect thing for a man would be to measure at 25.

• 51:24Dr. Darshan Shah?

  Exactly.

• 51:25Speaker 01

  Because there's a wide therapeutic range when it comes to a male. I mean, his testosterone could be normal at 400 or could be normal at 1400. So what is his normal? So yes, if I had a choice, would I measure everybody at 25? Yes.

• 51:40Dr. Darshan Shah?

  Yeah.

• 51:40Speaker 01

  But as you and I both know, we don't give testosterone to men who are younger.

• 51:45Dr. Darshan Shah?

  Sure.

• 51:45Speaker 01

  We have different techniques instead, which will raise their testosterone if it's low.

• 51:50Dr. Darshan Shah?

  Right, right, absolutely. Well, this has been an incredible conversation. It's like a grand tour of the hormones of our body and how we can affect them, how we can make them more normalized, and how they affect our cancer risk. And I really appreciate you taking us through some of your knowledge. I mean, you're so clear, and I think you brought up some topics that we've never talked about in this podcast, like pregnenolone and the importance of it, also testing urine metabolites. You talk about it a couple of times, but you've really cleared it up. And genetic testing as well. So I really thank you for making this appearance on Extend, and can't wait to have you back to really, really dive deeply into your next book, which is on toxins.

• 52:29Speaker 01

  Oh, perfect. Thank you so much. It's been a pleasure being here.

• 52:33Dr. Darshan Shah?

  Thank you. Where can people learn more from you on social media? And also, how can they, do you have a website and can they find your books?

• 52:40Speaker 01

  Of course. Actually, the best place to get my books is honestly on Amazon.

• 52:44Dr. Darshan Shah?

  Yeah.

• 52:45Speaker 01

  It's just the easiest and best to do, and it comes the next day, which is fabulous.

• 52:50Dr. Darshan Shah?

  Yes.

• 52:50Speaker 01

  And you can always reach me at www p precision medicine consultants.net.

• 52:55Dr. Darshan Shah?

  Thank you. Thank you so much for listening to the podcast today. Please remember to subscribe if you liked this episode and give us a good review and share a link with your friends. It really helps to support all of our efforts. I also want to remind you that the information shared on this podcast is for educational purposes only and is not intended to replace professional medical advice, diagnosis, or treatment. Please consult with your healthcare provider or physician before making any decisions or taking any action based on what you hear today, especially if you have any underlying health conditions or on any medications. Your doctor knows your personal health situation the best, and it's always important to seek their guidance.