749: How to Get Rid of Puffy Weight at Middle Age With Dr. Sam Shay

Child: Welcome to my Mommy’s podcast.

Hello, and welcome to the Wellness Mama podcast. I’m Katie from wellnessmama.com. And this episode is all about how to get rid of puffy weight gain around your middle or at middle age, and why this might be a deeper insight into something going on genetically. And we get to go deep, especially on the topic of the genetic side of this. I actually learned a lot in this episode, and I’m here with Dr. Sam Shay, who is extremely well-spoken on this topic. And in his day job, he solves health puzzles for moms, for entrepreneurs, and for people with Asperger’s so that they can exit survival mode and reenter community. And he started this journey based on his own chronic health struggles. And now he specializes in functional lab and genetics analysis and is known as the affiliate lab nerd. He loves to teach on podcasts. You’ll see why when you hear him speak today. And he has some very specific and actionable suggestions for understanding your own genetics and figuring out what he calls your individual fault lines and correcting them. And how often problems stem from having a mismatch between our genes and our current environments and how to fix it. I always enjoy talking to Dr. Sam, whether it be in a podcast or just offline. And I always learn a lot. I know that you will as well. So, let’s join Dr. Sam. Dr. Sam, welcome back. Thanks for being here again.

Sam: Thank you, Katie. Good to be back.

Katie: Well, we got to do an episode recently to talk about stand-up comedy, which I will link in the show notes because that’s a deviation from our normal topics around health, but I think an important one. And today we get to tap into your other area of genius, which is in the health world, and go deep on some topics that I think will be relevant and helpful to a lot of people listening. So to start broad, can you walk us through, I would love to talk about what you define as puffy weight in today’s episode, which I think you make a really strong case for not just being normal fat gain that you might see in other areas. And I think this is a common complaint, it seems like, especially from people in the perimenopause and menopause age range, but also potentially at other times as well. So to start broad, can you define what you mean by that? And then we can start getting solutions focused.

Sam: Sure. Puffy weight is, in short, inflammatory water weight. It’s the weight that doesn’t go away despite exercise. It’s the weight that doesn’t really go away by many diets. It’s a weight that’s kind of watery. It washes out the muscle tone. And it’s a weight that rapidly comes on and comes off. And I’ll give you a couple key examples. One I call the muffin test. So the muffin test is, you know, I’m sure so many people in your audience have had this experience, either for themselves or a friend, a family, a loved one, where they eat half a muffin, and then they gain one to three pounds. Now, unless that muffin was last year’s regifted Christmas fruitcake, it didn’t weigh one to three pounds. So what happened? It certainly wasn’t the calories in it. It wasn’t the weight of it. It wasn’t the volume of it. What happened? What happened was that the inflammatory chemicals inside that muffin, whether it’s the preservatives, the colorings, the sugars, artificial or otherwise, the baking ingredients, whatever the medals, whatever it is, it’s, it’s an affront, it’s a toxic chemical to the body. So the solution to pollution is dilution.

So what happens is that the inflammatory response to those chemicals, the inflammatory chemicals themselves from the muffin, but also the inflammatory response is, in a short-term attempt to try to deal with what’s happening, but long-term can cause a lot of damage to all the cells, tissues, organs, and so on in the body. So what happens is the body will rapidly retain water in order to dilute those toxic inflammatory chemicals to do what? To buy time for the liver and kidneys to filter them out. So if you have a half muffin and you create an inflammatory response in your body, you will put on water weight because your body is trying to drown out and dilute all the toxic chemicals that were introduced and also internally created as a response to what you just ate.

The other example is an exercise test. Now, I’ve lectured at some genetics conferences on what I’ve dubbed exercise-induced obesity. Exercise-induced obesity. So there’s a segment of the population based on their genetic profile where the more they exercise, the fatter they get. And what happens is that if these people are very pro-inflammatory genetically, combined with, they have specific sets of liver genes that make, that make it difficult for them to detox and handle the acute phase inflammatory proteins, what will happen is that exercise will not be a net anti-inflammatory experience. It will be a net pro-inflammatory experience. So they see this a lot in the CrossFit community, where they exercise, and then suddenly their muscles wash out, and they’re putting on weight, and they’re just exhausted, and they’re seemingly gaining more weight. It doesn’t make any sense. And it’s a weird type of way because now their muscles are like washing out because they have this like water layer above it. It’s because they’re over-inflaming, and they’re over-inflaming. It’s the same mechanism. If you over-exercise, you’re going to create the potential conditions where you’re creating a very pro-inflammatory state and your body’s retaining water to buy your liver and kidneys time to get flushed them out.

Katie: That is fascinating. And I would guess that you said it’s based on genetics on the exercise component. That would seem like…

Sam: And the muffin test as well. It’s also genetics. Genetics is the basis of this.

Katie: And that would seem like probably, especially for the exercise one on the extreme end. But is this also the reason, like I know on a milder scale, some women, if they do too much exercise, especially too fast, like if they jump into like really high intensity after not building up to that, will experience a stress response and actually kind of move in a counterproductive direction away from what they’re actually trying to accomplish. Is that similar, or is that more of a hormonal-based consideration at that point?

Sam: Well, they’re both tied together. And I’ll give you the reason why they’re tied together is that cortisol is one of the bodies, if not the body’s main mechanism to deal with inflammation. So if you’re hormonally compromised, like if your adrenals are overworking, as most modern women are dealing with, and plus you have a genetic thing where you create over-inflammation genetically, you’re in your exuberant pro-inflammatory response. Now you have this meeting of the two where you’ve got a blunted anti-inflammatory cortisol response meets an over-exaggerated inflammatory response. So they actually meet together and collide is a better term. They collide together.

And additionally, if the liver also has problems with genetics, with detoxing, genetically, then the body has to make a choice: is it going to deal with acute inflammatory chemicals, or dealing with sex hormones that are just kind of floating around. And when I ask this of audiences, what’s more important, dealing with inflammation or estrogen? Everyone says incorrectly, inflammation. That is the emergency thing to deal with. And in fact, the basis of the lectures I gave in the genetics conference was talking about not only exercise-induced obesity, but it was also talking about exercise-induced hormone dysregulation and cycle disruption in women and man boobs in men.

Now, the reason why I brought that up is because if the liver is overwhelmed with inflammation and it can’t detox estrogen properly, if your estrogen cycles are going to go awry in women, your cycles are going to go off. And in men, you’re going to start redistributing fat onto your chest and put on weight. And the reason I talked about man boobs in this thing is because I don’t have some bizarre fixation on man boobs, I’m just an observant clinician. And I was in practice, and I noticed that there was this pattern of men who the more exercise, the more they exercised, the more in pain they were, the fatter they got, and they got man boobs. And I was like, wait a minute, I think their genetics is, they’re not able to get rid of, obviously they had exogenous estrogens, and we dealt with all the lifestyle factors and the major ways, whether it’s through plastics or they’re exposed to sprays. You’ve undoubtedly had multiple people talk about xenoestrogens on the show. And so we had to deal with the lifestyle inputs, but then we had to deal with the genetic interpretations of those inputs and help through epigenetic lifestyle changes, change the inputs coming in, but also change the genetic responses to any of their inputs and help them actually detox the inflammation and the hormones in a very supportive way. These are the same men that came to me saying, oh, I need testosterone. I was like, actually, you don’t. Because we’re going to forgive you, testosterone is going to overconvert into more estrogen. And we gave them, I gave them a regimen that was focused on inflammation and estrogen detox, not more exercise and stricter diets. So,, the connection of hormones and genetics and this inflammatory weight gain is intimately tied together.

Katie: That makes sense. And one thing I try to speak to a lot on this podcast is the reframing of symptoms as the problem and as a negative thing in a sense because I have the firm belief that our body is always on our side and that symptoms are simply messengers. Or if you want to reframe it further, they’re gifts because they’re actually giving you insight into what’s going on in your body. And it sounds like, in this case, that’s a very loud and direct message related to something that’s going on both genetically, and you mentioned the liver in both of those cases. So I would love to hear more detail on what are some of the inputs that you tell people to be aware of and avoid? And what are some of those lifestyle factors that can help with the detox and specifically with supporting the liver?

Sam: Sure. So I think I’ll answer that by dovetailing on what you just said before, which is on like symptoms as gifts. I’m also going to salvage the reputation of inflammation at the moment because I think it gets a lot. Let me, inflammation is like cortisol. If you don’t have the capacity to have inflammation, you’re going to die. Just like if you don’t have cortisol, you’re going to die. And too much of it is bad. And so the point of inflammation is to heal an injury and to kill infections that were introduced from that injury. So evolutionarily, as a hunter-gatherer, if I’m going out with a group of people to hunt an extremely large animal with a stick, there’s a very high chance one or more of us is gonna get bit, mauled, gored, trampled, or otherwise injured. And what is a bite wound? If an animal bites my arm, what is that? That’s tissue damage plus infection injection from all the microbes that are in the saliva. And if I have an exuberant inflammatory response, inflammation will help rush in to dilute out whatever toxic stuff was injected in there. It will bring red blood cells and white blood cells to repair and to kill off, to repair the tissue and kill off any potential infection. That’s the point of inflammation. It’s to save you from acute injury.

Now, if I am genetically hardwired to be very pro-inflammatory, which I am, I will likely survive, more likely survive that short-term hunting incident than my less inflammatory-prone hunting colleague. But the tradeoff, and evolution and genetics is all about tradeoffs. That’s all it is. And the person who is less inflammatory prone may have a less likely to survive short term but will be more likely to survive long term. So it’s all things trade-off. Now, it’s the same thing with the liver not being able to detox estrogen efficiently. Why would that make any evolutionary sense? It’s because estrogen is expensive to make. So there’s, and particularly if you’re in a hunter-gatherer society where access to fats and access to calories is stochastic. It’s not a consistent thing. That some people are going to survive better by being very, very stingy from detoxing their estrogen. They’re going to clutch onto it with two hands and prevent it from leaving the body because it is so precious in a semi-starvation environment. So, this is why, when I, this happened to me. When I first got my genetics report back, Katie, I cried. I sat there and sobbed. Because I finally had answers as to why I was so sick as a child. And everyone gaslit me. Everyone thought, like, I was ill, I was unwell, and I had two shrinks for parents. And they were in the mode that it’s all in my head, and we’re just going to medicate you into submission so you stop complaining about how unwell you feel.

And when I saw my genetics and saw how proinflammatory I was, how much my liver was askew, my vitamin D receptors were off, my DNA methylation panel was a nightmare. I had, it was, I cried because I finally had answers, and I didn’t dwell in self-pity because the power of genetics is that if you know what gene, where your genetic fault lines are, then you actually know what lifestyle changes to change to shore up those genetic fault lines. I had, when I had my genetics test, I was having joint pain like an 80-year-old man. And in my, I was in my thirties. And so my inflammatory response goes into my joints, into my skin, and into my brain. So I get, I get emotionally dysregulated. I have pain, and I have rashes everywhere. That’s how my body handles inflammation.

And with the information I had from my genetics and the changes I made based on my genetics report, no rashes, no more joint pain, and way, way, way calmer. And this is even after doing functional testing and all these other lifestyle things. It’s the genetics unlocked an entire new lens to it. And to talk, so to give some context on, your body is always trying to help you and your genetics is always trying to help you. The problem is there may be a mismatch between the genetics you have and the environment you’re born into. That’s where the issue comes. So people who are now very pro-inflammatory, we don’t have, we’re not going out hunting large animals with tiny sticks anymore. So we don’t have that advantage we had past tense is no longer an advantage.

And also, because now we have so much, so many more pro-inflammatory inputs, which is now going into the, what you were, the question you were asking on, what are the things we need to, to avoid putting input into our bodies? So, for example, one of the things you can find out from the genetics, like, are you vulnerable to histamine? Because histamine is a major trigger for inflammation. In fact, I believe histamine, so histamine foods are, you can find if you’re genetically sensitive to histamine. So histamine foods include things like avocado, alcohol, chocolate, manufactured foods, particularly things like sausages and deli meats and so on. Any type of old food creates more histamine. That’s my theory. When I had a stint in Ayurvedic medicine for a tiny bit, my theory, term rajasic, like they say old food is rajasic, meaning it’s kind of fiery, like creates this kind of negative fiery temperament. I think that’s a code for histamine because old food collects histamine and makes this kind of more kind of inflamed, literally state.

The people who have the inputs that cause inflammation are a lot of the usual suspects. So unclean foods, pollution, heavy metals, things that are xenoestrogens, anything that is that, basically any food that didn’t exist 200 years ago is likely not real food. It’s a food product. If you eat foods that have more than one ingredient on the package, it’s likely a food product, not necessarily food. There’s other, there’s other things to also look for that can affect the inputs genetically into putting on puffy weight. So histamine intolerance is mentioned. Now, the point of histamine is, I think, it’s the body’s evolutionary response to venom. So this is my theory, I don’t know, I don’t have any papers on or anything. So if I’m a hunter-gatherer and I’m stung by a bee, a wasp, a centipede, a scorpion, a spider, an insect, specific types of plants, animals, sea urchins, whatever it is. And I have venom injected into my system, I need a mechanism to very quickly flood the area with water. I think histamine is the flood switch to flood the area with water to do what? Same thing as with inflammation, to dilute the venom, to prevent it from corroding and eroding bone, muscle, tissue, nerves, whatever it is. I mean, that’d be pretty strong if it’s melting bone, but I think there’s some spiders that can do that, like I think, but that’s easy to check on Google, whatever. But it’s venom. It’s the kill switch for, the floodgate switch for venom.

So the problem is if you have an exuberant response to histamine, the swelling can then choke off. So histamine will, if histamine, too exuberant responses of histamine, it will choke off nerve, artery, venous supply, or even like splint the joint. And if you’re trying to run away from something that’s biting you, you can’t peg your leg away and survive. So if you have too much of a histamine response, it can cause problems. But if you have too little of a response, then the venom can really cause damage. So this is the interplay that genetics, this is the balancing game that genetics plays. So histamine can create the water response. People genetically have salt intolerance. A lot of people think, oh, if I have salt intolerance genetically, I’m going to have high blood pressure. That’s not true. I’ve seen people have instead water retention. It’s high blood pressure or water retention. And so this has happened with one of my interns where she’s an athlete, perfect diet, but she still had, she’s given me permission to share the story, but she still had water weight around her belly and around her hands. She ran her genetics and the issue she was having, she was histamine and salt intolerant. Once she removed the histamine and salt, the weight around her belly and the swelling in her hands went away. So that even that wasn’t cortisol, the belly, the fat around the waist, it was the weight around the waist. It was actually water retention.

The other thing that’s related to the inflammatory, the puffy weight is low vitamin D utilization. So the vitamin D receptors, genetically, if people have variants on their vitamin D receptors, they can’t use vitamin D properly. Vitamin D is estimated to control up to 5% of the entire human genome, focusing not on bone density, but on controlling inflammation and the immune system. And if people, and what I found is that the number one predictor genetically for people struggling with chronic illness is homozygous negative variants of their vitamin VDR1 and VDR2 genes. That if I see someone with those two as red dots, I am pretty sure that they’re very, very, very vulnerable to chronic issues.

The other things that can also cause and affect the inflammatory weight gain that you can find out genetically is do you have a genetic risk to higher risk of food intolerances so that your immune system has a more exuberant response to any of the main inputs that could be food triggers. Then there’s also looking at specific genetic intolerances to foods. Like some people are genetically intolerant to dairy. Some people are genetically have a lot of trouble metabolizing alcohol. Other people are really genetically intolerant to caffeine, like me. So for me, caffeine is I can’t, I get caffeine induced anxiety and depression. Now, I don’t care how bulletproof it is, like how much, you know, coconut oil or cinnamon or whatever I want to put in that thing. I was a jittery, anxious mess whenever I had caffeine. And it was only through genetics that I really discovered that.

So, there’s many different ways that genetics can help identify what exact strategy you need in order to reduce this mysterious puffy weight. And the last one, the most arguably, I think one of the most important ones, is that nowadays we can do genetics where we can identify are you ideally suited for keto, paleo, Mediterranean, or high carb and the shades of gray in between. That technology exists now. Now, that’s not a 23andMe test where you’re looking for a variation on a gene. It’s a whole separate genetic analysis where it’s looking at the three-dimensionality of genes, meaning the number of copies. Literally, it’s called the copy number, the duplicates of the gene that break down carbohydrates. It’s a completely separate analysis. That’s not an Ancestry or 23andMe thing. So if you’ve got, if you are intolerant to carbs like I am, and I didn’t know that until I did my genetics, and I’ve been eating the most perfect Portlandia diet. I mean, like, I knew the names of my farmers and their chickens, like it was, you know, grains and this and all that and all the organic farmer’s market, and I was still having really bad digestive problems, energy crashes, and just like was feeling super off despite the quality was good.

But the issue wasn’t a quality issue, it was a quantity issue. And yeah, I made my genetics, I realized that the second lowest carb tolerance possible, I am way more suited for deep into paleo straddling keto diet. And like within one week, the digestive issues of 20 years went away because I was eating incorrectly for my genetics. And if people know what their diet, their carb tolerance actually should be, that’s going to do major things for the rest of their life on top of understanding, you know, inflammation and histamine and salt and vitamin D and trigger foods and all the rest.

Katie: This is so fascinating to me. Genetics has been a pet research project for me as well. And it’s the reason I won’t share directly when people ask, what exactly supplements do I take? What exactly did I do to resolve XYZ? Because I’m very clear on what worked for me is not going to have the same result for you. The process of figuring out what worked for me will help you figure out what’s going to have a result for you. But I don’t think, and I think this is something that’s not talked about enough in the health world, is that there is wisdom in each of these approaches and all of these experts that figured out their perfect system and turned it into a program. I think there’s something to learn from all of them. But I don’t think the thing to learn from them is to do the exact same approach because they figured out what works for them. And it’s not going to be replicable in another person necessarily unless they have very similar genes.

I’d love to speak a little more about the VDR side because it seems like there’s a subset of people, at least I’ve seen anecdotally, that don’t seem to respond much to supplemental vitamin D, who seem to need actual light exposure. And I feel like the sun has gotten unfairly demonized in the last few decades and that this is potentially harming a segment of the population quite a bit. But you know that world much better than I do. What do people need to look at? I know a lot of them may have done genetic testing and could go check what their VDR, what their genetics are, but are there some people that need actual sunlight to be able to optimize that part?

Sam: So when looking at vitamin D metabolism, you’re looking at two separate, you’re looking at two halves of a journey. So the destination is getting vitamin D into the cells. And every cell on the body except red blood cells and dead skin cells has a vitamin D receptor on it. And the destination is to get the vitamin D across the membrane into the cell as a transcription factor to then do its thing and to do its thing on the three to five percent of the genome for all the purposes that vitamin D does. That’s the destination.

Getting there is tricky because you’ve got the first half of the journey is actually getting vitamin D, usable vitamin D3 into the blood. And there’s three ways to get it into the blood. One is sunlight. One is supplements. The other is food. Then there’s, once the vitamin D is in the blood, then there’s can that vitamin D floating around actually dock on the cell, onto the vitamin D receptor to then let the vitamin D go through into the cell to do its thing. So there’s two halves to that journey, and there’s separate genetics to look at for each of those sides of the journey. The VDR is straightforward. Do you have the genes that make enough of these docking sites on the surface of the cell? Yes or no. So you can have all the vitamin D in the world floating around in there in the blood, but if there’s not enough docking sites to get in for the needs of the cell, you’re going to be, quote, deficient in how you use vitamin D, which is why I think that the link between chronic disease and the vitamin D receptors.

So then what you’re asking is about getting vitamin D, the first half of that journey. So, in regards to, there’s roughly six genes between sunlight and your bloodstream. And there’s, and any kind of cog, any type of thing that can get in the way that can slow that whole process down, and with, how do I put this? So you’ve got like one gene that helps capture the first sunlight from, that makes the first step of affecting cholesterol from sunlight, creating that first shift from the UV rays. And then you’ve got other genes that then, you know, transport it from like the liver to the next destination to the kidneys. And then there’s the conversion of the kidney into the next form of vitamin D. Then there’s another gene that does it hyper-excrete excess vitamin D out of the kidneys or not. Then you’ve also got the issue of inflammation, where if you’ve got a variant in interleukin-6 and I believe TNF-alpha that what happens is that the vitamin D that is in the blood can get sequestered into the fat cells. And so you can actually have vitamin D taken away out of blood into the fat cells. Now that’s not necessarily a bad thing because you need that for winter storage, in order to have a slow release of vitamin D, as in a hunter-gatherer situation, you’re going to burn through your fat stores over winter. And with that is the slow release of vitamin D as you’d have less and less sunlight over the course of the winter. So even, it says you can see like even inflammatory genes have a purpose to help you manage winter and the storage of vitamin D.

So in terms of, are there some people that need sunlight in order to get to where they need to in terms of vitamin D? I think that the answer to that is, partly I can answer, partly I can’t. And the reason when I can answer is that there are people who genetically can just easily feed and create vitamin D off of sun, assuming that that first gene is doing well in its interaction with the sun, plus all the other genes downstream of it to connect sunlight into vitamin D in the bloodstream. So there’s definitely that segment of the population.

The other part where I say I can’t answer is that sunlight does so much. So much. I mean, you can listen to, like light exposure is now really in the field right now of like getting out and getting sunlight in the first two to 10 minutes. And for two to 10 minutes when you wake up in the morning to help reset your cortisol rhythms, you know, the effect of light, even the angle of the light, different times of the day, and how it affects your internal clock systems. And how sunlight affects mood, you know, how sunlight if you’re out in sunlight, that also means you’re outdoors and you’re not, you’re usually moving around and getting other benefits that could affect your health and well-being. So, I think the sun is a bookmark for so many other things that are going on, not just vitamin D synthesis.

Katie: That makes sense. And I know that there’s probably a thousand directions we could go on genetics and still not scratch the surface. And obviously each person listening is going to have a whole different breakdown related to that. But I guess a point that a lot of people would be thinking right now is where do they learn more? Like what testing do you recommend? Where would they get started understanding this? I’m a huge fan of anytime people can have that data in their own hands and become their own primary healthcare provider and work with practitioners to analyze that and to optimize it but be able to take responsibility for themselves. So, where do you start people with that process?

Sam: So where I start with people is when I have a free ebook that you’ll have a link for, that people can start to learn more about the specific types of genetics panels that I run. But I also have a very straightforward genetics program where people can do a do-it-yourself or an office hours kind of community, or there’s an option for kind of individual coaching.

And the way that people can get started with genetics is there’s many different genetics programs out there. I want to emphasize one type of genetics lens that I feel everyone should start with. That what I don’t do genetics to find like, what’s the cancer gene? What’s the heart disease gene? What’s the stroke gene? What’s the dementia gene? I don’t chase disease genes. I look at the driver genes. Like what are the genes that drive all the different processes in the body? The seven major processes would be inflammation control, free radical scavenging, liver detox, vitamin D utilization, methylation, cardiovascular circulation, and fat energy metabolism. And look at the big, those are the big genes that are upstream of all the other ones. And there is a place for downstream niche, I got to find this particular thing. That’s important. But people want to start with the big umbrella, the big drivers of all the processes in their body. And to look and identify where are your genetic fault. The thing that genetics does is it tells you where your genetic fault lines to shore up, and it also tells you where’s your ideal lifestyle. So you can shore up one and go in the direction of the other. Also, to identify what your genetic ideal diet is.

And so I have on my website, people can go through and see what particular program that fits best for their lifestyle. And we can do it in a DIY community office hours or in a personal coaching capacity. And I just want to emphasize, there’s a lot of different genetic programs out there. The place to start is what is the big picture, the big movers, before we get fixated on the smaller ones downstream?

Katie: I love that. And I will make sure those are all in the show notes for you guys listening. It’s all at wellnesswama.com. And I’ll make sure we also have links to all the educational stuff you have available. I know there’s a tremendous amount. And I hope that we also get to have future conversations around this, partially because genetics is a pet research topic for me, but also because I think this is super relevant and that we live in an amazing time to be able to actually understand and optimize these things. And even just a few decades ago, that wasn’t even possible, but it’s always such a joy to talk with you, Dr. Sam. This has been such a fun conversation. I hope for many more in the future but thank you for your time today and for being here.

Sam: Thank you, Katie. Thank you for everything you’re doing. I so appreciate the people like you are just able to help so many people at scale, find this information and just help people take action. And you’ve been at this for such a long time. It helps so many people. And I just really love engaging with the public, and just in fact, it’s like our conversation we had last time on comedy, how can we prevent and mitigate what’s happened to us in someone else, and that’s when we’ve truly been healed is we’ve been able to create enough resource in ourselves to help someone else and educating at this scale is absolutely one of those ways so thank you.

Katie: Thanks. And thanks as always to all of you for listening and sharing your most valuable resources, your time, your energy, and your attention with us today. We’re both so grateful that you did. And I hope that you will join me again on the next episode of The Wellness Mama podcast.

If you’re enjoying these interviews, would you please take two minutes to leave a rating or review on iTunes for me? Doing this helps more people to find the podcast, which means even more moms and families could benefit from the information. I really appreciate your time, and thanks as always for listening.