Bariatric surgery and digestive problems

Dawn (00:00):

Hello and welcome to the Gastric Health Show. My name is Dawn Boxell and this week’s topic is kind of we’re just continuing this conversation about estrogen. And we’re going to kind of connect the dots between estrogen and digestive problems after gastric surgery. So that’s what we’re going to dive into and kind of explain so that you have information. You have the tools you need to have the right conversations with your healthcare practitioners.

Dawn (01:00):

And you can start sorting through maybe what is driving your digestive problems. I’m going to show you some of the evidence that estrogen could be causing your digestive problems even after gastric surgery. It doesn’t matter which surgery you’ve had it still could be why you are having digestive problems. So let’s kind of dig in and get started with estrogen causing digestive problems after gastric surgery. So are you having digestive problems that are kind of consistent?

Dawn (01:25):

And these are things like chronic constipation, diarrhea, abdominal pla.. pain, bloating, gas, those types of digestive problems. They can get mixed in with all the other things that cause digestive problems. I mean, we know that the different types of bariatric surgery actually do increase digestive problems. So we know that this is an issue in the bariatric community. But there’s some other factors that you may not have connected the dots with.

Estrogen levels after gastric surgery

Dawn (02:00):

And we know that certain levels of estrogen can cause digestive problems. We also know that your estrogen levels fluctuate a lot after gastric surgery. Here’s a fun fact or really just a fact that the average age of bariatric surgery is 40 to 45 year old females. The majority 80% or maybe even closer to 90 is in the female population who have bariatric surgery or some form of gastric surgery. And guess what?

Dawn (02:52):

This is the same age that perimenopause starts for many females. So that season of life where naturally your estrogen and progesterone levels begin to fluctuate. So it gets confusing and it gets kind of mixed in and it’s hard to sometimes decipher what’s really driving my digestive problems. But this is what I’m helping you sort through all the things that could be causing digestive problems after gastric surgery so that you have different avenues to explore with your healthcare practitioner or something that I can help work with you on.

Dawn (03:40):

I mean that’s exactly the things that I help do in the bariatric community is really help improve your digestive problems that can help maximize your estrogen metabolism or just your hormone metabolism in general. So let’s dig into the connection between digestive problems and estrogen after gastric surgery. So first off, there are some important estrogen facts that you should realize.

Important estrogen facts and deals

Dawn (04:09):

Estrogen is just a group of hormones that play an important role in normal sexual and reproductive development in women. They are also sex hormones. So the woman’s ovaries make most estrogen hormones but additionally, your adrenal glands and your fat cells also make small amounts of estrogen too. So that’s where it gets a little bit complicated and difficult when it comes to weight loss when you have obesity because your hormones can contribute to that weight gain in making you more efficient at gaining weight.

Dawn (04:40):

And this is one of the ways your fat cells produce excess estrogen and the more estrogen that you have can lead to weight issues. So now additionally estrogen regulates your menstrual cycle and it affects your reproductive and urinary tract, your heart and blood vessels, your bones, your breasts, your skin, your hair, your mucus membranes, your pelvic muscles and your brain.

Dawn (05:31):

So that’s a lot and I’m always perplexed at why this is not an aggressive research area. Now don’t get me wrong, there are thousands of studies, but I feel like as females we’ve settled for or accepted the status quo of these are just normal aging symptoms and you just have to live with it. And I think that’s where as females, we have to band together and not accept this as our future or our current norm. That we should be diligent together and teaming up and discussing everything that is impacting our health because we are at a higher risk for breast cancers, ovarian cancers and uterine cancers.

Dawn (06:30):

All of those are very high percentages for females. Then not to mention osteoporosis. And then one thing that I didn’t even really put in my blog post is the overwhelming issue with Alzheimer’s disease in the female population. Dementia and Alzheimer’s is essentially two-thirds female.

Dawn (07:05):

So that’s a pretty big deal. And when we know that estrogen deals with the brain, then it’s interesting that we’ve accepted this over the centuries. But here’s the good news, there are things we can do to protect ourselves. There are things we can do to team up with your healthcare provider and be an active participant. And this is all part of having health ownership and making sure that you’re doing your part. We all have to do our part, it’s our body. We’re the ones living in it. And if we don’t feel good, it’s okay to say this isn’t working, this isn’t enough. I need different ideas. And these are the things that you can come to your practitioners with.

Dawn (07:50):

Hey, what about my estrogen level? Have we tested that? Can we test that? And what can we do to help protect me so that I don’t get osteoporosis? Healthcare should be about prevention. Unfortunately it is more about sick care where we wait until we have these disease states and we don’t. The issue lies in insurance, doesn’t cover prevention. So again, it it’s part of the business model. So that’s where we have to take health ownership and say, You know what? I am going to do what I can to prevent these things from occurring. And I promise you, your doctor will be so excited and proud of you because you are taking action and being involved in

Dawn (08:54):

Your care and not just expecting them to solve all your health problems with one specific pill or a shot or anything. So that’s where working with practitioners like myself who can help you sort through and remove the ones that aren’t really an issue. And help you isolate and focus in the right areas so that you can get the best outcomes with your health and how you feel and being able to do all the things you want to do in life.

Dawn (09:30):

So hopefully you can see once we get through this that you’re going to see that making sure that you are optimizing your estrogen metabolism and improving and correcting your digestive problems after gastric surgery. Are going to help set you up for the best outcomes for overall better health. So now I named all of those things that your hormones or your estrogen is involved in.

Dawn (10:13):

But additionally studies show that there is a connection between ovarian hormones. So that’s where your estrogen and progesterone are secreted, and digestive problems around the time of your menstrual cycle and early menopause. So we know that this is an issue and let’s kind of dig into what the studies tell us about estrogen and digestive problems. And I’ll preface it with we’re also different that what may work for one of you may not work for 10 other people.

Ovarian Hormones affect and Gastrointestinal Symptoms

Dawn (11:00):

So the information, I think you have to just work with someone that can help sort through if this is the area that you should focus to really help dial in your health. So there was a study published in 1998 and they had reported that Peri and postmenopausal women have a high prevalence of altered bowel function and IBS like gastrointestinal complaints. And they felt this should be carefully assessed.

Dawn (11:31):

So we know that this issue has been identified for a while. And I didn’t dig in the research to see if there was something earlier than the 1990s. I did see some in the early 1990s, but I didn’t see if it went further back. So I feel like if we’re going back this far 20 years, I feel like, hey, that’s far enough back to let us see that hey, this is recognized. We see that this is something that is occurring frequently in females and we might need to understand how we can support ourselves during this season of life.

Dawn (12:04):

So a study published in 2012, and its titled “Do Fluctuations in Ovarian Hormones affect Gastrointestinal Symptoms in Women with Irritable Bowel Syndrome?” So this, they’ve isolated just IBS females, which is great but it doesn’t necessarily mean it’s going to apply to females that don’t have IBS.

Dawn (12:43):

But it would be interesting to see if there’s more correlation even with non IBS females. But what they found was the increase in digestive problems around the time of new menstrual cycle and early menopause occurs during this time when declining or low levels of ovarian hormones. Suggesting… So they’re suggesting that the estrogen and progesterone withdrawal may contribute either directly or indirectly to these GI symptoms. Or this digestive problems that we as females experience.

Estrogen cause constipation

Dawn (13:20):

Then in 2013 they kind of dialed in a little further. And this study is titled “Estrogen rather than Progesterone cause constipation in both female and male mice.” So although this is an animal study and it’s not always a hundred percent equivalent to humans, it’s controlled information. It is giving us feedback that we don’t have to worry about all the things that are influencing your estrogen and progesterone cause I’m gonna get into that in a minute.

Dawn (14:02):

So this is just helping us see that hey there, there’s some connection here. Although we don’t understand fully we know that maybe some of these fluctuating hormones could be driving the digestive problems that people are experiencing when those levels are shifting. And then we kind of fast forward to 2020. There was a study that found that postmenopausal fem.. females with IBS experience more severe digestive problems than premenopausal women with IBS.

Dawn (14:45):

So again, we’re isolating the IBS females, which to me is fine cause if you have a history of digestive issues and you’re experiencing more digestive issues during this season of life you probably are looking for solutions. And if you’ve had any type of gastric surgery, so we can think of roux-en-y gastric bypass, sleeve gastrectomy, duodenal switch or the adjustable band. We may find that these types of surgeries don’t protect you from this occurring.

Hormone metabolism and fluctuating hormones

Dawn (15:21):

So you might be going down a rabbit hole of something else being the cause of it when it’s really just your fluctuating hormones. And we need to look at optimizing that hormone metabolism so that you can get some relief. And again, we’ll get into that in a little bit. But in this study they concluded that the modulatory effect of female sex hormones on the brain-gut interactions, which affect your visceral perception in GI function, likely does contribute to these findings.

Dawn (16:00):

So again, I think we have to just recognize that some females with IBS especially may have more severe digestive problems because of these hormone fluctuations. And then lastly, a study published in 2019 found that estrogen can affect GI motility and sensitivity. But what do we know about after bariatric surgery? What do we know what happens with hormones after bariatric surgery? So estrogen after gastric surgery. A study published in 2017 is titled “The Effect of Bariatric Surgery on Sexual Function and Sex Hormone Levels in Obese Patients.”

Dawn (16:49):

And this is a meta-analysis. So this is a great kind of review where they review all of the studies that have been dialed into this topic and then they sort through everybody’s results and they give you a conclusion. And they reported that levels of estrogen’s, levels of estrogen were significantly decreased in female bariatric surgery patients. But here’s the thing. This is where you have to work with a provider that can help you sort through this. Because let’s be honest. There’s so many moving pieces with a woman’s body and your hormone levels.

Bariatric surgery lowers your estrogen level ?

Dawn (17:30):

And just because bariatric surgery lowers your estrogen level doesn’t mean that you actually have a low level of estrogen. So that’s where you can’t get confused in this. I want you to see that yes, bariatric surgery does shift that estrogen level, which makes sense. So if we think about that your fat stores produce estrogen. You’ve lost weight and guess what, you are going to lose some of those estrogen producing fat cells.

Dawn (18:17):

So again, that totally makes sense, but that doesn’t mean because your estrogen level does go lower, it doesn’t mean you actually have a low level. It might actually mean that you have a great level or it could mean you still have an estrogen that’s still on the high side. So it doesn’t necessarily mean one is causing the other. So well, one thing I will say is I would encourage you to review my post on healthy hormone metabolism because this can help you understand all the different areas that can influ.. influence hormone metabolism.

Dawn (19:00):

Because that does matter it. These are the things that we make us very individual. And to me there’s not one formula that’s gonna work for everybody. And that’s where working with people one on one and really dialing into their symptoms and their lab data and just really understanding maybe the picture.

What is hormone replacement therapy ?

Dawn (19:32):

Now I don’t do hormones, I don’t test hormones. That I leave to practitioners who can actually prescribe hormones if needed. Because there are a lot of studies showing the evidence with.. it is safe to use different forms, bioidentical forms of estrogen and progesterone and they are not cancer causing. So my approach is we really focus on improving your digestive symptoms, your gut health and optimizing your estrogen and hormone metabolism. So that if you need hormone replacement therapy as a perimenopausal and menopausal female to protect you from osteoporosis and breast cancer and ovarian cancers and all the things that we discussed.

Dawn (20:20):

That come along with your estrogen fluctuating your skin and your hair, your pelvic muscles, your brain all those things. We can optimize all these areas. And then if you need hormone replacement therapy, guess what? Your body is going to be ready and you will slide right into that and you will feel fabulous. Whereas if you jump right into hormone replacement therapy, the bioidentical forms not the progestin or birth control pills, I’m not meaning those as treatment options.

Dawn (21:29):

You may feel pretty miserable. You may feel really, really crummy. And you may say, Oh, that did not work for me. It made me feel worse. And it could be because your digestive problems and it could be because of your gut health and other areas. And matter of fact let’s just roll right into how do you support healthy estrogen metabolism? That actually can improve the estrogen metabolism and your digestive problems. And the reason why estrogen levels can be so individual is because your genetics.

Dawn (21:55):

Your detoxification, which is also wrapped into your genetics your methylation, your alcohol consumption, environmental toxins, so think plastic, BPA and then anything plastic.. like you’re heating food up in plastic. And then nutrient deficiencies. They can all influence how well estrogen is metabolized. So the good news is there are things you can do to improve your digestive problems that will then support a healthy estrogen metabolism.

Influence of beta-glucuronidase and detoxification

Dawn (22:50):

So one of those is optimizing your gut health, and the second is focusing on diet quality. So let’s dig into those and I would say first and foremost is your gut health. This is where a lot of hormones get influenced.. is in your gut. Because we know that gut bacteria can direct those hormones and influence them positively and negatively. There was a study published where they found that your gut microbiota regulate estrogen through the secretion of beta-glucuronidase.

Dawn (23:30):

And I’ve talked about beta-glucuronidase in quite a few other posts and videos and YouTube videos and podcasts. So you can refer to those there because that might help you understand it a little bit better. But beta-glucuronidase is an enzyme that deconjugates estrogens into their active forms. Let me explain and sort this out for you. Your liver during the phase two detoxification. So phase one liver detoxification is when your body, your liver is taking the exogenous.

Dawn (24:24):

So those are things from our environment and things that we put on our body. So these are coming that we’re adding to or just the environment is adding to or endogenous. These are things that our body is making the metabolites and stuff that it’s making that create toxic compounds. So all of that stuff is endogenous and exogenous are occurring all day every day. And so our body is taking those in phase one, they’re breaking them down into this more toxic compound.

Dawn (25:00):

They’re taking it apart so that it can package it up in phase two. So from phase one to phase two, you have this phase where you have all these active toxic compounds. And that’s why if you’ve listened to any of my other posts and videos and podcasts I talk about you want phase one to go slow. So you want this liver phase one liver detoxification to go slow so that it can break them down slowly.

Dawn (25:32):

And then you want phase two to go quickly because you want them want your liver to capture all these toxic compounds that are even more toxic now and kind of neutralize them. So that’s where phase two will neutralize those active. So toxic compounds. And then it goes into phase three.. three, which goes into the phase three detoxification where your body is excreting it. And this is through your bile. So your bile will take it out in your poop, your kidneys will take it out in your urine, your skin will take it out in your sweat, your lungs will take it out in your co2.

Dawn (26:00):

So these are all areas that your body is doing phase three detoxification. And if you have genetic SNPs that interfere with phase two, or slow down phase two detoxification that’s a problem. And that is going to keep these toxic estrogen compounds in the wrong type of form.

Dawn (26:55):

We want them to be neutralized, we want them to be deactivated. When they’re in your intestines and going out into your poop and throughout all these phase three detox avenues, we want them to be inactive. Beta- glucuronidase is in your colon and when this level is elevated this is when negative things occur. When we know that gut bacteria regulate this beta glucuronidase, then it is conjugating. What that means, it’s, it is taking it from an inactive form back to an active form. You’re taking that non-toxic compound to a toxic compound again in your colon.

Dawn (27:30):

And then it gets reabsorbed into your liver. But then that’s when it can get down pathways that aren’t helpful to your health. That can for some people genetically that are more predisposed to cancer. That’s how those things can occur. So high levels of beta glucuronidase in your poop indicate unfavorable metabolic changes in the colon. And it can indicate gut dysbiosis and an interference with phase two detoxification.

Estrogen and digestive problems

Dawn (28:29):

And usually this means that you’re having problems with detoxifying estrogen. And additionally, high levels of beta-glucuronidase is associated with an increased cancer risk. Now you can do a GI map stool test and we test for beta-glucuronidase and we can identify if you have elevated levels. That does not mean that you have cancer. It just means that for whatever reason, you are not.. your body is not dealing with this beta glucuronidase days is taking your inactive forms of estrogen and reactivating them and making them active in the wrong types of form.

Dawn (29:20):

So that’s where the stool test helps. It’s not to freak you out or make you feel like, Oh holy cow, I’m gonna have cancer. No, that doesn’t mean that. But it just means that hey, we have some work to do. And we might need to be super diligent and isolate some nutrients and focus on some foods so that you can actually support yourself. Support your estrogen metabolism and make sure that your hormones are being optimized so that they go down the right pathways that are promoting health not disease.

Dawn (30:04):

One of the best ways that you can approach this is correct any gut dysbiosis and reality is if you have gut dysbiosis it can show up as constipation, diarrhea, abdominal pain, bloating, gas. That’s what gut dysbiosis is. It can mean that you are having too much bad bacteria, not enough good bacteria too much bacteria in the wrong location you don’t have enough diversity of different types of bacteria. All these things create gut dysbiosis.

Dawn (30:40):

So again, working with a practitioner like myself can really help you dial in on your gut health and correct gut dysbiosis turn it around and get you feeling better so you don’t have any constipation or diarrhea issues or bloating or gas. So then we know if something shows up down the road, then we can kind of say, Oh, well we’ve already worked on this so it’s probably not that. Maybe it is your hormones.

Improve digestive problems to support a healthy estrogen metabolism

Dawn (31:18):

Let’s dig into that. So you can restore gut imbalances and you can also do this by improving your diet quality. And let’s kind of dive into your foods and why that matters and why quality is important when it comes to digestive problems and estrogen. But I will tell you it’s not always just black and white. There’s gray areas and it takes working with a practitioner like myself who can help sort through this cause you’re going to see that not all strategies work for every person. And there’s a reason why you have to personalize this. Because again, our genetics are involved, our detoxification and methylation is involved. All these things are how our hormones are metabolized and functioning. So all this matters.

Dawn (32:25):

So I want you to have healthy estrogen metabolism so that it doesn’t cause digestive problems now or in the future. So what are the things that you can do to support a healthy estrogen metabolism? Ideally is fiber. You need fiber foods. But guess what are the properties of food that increased digestive problems? Fiber. So that’s when it gets complicated. Because if you try to increase your fiber and you have worsening of digestive problems then those are red flags that you have gut dysbiosis. So to me it’s easy to say, Okay, let’s challenge it.

Dawn (33:00):

This is where I would say download my free 3 day low carb high fiber meal plan and test it. Do three days at a high fiber, low carb diet. So that you can really see how you feel. And if you have more digestive problems, you likely have some form of gut dysbiosis and you might need to work on it.

Dawn (33:46):

But here’s some facts that will help you understand why fiber is so important. It can be so helpful when it comes to estrogen. Fiber from flax seeds, whole grains, beans and seeds actually bind the unconjugated estrogens in the digestive tract. So these are the estrogens that are in the wrong form.. in their active forms. So we could say it in, they’re in the active estrogens and those get.. those fibers will actually bind estrogen. That’s a good thing.

Dawn (34:10):

If you have active forms of estrogen or more, your beta-glucuronidase is elevated. Because your converting back to those active forms of estrogen. Fiber will help balance that out and improve and remove those estrogens. So we also know that fiber will favorably influence intestinal bacterial balance by reducing beta-glucuronidase activity. So again, that’s going back to your the beta-glucuronidase is that is elevated, then those active or toxic estrogens are rising.

Optimize gut health to improve estrogen metabolism & digestive problems

Dawn (35:15):

And now if you consume fiber, then it can help lower that beta-glucuronidase activity as well. Taking probiotics with prebiotics combined with adequate fiber can inhibit beta-glucuronidase. So that is why I talk a lot about making sure you’re taking a probiotic with prebiotics and then making sure you’re eating adequate fiber. Those together are super important when you want to improve your gut health and improve your hormone metabolism.

Dawn (36:00):

They all work together. But there are some additional foods that can improve estrogen metabolism and optimize the short-chain fatty acid production that can help improve your gut health. And these include cruciferous vegetables. So these are things like broccoli, cauliflower, brussels sprouts, kale, those types of cruciferous vegetables. And then broccoli sprouts, turmeric, green tea, rosemary. Those are all foods that have therapeutic clinical evidence backing their support in helping you with detoxification, in estrogen metabolism, and even helping with your digestive problems.

Dawn (36:50):

And I’m gonna go a little bit deeper on this. The cruciferous vegetables have.. so broccoli, cauliflower, brussel sprouts, kale. ha…they all have a compound called Indol-3-carbinol, or what we abbreviated as is I3C. And that, went in presence of adequate stomach acid. So that’s why I’m always wanting you to optimize your digestion because you don’t get the benefits without the stomach acid because adequate stomach acid converts this I3C to Di-indol- methane, which we call is abbreviated as dim… DIM. And DIM actually removes estrogen from circulation.

Dawn (37:50):

So if you have higher levels of estrogen than what your body should be having DIM can be helpful. So what does that mean? Consuming foods like broccoli, cauliflower, brussel sprouts, kale. Are all going to, if you have the stomach acid will all convert to this DIM that will help make sure that you don’t have too much estrogen circulating and have high levels of estrogen.

Dawn (38:22):

But this takes consistency and also a volume. So 3-4 cups of these vegetables daily to help maintain this. So if you wanna keep your estrogen dialed in and your hormone metabolism dialed in with food, it’s going to require several cups, which can be complicated for bariatric patients.

Dawn (39:00):

This is where some practitioners might use a DIM supplement instead. You have the ability to isolate these nutrients or these compounds that are naturally found in food. And utilize it at a therapeutic dose that can actually help your estrogen metabolism and keep it at a level that’s safer and making you feel better.

Dawn (39:24):

So what happens if you have.. you’re in menopause or you have low estrogen because of other things, maybe you had a baby and your breastfeeding and those types of things. You wouldn’t want to remove estrogen from circulation, you don’t wanna make it go lower. Or that doesn’t mean you shouldn’t eat cruciferous vegetables. That is not what I’m saying. But that definitely means you should not be taking a DIM supplement. Because that is going to remove estrogen from circulation and that’s what we don’t want.

Dawn (40:00):

So it’s unlikely that you’re going to consistently eat 3-4 cups of cruciferous vegetables every single day the rest of your life to maintain that. And so again, that’s why practitioners will use the supplement. But if you have low estrogen levels or you’re in menopause we don’t want you taking DIM we don’t want you taking that supplement because it’s not going to help in your levels.

Dawn (40:35):

But if you take broccoli sprouts. So broccoli sprouts can be utilized with normal or low levels of estrogen and this is because they contain a compound called Sulforaphane. And this is an awesome actually, I think I’m going to do a whole post and video on Sulforaphane because it has so much great evidence for epigenetics and detoxification and just estrogen metabolism and hormone metabolism. It just, there’s so many positives with it that I think more people should be aware and should utilize this as a normal… in food that you include in your life.

Dawn (41:30):

So broccoli sprouts contain Sulforaphane and this can be used with low levels of estrogen and normal estrogen levels because it does not remove estrogen from circulation. So that’s a great thing. And Sulforaphane is just a great addition. Again, like I said for many things, but I’m, this isn’t the time or place to get into it, but it is a great addition.

Dawn (42:04):

So adding broccoli sprouts to your regular diet is a great way to increase that Sulforaphane. Of course there are supplements that isolate this compound and I do have some products that I do love and have found great benefit. I will use this myself. I use a supplement myself and it has made a huge difference and I find it to be beneficial in my hormone metabolism and really supporting me in making sure that everything stays in the right parameters.

Dawn (42:40):

That I feel good, my brain feels good and my energy and my digestive health, it all kind of works together. Again, I’ll have to do a whole series on this Sulforaphane and why it’s so important and can be included in your normal daily living. You can do it with broccoli sprouts. But you can also do it with some supplements, which is probably easier.

Dawn (43:17):

I add broccoli sprouts, two things like smoothies or my taco or on top of a salad or something along that lines. But you don’t want to heat it. So don’t put it over hot things and don’t cook it. It needs to be cool and chilled and kept in that cool temperature. Not heated up cause that deactivates the compounds. So in the chewing of the Broccoli Sprouts Act. Actually activate the Myrinase as which actually helps the Sulforaphane to be optimized. So again, it’s a process but again, I find it hard for me to include it every single day.

Why diet quality matters for digestive problems and estrogen ?

Dawn (44:00):

So that’s where I just started a supplement so that I can isolate this compound and gain the benefits. And then I just still add the broccoli sprouts when I’m interested in adding that too many foods. And just, again, it continues to support it. But I just need to probably work on more recipes that. I can utilize it in so that I can find more ways to get it in my daily diet.

Dawn (44:36):

So even if you have digestive issues, you can still meet your fiber needs while you’re restoring your gut imbalances. And that’s why working with a provider like myself who can help you isolate the right type of foods. And you can still hit your fiber goals on a low FODMAP diet. But yet not have all the digestive problems that come with FODMAP foods. There are things you can do, and that’s where I can help you accomplish that. So that you can again, have the benefits of the fiber.

Dawn (45:00):

That you’re getting short-chain fatty acid production and you are gaining the additional things that come with it. But yet not having all the digestive problems that the other types of fiber cause. And understanding how it estrogen impacts your GI motility can be helpful in navigating through digestive problems.

Conclusion

Dawn (46:01):

So even though your genetics, detoxification, methylation make estrogen levels very individual. Focusing on optimizing your gut health, your diet quality and just focusing in on a few nutrient compounds.  Can really help support a healthy estrogen metabolism and correct your digestive problems. So I hope you guys have enjoyed this and you found value in exploring this topic of estrogen. I know that as bariatric patients, you want solutions.

Dawn (46:30):

You want to do good, you want to do the right things, and you want to feel good. No one has bariatric surgery without wanting to lose weight and improve their health. That’s why you’re doing these extreme measures so that you can have a better life. And I think it’s just, again, dialing it in and personalizing this to you. So that you can have the health that you were hoping for. So it was so good chatting with you guys this week and we will see you next time. Bye-bye.e

Your future health awaits…