 Hi, welcome. Thank you for having me. Crazy group right now. I feel pretty inspired by our last talk, so hopefully I'll be able to follow them up pretty nicely. There was a lot of really good points in there that hopefully I'll try to tie into what we're talking about now. I what I do is I work with families. So I mean I work with preconception, pregnancy, pulse-partum, pediatrics, so I pretty much work with the whole family unit. One of my passions is talking about pulse-partum depression and all the other contributions to that because it is one of the areas that I feel is very empty in our literature and in our clinical care. So it's definitely something I focus a lot on and many people probably don't feel that perinatal anything applies to them because you know, they're either not trying to get pregnant. They might not have a uterus in which to get pregnant. They might not be planning to parent anytime soon. So I feel like a lot of people feel disinterested about the topic clinically and socially because you know that it doesn't feel like it applies to them personally and I would argue that really it applies to everyone. Every single massage therapist, fitness professional, is interacting with somebody who is very likely trying to get pregnant, is pregnant, maybe someday might get pregnant in 10 years. There's a lot of people out there, massage therapists, fitness professionals who talk about doing women's health. Well if you're going to do women's health, you are absolutely doing all of these things that we're going to talk about because a lot of this is setting the foundation for what comes next. We're not talking about, I mean really what I'm talking about is we're talking about downstream effects. So we're not talking about people who are in crisis right in this moment but how can we prevent that crisis 10 years from now, 30 years from now and the repercussions of that socially. So that's, that is my, I don't know, soapbox I guess. So diving into the microbiome, it's a topic that we, or a thing that we talk about a lot, the word gets tossed around what does it actually mean. Really it refers to microorganisms in an environment and what does our human microbiome mean? It is the microorganisms that live in our digestive tract specifically although really it can also pertain to the microorganisms that live on our skin and in our respiratory tract but specifically for the purpose of this discussion we're talking about the ones in the digestive tract. And it's made up of everything really, I mean it's not just bacteria so we also use the term microbiome and the term gut bacteria pretty synonymously in both literature as well as in clopeal speak and really it's not just bacteria, it's actually a very small part of that microbiome. There's also fungi, so yeast, like good yeast. There's parasites, good parasites that actually live as commensals or in community with our bacteria. So thinking about the fact that like really our microbiome is about diversity and that diversity is what contributes so much to what happens downstream is probably just a good statement on the world. And we have 10 times as many microbial cells as we do other human cells. So in terms of you know it's level of importance or the percentage of our body that is made up of all these critters is pretty high so it's obviously going to have a lot of effects. Sorry about that, there you go. So this is a nice little pictorial representation of how much there is and I actually am a tennis player. My tennis team is going to nationals in Florida in six weeks. The GI tract surface is as big as two tennis courts. That just blows my mind. So there's lots of pictorial representations of how important our microbiome is to our bodies and our health. This one seems to speak to me a lot and it's taken from a particular website so you can just see that website down below but I don't necessarily have any particular affiliation. So something that is that massive and takes up that much space and has that much real estate in our body clearly has a lot of jobs. And these are all the jobs. I don't know how well you can actually see this. Well probably pretty well. I didn't realize it about the lighting anyway. Digesting foods, synthesizing vitamins, metabolizing drugs, detoxing but also stimulating the renewal of the gut lining. So not only does it live there but it also helps regenerate it. And activating and supporting immune systems. This is partly where we're going to go with this talk and then also your neurotransmitters. So there's a lot of jobs that all these microbes have and they all work together to do these jobs. So obviously it has a lot of visibility, our microbiome, in conventional literature and I think that in conventional medical literature it's actually coming up more so as it pertains to pregnancy. As it pertains to pediatrics. So we're talking a lot about it in terms of like allergies and eczema. We're talking about it in terms of cancer care. So there's a lot of different places that the microbiome was showing up in research. And I see a lot of pediatric clients and sometimes over the weekend they end up going to Children's Hospital to the emergency room. They get sent home with an antibiotic prescription most of the time, not all the time. They get sent home with a prescription for probiotics. I think that's pretty amazing. So sort of feeding off of that topic of how long does it take for our discussions that we have in rooms like these to infect not only the medical literature but medical practice. It takes a while. People have been talking about the microbiome for a long time. But it's happening and it's pretty cool and in a way that's actually becoming accessible to people of all income groups. And the Human Microbiome Project really a way of cataloging and organizing and understanding who actually lives in our body and what do they do. That was better understood really just only five years ago. What else does it do? This is the part that I find incredibly fascinating. So when we talk about the microbiome I think a lot of the applications are immune system oriented. Eczema, allergies, its relationship possibly to even the turning on and off of different oncogenes or things related to cancer care. But where I find this extremely fascinating is its relationship to neurotransmitters. There's a couple of interesting studies starting to show some relationship although we're trying to figure out causation correlation. So whether it's just showing up at the same time or whether it's actually causing this thing to happen. That it seems to also affect disorder eating and maybe some of the underlying neurotransmitter or psychological pieces of that. It's also starting to show up in terms of how it affects our levels of stress. Not even just situational stress obviously it's not going to change what's happening in your life but how our bodies respond to that stress. Which I think is also fascinating because we can't necessarily change our circumstances but what if we could affect this and change the way our bodies physiologically respond to that. Our levels of anxiety and depression. And the other piece that I also find fascinating about this is that there is a direct relationship between what these microbes do in terms of how they create, regulate. And really just are in charge of or bossing around the neurotransmitters or the chemicals in our brain but also markers of inflammation. Which seems to actually be maybe as important or possibly more important to how our microbiome affects our mood. There are a lot of proposed mechanisms in terms of well this bacteria turns on this cytokine or a chemical that affects cells. Or this bacteria turns on this marker and IL-6 or something like that and that is a regulator of inflammation. So obviously you know more diverse you have or the more diversity you have in your microbiome the more opportunity you have to affect all those chemicals. All your inflammatory markers all your cytokines. The part that I also find fascinating about its relationship to inflammation. What bacteria controls what chemicals and you know and us figuring out that understanding or understanding that a little bit more. But also how it affects what's called our HPA axis. So if you're not familiar with HPA axis there it's the hypothalamus a little area of your brain. Also along with your amygdala also sort of part of that like reptilian or from kind of like primal brain. Your pituitary which is a little gland that sits like right in the middle of your brain and we call that the master gland. So that's the one that has a lot to say about your thyroid function and your reproductive hormones. And the a part of that axis is your adrenals. So you're the little tiny glands you know these little peas or raisins that sit right on top of your kidneys. And that we refer to a lot of people say the words like adrenal fatigue or they talk about stress response. And there is that relationship between the brain and your adrenals and that and what it controls is almost everything in your body. It helps to control or affect inflammation. Your circadian rhythms and how you sleep your blood sugar regulation your hormone function. So not only are the microbes in your gut directly affecting these chemicals that change inflammation but that inflammation being changed also affects downstream possibly your stress response. So when we affect inflammation we can also affect our stress response but we can also decrease the burden on that HPA axis or our stress response. So an example would be if we're able to decrease inflammation in our body maybe through our diet through exercise through improving our microbiome diversity we can possibly change not only the way our brain makes and responds to chemicals that affect our mood but also the way that even a stressful situation would appear to us and how it might kind of you know roll through our body and play out. So if you have more functional microbiome you know in conjunction with you know good sleep good exercise good diet you can actually positively affect your body stress response but also your mood. So there's a couple notes in here and I won't necessarily read all of it but the idea that a lot of these chemicals in our gut also very specifically affect certain neurotransmitters is something starting to understand a little bit more and this is kind of where it ties into you know pregnancy and pulse pattern depression. So when you're talking about certain chemicals in our gut that actually affects serotonin levels. So whether or not we I don't know make enough or we break it down appropriately because there's two you know two sides of that and every single coin but also whether transmitters that can you know block some of those chemicals that make us more like excited or anxious or you know cause us to have insomnia something like GABA. So here's a you know a little bit more detail about like which colonies at least so far we've identified seem to affect different chemicals and this is like a very very tiny list of the critters that are in our gut. This is like literally just talking about a couple species of bacteria. This isn't even really going into like the yeast and the parasites all the other kind of stuff that have important functions and how many different neurotransmitters they're affecting either together or even separately. So when you're talking about you know GABA which is the way of well if you've heard of like Valium or any of those medications that kind of like take down a notch that's what GABA does in our body nor epinephrine and epinephrine are basically like adrenaline response. So these things have the ability to both switch on and off that response. It's not necessarily even just that they're all stimulating and exciting that they're also really integral to keeping them in check. And then so how does it change with pregnancy? There's actually quite there's still more to be known about this and I think that a lot of what we know is mostly based on the condition of the placenta and not so much a lot of human studies and a lot of these are coming from rat studies too. So you know we have a long way to go in terms of understanding the diversity in a pregnant person but you can see that there are a lot of changes. You can see that Candida goes up yeast and then so you know everybody thinks oh well that's really you know terrible but there's also a really strong increase in lactobacillus. So one of the things that we often use to treat an overgrowth of Candida. So in a lot of ways the body does normalize itself but obviously there's ways that we can help. And I think this is one of the most fascinating things that I have learned through this process is that the changes to the gut microbiota and pregnancy happen immediately at the onset of pregnancy. So even before people know that they're pregnant or certainly have for a lot of people received any kind of care or you know guidance on diet or a lot of times before the nausea sets in and they're having all the digestive side effects all these things have already changed. Which explains in addition to hormones why some of the digestive side effects of early pregnancy set in in terms of like constipation or diarrhea a lot of nausea a lot of reflux and why some of those things might persist all the way through the pregnancy. And that the diversity of the microbiota or the microbiome in pregnancy changes over the course of the pregnancy which I also think incredibly fascinating when you think about how many things are growing in this person's body as they're progressing. The other thing that I find fascinating and at the same time possibly disturbing depending on how we interpret this data or this information is that pre-pregnancy weight and weight gain over the course of pregnancy seems to affect both the presence of certain colonies of specifically of bacteria it's mostly what they've been looking at but also the diversity in the microbiota and that having either a pre-pregnancy rate that weight that meets the classification of obese or above can actually mean that they're sort of starting off with a much less diverse microbiome but then also a lot of weight gain through the course of pregnancy can also trigger changes to the diversity for better or for worse. So fat mouse here because most of these studies I mean mostly they're looking at pregnant mice and causing these mice to either be overweight beforehand or gain a lot of weight during the course of their pregnancy but with some of these mouse studies they find that when they actually inoculate the mice with third trimester so like the end of pregnancy microbiota so basically taking the microbiome from a pregnant mouse who's near the end of pregnancy and put it in basically a non-colonized mouse that mouse becomes more inflamed there's more inflammatory markers which you know sort of like looping back to what we were talking about that those inflammatory markers can then in turn change hormones neurotransmitters and possibly predispose us to having a different type of mood response after the pregnancies over and the other piece of this mouse study is that it can change more so and you know quote-unquote for the worse in mice who tend to be obese. So the one thing that they did to create these changes specifically the weight gain changes in the mice was a high fat high caloric intake diet. So you know sort of coming to like alright so how do we positively affect this microbiome so that pregnant people can make the most of the diversity that's happening through the course of their pregnancy and can come out on the other side with as much diversity as possible and with the best chance of having optimal neurotransmitters so that they're happy and healthy and that their babies that they're raising you know our little pre-paleo people are also happy too. You could say well you know take a probiotic end of story thank you very much you know I mean that would be the end of it but diet plays a huge role in this and we know this but I think that this is the part that I would like to see us know a little bit more about you know what components of our diet change our microbiome for the worse and affect diversity by reducing it and it seems like a high caloric diet will generally decrease the diversity in the content of our microbiome. A high fat diet now specifically in these studies they don't say like oh yeah we fed them you know six grams of fish oil every single day they you know fresh caught salmon that's not that's not what was happening here so typically we're talking about these high fat diets from a study perspective especially with mice they're usually more with saturated fats and not necessarily even polyunsaturated fats so think you know high calorie high fat processed food type diet and that's also what's able to be quantified and you know stored and used in a study as well. So thinking about dietary changes pre-pregnancy because now we're coming back to like okay how do we look at this a little bit preventively and then also during the pregnancy thinking about well maybe you don't need to eat for two because you actually don't most people don't need more than 150 to 200 calories you're talking like one snack more than their regular diet during the course of pregnancy and maybe you could actually you know favor more lean protein vegetables and if you do grains and legumes you know thinking about things that are kind of higher fiber and kind of more nutrient dense so things like scarlet runner beans you know which have a ton of calcium versus stuff that's a little bit more highly processed or less nutrient dense. But the other piece of this is you know diet but then also the weight gain conversation which again I'm coming back to like well how much you know do I want to have this conversation about you know obsessing about people's weight I have to say that as a provider I very rarely make weight a big issue in my practice but what I do talk a lot about and kind of obsessively about I was like I want to know what you're eating you know I want to know what you put in your body because really if you gain 40 pounds that may not be a big deal for your body it may be a big deal for your body I definitely don't want to go back to you know the 60s where they're like hey take a dexatrim and smoke a cigarette you'll only gain 10 pounds and that's the best for your baby so you know I don't want to go in that direction but maybe we can change the discussion about it's not so much about your weight gain more so about appropriate weight gain you know that if you're eating nutrient dense food if you're eating stuff that's not only going to potentiate a very diverse microbiome you're going to gain the amount of weight that is better for you and your baby so you know just thinking about that conversation and trying to reframe that for yourselves but also for people you might be talking to. The interesting thing about the shifts in the microbiome is that they also are related to gluconeogenesis and glycolysis which basically you know breaks down to blood sugar regulation so thinking about like what is something that comes up for people in the course of pregnancy is gestational diabetes. How much of a microbiome could be related to and even in control of whether or not we actually have blood sugar regulation issues in pregnancy as intensely or more intensely than is already happening naturally and can we decrease the amount of diagnoses that happen in this time too. Because I will say that from a high risk standpoint gestational diabetes, poorly managed blood sugar creates some of the greatest complications in terms of preterm labor in terms of even hypertension to some extent because of the load on the kidneys and the liver and also moms developing kind of like wound to histones meaning like after C-sections that their wounds don't heal as well. So there's a lot of other sort of downstream complications that moms in particular experience as a result of poor blood sugar regulation. So anything that we can do to impact that particular little complication of pregnancy I think is worth from a public health perspective is worth investigating. But in addition to blood sugar regulation, inflammation, we have a direct effect on all of our neurotransmitters. So if we can actually improve the microbiome, we can set them up for having a slightly better postpartum recovery potentially. And the way that we can do that with diet is mostly with some of our high fiber and soluble and insoluble fibers. So I think again kind of coming back to some of the definitions of paleo people think about well if you're not going to eat a lot of processed food, you're not going to eat a super high fat diet or super high calorie diet, you should be eating bacon, bacon, bacon all day long. That's not really what this is saying. You know, a lot of this is saying like we want to actually to rebuild our microbiome and favor what's called like the firm acute over these Deroides species which are a little bit more favorable. We want to actually get a lot more fiber in there. This last piece is going to sound a little bit, I don't know, duh, but the higher presence of Bacteroides which is it's not a bad species. Again this you know coming back to that nothing's necessarily good or bad we have to stay in the nuanced middle. But when we have a lot more of these Bacteroides we have, you'll see generally more like IBS symptoms, things like that. They can be associated with lower inflammatory chemicals, but they can also be associated with social disruption, meaning stress. So there's sort of this social disrupts in meaning like anything in your body, anything in your life, your circumstances can also affect the presence and the balance of these. This one's a little bit challenging to see. So we talk of a little bit of caloric intake, high fat diet, pre-pregnancy weight gain and social disruption. What are the other ways that we can affect the diversity of our microbiome? Obviously supplementing with beneficial species. So there's a lot of formulations out there and I don't have any affiliations with any company or anything like that. Where they're looking at all these studies like okay so you know Bifidombacterium and Lactobacillus species and even some yeast like Saccharomyces are super beneficial for balancing neurotransmitters. Then maybe we should put those all in one little tablet and someone can take that and improve their microbiome, not have any issues with their neurotransmitter, not have any issues with postpartum depression. That might be true. But we also know that it's not as simple as that. We know that we have to address the fat content of people's diet and I would say that fat content meaning like saturated fats, processed food, that kind of thing. We have to address the caloric intake. You know is what's happening here sort of an appropriate amount from a calorie standpoint for the development, the healthy development of the pregnancy and for the baby. And a lot of times people families, whole families, everybody included, tend to overeat a little bit in pregnancy because like oh yeah, you know let's go hog wild, you can do everything you want. And that is probably one of the places where we can interject and say you know regardless of whether you consider yourself a perinatal specialist, like actually let's think about what can help promote a healthy gut so that we can have a healthy hormonal neurotransmitter response afterwards. I don't know that we can do a whole lot about you know our social disruptions. Sometimes they just happen and they often tend to happen to people who are expecting children because you know they decide to move, remodel the house, you know have a baby, invite all their family to come live with them or something like that all at once. And it usually seems like a good time to do everything and so there's a lot of social disruption that's happening in this group of people. In addition to the fact that now you are not only birthing a human but you are birthing new parents, you're birthing a new family. So everybody has to learn how to be a completely different human being right now. But what else can we do to modulate our inflammation? So just as the inflammation is modulated or changed or regulated by these little critters, we can also do things like addressing diet to modulate our own inflammation. So take the burden off that HPA axis so maybe the bacteria in our gut aren't so affected by the social disruptions in our life. Optimizing digestion, I kind of put that there is like you know there's a lot of things that people do that have natural species of bacteria in them. Kombucha, sauerkraut, a lot of the fermented foods, fermented vegetables, you know it's gaining a lot more interest. And I love them personally. I love fermented spicy food. I can eat all the kimchi for the rest of my life. But when you think about it from like a constitutional perspective, Ayurvedic medicine, Chinese medicine, fermented foods also have a lot of heat. You know they create a lot of irritation in the gut. So for someone who's digestive tract is really slow and sluggish and they're cold all the time and they're constipated and that kind of thing, that can be really helpful. But in someone who's having a lot of insomnia and heart palpitations and night sweats happens to a lot of people when they are pregnant and postpartum, this might not be the way to do it. So when you're thinking about those, the positive cultures and the beneficial bacteria that are contained in those foods, take that with a few grains of salts or a few grains of salt. And also I don't know what the exact right amount is to eat of kraut or kombucha or kimchi, but I'm pretty sure we're not supposed to eat six or drink 16 ounce bottles once to twice a day. So that is another one of my surprises. I don't know what it is. It's somewhere between a pinch and a gallon is probably the correct answer. These are some of the other integrative approaches that I wanted to put on there just for your own eyeballs to see it, but that there are other things that we do to help balance neurotransmitters specifically as it pertains to neurotransmitters and really just what's happening in a perinatal period. That there's other ways that we can complement a positive microbiome. But that also if we have a really functional microbiome, a lot of these things are more easily procured from our diet. If we're eating healthy fats and protein that contains B vitamins and we have a healthy ratio of our diet, we don't necessarily have to high dose supplement the B6. And we don't necessarily have to go with like six grams of fish oil to make a difference in someone's mood. And then if we are somewhat trying to take the burden off our HPA axis and our social disruptions and address sleep and things like that, we can not only positively affect our microbiome but also our mood. So these are some of the changes that we can make and I come back to that reframe around the pregnancy and the weight gain thing. Because there's a lot, I feel like that's going, anytime you talk about obesity being a contributor to poor health, we can run away with that. I will say specifically in the being in the natural health realm as a natural path. I see a lot of people who are like very rigid about their diet. There's a lot of good bad dichotomy in eating. There's to to the extent where I feel like it very often becomes disordered eating. And there's definitely a lot of like fat phobic information that gets circulated. So I feel like having that idea of we don't have to demonize people who maybe start off at a weight that is not their healthiest. We don't necessarily have to demonize the weight that they gain through the course of their pregnancy. But we can at least have those conversations with ourselves, with our families and maybe with people that you're working with in your own profession. Of like, you know what, if your provider is telling you you need to gain 50 pounds in this pregnancy, let's talk about what the other possibilities are here. Because for some people that might be fine. All right, here's all the, I got the flag, so resources and citations. That's not even remotely an exhaustive list. I probably had like 60 articles that I would have liked to stick in there, but it seemed a little intense. So, all right, I'm ready to stop. Any questions? I should just worm in here. Thank you so much. That was a great talk. I'm very sketchy on all of the details of this. So maybe you can crack me here. The placenta makes lots of estrogen, is it? Yeah, well, most of the estrogen itself is being made by the maternal, by the maternal glands. But the placenta itself has a lot of the receptors for those hormones, so a lot of the hormones will be contained in the placenta. Okay, so I think, again, correct me if I'm wrong, one possible explanation for postpartum depression was that normally the adrenals can also make lots of estrogen. But if your adrenals are not doing so well and you obviously have the placenta, there's a lag. And that, have you heard anything about this? Well, I mean, most of the estrogen is going to be made by maternal ovaries and then the receptors in the placenta. So when the placenta does pass, there is that, like, all of a sudden, a lot of the hormones that were in circulation were in the circulation of the placenta to feed the baby, and then now that thing has left. And so that's one of the, you know, arguments for placentophagy or actually consuming either, like, desiccated or freeze-dried placenta capsules is to replenish some of those hormones. On the flip side, there are a lot of reactions that get triggered as a result of the placenta being delivered that might possibly, and I think we're still learning this, that might possibly be stunted by consuming placenta afterwards. Thank you. Yeah. So I am pregnant, so you don't have to question that. So sometimes people don't want to know that. So on the topic of gestational diabetes, I've been keto for three years and in 27 weeks now, and I haven't had any glucose dysregulation of any kind, pretty much stayed keto the whole time. I'm very low fiber, low plant matter keto. However, I'm in a lot of keto pregnancy groups where they are told that they have to up their carbs, and you can. So I can up my carbs to 50, 60, and they're no longer in ketosis. And then I'm not a fan of the glucose tolerance test, but they take that, they fail that, they get the diagnosis. And they're told, and I would never blame anyone, but they're told there's nothing you can do, it's just hormones. And when I try to find that, besides HPL from the placenta giving a slight insulin resistant effect, I'm not finding what hormones are causing you to have a rapid increase in your glucose, or not being able to manage that. So I guess I'm just wondering your thoughts on that. And then also staying keto low, staying that way seems to prevent GD by current standards, but that's still pretty low fiber. I don't know if it's doing something else to the biome. Right, and that I think is something I would love to know more about. So I feel like there's also, there's two questions there. I would love to know about how much a low fiber diet could potentially be affecting the microbiome from, you know, in terms of not so much presence or absence, but the diversity. You know, like what things go down and up in a more keto diet versus one that contains a little bit more plant fiber in it. And I don't think that we have that information yet. My suspicion is that you would see sort of that skew between like the firm, acute symbacteroid type species and then a few other ones that are going to be more present when you have more plant fiber in your diet. But if it's not also in the absence of issues, you know, is it a problem? No. You know, if you don't have any IBS or, you know, like irritable bowel syndrome or if you don't have any like recurrent diarrhea and constipation. Is it an issue that your firm, acute symbacteroides are a little off? Not necessarily or at least as far as we know. I see that all the time with the glucose tolerance test that, you know, a lot of families that I see they try to eat well. They make better, you know, they're trying to make better and better choices based on whatever data and information we have to eat less refined food. And then they go and take the glucose tolerance test is like dyed bottle of dextrose and they fail it because it's gross. It's a dye bottle of corn syrup. And there aren't a lot of other options because we don't really have a lot of other data or research in the medical community that has, I should say, that has trickled into the medical community and into clinical practice that allows people to take the test differently or allows people to monitor their blood sugars for, you know, fasting and postprandial, meaning after meals for a week or two and having that be, you know, provide some kind of baseline for how people regulate their blood sugar. So I definitely see that too. I don't think it's necessary to add more carbs into the third trimester. I find that some people do naturally just simply because that is the trimester where babies are growing like they are literally gaining half a pound per week. So they're just getting bigger, you know, and this is anecdotally, I will say, you know, working with a lot of families that would like to breastfeed and, you know, decide to breastfeed for some months to years afterwards. I do find that when people are slightly more carb restricted, but not always, that it does seem to affect milk supply afterwards. That there is something to be said about that like rapid absorption of glucose and carbohydrates that seems to make milk supply more plentiful. But again, not always. It's just that's totally my observation. I did ask Jackie Eberstein at Low Carb San Diego because she gave a talk about pregnancy. So I asked her that and she specifically recommended upping your salt if you're low carb to make sure your milk supply is okay. That's just something I learned. Yeah. I think probably a lot of people do by default anyway, but yeah. Thanks. Outside of, you know, pregnancy, looking to resistance. My other question, just as a side, where people are taking probiotics, should there be any concern? Well, I would say to your first question, I don't know if I know the answer for that one yet. You know, I think I'm still looking into it and, you know, looking for more answers and I don't feel like I have a good answer on that one yet. And related to the probiotic question, you know, it's a good thing to think about because it does happen with our body that if we don't encourage it to do its things on its own as much as possible, whether it's genetically or, you know, with our diet and lifestyle, it's possible that those functions could get shut down. It doesn't seem to make sense to me physiologically that that would happen with the microbiome because it's not necessarily that like, receptor relationship like estrogen or thyroid or something like that, that it's really just, and it's constantly changing all on its own, even in response to our stress or our sleep or whether we eat more processed food or not, how much we play in the dirt, you know. So, that's hard for me to say. I do think that what happens, though, is that when people are taking their probiotics, they forget to think about, like, what are the things they can optimize in their diet. So, maybe that would happen. So, like, I got that taken care of. I don't need to eat, you know, real food. I can just, you know, take a probiotic. It's all good. I first, just a quick point about glucose tolerance tests. I'm not sure if Carolina, the group, people in your group are taking this into account, but if you're on a low carb diet, you're going to fail a glucose tolerance test and you have to up your carbohydrate level for at least four days, I think, before you can take one and get a proper result. The correlations between things like mood and strains of gut bacteria are fascinating and interesting, but we have to be careful because those are always, all the studies that I've seen show those in a high carbohydrate diet, and so the correlations might not hold, let alone the causations. But I also just wanted to point out that in germ-free mice who have no bacterial resonance at all, mood is improved compared to others. So, I just think we got to be really careful about imputing any kind of causation or saying we should try to increase this bacteria, we should try to increase that one, or, you know, feed this one and not that one. I think it's quite premature. Right, and that's why I think about more what can enhance diversity overall, you know, and the community of commensals as opposed to, you know, we should use this particular species of bifidobacterium so that we can get the GABA inhibition that we want or something like that. I mean, in time that will happen, people will say, oh, well, you know, this particular strain creates this type of neurotransmitter, let's create this one single probiotic, it'll become a drug, you know, called like, gabbateria or something like that, and then, you know, people will take it so they don't have anxiety, and it'll feel natural. Great, thanks. This is an incredibly important and interesting topic, and I really just, you did a great job from my perspective, I'm sure. I wish there were more people here. Well, pregnancy doesn't seem appealing to a lot of people. There's a new disease phenotype that's appearing in the obstetric gynecological literature, and it's called gestational apnea, and it tracks with comorbidity. It could be even caused in effect in some people with hypertensive problems, preeclampsia or hypertension in pregnancy and gestational diabetes. But the placental microbiome and the uterine microbiome, I mean, the fetus is exposed to a microbiome, and I'm glad you brought that up. Everyone thinks it's just the gut, and it's not. Well, it hasn't been explored. The mechanism, most of the work is being done at the University of Pennsylvania and at the University of Chicago by some obstetric gynecology researchers. And as far as I know, I don't think anybody has really explored the mechanism of how intermittent hypoxia of a mom and how the placenta communicates that you're going to be born into an environment where there's not enough oxygen. This is the whole developmental origins hypothesis, is that what we speculate, and I'm actually working with the people at Penn on this, is that a baby who perceives that it's low O2 thinks it's going to be born atop Mount Everest. There's actually an article that appeared in the 60s, Mount Everest in utero. But this is before anyone knew anything about microbiome. So I'm just thinking where you could take this next, because you're obviously a pioneer in this area, is, and I can send you some of this literature about gestational apnea and how it tracks with comorbidity with diabetes. Is it possibly that it's the microbiome that's being affected? It's not just the O2 deprivation, but there's a respiratory microbiome as well, that the mother, if she's not breathing through her nose and breathing through her mouth, she could be sending that microbiome to the fetus. I don't know. And maybe simply just the stress disruption that's causing that change to the microbiome too, it's hard to know, but I mean that's, yeah, there's so many things that could be affecting that, and then the whole neonatal microbiome is my other fascination.