Nutritional Endocrinology: functional approaches to blood sugar and 3 causes of subclinical thyroid dysfunction with Dr. Ritamarie Loscalzo

This week on The Less Stressed Life Podcast, I am joined by Dr. Ritamarie. In this episode, we discuss functional approaches to blood sugar and three causes of subclinical thyroid dysfunction. I don’t know about you, but I LOVE to learn. My favorite thing is when I can learn something new in a podcast interview, and Dr. Ritamarie really delivered in this one. 

KEY TAKEAWAYS:

• 6 things that affect blood sugar besides diet 
• Thyroid conversion mechanisms 
• Symptoms, labs, what you can do, and functional blood sugar ranges 

Such a great episode, especially if you are a health professional or health hacker.

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ABOUT GUEST:
Dr. Ritamarie Locascalzo, the founder of the Institute of Nutritional Endocrinology, is passionately committed to transforming our current broken disease-focused system into a true healthcare system where every practitioner is skilled at finding the root cause of health challenges and uses the wisdom of nature combined with modern scientific research to restore balance. 

Dr. Ritamarie, a licensed Doctor of Chiropractic with Certifications in Acupuncture, Nutrition, Herbal Medicine, and HeartMath®, specializes in digestion, thyroid, adrenal, and insulin imbalances. She’s also a master at using palate-pleasing, whole fresh food as medicine and is a best-selling author, speaker, and internationally recognized nutrition and functional health authority with over 30 years of clinical experience. Her podcast, Reinvent Healthcare, provides health and wellness practitioners around the globe to be part of the movement to provide root-cause care to people in need. 

WHERE TO FIND:
Website: www.DrRitamarie.com
Podcast: www.ReinventHealthcare.com
Facebook Main Page: https://www.facebook.com/DrRitamarieLoscalzo
Instagram: https://www.instagram.com/drritamarie/?hl=en

WHERE TO FIND CHRISTA:

https://www.christabiegler.com/

On IG: instagram.com/anti.inflammatory.nutritionist/

Please leave a review, submit a questions for the podcast or take one of my quizzes here: https://www.christabiegler.com/links

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TRANSCRIPT:

[00:00:00] Dr. Ritamarie Loscalzo: And they tell 'em, oh, just look at your glucose at two hours after a meal, and as long as it's under 140, you're fine. That is such a lie. It's not just misinformation. It's an outright lie because people are not fine. When their glucose goes that high 

[00:00:19] Christa: stress is the inflammation that robs us of life, energy, and happiness.

[00:00:25] Christa: Our typical solutions for gut health and hormone balance have let a lot of us down we're overmedicated and underserved at the less trusts life. We are a community of health savvy women exploring solutions outside of our traditional Western medicine toolbox and training to raise the bar and change our.

[00:00:44] Christa: Each week, our hope is that you leave our sessions inspired to learn, grow, and share these stories to raise the bar in your life and home.[00:01:00]

[00:01:02] Christa: All right. Today I have Dr. Rena Marie Loscalzo, the founder of the Institute of Nutritional Endocrinology. She's passionately committed to transforming our current broken disease focused system and a true healthcare system where every practitioner is skilled at finding the root cause of health challenges and uses the wisdom of nature combined with modern scientific research to restore balance.

[00:01:21] Christa: I thought that was so beautifully written. I did not wanna skip over. Dr. Brianna Marie is a licensed doctor of chiropractic with certifications in acupuncture, nutrition, herbal medicine, and heart mass, specializing in digestion, thyroid, adrenal, and insulin imbalances. She's also a master at using palate pleasing whole fresh food as medicine, and is the bestselling author, speaker, and internationally recognized nutrition and functional health authority with 30 years of clinical experience.

[00:01:44] Christa: Her podcast, reinvent Healthcare provides health and wellness practitioners around the globe to be part of the movement to provide root cause care to people in need. Froze. Excited to have you talk about blood sugar and endocrinology and metabolic dysfunction today. [00:02:00] Awesome. Thank you so 

[00:02:00] Dr. Ritamarie Loscalzo: much for coming.

[00:02:01] Dr. Ritamarie Loscalzo: I'm excited to be here. My favorite topics to talk about and we can go on for days if we wanted to. Cool. 

[00:02:06] Christa: I'd love to hear. Where your story fit into this, cuz that is often how we start to decide what we're really into. Maybe it's in practice, maybe there's a personal piece of the story, but you started in chiropractic and then added acupuncture.

[00:02:20] Christa: Maybe it was reverse word or whatever. So tell me how you landed in really specialized in endocrinology, which is a real necessary. 

[00:02:30] Dr. Ritamarie Loscalzo: Real necessary area. Yeah, actually I started with the interest in nutrition, decided chiropractic was gonna be the avenue for getting in front of people to become primary care.

[00:02:41] Dr. Ritamarie Loscalzo: And then I added the acupuncture and the herbal medicine and all that kind of stuff. So yeah, it was. The other way around. But I started, I mean my official first license was actually in chiropractic and then I got certified in nutrition. Got my master's probably two months later. So it was very close proximity.

[00:02:59] Dr. Ritamarie Loscalzo: Cause I [00:03:00] studied the both at the same time. How'd I get into this? So I was sick. It was my, I was in my twenties. I went from doctor to try to figure out why I had brain fog all the time. Why I needed 10 cups of coffee. Not, I didn't like coffee, but I scraped that. But 10 cups of tea, black tea, or Pepsi.

[00:03:16] Dr. Ritamarie Loscalzo: To keep me going. And I had sinus issues and headaches, and I had all these health issues and I'm in my twenties and nobody's able to help. They're like, oh, just take this, take that. And I was on a whole bunch of medications, tried a whole lot of stuff, and nobody could help. And I don't even know how I got.

[00:03:33] Dr. Ritamarie Loscalzo: I figured hypoglycemia was one of those things. I had no idea then that it was an endocrine disorder. But yeah, I was looking and looking and one day in the gastroenterologist office I said could it be my diet cuz it's pretty bad. And they went, oh no. Diet doesn't have anything to do with health.

[00:03:49] Dr. Ritamarie Loscalzo: So I said, yeah, and I went out to prove them wrong cuz I'm a rebel at the heart. And I went out and I just started researching. Unfortunately not in today's day and age. So there were no, it was no [00:04:00] internet and summits and podcasts that I could review on. I had to go to the library and the bookstores and figure it out.

[00:04:07] Dr. Ritamarie Loscalzo: And long story short, I figured out that, everything had this underpinning of toxicity and hormonal imbalance and so I was able to, Changed my diet, changed my lifestyle, started to meditate, learned all these different techniques, and turned my health completely 100% around within several months.

[00:04:25] Dr. Ritamarie Loscalzo: So 

[00:04:25] were 

[00:04:25] Christa: you already in college at that time? And did that change? I'd 

[00:04:28] Dr. Ritamarie Loscalzo: already graduated college. I had a master. No, I didn't have my master's yet. Or did I? Yeah, I did. I had a master's degree in computer science at that point. , I was working for a computer company. Yeah. I was long graduated from, not long, like six years outta college, and I decided that it was, I'm a computer nerd, I love to solve problems and I said I was able to solve this for myself because of my diagnostic. But what about the average person out there who's sitting there with brain fog and fatigue and all these other symptoms and doesn't have [00:05:00] a clue where to start? So that's when I decided to leave my computer job and go back to school and got my chiropractic and my acupuncture and my nutrition degrees and.

[00:05:10] Dr. Ritamarie Loscalzo: That's where it is. And basically it combined all those different modalities. Naturopathic was not licensed in very many states at that point, but it wasn't where I lived. Or I would've gone there maybe because I had a husband and needed to stay where he had a job. Yeah, so that's where it started.

[00:05:27] Dr. Ritamarie Loscalzo: And as I went through and started working with people, I started to see there were patterns, right? People, a lot of people had digestive issues, most people were fatigued and exhausted and there were thyroid imbalances and all. But the thing that kept popping up was this. Glucose, insulin and mallets.

[00:05:46] Dr. Ritamarie Loscalzo: And that was before all the great research there is today, really linking just about every disease that known to mankind, to insulin and glucose dysregulation. And so I just started I wonder if we test these people's glucoses after [00:06:00] they eat. , back in the day, very many glucose meters, you had to go to the medical supply store to get one.

[00:06:06] Dr. Ritamarie Loscalzo: And I started having people test and I started to see crazy patterns and really got interested in that and started researching it and that, that's one of the ways I got into it. But all the hormones are always stood out to me like, what is. The imbalance cuz I think that hormonal imbalances like endocrinology is not one of the subsystems of the body, like gastroenterology and whatnot.

[00:06:30] Dr. Ritamarie Loscalzo: It's the controller. Every single function in the human body is controlled by hormones. Everything. And so I started looking at that as being, we've gotta get this under control. And I look at insulin as being Queen B hormone. She's the one that controls everything. 

[00:06:48] Christa: Let's talk about insulin, but before we do, why don't we talk about in terms of hormones being the master controller, let's talk about endocrine organs in general in that entire [00:07:00] system and pull that together because I do think it's an area where you hear pieces of it.

[00:07:05] Christa: Everyone is not an expert on endocrinology, but we're so dang affected by it. So let's draw the lines between the glands and organs as part of the endocrine. 

[00:07:15] Dr. Ritamarie Loscalzo: Yeah, absolutely. So there are endocrine organs, right? You've got the thyroid glands, you've got the thymus, you've got the adrenals, you've got the reproductive.

[00:07:24] Dr. Ritamarie Loscalzo: But that's not the only place where hormones are secreted. Hormones are secreted by the heart, the lungs, the kidneys, right? All of these other places that are not considered. Hormonal or glandular structures. The gut makes more hormones than any other part of the body yet. It's not usually considered when we talk about the endocrine system, but it's a huge part of it, obviously, because it controls so much.

[00:07:49] Dr. Ritamarie Loscalzo: So that's where, we've got all those glands, but we also have tissues in the body that have endocrine secreting. And of course every cell in the body has [00:08:00] endocrine receptors. So it's a univers. . 

[00:08:03] Christa: . And I feel like it's hard to pick a topic sometimes when we're talking about the endocrine system because they're very important.

[00:08:10] Christa: Every single piece of it. So I know you brought up the word metabolic dysfunction before we hit record. And it's funny because I just got done talking to a cardiologist and he brought up metabolic syndrome, and this is one of those trash can maybe. It's one of those, everything is broken syndromes or dysfunctions or conditions.

[00:08:33] Christa: And so maybe we can talk about diagnostically, how do we identify metabolic dysfunction or how do we look at symptoms of that? And maybe that's where we start is what does metabolic dysfunction and or endocrine dysfunction look like? To a person, because the tricky part is our symptoms are gonna be there long before the labs change also.

[00:08:54] Christa: So how's that look like in symptoms? And then how do we start to look at that with lab data? 

[00:08:59] Dr. Ritamarie Loscalzo: [00:09:00] Absolutely. So it depends. You mentioned two terms, and I wanna make sure people are really clear. Metabolic dysfunction versus metabolic syndrome. . So metabolic syndrome has a specific diagnostic criteria, which involves lipid abnormalities.

[00:09:14] Dr. Ritamarie Loscalzo: Hypertension and glucose insulin dysregulation. So elevated insulin. Elevated glucose, fasting glucose is not normal. That's in the medical model. The truth of the matter is metabolic dysfunction occurs long before we can make a diagnosis of metabolic syndrome with metabolic. We're expecting, oh, the fasting glucose is above a hundred and the insulin might be in another range, and A1C might be in a certain range.

[00:09:45] Dr. Ritamarie Loscalzo: And with metabolic dysfunction, we're seeing changes metabolically that can be measured. On labs if you know what you're doing and long before, like decades before somebody's told, oh, you have insulin resistance, or, oh, you have [00:10:00] diabetes long before that. And so what we want is that people become aware that these symptoms and why we could talk about some of the symptoms can be a sign of metabolic dysfunction.

[00:10:10] Dr. Ritamarie Loscalzo: And if you don't shift, if you don't make changes, you're gonna be heading down that path, not just to diabetes and insulin resistance because. It never turns into insulin resistance or diabetes. There's the dysfunction that happens on the cardiovascular level in the endothelial linings of the cardiovascular system, in the blood pressure, in the lipids, and all of that stuff happens long before there's ever even a hint of a diagnosis of diabetes or insulin resistance.

[00:10:40] Dr. Ritamarie Loscalzo: Unless you're aware of and savvy about some of the tests you can do, and some of them you can do. 

[00:10:47] Christa: All right, let's start there. So you said, I've got a couple different subsections. So labs that change decades before insulin resistance or diabetes, whatever be diagnosed, and then symptoms as well.

[00:10:57] Dr. Ritamarie Loscalzo: . Yeah. So one lab that changes long [00:11:00] before that most doctors won't measure unless you're already diabetic, is insulin. , we can see elevations in insulin literally decades before the blood sugar goes outta control. Cause the body's just trying really hard to maintain things in a healthy level. But the elevations of insulin are dangerous in and of themselves, right?

[00:11:20] Dr. Ritamarie Loscalzo: They affect the blood vessel linings, they affect the blood pressure. Those are things that need to be addressed. But the other test that, again, most doctors won't tell you about is postprandial. , right? And when they do tell people to test postprandial and postprandial, meaning after eating glucose, they usually tell it to diabetics or people who are already diagnosed and they tell 'em, oh, just look at your glucose at two hours after a meal, and as long as it's under 140, you're fine.

[00:11:48] Dr. Ritamarie Loscalzo: That is such a lie. It's not just misinformation, it's an outright lie because people are not. When their glucose goes that high, they're having all kinds of [00:12:00] metabolic changes to the retina, changes to the kidney, changes to the peripheral nerves. So we need to teach people how to test your own glucose.

[00:12:08] Dr. Ritamarie Loscalzo: And I've been having people do this for long time and getting the little meters. Now we have these cool things called CGMs. Continuous glucose meters and they're more and more available to the general public. And you can eat a meal and look at the thing and go, whoops, , my sugar went up way too high.

[00:12:25] Dr. Ritamarie Loscalzo: . So the biggest problem with the testing is that all the tests are not done properly or not recommended. But the other thing is the measurements, the measurement ranges are like, they're for people who already have the. I personally don't want to find out that I'm on a path to diabetes, right when I get it.

[00:12:46] Dr. Ritamarie Loscalzo: No way. I wanna know, oh, you're heading that way. You're heading that way. When you go back to symptoms, the symptoms are things that almost everybody is experiencing on a day-to-day basis. That fatigue, hard to get up in the morning, [00:13:00] second wind late at night, falling asleep at your desk at four in the afternoon.

[00:13:04] Dr. Ritamarie Loscalzo: People think that's normal, right? I get that normal slump in the middle of the afternoon. That's not normal, right? Finishing a meal and then needing something sweet, right? Brain fog, all of these things that most people think are normal, everyday symptoms, and I'm fine. Everybody else has this. And those are all early signs of insulin resistance, metabolic dysfunction.

[00:13:28] Christa: All right, cool. So you're right. So many people have those things even though they were very specific. And so I love that we can be checking at home. This is how I approached. I failed my first glucose tolerance test with my, one of my babies. They made me do the follow ups, which I passed, but what a miserable sentence for my body to have to go through that test.

[00:13:51] Christa: Instead, I got a glucose monitor, I think it was $30. I don't know how much they are. Sometimes there's fancier ones and less fancy ones, right? Yep. So we're [00:14:00] talking about postprandial measuring after meals. Anyone can do this. Anyone can go buy the machine. The strips cost the money. You gotta calibrate the strips of the machine just walking you through, like you could really do this.

[00:14:09] Christa: And that is the most recognized number for one 40. Less than one 40 milligrams per deciliter post two hours post meal. What are the functional ranges for more optimal levels? Two hours post 

[00:14:21] Dr. Ritamarie Loscalzo: meal, two hours post meal. It should be the same as it is before the meal. It should be 85. So 

[00:14:27] Christa: what about fasting, do you think it should also be about the 

[00:14:29] Dr. Ritamarie Loscalzo: same?

[00:14:30] Dr. Ritamarie Loscalzo: Fasting should be around 85. It could be in the seventies, it could be lower. If somebody's following a low glycemic diet and they're trying to get into ketosis seven, you see it in the sixties and seventies, and that's fine, but it shouldn't get out of the mid 80. It could shouldn't get beyond 85 to 89.

[00:14:44] Dr. Ritamarie Loscalzo: It just shouldn't get outta the eighties. There's studies that show that once we hit in the nineties, there's four times the risk of cardiovascular disease, yet people are being tested all the time and, oh, your glucose, fasting glucose is 93, it's fine. 98, it's [00:15:00] fine. But once it hits that magic 100, . Even if you're at 98 for years before it hits a hundred, now you're insulin resistant.

[00:15:08] Dr. Ritamarie Loscalzo: That's the fallacy in medicine of diagnoses. You're fine. You're dead. Right? Or you're fine. You're very sicking in the hospital and we are looking at gradients, right? From a functional perspective, you wanna know the gradients, where are you heading?

[00:15:22] Dr. Ritamarie Loscalzo: And so what most doctors don't do, there are some that do is track people over time. What's happening to these numbers? Oh, you're still in the normal range, but, huh? You keep getting a little higher. Do we wanna wait until you're sick, or do we wanna address that and find out what's causing that before you get sick?

[00:15:40] Dr. Ritamarie Loscalzo: That's the medicine of the future. 

[00:15:42] Christa: So I wanna talk about everything that we can do with this, and I wanna talk a little bit about hypoglycemia. But before we do, I wanna go back to the other marker that you said that is usually not drawn. This is something you'd ask your provider for, which is insulin, but then there's the normal range which we're basing.

[00:15:55] Christa: Typically those ranges are adjusted like. Every handful of months [00:16:00] by the current population, which is not good. These numbers keep getting worse and worse the longer you've been in practice. So what is, what do you think the range or the number or the threshold for appropriate insulin should be? 

[00:16:13] Dr. Ritamarie Loscalzo: It should be ideally between two and five, no higher than five fasting, and then ideally it's between two and three.

[00:16:21] Dr. Ritamarie Loscalzo: And there's numerous studies that. For ideal health, two to three, two to five. I give people a little grace and a little leeway, but the range that the lab says is okay is up to 19 and sometimes even 25. You're very sick if your insulin is up there because the insulin is damaging your blood vessels.

[00:16:40] Dr. Ritamarie Loscalzo: The insulin is damaging, keeping your blood sugar high. It's causing the cortisol to go. It's all these other. That the insulins, it damages thyroid receptors, which most people don't realize that connection. . 

[00:16:52] Christa: Totally. Okay. Let's talk about what people do with it. Let's say that, because we can talk about diet, but we can talk about much more than [00:17:00] diet and other things in lifestyle, and I actually wanna talk about.

[00:17:02] Christa: Things before we get into all the things we can do, let's just abstractly about what affects blood sugar besides diet. Is there, when you are monitoring trends, do you see anything with menstrual cycles? Certainly exercise, but what are some of the other things that happen in life that affect blood sugar?

[00:17:17] Christa: Stress is a biggie. 

[00:17:18] Dr. Ritamarie Loscalzo: Stress is one of the biggest ones, and guess what? Most people are stressed 24 7. We have this perpetual tiger chasing us. That doesn't let. and that causes the insulin to go up, the glucose you up. But it causes the cortisol to go up and cortisol mobilizes sugar from stores.

[00:17:35] Dr. Ritamarie Loscalzo: That's what it does, because you're supposed to be running away from that tiger, right? And when there's no real tiger there, then you have all this sugar that's mobilized into your blood that causes increased insulin, and then that causes insulin resistance. . So stress is a biggie. Sleep is huge.

[00:17:50] Dr. Ritamarie Loscalzo: They've done studies where they've taken pupil who were quote unquote normal and deprived them of sleep for a couple of days in a row and then [00:18:00] gone back and looking. Now they're pre-diabetic. Yeah, I talked 

[00:18:03] Christa: about that study on another podcast, . I don't know if it took a week or two weeks. We talk about it in, at the episode if someone's listening, cause it will have come out before this.

[00:18:10] Christa: Then it's Sister Katie and Rhythm one with Julie Gillian Grieves and we cite that one, but it's alarming. It's 

[00:18:16] Dr. Ritamarie Loscalzo: a, and it could be just a one night, it could be just two nights. Now, depending on how long you're going without sleep, it'll take less or more time to return to normal. But yeah, these, some of the studies are just a couple of days.

[00:18:28] Dr. Ritamarie Loscalzo: A couple of days. Certainly the longer ones are gonna have more persistent insulin resistance. What? So here's the thing, timing of meals, right? Right now things are like intermittent fasting is the rage, and or looking at getting into ketosis and all this. I've been talking about this for I don't know, 15 years.

[00:18:48] Dr. Ritamarie Loscalzo: Like you need space between your meals minimum. Four to six hours between your meals o overnight, minimum 12 hours, right? You let the body go down to [00:19:00] baseline to allow the levels of insulin to go back down to normal. Otherwise, you're in this mode where insulin is up all the time. Insulin is a fat storage hormone and it puts the breaks on fat burning.

[00:19:13] Dr. Ritamarie Loscalzo: So there are so many people who are doing the 1200 calorie a day diets and saying, why can't I lose weight? Why can't I lose weight? It's the balance. It's the frequency of eating. It's what they're eating. It's the lack of sleep and the stress and the other things that create this problem with elevated insulin all day long.

[00:19:30] Dr. Ritamarie Loscalzo: And the old. School stuff where they'd say, oh, grazing is the best thing. Eat four to six meals a day. That way you can keep your blood sugar steady. Yeah. You keep your blood sugar steady, you keep your insulin elevated and you turn off fat burning. Nobody really likes when fat burning gets turned off, unless you're super skinny and high metabolic brain.

[00:19:50] Dr. Ritamarie Loscalzo: You need that. , I have 

[00:19:51] Christa: questions about that, and I'm gonna save 'em for any caveats around that when we get into hypoglycemia and other things. But before we do things that affecting blood sugar, besides diet, we have stress because, [00:20:00] Stress increases cortisol, mobilizes, sugar from stores. So on the same note, drinking coffee all day long 

[00:20:05] Dr. Ritamarie Loscalzo: could do that, right?

[00:20:06] Dr. Ritamarie Loscalzo: Yeah. Absolutely. How many and people are doing that, right? They, because they're so tired , right? Because of this metabolic dysfunction, they're exhausted and they're just trying to stay awake. , 

[00:20:16] Christa: Totally. Anything to say about alcohol and then also like those special times of life, like pregnancy, blood sugar, will vary a bit as well.

[00:20:23] Christa: So I wanna talk about those. Marker. . 

[00:20:25] Dr. Ritamarie Loscalzo: Yeah, so alcohol. I don't have a popular opinion about alcohol and I know a lot of people are, oh, it's organic wine. It's just, and there are studies that show some benefits to small amounts of alcohol, wine in particular because of the rel on the other antioxidants. But it's damaging the lining of your digestive tract, which means that you don't get to absorb your nutrients at well, as well, it damages liver cells, it damages brain cells.

[00:20:50] Dr. Ritamarie Loscalzo: Right. I. Get rid of the alcohol. You wanna have a sip of champagne at your kid's wedding? Go for it. But not on a regular basis. I'm not a fan of drinking [00:21:00] alcohol on a daily basis. People are using it to relax. But what about relaxation techniques that are not double-edged swords? That's where I think we need to look at, right?

[00:21:09] Dr. Ritamarie Loscalzo: Yeah. There's some positive benefits to alcohol, but there's a lot of negative meditation doesn't have any negative downsides, right? Relaxation, breathing, yoga, things like that, that get you out of that stress state in a much more effective way. Plus, it's all those empty calories plus alcohol contributes to insulin resistance in fatty liver.

[00:21:32] Dr. Ritamarie Loscalzo: Yeah, I don't see any positive things. . 

[00:21:35] Christa: . How about markers or blood sugar ranges in pregnancy? How do the use change? 

[00:21:40] Dr. Ritamarie Loscalzo: They do, right? They do. Yeah. A lot of things change in pregnancy, right? If you have a subclinical thyroid problem, it becomes a clinical thyroid problem in pregnancy, right?

[00:21:49] Dr. Ritamarie Loscalzo: Yeah. And so there's a lot, the body's trying to grow a baby. We need more calories obviously, to grow a baby, but we don't need more sugar. We don't need [00:22:00] more starches, we don't need more things that are elevating the insulin. So I don't know the exact ranges. I haven't really, if I'm gonna look 'em up, I look 'em up, right?

[00:22:09] Dr. Ritamarie Loscalzo: , cause I'm not working with a lot of women in the pregnancy time, but, We see that women develop what's called gestational diabetes, so they're having problems with more problems with insulin resistance. Yeah, they probably had some problems before, but the conventional medical approach to diagnosing it, Fails miserably.

[00:22:30] Dr. Ritamarie Loscalzo: Big time, right? So we didn't catch it that I have problems with insulin regulation. I have some genetic factors. I have, 25 years of eating Cheetos and m and ms and ice cream like, and nothing else. And no veggies, right? So I'm gonna have much more sensitive levels of glucose in insulin and there's a lot of genetic factors as well.

[00:22:51] Dr. Ritamarie Loscalzo: So we need to be looking. Pregnancy as a time when a woman is eating to grow another. , that's when [00:23:00] you should be eating wonderfully. Not oh, I need more calories and gimme more Cheetos. Which is what a lot of people are encouraged to do because the doctors don't really know much about nutrition, right?

[00:23:11] Dr. Ritamarie Loscalzo: So I think it's really important that women get this under control beforehand. So I highly recommend the postprandial and looking at insulin levels, looking at hemoglobin a1c minimally, and getting those things under control. Preconception. So that you're more likely to have a really healthy pregnancy.

[00:23:31] Christa: . Yeah, it's hard. I wanna go talk about problem solving, but I can't help but take a little path down genetic lane here. And I have some questions around genetics related to this, so maybe they'll all fit in under this little side note here. . So I think about, this is always interesting to me because in hindsight I definitely had these like low.

[00:23:53] Christa: Blood sugar issues, right? I was like, always packed a bunch of snacks or would be hangry between meals and all of those things. Failed [00:24:00] my first glucose tolerance test with my first baby. Maybe, I can't remember if the second one. Either way, , I didn't keep doing them . I just started checking my blood sugar and then there was some shifts that happened in health, et cetera, and there was a massive difference.

[00:24:12] Christa: But I always used to say, I used to stop and think about it. It's always good to think about her history. My mom did have gestational diabetes with both myself and my little sister. Child, fifth and sixth out of those. Oh, wow. Which is interesting. So like that to me was enough. Are there specific genes and so I'm gonna put that question there and then I've got another question about just genetics and endocrinology presentation as well.

[00:24:35] Christa: Yes. Anything to say about that? Yes, genetics 

[00:24:37] Dr. Ritamarie Loscalzo: plays a role, I would say in about 25% of the people genetics are such that you've gotta be super. More super. That you're not gonna get away with eating ice cream and coke and these sorts of things because there's genetic factors.

[00:24:51] Dr. Ritamarie Loscalzo: And yes, there are. I've got a beautiful 16 page chart with probably, four to six to seven on each page that [00:25:00] describes these different genetic factors. , do I have them memorized? No. That's why I create charts. But, IGF one is one and there's receptors and there's all kinds.

[00:25:09] Dr. Ritamarie Loscalzo: Factors. And when you have a bunch of these, a cluster of these, you're more likely to have insulin resistance, hypoglycemia, insulin, glucose dysregulation. . 

[00:25:19] Christa: So this brings me to another semi genetic question, so I'll throw it here. This is really a listener question. That was, she said, the first question I always get asked from doctors is, does anyone else in your family have thyroid disease type one diabetes, et cetera.

[00:25:32] Christa: And she said, I recently said no until my daughter was diagnosed with type one diabetes a couple of years ago, and I was diagnosed with Hashimotos hypothyroidism in 2021. Does that make you think about anything in particular from a genetic standpoint? There's so much, I like to think about.

[00:25:48] Christa: You're so much when you're a woman, you get the genetics from your grandmother, right? Because the eggs of the mother in her womb, right? So there's just so many things that are not really in your control, but it's in, and like maybe you're the [00:26:00] beginning of these, but it's what do you think about this situation?

[00:26:03] Christa: Yes. 

[00:26:04] Dr. Ritamarie Loscalzo: So there's the genetic factors and what you said about the grandmother. . There's also the epigenetics and epigenetics we find are past generationally. It's not just oh, it's what you do during your life. Epigenetics is the modification and the, whether certain genes are being expressed or not, but that's controlled by your diet, your lifestyle, and all the other factors.

[00:26:23] Dr. Ritamarie Loscalzo: And if you are someone who has bunch of stuff that you've epigenetic. . I don't wanna cause, cause cuz I don't wanna use it as blame. But you've created because of exposure to glyphosate, exposure to mold, exposure to this bad food choices, stress, et cetera, then that can be passed on, not just to your children, but to their children.

[00:26:44] Dr. Ritamarie Loscalzo: . So those kind of things increase the likelihood of your offspring. Having problems with blood sugar, balance with insulin resistance with diabetes. So having those questions is super important. Now, there's a bunch of factors that affect the thyroid [00:27:00] expression. There's a few that C T L A in particular comes to my mind is a specific gene that if you have that you're more likely to be a subject to having Hashimotos and more likely to be sensitive to gluten as one of the underlying causes of Hashimotos.

[00:27:15] Dr. Ritamarie Loscalzo: And there's a whole bunch of other thyroid related I. Seven page chart, of thyroid related SNPs, and those are important factors, but the interaction between the two is often just not even thought about. And there's a number of studies that show if you have. Out balanced thyroid, it's gonna be really hard to get your glucose under control.

[00:27:38] Dr. Ritamarie Loscalzo: If you have really hard, really out of balanced glucose and insulin control, you're gonna have a hard time getting your thyroid under control. And the other piece which relates to all of the endocrine system, what we don't really think about is the receptors on the cells. So the receptors on and in the cells and the nucleus and the mitochondria, et cetera.

[00:27:57] Dr. Ritamarie Loscalzo: So when we look [00:28:00] at receptors, that's oh, there's plenty of thyroid hormone in the blood. It's not getting into the cells, right? If it's not getting into the cells, it doesn't do any good to have it in the blood. Oh, your thyroid levels are perfectly normal. What about the intracellular? And that's really a functional assessment.

[00:28:17] Dr. Ritamarie Loscalzo: I've got constipation, I'm losing my hair, I'm cold, et cetera. I can't lose weight, et cetera. Those are symptoms, but what happens is insulin, excess insulin can cause receptor resistance for insulin, but it can also be related to receptor resistance for thyroid or estrogen for progesterone for a number of other hormones, and people don't even think about that.

[00:28:40] Dr. Ritamarie Loscalzo: I did a. Full day workshop a few years back for health practitioners on resistance, hormone resistance, and one of the leading causes of hormone resistance, estrogen resistance, progesterone, in addition to supplementing and over, over supplementing, which burns the receptors out, and inflammation was [00:29:00] insulin excess levels of insulin.

[00:29:02] Dr. Ritamarie Loscalzo: So it's not a good idea. To go get your insulin tested, and the doctor says, oh, it's 15. It's fine. No warning sign. No. That can create insulin resistance and also other hormone receptor resistance in addition to damage to the blood vessel linings and so much more. . Yeah. 

[00:29:19] Christa: You said something a little ways back that makes so much sense.

[00:29:24] Christa: Something that really annoyed me in the last, like handful of years was those subclinical thyroid symptoms not showing up on blood work. But it's like literally this is an issue. So it's circulating in the blood, but not getting into the cell. There's receptor sites and there's lots of co-factors that make that possible, right?

[00:29:40] Christa: B one 

[00:29:41] Dr. Ritamarie Loscalzo: Bs, right? There's a lot of nutrient selenium and all, but there's the, there's a. Mechanisms. I can just throw out a few of them, but there's a, sure it's integrate, but we've got the thyroid, which makes the thyroid hormone, and then it gets bound to a protein and then bound to the protein. It [00:30:00] circulates, and then when we're ready to activate it, the protein has to unbind.

[00:30:04] Dr. Ritamarie Loscalzo: If we have too many of those proteins, guess what? There's not enough free thyroid hormones circulating in the blood and we can't get activated. What kinda things can cause. One of the things that a lot of girls are subject to when they're teenagers is birth control pills. Estrogen causes increase in that thyroid binding protein.

[00:30:26] Dr. Ritamarie Loscalzo: Right? And then we can't free that. So that's why when we're testing, we can't just test ts H and say, oh, you're fine. Your TS H is good, or Ts H and t4. No, you're fine. No you're not. Because we have to look at all those intricate mechanism. . Yeah, so we have Antiglobulin, but then we also have the conversion from T4 to t3.

[00:30:49] Dr. Ritamarie Loscalzo: What the thyroid makes is mostly t4, like probably 90% of what the thyroid makes is t4. That's not the active hormone, the activist t3, so we have to activate it [00:31:00] into. , T3 from t4 and things get in the way of that. Like specific nutrients. You mentioned a few selenium, gut imbalance, liver imbalance. All of these things can affect that conversion from T4 to t3.

[00:31:15] Dr. Ritamarie Loscalzo: But the other thing that can affect it we talked about earlier, is stress. , when the body is stealing like unsafe , it's no way, we're not gonna up-regulate your metabolism. So we have another hormone, which most doctors won't test. Reverse t. And so the body will turn on the brakes and say, Nope, nope, nope.

[00:31:34] Dr. Ritamarie Loscalzo: And what meaning, but poorly educated. Maybe doctors will do oftentimes and say, oh, the T3 is low. Let's supplement with t3. And that's overriding the body's intelligence to slow things down, to turn on the brakes, cuz it could be a, an infection somewhere, right? It could be some sort of folk eye of inflammation [00:32:00] somewhere to any number of things that can affect the conversion.

[00:32:04] Dr. Ritamarie Loscalzo: From T4 to T3 and thus increase the reverse t3. And here's the thing that most doctors don't know. We're getting really geeky with the labs, but is that they'll look and go, oh, your T3 is in the range. Your reverse T3 is in the range, so therefore you're fine. No, it's the ratio between the two, right?

[00:32:23] Dr. Ritamarie Loscalzo: And we have to have a ratio of at least 20 to one, three T, three to Rivers, t. . It's a little tricky to calculate cuz some of the labs do different to our ranges and measures, but pretty much about there you so you can't just take it in isolation. Oh, your reverse T3 is not very high. How is it in relationship to the free t3?

[00:32:41] Christa: Yeah, I was gonna ask if how you felt about the ranges that are published or more typical for reverse t3. Because sometimes I think it should, it's a bigger issue, but it's just not flagging quite as high 

[00:32:55] Dr. Ritamarie Loscalzo: as it should. No, because they're not looking at the ratio. . 

[00:32:57] Christa: Yeah. Yeah. Makes a lot of sense. I like [00:33:00] that.

[00:33:00] Christa: You're right. That is tricky when the units for the right are different, so that is only if the units measured are the same for T3 and reverse t3. If they're at all different, then that would not necessarily, then you just, it's a 

[00:33:12] Dr. Ritamarie Loscalzo: factor of 10 or a hundred, but there's a really nice conversion. I think it's stopped the Thyroid Madness website.

[00:33:18] Dr. Ritamarie Loscalzo: You just put the numbers in, you pick what the range is, what the measurement units are, and then it calculates it for you. I don't like to do the math, so I just Cool. I was sticking in 

[00:33:27] Christa: the formula. Yeah. All right, cool. So we've talked about some reasons that blood work looks good, but people don't always feel good from a.

[00:33:36] Christa: Thyroid perspective or symptom profile because of blinding globulins and then conversion of T4 to t3. 

[00:33:43] Dr. Ritamarie Loscalzo: Anything else? Receptors. The receptors that's the most often 

[00:33:47] Christa: overlooked, which get burned by insulin, 

[00:33:49] Dr. Ritamarie Loscalzo: like they get burned by insulin. They get burned by thyroid supplementation, right? So when we over supp, oh, your T S H is high, therefore we need to supplement [00:34:00] t4, maybe making plenty of t4.

[00:34:02] Dr. Ritamarie Loscalzo: You can't get it into the cells and it floods the cells and it can damage them. Inflammation, excess cytokines, which we're seeing a lot of that inflammation elevated homocystine, actually affects the thyroid receptors. Low vitamin A affects the thyroid receptors. So there's all these other factors that we have to look at.

[00:34:22] Dr. Ritamarie Loscalzo: We have to look at comprehensively, how's the nutrient status? How's the inflammatory status, how stress, all of those things play in. To whether you're gonna have good, proper thyroid function. And the un, the sad part is that a lot of folks go to the doctor with a clearly defined set of symptoms that looks like thyroid, and they're told, oh, your thyroid's fine here.

[00:34:45] Dr. Ritamarie Loscalzo: Take some Prozac for your depression. Take some stuff for your, whatever laxative for your constipation, et cetera, et c. Drink more coffee to keep you awake, that sort of thing. And if it looks like a thyroid problem and it smells like a thyroid problem and it [00:35:00] tastes like a thyroid problem, it's a thyroid problem, but it's a cellular level thyroid problem, and they're not thinking about that.

[00:35:06] Dr. Ritamarie Loscalzo: They didn't learn that in medical school. I don't blame them. You didn't learn it. But when you start to see so many people who are not getting. on the conventional treatment, or they get better for a time, then they plateau and then they start to go downhill. Personally, I'm a geek, so I like the science, so I dig in what really is going on here?

[00:35:26] Dr. Ritamarie Loscalzo: What are some of the other factors? 

[00:35:27] Christa: Yeah, thanks for going through those, because it's a really big topic and I always think that it takes. A bit of effort and some nuance. There's a lot of possibilities to love on that thyroid and yeah, because stress is such a big piece of it. You're gonna be loving on the thyroid for a while or for a long Yes, but don't stop loving on it is a thing.

[00:35:47] Dr. Ritamarie Loscalzo: No. And don't give up because you tried this supplement or that you tried, X, Y, Z company's thyroid supplement and it didn't. Totally. It didn't work because that didn't address your imbalances. , what are your imbalances? And [00:36:00] then we haven't even talked about Hashimotos, right? About the autoimmune, which most doctors are trained in medical school, that even if there's antibodies, there's something you do about it, just give them t4.

[00:36:10] Dr. Ritamarie Loscalzo: So why bother testing? Whereas when we look at autoimmune conditions, which are by the way, reversible, at least, I've seen them be reversed, then we have a specific set of stressors that we have to look at on the body. How's the gut? Is there leaky gut? How's the microbiome? Are food sensitivities an issue?

[00:36:29] Dr. Ritamarie Loscalzo: And with thyroid, most of the time, at least in my experience over the last 30 some years, is gluten is a big. And so we have to look at it. How's the stomach acid? If the person's not making enough stomach acid and they can't digest their proteins, they can't digest their minerals, right? There's so many factors that we have to play in, and if we identify that there's a thyroid autoimmune condition, we have to treat it as an autoimmune condition, right?

[00:36:55] Dr. Ritamarie Loscalzo: Not a deficiency of t4. ? . 

[00:36:58] Christa: Yeah. Thank you for [00:37:00] talking about that. And it brings us right back to insulin and helping improve those elevated insulin markers because insulin is a piece of damaging these receptors, endothelial, lining, et cetera. So we talked about appropriate ranges of insulin. That's it.

[00:37:17] Christa: Easy, simple enough lab that can be drawn when it is elevated, when it's above five. What are some of the action steps? And we did talk about it a little bit with talking about things about blood sugar besides diet, but what are some of the possible action steps for elevated insulin? 

[00:37:32] Dr. Ritamarie Loscalzo: So I put people on what I call it, a metabolic reset.

[00:37:36] Dr. Ritamarie Loscalzo: And the metabolic reset is let's not give the body any reason. To elevate the insulin for 30 days, and it's amazing how quickly the body can turn things around in 30 days. So we look at the diet and we take out all the high glycemic foods, all the things that cause it to go up. But getting back to postprandial, your high glycemic foods may not be mine.

[00:37:58] Dr. Ritamarie Loscalzo: So we have to look at that [00:38:00] postprandial glucose, and we teach people to map it. If they have a C G M, it's even easier and we take out all the foods. I'm very strict about this, unless they're already diabetic, and then we adjust the ranges. But for the average person who's just trying to, get this under control before it becomes diabetes, I say anything that raises your blood sugar above one.

[00:38:19] Dr. Ritamarie Loscalzo: It's out not two hours, it's at one 10. I'm saying at peak, because what happens with glucose and insulin is we eat a meal and we're at baseline. So here's where your sugar is, and then what happens is it goes up after the meal, depending on what you eat. If you ate lettuce, it's gonna go up a little bit.

[00:38:37] Dr. Ritamarie Loscalzo: If you ate, Cheerios, it's gonna go up like this. Oreos or whatever, and then it comes back down. So the key things are how high does it go and how long does it take to come back down? And even if it's back down to 85 at two hour mark, but it goes up to 180 in between, you're causing damage to your system.

[00:38:57] Dr. Ritamarie Loscalzo: So we have people remove those factors, whether [00:39:00] they are stressors, whether it's the sleep factor, the food, whatever it is, and we help 'em to restore sensitivity. To those receptors, the insulin receptors via some herbs and some nutrients and other things like that. I think 

[00:39:15] Christa: the key takeaway is if receptors have been damaged, are they repairable?

[00:39:20] Dr. Ritamarie Loscalzo: I have found with insulin and I, haven't worked with somebody who's been type two diabetic out of control with 500 blood sugar levels for decades, but in my experience, very quickly they're repair. Cool. Yeah. If you go back and start eating the Oreos again and drinking the Pepsi, you're gonna throw yourself into that same situation.

[00:39:39] Dr. Ritamarie Loscalzo: Same as if you break your leg and then you get it repaired, and then you fall down the steps again. You're gonna break it again. Yeah. Doesn't mean there's anything wrong with your therapy, it's just that you're putting that same stressor 

[00:39:50] Christa: in the system. Yeah. No, love that analogy. I'm gonna go ahead and borrow that.

[00:39:54] Christa: Go for it. Speaking of sleep, and then a little bit more about hypoglycemia and it'll wrap up. [00:40:00] So sleep is awesome. It's so wonderful, and yet the majority of the nation struggles with it. I wanna just specifically talk about the people that are trying to do everything they possibly can to improve sleep, but they're still struggling.

[00:40:13] Christa: Do you have any words of wisdom for them? When they're really struggling they've done lifestyle changes. They're working on gut health. They're doing other thi they're trying to work on. Slowly 

[00:40:23] Dr. Ritamarie Loscalzo: but surely it depends on what it is. It really does depend. And so I did a whole series and we're just wrapping that up now on my podcast of 6, 7, 8 episodes in a row.

[00:40:33] Dr. Ritamarie Loscalzo: So it goes back to the lifestyle factors, it goes back to the diet, it goes back to. Sleeping in a dark room. It goes back to looking at it for environmental factors. Are there EMFs in the room? So there's so many things that we could spend three, four days talking about sleep. It's complicated and a lot of people have done everything, but really they haven't done everything because they've taken every sleep aid on the market, whether it's pharmaceutical or [00:41:00] nutritional.

[00:41:01] Dr. Ritamarie Loscalzo: and that's really not everything. So we also have to look at trauma and stress and what's going on. Are they waking up in the middle of the night cuz they don't feel safe? , are there cortisol levels going up? So in that case, if you have sleep issues that haven't been responding, you need to work with a good functional medicine person.

[00:41:17] Dr. Ritamarie Loscalzo: Yeah. Because they'll be able to help you and do some tests and figure out what's really going. . 

[00:41:21] Christa: Totally. Okay. So I wanna talk about one other thing. We were talking about spacing between meals four to six hours, which I totally agree with. And then there's a caveat, right? When people have hypoglycemia or if their adrenals are, and this was you, right?

[00:41:35] Christa: So you had hypoglycemia. I don't know if that was slightly lifestyle driven or if there was some. So I see when people have had long-term, And they've damaged mitochondria, adrenal function, et cetera, and they're not producing real great D H E A. Sometimes they feel like they cannot go more than a couple hours and there's solutions.

[00:41:53] Christa: But sometimes the temporary solution is you may have to eat a little more frequently. Would you agree or disagree or you think, [00:42:00] is there any caveats to this? Just because yeah, you see a lot of those people. 

[00:42:04] Dr. Ritamarie Loscalzo: Yeah. I'm sure you do. And we all do. But you've gotta do it slow, low, and slow. And so it's looking at what are they eating when they're not fasting, right? Like they go and they eat this meal that's shooting the insulin up comes down, it goes back to testing insulin. Is it a hyper insulinemia that's causing. Hypoglycemia. Most of the time it is. So whether you're on this end of the spectrum or that the hypoglycemia diabetes or the low end hypo, it's the same dysregulation syndrome.

[00:42:34] Dr. Ritamarie Loscalzo: So you still have to look at all the possible factors and causes. But yeah, in the meantime, we're just gradually, oh, so you eat every 15 minutes. Let's go to 20, let's go to 25. Let's change the composition of those meals. Let's make sure you're getting enough protein and fat at those meals, and you're not just seeding carbs.

[00:42:54] Dr. Ritamarie Loscalzo: And a lot of people, they're just like, Loading up on carbs because they instantaneously make 'em feel [00:43:00] better, but then you get the crash. So we really have to look at it on deeper level to, yeah, there's no protocol for anything. It's really a framework of an investigation to figure out what the root causes and what the imbalances are.

[00:43:13] Christa: Yeah. I love that so much. So we've. I think a beautiful gamut of things that are so darn helpful for people, which are, you can test at home. You can go buy a 30 to $50 glucometer and test fasting, pre-meal and postprandial or two hours post-meal. Those are the, always the standards, not that those all three need to be done every day.

[00:43:34] Christa: Maybe you would recommend post-meal maybe a little bit more early on, but those are the main ones, unless you have any other exceptions to that, I would say. 

[00:43:41] Dr. Ritamarie Loscalzo: Yeah. And going back to. Like fasting glucose. I think the two hour postprandial is not all that useful. It's what goes on between the meal returns to baseline.

[00:43:52] Dr. Ritamarie Loscalzo: How long does it take to return to baseline? How high does it go in between? What causes that? Is it [00:44:00] stress levels? Is it exposures, is it food? Is it some specific thing? So it's really for each person identifying what those causes are. And I think that, two hour postprandial, yeah, it should be back down to normal, right?

[00:44:12] Dr. Ritamarie Loscalzo: And maybe it's a little longer because the meal was higher and fatter protein, maybe it's a little shorter cuz you had a bowl of fruit. But the point is that we need to find that for each individual person. Everybody has their own glycemic index, so to speak. So it's finding. Yeah, to 

[00:44:26] Christa: clarify what you're saying is actually check prior to the two hours postprandial to see how much Oh, 

[00:44:33] Dr. Ritamarie Loscalzo: absolutely.

[00:44:34] Dr. Ritamarie Loscalzo: They may need, they need to find their peak and the peak is usually 30 to 60 minutes. So somewhere in there. I usually have them the first couple of days, be it testing every 15, 20 minutes so that they don't miss the peak. Cuz some people peak really early and then crash and then at two hours they're like below base.

[00:44:53] Dr. Ritamarie Loscalzo: And if you're at three hours, if you're below baseline or two hours even, but most people it takes a little longer, then [00:45:00] that's a dysregulation. That's usually excess insulin. . And we need to test 

[00:45:03] Christa: insulin. Yeah. That's the beauty of a cgm, which we didn't talk a ton about, but it's essentially looks like a quarter.

[00:45:08] Christa: You stick on your arm, you maybe scan your phone next to it, it'll tell you what it is, and there's no needle pricking. So we. , we talked about checking with a glucometer or a cgm if we're fancier, and those have become more accessible to the regular consumers now. They used to be more expensive. , we talked about getting insulin checked and how the reference range should be between two and five, not 20.

[00:45:29] Christa: We talked about things that affect blood sugar besides diet. Talked a little bit about genetics. We talked, you gave three very amazing points about why you can feel like you have thyroid symptoms, but it's not showing up in your blood. Work from bind me to receptor sites to convers. Gosh, there's so many good things here and I really appreciate you going through all of this.

[00:45:48] Christa: I think endocrinology is just one of those areas that we could talk about for a long time. Long, long time, but you wanna leave people with today? Oh 

[00:45:56] Dr. Ritamarie Loscalzo: boy. There's so many things I could leave people with. Take charge of your [00:46:00] health. Don't trust the doctor. If you feel like you have a thyroid problem and you go to a doctor and they say, oh no you don't, cuz your G S H is normal, find a new doctor, be empowered.

[00:46:09] Dr. Ritamarie Loscalzo: Learn this stuff so that you don't have the les over your eyes and you don't have a constantly degrading condition until if it is a Hashimotos or something that your thyroid is destroyed and can't be brought back. Like you have self-healing mechanisms within you. Let's empower those.

[00:46:27] Christa: Dr. Rita Marie, where can people find you online? I 

[00:46:30] Dr. Ritamarie Loscalzo: am dr. Rita marie.com is my website. I am at Dr. Rita Marie on all the social media platforms, including YouTube. And if you're a health practitioner, go to i n e Method i n e method.com, and then we have all kinds of programs for training, health and wellness practitioners to actually do this kind of care in their 

[00:46:50] Christa: practices.

[00:46:51] Christa: Thank you so much for coming on today. It was a treat, and I hope to have you again. I 

[00:46:54] Dr. Ritamarie Loscalzo: would be happy to thank. 

[00:46:57] Christa: Sharing and reviewing this podcast is [00:47:00] the best way to help us succeed with our mission. To help integrate the best of East and West and empower you to raise the bar on your health story, just go to review this podcast.com/less stressed life.

[00:47:13] Christa: That's review this podcast.com/less stressed life, and you'll be taken directly to a page where you can insert your review and hit post.