E133: The Foundations of Health with Dr. Gregory Plotnikoff

Episode 133 April 25, 2023 00:39:13
E133: The Foundations of Health with Dr. Gregory Plotnikoff
The POTScast
E133: The Foundations of Health with Dr. Gregory Plotnikoff

Apr 25 2023 | 00:39:13


Hosted By

Cathy Pederson Jill Brook

Show Notes

Dr. Plotnikoff practices holistic medicine, and thinks deeply about the role of healthcare for patients. He shares his views on honoring patients, considering alternative explanations, and the foundations necessary for good health in this episode.

You can read the transcript for this episode here: https://tinyurl.com/potscast133

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Episode Transcript

Dr. Greg Plotnikoff [00:00:00] Jill Brook: Hello, fellow POTS patients and super people who care about POTS patients. I'm Jill Brook, your horizontal host, and today our guest is a physician whom I admire so much for his breadth of knowledge, his deep thinking, and his commitment to scouring the research for ways to help complex patients like us. Whenever he has a new publication or video out, it is always something I rush to because it's always something incredibly valuable. Dr. Gregory Plotnikoff is the founder and medical director of Minnesota Personalized Medicine. He is a board certified internist and pediatrician. He has received international awards for medical research and teaching. The Minnesota Press has called him one of Minnesota's best Brains, and he has a really interesting background. Before getting his medical degree, he earned a degree from Harvard Divinity School. He helped establish the Center for Spirituality and Healing at the University of Minnesota, where he served as its first medical .Director. For six years he served as an associate professor at Keo University School of Medicine in Japan, where he studied, researched, and taught in Japanese, the Campo Herbal Medicine tradition. While in Japan, he was active in East-West medical integration issues with the Japanese Society of Oriental Medicine, National Geographic, and the World Health Organization. How cool of a background is this? Dr. Plotnikoff is a highly cited author. He's a published expert on things like vitamin D, the gut microbiome, IBS, and so much more. Dr. Plotnikoff, thank you for joining us today. [00:01:47] Dr. Plotnikoff: Thank you so very much. It's a great honor to be here and and I'm looking forward to fun in our dialogue today. [00:01:55] Jill Brook: Yay. Wonderful. I'm wondering, first if you could talk more about how you have written that you went to divinity school before medical school to better understand human suffering. Okay. So maybe not the fun topic that we're gonna get to, but can you talk about what made you decide to do that? [00:02:14] Dr. Plotnikoff: Well, it was very conscious decision to postpone and the reason came from having been a hospice volunteer during college and I got to work with great nurses and chaplains and it really sensitized me, oh, there were so many dimensions of what it means to be human. And if I want to be meaningfully helpful for people, medical school may not necessarily fulfill all of that, and I really want to study world cultures and religions, medical ethics but most importantly, pastoral care. I want to train as a hospital chaplain and really understand how I can connect and be meaningfully helpful to people who are in the midst of suffering and then start medical. [00:03:06] Jill Brook: That's so interesting and I know that one other thing that you have spoken about is fast and slow medicine. Do you mind talking about what that means and does that stem from what you're talking about trying to be most helpful to patients? [00:03:22] Dr. Plotnikoff: Oh yes, there is this logical connection because I think everyone recognizes time pressured health professionals. Constipation, throat, chest pain, pressure, discomfort. Yes. No. Yes. Who needs to foster or nourish a history? Instead we take a history. And I don't believe in forced transfer of ownership of someone's story. But I do like co- creating a narrative or story and putting things together and fostering the environment where an aha moment can happen and where people can make connections and see the things and very different than taking, it's really fostering or nourishing. And of course that requires time, and yet as I imagine so many listeners have experienced it's hard to get to an aha moment with someone under heavy time pressure. I guess I should say here's a bit of a particular bias I have. I think the worst term ever created on this planet was primary care provider. The reason I say that is primary care is what we do for ourselves, and I don't believe in giving that away to others. Second thing is provider sounds like is a one way transaction. And , I have T-Mobile or AT&T or Sprint or providers. I have no relationship with them outside of a financial transaction and they don't care one bit about me And so the idea of using the same term for people who have dedicated a lot of time and attention become a health professional, whether it's speech therapist or a physical therapist or pharmacist, or a nurse or a doctor or chiropractor, whoever, it's demeaning and it undermines this very important notion is that healing occurs in relationship. And a provider is a one way relationship. , I go in and I get my flu shot. Okay. But maybe that's a provider. But I go in and I have a concern that is important, maybe even shameful. It's like, I don't wanna see a provider. I wanna see someone in a relationship. And so honoring the fact that there's a profound difference between curing and healing is actually really important. And healing is something that requires relationship and requires time. And we have a focus now on a very fast provision of algorithm based treatments that are health, professional, dependent which can disempower people. I guess this is just another bit of language I feel really strongly about. And our clinic, we never use the word help, so people are forbidden to ask the question, how can I help you? Our focus is on how can I be most helpful? And maybe you can recognize there's a big difference in the power between how can I help you and how can I be most helpful? And we're a clinic that is dedicated to be meaningfully helpful. That is again, focusing on empowerment rather than disempowerment. It's reflection is different than the the quick fast medicine that so many people are so painfully familiar with. But the idea is there's actually true healing and we can cure a heart attack, so to speak, but to heal a broken heart isn't done in five minutes and it's not done by a stranger under most circumstances. [00:07:10] Jill Brook: That's why I love hearing you speak because you are so thoughtful about some of these things that I think most people never think about, and that's reflected in the team that you have created at your medical practice. Can you talk about who all you have involved in a patient's care? [00:07:32] Dr. Plotnikoff: Well, everyone in our clinic no matter what role they play is part of it. We consider ourselves a healing team. And that's very intentional. And part of our at least twice weekly ritual that we do where we gather in a circle, meaning we set forth our intentions. And I brought back a special handmade ball from Japan that has a particularly deep resonance, just boom and has this heartbeat as it resonates. Which is so cool. And we gather around it. Pre covid, patients would be more likely to be in the office. This, we include them in the circle and set intentions verbally out loud for them. Oftentimes there would be a new patient on a Monday morning, for example, and then with intentions that this is what we say as a group or one person leads. But it's a group shared experience as today and every day for all who are here. For all who come here and for all in the service of healing, may we be filled with the light of love. May we be guided and shown the way. May we be granted strength and wisdom in the capacity in our every act to foster health and healing in our world. And then we ring the bowl. Boom. Take a moment to ground ourselves. And then our mission is actually to then live up to that. And so everyone participates in that, whether they're scheduling or accounting but everyone's gotta sees themselves as playing a very important role in creating a positive healing space for everyone who comes. The suffering that comes into our doors is quite amazing, and part of that is the suffering of being discounted or dismissed or denigrated or dumped, but people can come in discouraged and depressed and our mission is to not reproduce any PTSD that people may have experienced. but we take people very seriously and we want them to have a very different experience than maybe they've had in other clinics. But we have a wide variety of people that we work with as partners, including nutritionists and dieticians and massage therapists and physical therapists, and a spiritual facilitator fabulous woman by name Catherine Duncan, who is worth knowing about. So if you google Catherine Duncan and I think her blog is learningtolive.org. But maybe if people Google they'll find all kinds of interesting things. Catherine's particularly important part of this because as a former hospital chaplain, someone who has had her own cancer crisis in childhood, someone who's worked in trauma stabilization room in a very busy inner city emergency room for four years. She has seen and done a lot and she really understands how to be meaningful in people's lives. Some of her notes and back can just bring tears to my eyes are just powerful and my sense is that there wasn't someone like her and people would be seeking out medical responses, which then lead to pharmaceuticals and again, could be very disempowering. and obviously as a physician, I absolutely understand the power of pharmaceuticals, but our philosophy here is fundamentals first, then pharmaceuticals. As a physician, my education was pharmaceuticals first. Forget the fundamentals. They don't really matter. But I have to say the five fundamentals are really important. Breathing, eating, sleeping, moving, as an exercising and loving, there's a life of connectedness, a life of meaning and purpose. And those five fundamentals gosh, there's no pill for any of them. That's why I say, okay, empowerment means gaining skills and capacity in any one or more of those five areas. [00:11:28] Jill Brook: You had mentioned a minute ago that you could tell stories about what it means to do, maybe this type of medicine instead of maybe the traditional normal Western method. Can you see it in somebody's health when they do put one of these fundamentals into place, such as finding meaning? Like do you have any, I don't know, any examples or stories that show what you're talking about? [00:11:55] Dr. Plotnikoff: Well, this is one from about 30 years ago. And so it was kinda like a youngster outta school. And that was back when I was into suppressing symptoms. And I was working at Inner City Primary Care where we worked in at least 14 different languages. Fabulous. Wonderful. Love, love, love, love, love my nine years there and this was an early on lesson, seeing a woman on a monthly basis often had multiple symptoms. She came in one month describing chest pain. And I'm just like, oh, but we've done a cardiac workup and as I interviewed her more and more. Really sounded like reflux. And I was more than happy 30 years ago to just write a prescription for Prilosec I said, I sense something is different this month and I see that my next patient hasn't shown up yet. And do you have a moment? And she said Yes. And I said, well, tell me is there something new and different in your life? And she goes, Yes. I said, oh, tell me about that. She went on to describe about her brother with whom she'd been very close had died suddenly and unexpectedly back in their home country of Iran. And because there was Iran she couldn't attend a funeral. So it led to con conversation. Funerals being for the living and an importance of closure and honoring person's lives, et cetera and we concluded and she came back the next month and I said, oh, how's the chest pain? Said, it's gone. I said, great. The pills worked. She went, Dr. Plotnikoff it wasn't pills, it was poetry. And she had gone home, after a conversation and written a poem and honor of her brother in their native tongue of Farsi had done it up in the beautiful calligraphy, had it printed up and sent to family, friends around the world, he said, and then the pain disappeared. And I'm just like, wow. What a powerful lesson. It's not Plotnikoff, it's not pills, it's poetry. And so I think part of what I've seen in the decades since then is that anything that has the power to bring forth tears is worth writing about and we've seen published clinical trials, actually 30 minutes, three days in a row. Pen, a paper writing only to oneself. No self-editing, no concern about perfect sentences, paragraphs, word choices, just writing flow of consciousness. 30 minutes, three days in a row. One topic. The most stressful event of my life. That unleashes some power that's not normally accessible in our unconscious. And can play a profound role in bringing relief to many people. In fact, an article published in the Journal of American Medical Association that got the editor in trouble did just that for people with chronic severe rheumatoid arthritis or chronic severe asthma, so severe that they were in maximum medical therapy. 25 years ago and still symptomatic. And with quantifiable measurements by airflow are things of impaired function and fairly frequent use of the emergency room and the result of just that intervention significant reduction in medication requirements. Improvements in all quantifiable measures and near elimination of ER visits. [00:15:42] Jill Brook: What, wait, how many days did they do this exercise? Just the three, or they kept going. [00:15:46] Dr. Plotnikoff: three days, 30 minutes. One topic just running through himself. Why did the editor get in trouble? If there was a pill, it'd be a trillion dollar bestseller. But again, this bypasses the medical system and you can't have people getting better without doctors. [00:16:04] Jill Brook: Oh my gosh. [00:16:06] Dr. Plotnikoff: It just affirms that there's a whole dimension to health and wellbeing that is beyond pills. I worry about a culture in which there's a pill for every ill and and obviously every listener that yes, that their experience, their challenges you need. It's like a big pizza and you have a pizza slices for this and pizza slices for that. But what really counts is the bigger picture. You've gotta develop all these dimensions and just focusing on one. It may be necessary, but it's not sufficient. [00:16:40] Jill Brook: Wow. So is there any downside risk? Do you recommend that everybody try that exercise? [00:16:46] Dr. Plotnikoff: Well, I'm not aware of any downside risk, but I am aware that anything with the power to bring forth tears is worth addressing. And sometimes it's best addressed with a partner. Maybe a health professional. It might be a psychotherapist, a psychologist especially when things come bubbling up and there's a need to process it. It's worth recognize they don't have to put all the burden on oneself, but writing to oneself for oneself about one. Can be very powerful. Maybe that also opens access to one's inner wisdom and it may lead someone to say, actually maybe be really good for me to work with so and so and so, or partner with someone on this, this and that. And that may be very helpful, but I'm all in favor of growth and awareness. And I say in the absence of awareness, it's really hard for good things to happen. But with awareness then inner wisdom can come forth. And so a challenge for everyone is, I think about the metaphorical vitamin A for awareness and say, you don't want be metaphorically malnourished in vitamin A. So every day is a challenge to ourselves to make sure we get enough of this metaphorical vitamin A we call awareness. What a new awareness came forth today is a nice way of ending the day. [00:18:13] Jill Brook: Oh, I love that. [00:18:15] Dr. Plotnikoff: Growing in awareness to invite inner wisdom to come forth and and maybe this writing exercises. Other exercises in accessing unconscious, maybe poetry or art or other things may be really powerful for that as well. [00:18:31] Jill Brook: Wow, that's so interesting. Now you work with a lot of POTS patients and also mast cell activation syndrome patients. [00:18:38] Dr. Plotnikoff: and dysautonomias in general and the hypermobility and gosh, this whole new Venn diagram of challenges where people can find themselves falling through the cracks of our current system. [00:18:53] Jill Brook: Mm-hmm. because I guess, was it arthritis and asthma that you said was shown to respond to the three days of writing? Because I guess I wonder if mast cell activation syndrome would be a little bit in the same category. Because it's an immune response. [00:19:10] Dr. Plotnikoff: Well, absolutely because we know that meso activation can be driven by imbalances in the autonomic nervous system, particularly sympathetic system excess, and can also and so high stress environments we think about. The five types of stress, environmental, physical, emotional, pharmaceutical, dietary, just a high environmental stress situation can perpetuate mast cell activation. High cortisol levels can perpetuate mast cell activation or lower the threshold for mast cell reactivity. When you think about it, I think of mast cells as being like sentinels. There are boundaries with outside world. And they've got binoculars out there looking for icebergs or they've got sniffing for forest fires. And their threshold for r esponding to keep us safe is gonna be lower when there's been a whole series of stressful environmental things. Okay? If it looks like an iceberg sound alarm, we want to be safer than sorry. And so the threshold for reactivity, goes down. And so it is true we can raise that threshold for reactivity when at an unconscious level and a conscious level, we know that actually the environment is safe. I think Jill you've probably seen, , things like the DNRS and the Gupta program and other things are structured ways of re-experiencing sense of safety. I think it's just a really important concept and gosh. And what happens? The first thing, you go to a clinic, you say, well, we're gonna come take your vitals. What? I don't Vitals taken? No, no, no. So here's a quick guide to everyone. Next time someone says they wanna take your vitals, you say no. You may measure them, but you may not take. [00:21:14] Jill Brook: Oh, another subtlety. Wow. Okay. So all of this is so fascinating and I'll just let our listeners be reminded that we did have three episodes on the various forms of limbic retraining and DNRS and all of those, and they can check those out. I think it was about episodes 110. But you said something before that that I had never heard about and you said there are five types of stress and a lot of them made sense to me. Environmental. I imagine nutritional stress means being out of balance, but maybe you could talk about those, and especially pharmaceutical stress. What is that? [00:21:55] Dr. Plotnikoff: Okay. Yes. So I talked about the five forms of stress environmental, physical. Emotional could also be spiritual, pharmaceutical, and dietary. And pharmaceutical stress would be adverse effects from prescribed medications. So, for example many people are in beta blockers and beta reduce the capacity for a body to make melatonin. Well, melatonin is so critically important for coordination of functions. It is circadian rhythm and so much more. Melatonin has direct anti-inflammatory effects, including anti neuroinflammatory effects, gut health, so many issues. So you think about, okay, well, Adverse effects that no one really thinks about. Well actually loss of melatonin does cause a disruption of coordination in the system and may have other unrecognized but important effects through its anti-inflammatory activity. People may use prednisone and gosh, prednisone definitely has an adrenal suppression and focuses on cortisol, but people ignored DHEA and where the blood measurement form DHEAS and Stanford rheumatologist number of years ago found women with lupus on prednisone, ran extremely low DHEAS levels and this is a really important anabolic hormone that is build up hormone which is the opposite side of the teeter-totter balance from cortisol, which is a catabolic or breakdown hormone. And both of these are important, and people said wait a second, breakdown. No, no, no, I don't want any of that. But actually good health is a good balance of both of these. So, for example, our bones are constantly being built up and constantly being broken down. And we want both of those to be active. Too much build up, and that's PA's disease. Too much breakdown. That's osteoporosis. We want a good balance of both. And what I've found is that if the teeter totter balance is high, high, high on the cortisol side and low on the DHEAS, then this puts people into more of a catabolic state and they experience fatigue, muscle loss, bone loss, often weight gained, but it could be weight loss as well. But they have cognitive changes, sleep changes, mood changes, decreased libido, increased wear and tear, decreased resilience. So we do measure DHEAS and when appropriate, use short term courses of low dose support to kinda get people back on track. I have seen previously healthy nurses in their twenties who were in working in a very toxic work environment, and they should be running DHEAS level around 250 and they're running levels in low twenties. [00:24:53] Jill Brook: Well. [00:24:54] Dr. Plotnikoff: Oh yes. Does that make it hard to get outta bed in the morning? Ah-huh. And we found that actually changing the toxic work environment came into a non-toxic work environment. And getting into mind body self-care that alone and DHEAS levels rose. But it's a little side note among this idea about, yes, every prescription drug may have under-reported and under-recognized side effects. And so when thinking differential diagnosis, I'm always thinking what else, what else, what might be playing a role here? And so those are two ones that may be most noticeable for people with POTS. [00:25:35] Jill Brook: Yeah. Well, I love how you just go deeper than seemingly anyone on all of these topics and so much more detail about each drug. And when I was looking at your website, one thing that struck me was that in addition to having all kinds of cool people on the health team, including massage therapists, nutritionists, people like that, you had somebody called a medical literature and evidence specialist. That just made me so excited and then I started wondering why have I not seen that in other medical offices? Can you talk about what that person does? [00:26:11] Dr. Plotnikoff: Well, Linda Deborah is fabulous and she is dedicated and extremely well-read. So she's scouring the PubMed for articles of interest. Obviously, no one can read 4,000 journals a month, much less 4,000 articles a month, But having Linda as part of a team it's really helpful. So an article we've been working on for quite some time, we've gone through a couple of different titles, but essentially about the symptomatic patient on a plant-based diet. Seven questions for every clinician. She's finding articles of great interest relevant to this topic and and so in some sense, our clinic is a learning community where everyone's a teacher and everyone's a learner and includes everyone who comes to the clinic and everyone who works in the clinic and Linda's role is to keep us abreast of things. Keep us ahead of the curve on things. [00:27:09] Jill Brook: That's great. So one of the things that I think you're ahead of the curve on is osteoporosis and treatments for it. You have published widely on that, and since many POTS patients, Sometimes don't get as much weight-bearing exercise because of orthostatic intolerance or maybe post exertional malaise. Is there anything that they can do to help promote good bone density as they age if they're not gonna be able to do the normal, like high impact exercise. [00:27:41] Dr. Plotnikoff: Well, I wanna point out, yes, not everyone needs to do high impact exercise. And so let me share a very important story. It goes back to this fundamentals first, then pharmaceuticals. And why I'm not big on ever being on osteoporosis medications. But a number of years ago, I had this great title. I was chief Medical Officer of the National Geographic Blue Zones Expedition to Okinawa. And so we got to interview all these people who were age 100 and learned a very important lesson one day. We were going to see a woman, 106 years old, living on a remote island from the main island of Okinawa. And we called her daughter the day beforehand and she said, oh, I'm sorry my mother died last week, but you can come interview me. And we already had the boat and everything and so said we would, but she said, but I have to tell you, I'm busy. We take a couple hours to get to this island, walk to her home. We find her just heading out to the fields to tend her gardens where she grows her own food on this remote island. She's got this wheelbarrow. She's got a lot number of tools and I was thinking to myself, her mom was 106. How old is she? For sure she's at least in her mid eighties. So we walk up to her home and because it's an island and area of typhoons and stuff, we walk up like 12 steps to get to her raised walk, invite us inside. We take off our, our shoes and step onto to Tommy Mat and there's no living room furniture. You sit on a Tommy mat and she went over to her little kitchenette area and prepared tea for us. Now she brought this tea on a tray and this beautiful tee-ball and beautiful teac cups. Heirlooms clearly things that are great treasures. And without skipping beat, she holding this tray in both hands, lowered herself to the floor and proceeded to serve us tea. I'm thinking, oh my God, I'm less than half her age and I can't do that. And I thought, this is really interesting. She sat on the floor every day, so she was getting up off the floor everyday and she's in the gardens. Every day she unintentionally was focusing on balance, strength, and flexibility. Now I take those as fundamentals before pharmaceuticals in terms of osteoporosis. So anything that one's body allow. To to focus on balance, strength, and flexibility. And I know many people are hyper flexible, but for people like me who are not very flexible it's much more important. But maybe balancing of muscle groups are very important. I think that's fundamental and so much exercise can be done while on one's back. I would caution people of not avoiding exercise but doing what one can on one's back in a horizontal position is really important and focusing every day on what is feasible and doable. Maybe partnering with your physical therapist and others for guidance. But balanced strength and flexibility are really key issues. And along that line also the Okinawan thought is that bones much more as a coral reef than a rocky mountain. And I think so much of osteoporosis thought is simplified to calcium. Bones are a very complex living ecology and so again, going back to fundamentals first how is the vitamin D level, there's a whole long list of elements of a healthy coral reef that makes for healthy bones. inflammation and adverse food reactivity and hormonal status, including DHEAS, vitamin K status, which people don't talk about enough. Vitamin D, homocystine, there's a whole long list. But , if I keep going back to the five fundamentals all of them play a significant role in bone health. [00:32:04] Jill Brook: That's so good to hear. Yeah, the power of the fundamentals that we all could do, but we all tend to overlook, I think just because there's all these fancier, sexier things that grab our attention. [00:32:16] Dr. Plotnikoff: Yes. And that's the thing. But so many of these medications for bone health, they're hidden value judgments behind them. What is the absolute risk reduction? What are the numbers needed to treat for benefit? What the numbers need for harm? That is, how many people, weighing pros and cons . I think now one classic medication, its absolute risk reduction is 2% in postmenopausal women who have already had one osteoporotic fracture and in that population, a 2% risk reduction translates to need and treat 50 such women for five years to prevent one osteoporotic fracture. [00:33:02] Jill Brook: Whoa. [00:33:04] Dr. Plotnikoff: I said, that's a hidden value judgment there. Very important concept. What is the absolute risk reduction and what does the numbers need to treat? And I'm finding a lot of people are going on pharmaceuticals because, well, it looks like you have osteopenia and for optimal bone health, blah, blah, blah, blah, blah. And then no one talks about balanced strength flexibility. No one talks about nutritional metabolic status. No one talks about sleep et cetera, et cetera. And so that's why it gets me a little bit grumpy about the value judgements being shifted towards the answer being found in a pill. [00:33:42] Jill Brook: Hmm. , one of the things that I enjoy doing in the community is a lot of volunteer work as a statistician to some of the doctors who have data but maybe don't have access to like a statistics department at their institution. But one thing you learn pretty quick statistics is that for a lot of these drug trials, All they really need is to get a significant P value in order to say we had significant results. And when you start really digging into what was significant and in which populations and what the effect size was, you realize, wow, there's a lot of things that can get lost. When the drug rep says to a physician, Hey, this significantly improved bone density, like that doesn't mean something that. [00:34:29] Dr. Plotnikoff: right? Well, notice that significant is a value judgment, the results were significant. Well, significant for whom, significant in a statistical sense versus significant in a clinical sense or even better in a personal sense. Yeah. Dr. Jill if I take this pill, will I get well, and that's where we kinda get into the bell curve as well. Well, on average for most people, we can expect this type of benefit that we only need to treat 50 such people like you for one person to benefit. And that's pretty good. We say, well, well wait a second. Are there logical options for me to consider? Or is this the only option that I have? And I think that especially when people find themselves in an, for lack of a term, an orphaned disease category like POTS and related concerns on average for most people, doesn't include people with exceptionally challenging conditions. What about the five, 10, maybe even 15% of people who are on the left side of the bell curve? It's kinda like our systems really addressing them. Or when systems talk about population health, that's great on average for most people. But what about people with exceptionally challenging conditions? It leaves them behind and they are deprioritized, and that's why people feel dismissed and discounted. They're not in the middle of the bell curve. So that's why podcasts like this are so important is this kind of, yeah, we've gotta take this further and seek empowerment because systems themselves may be somewhat disempowering. [00:36:15] Jill Brook: Mm-hmm. .And , in your introduction, I think I failed to mention that you are on our Board of Medical Advisors, but I'm just so thrilled and so proud that you're on our Board of Medical Advisors that I wanted our listeners to know that, that you are just so thoughtful about everybody, not just the people at the center of the Bell curve and I don't think there's a lot of people like you. You're such a gem! [00:36:39] Dr. Plotnikoff: You're very kind. I have no idea how long I'm on this planet, but I think, thanks to your hard work and the organization's hard work there's a bigger thing happening here and we're fostering together really positive changes and true primary care is what we do for ourselves. And so anything that we can share to empower people is gonna be deeply meaningful on some level. And so kudos to you and to Standing Up to POTS group broadly and listeners for all the work that you're doing to transform this world and empowering people to be able to feel more in control of their own health and wellbeing. [00:37:18] Jill Brook: Well, thank you so much and there's so much more I'm excited to talk with you about someday. I know you are an expert on vitamin D and gut microbiome health, and I'm excited to ask you about the the herbal Japanese tradition, but I know that you need to get running and get back to your patients. We're so grateful for your time and for all that you do for your patients and for the community at large. And we hope you'll come back and talk to us again sometime. [00:37:41] Dr. Plotnikoff: Jill, it's an absolute honor and listeners, you can't see me, but I'm actually doing a deep bow before you and before Dr. Jill. And so in this new year, I'm wishing all of you the very best of health. [00:37:53] Jill Brook: Thank you so much. Okay, listeners, that's all for today. We'll be back again next week, but until then, thank you for listening. Remember, you're not alone, and please join us again soon.

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