How Balanced Hormones Lead To Healthy Aging

Mark Hyman, MD

Full Transcript

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Dr. Mark Hyman: Now, as we age, our hormones change and they get out of balance, leading to faster aging. Sex hormones go down, stress hormones go up, growth hormones go down, thyroid problems increase, and insulin goes up, all leading to a steady [00:00:30] decline in energy, function, and vitality. And it happens slowly, almost imperceptibly so we barely notice. And one day we wake up just feeling older. Things that should go up, go down, and things that should go down, go up. These hormones are all connected in a finely choreographed dynamic dance. And when they're in balance, you feel young and strong and healthy. And when they're out of balance, you feel tired, weak, and old. [00:01:00] And while it's common for these imbalances to occur, it's not inevitable. Getting your hormones in balance and in harmony is a key part of aging well. And yeah, it takes a little more work as you get older, but it's doable. To keep your insulin low, for example, you have to really limit starches and sugars as you age, and you have to exercise more. You need to do things like meditate and do yoga to regulate your stress hormones. You need to lift weights and build muscle [00:01:30] to keep testosterone and sex drive up. Hormones are the great communicators of your body. And they send signals and instructions everywhere. Your cells talk to each other through different messengers or languages. There's the endocrine language, which is your hormones. There's the immune language, which is your cytokines. And there's the nervous system language, also known as neurotransmitters. Your hormones are produced and controlled by your endocrine glands. These are the conductors or the command and control centers for [00:02:00] all your hormonal functions. These glands in your brain are the hypothalamus and the pituitary, and they send signals from your brain to different parts of your body. For example, your stress response goes through your adrenal glands. Your blood sugar balance is through your pancreas. Your thyroid hormone is through your thyroid gland. Your sexual function and behavior is controlled through your reproductive organs like ovaries and testicles. Now [00:02:30] this network of glands sends and receives messages in a finely orchestrated symphony, and they have their effects through the whole body. Now, if we have imbalances in our hormones, we can experience advanced aging. And this looks like difficult and debilitating symptoms during perimenopause and menopause, it looks like a severe drop in testosterone, otherwise known as andropause in men. It can lead to increased belly fat, to fatigue, a low libido or sex drive, and [00:03:00] lots more in men and women. And this isn't just something we need to worry about when we're 40 or 50 or 60. Imbalances in our hormones can occur in our twenties and thirties. And they cause infertility and weight gain and muscle loss, fatigue, acne, severe PMs, and lots more. In this episode, we're going to discuss the wide array of hormones that influence everything from our blood sugar, to our mood, to our sex drive, to thyroid health, to stress response, and lots more. So one of the keys to successful aging is to [00:03:30] understand your hormones, to understand how they get out of balance and how to get them back in balance. And it's so common to have these problems. You know, one in five women and one in 10 men have low thyroid function and often it's not treated and diagnosed. In fact, over half of them are not diagnosed and probably 90% are not optimally treated or balanced. Sex hormones obviously get different as we get older. Men, testosterone levels drop. Women also [00:04:00] have lower testosterone levels. They go through menopause and estrogen levels and progesterone levels drop. And that effects their wellbeing and their vitality and their energy, their brain function, even. Thyroid often starts to dwindle as we get older because it's influenced by so many things, our diet toxins, stress and lots more. And of course, insulin is the most important hormone of aging, which we've talked about in the docu-series and it needs to be aggressively managed so that you keep your insulin levels low [00:04:30] and your health high, your belly fat, low, and your muscle high. As you actually drive the changes around hormones, you see a lot of them have to do with something that we call sarcopenia, which is when we lose muscle. And as we lose muscle, our sex hormones get worse. Our adrenal hormones start to get worse because when you have low muscle, you have increased stress hormones like cortisol. You get lower growth hormone, which is a repair hormone. [00:05:00] You get more insulin. So everything is going the wrong direction and the key to balancing your hormones, and they're different for each one, is understanding what causes them to be out of balance and what helps them get back in balance and then systematically tweaking and applying it. Elizabeth Boham: Sarcopenia is the loss of lean muscle mass and strength and agility that occurs with aging, but it doesn't have to. Sarcopenia is a major cause [00:05:30] of increased aging and something we really want to work against. We know that when we maintain good, strong lean muscle mass, that helps with our mobility. And it helps with keeping our joints stable and strong and without pain. And it helps us so we can get up and down off the floor and play with our grandkids. Maintaining good lean muscle mass is critical for overall health. When we are at rest, let's say we were an astronaut and went into space, or maybe we were just laying in bed because [00:06:00] we weren't feeling well. We will lose one to 2% of our bone density every month. And of course, with less bone density, that increases our risk for bone fractures. Lean muscle mass is critically important for your bone density. Your muscles are pulling on your bones all the time. And that stimulation, when your muscles pull on your bones, it stimulates your bones to say, "I better absorb more calcium. I've got to get stronger." So keeping your muscles strong is one of the best things we can do to keep our bone density strong. Dr. Mark Hyman: [00:06:30] Diet plays a big role. Exercise is a very important thing. Especially resistance training, managing stress to lower cortisol is important. All these are important, but diet plays a huge role. And here's what happens as we age. We need more protein in our diet to build muscle. And here's what the science shows. Even if people can get away with it when they're younger, when they're older, they can't, and even studies [00:07:00] that show, for example, improvements in health with lower animal protein when they're younger, when they're older, if they don't have adequate animal protein, they can't build muscle. And here's why. All protein is not equal. Protein from a lentil is not the same as protein from cow. And the protein from animal protein has a high level of a very important amino acid called [00:07:30] leucine. Now this amino acid is so important because you cannot build adequate muscle unless you eat about two and a half grams of leucine in a serving of protein. And you need about 20 to 30 grams of protein to build muscle after you eat. If you eat, let's say 10 or 15 grams of protein, your body can't turn that very effectively into muscle. That's why you see these guys who are weightlifters, they have this big whey protein shake after they work out because [00:08:00] that gets turned into muscle. So you can use these strategies. You don't have to be a giant bodybuilder Mr. Universe or Miss Universe, but you have to use a strategy of string training with protein intake and the right kind of protein intake to build muscle. It's so, so important. So this is a really critical strategy, muscle building, muscle strength, muscle quality, protein quality are all things we don't pay attention to as we age. And they're more important than anything because the reason people end up in nursing [00:08:30] homes is not because they have a disease, it's because they can't get up out of bed. They can't get up out of a chair. They can't tie their shoes anymore. They lose function. And I've seen people at 80, 90 years old who are strong and can function at a much higher level. My dad was 80 years old and I saw him and he was dwindling. He couldn't get up out of the chair anymore. He was struggling with his daily functions of life. He couldn't tie his shoes. I said, dad, I'm going to for your birthday, give you training [00:09:00] sessions. Now he's 88 years old already, but I sent him to the gym. I paid for his trainer. He worked out three times a week and it was amazing to see the gains in his strength. I saw the videos that his trainer would send. It was just incredible. And he noticed how much more functional and happy and energetic he was. So we have the potential at any age to impact this. Now it's important to understand that if you wait too long, it's harder and you may not be able to gain the full amount of muscle. So it's important to start early. I didn't, [00:09:30] I started when I was 60, but I think I'm making up for it now. And I feel like I'm able to actually gain strength that I never knew I had. I used to try to do 10 push-ups at 50 years old and I could barely do 10 pushups. And then I started working out a little bit and doing pushups and that was my strength training. I could do like 30 pushups, but by 29, I was feeling it. The other day, I just like dropped down and did 30 pushups. It was like doing three pushups. I could have kept going [00:10:00] simply because I've been training myself to get stronger. And I think as we age, it's more important than ever. Elizabeth Boham: We know that when we're at rest, if we're sick and we're laying in bed, or if we're an astronaut and we go into space, we lose about one to 2% of our bone density every month. So staying active and keeping our lean muscles strong is one of the best things we can do both for overall health, for our joint health, for our strength, for our agility, as well as for our bone density. [00:10:30] Nutrition is critical for strong bone density as well. And so we're always thinking about things like calcium, magnesium, boron, vitamin D, vitamin K, and a good protein source. All of these nutrients that are really critical for building strong bones. So we've heard a lot about calcium over the years in calcium is important for strong bone density, but we probably don't need to be supplementing with as much calcium as we used to supplement with. When I'm working with somebody who has osteopenia [00:11:00] or osteoporosis, and we need to make sure they're getting enough calcium, one of the first things I do or one of my nutritionists does is we add up all of the calcium that they're getting in their diet. So if the recommendation for their age and their bone density is to get 1200 milligrams of calcium a day, we look to see how much are they getting from food and then subtract that from how much they need and then maybe supplement with the rest. So you don't necessarily need to supplement with all of those 1200 milligrams. And [00:11:30] you can get calcium from lots of different foods. People are always focused on dairy, but lots of foods have calcium. Sardines are a wonderful source of calcium, salmon in a can, also great source of calcium, all of your green, dark green, leafy vegetables, collard greens, broccoli, almonds, all very good sources of calcium. So you don't need to always get it from dairy, or even if you can't tolerate dairy, there's many, many foods that you can get your calcium from. If you do supplement [00:12:00] with calcium, I usually go with a calcium citrate. And as I said, calculate the amount you need based on how much you are not getting from your food in a day. For men, we don't typically use calcium supplementation unless they really are having problems with digestion, absorption, or a very low bone density. And that's because there's been some association with calcium supplementation and prostate cancer and even heart disease. So, we want to be careful with overusing calcium supplementation for both men [00:12:30] and women. We also want to make sure that the calcium is going to the bones and it's not going to the arteries, right? We know that if calcium gets deposited around the arteries, it can make the arteries less flexible and there could be more plaque production and increased risk of heart disease. So it's important that the calcium gets directed to where it needs to go. And there's two nutrients that really help the calcium go where it needs to go. The first is vitamin D. Vitamin D is critical for absorption of calcium. So you need to have [00:13:00] enough vitamin D to absorb your calcium. We typically want somebody's 25 hydroxy vitamin D level in their blood to be around 50 to 70. That's a good range, especially if we're dealing with bone density issues. So if you have issues with bone density, make sure they're checking your vitamin D level and then supplement as needed. People need anywhere between 500 to 2000 to sometimes 5,000 or even higher IUs [00:13:30] a day of vitamin D to achieve a normal vitamin D level, and everybody is different. So for you, it may be something you want to check periodically to make sure you're getting the right supplementation of vitamin D. And then the second nutrient we're really paying attention to is vitamin K. Vitamin K is a fat-soluble vitamin that helps make sure that the calcium goes to your bones and not to your arteries. And so typically we want about 180 micrograms [00:14:00] of vitamin K2 in a supplement. And there are many vitamin D supplements that have that K with it. Your body will make K2, which is the best form of vitamin K for your bones in your gut. So it gets converted by some of the bacteria in your gut. So that's actually why changes in the gut microbiota influence vitamin K2 levels. You can get vitamin K2 naturally from things like natto, which is a fermented soy. [00:14:30] They eat it a lot in Japan. It's a strong taste. And we also get vitamin K from our leafy green vegetables, collard greens, kale, spinach, broccoli. Those are typically vitamin K1, and then the body needs to convert it into vitamin K2. But when you're looking for a supplement, go for the K2 form, most of the time. So collagen is a really important nutrient for bone density. And we sometimes don't realize how important it is. One of the things [00:15:00] we know about collagen is that vitamin C is important for good collagen production, which is important for our skin and our bone density. So we want to make sure we're getting enough vitamin C, we get vitamin C from our vegetables, our fruits, we're always thinking about citrus fruits, but it's also in many other fruits like kiwi and in many vegetables like your peppers and your broccoli, vitamin C is really rich in a lot of our citrus and non citrus fruits and vegetables. [00:15:30] Lifestyle has a huge impact on hormone balance. So by focusing on balancing blood sugar, that means getting some protein, good, healthy, fat, and fiber at every meal that helps with balancing all the hormones in the body. We know that good exercise, daily exercise helps with also balancing all the hormones and managing stress is really important for maintaining good cortisol levels, supporting your adrenal gland. And that is resulting [00:16:00] in balancing all the hormones in your body. Dr. Mark Hyman: So in addition to the rhythmic living and the moderate exercise and things like meditation and yoga that can help balance the stress response, there's often nutrients that are really important to help support adrenal function and the stress response. The B vitamins like vitamin B5, for example, and also herbs like ginseng and Siberian ginseng and Rhodiola, and all these wonderful herbs that you can take to help support your adrenal response and make you more stress resilient. That's what the astronauts [00:16:30] use when they go in outer space to help them stay more stress resilient. So getting your stress response in balance is a really key part of healthy aging as we get older, particularly for women as they go through menopause. The second thing that happens is often the thyroid gets a little out of balance and the stress hormones make it worse. Diet can make it worse. If we're eating gluten, for example, or exposed to environmental toxins, that can disrupt our thyroid. So sometimes people need a little bit of thyroid support, and that could be something as simple as cleaning up the diet [00:17:00] and reducing inflammatory foods. It could be as simple as taking vitamin D and selenium and zinc, which help thyroid function or iodine, which can some from seaweed, or sometimes they need a little bit of thyroid support. We use bioidentical thyroid hormone just to top them off. And often the numbers that you get when you go to the doctor look normal. But what normal means is that's the average of the population. And if you have a sick population, the range is wrong. In other words, if you were a Martian and you landed [00:17:30] in America today, 75% of us are overweight. So that would be normal. It's not optimal, but it's normal. So we want optimal thyroid, which is actually something we know how to identify and balance. Todd Lepine: The role that thyroid hormones play in aging can be very subtle. And there actually is a condition in medicine, which is termed subclinical hypothyroidism. And what that basically means is that somebody's thyroid is slowing down and [00:18:00] that may manifest itself by an elevated TSH level or thyroid stimulating hormone, but the patient's thyroid hormone levels are actually okay. And currently the standard of care is that somebody is having a subclinical hypothyroidism, you just sort of watch them. There is evidence, however, if you look into the medical literature that keeping the TSH level on the lower end of normal, so that you have adequate tissue thyroid [00:18:30] function is really the way to go. And also realizes that the way that most people are measured for hypothyroidism is just a screening TSH level. And TSH as a hormone level by itself is really inadequate to look at full thyroid function. So our bodies have TSH, TSH stimulates the thyroid to produce T4. Your body then has to take T4 and convert it into T3. [00:19:00] T3 is the active form of thyroid hormone. And then your body also produces a compound called reverse T3. So looking at the whole big picture of the thyroid is really, really critical. The other thing that I like to do to, for looking at thyroid function as a person ages is looking at thyroid antibodies. Thyroid antibodies are a little bit like the check engine light coming on in your body, because you can have normal thyroid levels, but if you have elevated thyroid antibodies that tells me that the body is attacking [00:19:30] the thyroid. And if you don't have overt clinical hypothyroidism, you're going to develop it down the road. So I really like to dial in thyroid as patients get older, although a lot of young people can actually have thyroid issues too. It's not just from aging, there's other things that can cause that. And then also it's very important that people realize that about one out of five people will have problems if they are hypothyroid, and they're given standard of care, which is T4 [00:20:00] thyroid medication, things like levothyroxine and Synthroid, one out of five people have problems converting that T4 into the T3, which is the active form of the thyroid. So 20% of your patients, if you're just giving them a standard therapy, you're checking their TSH, you're giving them a T4 leibow thyroxine, you're going to be missing the boat and they're going to be under treated. In that situation, what I typically will do is I'll give patients a form of thyroid, which is [00:20:30] a combination of T4 with T3. There are various prescription medications like that, like nature's thyroid, or NP thyroid. You can also get thyroid compounded if you need to. Or in some cases you can give patients a T3 alone. Most patients in my clinical experience feel better when they get a combination of T3 with T4. And the nice thing about that is you can really titrate that according to how they're feeling, and also according to how their blood levels are. [00:21:00] The other thing, there's also a recent paper that came out in the thyroid literature saying that the optimal level for patients who are being treated with thyroid medication is to get that TSH level down to about 0.03 to 0.3. That's sort of the sweet spot. So really keeping that TSH level on the lower end, that's when people feel the best. And that's when people are optimal with thyroid replacement. Iodine is needed for proper thyroid function. And then also [00:21:30] there's an enzyme in the body called five-prime deiodinase, which is how the body cleaves off the T4. T4 stands for four iodines and T3 stands for three iodines. So when the thyroid molecule has three iodines, that's the active form of thyroid. So making sure that the patients have enough selenium, selenium is one of those super micronutrients. There's been a lot of work by Bruce Ames about the multiple effects of selenium. It affects thyroid function. [00:22:00] So looking at selenium levels, looking at iodine levels, looking at oxidative stress levels, all of those things play a role in optimizing thyroid function. There are some supplements that people can take to support the thyroid. And then also making sure that they're not having excess amounts of foods, which are goitrogenic things like a cabbage can be goitrogenic and, and can cause a thyroid enlargement. There are some rare [00:22:30] cases where some patients may take some medications like amiodarone, which can cause thyroid problems or prescription doses of lithium, which can also affect thyroid function. But those are the major things to be looking at. So all of our hormones do naturally decrease and decline as we get older. In women, we call that menopause in men, there's actually a term called andropause. So not only do women's hormones go down, but men's hormone levels go down. And what I would [00:23:00] venture to say is that most people, most women probably don't need hormone replacement as they go through menopause. As long as you have your ovaries, the body's able to make sufficient amounts of hormones. You can measure the hormone levels. And when the hormone levels go below the normal range that you would expect for their age, that's when people would benefit by hormone replacement. Or if you combine that with a patient's symptoms, because everyone's different, [00:23:30] you can actually have some people who are having symptoms and their levels are normal and vice versa. So you really have to look at the whole context of the whole big picture as far as what's going on, but definitely, lack of estrogen in women and estrogen is only one of the hormones that women have. Women have estrogen, they have testosterone, they have progesterone, there's three forms of estrogen. There's E1, E2, E3. We also have DHEA, we have cortisol and all of these hormones interact together. [00:24:00] The master hormone, when it comes to the body, in my opinion is cortisol. So oftentimes when people are having either too much or too little cortisol, when you get their cortisol levels into balance, that's related to your circadian rhythm, which is your sleep wake cycle. The other hormones will oftentimes tend to balance themselves out. But there are times when men need hormone replacement therapy and women need hormone replacement therapy. Dr. Mark Hyman: One of the things that happens to men as they get older is, often [00:24:30] I see this in 30 year olds and 40 year olds now because of our poor diet, is they tend to increase belly fat and they tend to lose muscle. And when you do that, you accelerate what we call andropause, which is, androgen is the male hormone and andropause is like male menopause. And it's a real thing. And guys feel less focused, less motivated, less energetic, have trouble with sexual function, with sexual desire. [00:25:00] They often, if it gets really bad, they get these big bellies, they get high levels of estrogen, which is produced in your fat tissue. So they'll get man boobs, they'll lose the hair on their chest, the hair on their legs. And they kind of become more like women, but it's not inevitable. At any age, as a guy, you can reverse that trend and fix your hormones by fixing the thing that causes it to go down by your testosterone going [00:25:30] down, you're going to have all those symptoms. It's called low T syndrome. And it's a real thing. But I see it mostly in guys who really haven't taken care of their health, who get the belly fat, who eat too much starch and sugar, because the bigger your belly, the lower the testosterone. The bigger your belly, the more insulin you produce. And when that happens, you get in some resistance, and that's what causes low testosterone in men. So I see guys who were 40 or 50, you have testosterone levels of 90 year olds, [00:26:00] and that's not necessarily inevitable. So by cleaning up their diet by strength training, lifting heavy weights, that'll increase your testosterone. If you eat good fats, that'll help increase your testosterone. If you get rid of starch and sugar, that'll boost your testosterone. So often through natural strategies, we can help men get rid of all that estrogen, build up their testosterone naturally, and feel more vigorous and energetic and strong again. But again, sometimes men need a little help [00:26:30] and that's okay. And using bio-identical testosterone, it can be delivered through shots or gel, or even pellet sometimes, can really help men with sexual function, sexual desire, building muscle at any age. So I'm not opposed to hormonal therapy. I just don't think everybody should get it as a knee-jerk reaction as part of aging. And that we should use a lot of these other strategies to help optimize hormones in the absence of having to give bio-identical hormones. But it's not bad if you have to do that, it just should be for the right person at the [00:27:00] right dose at the right time. Elizabeth Boham: Typically, a woman goes into menopause between the ages of 45 and 55. And peri-menopause are those years before a woman goes into menopause. And that may be six years before they go into menopause they may be in peri-menopause. They may be in peri-menopause for 13 years before they go into menopause. Every woman is different, but that perimenopausal time is a time where hormones are more erratic. They're not as regular. [00:27:30] You may have cycles in peri-menopause where you don't ovulate. And when that happens, your progesterone level doesn't go up as it does when you're regularly ovulating before you go into perimenopause. In addition in peri-menopause, things shift back and forth all the time. There may be one month where you do ovulate and then the next month where you don't and then your periods can become more erratic. You could have some cycles where progesterone doesn't go up like it should. And as a result, [00:28:00] women often feel a lot of symptoms. Sometimes women feel more irritable. They may notice that they have trouble with sleep. They may feel more anxious. They may have a harder time calming down their body. For some women, they get more hot flashes. These are all symptoms that are more common during perimenopause. And we can really help with balancing that in so many different ways. And one of the best ways that we can work to rebalance that is by supporting the adrenal [00:28:30] glands. And why is that? Because the adrenal glands make hormones like cortisol. And if the body is under chronic stress and needing to take all of its hormones to make cortisol, then it doesn't have as many of those hormone precursors to make some of the other hormones that the body needs like progesterone and estrogen. And so what's really important is doing things that help with balancing and supporting the adrenal glands. I think that's one of the best ways [00:29:00] that we can help support a woman through those years of peri-menopause. When we support the adrenal glands that supports that transition that can be difficult for some women. And so you can support the adrenal glands with getting good sleep, maybe getting enough B vitamins in your diet, or some women take an extra B vitamin complex with methylated folate. By doing some stress management techniques, we know that when a woman incorporates some meditation for 15 [00:29:30] minutes, twice a day, she's less likely to get hot flashes. And if she does get hot flashes, they're not as severe and intense. So there's a lot we can do to support the adrenal glands that support all the hormones in your body. For men, one of the things we focus on the most to help with balancing hormones is maintaining good lean muscle mass. We know that our body fat takes hormones and turns it into estrogen. So when we have more body fat, [00:30:00] whether we're a woman or a man, we are converting more of our hormones like testosterone or DHEA and converting it into estrogen. So when our body fat increases, so does our estrogen level and for women that can increase risk of breast cancer and uterine cancer. For men, that can increase their risk of insulin resistance, prostate cancer, diabetes. But we also know that that results in men just not [00:30:30] feeling as good. They don't have the same level of testosterone if their body is taking that testosterone and converting it into estrogen. So one of the best ways we can help improve that is by maintaining good lean muscle mass. So through strength training exercise, through keeping their body fat nice and low, or in the right range, we can help with preventing that conversion into estrogen and keeping the testosterone higher. We know that strength training and exercise stimulates production [00:31:00] of testosterone. And we also know that when testosterone is high, we are more likely to have more lean muscle mass. So it all works together. When you hear the term bio-identical hormones. What we're talking about are hormones that are identical to the structure of a hormone in our own body. So there are bio-identical hormones that you can get from a regular pharmacy that are prescription medication, as well as bio-identical hormones that you can get from a compounding pharmacy. So bio-identical hormone just means [00:31:30] that it's identical to your own body's hormones. For women, that may be something like estradiol, that's identical to your own body's estradiol that you have floating around. And as I said, you can get that from conventional pharmacies as well as compounding pharmacies. Bio-identical hormones are probably healthier hormones for us than a synthetic hormone. And there are many ways you can provide bioidentical hormones. You can give them transdermally through the skin. You can give them [00:32:00] as a pellet under the skin or troch in the mouth. You can give them vaginally. You can also for testosterone there's things that look like a deodorant that you can spread on your skin, or you can rub it on your skin as well, as well as injections of testosterone. When we're thinking about, do we need to provide somebody with hormones, it's a very individual decision. We're always weighing the risks and the benefits. And you know, what's important if you're thinking about hormone therapy [00:32:30] is that you want to work with a provider to look at all your individual risks, and what are the symptoms that you're struggling with? Can these symptoms be just improved with managing your stress better or changing your diet, or maybe you need a little hormone to support you through the transition into menopause for a period of time. We typically work to use the least amount of hormones we need to use for the least amount of time, but every person is an individual here. So it's important that we [00:33:00] work with each person as an individual to make sure that they're not getting too much risk from the hormones if they need to use them. And we work to wean them off when they don't need them anymore. Dr. Mark Hyman: Balance is the key to staying healthy. And nowhere is this truer than in the world of hormones. Don't think of your hormones separately. They're all connected parts of a whole that all affect each other. See hormones are influenced by imbalances in all the foundational key seven systems of your body. They're all connected and balance or [00:33:30] imbalance in those systems means the difference between health and disease between a vibrant, healthy life or a slow steady decline. Now, our body is one whole system where everything is linked to everything else. So improving your nutrition, reducing inflammation, fixing your gut, boosting your energy system or mitochondria, optimizing your structural system like your muscles and getting rid of toxins all support the normalization [00:34:00] of hormone function, which then translates into better mood, more focus, healthier aging, and even better sex drive. Balancing your hormones is a process, but with the right steps, you can reverse your biological clock and live younger longer. We'll see you next time for episode five.