Dr. Buchkina (MD) Functional Medicine

Dr. Bouchkina is a functional medicine practitioner who focuses on chronic diseases and lifestyle interventions. She left her job at a university to start her own private practice, where she can spend more time with patients and discuss lifestyle changes. Most of her patients are women in their 40s to 80s who have not found relief from conventional medicine. Functional medicine can help with symptoms related to menopause, such as anxiety and elevated cortisol levels. Dr. Bouchkina believes that starting functional medicine at a younger age can have a greater impact on overall health. Insurance coverage for functional medicine varies, but some tests and treatments may be covered. Hi, this is Ayusha Adhikari, and I am back for my third and final part of my three-part podcast series discussing everything health and stress-related. Today, we will be speaking with a functional medicine practitioner to learn a little more about the field. Our guest, Dr. Bouchkina, will tell us about her approach as a patient and how it differs from when she worked in conventional medicine. She'll also break down some concepts of anxiety, cortisol, and brain fog, and the things that she would recommend to manage those symptoms and feel a little bit more productive in our daily stressful lives. My name is Julia Bouchkina. I'm an MD-MPH. I practice functional medicine in Iowa City downtown. I graduated from the University of Iowa Medical School, and I did my residency training also at the University of Iowa in family medicine. And I practiced at the University in family medicine for three years. I saw outpatient clinic patients. I saw patients in labor and delivery. I delivered babies during that time. And, you know, I developed quite a following within the outpatient clinic for people who were wanting a functional medicine doctor. But I was also at the same time still seeing my regular panel of patients, you know, well child visits, adult well physicals, all which are very important to do. But as time went on, I was feeling more called to really work specifically with this population of patients who were interested in working more on what I call slow medicine, where you're working on chronic diseases like hypertension, diabetes, autoimmune disease, you know, diseases that are generally, you know, not acute, are going to be with you for years, and generally when we're treating things conventionally, require prescription medications. And in functional medicine, we know that a lot of these diseases respond really favorably to lifestyle interventions, like working on nutrition changes and movement and especially stress management. We know that over 95% of all diseases are caused by stress or have a stress-related component. And so in 2016, I left the university and I started my own private practice in downtown Iowa City called Upstream Functional Medicine, and I've been here since. And, you know, it's been a really good shift for me in my career. I feel like what I do every day is really gratifying. I feel like I'm able to help people in a way that I wasn't able to, you know, only having people at the university, which, you know, it's a system that is geared more towards acute care, where, you know, you get maybe 15 to 20 minutes with each patient. It's maybe enough time to update their medical record, hear about any major changes to their physical health, and then prescribe a new medication, potentially, or adjust their current medications. And I found that I really wasn't able in that setting to talk about how to adjust, you know, your diet to help with all of the symptoms that someone might be having or to talk about new evidence-based approaches to, you know, stress management and lifestyle. And so that's what being in my own private practice has allowed me to do. I can spend, you know, up to an hour with people in the office. It gives us a lot more time to focus on what can meaningfully be changed lifestyle-wise so that people can truly start to feel better and also be empowered, hopefully, not to need me as much, so that they can go off and make day-to-day decisions about how they're going to live their lifestyle that are going to give them better health in the future. I mean, the experience that I've had with healthcare so far is when I was younger, I obviously had, like, a family practitioner, and then they referred me here or there. And then if I have an issue, I'll go to, like, the nearest doctor, right? But when it comes to, like, functional medicine, I'm sure it's something that not a lot of people know about, and it's not their first choice. So how do you get patients? Is it because they're, like, at a certain age where they feel responsible enough to change things? So most of my patients come from word of mouth or referrals at this point. As I was getting started building my practice, I think a lot of patients came from Google searches and people who are already interested in functional medicine. It's definitely a patient population that skews toward, I would say, the age 40 to 80-year-old demographic. It really is a group of people who have already seen their own physician or maybe multiple physicians, and people come in and say they've seen 20 doctors for their symptoms and just haven't felt any better. And so there's a little bit of a sense of desperation sometimes when people come in because they just want to feel better, and for whatever reason, conventional medicine isn't getting them to that point. And I want to be careful to say that functional medicine isn't any kind of magical cure either. It's a lot of hard work changing your lifestyle. And so the things that we talk about are not necessarily the simplest things to put into action, but by the time that people come to me, I would say generally they are ready. They've got some skin in the game. They are willing to make some changes and do anything that they need to to make their health a priority. And so I would say most of my patients are women. I haven't run the statistics lately to be exact, but if I had to guess, it's probably one to three splits, so probably a quarter of my patients are men, and the other three quarters are women. I work a lot with women in perimenopause or in the postmenopausal years, which of course can be really difficult for women when they're going to a regular doctor. The most common thing that I hear from women in that age range, like from 45 to 60, is that, you know, I've been to my doctor multiple times, and I've told them about my symptoms, and they say, I just have to live with them. This is a normal part of getting older, and I need an antidepressant or something for anxiety. And a lot of times, what those women need are very specific, targeted nutrition changes, movement that doesn't just focus on cardio, but specifically that works on strengthening flexibility, range of motion, and then also really working to lower cortisol, because a lot of women around menopause have elevated cortisol levels. And so, you know, in conventional medicine, we just really aren't trained in medical school to guide women through that process, and being able to empower those women to improve their symptoms through lifestyle is really, really kind of great. I was going to ask about cortisol, but before that, would you like, do you think that expanding your population to a lower age group and having them start in functional medicine would be more effective in, like, I guess, garnering an overall healthier lifestyle into the future? And if you were to have, like, patients that don't come in with specific issues, but they just come in because they're curious about functional medicine, and they just come in because they want an overall checkup or want to discuss, like, what would your approach be for that? Yeah, I would love that. I think that the earlier you start with functional medicine, the more impact it can have over your lifespan. There are so many diseases that actually start, like, 10 to 15 years before they're actually diagnosable, and we can intervene at every step of the way as those diseases are developing to start turning back the clock, to reverse the process to things like Alzheimer's, dementia, which is, you know, can run strongly in families. You know, if somebody in their 20s or 30s knew that that was, you know, something that ran in their family and wanted to prevent it, we have really, you know, well-researched protocols for how to prevent Alzheimer's. We know exactly how to prevent diabetes and heart attacks and, you know, metabolic syndrome and all of these, you know, cardiovascular issues. Not to say that everything is lifestyle-related. Obviously, there are some genetic predispositions that, you know, can really kind of moderate what your risk for things are in the future, but in general, genetics play about 10 to 30 percent of, you know, the risk for a future disease, and 70 to 90 percent is really how your genetics interact with the environment, so how your lifestyle is impacting your risk. And so for somebody to, you know, be able to start early and look at their metabolic, you know, risk factors to look at, like we have a machine in our office that measures visceral fat, so body composition scales that, you know, I've actually met a number of people since getting this scale who are of a normal weight. You know, they look like weight is not a problem for them, but then when we put them on the scale, we can see that they have a lot of inflammatory visceral fat between the organs and the torso, and that is an absolute risk factor for future development of heart disease. Well, all of these new resources are really cool and exciting ways to learn more about your body. Insurance does play a huge role in every type of care we get here in the United States, so when I asked Dr. Bouchkina about insurance and its role in conventional medicine, this is what she had to say. So we as an office don't accept insurance, but we provide all of the invoices, paperwork for people to be able to submit to their insurance after the fact. And so the reason is we're opted out of insurance companies, including Medicare. But, you know, the nice thing is a lot of insurances will still cover lab testing that we do, and, you know, surprisingly, Medicare will often cover, you know, some more complex nutritional analyses or more intricate, like, stool testing that we can do, like mapping out the whole microbiome that's covered by Medicare. And now for younger people, I would say that, you know, the ideal is that if you can kind of start doing all of these tests that would be covered by insurance already, you know, a lot of people are on commercial insurance at least under their parent's plan until they're 26. There are a lot of really good basic tests that we can just get covered by insurance. We also are partnered with a medical credit card called Advanced Care that allows people to have interest-free monthly payments. And so, you know, when the payments are broken down monthly and you've got 12 to 18 months to pay it off, it can make it a lot more affordable just in terms of knowing that, you know, you don't have to pay a large amount of money up front. It's kind of like, you know, when people get orthodontia or other kind of higher medical program fees up front, you know, we offer a three-month and a six-month medical program for all of our new patients, which includes all of the medical visits with me, all of the coaching visits with our health coach so that they've got support along the way for implementing all the lifestyle changes. And then, you know, we allow people to divide that program fee into individual monthly fees so that when you submit it to insurance, you're more likely to get an additional percentage back because of that. I've seen with Blue Cross Blue Shield here in Iowa that they will often give anywhere from, like, 10 to 50 percent of the visit cost back for commercial insurance, so it's definitely worth submitting. It's not nothing. But we are considered out-of-network with all insurances. And the main reason is that, you know, we as functional medicine providers are not practicing standard of care. And so, you know, when you submit something to your insurance, the insurance company is paying the physician based on the agreement between the physician and the insurance company that that physician is practicing standard of care. And because I'm openly practicing and saying, I'm out here doing things that are not FDA approved, and every patient comes into our office and has to sign a piece of paper saying that the things that we are advising, even though they are evidence-based, they're not all FDA approved. So basically every treatment, whether it's a nutrition change or movement therapy or stress management, even some of the medications we prescribe, it's all considered, you know, in quotation marks, off-label. Yeah. Which, honestly, is not a new concept. You know, a lot of the ways that even conventional doctors practice within, you know, a hospital system, they're also going to be prescribing off-label treatments. But it's always important as, you know, a patient to understand that the things that you're being offered are not considered to be standard of care. Yeah. And, you know, that there is some inherent risk in accepting those treatments because they don't have as much, I guess, research and years of medical practice behind them. No. Even though with nutrition changes, with movement changes, and with stress management changes, it's really hard to, you know, do any harm to yourself. That said, there are always risks to any medical intervention, and so we always like to know that our patients have been fully counseled and understand that, you know, there are pros and cons to everything they might do with their health. So when you, like, you got your certification in family medicine from the University of Iowa, and when you decided to switch from just conventional practice to functional medicine, did you have to, maybe I didn't catch it when you said it earlier, but did you have to get any type of extra certification to qualify for that? I did. I completed certification through the Institute for Functional Medicine. Okay. And so they have a certification process that needs to be repeated every 10 years. Okay. Similar to the boards. Yep, similar to the boards. And then I was also board certified in integrative and holistic medicine through the AIHM. And they essentially grandfathered me into kind of what they called lifetime board certification, so there is no, you know, ongoing repeat certification. I repeat for that. Okay. And then I have kept up my family medicine board certification every 10 years. Okay. I sit for that again. And I do think that's an important certification to maintain. You know, I think that when you look up functional medicine providers near you, which, you know, if anybody isn't in the Iowa City area listening and wants to look up somewhere, you know, else around the country, if you go to ifm.org, they have a find a practitioner search by zip code, and it will show you all of the certified functional medicine doctors close to you. And a lot of them you may see are not MDs or DOs. Anybody who has an advanced degree like a nurse practitioner or chiropractor or dietician, you know, pharmacist, they can all sit for the functional medicine certification too. But I do think that, you know, there's a little bit of additional credibility that comes with that ongoing board certification in family medicine. You know, if I need to, I can prescribe medications. I'm absolutely not against prescribing medications. I think that it just gives us a wider toolkit in functional medicine to be able to. You know, both sides. Right, right. So, you know, my philosophy with that is that if somebody comes in and let's say they have really high blood pressure and, you know, it's a fairly common scenario that someone would come to me because their regular doctor just diagnosed them with something new and advised them to take a medication. And they don't want to take the medication. They want to know what's the natural way that I can deal with it. But the first thing that I'm going to tell them, you know, especially if somebody walks into my office with a blood pressure of, you know, 210 over 100, which is too high, I'm going to make sure that they leave with a prescription for a blood pressure medication that they can start so that we can get the blood pressure controlled while we work on the nutrition changes. And, you know, potentially that can involve some nutritional and some other supplemental support. But it would be just devastating and tragic if someone were to have a stroke, you know, a month before we actually get the blood pressure under control with nutrition and lifestyle changes. All of these changes that we make are, you know, slow and they require significant new habit formation, which can be a hard process. And so my first rule is just always keep the patient safe and make sure that we're doing what we need to do while still working towards the goal of potentially not needing that medication in the future. My interest in functional medicine actually first started when I saw an increase in conversations on social media about stress and cortisol and how many ways it can affect the quality of your life. I saw most of them take lead in talking about things like feeling more confident in yourself for aesthetic reasons like losing belly fat and inflamed faces. But some of them talked about how it can worsen your symptoms of anxiety, depression, and brain fog. And like we talked about before, stress is the cause of about 95 percent of diseases and it plays a really big role in your mental health as well. So I began by asking Dr. Boushkina about stress and cortisol and why it is such a popular conversation in the media these days. Yeah, cortisol is the body's main stress hormone. Of all the hormones in the body, cortisol is the one hormone that we cannot live without. If our adrenal glands stop producing cortisol, we die. So it's a very important hormone. But one way that it can play a role in producing or starting a lot of these inflammatory disease processes is when our bodies kind of get stuck in fight or flight mode all the time. Whether it's just from day-to-day modern life, like in school you're always studying for the next test or worried about getting to class on time or completing your homework assignments. All of these kind of time pressures tend to keep our cortisol elevated. And then it could be something as benign as you get cut off in traffic or somebody on the street yells at you for no reason. There can be a lot of different scenarios where our cortisol and adrenaline rise without there being kind of a life-threatening situation. And when we kind of live with that heightened state of cortisol most of the day, it can then be hard for us to come back down to the opposite mode, the rest and digest mode, at the end of the day for us to go to sleep, for our immune system to go through all of its repair and restore cycles, which are important to happen for at least four and a half to six hours a night minimum while we're sleeping. And when we don't get that good restoration from rest and digest mode, the cortisol just continues to kind of wear and tear the body. And so that can lead to a lot of different physical issues, including depression and anxiety. But also there are a lot of cortisol-related gut conditions. We know that cortisol increases something called intestinal permeability, which we talk about a lot in functional medicine. So this is what's referred to, if you read about it online or hear about it on podcasts, as leaky gut. And that is not something that regular doctors necessarily talk about or recognize as a condition because we don't have an FDA-approved medication that you can prescribe for it. But at the same time, it is really one of the most important things that I talk to my patients about in functional medicine because in order to kind of heal what's going on with the immune system and in the gut, we have to repair that intestinal permeability. And part of repairing that, aside from putting in specific nutritional supplements and adjusting the diet, involves lowering the cortisol. Lowering cortisol does not look the same for every single person. So we talked about ways that you can monitor the way you're feeling and the way your body is processing the things around you. So two of the most helpful things that I have recommended to patients with high stress are to get some sort of tracking device that can look at your heart rate variability, or HRV. And so examples would be like an Oura Ring, an Apple Watch, a lot of the new Samsung watches, Fitbits, Garmin. Almost every company now has some sort of HRV tracker put into their device. And the reason that HRV, or heart rate variability, is so important is it's basically a measure of how resilient you are in recovering from the previous day's activities. And so if you have an HRV of at least 30 milliseconds a day, we know that you are pretty well set up for staying healthy and maintaining the current status quo. But 30 is just kind of the bare minimum for maintaining good health. The higher the better. So if you can get it up to 40, 50, 70, 900, the better. And the things that we know that increase HRV are, number one, good sleep. But then number two, really nourishing your body with foods that your system can absorb well and are tolerated and do not cause inflammation. I noticed that one of the first things that helps people's HRV go up when we start working together is when they cut out sugar, when they cut out alcohol, when they cut out processed seed oils. A lot of fast food restaurants fry in vegetable oils that are high in omega-6s, which are inflammatory. And so just from that basic nutrition change and getting good sleep, you can see a fairly big jump in somebody's heart rate variability. Another device that can be helpful, obviously it requires an investment, but it has a lot of evidence behind it and research. It's called HeartMath, and it's a device that clips on. It's a Bluetooth device. It clips onto your ear and then connects to your smartphone and guides you through a breathing where you purposely kind of conjure positive emotions, and that helps your brain and your heart and your endocrine system all come into sync, which stimulates the vagus nerve and gives us that boost in heart rate variability. And so the idea with heart rate variability is the heart is not a metronome. It's not like steadily beating at the exact same pulse, but there's a little beat-to-beat variation where the heart rate is slowing down and then speeding up and kind of varying how fast it's beating. And we actually want that. We want that variation in the time between the heartbeats because that means that all systems are in sync. When the heart starts beating like a metronome, there's a crisis. The body is going into sympathetic overdrive, and that is increasing our cortisol, increasing our adrenaline, and wearing and tearing the body. Would you be able to tell us a little bit more about vagus nerve stimulation and some of the other recommended methods that I've even tried myself, such as EFT tapping, which I've tried, and it works, but it's just so cool to me because I can't really see what's happening in my body, but it just automatically makes me feel better. And things like meditation. Yeah, so first, the vagus nerve stimulation has gotten a lot of new requests because of the COVID-19 pandemic. People are now being treated for long COVID. What they are experiencing is essentially a syndrome called dysautonomia, and so it's where the vagus nerve tone has been downregulated, and they can have a whole plethora of symptoms in different parts of the body that seem unconnected but are really all part of the same syndrome because it's primarily the nervous system, the autonomic nervous system that's being And so people can feel dizzy. They might be sitting for a short or long period of time and stand up and then feel like they have to grab onto a wall. They might feel chronically dizzy. They might feel like their heart is palpitating or beating in an irregular rhythm or fluttering. They may have brain fog. They may have anxiety and depression. They may have crushing fatigue that makes it hard to leave the house or do anything professionally or educationally, and all of these symptoms are related to dysregulation of the vagus nerve, and so the vagus nerve is the 10th cranial nerve that innervates many different parts of the body, so it comes down from the brain through the throat, connects to the heart, regulates blood pressure and pulse, connects to the diaphragm, and the GI tract regulates peristalsis and digestion, regulates your bowel movements. It regulates bladder contractions. It regulates the adrenals, so it will shut off adrenaline and cortisol release, and if that nerve is downregulated, so it's not as active, the sympathetic or the fight-or-flight part of the nervous system is going to take over and be active, and that's essentially what we think is happening in long COVID, and so you're hearing a lot now in the research about vagus nerve stimulation as a treatment for long COVID, but we've known about vagus nerve stimulation for quite a while, and it is very helpful for a lot of different symptoms that people have, again, all related to kind of this overactivity of the sympathetic nervous system, so it can be a great treatment for anxiety. If you have a vagus nerve stimulator and you put it on in the middle of a panic attack, it's one of the best ways to just stop a panic attack. Some people use it for migraine headaches. It's been used in some studies, at least animal studies, for seizures as well, and then some of our chronic pain patients have found it beneficial in just managing fibromyalgia and migraine, and so I love vagus nerve stimulation just as a general intervention for someone who's dealing with a lot of anxiety because it's one of those ways where you can just essentially flip your physiology like a switch, which having a panic attack can feel super disabling. It's one of the scariest things that can happen to anybody because in the moment, it just feels like you're dying, and you don't always know exactly how to have control over the feeling or sensation. With EFT, or emotional freedom technique, it's a tapping technique that kind of works on the meridian systems that are used in acupuncture. I love that as well. It's great for people to learn how to do just in the moment. You can do it anywhere. If you're out in public, obviously people are going to see you tapping, but who cares? There has been a lot of research on meditation, in particular transcendental meditation on things like hypertension, cardiovascular disease. We know that transcendental meditation can help people eliminate blood pressure medications. It's very powerful. The way that we think meditation works primarily is just by slowing the breathing. Again, with that increase in vagal tone, you're getting not only increased oxygenation, but you're getting that stimulation of that just rest and digest mode that's going to shut off the adrenaline. It's going to shut off the cortisol. It's going to lower the pulse and the blood pressure. It just allows all of those systems to synchronize. I think that there's so many different forms of meditation, it's a benefit almost because there's really no wrong way to meditate. I know some of my patients in my practice are not meditators. They do not love meditation, but I just tell them if you can find any way to just lay still and be quiet in your body and just kind of focus in on what's happening with your breathing, what's happening with your physiology, you don't have to worry about thinking or not thinking a certain thing. There are so many different apps now that are available, like the Calm and Headspace. I have an Aura ring and I really like the guided meditations within the Aura app because you can actually see your HRV then after doing a certain meditation. It's absolutely worth everything to me just because the decisions that I make every morning based on what my ring says are really valuable to me. If I wake up and I see, even if I feel okay, and I see that my HRV has dropped 20 points for whatever reason, sometimes I know, sometimes I don't know. Sometimes I just ate too close to bed and I can just see that it took my heart rate a really long time to come down. It's very predictable then that in the next day my HRV is going to be lower. But sometimes it could be something I don't know about, like my kid brought home a virus from school and I'm about to get sick or something that I ate maybe didn't agree with me and I haven't figured that out yet. But it just gives me that kind of heads up like, hey, your immune system didn't fully recover. You're probably more in fight or flight right now than rest or digest. So I might start that morning out with some meditation or I have a Vegas Nerve Simulator. I keep it right next to my bed. I'll just grab it, put it on my neck for two minutes and I know that, okay, I've at least done something right away to counteract that drop in HRV. And then the rest of the day I'm probably going to take it easy at the gym. I'm not going to do anything to really physically stress myself. I'm going to make sure I get to bed as early as possible the next night and not eat too close to going to bed. So it just gives me that additional data. And then if I see, hey, my HRV is 80, then I'm going to hit the gym hard. I'm going to probably lift stronger weights than I have before knowing that this is probably going to help me to level up and push my body a little bit. How did you start your personal education on supplements? How did you even begin? And what are some of the more popular supplements that you educate your patients about? And when I say popular, more like could be effective for generally everybody because I've done some research on magnesium and how the reason why it's talked about so much or described so much is because through the American diet and seeing that Americans lack magnesium in their bodies, so it's a more general thing that people do recommend. But I was just wondering what your journey with that has been, I guess. And then is there a certain risk to supplements? And what do you think would be the most effective in when we talk about calming anxiety, brain fog, fatigue, and increasing productivity? Yeah. So I started my education on evidence-based use of supplements through the Institute for Functional Medicine. They do a really great job of educating practitioners. But then also just kind of through continuing education over the years and working with a couple of local compounding pharmacists that we are lucky enough to have here in Iowa City. They've been able to provide me with a lot of great information. Locally here, Towncrest Pharmacy is a really great source for good quality supplements that work. And so anybody who's in Iowa City looking for more education on that for themselves, I would recommend that as a resource. So I do think that there are really smart ways to take supplements and then not so smart ways. I think that most people really do benefit from a good quality multivitamin, magnesium, and fish oil. Those would probably be like the top three. If somebody didn't have any current physical or mental health issues they were dealing with and just wanted to stay healthy as long as possible through their lifespan, the high quality multivitamins are the ones that are going to have activated B vitamins and that are going to have essentially a lot of ingredients ending in either chelate or glycinate because those are the easiest forms to absorb in the body. Now there are studies out there that say, you know, we've done research on multivitamins and multivitamins are just going to give you expensive urine or in a worst case scenario they could actually be detrimental to your health. And the studies that have been published on those have actually used non-activated B vitamins and otherwise synthetic vitamins that are hard for the body to absorb and use. And so, for example, there was a notable study just probably a decade ago that came out and showed that daily multivitamin use was associated with higher risk of colon cancer, especially in men. And they were using folic acid, which is a synthetic form of vitamin B9, which is really hard for most men especially to utilize. So about 20% of the population has a genetic mutation called MTHFR, which makes it hard for the body to absorb synthetic B vitamins and use them. And so what these vitamins end up doing is just creating more oxidative stress in the bloodstream and then the body has to deal with the fallout of that and likely that could result in some DNA damage that possibly could increase cancer risk. And so I think that that is why we saw that data come out like that. And it does not deter me from recommending just a good high-quality professional pre-activated multivitamins. So brands like Orthomolecular or Thorne or Designs for Health, Metabolic Maintenance, those are all examples of very high-quality professional brands that I would absolutely trust to get a multivitamin from. And then fish oil is really interesting because we've gotten more research in the last 10 years on omega-3s and longevity than we've ever had before. And we now know that if you can get your omega-3 blood level up to 7-8%, which is just a simple blood test that can measure that, you fall into the lowest quartile of death from all causes. So people who are on, I generally see, because I check a lot of omega-3 blood levels, I generally see that if you take 2,000 milligrams of a high-quality omega-3 supplement a day, that will get you to about 7-8% for the majority of the population. You will just die less often from every cause if you're on that. And so that's pretty powerful. So it's all just about education. Yeah. And then magnesium can be really helpful for anxiety. It helps maintain normal heart rhythm. It helps relax muscles if they're cramping up. Magnesium glycinate can be very helpful for sleep and anxiety around bedtime. The one risk to be aware of with magnesium is some people are very sensitive to the bowel side effects, and so magnesium can act as an osmotic laxative, where it's pulling more water into the colon, and then it can cause diarrhea. But for most people, magnesium glycinate does not cause diarrhea or loose stools, and you can take it pretty safely without worrying about that. Magnesium citrate, though, which is the main ingredient, and there's a product called Natural Citrate that's very popular for promoting sleep and preventing leg cramps at night. So I remember when I did go to my practitioner to kind of discuss some supplements, because I had refused antidepressants at that time. Her main response to me was that it's not FDA-approved, and I can't, you know what I mean? I can't. And then she told me to go to a dietician. So do you think there's a correlation between good supplements and reliable supplements and its FDA certification, or do you think it's just because there's like a lack of research and resources, which is why most supplements haven't been approved, and that shouldn't deter people away? I would agree. People shouldn't be deterred from using high-quality supplements because of the FDA certification. So the bottom line is the FDA just does not regulate supplements and vitamins. They probably never will, and so we're never going to be in a position as healthcare providers or consumers to be able to see any kind of FDA approval on over-the-counter nutrients, vitamins, and other supplements. And so that's where I think it can be really important to make sure you know your source. I myself only take supplements that come from the professional companies that are third-party tested, and I also routinely test my own blood levels to make sure that my kidney function is good, my liver function is good, my nutrient levels are in the ranges that I expect based on what I'm taking. I guess one thing for people to know is that it's really inexpensive to do some of these blood tests. You can do an entire nutrient panel for around $100 and get really good information on just what are you getting from diet? Do you have any gaps in your nutrition regimen? And we do blood tests for anybody who wants it in the community for just the cost of blood tests plus $25. We can't always submit those tests to insurance, but they are pretty affordable. And then even more affordable than the nutrients, we can do a lipid panel for $2, a thyroid test for $2, a basic complete blood count for $2, electrolyte liver kidney panel for $2. All of these things that you would often do at your doctor's office and submit to insurance. Sometimes when you're trying some of these things out, you get a supplement over the counter and you just want to know, without going to the doctor, how is this working for me? You can come into our office and for a pretty low cash price, make sure that you're on the right track without having to see me for a consultation or even the health coach. One thing that would have been available to me 20 years ago was the ability to do toxin testing. As I've gotten into my 40s and I have done more testing on myself for medical detox, I have a lot of toxins in my body. I think about, I've got three children, whenever you're pregnant and then I breastfed all three of those children, knowing that I breastfed them and one of the best medical detoxes you can do is breastfeeding a baby because the toxins are going into the breast milk, into the baby. I wish that I had done a formal medical detox before I got pregnant as part of my fertility preparation. But I didn't know about the possibility of doing that and I hadn't done any of my functional medicine training at that point. I didn't even know it was a thing. Now, having gone through a medical detox, I feel really, really good and I've done before and after testing. I know that my levels have come down. I know that I've reduced my risk for a lot of the toxins from reaccumulating just in some changes that I've made to my lifestyle and so that would also just be another thing that if I could give a gift to my 20-year-old self, I would have tested for that and done that treatment because it is a very simple thing to do relatively. Although this is not meant to be direct medical advice because all of our bodies do function a little bit differently and you can only know more through lab testing and a direct visit with a provider. But I hope this podcast provides everyone with a direct insight into what functional medicine looks like, what your options are and if a normal visit to the doctor's office isn't working for you, there are more options and there are a lot of ways that you can learn about your body.