Episode 31: Ayla Neal, CNS on Addressing Estrogen Dominance and Supporting Fertility with Nutrition

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SPEAKERS: Dr. Andrew Wong, Ayla Neal

“I think connection’s more important than nutrition because you can just eat the most healthy way and you know, loneliness is connected to early you know death, disease, things like that not to get dark but it, I honestly think that eating healthy is important but having those connections are even more important. So if you have to have you know if you go out and your family’s having ice cream or pizza or whatever have that ice cream have that pizza have that birthday cake because that have that wine if it’s there like that’s the most important part of life is connecting with other people and then you know get back on the healthy train when you get home” -Ayla

How does gut health affect hormone health and how do foods affect both fertility as well as hormone balance? These are questions that we talked about today with our integrative and functional nutritionist Ayla Neal. I am Dr. Andrew Wong co-founder of Capital Integrative Health. This is a podcast that is dedicated to transforming the consciousness around what it means to be healthy and understanding the root causes of disease and wellness.

Ayla is a certified nutrition specialist who focuses on female and male fertility as well as prenatal and postnatal lactation and nutrition. Please join us for this conversation about how nutrition impacts estrogen, progesterone, and much more, how the gut microbiome is involved with estrogen balance, and what you can do to balance your hormones using the power of food.

Dr. Wong

All right Ayla, welcome to the podcast, and great for you to be here today.

Ayla

Thanks for having me. I’m excited to be here.

Dr. Wong

Ayla you grew up here at CIH is what we were just talking about you started as an intern then a nutrition assistant now a full-time nutritionist here so such an awesome journey.

Ayla

Yeah. I’m super grateful to have that opportunity and this is a great place to learn, and to grow, and to really cultivate a good practice.

Dr. Wong

And we have a lot of exciting news such as you recently got married and then, now have a baby.

Ayla

Yeah, so I got. Actually, my one-year anniversary is on Thursday.

Dr. Wong

Congrats! I am so excited.

Ayla

On the third, so I’m excited about that, and yeah then my daughter will be one. A month after that so we got married while I was pregnant but yeah.

Dr. Wong

Time flies, yeah.

Ayla

Yeah. So we’re excited. Lots of good things happening.

Dr. Wong

And then we should talk about your name change just for all the listeners who may be your patients or future patients. So you change your name recently which I was just learning about yeah so.

Ayla

It went from Neall which is my maiden name, what I grew up with and now I will be Ayla Heppding. So if anybody sees a change on the portal like with their appointments, things like that don’t be alarmed there’s not another Ayla here.

Dr. Wong

Yes. So, Ayla, having a very unique name I wonder if there’s any other Ayla happenings in the world but

Ayla

Probably not, but it could be.

Dr. Wong

Yeah. Yes, that’s awesome. Well, let’s talk about what motivated you to become a nutritionist? What kind of got you started?

Ayla

Yeah. So I have an older daughter she’s seven now when she was around two or three I was like really interested in learning how to feed her right and I just kept like, researching all these things and even before that, I was super interested in nutrition. I was a vegetarian for a long time tried to find the right path for myself with my nutrition but then I just kept coming at stalemates and I was like researching on the internet and things like that seeing all these Fad Diets really like extreme stuff. So I was like, I had my bachelor’s degree and I was nannying at the time I didn’t have really a good like set career, I didn’t want to be a nanny for the rest of my life I mean I loved the job but I didn’t want to do that my whole life and I knew I always wanted to help people in some capacity so I was researching grad schools, I was looking for different nutrition programs or psychology programs and I fell upon Maryland University of Integrative Health and it just like called to me. It was everything I wanted in a program I definitely knew. I didn’t want to do the food pyramid or you know I was looking at nutrition professional as like macronutrient counting only or like you know weight loss only things like that I knew I wanted to use my degree for more than that so then I found the integrative stuff and I fell in love with it. And then I was introduced to functional stuff during school and I just you know, I knew that’s where I wanted and I needed to be. And so long story short selfishly I went to school for nutrition to make sure that I could take care of my family the best way I could.

Dr. Wong

Well, as Mark Hyman says, “it starts with food”. I feel like everyone here at Capital Integrative Health is a foodie.

Ayla

Yeah, for sure.

Dr. Wong

And one way or another and like you said taking care of yourself and your family and your kids, it really does start with food and I love how you mentioned how you thought about going to school and nutrition but chose integrative nutrition because in functional nutrition because it is so much more than just like calorie counting and Fad Diets and weight loss and things like that.

Ayla

Right, definitely yes.

Dr. Wong

We wanted to kind of focus today a bit on general female hormone health. I know you’re very into women’s health and female hormones and how nutrition relates to female hormones. So what are some possible nutrition-related root causes for female hormone imbalances? Maybe you could just kind of take the listeners through some of the imbalances that you see in your practice in terms of female hormones.

Ayla

Right. So some imbalances that we see often are estrogen dominance or maybe androgen dominance like high testosterone or high DHEA something like that. Sometimes it’s just low progesterone itself or a combination of all of these things and where we would start typically you know, we all work together in this practice with medical and everything but nutritionally where we would start is any like low-hanging fruit that might be there. So what is their regular macronutrient balance look like, what do their calories look like, and calories, meaning you know whether they’re vastly overeating or vastly undereating it’s very important to eat enough when it comes to balancing hormones and then are they getting enough protein at each meal? are they getting enough healthy fats? and then we really start there with balancing the plate and then we’ll bring in other things with that like adding in foods that are good for detoxing estrogen, like cruciferous vegetables colorful really phytonutrient dense vegetables and then you know when I say nutrient dense it just kind of means more bang for your buck when it comes to food and you know calories like I guess organ meats and things like that can be really good bang for your buck. But we talk about that kind of stuff if needed but the low-hanging fruits I mean like just balancing the macronutrient out to whatever their specific needs are and that can depend on activity level, age what their job is like really. Anything and then is there any like alcohol or things like that, that needs to be reduced and kind of just like, those outside obvious things including hydration as well.

Dr. Wong

It sounds like, poor diet then or imbalance, an imbalance in the nutrient ratios could be a root cause the root driver of hormone imbalances is that what you’re implying here.

Ayla

Yes! I think what I’m trying to get at is balancing blood sugar. So when the blood sugar is imbalanced it can lead to different kinds of hormone imbalances as well. So insulin can drive the production of androgens from the ovaries and things like that and then you know maybe high fructose intake or something like that can slow down and make the liver a little bit sluggish, those kinds of things, high alcohol intake but you can be doing everything “right” and still have these problems and then that’s where we would talk about specialized you know foods or diet plans or you know herbs, supplements, lifestyle other things like that.

Dr. Wong

I wonder about low-hanging fruit. That’s a funny analogy for nutrition and with fructose, I wonder if we should call like low-hanging vegetables or something.

Ayla

Or low-hanging fructose.

Dr. Wong

Low-hanging fructose. Yes, yes all right we’re gonna coin that one. And what do you think about calorie counting, the whole idea of calories in calories out? This has been popularized since the 1970s, low-fat diets you know low carb diets things like that. What is your thought about that in terms of is that beneficial or not?

Ayla

I think it’s a tool, I don’t think that it’s a lifestyle. I don’t think it’s okay well, I don’t think everybody needs to do it but I think that if it’s not triggering to anything like a past eating disorder or some kind of anxiety around food then it’s a great tool to use in the short term to one see where you are at the moment. So don’t change anything, don’t you know judge yourself when you’re doing it but just be honest and write it down and see where you’re at and then what might need to be adjusted. It could be one easy adjustment adding a little bit more protein to meals or you know watching the amount of rice you have at lunch or something like that and then some people actually find that they undereat so, especially a lot of women and a lot of high-powered women who work in very busy jobs and things like that will go all day and not eat you know or they’ll have like a protein bar or a smoothie in the morning and not eat till dinner and then total calories is like under a thousand.

Dr. Wong

And it’s a badge of honor, I think for some people right, it’s kind of like how long can I go or I’m just too busy at work and things like that. I feel like cave people never calorie counted.

Ayla

Oh no no, yeah. So in the long term, the goal is to not calorie count definitely and just be able to listen to your body and say okay I know I need my plate to look like this or my bowl to look like this and I need to eat x amount times a day to feel my best and to function at my best.

Dr. Wong

I think we’ll do a little sneak preview here, we might talk about that with Holly about intuitive eating you know this idea that nutrition is not only about food but about really feeling how your body reacts to different foods or either eating or not eating and just being more in touch with our bodies you know.

Ayla

Yeah, yeah. So we use all kinds of tools and I’m sure Holly will talk about it so we don’t always calorie count. We’ll use like food journals or you know some people are just into using their minds and senses and things like that or a combination of all those things.

Dr. Wong

Great! Let’s talk about important nutrients for hormone health. What are some of those stars, superstar nutrients that we can kind of support for, especially for women’s hormone health?

Ayla

Well, for hormone health, one of the main ones once you have your blood sugar balanced and you kind of have that you know down eating that way. I really like healthy fats we need and healthy fats meaning leaning more towards whole foods things that you would find in nature more often rather than like industrial seed oils or anything in those where it’s a little bit harder to get the fat out of the product.

Dr. Wong

What kind of oils are industrial seed just for listeners?

Ayla

Things like you’ll see them as like, canola oil, corn oil, grape seed oil, rapeseed oil, cottonseed oil.

Dr. Wong

Darn it, those are all the ones found in those chips right those amazing crunchy textured but yet very processed foods that we often eat or that hijacked our taste buds you know.

Ayla

Yeah! So I mean when you think about eating for hormone health it’s not there are definitely certain foods that are more helpful than others but it’s really about eating whole foods more towards the planet the earth how it came, of course, you can process it, you can process something into hummus you can process chickpeas in the hummus like that but if it requires a lot of like preservatives, artificial colors, flavors things like that those are the things that are going to be a little less helpful in balancing hormones so healthy fats like avocados, nuts and seeds, walnuts that kind of stuff. Some people will do well on high-fat dairy products it depends the person you know food sensitivities can come into play there but really healthy fats are really good for your hormone function to function properly and your absorption of certain nutrients that are required for hormone function.

Dr. Wong

Let’s open up the meat freezer now. So meat is high in protein but also fat. Where are you on meat or what do you think about meat in terms of hormone health and how that support it?

Ayla

Yeah. So definitely I am a proponent of eating meat if that’s something that you include in your diet because it just like I said earlier the bang for the buck situation. So you just get so many nutrients, so many high-quality fats, so many so much high-quality nutrients, protein, iron, minerals out of that meat, and if you’re digesting it well and absorbing it then that’s going to provide the hormones with the backbone structure that it needs and you know the pathways and the vitamins and minerals required to convert and detox and all of that.

Dr. Wong

So there’s maybe greater bioavailability with meat and certain aspects, protein, and things.

Ayla

Yeah, for sure. So it’s gonna have all the amino acids that you need to function and it’s not just hormones, it’s neurotransmitters and you know, immune system, skin all of that kind of stuff but it’ll definitely be more bioavailable and better absorbed in somebody who’s absorbing well we can, of course, get into gut health but

Dr. Wong

Right and just to be clear we work with all types of people, different diets.

Ayla

Oh yeah, for sure.

Dr. Wong

Vegans, vegetarians, omnivorous people as well. I mean there’s ways to get protein fats with any type of diet.

Ayla

Yes. So if you are a vegetarian, vegan, no judgment at all. Everybody eats their way for a reason we would just work with you to make it as healthy as possible for fertility, pregnancy, all that.

Dr. Wong

So in terms of healthy fats. I wonder if there’s a good mantra if people are doing like a meditation, like something like healthy fat is good and just keep on chanting that because it’s such embedded I think in our society that fats are bad you know. We think about cholesterol and triglyceride and trying to reduce these numbers but yet cholesterol is apparent hormone for many of our female hormones, correct?

Ayla

Yeah. So cholesterol is super important for the different female hormones even testosterone as well women need testosterone too. I’m just you know at the moderate level, not too high not too low for healthy fertility, healthy vitality, even if you’re not looking to get pregnant these things are very important just to you know live vitality like motivation to go out in the world and things but also bone health skin health, brain health, brain fog all of that, yes.

Dr. Wong

We talk about fats, proteins. What foods may be connected to hormone imbalances some foods that people might be more sensitive to?

Ayla

So sometimes things, food sensitivities can be connected to hormone imbalances whether directly or indirectly. So something like gluten for example can if you have the right situation going on leaky gut it getting into the bloodstream and then the whole theory of molecular mimicry with the thyroid in that situation, definitely food sensitivities can cause a hormone imbalance because your thyroid helps to regulate everything else in your body as well.

Dr. Wong

So you’re saying if there’s a sensitivity to certain foods the immune system may be attacking the thyroid because the thyroid looks like some of the thyroid proteins look like some of the gluten proteins and things like that?

Ayla

Yeah, yep. So the whole idea behind molecular mimicry is the molecule of the gluten or whatever food it is can look like the thyroid cell or whatever cell it is and create antibodies against both.

Dr. Wong

And I think we’ve seen a number of times our patients sometimes they’ll kind of identify either self-identify on a test that they have food sensitivities say to gluten or dairy or something and then as they remove those foods we see that those thyroid antibodies go down, go back towards normal which is really great to see.

Ayla

Yeah and then also if you’re sensitive to dairy or something like that you can just have some low-level, low level, or high level or anywhere in the middle inflammation going on that is driving something like you know blood sugar imbalance or just inflammation kind of lead hormone imbalance.

Dr. Wong

Speaking of skin I mean this is another kind of topic for hormones as we just recently had Dr. Julie Greenberg on he’s a naturopathic doctor that specializes in seeing dermatologic patients and of course, she was saying how dairy can really trigger acne for a lot of people so kind of going along with that inflammation.

Ayla

Yeah. Definitely, and then that inflammation can also lead to the high androgens causing the acne as well. Also, I wanted to bring up when in this part of it I guess would be environmental toxins too. so that kind of is not food sensitivity but it’s kind of like a sensitivity. Some people can handle more environmental toxins than others but I think it’s really important when thinking about balancing your hormones, especially in a situation of like estrogen dominance or something, is to try to clean up your environment as much as you can. Meaning if you’ve heard of like BPA, those kinds of things phthalates, what’s the other one that I’m thinking about? Parabens.

Dr. Wong

Any sort of parabens, kind of plasticizers.

Ayla

Yeah and pesticides, excuse me, pesticides as well yeah plasticizers, those kinds of things go in and the same level of like molecular mimicry they look like your hormones and they kind of act like your hormones in your body and block certain pathways and overwhelm the liver and things like that. So those kind of things are some low-hanging fruits as well that we can start to clean up.

Dr. Wong

Yeah or low-hanging toxins that we clean up off that tree. It is huge. I mean that’s a huge topic as toxins, it really disrupts that hormone synthesis and metabolism so that’s a big, big topic, big deal.

Ayla

I just saw a new study out where they’re kind of looking at environmental toxins in relation to diabetes. So you know people who eat fairly healthy and they still end up with type 2 diabetes, environmental toxins playing a role there it’s very very

Dr. Wong

Hijacking the insulin sensitivity essentially, yeah. So it’s all something we need to clean up our planet and go back to regenerative agriculture and everything that’s a big, big deal. Let’s talk about gut, and how the gut health really can impact the hormone system. You know, we know that in functional medicine, functional nutrition, naturopathic medicine, it’s a lot of it and ends up in the gut you know we have all these systems in our body but as Hippocrates said many years ago health and disease both begin in the gut so can you just kind of walk our listeners through gut health, how that impacts female hormone health?

Ayla

Yeah. So in so many ways, the gut impacts everything. But I guess we could start at like estrogen detox or something like that. So estrogen gets detoxed in the liver and in the gut so there’s two phases in the liver there’s one phase and the gut so we normally start in the gut just because you kind of want to work backward when you’re detoxing something out so it doesn’t build up so say you start at phase one and phase three is backed up then it might start to create some toxins inside of you some metabolites that you don’t

Dr. Wong

Kind of a misnomer maybe we should call it phase one as the like right the colon in a way and that’s the first thing to start but it is called phase three.

Ayla

But if you like, google it or something phase one isn’t deliberate.

Dr. Wong

That’s right, that’s right! Yeah then yeah google kind of dominates yeah you can’t do that.

Ayla

So phase three is technically in the colon and your estrogen and different toxins as well get packaged up and pooped out into the toilet for lack of a better word sometimes something like bacteria overgrowth or some kind of dysbiosis, meaning like the, you know, certain bacterias are overgrowing certain bacterias are undergoing you can have it go both ways or one way or another you might have parasites or something like that that will cause the enzyme beta-glucuronidase to go up and prevent you from being able to detox properly those extra hormones especially estrogen and they get reabsorbed into the bloodstream causing an estrogen dominance type situation an estrogen dominance meaning your estrogen’s either too high compared to your progesterone or it’s like at a normal level but your progesterone is too low.

Dr. Wong

What are some conditions that are associated with estrogen dominance? What kind of things would you see if someone would a patient see your patient feel in terms of symptoms if they had like, estrogen dominance?

Ayla

Yeah so estrogen dominance can cause certain symptoms like weight gain, fatigue sometimes acne, brain fog, and then short like in between cycles so in between day one of your period to the next period it can be a little bit shorter your period can be heavier last longer cloudy and then that can lead to things like iron deficiency and stuff like that and then it’s also a lot of times related to associated with you know chicken or the egg situation with hypothyroid a lot of times so you want to definitely look at thyroid and I think we look at thyroid with everything.

Dr. Wong

We do absolutely, yeah. We look at it every single patient pretty much.

Ayla

Oh, and estrogen dominance can and a lot of different hormone imbalances are often related to IBS you know another chicken or the egg situation but oftentimes when we work on the gut and you know at least improve what’s going on in there that people will find an improvement in their symptoms and their hormonal symptoms as well.

Dr. Wong

Yeah, almost like the gut inflammation is driving some of that hormone imbalance, and then definitely I think I’ve also seen people with things like breast cysts, fibrocystic breast you know fibroids things like that, uterine abnormalities. So there’s a lot of different factors that might even lead to hormone imbalances that might lead to structural issues even if it gets too far advanced.

Ayla

Yeah. So that those are some of the sequelae I guess they would call it like after it happening too long and too high and then definitely tender breasts as well even if you don’t have the breast cysts can be.

Dr. Wong

What are some supplements even though that’s a supplement to food you know it’s all about whole foods and the anti-inflammatory type of diet trying to balance the fats and proteins healing the gut you know balancing the gut microbiome. Are there any supplements that you find helpful for you know people that might either have estrogen dominance or some sort of female hormone imbalance?

Ayla

Yeah. So supplemented foods, so cruciferous vegetables are super important for I think everybody and everything you may have gas and bloating with that and we can address that and you know appointments and things like that, that could mean a GI imbalance or a microbiome imbalance but they really help with detoxing excess estrogens and getting the estrogens going down the right pathway in the liver. So the different, well the fibers will help to pull out that excess estrogen through the stool and into the toilet but then also the sulforaphane, the different nutrients, the sulfur, actually composition I believe there’s some cysteine in it as well can go to the liver and help to get stage phase one and phase two detox going in the right direction.

Dr. Wong

Yeah. It makes sense.

Ayla

Cruciferous vegetables are broccoli, cauliflower, you can do some onion garlic, brussels sprouts. I just want to make sure everybody knows arugula.

Dr. Wong

Yeah. Brussels sprouts are great I’ve gotten more into it recently not something I grew up with but kind of an acquired taste but I started to like it you know. What’s your favorite recipe for cruciferous vegetables? What do you what kind of do you eat them raw cooked or?

Ayla

Definitely cooked. They’re a little bit easier to digest cooked you know if they’re raw they have to be dipped in hummus or something but I really love roasted cauliflower it’s probably my favorite and you can flavor it any way you want and you just roast it in the oven and then I have this cabbage I like purple cabbage or red cabbage better than the other colors for some reason probably just because of how it looks and you just saute it up with some like allspice and onion garlic all that.

Dr. Wong

That’s delicious! Sounds delicious yeah, love roasted vegetables as well. Let’s go into pregnancy you were recently pregnant, delivered a beautiful baby girl who’s I think thriving from what we can see on zoom and everything it’s awesome. What nutrition recommendations do you get for preparing for pregnancy for you know women out there who may be about to give birth or wanting to get pregnant?

Ayla

Yeah. Definitely, everything that we talked about so far balancing blood sugar adding in those healthy fats making sure your protein is where it needs to be, and if you need help figuring out where your protein and macronutrients kind of lie it can be a little bit of a you know you start somewhere and then you adjust as needed but talking to a professional is helpful in that arena but specifically I mean, I’m, I lean a little bit paleo if we’re honest I really like the fact that animal products provide more bang for your buck when it comes to nutrients you know grass-fed if you can, pasteurized if you can as close to nature as possible because that’s going to provide a least toxic and more nutrient-dense product if you can only afford something like conventional meat that doesn’t mean you skip out on it you know you is still including it is going to be important in balancing hormones and balancing blood sugar in that way and getting all those nutrients that you need eggs are great so eggs have the choline, iodine different vitamins and minerals in there that are really important for hormone health and then having a healthy baby so you want to make sure that you have those stores up as much as your body can store them to be sure that there’s enough provided for the baby because what happens is when you’re pregnant your body takes what it needs from you and gives it to your baby, but it takes from you so if you don’t have enough you’re gonna be anemic or you might lose bone density things like that.

Dr. Wong

Got it. To get stored up so that you can give but then still have enough for yourself.

Ayla

I like to think about like traditional villages and tribes and things like that when it comes to that like there was always it always seems like I’m not exactly sure I’m not a historian but it seems like there was always that like Grandma of the village or whatever making sure everybody was like fed and well nourished and I think that’s part of like having a healthy community is making sure moms are nourished.

Dr. Wong

Yeah, we should reinstitute that in society it sounds like.

Ayla

Now all the moms are depleted, yeah.

Dr. Wong

So we need that village, village chef to go around and go to everyone’s house to make sure they have enough food.

Ayla

I can’t wait to be the village grandma.

Dr. Wong

It sounds fun so you can cook and watch everyone else savor the food and enjoy and that’s great. Well, thank you so much Ayla for coming on today and providing all of our listeners with an overview of the general female hormones, hormonal health how nutrition is so important and critical in that, and how the gut microbiome is really important to balance with that. We have one closing question we wanted to say and you know we know you’ve been in CIH for a number of years now so grateful for you to be here we know that one of the pieces of health is really cultivating joy and purpose and meaning in life, so one of the questions is you know what do you do every day to cultivate joy?

Ayla

I get off work and then I play with my children or if I’m working from home and it’s lunchtime I get to see my kids which I’m super thankful for but yes definitely just being around my kids being around my husband and then when I can, visiting my family. I’ve always been a person who needs my people and that’s the main way I get joy I think is just making sure I see everybody as often as I can even if it’s just on facetime or something like that and just getting hugs, I like that!

Dr. Wong

Yeah and I think you know connections like you said the hugs attach the time with your family loved ones that bring meaning to life, you know and I think even when we talk about nutrition your nutritionist and a good nutritionist, what is the role of connection with nutrition? how does, is that tie in yeah your opinion?

Ayla

In my opinion, I think connection’s more important than nutrition because you can just eat the most healthy way and you know loneliness is connected to early you know death disease things like that not to get dark but it I honestly think that eating healthy is important but having those connections are even more important so if you have to have you know if you go out and your family is having ice cream or pizza or whatever have that ice cream have that pizza have that birthday cake because that have that wine if it’s there like that’s the most important part of life is connecting with other people and then you know get back on the on the healthy train when you get home. So having a balance there I guess is what I mean.

Dr. Wong

Yeah, if your loved ones are off the healthy train spend some time with them if needed you know off of that and go back on is what you’re saying it’s good advice you know connection’s really important.

Ayla

And then you’ll be a good influence on them too so you know not to talk about like you know nobody likes to talk about diet all the time or whatever but just be like yeah I’m I’ve included I don’t know organ meats to support my fertility for when I’m pregnant and then it just starts a conversation you know and gets people interested in what you’re doing.

Dr. Wong

Thank you so much Ayla for coming on today really a pleasure to have you on.

Ayla

Thank you.

Dr. Wong

And it’s your very first podcast.

Ayla

Yeah, my very first one.

Dr. Wong

And love to have you back for more taking a deep dive into some of the women’s health issues that we kind of see here and that you could share with our listeners. So how can our listeners learn more about you and work with you?

Ayla

Yeah, so you can find me on the CIH website.

Dr. Wong

Which Jen has amazingly put up, yeah.

Ayla

Yes definitely amazing. That’s probably the main spot you would find information about me you know call in and make an appointment with me if you’re interested but yeah that’s really the main spot that’s really I’m not really anywhere else.

Dr. Wong

Oh, good to see you in person Ayla and it’s, we’ll chat later. Great to see you.

Ayla

Yeah, okay thank you so much.

Dr. Wong

Thank you for taking the time to listen to us today if you enjoyed this conversation please take a moment to leave a review it helps our podcast to reach more listeners don’t forget to subscribe so you don’t miss our next episodes and conversations and thank you so much again for being with us.