We are with Dr. Elizabeth Sierakowski, one of our HER Expert panelists. She’s also the owner of the Six Forks Rd location of Essential Health and Wellness. She is trained in the trifecta of family, integrative, and functional medicine.
To start us off can you tell us a little bit about your qualifications? I told everybody you are trained in the trifecta of these three areas. So, what does this mean? What does it mean to be trained as a doctor, to have a background in functional medicine, integrative medicine, and alternative medicine? Can you help us understand?
Absolutely! It took me a long time. I still wonder how to really describe what I do sometimes. There isn’t really a short elevator pitch.
I have spent the past 15 years picking every tool I can to put in this toolbox, because ultimately there isn’t one size fits all for anybody. I believe very strongly in personalized medicine. What you need, what I need, what someone else needs are all going to be different things.
Being a generalist, a primary care minded person and trained in family medicine, I don’t separate people down into parts and systems. I want every system I can get my hands on. If it works I want to know about it. There was something I learned about a long time ago that actually talked about shamans and shamanistic medicine, native healing, it talked about how we are poor decision makers for our own health to say which system is really affected. In modern society, we are leaving it up to each person to say, “I don’t feel well. Is it my body? Do I need a doctor? What kind of doctor?”
There’s no referrals needed anymore, you can just pick your specialist and make your appointment with them. Maybe it’s my mind and I need a mind doctor — is it a psychiatrist? A psychologist? Is it a Christian counselor? Is it something else? Is it my spirit? Ultimately, all of that is so separtist. If my mind, body, and spirit are all these different things and I need different specialists for all of them and nobody is the quarterback anymore. So my job is to be that person. To help someone when they come in and just say “I don’t feel well. Help.” Then I can help them walk through where we are to where we need to get to.
Lovely. And I can say personally I love that piece. As a mom, and this is one of the reasons Crissy and I created HER Health Collective was because it’s so hard to know where to go and who to see, all these different professionals.
It’s pretty tremendous. In terms of the training piece of it, those words mean different things to different people which is why those labels are difficult.
So the best we’ve got is saying, by conventional medical training, I am an MD in family medicine which means I’ve gone through the allopathic medical school and residency. I am trained in pediatrics and geriatrics and everything in between, so what they call cradle to grave so to speak. I can do wellness and I can do illness. I can help optimize. There’s really very little that’s out of my specialty area as a family medicine doctor, which I love.
I added the integrative medicine piece because I wanted more of the nutrition training, how much does wellness impact ourselves, and what about other entire systems of medicine? We sort of pluck and pick and choose in the United States. Yoga is now yoga Bootcamp and yoga aerobics and all the things that are really not yoga. Ultimately that’s part of Ayurveda which is an entire system of healing that’s based on lifestyle choices and when you eat meals, food combining, breathwork, and body movement. Then separately, in Chinese medicine, you go back to acupuncture which has also been plucked out as one treatment modality, but it’s not in traditional Chinese medicine, it’s part of the entire system. You can’t just put a needle in somebody and think that’s going to heal them. They need the herbs, they need to understand a liver in Chinese medicine is not the same as a liver in conventional medicine. I wanted all of that training as well.
Just a couple of years ago I went down the functional medicine rabbit hole, which I had really already been practicing. Paleo lifestyle eating, that was my undergrad thesis and how the agricultural revolution absolutely mirrors the decline in human health and rise of disease which is pretty fascinating. But I wanted to know more about what we can do for root cause healing. You know conventional medicine puts symptoms in categories and labels it a disease process and that disease process has a prognosis and a treatment plan.
Integrative medicine sort of does that, but with more tools in the toolbox. Functional medicine puts all that aside and says “I don’t care what we’re going to call it. I want to know what your constellation of symptoms are, how did you get that way, and what are all the dominoes to get from here to there?” That’s all really helpful, but you need all the pieces.
So essentially, you offer almost an advisorship to your clients.
And a fee for service. So you go to the doctor because something hurts, can you explain more of that?
Yes, we do both. Ultimately, I do both for that reason. Everybody needs something different. In my primary care world it is an advisorship. It’s a high level relationship where I know you and your family, your needs, your goals, and we revisit them all the time, so it’s not only how do you feel right now, like last night I had somebody call because he thought he broke his finger and we talked through that together, but also knowing what are your goals next year and five years from now and ten years from now. How can I strategically help you get there with how much effort you want to put in? Somebody says I want 40 supplements and somebody says don’t give me a supplement I’m not going to take it. So we can walk through that.
But we also do consults. A consult would be a very straight fee for service. You want to pay for my time, I’m happy to help in any way I can and that is just on an hourly basis with no strings attached for that reason. Because sometimes people just want some advice and they want to take that information and plug it back into their medical team that works for them. That’s great! Happy to do it either way!
Dr. Sierakowski, I love everything about Functional medicine. It’s very appealing personally on many levels, but I think a lot of people’s hang-up comes back to something you mentioned, which is the supplements and also I think the lab-work piece. A lot of us think about functional medicine and we just think oh they are going to order so many labs for me and I’m going to have to take all these supplements. Why is that? Can you talk a little bit in the realm of functional medicine why that exists?
Absolutely! And that is a big hang-up. That’s partly why that’s not the only way I take care of people.
The concept there is it’s really root cause healing. When someone has sought out functional medicine care, it is because they don’t want a surface level answer, they want to get to the underlying reason. The only way to do that is to “test, don’t guess” as they say, but testing is expensive. It’s specialty testing and the insurance company doesn’t care. An insurance company is driven by ultimate cost savings. That is the entire reason an insurance company exists. Ultimately the byproduct is that you should be healthier, and you cost less if you are healthier, but the reason they make decisions about what is and isn’t covered is entirely based on cost savings over your lifetime. So that has nothing to do with wellness and prevention necessarily. If it’s not proven they won’t pay for it. So most functional medicine testing is not covered. It is highly specialized, it is specialty lab based, it’s often other body fluids. Some are blood, saliva, urine, stool testing, and those add up. So that gets difficult. But, the concept is test, don’t guess.
I’m not going to take your history and say okay, in three minutes I think I know what this is. Now conventional medicine doctors are very good at that, so I just want to put out there it feels bad to have them not touch you, barely listen to your story, ask you a couple questions and feel like they’ve pinged you, but at least 50% of the time they are probably right. That’s their job is to do that. But that’s going to be a superficial level answer.
So the other piece are the supplements and that gets back to if you’ve gone to somebody because you don’t want a pharmaceutical grade prescription which is highly concentrated and designed to be very effective in a short period of time to prove that it works, then you’re looking at lifestyle medicine and supplements. It’s going to take more supplements over a longer period of time to achieve the health effect that you might achieve in a couple of weeks from a pharmaceutical, but you’ll do it with fewer side effects and you’ll do it where you actually achieve wellness rather than suppressing a particular system, symptom, or disease process.
The testing and supplements have their purpose if that’s what you’re looking for. But not everybody necessarily is. If you don’t have the resources for it, functional medicine is expensive. I’ll be very clear, I do not think any of this medicine is just for the wealthy healthy, and I’ve heard that before.
It is clearly for people that need to or want to prioritize their health for any number of reasons. They’re sick, they’ve been through it all. They’ve spent – maybe it’s not their own money, but they’ve used insurance money – but there are often people that have spent $100,000 by the time they come to me in the conventional system and then I want to look at $1,000 of testing because I need food sensitivities, a gut panel, and a SIBO breath gas test, and that feels like so much money. Ultimately, that’s because that’s what that test is worth versus the CT scans, MRI’s, specialist visits, ER visits, medications, and the lost time at work. It gets difficult. That’s the key to the functional medicine piece. It can be a barrier or it can be a path to healing depending on where somebody is at and what they need.
Dr. S, so we talked a little about your method of providing care for your patients and you’ve touched a little bit on conventional medicine. If we have doctors already, doctors who we are being served by, certain providers, what are some indicators that we are working with the right one versus various different red flags that we need to look for that we need to find somebody else?
Absolutely! I have tremendous respect for the current medical system in that it is doing the very best that it can. For a great many people they have a good relationship with a team of providers, with their primary care, their gynecologist, a dermatologist, an ophthalmologist, and a dentist. Many people have all of those, that’s sort of your base.
Signs that you have the right relationship are you don’t dread going to your appointment, when you ask a question they hear your question, if you show up with a list you don’t get an eye roll, and that someone actually touches your body at least once in that visit. And sometimes you have to ask. It can be a prompting. Maybe the doctor is thinking you’re just there to have a conversation or that a physical exam won’t necessarily give them any more information, but you can say “could you just check?” If they say, “no. I don’t need to do that.” It’s probably not the right relationship. If someone says, “of course, let me just check.” We find things that way. But if someone ever tells you that what you are experiencing is not valid or real, leave. End of story. I’ve, unfortunately, heard that a great many times.
Something like fibromyalgia is now increasingly being understood as a very real entity, but for many years it was not considered so and in many practices it is still not considered so. If somebody says, “I can’t find anything wrong, therefore there is nothing wrong.” You’re done. There’s a difference between “I don’t know” and “there is nothing wrong with you.” Somebody needs to be able to say, “I’m not sure” or “I don’t know, let me look it up. Let’s find another specialist. Let’s get another opinion.” Those are great things. Doctors are people. They are not God. They are not machines. They are doing their very best with what they’ve got. But, we have to admit that and we need the patient to understand our own limitations.
I walk through that with my patients all the time and I’ll be very clear, especially on a consult basis. I was just having this conversation with my team yesterday. Major Imposter Syndrome. I was feeling very frustrated because this happens to everybody. I was thinking, Am I really helping people? Or am I just taking their money? I have no intention of doing that.
I wrote a poem to myself last night.
I wish I had a crystal ball.
I wish I could know when you call
me for a meet and greet,
if I’m going to be able to help you,
how I’m going to be able to help you,
which test is going to work,
which treatment is going to work,
how much that’s going to cost you.
I wish I could project if I didn’t know the answer, who would.
I wish I could know who I could refer you to.
Because, if I could know all of those things in advance, even if it was to say this is going to take you 10 years and $10,000 I wish I could tell you that! If it was, nope it’s this one thing. I’m going to give you Nystatin and clear your candida and everything is going to be better. But you know one in fifty times that happens. It feels really good, but a lot of times it doesn’t.
So I feel very strongly that the relationship you make with your health provider is entirely based on their respect for you as the expert of your own body. That’s it. Circling back to where we started, you may not know what the problem is, but you know that there is a problem. And if they don’t respect that and help you find an answer one way or another then it’s not a good relationship. If they do, then it is.
Dr. Sierakowski, I just have to pause and say I have the utmost respect for you. In listening to you right now I can’t imagine a person coming into your office and not feeling everything you just said. If we could make over the entire health care industry in your model, I think we would be in a much better place. I wish every woman could experience a physician like that. It would be a game changer. Thank you, for your honesty and your vulnerability and for being the person you are basically.
I appreciate it so much. I really do. It would be my hope and goal that this was available to everyone, all walks of life. Even before I worked with Essential and took over this practice and own it and run it the best way I know how, I did the best I could in a totally conventional medical practice.
Before I came to Raleigh I was working in Montana and Wyoming for coal power workers, miners, and ranchers, and just as an aside I really looked like I was 12, I had braces, I was fresh out of residency. Those guys came in with their handguns, their spurs and they looked at me like it was supposed to be a joke that I was there to take care of them. I would win them all over. It was fantastic. By the time I was done it really was quite an experience.
You do what you can, with what you’ve got. In that system, I was always chasing my tail. I could provide spectacular care, even in 8 minutes you get really good at it. But, without changing the system, without enough time to talk about lifestyle change, I can do your trigger points and dry needle, inject some saline and make your headaches go away, but if we don’t have enough time to go over how your body posture got you to that trigger point in the first place, it’ll come back. Over and over and over again until you have arthritis in your neck, you need pain medication, or you need a spinal surgeon.
There’s nothing I can do to prevent that unless I have enough time to teach you how to prevent that from going on in the first place and if I can catch you early enough. Some of that, I think, is some of the frustration with integrative and functional medicine. They’ll say it doesn’t work. It can. In the right set of circumstances and given enough time and caught early enough.
But if you already have a disease process I can help mitigate how that feels. It’s not always possible to reverse disease. It often is, but it isn’t always possible. But I can always help and there is always hope. So understanding where we are in the curve of the process, where we are in the journey and respecting that is another key piece to healing, and understanding what healing means.
That is beautiful. We are going to jump over to female issues. Specifically we talked a little bit about supplements, I know especially through pregnancy you’re told you need to make sure you’re getting all of this and you’re not getting any of that. What nutrients in particular do women need?
Nutrients for women it depends a bit on where they are in their life cycle and in their reproductive cycle.
All women need folate and we’ll talk a little bit about that. Folic acid is often referred to. Folic acid is the synthetic version and it does help prevent spinal cord defect when given prenatally. The reason we say every single woman of childbearing age needs to be on a prenatal vitamin is entirely because of folate or folic acid. That key nutrient prevents neural tube defects, things like spina bifida, basically the way a baby’s spine is supposed to close entirely so that when they come out nothing is showing, that is based on folate or folic acid.
A nurse in Australia actually figured that out with Vegemite, which is really cool. Go women! That was an amazing discovery. Folic acid does prevent that. Folate is the natural form, much better absorbed, much more bioavailable which is why we like it. It is in things like leafy greens. You can get some in your diet, but not enough.
Anybody of childbearing age we like at least 400 micrograms of folate every single day because accidental pregnancies happen all the time. By the time you know, it’s not that it’s too late but if you have a low folate store and pregnancy happens without you being aware and you haven’t started that prenatal vitamin yet there is a very small short window that having the folate on board makes all of the difference. If you wait until you know it’s usually much more difficult to play catch up. Everybody should be on folate if it’s even remotely possible, which in a conventional medical stance if you are menstruating and not in full menopause and not like 8-years-old, it is possible. So you’re on the vitamin, end of story. So folate is a big one.
Calcium is another really important one and there are a lot of myths around calcium. For example, it has to come from dairy, total myth. There are plenty of indiginous people who do not eat dairy at all and have incredibly strong bones, so you do not require dairy for calcium. In fact, dairy being an acidic food it will actually leach calcium at about the rate it puts it back, so it’s kind of a net neutral. Soda will also leach calcium right from the bones, so be very careful. Excess grains, starchy processed foods will do the same. So it’s just as much about making sure you’re not losing the nutrient as it is that you’re putting it back into the body.
The key with calcium is it depends again where you are in your life cycle for how much you need. In general, an adult female needs about 1,000, if you’re postpartum or menopausal you need 1,200 and that helps protect your bones. You start losing your bones at a higher rate from the age of 45, unfortunately even if you’re not menopausal yet.
The key with supplementation is most women either undersupplement or oversupplement on calcium. Not enough and we run into trouble. Too much and the body can’t actually absorb it and put it all away fast enough every day. So when you take a whole bunch of calcium at once or take all 1,000 of your calcium in supplement form, you end up putting some of it in your arteries where it doesn’t belong. So you really only want about 500 milligrams from your supplement everyday and then get the rest from food.
Calcium is in all kinds of things. It’s in broccoli, dark leafy greens, and dairy of course, and actually my favorite is canned salmon with the bones in it. People get really heaved out when we talk about it, it comes out looking funny but don’t look at it. Mash it up, the bones completely dissolve, you never know it’s in there, you make salmon cakes, salmon burgers. They are phenomenal. A couple times a month and you’re solid. I’m a big fan.
There’s lots of forms of calcium as well. The easiest is going to be Calcium Citrate. You don’t need robust stomach acid to absorb calcium citrate. We used to think that was only for the elderly population, but many of us don’t have enough stomach acid. So those are two key ones.
Iron is tricky. I don’t recommend supplementing iron unless you have been tested. Many women are low and many are not. You don’t want to overdo it. Iron is easy to overdo and then it deposits in the liver where it doesn’t need to be. It’s important to make sure you have enough, and you don’t have too much. There’s also a very common hereditary malformation that makes you hold on to too much iron and deposit it, it’s common and you would want to make sure that didn’t happen.
Vitamin B & D
B Vitamins are certainly helpful, but I’d say those three the folate, calcium, and iron are the most critical and the D. Vitamin D is another big one. The vast majority of us are going to be low. It’s pretty difficult to get enough even if you are basically outside in the nude all summer, you’ll probably have enough D then and that’s about it. Fall and winter you’re really not going to make enough.
That one is pretty safe to supplement up to about 2,000 every single day without needing a test. I like testing the Vitamin D because it tells me how low somebody is and how high they need to be. The sweet spot on your lab value is between 40 and 60. I frequently in North Carolina, even in the summer, have people at 17. That’s enough that your bones are melting. Under 30 and you’re not making enough for hormone production so that’s not optimal, but under 20 and we’re really on the struggle bus. So you really want to make sure you’re getting enough.
This is the perfect segway into hormones, but Crissy did you have a question first.
Just a really quick follow-up question, if you had every woman in the world and you could give them one magic pill, what would you want every woman to take?
Oh, that’s really hard. Like one nutrient or one multinutrient? (Laughing)
Yeah, what about a multivitamin. Do multivitamins give you everything you need?
Most of them don’t. I would say a good multivitamin would cover your vitamin D, a little bit of your calcium, a little iron depending on if you needed it or not, some B vitamins, your K, a little selenium, a little iodine. Those cover the thyroid and help hormone optimization.
A good multivitamin. There’s definitely some tips and tricks on how to pick a good multivitamin. I’ll share the really quick ones. Make sure you’re getting a company that has good manufacturing practices. It’ll have a GMP label on it, that’s a great step in the right direction. Then look at where it talks about the Vitamin E. If it says DL Alpha, that’s a synthetic vitamin E and it’s probably a garbage multivitamin. The hands down super fast test. The ones that say D Alpha is at least trying. So it may not be perfect, but it’s far better than the others. There’s a great many multivitamins that are basically chalk. You’re not getting much, you’re not going to absorb it. It doesn’t really matter what’s listed on the label just to look good. If the volumes aren’t right you can’t actually get it in your body. So spend the money and do not buy cheap multivitamins. They are doing nothing for you and they are probably harmful. Get a good one.
Now I’m going to run and check my multivitamin.
And gummies! No with the gummies. I can’t.
Kids love them.
I have a magnesium gummy I am obsessed with. They taste so good.
I was just going to say some things in gummy form are just fine. Fun fact, I looked this up very purposefully. Folate does actually function in a gummy. That’s okay if that’s your prenatal, but you’re probably not getting much else out of that.
Good to know!
Yes! So you mentioned hormones. You mentioned how several vitamins and minerals we take through supplements can help support hormone production. Another buzz word we’re hearing a lot about is inflammation. So, I’d like to lead us into a discussion on hormones and talk a little bit about inflammation. Specifically, recognizing when something is inflammation based or hormonally based, like a deficiency or your hormones aren’t firing properly. When do we need hormone balancing and I’m so confused on what hormone replacement is as well. And let me know if you need me to repeat anything, That was loaded!
I wrote a little thought tree down, so I should be good! There are two things that left me when I had Gabrielle, one is math. I was an A-team Mathlete. I got differential equations and I loved it and now that is all gone! And the other thing is I cannot hold a list of things. If there’s three things, number one I’ve got, all the rest are gone! My mom used to say she gave me all her brain cells and now I understand. It happened. Just passing them on. Here you go!
Okay, hormones and inflammation honestly underlie just about every disease process there is. I’m going to make a very bold statement but I think that is true. In one example, we are learning a lot more about dementia and Alzheimers and we are understanding that many of us are at tremendous risk for this right now, which is frightening. I think of all things, we think about what makes us who we are — you could take all of my limbs and I would still be Elizabeth, you could take a lot of pieces of me and I would still be Elizabeth, but if I don’t know who I am and I can’t converse with you anymore, and I don’t have my memories, I am still me but it’s much more difficult to find that. I think that’s what makes that so isolating and so scary for our loved ones. So that’s a really big thing right now and we’re all talking about it. I’m a huge fan of a book by Dr. Dale Bredesen called The End of Alzheimers. It’s a phenomenal read. If anybody is worried about dementia at all, for yourself, your family, anybody, read the book. It’s awesome! But I bring that up because he really did a phenomenal job looking at this from a different standpoint. This is a great explanation of conventional, functional, and integrative medicine. Conventional medicine says Alzheimer’s disease is a particular disease I can test for and has something to do with these TAU and amyloid plaques and if I can get rid of the plaque you wouldn’t have Alzheimers anymore. Except we have not found that to be true at all. There’s no effective medicine and we can’t predict who has it and who doesn’t have it. So that method is terrible.
Integrative medicine says you might get it. Maybe if you live a really healthy life you won’t get it. If you do, we can be at peace with it and this is how we can go through that process together. It very much treats menopause the same way. Menopause is a natural thing. Every woman is going to go through it. We’re going to do this with as much grace as we can and try to mitigate any discomfort through herbs and living our wild woman ways, which I can totally get on board with most of the time. Unless you don’t have brain cells anymore, you can’t function, you can’t do your job and you’re miserable, you can’t have sex, your vagina hurts, you have urine infections, and your bones are disintegrating, and you have heart disease. No, thank you. I would like to do something about that.
So this is where functional medicine comes in. It says, yes those are natural progressions of things, but they don’t have to be that way and we can do something about it. So I’m going to circle back around to the Alzheimer’s example and then I’ll jump over to hormone shifting. Instead of saying, we are trying to figure out what to do about it or we can’t do anything about it, we’re going to say maybe it’s a constellation of symptoms. Maybe Alzheimer’s isn’t one disease process. It is the brain protecting itself from onslaught over an entire lifetime and that the plaques are actually a protective mechanism, the pruning of memories is a protective mechanism to say well we don’t have enough resources, or we’re battling such a siege on all fronts for so many years. Okay I don’t need to remember how to play the piano anymore, but I do need to remember how to breathe. I’m going to focus on that one and we’re going to let go of memories, let go of skills to preserve function. Put that way, it puts us back on the same team as our body, which I will always go back to. I would like to always be on the same team as my body that has gotten me through so much. I don’t want to hate it. I don’t want to resent it. I don’t want to feel like it is failing me. Instead, I want to recognize that it is clearly doing the very best it can with what it’s got. What can I do to help support that process?
In this case, hormones and inflammation, and then toxins would sort of be the other category. Diabetes is a really big one, glucose functions essentially as a toxin in the body. It sticks to everything and accelerates the degeneration process. Inflammation for many number of reasons, whether it’s an external toxin or it’s a chronic virus that we’re dealing with something like mono or herpes virus or chickenpox, things that we got when we were kids and everybody says “alright, it’s no big deal, let’s have chickenpox parties.” But it is a big deal. These things stick with us for an entire lifetime. Chickenpox specifically, it lives in your spine and comes out later and kicks you when you’re down and gives you shingles. It’s really rude! All of those things together, it’s all exposure over a lifetime.
I’m not an ageist at all. Very few things are because somebody is old, if someone says I’ve had this many years on the planet I’m going to have wear and tear, not necessarily true. I’ve seen 25-year-olds with wear and tear because they are elite level athletes and they’ve done something in repetitive motion too many times. I’ve also seen 89-year-olds who don’t have any wear and tear because they move their body in a variety of ways and do it in a sustainable way. So it has very little to do with how many years you’ve been on the planet and everything to do with how you’ve used your body, what it’s been exposed to, and how you’ve taken care of it. So all of that to say, hormones and inflammation underlie just about everything.
If I could sum up what I do in a pretty short statement, this is it. I will help you to find major deficiencies, whether it’s hormones or nutrients or joy. Deficiency of joy is a major problem. I can’t measure that. But when you say, “when’s the last time you’ve belly laughed and didn’t think about something you had to do.” People just stare at me. It’s sad. But it’s common, all too common. If I can help you restructure your life so that you have a daytime and a nighttime, a work life and a home life that is in harmony, not necessarily in balance, but at least in harmony with each other. If we can get you on the same team as your body, that you live an anti-inflammatory lifestyle. That is all day every day for your entire life. This is not a “diet” that you “anti-inflammatory” for a month and then go back to Bojangles and Chick-fil-a. Just no! On occasion, sure!
What do you mean by anti-inflammatory? Can you go into that a little bit?
Yes, absolutely! What is an inflammatory agent? Anything that’s going to create heat, degeneration, toxic environment, anything that’s going to trigger your body’s autoimmune response to say whatever this is is too much for me to handle. Those are inflammatory.
Anything can be inflammatory. Emotions can be inflammatory. Trauma is inflammatory. Car air fresheners are inflammatory, to deal with the fragrance that’s going to disrupt your endocrine immune system. Too much kale can be inflammatory! It will give you oxalates and cause kidney stones, don’t do it! I have seen kidney stones from kale shakes more often than I can count.
The goal in terms of what is an anti-inflammatory lifestyle would be asking: how can I be at peace? How can I have passion and joy for what I do? How can I have gratitude? Those things I’m going to say are foundational and are free. The things that go into your body all day everyday are really important. Things like your water, your air, and your food. So we start with safety. Am I safe and protected? Am I joyful? Am I at peace? Then do I have clean water and clean air and clean food? And that means different things to different people. If you have lots and lots of resources, maybe that’s a reverse osmosis installed in your kitchen sink and special air purifiers and all organic everything. For others, it’s can I just make sure my city tap water is okay and read the statements that come out from the city and make sure my tap water is okay. If it’s not then I boil the water first. That’s a free way to get really clean water, and that’s okay! And then clean air. Making sure you’re not surrounding your home with burning candles, Glade plug-ins, incense, and fabric softener. It’s adding up. A little is fine. A lot is not. Same with food. People get worried about organic, but you know what’s definitely not organic? Goldfish. Just start with the basics and do the best you can with what you’ve got.
The two very best anti-inflammatory supplements hands-down are going to be Vitamin C and Turmeric. A third would be fish oil. Phenomenal. Not going to overcome bad air, bad water, toxic relationships, and that you hate your job. It’s not going to happen. You have to start with the foundation, and then you can add the good stuff on top. Now I have seen fish oil, vitamin C, and Turmeric in the right quantities, right extracts, without filler and other things be really effective for people but it’s most effective when it’s coupled with a whole picture healthy living.
The holistic picture you just painted is beautiful. When Cindi and I first started dreaming of HER Health Collective that is what we kept coming back to. Everything is so piecemeal in our healthcare system and women have to seek out answers from all these different specialists and it really is beautiful when it is this whole system and you look at the whole picture. Thank you for that! Speaking of the healthcare system and it being piecemeal, what doctors would you say women need to see and how often?
Phenomenal question, and it gets very confusing. A little bit depends on where you are in the country, and where you are in your life cycle. Obviously, I prefer a family doctor. That was my training, let me just speak to that, the difference between family medicine and internists. An internal medicine doctor is only trained in18 years and older, they are not trained in pediatrics at all. A pediatrician is only trained in children under 21-years-old. You can think of a 20 or 21-year-old and they are in the military and are essentially an adult, but a pediatrician goes up to that so there is this gray area where they overlap. But a family medicine doctor gets the whole picture, and the reason that’s so critically important is I am effectively able to address things that cross over. I understand childhood illness and childhood trauma and how that can affect you as an adult. I understand being an adult and being a parent and how that works in the other direction to take care of your children.
An internist is really much more focused on the disease process. When I can’t figure something out from a conventional standpoint I will typically refer to an internist or potentially a geriatrician depending on the age, but somebody really skilled in the pathology, meaning from a conventional standpoint what is the disease process that’s happening, what conventional testing needs to happen versus a family doctor being somebody that is already inherently more holistic and looking at your whole lifestyle, what is happening at home, your body, mind, and spirit.
So, if a woman has access to a great family physician then she does not need a dermatologist or a gynecologist necessarily, because your family physician will do your pap smears on your regular routine screening, unless something is abnormal. If you get to the abnormal then you probably need a specialist depending on how skilled your family doctor is. Some of them still do things like colposcopy, and endometrial biopsy. I do not in my practice because it’s a lot of equipment and I don’t do it often enough. I want you to go to someone that does it all the time. Just like your surgeon, you don’t want to go to someone who is doing the surgery once a year, you want someone who does it ten times a month. If you have access to a great family doctor you really need access to that person and a dentist, and maybe an eye doctor, but if you just go every few years and make sure you don’t have retinal disease or glaucoma or high eye pressure, you’re probably fine.
A good family doctor and a dentist are critical. Family doc you want a relationship with all the time. Somebody you are seeing at a minimum once a year, just to touch base but you need that relationship. Please, please, please do not wait until you have something wrong to make a relationship. One, it’s going to take you forever to get that appointment and you’re going to be really upset about it because you’re a new patient, and two, they don’t know you from Adam. You need someone who already understands you, your thought process, what’s going on with your life, what has happened in your life, to then put all that together when something happens. Have that relationship now! Don’t wait! Then a dentist every six months.
If you do not have access to a good family doctor and you have an internist, that person is fantastic, but may not do skin checks, may not do pap smears. In that case I would say a dermatologist once every few years unless there is melanoma in your family in which case you need to go every year. A gynecologist once a year, unless something is wrong. Those are the basics. People don’t otherwise need another specialist, unless that core team needs the advanced expert opinion.
You mentioned gynecology. You do or you do not do gynecology in your office?
I do. So as part of family practice my responsibility is all of the basic screenings that help make sure people are well cared for. That would include the gynecology screening, so I do pap smears, pelvic exams, take care of UTI’s, I can diagnose prolapse, help identify sexually transmitted diseases, why somebody has pain, or vulvodynia, or coccydynia, or any of the other “dynia’s.” Where I stop and say you need a specialist is if your pap smear is abnormal and you need the next step, if you need a surgeon, if you’re going to have a baby – I will function as a co-pilot for prenatal care but I am not a prenatal provider because what that means, and this gets very tricky so I’m glad you brought it up, prenatal care means different things to different people. But, from a conventional standpoint it is who is monitoring your pregnancy to make sure it is happening on the timeline that it is supposed to, that baby is growing the way it is supposed to, that you don’t have pathology and disease processes happening in that early pregnancy time period. That is critically important because you don’t always know. You can’t always just tell, “well, I feel fine and I feel the baby moving, so everything is fine.” Not necessarily. That is a critical time where you need somebody to be doing the blood sugar testing, protein, urine, and blood pressure testing.
Separately from pathology driven conventional gynecology care, whether that’s with a gynecologist or a midwife, I think everybody knows I had a home birth with a midwife. Phenomenal experience.
I did too!
Yay! I loved it! We had an obstetrician. So OB-GYN, the OB is the birth baby part and gynecology is the vagina and surgery part. I had a back-up OB in case we needed it. But, on the other end is the primary care piece. What I do for women while they also have their prenatal and obstetric provider, I help make sure the woman is healthy, well cared for, and is prepared for this transition in life and what that’s going to look and be like. That her nutrients are up to date, not just vitamin D but everything. What does your calcium look like? What does your protein look like? What is your vitamin K and your iron and your amino acids? We can go down that rabbit hole depending on how detailed somebody wants to get. I have the time to go through dietary choices and rest, and what can I do and what can’t I do during pregnancy. In general, you’re not going to have quite as much information from your OB-Gyn provider on that front. Both are helpful.
Great! And I’m assuming also that if you’re seeing women for their pelvic care that you’re also talking to women and have a lot of inside information on sex. Is that true?
Lots! Absolutely true!
Well that takes me to my next question. Are women really different than men when it comes to sex or wanting sex?
Different, yes. Wanting, not necessarily.First, there are two topics that are probably my favorite to talk about, I think probably because people are uncomfortable and I love making people comfortable. So, I want you to be able to talk about your poop and I want you to be able to talk about sex. Maybe not at the same time unless that’s your thing, I don’t know! We can talk about safety regarding that.
In terms of wanting, their is this concept that men tend to always want sex all the time and women have to be coerced. That is the rhetoric in society and that is an absolute disservice to both men and women. Many men do not want sex all the time and they feel abnormal that they also need foreplay or want a relationship or want it to be romantic. That just has to go!
All men and women are individuals. Some really like it all the time and if you are that person who genuinely enjoys having sex three times a day, every single day, and you have a partner who genuinely enjoys that with you, that’s great. That’s not abnormal.
If you have sex three times a month with your partner and that works for both of you, also totally normal. Normalizing volume is really important. Different countries and cultures around the world have different amounts of sex. Americans in general report more, I am not sure if that’s because they’re having more or if it’s because there is this idea that we’re supposed to have more and we talk about it. I don’t know yet. In general, a few times a month is most common.
If somebody says that they are in a committed relationship and they have sex once a year, we’re going to talk about it. That’s unlikely to be healthy and normal for both parties. It’s possible. That it’s this big deal, it’s spring equinox, and you make a big deal out of it. I don’t know. Maybe!
How many times on that one time a year?
That’s right! So, it depends on the person. But it is a couple’s relationship. Now that we’ve said that, many women do want to have sex and they want to enjoy it. They want to feel wanted. The major difference is that for a man there are two things required to be aroused, visual interest and blood flow. If they have something that they think is sexy to look at, and that part is absolutely variable, but the man has something he thinks is sexy to look at and he has good blood flow and erections can be achieved and can probably achieve orgasm. It depends, but those two things are the most consistent. Which is why erectile dysfunction is so devastating to a man because it is really the big key. There isn’t the whole body experience with sex that women typically experience. Our erogenous zones are all over our bodies and we can talk about that. For the most part, men have a couple, but it’s largely his junk. If it doesn’t work right he’s going to feel uncomfortable about it.
Women on the other hand it’s vastly different. Women are turned on starting a week ago. Foreplay is a long process. It isn’t right now in these five minutes while I’m thinking about the dishwasher. That is not sexy. I’m just trying to think about what we are going to do for the day or did the kids have snacks. It happens in the mind.
Something I find fascinating is the supplements for men are almost exclusively triggered to blood flow, nitric oxide and energy boosting things. For women they’re almost always adaptogens and herbs to release stress. So that alone will tell you most of what you need to know.
The big key is somehow, this kind of gets back to that medicine is respected in our culture but medicine until very recently has been men. A woman’s body has been a mystery to men for a very very long time. So instead of understanding each aspect, you know men’s parts are outside of their body and very obvious. Everything a woman has is tucked up inside her body, except her breasts, and that feels like this magic mystery box that nobody understands. There’s jokes about it and whole movies made about what a mystery this is. It’s really not. We understand what a liver is and I can’t see that, I know it’s inside my body. So really that comes down to somebody needing to care enough to find out and that is just finally starting to happen.
There are some phenomenal women doctors out of France who actually researched the clitoris and built these models of it to explain to women it is not this tiny button. That’s the tip of essentially what makes a wishbone. The clitoris is the entire erectile tissue, is actually a column, when I was in med school it was described as a tiny penis and I’m like no thank you. I don’t have one of those. I have my own organs that deserve their own explanation. But that tells you that women’s sexuality has been understood in the context of male sexuality. My clitoris is a tiny penis. Our libido pill is the pink viagra. Everything is the female version of a male thing. False. They are different systems and we have to understand them to be different systems. So the clitoris is actually a column of erectile tissue that splits and actually goes down both sides of the entire labia. Every woman is different. Some need direct contact and some need the girth because that’s where the rest of your entire clitoris is, down across the opening.
It’s also why post-labor without pelvic floor therapy, a lot of women have trouble ever achieving orgasm again, because that tissue has been stretched. Quick sidebar: this concept that it stretches and never goes back to normal is also completely ludicrously false. The body is tremendously skilled at healing and this is a normal process, not a pathology. Everything can regain healthy compliance and function, but it’s similar to nerve damage. It takes time and dedicated rehab. I’m a huge fan of postpartum rehab, it should be a requirement. It should be a part of what every woman does post every single baby, you don’t wait until you’re done. You’ve had a baby, you have rehab. If you have five knee surgeries, you have five sets or rehab, so it’s very similar.
I think those are some of the biggest myths that prevent couples and women from achieving healthy satisfying robust sexual relationships that they want and desire. It takes understanding who we are and that we are different and having the conversation.
Speaking of problems down there, how do you suggest women prevent things like UTI’s and yeast infections?
Yes, things like UTI’s, yeast infections, bacterial vaginosis (BV), maybe with dryness are definitely the four things that are the cornerstone of things that don’t feel good. Part of it is if something doesn’t feel good please go see your doctor. There is a lot of over the counter medicine, but it gets back to that very first thing we talked about which is that’s leaving it up to you to decide what’s wrong with your vagina. You might not know and it’s not always obvious.
Women think okay if there is white, cheesy discharge it’s a yeast infection and I should be itchy, but maybe it’s not. Maybe it’s burning. Maybe the only thing you experience is peeing your pants. If you had urinary leakage would you expect that it might be a yeast infection? Maybe not. You would say oh it’s because I’ve had babies and it’s totally normal that I pee my pants sometimes. False! False! False!
If something is wrong, ideally you have a relationship with a doctor that you can call and go see fairly quickly, it’s not three weeks from now and they’ll check and talk to you about your symptoms and figure out what we can do about it. So, that would be number one. But, sometimes you really do know. You’re like okay this is my body, this is how I experience these things. I know this is a yeast infection.
Getting back to the prevention piece, some of this is the health and lifestyle. When we are generally healthy, exercising, deep breathing, good tissue oxygenation, and we are living an anti-inflammatory lifestyle then we are more likely to have healthy robust levels of estrogen that keep our vaginal tissue from being overly dry which leads to urinary tract infections and leads to bacterial imbalance. A general anti-inflammatory lifestyle is very important!
Two, absolutely no soap in the vagina. I actually have my conversations with my female children patients with their moms in the room on purpose because the number of times I am explaining something and I can tell mom is like, “Really?” It helps in a low-risk environment for the mom. She doesn’t have to ask the question or feel like she was supposed to know that. It takes all of that off the table and I can just have the conversation. Many of us were taught by our moms who were taught by their moms that you’re supposed to use soap on the inside. Please don’t.
Your vagina is absolutely self-cleaning. It is very much like the inside of our mouths. We do not wash our mouths with soap, because nobody taught us to do that because we don’t need to. People would say that’s because soap is gross. Nope. If someone decided that we were supposed to be washing our mouths out with soap, someone would have made tasty flavored mouth soap and you would wash your mouths every night when you take a shower. But we don’t, on purpose. Because it has its own flora and that’s very much true of the vagina as well.
So the key things that help promote a healthy vaginal environment are enough acid, it’s supposed to be an acidic environment. When the pH gets really basic, that’s when bacterial vaginosis happens. It’s not an infection, it’s an imbalance.
The same thing with yeast. Everyone has yeast. The yeast is already there, it can just overgrow. It’s opportunist. If the flora is off, if you have a robust lack of bacillus then you can overgrow yeast as well. One of the greatest treatments if you’re beginning to feel uncomfortable is to take a warm bath with a cup of vinegar in the bath, apple cider vinegar or white vinegar. It helps to take that vaginal pH back down to that acid environment it’s supposed to be. Over the counters are widely available and effective. It brings the environment back down the acid where it belongs while bacterial flora does what it’s supposed to. That keeps the yeast in check and keeps the tissue of the urethral opening healthy so that we don’t end up with UTI’s.
Sometimes UTIs happen. Women have a really short urethra and men have a really long one. It has to go the entire length of the penis before it gets to the bladder. Our pee hole is right under the clitoris, anytime there is vaginal irritation, that could be sex, a lot of women get UTI’s after sex. Peeing after sex, not a lot of benefit in terms of evidence, some women swear by it. If it works for you, please do it. If it doesn’t, don’t feel bad. It’s not your fault. Being really careful about what’s there. Knowing if you’re sensitive to certain condoms, lubricants, or detergents – whatever you wear for tight underwear, if you’re using a fragranced detergent that alone might be enough to cause tissue irritation. That aspect of the body is open to the world, kind of like the inside of the mouth, it’s a mucosal barrier. The inside of our eyes. Yes, it’s inside our body, but it’s kind of outside as well. It’s really delicate tissue that is sensitive to its environment.
I think those are the really big ones: no soap, acid environment, keeping it healthy. Eating probiotics with lactobacillus, eating yogurt are proven to help vaginal flora. I don’t know if you’ve seen the Lume commercial, but there’s a part where she looks to the side and says, “It’s open borders down there.” It is!
The anus, the opening to the rectum is right next to the vagina. That tiny little island barrier of tissue is not protecting anybody. Everything really does go back and forth. The body’s designed for that. That’s why we don’t use soap. That’s why we have a robust bacterial balance in our vagina’s as well that helps keep it the way it’s supposed to be, to fight the fecal flora or the bacteria coming out of the colon. That’s why most urinary tract infections are E coli. That’s where the E coli is coming from. Urinary Tract Infections are frequent when people have diarrhea. When children have diarrhea. Constipation is another really big impact on the bladder and vagina. If we’re constipated all the time that throws the bladder out of whack too for a great many number of reasons. In general, if you can keep a good healthy bowel function, acid function, you understand how the vagina works in the first place then it’s much easier to keep the vagina healthy and provide it the environment that it needs. But, if you’re not sure please see a doctor.
Can you use soap to wash your anus?
So basically the pubic hair and the anus, yes. You can use soap to wash the anus. Mostly just to keep the area clean, again nothing on the inside. That’s your body, it’s supposed to have bacteria. Fun fact, stool is like 80% dead bacteria from the body. That’s its job. Bacteria is helping you digest your food and get your B vitamins and stuff like that. But, outside is very important to keep clean so that skin does not have contact with the bacteria all the time, so you don’t get infections or irritations. So anywhere there is hair or pubic hair, which includes around your bottom that can be washed with soap. The outside of the labia is fine. The inside of that lip, leave it alone. Rinse with water, but that’s it.
You mentioned a vinegar bath. Is that something a woman should do periodically or is that just in response to feeling like something might be off?
I would suggest in response. I have read a lot about baking soda being used for detox baths. I’m really not a fan. Baking soda is an antacid. If you’re soaking in an antacid you’re going to be changing your vaginal flora and making it too basic, so I’m not a fan of that. You can put your feet in it but not your whole body. I would say if someone was predisposed to yeast infections or UTIs then that would be something to think about. Maybe once a week you could do a cup of vinegar in a whole bath and it’s really not going to hurt anything by doing that. But, if you’re having something that frequent I would again hope that you have a good relationship with your doctor and understand with your provider what your overall plan is.
Does epsom salt…
They don’t affect anything. I love epsom salt baths! But not the fragranced ones. Bath bombs, they’re very beautiful, but please keep them very limited, if at all. That’s a very frequent cause of UTI’s. Hot tubs, bath bombs, soap. Hot tubs can do it too. I think it’s the chlorine.
So we talked about the difference in males and females in their sexual desires. There’s also a difference between how males and females carry their weight. I know that it’s because we have different hormones and whatnot, but can you go into a little bit of detail about the difference in our metabolisms, methods for maintaining our metabolism as we get older, and perhaps how to talk about physical body changes, because women will have physical body changes all throughout their lives, blame it on their metabolism. They’re mad at men because they don’t have the problems we have. So can you just touch on this a little bit, the difference between men and women.
Absolutely. I will say again, kind of being on Team My Body, it is really important for women to recognize we spend our entire lives in a state of flux, always. There is no getting off the crazy train once it gets started with the hormones. Everything is a cycle. If we lean into that it really is a beautiful thing. It’s what gives women strength in adversity and challenging times of uncertainty because we’re already used to uncertainty and we’re already used to things being different day after day.
That doesn’t change post-menopausal. I think a lot of women are disappointed, thinking that the cycles have finally stopped shouldn’t I get to be steady now. Not necessarily. It’s also like an invasion of the body snatchers and they feel like it’s a completely different body and they have to relearn it. That’s true. If we lean into that and say this body is different than I had before, just like postpartum. This body is different from the body I had before. It isn’t bad. It isn’t damaged.
I caught myself talking with a friend and I said something about my unadulterated body, thinking about my body as a youth, this body that hadn’t experienced anything. I thought what a terrible way to view this process of living life and having experiences in this body. It doesn’t soil, or taint, or damage. It’s a life experience. We have to lean into physical change as women, because that is ultimately how we succeed. Women who love their bodies work to heal and support it and do what it needs to feel good. Women who hate their bodies, who dislike how they look, who say I feel bad all the time and it’s my body’s fault — you can’t heal a body that you hate. You just can’t. I find that all the time. The key here is leaning into the challenges that women have, the changes that we are used to, then we say we can do this. It’s just different and I have to relearn it.
Men on the other hand are not used to change. They have it — not, easier — well, sometimes. You’ll get a husband and wife and all he has to do is drink one less beer a day and he’ll lose 50 pounds and the woman is like I’m only eating lettuce I can’t even look at his food and I gain weight. It’s so unfair. That is almost exclusively testosterone. Men have massively more muscle mass than women, so they are burning more at baseline than a woman is going to be burning. I’m going to circle back to that, but men are used to that their whole lives. If something happens, they get injured so they’re not moving or they hit manopause or andropause, which is very real – the decline in male testosterone is a very real thing and they don’t know what to do with that. They are not used to change. They are used to their entire lives saying this has worked always, and now it’s different and everything is terrible.
Women have a strength in that they are used to change and we just have to lean into that. That makes a big difference. In terms of what to do about it, I would say while perimenopause – no matter where we are on the lifespan, exercise is everything. Exercise! Exercise! Exercise! You can’t just not eat your way to a healthy body. It doesn’t work. We have to stop with the diet culture. It’s not effective at all. We have many studies that show that we start here, we diet, we yo-yo back up, diet, yo-yo back up, and ultimately it is this upward trend over a lifetime and we feel increasingly bad about it, increasingly guilty. None of that is effective.
Ultimately, it’s embracing the body that you have. You want to nourish your body. Eat to heal. Eat to function. Exercise to function. Move with joy. I have found those things to be really effective. People who move with joy and eat this because — not to eat my feelings, because this is comforting — but, I am eating to feed this body because it is going to do really cool things for me today. Really effective.
The change from whatever has worked for you over the course of your lifetime to menopause, the big thing that happens is a drop in testosterone and a drop in estrogen. That changes a number of things. It changes motivation. It shifts your hormone function toward cortisol which shifts towards that midsection gain that women get. That’s usually cortisol and deficient estrogen. Because your testosterone is down your muscle mass has gone down. It’s a vicious cycle, now you’re not doing that 24-hour burn where your muscles are using the energy that you put into your body. You have even less of that so the basal metabolic rate goes lower and lower and women try to chase it by eating less and less. Energy goes down, they lose muscle mass, you see this downward trend. It doesn’t feel good. It’s exhausting and grossly ineffective.
Eating enough and exercising enough are really critical. For women the two key pieces are fiber and movement. Fiber is everything. The more body fat we have the more we take whatever testosterone we do have and convert it into more estrogen. The estrogen is just hanging out and it really needs to leave the body to create this flow that is healthy. That requires fiber. Fiber binds up extra estrogen and you get it out through bowel movements. If you’re constipated, hungry, not moving, and you don’t like your body, you’re in a bad place. The way to get to a good place is pooping, loving your body, nourishing it, and moving in joy. That will make all the difference.
I love that all of that started with pooping. It’s so important!
I wasn’t kidding! It tells me so much.
I wish I could shrink you down to pocket size and put you right here and I could turn to you anytime and ask Dr. S, “what do I need to do right now?”
I would love that! That would be the coolest. I love the relationships I have with my patients. I love what I do.
I can tell. You can just feel it through the energy on the screen how much you enjoy educating people, healing people, nurturing people. We are so grateful you are on our team and on our panel.
Yes, I love teaching. Doctor comes from Latin doserri which means to teach. That’s where it came from. It isn’t about the medicine I can prescribe you. The vast majority of the help I can provide is in that I spent all of these years gathering knowledge and I can help point you in the right direction. You don’t have to spend all the time researching what it is that ails you.
I remembered what I wanted to say way back now, but it’s actually a perfect closure here. I was thinking through this process of a medical education. When you’re a layperson you look at people as humans. You know I look and I see Cindi and Crissy. You go to medical school and people become an anatomy lesson, everybody becomes this bag of body parts. That’s what medical school is about. You get farther along in that education and a body becomes this really cool machine, a very complicated machine. You understand the joint mechanics, enzyme reactions, neurochemical imbalances, that love is serotonin. Talking about all this human experience as if it can be written down on a piece of paper as a series of biomechanics. Many doctors stop there. Functional medicine takes it to the next level. I can figure out anything and call it an enzyme reaction, supplement need, or hormonal imbalance. I think all of that falls short and I realized there is this next level entirely and this is the realm I practice in. You go from a body, to a machine, to a walking miracle. I’m actually really emotional. Human beings are capable of tremendous love and beauty. We all deserve that, for ourselves and for each other. It is really important to remember we are not a collection of enzyme reactions. We are walking breathing miracles.
You are such an incredible human. Thank you for blessing us for the past 90 minutes with your knowledge and your beautiful heart. We are so blessed to have you on our panel.
It is an honor and privilege to be a part of HER Health Collective. To get the information out there and get women talking, to ask the questions and ask for what we need.
Dr. Elizabeth Sierakowski is a physician and owner in the North Raleigh office of Essential Health and Wellness. She is trained in the trifecta of Family Medicine, Integrative medicine, and Functional medicine. Dr. Sierakowski has completed a combined Family Practice and Integrative Medicine Residency at the University of Arizona Alvernon followed by a Fellowship in Integrative Medicine through AZCiM, and is currently pursuing Fellowship in Anti-Aging, Regenerative, and Functional Medicine through A4M. She is board certified in both Family Medicine and Integrative Medicine. She carries certificates in functional endocrinology, mitochondrial health, bioidentical hormone replacement therapy, and an array of integrative modalities and specializes in the treatment and prevention of professional burnout and gut dysbiosis.
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