 Hey everybody, thanks for joining us again. Today I am so excited to have my friend and colleague, Dr. Van Zant. We'll get into our story, but just a little intro before I introduce her formally. We go way back to Illinois. Yes, and it's just such a neat story because I did my medical training in Chicago, came back to Illinois, did my residency in family medicine there, and then I stayed on with the hospital that was, it's now Unity Point, but it was Methodist Medical Center. And remember really talking to the CEO and saying, you know, we need to get some integrative medicine in here. And fortunately, he was insightful enough to see the need. And we created an integrative medical center. And Dr. Van Zant was my medical partner there. And so we have actually practiced together in Illinois. And I just have such great respect. It's so fun to reconnect. And she has her own practice now in Illinois. And she'll tell you all about that. We'll be sure and link you up to that because I know a lot of you out there. In fact, if you're listening today and you're from Illinois, say hello, because we have a lot of, I still have a lot of patients from Illinois. And obviously, patients that I used to see, some of you still follow and watch these. So if you are out there and listening on any podcast, YouTube or Facebook, please say hello, because I feel like it's all my old friends in Illinois. So I'm so delighted to have Dr. Van Zant. Before I introduce her just a little background, you guys know, you can find all of my videos on my YouTube channel. It's just under my name, Dr. Jill Carnahan. There's like over 60 hours there. It's all free content. And today we're going to be doing another one, and it'll be posted there shortly. If you want anything on the website, we have free blogs and all kinds of resources at JillCarnahan.com. And my retail store is at Dr. JillHealth.com. So those are the places you can find me. Now without further ado, I want to introduce my beautiful friend and colleague, Dr. Roberta Van Zant. She practices functional and holistic medicine in Illinois. And as you've been around a while, you all know what functional integrative medicine is, kind of getting to the root cause. She is a kindred spirit in many, many ways. And we've had our own adventures. And then I moved to Colorado in 2010. And she, like I said, has her own practice. She is trained as an osteopathic physician, which is, I always feel like they have bonus material that we don't get in allopathic medicine, because she knows how to adjust entry through movement to manipulation, as well as all the same training that allopathic physicians get. I always find this may or may not be true. It's my own little take on it. But my colleagues that are osteopaths are a little bit more open-minded. And I really like that about their training. I think they get probably a little bit more nutrition in some of the things that, again, allopathic physicians miss out on. But same training, great medical doctor that she is. And she is trained in family medicine, like myself. She's board certified in family medicine and osteopathic family physicians received over 300 hours of additional training in functional integrative medicine, as well as osteopathic manipulation. She got her medical degree at University of Texas Health Science Center and Texas College of Osteopathic Medicine and completed her residency in family medicine at Harrisburg Family Medicine program in Harrisburg, Pennsylvania. Also the first graduate of the Women's Health Fellowship through the University of Illinois College of Medicine in Puria. So love, love, love having you here, Dr. Banzia. It's like old friends. It is, yes. So great. Yeah, thank you so much. It's wonderful to be able to talk with you. I'm really impressed with everything that, you know, you're able to share. You do such a great job. We do go so far back. I think when I first started as a fellow, you were in your third year of residency and then you went out and started doing functional medicine right from the get-go. And I was so blessed to be able to come on board and work with you at the Center for Integrative Medicine years back. And really, that's where I got my start, you know, was working alongside you and you have taught me so much when we worked together. And it's just been a joy to be able to continue to do functional medicine full-time. It really is amazing to me as I look back, you know, I've been doing it for 16 years now and it's hard to believe, but yeah, I started out working side-by-side with you and you taught me so much. Oh, thank you. I feel like I always went the same way. You taught me just as much and it was so neat back then. We were just like, you know, honestly, did we really even know what we were doing? No, sometimes I still question that, but it's okay. Yeah. I know you learn along the way and you just grow. And I think that God just puts before you the things you're supposed to learn in certain seasons. And you know, I still think every day there's so much more that I could know and need to know, so we just never stop learning. Thank goodness, right? I'm the same way. I'm always like up for a new, you know, it's interesting to you. I'm sure you have this perspective, but I have patients who've been a lot of different places and different practitioners and still looking for answers. And I'm always surprised at how many times they tell me, you know, the docs said, I'm sorry, I can't help you anymore. And I just like my heart drops and I'm like shocked because I don't have all the answers, but I'll never stop trying. And I know you have team velocity. And it's always like you said, the way that I feel like I get my greatest education is through my patients, because I'll come in with something new or something slightly different than what I've seen before. And I have to help them be a team with them and figure it out. And I get excited. But that's where I that's where I learn like we wouldn't learn about the people that come in and bring me. Absolutely. Absolutely. There's no way we can know there's the amount of information, especially available to us now that, you know, we are able to search the vast internet is vast, more than we could ever stick in our brains and try and spit back out. So I'm usually appreciative when people bring new ideas to me. And, you know, whether or not I continue with exploring those ideas, it's always an option. But I think it's a good thing when we're exposed to new things, new ideas, new thought processes, because no, no two functional medicine physicians practice the same or think the same. And that's a good thing. Because as we were just talking about before we got on the air, you know, everybody has a passion based on their experience. And it's what the experience is that you have in your life, how the impact you really drive what you do and and how you then can help your patients and interact with them. So well said. And that's a great segue because what I love to start with is kind of your journey from osteopathic medicine manipulation into functional medicine and obviously family practice in there too, just like myself. Tell us a little bit about how you had interested in functional medicine and then some of your own challenges with patients or our family or friends or people that have kind of driven you where you're at today. Well, you know, I actually did not go out of come out of my undergraduate thinking I was going to go right into medical school. I went into my undergraduate thinking I was going to go into medical school. And then I discovered there was other things out there that I wanted to do. So after I graduated from college, I actually went and worked in research for a while. And then I was a medical editor for a neurosurgeon for a while. And it was while I was working with him that something happened. And I realized I wanted to go to medical school. But more than that, I had kind of had not major but some minor health challenges. I had a friend at the time who had been raised without any antibiotics and just very non traditionally. And so that introduced me to using herbals and things like that. So I that was my first taste of kind of non traditional medicine. And it was that combined with a spiritual journey that I was on really made me think that I wanted to become a physician who treated the whole person person you know that quote unquote holistic approach. And after after knowing that I started looking at where I wanted to go to medical school and ended up at the osteopathic school that you mentioned. And no, I not every person who goes to an osteopathic school has a real widened or more thoughtful approach. But I do feel like there are certain people who choose that. And it's because the philosophy really is that the body has the capacity to heal itself. That's the very essence of the osteopathic philosophy. And so I loved that. And I wanted to treat people birth to death and be able to just sit down with them and talk. So I ended up going to, you know, an osteopathic medical school and learned a couple other tricks, I guess along the way, you know, doing osteopathic manipulation, which has been wonderful. But I really loved the approach to it. Then I went into residency up in Harrisburg, as you had said, and did a family practice residency. And honestly, it was pretty traditional. And that's okay, because I always think that my traditional training gives me a sense so I can keep feet in both, both worlds, you know, and in some degree. So a foot in the traditional world, I understand how that works. I've treated patients that way. But in the integrative or functional medicine world, I can see the bigger picture, the bigger toolbox. So I had a pretty traditional training program and then moved here actually to do a women's health fellowship where I live now in Peoria, Illinois. Never thinking I would be here 16 years later, because I'm not from this area. But the way things happened, I did get a job. I met my husband who was from this area and ended up staying here. And the first job I had really was what challenged me. I again was doing, I was lucky enough to be able to spend about 30 minutes with a patient. I said, at that point, I did primary care women's health. So I was spending about 30 minutes with patients and I loved that because I could spend that time. I knew I never wanted to be a physician who just, you know, ran in and out and saw 30 to 40 patients a day. That was never going to be a good fit for me. But it was while I was working at the women's health that I started to learn about bioidentical hormone therapy. And you would think in a women's health fellowship, I wouldn't know all about that, but it was pretty traditional. And I knew some, but it was going to a conference on bioidentical hormone therapy and adrenal, thyroid testing, et cetera. I walked away and I thought, why did I not learn this in medical school? Why did I not learn this in residency? This just makes so much sense. And it was then that I started really doing what I'd call functional medicine right after I got out of my fellowship, because it was looking, you know, behind the cover, trying to figure out why, asking the question why. You feel this way, but why. And so I started really doing just more hormones, thyroid, et cetera. I worked as a faculty member for a while at a residency program here in Peoria family practice. Really enjoyed that. But when I had my second child, I knew I didn't want to work full time and you had just opened up the Center for Integrative Medicine there. And so I remember I approached you and I said, I just want to work part-time and I know that I want to do all functional medicine. I don't want to do traditional medicine. I never will. And, you know, that's when I embarked upon doing all functional medicine and have never looked back, you know, at and all the other things. And then it's through your own experiences in life. And, you know, you name it in functional medicine. We've had it either I've had it or my family member, somebody I know, you know, autoimmune or thyroid or adrenal or hormones, all of it infection, et cetera. You know, Lyme disease, tick-borne disease. So all of this has just layered on my experience. But, you know, the cardiovascular stuff that we do at my office as well is kind of my own personal experience. That's the thing that I would say has driven me to lean into that area kind of specifically in a special way because of my family history and my own personal history. Yeah, I'm so excited. Like you said, we haven't talked a lot about heart health and for women, I believe the statistic is the fourth leading cause of mortality among women. And so, often we talk about men, we think about men, we study men, but we're just as prone to this and actually I think underserved sometimes the statistics and the research and even absolutely. So, and again, I love how you frame that. I feel the same thing. We've had this wonderful conventional training and I embrace it and I love all the important things we've learned, but now we've got a bigger toolbox and more things to do. Instead of just going to drugs and surgery, we can actually go to root cause and say, how did this happen? Why did it happen and try to reverse it? So, I want to talk about that. And I just, like I said, I want to acknowledge our journeys here. One thing that came to mind as you were talking and I priced this before, but I remember back in medical school, I was like the oddball because I was interested in integrative medicine. I brought like, you know, we had an integrative club that I started at Loyola. And I remember my colleagues just kind of were like, yeah, whatever Jill does her thing. But what's happened over the years, and I'm sure you've had this too, is as they or their family members comes across their own illness or something where the commercial medicine doesn't have a great answer. I get calls all the time now where they're like, you know, Jill, we remember back in the day when you were the weird one and now is there anything you could help us? And I think things are shifting. There's more and more doctors that are frustrated with the limited time with patients and the limited answers really, because there's some great stuff with trauma and heart attack or car accident. But then more, but wait, there's more. So so cardiovascular disease, let's dive in and give us just the state of affairs. Like are you seeing a lot in women? Are you seeing younger? How does this first present? What kind of symptoms would people be concerned about or family history? And then we can talk about what you do for diagnosis and treatment. Well, I really think there's probably two categories of people when it comes to cardiovascular disease. People either know that they had a family member who had cardiovascular disease, you know, parent, grandparent, et cetera. Alzheimer's is kind of in there as well. You wrap that up as a cardiovascular issue or some type of dementia. And they they are either accept it very frankly, like, this is just something that I'm going to have, or they're scared of it and want to just ignore that they might have that. But either way, they know it's part of their family history. And then there's the patients who may not have it as part of their family history, or they're already doing something to be very proactive and think, I'm healthy, I'm taking care of myself. And obviously, lifestyle is a huge deterrent to all kinds of illness, cancer, cardiovascular disease. But the unfortunate truth is that cardiovascular illness is the number one cause of death in the United States for both men and women. One in two people will die of something related to a cardiovascular event, as opposed to, and for example, breast cancer for women, one in six women will develop breast cancer, which is different. They don't actually die from it, but one in six will develop breast cancer. But we have so much technology and advancements that we can actually do many things to prevent progression, treat it, et cetera. Whereas cardiovascular disease, it kind of gets swept under the rug for women, or does it, you know, we have the Go Red for women month in February. And I think more women are aware of that, but it's still on the back burner in medicine. We don't talk about it enough. And certainly, I think most women are surprised to hear that their number one chance of dying is going to be from some type of cardiovascular related event. So telling just like when you're seeing patients in the clinic, obviously, they might be coming for hormones or that. And I'm sure as a great functional medicine, you're looking at all the risk factors because you're doing a big wide swap of testing. What percentage is kind of a new thing when you bring up, you know what, you're kind of at risk here. We need to address this. Is there a, would you say it's 50-50 people who know versus that you have to actually bring that to their attention? Or is it? I think it's probably more age related, honestly. You know, the older person gets, the more they think about their mortality. And so, you know, women who are probably 50, at least 60 or above, they're thinking about that risk for themselves. In my experience, more or less, they may have been told they have high blood pressure or high cholesterol. By that time in their life, it's supposed to younger individuals who may not have any clue about that. But my biggest concern is really for those women who are 30, I shouldn't say just women, okay? Men as well, but you kind of asked me about women. So my biggest concern is for those individuals between 30 and 50, we know that statistically plaque happens between the ages of 40 and 50 for the most part. That's when most plaque starts to occur. And I really think that that's those people that we have to educate. And this is a different brand for me of trying to share with patients in functional medicine, because I'm sure you know this. You don't have to really try and advertise functional medicine, because when people know about functional medicine, they find you. They know that it's different, that you can offer something that other physicians aren't, that you're going to look at the root cause. They're not feeling well. Something's not right for them. The cardiovascular prevention is a completely different thing. I mean, it's true. What I would hope is that it's true prevention. And so that's education. You have to educate people about understanding why they need to really get that risk, because they can obviate that risk very early in their life. And we can actually identify their risks much earlier than they would think. So in traditional medicine, there's this paradigm of either you've never had any issues with this, right? You've never had a heart attack or stroke. You've never had a stent. Or you have, like it's black and white. You've either not had anything. Maybe you have some risk factors or you have it. And probably the one exception to that is diabetes, right? Diabetes is called the cardiac equivalent. We know that high blood sugars are hard on the blood vessels. And so that's the one thing that in conventional medicine, we try and be a little bit more aggressive about, even if a person hasn't had symptoms. But really, the amazing thing is there's plenty of tools out there, relatively simple, outpatient tools, labs, and testing that you can do to figure out if you fall into what I'd call that middle category, which is not that you haven't had symptoms, but that you actually have disease or inflammation of the blood vessels, but you haven't had an event. So really, three different categories, right? You either have no disease. This is more of an arterial disease. And I totally give credit to Dr. Bale and Dr. Donin of the Bale-Donin method for bringing this idea and this understanding so eloquently to the forefront, which is that we really have three different categories. It's arterial disease that we need to be looking at, not just have you had an issue or have you not, but rather, is there a problem with your blood vessel or not? And you either have had problems with your blood vessel or you haven't, but if you have, you're going to be in that, yeah, we know that category. If you haven't, we can actually divide that out and look at, well, do you have issues ongoing right now? Do you have plaque? Do you have inflammation in your blood vessels? And if you don't, that's true active prevention to keep it that way. But if you, if we can find, if you have plaque, or if you have endothelial inflammation in your blood vessels, then, and you haven't had an event, we can actually impact that too. You're not just a sitting duck. And so that's the paradigm shift that, you know, that we're trying to affect, which is that you can truly be preventative. You don't have to just be a sitting duck. But more than that, you can know about what's going on inside your blood vessels. And, and we can figure out what's causing the problem too. There's enough data and enough evidence out there that it's not just, do you have high cholesterol? Do you smoke? Are you overweight? Do you have high blood pressure? Those are important. Absolutely. Those are the obvious risk factors. But other things like, do you have PCOS? Do you have a nitriosis? Sleep apnea is a huge one that goes, yeah, grossly undiagnosed. Chronic inflammation, autoimmune disease, infections, you know, patients who have ongoing infections. You know, all of these things, genetics play a huge part. I know that you spoke with my friend, Sharon, husband, co, and a couple of weeks ago, I love, and, you know, the genetic component of it really, I think is so important to talk about with all illnesses. But for sure, cardiovascular illness, there's some genetic predispositions that we can actually kind of manipulate, you know, with the epigenetic impact and help offset. So I think that there's so much that can be done. It's educating people about that. Coming back around to what you were asking me a minute ago, the educating patients to know what they don't know, or they don't think is important right now, that's different than I would say more of what patients traditionally come to me for in functional medicine, which is I have this problem. I don't feel good this, this, this, and I need help. So it's a nice segue for the most part to be able to look at people's risk factors and talk about, you know, hey, we have this program or we have some ways to figure out if you're at risk now. I know we're talking about all these other things, but I know you know this, you know, in functional medicine, my goal is always to get people feeling better and out the door. I don't want them to be lifetime patients of mine. I want them to feel good and to eventually move on. But while they're there, I'm hoping that we can talk about their cardiovascular risks too and make that long-term impact on them. Gosh, love it. What a great kind of overview. And when they're coming in, are you assessing everybody who comes in for heart health and then making offering, how do you give them into the heart program? And then what does that look like? Well, I think that it's always in the back of my mind. But you know, with any person, you know, you're going to address the things that are most important to them first. And sometimes that's a discussion at the first and sometimes it's not. But if they have risk factors, it will be something that we try and get into the discussion at some point because my goal is to take care of all of them and help them to get truly healthy from whatever they're suffering from, but also for the long term. Then we also do have patients who come just for the cardiovascular program that we do. I call it the healthy heart program. And they come specifically because they know that they have risk or they're concerned because of family risk. Or, you know, they've had a family member. Now the word's getting out. We have more people who come who, you know, the husbands drag their, excuse me, the wives drag their husbands in, you know, or, you know, there are some younger people who are educated enough about cardiovascular risks that they know they still need to figure out what's going on. So it is a little bit of different. Some genetics and advanced lipid profiles kind of the basic, but what else? I'm assuming you're checking the gut, you're checking inflammation markers. What kind of a workup in general are you doing with these patients? Well, I'd have to say the various thing that I do is look at their blood vessels and that's through that simple test of CIMT crotted into me in media thickness. And do you do that or do you have any options to do that in your area? Yeah, the area. Yes. So, yeah, CIMT testing really changed the game for me because I had known about it a long time ago. I tried to get one of the local hospitals to do it and it was kind of blown off like, well, we don't do that. And nobody really, it's a very specific measurement, blah, blah, blah. So it wasn't until probably about five, six years ago that I discovered the bail-doning method, which I really credit with helping me to understand more about my own health, which is then of course how I wanted to implement it for my patients. But CIMT for me is foundational because it visualizes the arteries of the neck of the crotted and it tells us both about plaque and about inflammation in the blood vessels in the intimate media that of course that's aligning right underneath the indelium. And that is what can actually change in size. It's representative of inflammation and many different things can impact that. And all of those things we think about, gut dysbiosis, sleep apnea, high cholesterol, genetics, insulin resistance, high blood pressure, infections, inflammation, all of the things that we've discussed a minute ago, all of those things impact the thickness of the blood vessel aligning and we can actually measure that and determine if it's thicker than it should be for a person's age. And if it is more than five years discrepancy from their age, then there is something going on to accelerate their vascular aging. And if the intimate media is thickened, then that actually creates a sticking point for that LDL. So, you know, we hear a lot about whether LDL is good or bad, but I mean, it's really only bad if it's sticking in the cluster or sticking in the blood vessel wall. And so CIMT testing tells us that we can tell if you have a thickened blood vessel aligning and we can tell if you have plaque and then we can determine if the plaque is risky by how thick it is by the circumference of it and if the type is stable or unstable. You know, so that's where the rubber meets the road for heart attacks and stroke is if you have unstable plaque, you have to have plaque. You can't have a heart attack or stroke without some type of plaque for the most part. And if you have plaque, if it's unstable, you're at risk for having an event, a heart attack or a stroke and suffering some kind of illness from that. So CIMT testing is usually where I recommend everybody start because I can get a really clear picture of how immediate their risk is. Obviously, if they don't have plaque, there's some time. If they do have plaque, then we may want to be more aggressive. And then I layer in the advanced lipid testing as you referred it to. And I mean, again, simple blood tests that tell us what's going on backstage, right? It tells us what's going on as far as inflammation in the endothelial lining if the blood vessel is able to make enough of its own nitric oxide. If the blood vessels are cracked and allowing protein through, it tells us if the plaque that's present is inflamed or not. So I really feel like it's so much that we can tell from a simple blood draw in the CIMT to effectively give a person, do they need to do something now? Or if they are looking pretty good, what can they do to keep it that way? But I love this because some of the stuff that you and I do is cash only. And it sounds like the basic blood work and probably the crowded intermedial thickening, if some of that would be covered by insurance, is that true? Or can they get reimbursed? Well, the labs usually are not all of the labs. There's a few genetic tests that aren't their cash pay, but most of the labs go through insurance, especially with appropriate diagnoses, either if a person has a diagnosis of hyperlipidemia or family history, etc. The CIMT is usually not covered. Medicare will reimburse for it if it's done through a traditional office, but not much. So usually that is a cash pay out of pocket, but different places offer different prices, but usually it's not going to break the bank. You're not talking thousands of dollars, a couple hundred dollars, you can get a look at your blood vessels. And the crottids are just representative. Honestly, I don't think I said that, but they're representative of what's going on in the heart and in the brain. Easy to access. You don't have to disrobe. It's easy to get to. Do you usually do so? Say you find someone, say a 55-year-old woman or man, and you find some issues and you're starting to address them. Are you typically checking that again every year? Yeah, usually no more than annually because you can check the blood work. The blood work is usually helpful because if you have inflammation, I always tell patients that you can tell if the chemicals are off than what's going on in your blood vessels. We can modify that and that's our roadmap, but we'll repeat the cardiovascular CIMT in a year. I remember the first patient who had, he had tried many things and he was dedicated to lifestyle change. He was not overweight. He was trying lots of supplements and when we got a CIMT, I was just floored because he had a decent amount of plaque and unstable plaque. We got his labs and his plaques were unstable and it really scared me for him honestly because we know that with certain labs, if they're off, the risk for an event could be tomorrow, i.e., a heart attack or something could be tomorrow or five years. After being able to have that conversation with him, we've made appropriate changes and the year later, some of his plaques had reversed, some of them had stabilized. He was in a much safer place and I knew that he was going to be okay. Of course, as a doctor, you want to do the best you can for your patients, but if I had known that this gentleman, despite everything, had still had a heart attack or stroke, it would have just sickened me. Going, what else could I have done? Well, I really feel like now I know. Now I know how to help people know what's going on with them and give them the information and they can make some choices. Yeah, Gaston, I love it. If you're listening, you probably know this, but what is so classical is the lipids and some of those genetic factors like you believe for, but what Dr. Van Zand and I also look at is, like what she mentioned, infections and inflammation and endothelial dysfunction is so common with viruses and bacteria and toxic exposures in our environment. So even if you are, you know, the patient like you typically, the ones that I see in my clinic, which are mold and Lyme and that, you still, even at a young age, could have a very high cardiovascular risk just because of infections and inflammation, double genetics. So it's very relevant to even populations that may not think they have a high risk. Yes, absolutely. So this is great. And I want to talk about the other part of our title was on optimal stress resilience. And if you're listening, you may wonder obviously stress and heart do go together. But I think this could be maybe one of the most important things we talk about. How do you approach, because this is a factor I always find for me or patients or anyone else, it's easy to give a pill, whether it's a drug or a supplement. It's a lot harder to make the lifestyle changes than to get people motivated to do that. And yet the most important things, what are you looking at for the program as far as stressors and sleep and what kinds of things are you looking at, what categories and what are some of the kind of practical ways people can look at those areas in their life. Absolutely. I think that you mentioned sleep. One of the things that I usually check in patients, if I have even a whiff that they may have a sleep disorder is checking for sleep apnea. And there's so many different neat ways now to treat sleep apnea. And thankfully we can do most sleep tests at home. So it's easy to have home tests looked at, because sleep apnea is something that I can't treat. You know, a patient's going to have to do something, whether it be weight loss or an oral device or potentially even a CPAP, if it's significant enough. Sleep apnea is probably one of the most undiagnosed things I see. And it always makes me a little bit sad and angry when a patient comes to me and had chronic blood pressure elevation or unfortunately chronic fatigue. And nobody's evaluated them for that in a traditional world, because to me that's like bread and butter. And so I would say that evaluating sleep is huge. And there are so many things that can disrupt sleep, but making sure that, am I okay here? I'm sorry, I'm trying to give this echo off here. There we go, we're good. Okay, all right. Yeah, so evaluating sleep apnea is a big, big thing because poor sleep is going to lead to poor stress resilience, right? Your cortisol curve is going to be significantly altered. Women who have hormone imbalance often experience sleep difficulties and so addressing hormones, obviously. And then just the stressors of life. We've had a really hard year across the board. I think everybody has felt the impact from COVID in one way, shape or form. And it's brought with both obvious stress and then that subliminal stress. So giving patients that area to talk, I think is important, talking about their concerns. And using the resources around you, I really encourage patients if they need to see counselors. Important to do, getting involved in activities. I think it's trying to have people engage in some type of exercise or activity that they like is so important. And the older I get, the more I understand that, right? There has to be joy in what you do. You can't just slog yourself to the gym every day if you absolutely hate it. Because there is that opposite down effect of a lack of gratitude. We know that gratitude and hope really create so many wonderful chemicals in our body and so many chemicals that help us to relax that if you're doing something you hate, it's not worth it. So I try and engage with patients and get them to think a little bit outside the box and talk about being active in something that they enjoy is important. And then I think that diet is obviously going to be always part of the picture. And this is where I hope that although not a dietitian or a nutritionist, just the functional approach to trying to understand what is going on for them. And there's so many layers to that. The longer I do this, the more I know that that obviously not even one functional medicine diet is appropriate for everybody, right? Paleo or low histamine or whatever. I mean, really trying to help people figure out what makes their body home. And that's that functional medicine approach to it so that their body likes what it's getting. And when it likes what it's getting, lower neurochemicals, you know, lower stress hormones. And then the genetics are huge. I have to tell you, I mean, I feel like and I used to shy away from genetics because everybody wanted MTHFR. And I felt like I don't know if it helps either here or there. Give you B12 full late. I mean, how do we know? But it was really the cardiovascular genetics that got me back involved in looking at that again. And now, of course, I do Intellex through, you know, Dr. Hausman Cohen's company. And that has really opened my eyes. There's a mental health wellness panel and really looking at how people are set up genetically to be triggered to have more chemicals, you know, more stress chemicals. And so I think sometimes if patients do get that information, being able to share some of that with them so they beat themselves up less, you know, I think, of course, you and I grew up and still, you know, the world of giving a medicine or feeling like you can just get yourself through it. The whole the whole attitude towards mental health and mental wellness usually being one of nobody wants to talk about it. But knowing that you may be predisposed to actually having more adrenaline because you have a com T issue, you know, that that some of these things we can actually then treat through breathing exercises, humming, singing, things that stimulate your parasympathetic nervous system. You know, all these tools I think are important to talk to patients about usually don't happen in one visit, but along the way talking about, you know, reducing stress levels by looking at all of those things, body, mind and spirit. Love that because it is so critical with the cortisol and HV axis, the heart and long term outcomes on really every level and all of our patients. We were just talking before we went live about how just this next level of healing is really going to take mind, body, spirit and so critical for us to address, not just supplements and not just medications or anything like that. Yeah. So stress, resilience, absolutely critical. I know in my own journey, I've said this before as well, but it's interesting place to be a get up at 530, go do a run or go do high intensity interval training. And about three, four years ago, I realized that wasn't serving me because I was actually continuing to I have a comp to issue and I was just raising my cortisol and what I found is as I sat in the mornings and meditated and was much more slow. And now my exercise is actually quite minimal. I hike and I walk and then I do a little bit of free weights, but it's so much less than I used to do six days a week. I'm in better shape than I've ever been. The less body fat, better muscle. And it was a shock to me after going through medical school, medical training, we should know the stuff that, well, of course that for me was raising my cortisol and sabotaging metabolically. And again, I was joking. I stopped exercising. I got in the best shape in my life. Now I didn't stop exercising, but what I did is I do stuff in nature that's natural and it's not at the same program. And for me, it's really, really worked. And I think a lot of women are overtraining. And so it's great to find that balance. Not everybody, some of us need to move more and some less. I needed to actually pull it back. And it was a profound change that I found in that. And then the mental chatter we have all these things can drive cortisol. And I think that's probably one of the bigger risk factors that is unacknowledged with heart disease. So love this. Absolutely. Our last few minutes now gut, you know, is my thing. And I talk about that a lot. And I know that there's relation with LPS and the gut and the heart. What piece does gut play? And do you do that just in some people who have symptoms? Do you always check the gut for heart patients? Or how does that connect in your healthy heart program with the gut? Well, I think, yes, I think that's one of the pieces that we always talk about and look at. And anybody who's symptomatic needs to have some type of evaluation. And, you know, symptoms, sometimes you have to pull out from people because they may just think that it's normal. Yes, I'm fine. And, you know, of course, everybody laughs because the discussions about digestive habits are much deeper than people like to usually share. But it's so important to know what is normal for what a person considers normal versus really what's optimal. And so, yes, I think digestively, it's something where we look at it individually and person's complaining of symptoms and it's going to need to be evaluated. There's some really good gene relationships between cardiovascular risk and gluten, obviously. You know, there's the haptaglobin gene, where if you have a haptaglobin gene, too, too, it increases your risk of making the LPS, I'm sorry, making zonulin, which of course, you know, you're talking about leaky gut, et cetera. So, and the things that trigger zonulin and then, you know, bacterial dysbiosis and LPS, all important parts of the immune system overreaction. So, I would say that it's part of our evaluation with every patient by looking at first what their symptoms are. I'm not going to go trying to turn over stones that don't need to be turned over, but we certainly have a good history there with evaluating what's going on and addressing it as appropriate because there's so many things that you could address. You have to go with what's going to impact the patient the most. You know, if they're not having an issue with something and you make it an issue, my opinion is it may not be the best approach for them. You want to ask them what's important to them. And then, if you find things that you don't need to be important to them, it's an educational tool. So, yeah, I feel like gut health is, it's an interesting background, a relationship for cardiovascular wellness. And that's why I really love the approach that we have because it really is a functional medicine approach. Yeah. Honestly, I just think it's a good medicine approach. I honestly hate to even label myself as a whole estate functional medicine integrative doctor because to me, I'm just practicing good medicine. That's what I say all the time. Like, to me, this is how I think all medicine should be practiced. What is odd or different about this? This is just good medicine. I listen to you. I take a good history. I do a good exam and I'm looking at all the pieces of the puzzle and we're going to figure it out together. So, that's why I love the cardiovascular program that we do because it looks at everything, including those things that may not seem to make sense initially, such as gut health. It's going to be important. Well, this is so great. And where can people find you, get more information about you, schedule appointments, where can you be found? Oh, yeah, thanks. Well, vansantmedicalgroup.com is our website. And if anybody wants more information, they can send an email to vansantmedicalgroup at gmail.com. We have a new patient tab on our website. If anybody's interested in getting testing for cardiovascular issues in particular, you just have to call. We can schedule you for CIMT testing first and then do a follow-up after that to review those results and look at your risks. I'm also on Facebook and Instagram, vansantmedicalgroup. Awesome. I will be sure and put links wherever you're watching this, you can find. And if you're in Illinois, again, we've got a lot of connection from there. I highly recommend Dr. Vansant. She's always the one, if you call me and ask me about a doc in Illinois. This is who I recommend. I appreciate that. I do. Thank you so much. Well, hi, Mary. I'm so proud of everything that you've accomplished. And I know you're an amazing blessing to many, many patients. And just doing things like this, provide people with a lot more information that they can trust. So that's important. Thank you for what you're doing. Thank you for being in Illinois. I'll drop by like in the mountains. Oh, yes. Say that again. Thank you for I live in Illinois. Sorry about the community. Thanks. You have to rub that in. Oh, gosh. Well, it has been so fun. I love all my people in Illinois. Oh, gosh. Well, I'll come visit you. You can come visit me. And anyway, that's you. And thank you so much for the great information today. Thank you. Thank you again for having me on your program. I really appreciate it. It was fun.