 I want to introduce Dr. Sarah Ballantine, who I'm informed is now a New York Times bestselling author and she'll talk about lifestyle and autoimmune disease. Can you guys hear me? Oh yeah, I can hear me. So clearly you can hear me. So thank you so much for sticking out for the last talk of the day. So there's been like amazing talks and now I'm supposed to be this big grand finale so like no pressure. I'll do my best. I'm going to start with if you guys know I have this little ritual I like to start every talk with I like to take a picture of you and this is kind of my way of like remembering the lovely day, the lovely afternoon we're about to spend together. So if you guys could all pretend because I can't do this in the middle of the talk I have to actually focus on what I'm saying. If you could pretend like I'm in the middle of the talk and I'm saying something like groundbreakingly interesting. You guys can't believe this like super cool information I'm giving you. It's like changing your lives and now if you could pretend it's like the end of the talk and it was like the best talk you've ever been to and huge round of applause. Come on guys like you gotta like feel free to give a standing ovation. Maybe my talk is going to be that good. You're going to want to do standing ovation like feel free. My number one up up remember sitting as death. Thank you very much. I believe my talk is done. Oh no wait I still have to do it. If you've heard me talk recently you know that I've been on a bit of a nutrient density bandwagon lately and and I've been talking a lot about nutrient density nutrient density. Today I'm actually going to talk about something that's very parallel to this focus on nutrient density and that is really the direct effect on gut health that our lifestyle choices have. Now if you haven't heard me talk lately you might not know who I am. I'm Sara Ballantyne I blog at the paleo mom and I was a medical researcher I have a PhD in medical biophysics I did four years of postdoctoral medical research in critical care medicine and epithelial cell biology before I had my first daughter and I decided to take a break from medical research in large part because I wanted to be a perfect mom yeah that shift has sailed but also because I was morbidly obese and I suffered from 12 different health conditions and I was having a really difficult time finding work-life balance. So I focused on life and that also allowed me to focus on my health and my health journey eventually brought me to a paleo diet. It managed to reverse all of my diseases I discontinued six prescription medications it contributed to my 120 pound weight loss and I credit the paleo diet and lifestyle for now being in the best health that I've ever been in. So my perspective when I talk about these topics comes both from my science background and my just inherent geekiness and desire to understand the detailed mechanisms of how my choices are working but also my passion and my personal experience with living this and changing my life with these types of choices. So if you're like me and you had an autoimmune disease or two or three and you've come to the ancestral health movement you've come to a paleo or a primal template in order to handle your autoimmune disease or other immune related diseases you're probably familiar with the paleo autoimmune protocol. So this is a more restrictive version of the paleo diet and I really don't like using the word restrictive even though it's technically true here. I prefer to think of it as a more specific version of the paleo diet because what it does is it not only removes some foods that have immune stimulating compounds in them that can be a problem for those of us who are more genetically susceptible to react to those foods but it also changes our focus to an even greater focus on nutrient density. It encourages us to eat more organ meat, more seafood, more vegetables to seek out the best quality foods that we can and to also incorporate a large amount of variety in our diets. We do this of course with avoiding a few good foods like tomatoes, nut seeds, eggs and that can be really challenging. We also have more of a focus on moderation when it comes to things like fructose, omega 6, polyunsaturated fats, caffeinated teas, coconut. All of these dietary choices, let's use the word choice here, they all come from our understanding of how food interacts with our body and they are really targeted at immune regulation. So when you have an autoimmune disease or an immune disease, actually any chronic illness, one of the things going on there is that the immune system is not regulating itself properly and so we make these diet choices based on regulating immune system and they do this in three ways. The first is nutrient density so we're providing our bodies with the nutrients that the immune system actually needs in order for its regulatory mechanisms to function properly. It also provides us with the nutrients that our bodies need to heal damaged tissues. We're also making diet choices based on hormone regulation so regulating insulin and insulin sensitivity, leptin, ghrelin, cortisol, these are all affected by our diet choices and their regulation is really really important when it comes to the immune system because all of these hormones directly impact how easily stimulated the immune system is, how turned on it is, how well regulated it is. So we need to regulate these hormones in order to regulate the immune system and then probably what is one of our biggest focuses in the paleo movement in general is gut health and this is incredibly important when it comes to autoimmune disease because a leaky gut or more technically increased intestinal permeability has been found in every autoimmune disease in which its presence has been investigated. Similarly gut dysbiosis has been found in every autoimmune disease in which its presence has been investigated and leaky gut and gut dysbiosis seem to go hand in hand. So this is led to the hypothesis that a abnormal gut environment whether that's increased intestinal permeability, gut dysbiosis or the combination may be a prerequisite for autoimmune disease to develop. So that means not only do you need this genetic predisposition and you need a trigger but you need a leaky gut or you need a damaged gut or you need the wrong kind of bacteria or too many bacteria or not enough bacteria growing in your gut. There has to be something wrong going on there and when you consider that 80 percent of our immune system is housed in the tissues around our gut it starts to make some sense that gut health would be really really important to the development of autoimmune disease and also to the management of autoimmune disease using diet and lifestyle. But here is the crux of my talk. Gut health is not just about the food choices you make and as you embark on this really specific diet this diet that requires a lot of effort. It becomes even more important to focus on the lifestyle factors that impact gut health because you're going to all this effort. You are working so hard to make the right choices. You're doing all of this cooking, you're going out to farms, you're spending more money on your groceries and if you don't get these lifestyle factors in place you may not see results for your effort and I can tell you there is nothing more frustrating than putting a ton of effort into your diet feeling horribly deprived and not seeing a benefit from it. A huge variety of lifestyle factors actually directly impact the health of the gut. This is not indirect, this is direct and what I'm going to talk about today is how stress, how much stress you're under, how well managed it is, how much activity you do, what type of activity you do and also how well entrenched your circadian rhythms are and how those directly impact gut health. So if I'm going to talk about gut health it's probably good to just do some basic physiology right now. When I'm talking about the gut what I'm really talking about is the small intestine. So the small intestine is that big tube that joins your stomach to your large intestine which is another big tube. The small intestine is longer and smaller in diameter hence the word small and this is where basically the majority of digestion occurs and this is where the majority of nutrient absorption occurs. So it's an incredibly important organ and if you think about this if you didn't have a small intestine if your small intestine is not working properly you can't absorb the nutrients that every tissue in your body needs. This is a vital organ we need our small intestine and it's actually a pretty cool organ except for the part where it's full of gross stuff. It has a structure that is designed to increase surface area and actually every time you magnify you look at it in with a microscope and you look closer and closer and closer it still has structures that increase surface area so it's these structures that fold upon these structures that fold upon these structures that fold and if you actually unfolded the entire small intestine you would have a surface area about the same size as a tennis court. So think about that for a second. Your small intestine inside your body you unfolded it tennis court that's that's pretty big. So the largest structures are called the pleike circularies. These are the macroscopic folds the ones that you could see if you were actually looking at someone's small intestine which I hope you're only doing under very controlled conditions. When you look more microscopically than that you see these structures that are like columns they're often described as hills and valleys they're like Dr. Seuss Hills because they're really really steep they're more like a bunch of fingers together they're called villi and the valleys are called crypts. These are actually the dominant structure that really gives surface area to the small intestine and they're they're really really important. This entire surface is really formed from one continuous sheet of a highly specialized type of cell called an epithelial cell. These cells are I've studied epithelial cell biology so I can tell you from like a I spent two hours studying these cells or two years studying these cells they're super cool. I never ever got bored. Epithelial cells have a top and a bottom and that's really really important because not every cell in your body has a top and a bottom. So the top which is called the apical side and this is when we're talking about the gut epithelium is the side facing inside your gut which is actually outside your body I know mind blown right now. This apical side of the cell membrane has again structures designed to increase surface area and they're more microscopic than villi so we call them microvilli and again they're sort of finger-like projections and their entire purpose is to increase the amount of outside of the cell that the cell can interact with. The rest of the membrane is a different structure it doesn't have these microvilli. The rest of the membrane would lump the sides and the bottom together because the cell doesn't really know the difference between sides and bottom it's called the basolateral membrane. The cell has a very specialized structure that helps it know the difference between its apical membrane and basolateral membrane and this structure is very relevant to everything I'm going to be talking about today it's called a tight junction. Tight junctions are essential for epithelial cell health and in fact if you take epithelial cells and you grow them in a petri dish and you do something to them to disrupt their tight junction they turn into cancer. So tight junctions are phenomenally important for these cells to maintain what's called cell polarity which basically means the cell can keep track of which side's the top and which side's the bottom. It's also really important for the integrity of the epithelial barrier so these tight junctions actually control how easy it is for substances to cross that epithelial barrier and that's really what we're talking about when we talk about leaky gut we're talking about the epithelial barrier no longer being able to control what crosses it. I want to show you just a little bit of how complex these tight junctions are they're phenomenally important and I have done a lot of microscopy staining for these proteins in the past. It's generally a structure made up of a transmembrane protein so proteins that start from the inside of the cell go through the membrane and end up on the outside of the cell and they're very tangly bent proteins and they kind of interlock and they form like a knot now you can think of a knot you can loosen the knot a little bit that opens the tight junction and allows some things to travel through you can close that knot tighten it and now you've closed the tight junction and now things can't travel through as easily. The tight junction is a highly regulated structure within the cell. The cell has a dozens of proteins that help control how exactly all of these proteins link so that it can control how open or closed the tight junction in is. It is a dynamic structure so it's not permanently closed the cell actually opens and closes it in a controlled way to purposefully allow substances to travel paracellularly which means between the cells across the epithelial barrier and I love showing transmission electron microscope images because they're pretty this is the top of the cell so these are actually the microvilli this is two cells side by side and they would go like straight through the floor that's how magnified that we're looking at them and this dark area right here is the tight junction what makes it dark on electron microscopy is the density of proteins that are there interacting with each other forming this really complex complex and it's it's integral to the integrity of an epithelial barrier so we're talking about gut health we're really talking about epithelial cell health and how well controlled that tight junction is so how well the cell can actually decide whether or not that tight junction is open or closed and I'm going to start with stress it is well known that stress increases intestinal permeability it is well known that stress decreases digestion by decreasing gut motility decreasing mucus production inhibiting pancreatic secretions inhibiting gallbladder function it inhibits the gut immune system and because it slows down digestion it changes the environment for microorganisms it is permissive for gut dysbiosis and overgrowth so stress is a big deal and this is fairly well understood but what's really important to understand when we're talking about stress we're not just talking about you know ah a lion is chasing me or ah i'm stuck in a traffic jam which really our body sees being the same thing it is activation of the hypothalamic pituitary adrenal axis or the hpa axis so the hippocampus is the area of the brain that really assembles information from our senses and kind of goes okay wait there's a lion or bad traffic it sends signals to the um hypothalamus which is really the area of the brain that has a lot of control when it comes to hormones the hypothalamus is really like the hormone controller area of the brain uh the hypothalamus goes great lion we got to do something and it releases corticotropin releasing hormone or CRH corticotropin releasing hormone goes to the pituitary gland which sees it and goes a whole lion or traffic jam um time to get the adrenal glands going so it releases and please only make me say this once adrenocorticotropic hormone or acth i'm gonna acth from now on this is too many syllables um and acth travels to the adrenal glands and says hey guys time to get going and adrenal glands release all the things that they release so that's cortisol which is going to be most relevant to our discussion today but also catechol means like adrenaline you know it's really important about the hpa axis is that there's a built-in control when cortisol is traveling through the blood it sends signals back to the pituitary gland and to the hypothalamus that okay guys we got the message we understand traffic jam or lion we're doing it we're on it and cortisol is really important for um diverting resources to the brain for um heightened decision making and to muscles for running away from the traffic jam and so um and so it's telling the brain at the same time that it understands that we've got this stress and we're doing our job and i want i'm going to come back to that negative feedback in a second let's talk start with cortisol we think of cortisol as the master stress hormone so clearly cortisol has a role in everything it has actually a very important role in gut health but maybe not the role that um you're thinking of right now because cortisol actually regulates tight junctions and it tightens them so we think of stress increases intestinal permeability but cortisol actually decreases intestinal permeability how is that working well cortisol is actually a natural hormone as much as it's part of the fight or flight response it's also a circadian rhythm hormone it's also a metabolism hormone it helps us access stored energy between meals so it's really important to understand that cortisol has these normal rules in the human body and one of them is very very likely helping the gut epithelium to regulate absorption of nutrients um after a meal when it's low and it allows tight junctions to to open and between meals when it's higher and tight junctions are closed when there's not necessarily things to be absorbing the problem is when cortisol is too high or too low so too low might happen in example for adesins disease or chronic adrenal insufficiency or what we lay people call um adrenal fatigue um when you've gone so long going so high um that your adrenal glands have basically said like okay we're done we quit this is not a not not the job we signed up for and now your body is chronically producing too low of cortisol i have extensive personal experience with this um and then what happens is that actually um opens up the tight junctions is causes a leaky gut so adrenal fatigue in that burnout phase just automatically by the nature of having low cortisol causes a leaky gut so normal high cortisol is good but then really high cortisol um again it alters the structure of the tight junction but now in a more complex way so it's not as simple as saying oh it makes leaky again it makes the tight junctions more permeable to small molecular weight substances so small things can cross and it makes it less permeable to high molecular weight substances so there's a give and take there um and the details of exactly why and what the impact in that is still something that's being studied but when we're talking about cortisol um you know a lot of the studies how we understand the effects of cortisol is by adding exogenous cortisol and we do that by treating with steroids like prednisone and what we know is that when somebody's having an autoimmune disease flare and we treat them with steroids it actually tightens up the tight junctions and it decreases intestinal permeability that's one of the reasons why prednisone can be a life-saving medication during an autoimmune flare and it does this and this is the really important part through glucocorticoid receptor binding so cortisol has its effect through binding with a variety of different types of of cortisol receptors throughout the body and it's this binding that is responsible for the action on tight junctions and this is really important because when you're under chronic stress in a situation that's completely analogous to loss of insulin sensitivity when you're eating way too much sugar and your insulin is chronically high and then eventually your cells just aren't as sensitive to insulin you have insulin resistance we have cortisol resistance or more technically cortisol receptor resistance and that is one of the detrimental effects to chronic stress and so even though your cortisol may be high because you're chronically stressed and your adrenal dance haven't given up the ghost yet you may be causing a leaky gut because you've got cortisol receptor resistance and this is something that is still a hypothesis that has not yet been investigated but the hpa axis as i already described as much as cortisol is important it's not all about cortisol and i want to talk about corticotropin releasing hormone CRH because its impact on gut health is probably more profound than cortisol and this is really interesting to me because when you talk about adrenal burnout when you talk about adrenal fatigue you're not producing enough cortisol you're also losing that feedback so what happens is you're stressed so you've been in traffic for a really really long time and now there's an angry driver behind you and it just like totally is the worst day ever your coffee spilled on you your kid cried when you left the house awful your adrenal glands have given up so your brain is perceiving stress it's telling your hypothalamus to produce CRH your hypothalamus is telling your protruding gland to produce acth the acth is telling your adrenal glands to produce cortisol no cortisol is being produced so you're not suppressing that system so you keep producing more CRH more acth and these are hormones themselves and they have an impact themselves they're not just in that one line of signaling so in particular CRH increases epithelial permeability in every epithelial barrier that it's been tested so that's gut, lung, blood, brain and skin and a leaky epithelial barrier is never a good thing now it does this in two ways it does this through an action on the tight junctions themselves by changing the type of proteins that are involved in it and it actually changes it to one that's not able to create such a tight knot compared to other protein options it also does this indirectly by activating mast cells mast cells are immune cell type that are present in just about every tissue in your body and they're actually the cell that is really responsible for allergic reactions they produce histamine they also produce heparin which is a blood thinner and a variety of pro and inflammatory cytokines they're really kind of one of the cells to get things going so there's a direct effect on tight junctions and a further effect on permeability by activating mast cells from CRH so when we talk about the HPA axis and how this is important for gut health what we're really talking about is the gut brain axis we're certainly one part the hormone part of the gut brain axis the gut brain axis is also much more complicated it involves cytokine signals and it involves nervous signals now what happens when you are stressed experiencing strong negative emotions is that the vagus nerve output is decreased so the vagus nerve innervates most of the thoracic and abdominal cavities so that means that it branches out into the nerves that control all of your organs that are part of your digestive system and so when that output is reduced you end up reducing digestion you lower stomach acid production you reduce the secretion of pancreatic enzymes you inhibit gallbladder function you decrease gut motility all of these things that we said chronic stress does it's not just a hormone effect it's also through a direct effect through the nervous system and when you suppress digestion you again create an environment that's personmissive for gut dysbiosis and overgrowth the connection between the brain and gut health is even more complicated because it also involves circadian rhythms in particular it involves melatonin so melatonin is the sleep hormone our body is produced melatonin it's the pineal gland that produces it it's secreted into the blood about two hours before you go to bed lowers body temperature it slows down your metabolism makes you feel sleepy and happy and makes it prepares the body for sleep melatonin though is also produced by the tissues in the gut and in fact there may be 10 to 100 times more melatonin produced in the gut than produced in the pineal gland and the gut itself can house about 400 times more melatonin than the pineal gland can melatonin is one of two neurotransmitters that regulate gut motility so it's serotonin and melatonin they work together so that really all very important peristaltic action of your digestive tract to move stuff down is regulated by melatonin and serotonin the gut further is probably important in how your body clears melatonin so your pineal gland releases it in the evening you go to sleep your melatonin eventually leaves the bloodstream where does it go it actually is sequestered by the tissues in the gut and so you need that to be able to work normally so what we know is that melatonin decreases intestinal permeability through direct action on tight junctions but if you are supplementing with melatonin to support sleep that long-term supplementation with melatonin has the opposite effect we don't exactly know why probably because your endogenous production is different and exogenous is typically different um melatonin production both in the brain and in the gut is influenced by circadian rhythm so it's influenced by uh sleep cycles how well entrenched your sleep cycles are do you go to bed at the same time every night it's influenced by the light dark cycle are you being exposed to bright light during the day are you sleeping in the dark at night it's based on it's the amino acid tryptophan it's just five steps away from tryptophan so it's also based on nutrition if you're not getting adequate tryptophan then you are really not able to make enough melatonin and um it also has an indirect effect so we've got this great direct effect for melatonin it has this indirect effect because when you support melatonin production melatonin is another circadian rhythm hormone as is cortisol when you support your circadian rhythms you support normal melatonin production you also reduce activation of the hpa axis so you're reducing stress so you're promoting gut health that way as well i drank in front of a room full of people and i did not pour it down my dress that's a it's a win um so i think that when we talk about stress and we talk about its impact on the gut it's a pretty easy thing for people to wrap their heads around i mean there's some extra like oh cool i didn't know that crh did that that's really neat um but it makes sense to us and it makes sense to us in part because when we're stressed we tend to feel it in our abdomens if you're really stressed and you might feel nauseous you might have loss of appetite you might have increased appetite depending on the stress um you might have you know you might have sort of butterflies in your stomach or that feeling and so this idea that there's a direct impact um on gut health from stress is not such a challenging concept but it maybe is a little bit um more of a surprise to know that how active you are and what types of activities you engage in also has a direct impact on gut health now physical activity also has indirect effects because being physically active helps reduce stress um so it actually makes you more resilient to stressors so you have less hpa axis activation when you're under psychological stress so physical activity is phenomenally important from that standpoint from hormone regulation and the effects that those hormones have on gut health it's also entrenched circadian rhythms so when you're physically active you're supporting melatonin production so there's all these indirect effects through the mechanisms that have already described but there's also a direct effect and the direct effect is not so much from being sedentary it's from being overactive so we know that being sedentary is really um horrible for your health um in fact the world health organization lists physical inactivity as the fourth leading risk factor for global mortality it's like one of my favorite statistics so just sitting on the couch all day is one of the worst things that you can do for your health but being overactive can actually be very damaging to the gut anybody here has done any endurance training marathon running anyone anyone run a marathon oh my gosh really you crazy people i've run marathons too so i'm with you there's this thing called runner's runs runner's trots the gingerbread man run run as fast as you can and it's a it's a joke within endurance training you know you just you plan your long training runs you know where every bathroom is on the way and it's characterized by extreme gastrointestinal distress typically diarrhea while training and it is a symptom of something far more profound that's happening inside the digestive tract which is injuring the integrity of the gut barrier this also happens in other endurance athletes it happens in cyclists triathletes and it can even happen in bodybuilders so people are doing really high strain activity that's not technically endurance activity high intensity interval training can do the same thing and it actually increases or increases intestinal permeability via a direct action on the tight junctions this is different than the stress response so clearly when you're doing these super intense um of training exercises you're doing super intense physical activity it's a stress on your body and we know that cortisol increases but the action on the tight junctions is actually via heat shock proteins so it's actually a different system than that the hpa axis and it's increasing tight junctions we also know that prolonged intense activity diverts blood flow from the intestines it's part of the fight or flight that is cortisol dependent and it's because digestion is really not a priority when you're in the middle of an 18 mile run now one of the things that runners do and a lot of other endurance athletes do is they try to fuel their activity by eating and that's one of the worst things they can do because their digestive system is already not getting enough blood flow the tight junctions are already opening and there's actually a type of anaphylactic allergy that endurance trainers experience because of this effect it's made worse by um NSAID use so as many endurance trainers are very fond of their Advil that's actually making this effect worse and it's making it worse when you're exercising in the heat so if you're doing this in the summer compared to the winter you're creating an even leaker gut than you would if it's cold outside and very importantly there's the cortisol effect from this type of training but there's also a direct effect on gut health and i actually want to read you a quote from the abstract from this paper which summarizes all of the research to date on how exercise regulates tight junction assembly tight junction integrity is altered by the phosphorylation state of the proteins occludin and cladins and may be regulated by the type of exercise performed prolonged exercise and high intensity exercise lead to an increase in key phosphorylation enzymes that ultimately cause tight junction dysfunction and what this really means is that we see this type of tight junction dysfunction these tight junctions opening and the gut becoming leaky from different kinds of intense exercise whether it's prolonged exercise or really intense bodybuilding training high intensity interval training we see this effect and the effect may be slightly different the details of the mechanism are very likely slightly different and there's probably details from that are different from individual to individual because a lot of how you respond to something like this is going to depend on how well managed stresses in your life how much sleep you're getting what your nutrient status is but it is definitely something to be wary of if you are looking to regulate your immune system you want to make sure that you're active because being sedentary is definitely a problem but you want to make sure that you're avoiding this type of really intense activity so the take home message is that gut health while being clearly profoundly impacted by your choices of food is also impacted by how well you manage stress whether or not you're able to reduce stresses in your life how active you are what types of activity you are doing and how well in trench your circadian rhythms are and that these lifestyle factors actually interact with each other it's not just that they all dump in on gut health but how clean your diet is actually influences your stress response if you're getting adequate tryptophan that makes it easier to produce melatonin if you're being active that also helps improve your stress response so all of these things are interlinked and they really need to be thought of that way when you're approaching your choices in order to manage an ideally reverse disease so just to end on a bit of a practical note what does this actually mean for day-to-day living when it comes to managing stress i highly recommend taking up meditation practice it has been very well documented in the scientific literature to reduce cortisol production help regulate hormones this is not some airy fairy granola idea this is science and it's fun it's really important to have fun to play to smile to laugh it's really important to get enough sleep consistently every single night and to have a sleep routine so you have a bedtime not just your kids but you have a bedtime it's important to be active to include as much light activity in your life as possible things like walking yoga play anything that you find fun it's important to be in nature and it's important to connect with others these are all things that help reduce the stress response so it improves our resilience to stress and in addition to working on our resilience to stress we also want to try to reduce stresses in our life and that's an individual situation that every person needs to work out for themselves when it comes to supporting circadian rhythms you want to be getting exposed to bright light ideally sunlight during the day but any blue wavelengths of light will do and you want to be in a dim environment in the evening and in dark at night and by dim and dark i mean no blue light and you can hack this by turning down your lights in your home and wearing amber tinted glasses those are the yellow safety glasses they block out blue light and they're an awesome fashion statement scientific studies show that wearing them two to three hours before you go to bed dramatically improves sleep quality and they cost like eight dollars go to bed early you have a bedtime your kids have a bedtime you have a bedtime turn off facebook unless you're looking at my page then by all no um sleep in a cool dark room uh do things like cover lights in your room so if you have like i have baby monitors still beside my bed even though my kids are seven and four let's not get into it um but i have duct tape over the led lights on the baby monitors so that i hear their white noise machines is quite soothing um but i don't see any light be active during the day so yay another point for activity and make sure your evenings are relaxing so try not to work in the evening um try not to watch horror movies um so some of the things that you think you're doing to de-stress or it's actually activating your hba access so be really um picky about your evening activities and then when it comes to being active you want to be as active as possible while avoiding these high string activities so um avoid sitting for prolonged periods of time if anybody wants to stand up right now it's like totally cool um if you're working at a desk job a standing desk or a walking desk is a great idea but also just getting up every half hour and walking around stretching your legs getting your blood flowing um even if you're at a standing desk you actually still want to take every about every half hour to really change your body position maybe you know just squat or bend down and and stretch your legs a little bit that's actually still really important all the little tricks that we see that is all over every media like parking farther away and walking or taking the stairs until instead of the elevator these are all really important and it's one of the things that um the government is really getting right in terms of recommendations and play do something fun um playing is is really important it's active it has all the right hormones it reduces stress um it's it's amazing body weight exercises walking is the classic so um you know anything that's moving your body weight around and anything that's going to build strength those are really really important for regulating all of these hormones and for supporting gut health so um I hope that I have inspired you to critically look at how lifestyle is impacting your gut health you can get more information in my books and my blog I'm doing a book signing tonight at Barnes and Nome Emeryville at seven o'clock so I would love it if you guys can come out and thank you very much no standing ovation see I was good it's good I got it at the beginning