Q&A #28: Lowering Heart Disease Risk—Functional Foods, Statins, & Cholesterol

Hey everyone, welcome to Crowdcast number 28, the October 2021 edition. Amazing, this is the 28th round of Crowdcast. For those of you that are new, generally speaking, I do see a lot of people posting questions in the chat here on the side. Just so you guys know, when my team and I are going through questions to choose for the upcoming Crowdcast, we do not look at the chat. We are looking at the question and answers section where people can vote on the questions. So please, please, please add your question to that section because that is typically what we go through to look for questions. Sure.

Generally what I do is I go through questions, I look at the top voted ones, and I try to go through every single question and find questions that I think may be interesting to cover because they're new, a new topic, maybe perhaps we haven't covered that before, or questions that have been asked in several ways, shapes, or forms by other people. So I go through and choose a few questions. Typically I will do a deep dive on a couple. of those questions. So I will go into depth on a couple of questions, and then some other questions may have a short answer, and then I follow up towards the end of the Crowdcast Q&A with rapid-fire questions. So these are questions that I can answer in a sentence or two, perhaps even a word.

So today's Crowdcast will have more— it heavily leans on more of the deep dive. Sometimes we'll have Crowdcasts where A lot of the questions are really easy to answer and they're sort of short answers, and so we'll have a lot of rapid-fire questions. Today, not as many rapid-fire questions, but we still will have some towards the end. And I also go through all the questions and try to answer some in future Crowdcasts that I did not get to. So if your question has not been answered this time, Don't worry, you can also resubmit it, but also even if you don't resubmit it, I do go through previous Crowdcast questions as well.

The chat I like to use for our live Q&A where we're having a discussion and people can ask questions, you know, on a topic that I'm currently answering a question on or, you know, related to or in some way. So as always, remember this These Crowdcasts are me and my team often diving into the scientific literature, giving— stating facts, you know, speaking to the data, perhaps somewhat of an opinion, but it is not medical advice. So if you do need medical advice, please seek it out from a qualified healthcare professional. With that, I'm going to go ahead and start with the first question on my list. That was a deep dive question. And I personally was interested in this question. I've seen a lot of people ask about it. So I'm excited to kind of dive into the topic.

The question was submitted by Rob. And Rob asks, hi, Rhonda. What's your take on supplementation with chondroitin and glucosamine to support bone cartilage health in athletes? So athletes have exceptional bone health because their lifestyle with high-impact exercise, which really helps improve bone density and also reduces the risk of fracture. But a lifestyle of really high-impact exercises can also take a toll on cartilage and joints. So athletes are also very susceptible to osteoarthritis. So let's talk about a couple of studies. In one small study, there were 66 participants. These were soccer and rugby athletes. They were found to have a higher rate of collagen degradation, but they had the same rate of collagen synthesis compared to non-athlete controls.

So net-net, that would be a loss of collagen because you're having— sorry, that would be a loss of collagen because of the higher rate of degradation. So supplementation with glucosamine, so this was 1.5 grams a day or 3 grams a day, so there was a dose response that was done, showed a decrease in collagen degradation after 3 months in these athletes. So both doses showed a decrease in degradation, meaning that even the lower dose of 1.5 grams of glucosamine a day was effective at decreasing the collagen degradation. Interestingly, the collagen synthesis was not affected by glucosamine supplementation, suggesting the Glucosamine seems to help stave off the accelerated degradation of collagen induced by high-impact exercise versus just full-stop increasing collagen synthesis.

And the authors concluded in that study, they said, based on these findings, it's tempting to speculate that glucosamine exerts a protective action against endurance endurance athletes by inhibiting type 2 collagen degradation, but maintaining type 2 collagen synthesis. So, it seems as though glucosamine could be continuously given to endurance athletes to help with that. However, when the glucosamine was withdrawn, in other words, after the trial ended, the collagen degradation came back. So, it has to be a continuous supplementation to help stave off the degradation of collagen. There was a similar study done. And this was a randomized double-blinded placebo-controlled trial. This was 43 college soccer athletes.

They were given either— they were given 2 grams of glucosamine a day or a placebo for 16 weeks. Similar to the previous study, collagen degradation was significantly decreased again in the glucosamine group, but not in the placebo group. Collagen synthesis was unchanged in either group. So this study with the 2 grams of glucosamine in soccer athletes was then repeated in cyclists. And the same results were found where it was— there was a significant inhibition of collagen degradation, but no effect on collagen synthesis. So I think really the strengths of these studies are that they used objective biomarkers of collagen metabolism rather than the subjective pain assessment that a lot of studies will use, which is, again, very subjective.

In osteoarthritis specifically, loss of collagen in a certain area, the synovial joints, precedes pain. So the biomarkers used here actually would be an earlier diagnostic for osteoarthritis before actual pain sets in. So pain actually was not assessed in either of these studies or any of the studies that I just mentioned. I think overall, there's very little data to compare athletes to older non-athletes, which are also very subjective to— very subject to osteoarthritis. So the studies I just referred to, these were young individuals, these were athletes, these were not older sedentary people. So it's hard to know if you can sort of generalize these findings and say, oh, Anyone who's prone to osteoarthritis should take a glucosamine supplement. Well, we don't really know that.

We know that it seems to really benefit athletes. Maybe there's something— maybe there's some kind of combination of exercise and glucosamine that is beneficial that you wouldn't see in a sedentary person. It's hard to know. Supplementation with glucosamine and chondroitin for older non-athletes is a little more nuanced. Doses of glucosamine less than 1.5 grams a day and chondroitin less than 800 milligrams per day have no effect on osteoarthritis, whereas doses greater than this show a very slight improvement on X-ray compared to placebo over the course of 2 to 3 years.

So there is— there's some, you know, preliminary evidence that the glucosamine above 1.5 grams a day— 5 grams per day and chondroitin above 800 milligrams per day can possibly help with older individuals in terms of improving their collagen and their osteoarthritis risk. There was a GAIT trial. This was the largest investigational study to address the issue of older individuals with symptomatic osteoarthritis. So this was 1,583 patients. They received either 1,500 milligrams of glucosamine 1,200 milligrams of chondroitin sulfate daily, or both glucosamine and chondroitin sulfate. They also either received a standard of care or a placebo.

While 64% of the glucosamine and 65% of the chondroitin and 66% of the combined glucosamine chondroitin group all saw improvements in their joint pain, it was not statistically significant. To the 60% improvement found in the placebo group. Again, pain is also very subject— a subjective measurement. But there was a sub-analysis that found for patients with moderate to severe pain at baseline, pain improvement was significantly improved with the combined glucosamine and chondroitin therapy compared to placebo. So that's kind of what the literature says. I know the question was really about athletes.

It seems as though There really seems to be evidence that glucosamine supplementation, 1.5 grams a day, was really the minimum dose that was found to be effective to inhibit the accelerated degradation of collagen. So, I think that seems pretty encouraging. Just checking the chat to see if there's any related questions. I'm going to move on to the next question. This question was submitted by Naomi. Naomi says, hi Rhonda, you mentioned on Rogan that lavender oil is a hormone disruptor. I have a family history of breast cancer and try my best to avoid any hormone disruptors. But lavender oil is in all my skincare products. It mostly— it's mostly at the lower end of the ingredients list, but it's still there, and I use these products twice a day every day.

I'm concerned, and I have done some research, but I'm still unsure about the whole topic. So lavender oil is a weak estrogen agonist and testosterone antagonist. In other words, Agonist means an activator, so it's a weak estrogen activator. And antagonist means a disruptor or inhibitor, so it's a weak testosterone inhibitor. There are several case reports where prepubertal boys and girls develop breasts because of their use of lavender oil creams. In these cases, the breast returned to normal after stopping the lavender oil use. So it was not a permanent change. There's no data to suggest there's an increased risk of breast cancer or any kind of cancer for that fact with lavender oil use. That is not to say that it doesn't have an effect.

We just don't have data to really know whether there is or not. There was one animal study that showed topical lavender oil use did not affect the size of the uterus, which is an estrogen-sensitive organ. So with that one study, it seems at least with one organ that we know is sensitive to hormones, like breasts as well, the uterus did not seem to be affected with lavender oil use. So I'm not sure it's a huge, huge concern for creams where You're not like applying lavender oil in and of itself. It's just a small little, you know, most of the time you'll have a small little drop of lavender oil that's in cosmetic products, sometimes for fragrance, sometimes for, you know, purposes of disinfection. It's, you know, lavender oil, a lot of these essential oils have antimicrobial properties.

And also it can be somewhat of a preservative in some regards. So most of the time when you have lavender oil in a cosmetic product down towards the end of the ingredient list, it's really not something that's in a high quantity. But that is something that you could discuss with your physician if you really are concerned about it. Frank says in the chat he's been taking glucosamine 1.5 grams for over 15 years and it's really helped with his arthritis pain. There's also been some studies interestingly on Meriva, the phytosomal curcumin, which is basically curcumin in a type of liposome. It's called a phytosome because it's dispersed a little bit differently, but pretty similar concept.

And there's been some— a couple of studies looking at biomarkers of inflammation like high-sensitivity C-reactive protein and a couple of cytokines. I can't remember off the top of my head, perhaps IL-6, looking at people with osteoarthritis and before, you know, at baseline and then after supplementing with the Mareva, and there was pretty significant effects on lowering the biomarkers of inflammation in these individuals. There was also pretty significant changes in their mobility and their distance to walk, timed distance walking. So they were able to take more steps in a shorter amount of time, presumably because they're having less pain.

So it's interesting that perhaps even in combination with this phytosomal curcumin, whether like a glucosamine would have an additive benefit, additive effect or not, or even just synergistic. That would be interesting to know. So, this next question was submitted by Gal, and the question has to do with a type of probiotic called L. reuteri. and its effects on lowering cholesterol. Hi, Rhonda. I remember you once mentioned that you were experimenting with this. I had trouble finding any probiotic supplements with adequate levels of L. reuteri to make any difference. Would love your advice on how I could intake more of this strain, whether through food or certain supplement brands. Also, have you had a recent talk or deep dive anywhere on things we can take for lowering cholesterol?

I may have missed it. Thanks. So this is a many-part question, actually. And the very last part of this question has to do with other types of nutraceuticals, lifestyle factors that can affect cholesterol. That was a question that was also submitted by other people in this Crowdcast. So I'm going to address that question as well. But first, let's talk a little bit about the L-tryptophan. So the best source— so by the way, we are in the process, I have a first draft of our L-tryptophan topics page article. For those of you that don't know about our topics pages, if you go to foundmyfitness.com, you can click on the topics icon in the toolbar on the top of the page, and that takes you to another page.

It says popular topics, gives you a list of the popular topics, but then as you scroll down, it alphabetizes every topic. And so right now we don't have an L. reuteri on there, but it will be, it will be soon. So make sure, um, that you guys check out our topic pages. They're really, really, really good. They're in-depth. They're like, in my opinion, they're what you would see as a review article in a peer-reviewed article. We do internal peer review. We even send out our topic pages to many authors that we cite in our articles and they give us feedback. So they're really— we have a great peer review, internal peer review process that we do at FoundMyFitness. So please check out our topics pages.

But the Albert Heijn yogurt, the best source in terms of like— I'm saying Albert Heijn yogurt because there's a protocol on how to make this yogurt and I have followed this protocol. You can find it on the— it's the Luvele, L-U-V-E-L-E.com. They have a blog and I will link to this when I send out the timeline email for this Crowdcast. They have a great blog on how to make L. reuteri yogurt and they list all the ingredients you need, the BioGaia probiotic supplement, There are some products you'll have to purchase in terms of being able to make the yogurt. It's not terribly expensive. It's a little bit of an investment, but you can play around with this protocol and make your own yogurt, which we've done a few times.

So that would be the best way to get the most amount of this specific type of probiotic. Is this making this yogurt. And again, you can find that on the L-U-V-E-L-E blog page. And in fact, I'm going to go ahead and just put this in the chat because this is the actual blog page where you can find it, the protocol. So that would be my recommendation in terms of sources of L. reuteri, best sources. Now, in terms of its effect on cholesterol, So the bacteria, the gut microbiome does play a role in recycling bile acids and cholesterol. So L. reuteri makes it so bile acids cannot be reabsorbed. So this has a net result of decreasing total cholesterol.

I know there's some new, there's some new pharmaceutical treatments out there that are sort of targeting the bile acids as well in terms of as an alternative to statins, for example, for a type of therapeutic that lowers cholesterol. So the L. reuteri probiotic does prevent the reabsorption of bile acids, and this then has an effect on lowering cholesterol. There have been some more recent studies in humans that have found the cholesterol-lowering effects of L. reuteri So there was one double-blind randomized controlled trial where researchers asked participants with high cholesterol to consume yogurt containing 5 billion colony-forming units of the microencapsulated L. reuteri or a placebo yogurt.

And participants that consumed the L. reuteri yogurt twice per day for 6 weeks found they had a 9% reduction in LDL cholesterol and a 5% reduction in total cholesterol. In a later study— and again, this was just from consuming the L. reuteri yogurt compared to the placebo group, which was consuming just regular placebo yogurt without the L. reuteri. There was a later study that was done where the encapsulated microparticles were added to food. And this was the same group that did the other yogurt study. They were testing the cholesterol-lowering effects. And found that the participants that had high cholesterol at baseline that consumed 3 billion colony-forming units of the L. reuteri for 9 weeks had a 12% reduction in LDL cholesterol and a 9% reduction in total cholesterol.

So that's pretty much the gist of the L. reuteri, I think that it's very interesting. And there's also been some other effects on mood as well. I think that, you know, it's something that I wanted to continue to experiment with. I've recently been doing a kefir yogurt. So, I'll mix my kefir with a little bit of the Bio K yogurt, which is a pretty strong probiotic yogurt. And then I mix it with some raspberries and blueberries in my little NutriBullet. And so that's something that I've been doing.

And what really kind of reinvigorated my, you know, wanting to use the kefir and the fermented yogurts again was the Sonnenburg study from Stanford, the small study that showed people that consumed kefir or kimchi or sauerkraut or some sort of fermented foods over the course of, I believe it was 4 weeks, they had a really big boost in their microbiome diversity and they also had lower levels of blood biomarkers for inflammation. And so I thought that was very interesting. Who says cholesterol is bad? I think there's a lot of nuance to that, and there are many people that have elevated cholesterol in combination with elevated triglycerides, elevated HbA1c, which is a long-term marker of blood glucose.

Perhaps they're pre-diabetic, perhaps they have familial hypercholesterolemia, and they've had a family history, someone who's had some sort of cardiovascular disease early. There are many reasons and nuances for, you know, why cholesterol can be problematic. I think the statement in and of itself saying, oh, cholesterol is bad in and by itself, is not entirely accurate, and perhaps that's what you're speaking to. But generally speaking, and we're going to talk about this in a minute, in a couple questions later about statins, but there is a whole— sort of dyslipidemia type of phenotype where there are many different factors to look at, cholesterol being one of them and being one that's one of many that can be modified. So Rachel's asking what brand of kefir I like.

Right now I'm using the goat kefir and I can't remember the name. Probably the one that's like most ubiquitously found in like, I get it, you know, I get them like a Whole Foods type of market. So something like that. It's the goat one. That's the one I like. So the second part of this question was also, again, it was submitted by other people in some shape or form, and it really had to do with things that can lower cholesterol and/or modify cholesterol. So before we talk about that, it's really important to remember that there are other modifiable risk factors that can increase the risk of heart attack and stroke independent of cholesterol. So there was the INTERHEART study that analyzed the lifestyle of over 15,000 heart attack patients from 52 different countries.

And they found that there were 9 modifiable factors that accounted for over 90% of first-time heart attacks. These factors were cigarette smoking. Believe it or not, everyone focuses on lung cancer with cigarette smoking. And the interesting thing is if you look at a graph, like a dose-dependent graph of how many cigarettes a person smokes a day and their Their risk for lung cancer, you'll see a very linear graph. In other words, the more cigarettes smoked, the higher the risk for lung cancer. Heart attack is one of— it's very like— it's probably one of the most robust effects that smoking has, and it's not linear. In other words, smoking completely dramatically elevates your risk of heart attack. Full stop.

So that's probably the number one modifiable risk factor for heart attack and stroke, particularly heart attack. That really is like, you just need to quit smoking and you can dramatically lower your heart attack risk. The other factors are dyslipidemia, hypertension, diabetes, abdominal obesity, and then there's psychosocial factors. A lot of stress factors, financial stress, social stress, things like that really increase the risk of heart attack as well. The protective factors were physical activity, a healthy diet, daily consumption of interestingly small amounts of alcohol.

The diet in this case was defined as a diet that was really heavy with vegetables and fruits and fiber, And foods with a low glycemic index, monounsaturated fat rather than trans saturated fat, and a high omega-3 fatty acid content as well. And diet and weight loss was another factor. So the study found that losing 5 pounds of fat could lower LDL cholesterol by 5%, and it could lower the risk of cardiovascular events by 25%. That's pretty significant for just losing 5 pounds of fat, lowering your cardiovascular risk by 25%. So I would say that, you know, there's a lot of lifestyle factors that play a really important role in a person's risk for cardiovascular disease, and cholesterol is really just one of many. So we can talk about some of the— The lipid-lowering nutraceuticals.

There's a really interesting review article that we can— we'll link to when we send out the show notes and the timeline that really summarizes a lot of these. I would say the main one is the omega-3 fatty acids. We've talked in detail about this, you know, many, many different Crowdcasts. Really, I would say the most robust evidence in terms of everything we're going to I'm going to mention here in a couple of minutes, anywhere between 2 to 4 grams a day has a pretty robust effect on lowering cardiovascular disease risk. There's, you know, effects on lowering triglycerides, lowering inflammatory biomarkers, lowering blood pressure, and also decreasing LDL cholesterol in some cases, particularly with EPA.

Some of the other sort of interesting nutraceuticals that have been shown to have some effect on Lowering cholesterol or lipids are some of the plant sterols and stanols. So these are found in nuts and seeds. 400 milligrams to 3 grams a day can lower LDL cholesterol by 8 to 12%. It also has been shown to lower C-reactive protein. Soluble fibers, 5 to 15 grams, can lower LDL cholesterol by 5 to 15%. Soluble fibers also reduce triglycerides and blood sugar levels. So it sounds to me like there's a, you know, it's not just one thing that's happening here, but it's affecting multiple different biomarkers and parameters that are known to affect cardiovascular disease. There's something called chitosan. It's a non-fiber lipid-lowering agent that's isolated from shellfish and sea crustaceans.

It inhibits cholesterol absorption in the bowel and it's really— 1 to 6 grams a day can lower LDL cholesterol by 5%. I haven't really looked into this. I don't know what the side effects are. I'm just mentioning it because I had never heard of it before and so I thought that was kind of an interesting nutraceutical. Probiotics, depending on the strain and the amount, have been shown to lower cholesterol anywhere between 0 to 5%. So we talked about arbuteri being one. Garlic, high-dose garlic, 5 to 6 grams a day can lower LDL cholesterol between 5 to 10% as well as decrease blood pressure. There's a dimeric form of pantothenic acid, vitamin B5, it's pantethine. It basically has the addition of a cystamine and 600 to 900 milligrams of it per day reduced LDL by 10%. That's pretty significant.

Bergamot, or I'm sorry, bergamot, 1 gram per day has been shown to lower LDL cholesterol between 15% to 40%, as well as decrease C-reactive protein and TNF-alpha. I'm just listing off some nutraceuticals that have been shown. I have no idea, you know, I'm not talking about like how safe they are or, you know, they could have side effects. That needs to be done, you know, for further investigation. I'm just sort of listing off some of the nutraceuticals that have been shown to affect LDL cholesterol and total cholesterol and other biomarkers of cardiovascular disease like blood pressure and blood sugar. Berberine is another one. We have a topic page on berberine. I know there was a question in this Crowdcast. Someone was asking about berberine being very similar to metformin in some ways.

Please go to our topic page. You can find it again, topics on the toolbar on foundmyfitness.com. Scroll down to the B section and you'll see berberine. Click on it. We've got a pretty comprehensive topic page that covers a lot of things, including negative effects. So look into that if you're interested in berberine. Berberine has been shown between 0.5 and 1.5 grams per day to lower LDL cholesterol by 15 to 20%. It's also been shown to decrease ApoB, triglycerides, C-reactive protein, IL-6, blood sugar, and blood pressure. So some interesting results there.

And, you know, it also may be one of those things where, you know, people— like, the biggest concern is, is it mimicking metformin for people that are physically active and, you know, negating some of the exercise-induced benefits of You know, adaptations that occur from exercise. Not a lot of evidence there to know either way, but, you know, this may be something that's beneficial more for people that are sedentary, perhaps. Interestingly, I'm not a huge, huge fan of soy, but there's been some evidence that soy, anywhere between 25 to 100 grams per day, can decrease LDL cholesterol by 3 to 10%. So those were some of the interesting nutraceuticals. I think that you guys can look into some of these or request we do a deep dive on one of these in general. But I'll leave it at that.

Okay, so this is sort of a good lead-in to the next question, which was submitted by Joanne. And this has to do with the statins. And the benefits and risks of them. So I think, you know, there's, there's a, you know, whether a lot— whether or not a person would benefit from taking statins depends on so many different factors, their personal risk for cardiovascular events like heart attack, stroke, coronary artery disease. The American College of Cardiology, there's a tool they have, it's called the ASCVD risk estimator. I'll link to it in the show notes again and the email we send out. It estimates the risk of a cardiovascular event in the next 10 years based on a variety of parameters like your age.

And so your blood pressure, your cholesterol levels, diabetes, all that stuff, gender, race. I've used the tool. I think it's probably a better— it's probably a better tool for people that are older. than someone that's younger. But I think another really important factor that often gets overlooked with respect to statins, like whether or not a person will benefit from statins, is their willingness to make lifestyle changes that could also be very effective in reducing their cardiovascular disease risk. We just talked about all these modifiable lifestyle factors. There's 9 of them that were identified in this huge study, 52 different countries. 90% of those lifestyle modifiable lifestyle factors were something that played a role in a cardiovascular event.

And what that tells me is that there's a huge, huge place for diet and lifestyle in someone's cardiovascular, you know, event or cardiovascular disease risk. And that is something that is often not emphasized when a patient goes into a doctor's office and gets a blood test or something like that. So I think that that is something that I'd like that's mostly emphasized, that I think that's the main thing is if a person is willing to make lifestyle changes, like if they're overweight and they're willing to try to lose weight, if they're eating a high refined carbohydrate diet in combination with saturated fat and they're sedentary, you know, and definitely if they smoke, I mean, that's a no-brainer. But, you know, these sorts of changes, they have to be willing to make them.

And if they're not willing to make them, if they're not willing to lose weight, if they're not willing to change the way they're eating, if they're not willing to exercise, And they have a high risk of a cardiovascular event. So the American College of Cardiology recommends that people with LDL cholesterol over 190, in combination with other factors like dyslipidemia, high blood pressure, high blood glucose levels, things like that, if they have diabetes, that they take a statin. And again, I think, you know, for someone that is not willing to make any changes, there's just been a lot of evidence, large, large randomized controlled trials showing time and time again that these high-risk individuals with this high-risk profile of high cholesterol, high blood pressure, high triglycerides, dyslipidemia, all these things, that they will— Live longer, significantly longer, and they will have fewer cardiovascular events if they take a statin.

And that's where I think a sort of generalization has come into play and an overprescription of statins has sort of dominated in some ways because now— because there's been such strong evidence that you can prescribe these people statins and it will absolutely lower their risk. their risk of a heart attack or stroke or coronary artery disease and it will extend their lifespan, like their all-cause mortality will go down. Like that's really been shown very strongly. I think there's been this over-eagerness to prescribe people statins, which do have risks. And, you know, so it's a bit of a problem in some ways, you know.

So there's been some studies that have shown high-risk men taking 40 milligrams of a statin for 5 years had a decrease, you know, 26% decrease in their LDL cholesterol, but more importantly, they had a significant decrease in their risk of cardiovascular events. And they live longer, these men live longer. And there was, again, a decrease in all-cause mortality. But this has not really been shown for people with a low-risk profile. And so the problem is you start to like overprescribe it to people just because they have maybe high cholesterol in a range that's considered excessively high. high, but perhaps they don't have all the other risk factors, right? So it's really, I think, a lot more nuanced.

Also when it comes to people with moderate risk, so people that do have a few of the perhaps risk factors or a couple of them, but they aren't necessarily high risk, you know, things like doing the particle assay where you're measuring not just— you don't just measure total LDL cholesterol, but you've got to look at the small dense LDL cholesterol. You have to look at the type of cholesterol that's actually atherogenic, the stuff that's actually playing a role in causing these cardiac events. And Dr. Ronald Krauss, a good friend of mine, and he was the inventor of this assay to actually measure particle size of lipoproteins. And I think it's something that is not standard yet and it's something that needs to— a lot of patients have to request.

But generally speaking, if you request it, a physician will do it. Well, they'll— they're not gonna, you know, really, uh, say no to measuring more things. Um, with the risk factors, there, you know, statins— there's the general things. It can cause mild liver damage. It's associated with an increased risk for diabetes. Um, but, you know, that risk is like 1 per 1,000 individuals. There's also a risk with a severe deterioration of skeletal muscle, sarcopenia. So statins inhibit the body's production of coenzyme Q, of ubiquinol, and this may be really responsible for the muscular side effects. And also, I think it could be responsible with some of the cognitive effects.

There's been a variety of studies looking at the lipophilic Lipophilic statins, so the ones that are— that can cross over lipid membranes better. So these include— they include atorvastatin, lovastatin, simvastatin, and that's it. Those are the lipophilic ones. There's been studies that have linked them to an increased risk for Parkinson's disease. Now, coenzyme Q is really important for mitochondrial function. And Parkinson's disease is notorious for mitochondrial dysfunction being at the heart of it, being at the root of it.

So I mean, do you need to unnecessarily put someone at risk for some of these side effects when perhaps all they have is high cholesterol and they don't have the other risk factors and you didn't take time to look at that because you just thought, oh, their cholesterol is over 190, I'm giving them a statin, they're at risk. Or perhaps they're not overweight, they eat a good diet, they just have some kind of genetic high cholesterol, but there's no family history of cardiovascular disease or— so there's lots of things that are sort of at play here.

And while I do think statins have absolutely saved people's lives, I think the people's lives that they've saved are the people that are high risk for having a cardiovascular event and they're people that are not willing to make a lifestyle change. Okay, so that was a long-winded answer, but it's really, it's an important topic. It's one like, you know, I've got I have family members that have been prescribed statins that absolutely did not need it and had terrible side effects. I also have family members that, you know, probably are at a high risk of a cardiovascular event and are not making other lifestyle changes. And so I'm wondering, would they benefit? Maybe they would, you know. So it's really— it comes down to just— there's an individual basis.

And I think the problem is that that oftentimes gets overlooked when you have a patient in the doctor's office and doctors are seeing so many patients a day. And sometimes it's just easy to look at this one number and go, oh, this one number is high, maybe I should prescribe them a statin. So it's a bit of a problem. And you can see it's also very nuanced. I'm not like saying statins— Statins do save people's lives and they absolutely increase people's lifespans as well. So there are certain people that will absolutely benefit from them. And Maxime is asking in the chat about all these other factors, ApoA/ApoB ratio. Exactly. All these things are important. There's a lot of factors to look at when looking at someone's overall risk.

And so when I'm saying a high risk or low risk, it's talking about looking at all these different biomarkers, not just just one biomarker, right? So there's many different things. And again, someone's, you know, blood sugar regulation is also very, very important for cardiovascular, you know, disease and cardiovascular risk of having a cardiovascular event. So again, something else that's really important. Moby's asking in the chat about stopping a statin once you started. That would be something to talk about with your physician and, you know, talk about lifestyle changes that you're making or have made or want to make and maybe, you know, tapering down on the dose and eventually trying to see if you can get off it.

I think that would be something that a person would need to discuss with the physician. I am not a physician, so I don't know anything about just stopping statins. whether or not that's safe to do or not. I think that would be something that could be discussed with a physician. And they— and for the most part, if you're willing to make these lifestyle changes, I think they're willing to go ahead and give it a shot and see how it goes. Okay, so the next question was submitted by Jen, and Jen asked about melatonin and thoughts on regular daily use of melatonin. And this is a really— it's also sort of a nuanced— there's a nuanced answer to this question.

I think most people that are under the age of 45 or 50 don't necessarily need a melatonin supplement unless they have some sort of sleep disorder or are traveling into a different time zone where melatonin can sort of help in some cases, help with your readjusting your circadian rhythm. I personally, have something called REM sleep disorder where I get night terrors. And melatonin use, like supplemental melatonin use, has almost completely stopped them. And if you look at the actual normal treatments for REM sleep disorder, it's terrible. They're like benzodiazepines. I mean, no way.

So the fact that melatonin can really play a really significant role in dampening the night terrors and make it so a person wouldn't have to use something so terrible for you, I think is really, really encouraging and should be absolutely used way, way more than it is in terms of the people that have night terrors. But let's talk about people that are younger, don't have a sleep disorder, aren't traveling in another time zone. There have been meta-analyses that have shown that melatonin can help people who struggle with going to sleep. So that would be the sleep latency. And it really does not have benefits for people who struggle staying asleep.

And these meta-analyses have shown that on average, it improves sleep onset by about 4 minutes and increases total sleep time by about 15 minutes. These are averages though. So I think the reason why they're so low is because melatonin, it only works in certain circumstances. And so there's a lot of other reasons why people are having poor quality sleep other than their melatonin production and their sleep onset. Another thing is that melatonin supplements do not improve sleep onset if they're taken right before you want to go to sleep. It takes at least 30 minutes for your body to digest it. And so really, it should be taken 1 to 2 hours before you actually want to go to sleep.

And that's a really common problem I see a lot of friends of mine or, you know, family members make that mistake where they just try to take it right before bed, and it's like, well, it doesn't do anything. So taking it 1 to 2 hours before bed is sort of a good rule of thumb. Melatonin production decreases with age, so as we age, and it can cause fragmented or delayed sleep in individuals that are 50 years or older. And that does have a lot to do with the precipitous drop-off in melatonin production as we age. Taking between 0.3 and 0.5 milligrams per day has been shown to be pretty sufficient in achieving normal physiological levels of melatonin. Taking 0.3 to 1 milligram You know, doesn't necessarily— it won't necessarily improve your sleep more than taking the 0.3 to 0.5 milligrams.

And taking really, really large doses of melatonin, particularly people that take it right before bed, it often can cause morning grogginess because the physiological levels of your melatonin get so high in your bloodstream that they're still high and elevated when you wake up. And so people will often be sort of drowsy when they wake up in the morning as well. There's been some other evidence that I've seen that's been referenced by some of the MIT researchers that were really involved in doing some of these original melatonin supplementation trials, where they suggest there may be a desensitization desensitization of some of the melatonin receptors, particularly melatonin 2 receptor in the brain.

And so it could cause a dependence on supplemental melatonin if someone's taking these supraphysiological levels of melatonin daily. Again, I'm taking a high dose because I've got this REM sleep disorder, and it's like really the only thing that completely stopped it. And so To me, that's pretty a pretty good reason to to take it. Plus, I I do sleep really well. So so that's sort of the exception. But I think it is kind of it's it's not really I wouldn't say there's super super strong evidence to say for sure it's going to desensitize your melatonin receptors. There's been some suggestions of it, and I there needs to be more evidence to convince me that that absolutely is happening. I think there's a good theoretical plausible hypothesis behind that.

I would like to see more evidence of that, but it is something to consider. People, I think, that are having problems sleeping, you know, one of the really main— like people that are not 50 and older that are experiencing this, you know, precipitous drop in endogenous melatonin production, you know, one of the main things you can do to make sure your melatonin levels are high when they're supposed to be is early bright light exposure that resets your circadian clock. And that means once that clock is reset, you go outside for 30 minutes in the morning, get bright light. It needs to be bright. It needs to be more than just inside with the lights on.

And you need to be outside even on a cloudy day, like getting outside, drink your coffee outside, go for a walk, go for your— do your exercise outside. That will reset your clock so that as evening comes, your body is making melatonin when it's supposed to earlier so that you actually go to sleep and have a decent bedtime. The other thing obviously to do that most people focus on is to then avoid blue light exposure at night because again, that would— there's a twofold problem here. One is you're not resetting your clock at a normal time because people don't ever go outside anymore. We spend all our time indoors in offices, schools, you know, so like people's clocks aren't being reset with the bright light exposure. That's the biggest problem.

Um, but the second thing is that when we do come home at night, we have all our lights on in the house. And so, um, getting a dimmer, you know, getting something as simple as those orange goggles you can wear, getting Philips Hue lights that you can program to turn red at night, you know, there's a variety of options out there that are some more affordable than others. And that would be another really important thing to do because you don't want to inhibit your melatonin release. Digital screens, lots of apps you could have on your computer or phones. And you can also turn down the backlight on your TV to zero so that you're not having the bright blue light. And then caffeine, of course, like drinking caffeine Can reset, can delay your circadian clock by like 45 minutes.

So, like the other night, I had a decaf espresso after dinner. It was kind of like a treat. It was decaf, but you know there's still caffeine in it, and it absolutely disrupted my husband and I sleep. And we knew exactly why. So, I think those things having that good sleep hygiene is is. is really paramount to taking a melatonin supplement unless you have a real bona fide reason to take it. And then people that do start to have their drop-off of melatonin because they're older, taking between 0.3 and 0.5 milligrams, again, should be enough to raise melatonin levels to a physiological, like a normal physiological level. L says, I would love to see a melatonin topic page. I would too. Great idea. That is actually on our list of topic pages to cover. So thanks for reaffirming that.

Maxim is asking in the chat, does melatonin prolong the REM phase of sleep? I am not aware that it does that. I mean, really, I think the strongest evidence is that it really helps with the sleep onset, and that's pretty much it. But who knows what do— when you go to buy a melatonin supplement from any nutraceutical company, you'll see— and often it's hard to find low doses. Most of the time, you'll find the lowest dose 3 milligrams, which is quite high. So the question becomes not does melatonin prolong REM phase of sleep, as does the supraphysiological doses of melatonin, what effect does that have? And I don't know. There's been tons and tons of research done on these super high doses, you know, 5 to 10 milligrams of melatonin. So there's a lot of unknowns here.

Francesca's asking about eating and how eating close to bedtime affects sleep. I think there's been a lot of data that has now shown that eating food, certainly 2 hours, but like if stopping eating 3 hours before bedtime really seems to improve people's sleep. You know, you don't want your body digesting food while you're sleeping. Like, like that's that sort of stuff. Just like ambient light or ambient noise that you may not even know is there. Let's say you have a window open and you're relatively close to a road where cars are driving by or something like that stuff will wake your brain up in the middle of the night, even though if you don't actually know, you're not aware of it, it affects it. And so. I think that that could also be the case, you know, with digesting food.

Like, your stomach's gurgling, you're doing all— like, all this digestion's happening. Like, you know, that probably also is going to affect your sleep. And I know that a lot of Dr. Satchin Panda's data on his— with his using his My Circadian Clock app, the clinical data he's gathered, has shown that it really does affect people's sleep. I do— Maxime's asking if I use a sleep tracker. For the longest time, I was using my Oura Ring. I haven't been wearing that because my battery is so terrible on it now. I have to charge it every day. I have an Eight Sleep mattress, which also somewhat tracks my sleep. But I do, I did, I did enjoy the Oura Ring, so I might just get another one that has a better battery life because the constant recharging is a big, big hassle.

Okay, so I'm gonna move on to some COVID-related questions and then finally end with some rapid-fire questions. There were a couple of COVID-related questions. Victor was asking, Dr. Patrick, I have 3 kids, all girls, age 11, 16, and 18. We've been asked to get our children vaccinated for COVID-19, and I wanted to get your opinion on safety concerns. We are in Australia, so currently available options for us are AstraZeneca, Pfizer, and soon Moderna. Thank you. So I'm not a huge fan of the adenoviral COVID vaccines. particularly AstraZeneca, because AstraZeneca did not make the 2 proline amino acid insertion into the spike protein that, for example, the Johnson Johnson adenoviral made. All the mRNA vaccines made them. And so there's a few reasons for that.

My concern for that is, one, body is making post-fusion antibodies against that spike protein post-fusion. So the, the 2 prolines that were inserted locked the spike protein into the pre-fusion conformation, and that's really important because it can't make a structural change into this post-fusion conformation. And, and therefore your body does not make a type of antibody called post-fusion antibodies. And post-fusion antibodies have been shown to play a major role in antibody-dependent enhancement. So all the vaccines that are in the United States have this insertion, and so none of those vaccines elicit the production of post-fusion antibodies, but AstraZeneca does not have that.

And so I'm not a huge fan of that particular vaccine, and also adenoviral vaccines in general, I'm not a huge fan of for other reasons. With respect to children, you know, I think the biggest concern is myocarditis, and girls have the least risk of myocarditis compared to boys aged 12 to 17. So I think the study that has me the most concerned about boys which we'll talk about in just a minute. In that same study, girls only had a risk— 1 per 100,000 girls aged 12 to 17 got myocarditis and were hospitalized for myocarditis, but it was treated. So I think girls are at a much— have a much lower risk of adverse side effects from vaccines, but— But let me move on to the next question because it really relates to my opinions on children getting these COVID-19 vaccines.

And I think, so this question was from Rayanne. Rayanne says, this is another vaccine question, but it's specifically asking about children under 12 and the mRNA vaccines. I'm asking because although I'm fully vaccinated, I have some concerns about the inevitable pressure that will come to vaccinate my young children soon. as they're approved in Canada. I would not be as apprehensive about a more traditional vaccine, but I'm not sure how I feel about vaccinating young children with mRNA vaccines at this stage. Wondering your opinion. I do have pause about vaccinating children with any COVID-19 vaccines. And what I mean by pause is I don't think we have sufficient data to know for certain that they're completely safe in children. I think that's a different case for adults.

Most of you guys know my opinion, but specifically for children, there have been a couple of studies that have come out that have given me pause. And I think if you look at the different types of vaccines that are being used, there's the Pfizer vaccine and the Moderna vaccine. And For children aged 12 to 17, they're receiving an adult dose, which is for Pfizer, 30 micrograms, and for Moderna, 90 micrograms. There are fewer side effects and fewer myocarditis events happening in children that get the Pfizer vaccine versus Moderna. So I would say hands down, it looks like Pfizer is safer for children. Whether or not it's even safe is still another question. I'm just comparing the two.

There was a pretty recent study that came out and it really showed— it's not been peer-reviewed yet, so I'm waiting for peer review, but a couple of things that it showed. One, that the Vaccine Adverse Events Reporting Site, the VAERS as I call it, there's an underreporting of myocarditis in children, and that in and of itself is concerning. 2, it compared hospitalizations of children aged 12 to 17 from myocarditis induced by a vaccine in theory, so myocarditis that happened shortly after a child was vaccinated, or children 12 to 17 that were hospitalized from COVID-19.

And then I think the main findings from this study were that if you looked at All the males, all boys aged 12 to 15, there was a 1 in 6,000 chance of a boy aged 12 to 15 being hospitalized with myocarditis shortly after their second dose of an mRNA vaccine. If you looked at all the males 16 to 17, there was a 1 in 10,000 chance of a boy being hospitalized. with myocarditis shortly after the second dose of an mRNA vaccine. Girls, that was 1 in 100,000. So it was really much, much, much smaller risk. And just to give you some context, in 2019, the risk of dying in a car accident was 1 in 8,000. So, you know, it's still a— we're still talking rare events here, but Nonetheless, let's compare it to the hospitalization data.

So risk from being hospitalized from COVID for males was 44 per million, and compare that to all males, that was 162 per million. So really, it's, you know, these boys were being hospitalized for myocarditis shortly after their second dose of a vaccine compared to being, you know, hospitalized for COVID. Males with at least one comorbidity, so young males ages 12 to 17 that did have at least one comorbidity, whether that was high blood pressure, obesity, overweight, diabetes, they actually had a higher risk of being hospitalized from COVID than hospitalized after a second dose of an mRNA vaccine.

So in other words, It was the healthy young boys aged 12 to 17 that seemed to be at the highest risk for hospitalization from myocarditis shortly after being vaccinated compared to any other population. And, you know, I would say that basically we don't know if some of these boys actually had a SARS-CoV-2 infection. that's part of the peer review process will help bring some of that data out. But I think just knowing that data and seeing that, like, for example, in California yesterday, governor came out and said, once the vaccines are FDA approved in children, there will be a mandate in all schools, both public and private. And to me, I feel that is getting ahead of the actual data in terms of safety.

And, you know, it's a little— to me, it's a little concerning because, you know, I really think we need to follow the data and we need to look at, you know, all the data and make sure we're really, really certain about it before we start doing things like this, you know. And in fact, I don't think we should do this, but that's another question. The other thing I want to mention is that the most recent clinical trial that has been talked about in the press was using the Pfizer vaccine in children aged 5 to 11, and the Pfizer vaccine was dramatically reduced. So it went from 30 micrograms, which was given to the 12 to 17-year-olds, by the way, which I think they should reduce that dose in that age group. I think that would actually dramatically lower the myocarditis risk.

However, in the 5 to 11-year-olds, the dose was now 10 micrograms, so it's 1/3 the dose. And the study that I was mentioning just now with the hospitalizations that also include Moderna, and we know Moderna, these children 12 to 17 are given 90 micrograms. That's more than what I was given. I got Pfizer and I was given 30. And so I just think that that is way too high of a dose for children, and it's absolutely been linked to a higher myocarditis risk in that age group. And the other thing I want to mention is that there was an animal study that came out fairly recently, and the animal study was using mRNA COVID-19 vaccines, and they injected these COVID-19 vaccines, mRNA vaccines, either in the muscle, so intramuscularly, which is what all of us people are getting theoretically, or they injected it intravenously in a vein.

And what the animal study found was that animals that were given the injection intravenously had myocarditis, inflammation of the heart, but the animals that were given it intramuscularly did not. And the reason I think this study is so interesting is because Um, so, so Dr., Dr. John Campbell, he has a YouTube channel, he's friends with Dr. Roger Seheult, came out with this interesting YouTube video where he talked about how easy it is to basically put the needle what you think is in the muscle and actually hit a vein. And unless you aspirate the needle, in other words, pull it back to see If you pull blood in, if you pull blood in, then you hit a vein and you should not inject. You need to like take it out and find another spot.

That basically without aspirating, you don't— the phlebotomist or nurse or doctor, whoever's giving the vaccine, doesn't actually know if they're actually administering this intramuscularly. They could actually be injecting it into the vein, which would then get into circulation. And so I don't know why the FDA recently stopped phlebotomists. It used to be that phlebotomists and stuff giving vaccines had to aspirate to check whether or not they had hit a vein. And so I think that really that is an important consideration that is not being discussed, that absolutely should be discussed. And I think that anyone going to get a vaccine should ask, please aspirate. I want you to aspirate to make sure we're, you know, we're not— you're not hitting a vein.

Because, um, I think he was saying, John Campbell was saying something like maybe 1 in every 300 or something crazy where it's like— or 1 in every 600 or something like that, where it's, it's quite common to hit a vein. So, um, I, I find that also very concerning, but I think, you know, The bottom line is that we— I just think we need more data. And Roman is pointing out another study, and I know I've discussed this study before with Dr. Seheult, is that there was one study that compared myocarditis risk from vaccines to myocarditis risk with COVID and it was higher with COVID It was like 6 times higher.

But again, This was not looking at healthy— this was looking at all children 12 to 17, including those with comorbidities, which are at a higher risk for myocarditis, versus the healthy young boys, the healthy young boys with no comorbidities. And that's the biggest concern. You have to stratify data. And also, the underreporting was a big thing. And it's— this new study showed that it's vastly underreported, and that is also a concern. And so I'm not saying that vaccines are dangerous for children. What I'm saying is we just don't have enough data to know how safe they are and if we have the right dose and if we're doing this correctly. And to just go ahead and mandate it without all that data, to me, is very irresponsible.

So, you know, that's kind of my current thoughts on children and COVID-19 vaccines. I think that Again, it's the young boys, 12, we don't even know what the data of 5 to 11 is going to be, but it could be, the fact that they lowered the dose so dramatically could have had a huge effect on lowering this whole myocarditis risk thing, but they didn't do that for 12 to 17-year-olds. They're giving them the adult doses in both Moderna and Pfizer. I don't think Moderna was approved. I think it was just Pfizer that was approved for 12 to 17-year-olds, or for 16-year-olds, sorry, 16 and older. Emergency use is still what we see with 12 to 15-year-olds. But still, I think that we just, we need to like, there's just not enough evidence right now and we're still gathering that evidence.

So I think that evidence needs to be gathered. Okay. Okay. So, Dr. Roger Seheult is coming to my house for dinner tonight, and him and I will undoubtedly be talking about this over our salmon and tomato caprese salad, which I'm making. So maybe we can revisit this idea sometime next month. Well, maybe we'll have more data then as well. Some rapid-fire questions. So Christian asks, in a previous video, you were talking about natural immunity against the Delta version of COVID What is your opinion on vaccination for people that had COVID? Is there a statistic about reinfected people? For how long do they have immunity? There was a very, very large Israeli study that found people who were fully vaccinated with Pfizer-BioNTech mRNA vaccine compared to people that had natural immunity.

So they were 6 to 13 times— people that were fully vaccinated were 6 to 13 times more likely to be infected with the Delta variant compared to people with natural immunity. And I, you know, this was like really strong data, and all the other data before Delta with like the Beta, when the Beta variant was dominant, really showed that people with natural immunity had a similar immunity to people that were fully vaccinated. And I think once Delta came around, then it was sort of switched where people with natural immunity seemed to be less likely to be reinfected than people that were fully vaccinated were more likely to have a breakthrough infection. So It's unclear how long the immunity lasts. I've seen some studies going out like at least a year.

So, you know, to me, it's kind of— I don't understand why science isn't being used more in terms of like people that are being required to be vaccinated for, you know, their jobs or, you know, whatever state requirements that are cropping up. I think that people with natural immunity, there should be an antibody test that they can, you know, show that they have very high levels of IgG against the spike protein, and that should be that. I don't see why people that have really high natural immunity should be required to get a vaccine. It's not, in my opinion, it's not very science-driven. But I also don't, I also think, I don't believe really in mandates. I think people should choose, be able to choose to get vaccinated. So.

The next rapid-fire question was from Fatima, and she says, for a parent whose child has recently been diagnosed with autism, what tests would you be looking to get done, and what dietary nutrient interventions would you be looking to make, particularly for a nonverbal child? I think there's a lot of low-hanging fruit, like making sure adequate vitamin D levels making sure the child has adequate vitamin D levels between 50 to 60 nanograms per mL, omega-3 supplement. You can get these omega-3 gummies that you can get them from Pure Encapsulations. Nordic Naturals also makes some that are zero sugar. But I think probably some of the strongest data I've seen is from the randomized controlled trials looking at sulforaphane and— in both children and adolescents.

And the sulforaphane was disguised, quote unquote, in pineapple juice. And so a lot of parents will crush up the sulforaphane supplement and put it in pineapple juice and give it to their child. And that— a lot more data on that can be found on the Chemo Protection Center website. They have a facts page. that talks about a lot of the autism studies there. I read that you take 2 grams of DHA in the morning and 2 grams of EPA in the evening. The omega-3 supplements you recommend in the Q&A last month have significantly less DHA. Does this really matter? No, I was really optimizing for high EPA because of the really robust evidence on cardiovascular health, and a lot of the supplements I mentioned do have a good amount of DHA.

So I'm just sort of doing this experiment, and I don't necessarily think that it matters that the supplements that I mentioned don't have high EPA. However, you can go through the list. I did— we did just record a video, and I'm linking to my spreadsheet, and you can sort the spreadsheet according to high DHA supplements with also a low EPA. total oxidation number if you also kind of want to try to do a similar experiment as me. In other words, you want to buy both a high EPA and a high DHA supplement and take one in the morning and one in the evening, then you can try that. So that spreadsheet will be available probably sometime in the next week. You guys should be able to have access to that. Does drinking ice-cold water in the sauna prevent core body temperature from rising?

I assume that the hotter I feel, the more it's working, so I try not to cool myself down at all. Personally, I think it's best to drink your water after the sauna. You can sort of cool down your core body temperature to some degree by drinking ice water. So that's just my 2 cents. Jen asks, hi, Rhonda. Is there a database that would reveal protein quality variance amongst different protein powders? How would we know which has superior quality? I'm referring mainly to whey proteins. What's your favorite supplement review site? Jen, I personally like to use ConsumerLab. It's a subscription. I think they charge something like $30 a year or something like that. And they do a lot of reviews on protein powders, on chocolate powders, dark chocolate, on supplements, curcumin, all sorts of things.

So I find them really useful. And another site that I don't subscribe to, but I know does also review protein powders, is Labdoor. So that would be another potential option. Another rapid-fire question. Owen asks, Dr. Patrick, is there a brand of sardines that you consume? Yes, I consume the Vital Choice brand. I really like their seafood. What are your favorite scientific journals to subscribe to? How do you like to stay up to date in an affordable way? I would say that the cheapest, which would be free, the ones that I sort of daily— and I saw some comments to this question about daily searches and stuff like that— the ones that I like to drink my coffee and look at the science stories of the day, I think the best ones that are free are Eureka Alert, E-U-R-E-K-A-L-E-R-T, and Science Daily.

They often have a lot of great, you know, science stories posted daily, health and fitness, aging-related, all sorts of stuff, cancer, stem cells, just, just everything. Um, that would be the most affordable. But in addition to that, some of the great science communication journals that are easier for non-scientists to read and understand would be New Scientist and Scientific American. I don't remember if it's like $1, $4 a week or something like that. I don't recall. I'm subscribed to both of them. I've been subscribed for so long that I'm sure the weekly price has changed. New Scientist and Scientific American are great ones and you can just choose between one of those.

And then the other journals that I like really are, which I don't subscribe to, I don't pay for them, but they often have a lot of free access journal— free access articles, are the American Clinical Journal of Nutrition. They have a lot of great nutrition studies, randomized controlled trials on different types, you know, dietary factors or supplements. And Cell Metabolism is another really great one as well. All their articles are not free, but they've got a good amount that they do have open access posted for. How soon after giving birth did you resume using the sauna? Should sauna be avoided while breastfeeding? I think this is really a personal choice. I, after around 6 months, kind of started using the sauna very sporadically.

And then after about a year, I mean, I just like didn't feel that great with like, you'll just, you'll feel the way you feel when you're breastfeeding. Like, your infant is entirely 100% breastfed. You're making a lot of breast milk every day. And so, It's more challenging to do things like the sauna. Hi, Rhonda. Did you do research before giving birth on a natural birth or an epidural? If so, what were your findings about risks and benefits of each? There seems to be schools of thought on risk-benefit analysis for both a mother's recovery and also the baby. Also, any other things you did to prepare specifically for the birthing process? I will say bottom line here, you will not stick to your birth plan. Do not worry about it. Everything's going to be okay.

I did initially want to have a natural process and I went through a very, very long and painful time where I basically was holding off on the epidural and I ultimately did get it and it was all fine. You know, there's always a risk for any sort of treatment that you do. But, you know, the main things I tried to avoid was having my water, you know, unnaturally broke. I forgot what they call it, but like, they want to like, you know, do something to like unnaturally break it. So I— But again, like, you, you kind of at this— at a certain point when you're, when you're going through it, you just kind of have to, you know, go with the flow in a way, you know, because there are things that are out of your control. Um, so I just wouldn't really stress a lot about it.

Um, things will, will, will work out. And, um, I don't think there's a really big problem with, with doing, you know, an epidural. I think that There could be if a woman gets like a really high dose injection, maybe like her recovery, like she won't be able to use her legs as well, or she won't be able to feel like if she's pushing as well. And that's probably the biggest thing, but it's really not that big of a deal, to be honest. So I wouldn't stress too much about it. Everything's going to be great. All right. I think that wraps up this Crowdcast. Vessi is talking about— he's from Finland and he's talking about breastfeeding mothers in Finland. They actually go to the sauna 1 week after giving birth. So again, it's really an individual decision.

I personally was an overproducer of breast milk. big-time overproducer. And so I was like getting engorged quite frequently and my risk of mastitis was quite high. And so for me, it didn't feel good for me to immediately go in when I was producing so much milk. But I think that's just, again, it's like an individual sort of decision that you can make. Jessica asked if I'm still doing keto. Unfortunately, I'm not. I just told you about my kefir drink I had this morning, so clearly I'm not doing keto. It's— I just found it quite challenging. I am going to restart it up again, and— but The main things I found to be beneficial for me were my energy levels being sort of even keel throughout the day and just not getting that tiredness after a meal.

So I think those were some of the main things, and the anxiety was also lower as well. But I will be doing a more scientific breakdown of my keto experience once I restart it up again. Thank you everyone so much for these wonderful questions. I'm just looking at a few more of the chats here. We can follow up on some of the COVID stuff with vaccines in children, I think when there's more data next month, hopefully. And so we'll see where it's at next month. Heather was posting in the chat there was a preprint that was overstated, and I believe that preprint was in Canada. I wasn't referring to any of those studies today. In fact, I hadn't even— I had seen that, the preprint, but I hadn't read it.

And before I even had a chance to have read it, It was withdrawn because there was a statistical error in the calculation for myocarditis risk in vaccinated children. And this was in Canada. It's a study from Canada. So I was not referring to that study. But we will see where we're at. And again, I just think that we need to really follow the data in every aspect. Of, you know, whatever question we're looking at. So— For those of you, like Kevin, who are in my monthly hangout that happens the first Sunday of every month, we go really, really, really in-depth into questions people have. It's a discussion. We all talk and see each other on screen. Although some of us, some people like to stay muted and have their avatar shown.

But any of you are interested in doing that, please, please check out the monthly membership. It's really great. And for those of you that want to replay this video, want to listen to it again, please make sure you have downloaded your private podcast feed player. You can get that on your dashboard at foundmyfitness.com. And along with that private podcast feed, you'll get access to our aliquot episodes we release almost weekly and our infamous Crowdcast mashups where we take all these Crowdcast questions and we give them themes. So we've got one on pregnancy, fasting, sauna. We've got one coming up on— oh wait, we've got one on supplements, Rhonda's supplements she takes, and then we've got one coming up on biomarkers soon. So be on the lookout for that.

You can also watch the video on the Crowdcast website. For those of you that are here live, you're already Crowdcast members. And we send out a replay email video on our newsletter. So make sure our emails are not going into your spam folder. So we will be sending out a summary. This week with a timeline, some links to the references that I mentioned today, and a YouTube video where you can replay the video. So thanks again for everyone for your questions and for attending these live. They're so much fun for me, and I look forward to next month's. So I will talk to you guys soon. Bye. Bye.