Heart Sense for Women

Dr. Drew Sinatra: We all know the classic signs of an issue with your heart — pain in your chest, shortness of breath, numbness in the left arm.

Dr. Briana Sinatra: But those are all the warning signs for men. Heart disease in women presents differently. It is the number one killer of women, but it doesn't get as much attention as many of the other health issues we face. Today, we'll make sure you understand what to be aware of, how to protect your heart, and all the questions you should be asking your doctor. Hi, I'm Dr. Briana Sinatra.

Dr. Drew Sinatra: And I'm Dr. Drew Sinatra, and this is Be HEALTHistic.

Narrator: Welcome to Be HEALTHistic, the podcast that is more than just health and wellness information. It's here to help you explore your options across traditional and natural medicine, so that you can make informed decisions for you and your family. Health isn't a one-size-fits-all approach, everyone has their own needs to Be HEALTHistic. This podcast illuminates the whole story about holistic health by providing access to the expertise of Doctors Steve and Drew Sinatra, who together have decades of integrative health experience. They'll share with you the best that traditional and modern medicine has to offer, so that you can be more productive and more proactive in managing your overall health.

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Dr. Drew Sinatra: Hi folks. Before we launch into our discussion today, I wanted to encourage you to be a proactive member of our Be HEALTHistic community.

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Dr. Drew Sinatra: Hi everyone. This is Dr. Drew Sinatra, and today I'm with Dr. Briana Sinatra, and we're going to be discussing heart sense for women. This is actually a topic my dad wrote a book on years ago, and we are going to be discussing how heart disease manifests differently in women, risk factors to look out for and how to be proactive in your heart health as a woman. Many of you may not know this, but heart disease is the number one killer of women. It causes one in four deaths in the U.S., yet women are still more aware and fearful of breast cancer. We need to change the paradigm and put the emphasis where it belongs, on the importance of heart health and what women can do to protect themselves.

Dr. Drew Sinatra: So Briana, when a woman comes to you inquiring about her heart health, maybe there's a positive family history and she might just know her cholesterol levels, but what else are you looking at to assess for cardiovascular risk?

Dr. Briana Sinatra: When a woman is coming in preventatively to check in on her heart health, I think it's an excellent time to evaluate and have a conversation about all the aspects of her life that impact her cardiovascular health. These can include diet, stress, her emotions, if she's passionate in her job, what her home life is like. There's so many factors that contribute to stress and emotions. Her weight, what her exercise routine is like, whether she's smoking, her alcohol consumption, drug use, and to look at all the other biomarkers of heart disease such as blood pressure, her heart rate. You know, there's a lot there.

Dr. Briana Sinatra: So Drew, as a doctor, if you have a 45-year old woman coming into your office with just knowing her cholesterol levels, and she wants to take a deeper dive, what additional testing are you going to discuss with her?

Dr. Drew Sinatra: There's so much out there on cholesterol. There's a lot of misunderstanding around cholesterol because really, cholesterol is not the cause of heart disease. The way my dad taught me when I was younger is that the cholesterol is found at the scene of the crime, meaning it's found in plaque formation, but it's not the perpetrator. It's not the culprit. And unfortunately, we tend to blame cholesterol for a lot of things. And I got to tell you, when patients come in today, or in my clinic, you know in today's world, they bring up cholesterol all the time.

Dr. Drew Sinatra: They say, "Doc, I'm at 210, I'm at 205. What do I do? I'm supposed to be on a statin right now." So first we’ll have a conversation around the importance of cholesterol in the body, how it's needed for brain health, how it's needed for your skin. It's needed for other different functions in the body. And so it's really an essential compound that we really do need. And yes, there is, of course, a risk if cholesterol is sky-high. And if there is a familial risk there, there is a time and place for statin medications, which are cholesterol-lowering medications, but generally speaking, I like to look at more than just cholesterol.

Dr. Drew Sinatra: Now, if I have it my way there is different tests you can run on cholesterol itself. You can do like the NMR tests through Lab Corp, which is the one that I usually run — and that looks at different sub-fractions of the cholesterol particles, like the LDL and the HDL, and it will tell you that the particle count number. And also you can determine really, if these LDLs and HDLs are good versus bad, because technically speaking, we like to say that HDL is good and LDL is bad, but that's not the whole story. I mean there are components of LDL that actually could be good. These are more of the fluffy LDL compared to the more dense LDL, which may be more problematic. And same thing for HDL. You actually don't really want to have a really high level of HDL. So, there is sort of a bell curve with HDL and protective benefits.

Dr. Drew Sinatra: If I have it my way, I always like to do one of these lipid profile tests, like the one from Lab Corp, which is the NMR Lipo Profile test. There's also one from Quest called the Cardio IQ Report, and if we have availability of that, if that's accessible, I would like to have that on board, because then I can really dive deep into cholesterol, to really understand those numbers.

Dr. Drew Sinatra: Now, besides cholesterol, I like to run other markers on my patients. I like to look at a LP(a), which is Lipoprotein (a). I run homocystine, I run fibrinogen, I run LPP LA2, I run MPO, which stands for myeloperoxidase, ESR, CRP. And of course, I'm always running other blood markers on patients, whether that's a CBC, just looking at the red blood cells or white blood cells. I do a chem panel, assessing for liver function, kidney function — and of course, we're looking into blood sugar because that's a huge component of, heart disease, insulin resistance. So I'll do a hemoglobin A1C, I'll do a fasting blood sugar, and also a fasting insulin, if the patient's fasting.

Dr. Drew Sinatra: And I find that doing all these tests — including a thyroid panel if we need it, or maybe some iron studies — we have a much more comprehensive understanding of what's happening in this moment, besides just looking at a cholesterol panel, which really only gives us a certain amount of information. So if possible, I like to order these tests on my patients and then I get a really greater understanding of how it can help them.

Dr. Briana Sinatra: That's such a good point. I love how you're looking at it from such a holistic perspective — that it's not just your cholesterol levels, it is how all of your organs are functioning and how they all work together. I think it's an excellent time for a woman to be evaluating all those aspects of her health.

Dr. Drew Sinatra: You know, what are some red flags that we need to be aware of and regarding symptoms, because today we're talking about women and heart disease. And I think a lot of our listeners…we've seen in movies, where men have a heart attack and they're gripping their chest, and they're falling down to the ground, and they're in pain. You don't really see women having heart attacks in a movie or a TV screen. What's happening there?

Dr. Briana Sinatra: Right, yeah. We see that radiating pain to the jaw or down the arm, and that's what we think of when we're thinking about a heart attack, or predisposing symptoms that want us to take a closer look at the cardiovascular system — and some women can manifest like that, so it's good to be aware of. But I think so often, women's symptoms are more subtle or insidious in their onset. I think women are really good at being aware if there's a change in their body, or new symptoms that they need to be aware of, but they may not realize that some of the new symptoms that they're starting to experience are actually related to their cardiovascular health — and not just the systems associated with the symptoms. So for example, a woman might experience more gastrointestinal symptoms. She might have some indigestion or nausea, heartburn that's kind of new and starting, and think that it is her digestive system. She might go in and you know, get a proton-pump inhibitor. But it's really important with any new symptoms to evaluate cardiovascular health, and make sure that that's not what's behind it.

Dr. Drew Sinatra: So you're saying that like a man, women can still have the same classic cardiovascular heart attack-like symptoms, which is gripping the chest or pain in the chest, discomfort there. They still may have a radiation of pain down their left arm or pain in their jaw. They may experience nausea or sweating, or this impending doom that they're feeling. So those things are very similar to what men experience, but you're saying that, in addition or alternatively, they may only experience some indigestion or some things just like they might feel dizzy or, from what I understand too is a lot of women can feel fatigued more so than usual. Where they might be doing something upstairs, walking up the stairs, and all of a sudden they feel out of breath, and that's another sort of, red flag right there.

Dr. Briana Sinatra: Absolutely. Or making the bed, doing something that they're used to doing, but they're noticing that they're getting winded easier. They're a little more breathless, and they have this new onset fatigue that isn't normal for them. And so even that in itself can be a red flag to go in and get a deeper look at your cardiovascular function, and see if there's any changes that need to be addressed. I think another thing too is anxiety. You know, changes in our heart rate can manifest in different ways, and so if there's a new onset anxiety, yes, there could be a stress and emotional piece, but again, this could also be a sign that maybe there's some changes in your cardiovascular system.

Dr. Drew Sinatra: And for women listening to this, if you feel like something's not right in your body…I mean, women know their bodies very well, they're very intuitive — and if you're listening to this and something isn't right in how you feel, then get checked out. Without a doubt, go in, get screened, get an EKG, whatever it is, something that you can do to assess what's happening to you in that moment.

Dr. Briana Sinatra: Absolutely. I think it's so important to listen to your body, trust your body, and if something doesn't feel right, go in, get it evaluated. And, knowing some of these symptoms that are more red flags for women can help you to be an advocate for your health, and make sure when you go in, your doctor is considering your cardiovascular health as an aspect of this. Even if it's just an important rule-out, and to give you a baseline level of what your heart health looks like now.

Dr. Briana Sinatra: Another thing that I think is important to be aware of is any type of sleep disturbance or insomnia. You know, I think around middle age when hormones are dropping, we can think that that is the culprit. But I think it's also important, if you are having insomnia to consider something like a sleep study, and see if you are having sleep apnea or something that is decreasing your blood oxygen level at night, because that is not good for our cardiovascular system, either.

Dr. Drew Sinatra: And the sleep apnea is actually quite common these days. So it's something that we've said should certainly test for.

Dr. Briana Sinatra: Absolutely.

Dr. Drew Sinatra: Let's talk about the emotional side, the emotional piece involved in cardiovascular health and women.

Dr. Briana Sinatra: Yeah, absolutely. I mean I think around mid-life, through the menopausal transition and all of that, there is a lot of change that's going on. You know, there's maybe a change of focus. The kids are getting older, you might be an empty-nester, you may be cleaning out the family home and downsizing. You know, your role in your job might be changing. Being an empty-nester, now you're reevaluating your relationship with your partner and what it looks like going forward without having kids as the focus. There's so many changes that are going on around that time, and as we're looking at cardiovascular health, I think looking at the emotional landscape of your life is super important.

Dr. Drew Sinatra: And the stress component that's tied in with that, too.

Dr. Briana Sinatra: Absolutely. Yeah, absolutely. And you know, going through menopause, our sex hormones, our estrogen and progesterone, are kind of protective in helping us mitigate the effects of cortisol in our system. So without that estrogen and progesterone there to buffer it, cortisol is a lot more reactive to our bodies. And so I think the tools that we bring to the table, whereas maybe we were just able to be in a chronically stressed state before, our body isn’t able to roll with it quite as easy in those later years. Stress has much more of an acute impact on our health, so I think it's really important to educate our female patients on that, and help provide them with tools for how to mitigate those effects of stress.

Dr. Drew Sinatra: What are some of those tools? What kind of recommendations are you making to your patients?

Dr. Briana Sinatra: I think one of the biggest things is self-care.

Dr. Drew Sinatra: Yes. I'm so happy you mentioned that.

Dr. Briana Sinatra: You know, and not thinking of it as a thing that I get to do. It's like, no, it's a thing that you deserve. It's mandatory. It's necessary. You need to take that time for yourself. Whether it is reading a book, taking a bubble bath, going for a walk with a friend.

Dr. Drew Sinatra: Getting a massage.

Dr. Briana Sinatra: Getting a massage.

Dr. Drew Sinatra: Going to a spa or whatever it is to just calm down and enjoy yourself.

Dr. Briana Sinatra: Absolutely. Whatever that self-care, self-loving thing that you can do for yourself I think is super important. And then there's tools like meditation, and meditation can be a little tricky for people. Some people think, Oh, I can't meditate. I don't know how to meditate. But there's many ways where you can, even if it's for a minute or two, be sitting still and focus on some deep breathing.

Dr. Drew Sinatra: Well, what I'd like to recommend is that app called Breathing Zone.

Dr. Briana Sinatra: Oh yeah.

Dr. Drew Sinatra: And why I like it is because all it does is pace your breath. So you can set it for, let's say, five breaths per minute. And you can just do this while you're driving too, you have it up on your dashboard. And there's a little color-coding to show you when to breathe. And there's also a little, an auditory input, as well. And what I like about that is you don't have to be in Lotus position, meditating on the top of a mountain top. You can be in your car, you can be in your home, you can be standing in line at the bank — and you can just be breathing in and out. Slow inhales and slow exhales. And I find that that for people can be really helpful, particularly for blood pressure, which we'll talk about in a moment.

Dr. Briana Sinatra: Yeah, absolutely. I love that. You can also do pranayama or alternate nostril breathing — of closing one nostril, breathing in for a count of four, closing that nostril and holding your breath for four and then opening up the other nostril, breathing out for four closing it again, holding for four — and just keep breathing in that circular pattern. And it can also really help regulate and calm your heart rate and your nervous system.

Dr. Drew Sinatra: And improve heart rate variability.

Dr. Briana Sinatra: Absolutely, which is very important for cardiovascular health.

Dr. Drew Sinatra: Now in regards to stress, I want to come back to that. I want to share a story of a patient I had a couple months ago. And basically what happened was she came in with high blood pressure and I actually had, I tried all these things, I tried magnesium, I tried CoQ10. We tried stress reduction practices. She got massages. She went out into nature as much as she could. I even had to put her on a pharmaceutical at one point to help lower blood pressure. Nothing was really working. So she kept coming in and I kept saying to her, “What's going on here? Like, is there some piece of this that we're not addressing? Is there an underlying stress that you haven't told me about?” She said, "Yes, my son is really struggling." He was, I think he was 23, 24-year-old, living on his own, depressed, not having a purpose in life — and she took that on.

Dr. Drew Sinatra: And so as a result, her blood pressure went up from that. And we did lots of counseling, and I think every visit after that it was all about sort of a psychotherapy counseling piece where we talked about the importance of her being present for him, being a mom, being supportive of him. But not being fully responsible for his actions, because she did everything that she could to support him, even financially she was helping him. And as soon as she let go of that overbearing piece, of feeling like she had to save him, her blood pressure finally dropped. And so we took her off the medication and I even had, I took her off some of the CoQ10 and the magnesium — and now she's not on anything, and she's at peace with it. And that, from you, is a huge eye opener of how much stress can influence the heart, and in particular high blood pressure or hypertension.

Dr. Briana Sinatra: Yeah.

Dr. Drew Sinatra: Well, what other lifestyle factors do you think about for the heart and improving heart health? Is there anything else?

Dr. Briana Sinatra: I think exercise is super important. You know, from more low intensity, relaxing exercise like yoga or restorative yoga, you could increase the pace more, do more like have a flow or a power yoga. I think anytime I'm talking about exercise with a patient, it's really finding what form of movement do you love and are you going to be motivated to do. You know, even walking is fantastic. It's movement, it's like a walking meditation. It's getting you out, helping with your blood circulation. And often, if you can do it out in nature, that's fantastic. There is also more cardiovascular exercise like running, more short stints or working your way up to a jog, and even weight bearing exercises. As women, getting that weight bearing for our bone health is super important.

Dr. Briana Sinatra: So, you can choose a variety of different exercises that support not only your cardiovascular health, but your emotional health, your bone health. Exercise has so many different benefits.

Dr. Drew Sinatra: And the key, too, with exercise I find is something that you enjoy, that you're passionate about and that is close by. Because if you join a gym that's 45 minutes away, you're not going to be going to that gym regularly. You got to be finding a place that's closer, like maybe five minutes away, maybe 10 minutes max, 15 minutes away — or else you're not going to go do exercise. And you've got to do something that you enjoy. Maybe if you're not really into the elliptical or walking the stairs at the gym or whatever it is, then you've got to find something outdoors that you do enjoy. Even a simple walk in the woods, I find, is incredibly helpful for people.

Dr. Briana Sinatra: Yeah, and women are often quite social, so enlist your friend, do it as a buddy thing to help keep you motivated. And then you're not just going to the gym by yourself, feeling like it's a chore. You can connect, you can talk, you can talk during your workout to get what's on your chest, off your chest. Plus you're moving and getting some exercise and connection.

Dr. Drew Sinatra: I'm finding that, you know that I go to Orange Theory, so every time I go, I'm pretty much one of the only males in there. There might be maybe another one or two guys, but the women in there are all connecting. They're all chatting and they're talking about their day, what they did that morning, how their kids are doing. And I feel like it's so sweet, because there is that community aspect of really coming together as females and talking about their day and sharing their experiences, and at the same time they're getting a heck of a good workout in.

Dr. Briana Sinatra: Yeah, absolutely.

Dr. Drew Sinatra: Now, I mentioned blood pressure earlier because this is something that we treat often in our patients. Is there anything else that you like besides, I mentioned CoQ10 and I mentioned magnesium, is there anything else that you like for helping people with blood pressure and all the lifestyle stuff we talked about, all the stress management with meditation and breathing and the exercise and all that, and of course healthy eating. What else do you suggest?

Dr. Briana Sinatra: As far as nutraceuticals?

Dr. Drew Sinatra: Yeah, that's what I'm thinking of. Yeah.

Dr. Briana Sinatra: Yeah. I mean some other, if you think about your cardiovascular system and your mitochondria within your cardiovascular system, those are really the energy powerhouse of the cell. So you want to feed those cells with nutrients that are going to give it that important energy production, like the CoQ10 and the magnesium that you talked about. But ribose and carnitine are also really important there. Taurine is really helpful. All of those key nutrients for cardiovascular health. Additionally, essential fatty acids, or like omega-3 fatty acids in a fish oil, or another type of omega and marine oil can be really helpful, especially if there's any underlying inflammation going on there, too.

Dr. Drew Sinatra: And one thing that I'm finding to be really helpful is fasting, and intermittent fasting in particular. And that does so many different things for the body, including helping with metabolism, and glucose regulation, and insulin sensitivity and all that. But the reason I'm talking about fasting, because I had a patient in when we were practicing up in Canada, and he came to me because he wanted to do a 10-day, water-only fast because he was having a hypertension or high blood pressure. And, I agreed to support him through this fast and low and behold, by the second day of a water-only fast, his blood pressure dropped tremendously and every day, I think for the next five or six days, his blood pressure continued to drop until it kind of plateaued out at a very healthy 110 over 70, when this guy was running at, I think it was around like a 180, 170 over 90. And so I really learned from that experience that fasting, giving the body a rest, for this gentleman, was really helpful. And I've been trying to incorporate that more into my patients that have hypertension, is some form of intermittent fasting. Or if they're willing to do a one-day, a water-only fast per week, then I do recommend that, because I feel that there's certain foods that we do eat that might be pro-inflammatory, and people may not know that.

Dr. Drew Sinatra: And so when they're doing a fast, it's giving their body a rest and allowing it to do some healing, actually.

Dr. Briana Sinatra: Absolutely. I think even something as simple as giving yourself a 12-hour overnight fast — you know, have your dinner and then let that be it. I think sometimes when we have those foods that are maybe more pro-inflammatory, or more high in carbohydrates and gives us more of an insulin spike, are those snacky foods that we eat late at night. And so even just making that commitment of, okay, if I'm feeling like I need something else, maybe having an herbal tea or something. But not going for the popcorn, or the crackers, or those extra things that are just giving empty calorie. But, stopping eating and then eating again 12 hours later.

Dr. Briana Sinatra: If you're just looking at 12 hours, that's 8:00 PM to 8:00 AM. That's not that long. Shuffle that a little earlier and you have 14 hours. So I agree, I've seen that make a really big difference for blood sugar, inflammation and all of those things are intertwined and can definitely make a huge impact in cardiovascular health. So it's not just looking at those systems in isolation, but how you can make a few key changes in your diet and lifestyle that really impact a number of your systems.

Dr. Drew Sinatra: It's funny you mentioned that, because the other day I was thinking that it's very easy for us to eat late at night. I think everyone, we do it partly per stress purposes. We’re stressed out, we want to eat some potato chips or whatever it is. And it's also because we have food in our shelves that we do it. And I've been finding for myself, and patients too, that that's a really hard thing to do, is to not eat after dinner. And I do encourage people, though, to do what you were saying, to extend that intermittent fast. If you can end your dinner at 7:00 and not snack before you go to bed, and you wake up and you go until 10 o'clock, well you've done, you've done a 15-hour fast right there. So that's great.

Dr. Briana Sinatra: Yep. Absolutely. So I had a patient who was in her fifties, and she was coming in because she had some elevated cardiovascular markers that were concerning to her, and she also had some elevated blood sugar markers. And I just remember her saying, "This isn't my story. This isn't how it's going to go." She had daughters in their twenties, she wanted to be there for their wedding, she wanted to be a grandma, she wanted to be an active grandma, and she was really motivated to make some changes. And so with my guidance, she made some lifestyle changes.

Dr. Briana Sinatra: She started moving and exercising more. She made some changes to her diet. We added on a few different nutraceuticals. She started going to restorative yoga, prioritizing her health, making sure she was doing and making time for her self-care, because she was in a high-stress job that didn't really have a turn-off time. So her cell phone was going all the time, and she was always feeling like she had to check in — and it was just so amazing to see how, when she was so receptive and open to making these changes, we saw in a very short amount of time, weight was coming off, her blood sugar was normalizing, all of her cardiovascular risk markers improved and went more into the normal zone and she was feeling better. It's so amazing to see how, when you take this global, full body approach, that making changes to improve your blood sugar makes such a huge impact on your cardiovascular system.

Dr. Briana Sinatra: How exercising, focusing on relaxation, incorporating movement, all really impacts our cardiovascular system. And then we were able to then decrease some of the nutraceuticals that were super important at the beginning, but she then started incorporating intermittent fasting, and that was able to take the place of some of the dependency on the nutraceuticals. Once her diet had cleaned out a little bit, she knew the foods that were triggers for her, and knew the foods that were helpful for balancing her blood sugar and everything that, again, really — we saw a huge, wonderful impact on her cardiovascular system.

Dr. Drew Sinatra: What I love about that story is that she came in motivated to make some major changes, and then what happened was she changed her diet. She reduced stress in her life. She basically said no to these things in her life, which is saying yes to yourself, and bringing on some nutraceuticals, whatever it was with the meditation, the yoga that she did. And then she started to see changes in her body, right? And then that allowed her to move forward from there because she was feeling better. She lost some weight. And then once that happens, I feel like people are just, they're in. They are saying to themselves, "Okay, I'm here. I want to stay at this place where I feel so good in my body. I want to continue moving forward."

Dr. Briana Sinatra: Yeah, absolutely.

Dr. Briana Sinatra: So as we wrap up our episode today, we want to remind you there's key differences between how men and women manifest when there is an underlying heart or cardiovascular condition. So, if you are showing signs or new signs of nausea, indigestion, anxiety, sleep disturbance, fatigue or increased breathlessness, go to your doctor and get a baseline evaluation for your cardiovascular health to make sure this isn't an underlying factor.

Dr. Drew Sinatra: And the way that we go about approaching cardiovascular risk through lifestyle and comprehensive testing, such as running more tests than a standard lipid panel, which may include an LDL and HDL, a triglyceride, and some ratios there. I like to do more of a deeper dive into that cholesterol, and there's many different ways to go about doing this through Quest and Lab Corp. And then we'll understand more about that cholesterol and how detrimental or protective it might be. And then, of course, running other labs like LPP, LA2, MPO, ESR, CRP, fibrinogen, homocysteine, thyroid markers, if we need to run down that, or some iron studies or CBC, chem panel, etc., to get a more comprehensive understanding of what's happening in the cardiovascular system.

Dr. Briana Sinatra: And if you have elevated blood pressure, which is a significant cardiovascular risk factor, it's super important to look at lifestyle modification, stress level, and different nutraceutical ways that we've seen really make a positive impact on reducing your blood pressure — such as magnesium, CoQ10, ribose and carnitine.

Dr. Drew Sinatra: Before we wrap up this episode of Be HEALTHistic, it's time to share our Wellness Wisdom for today. One of the points we touched upon in this episode was the importance of blood pressure as an indicator of heart disease — and you really need to know your numbers. It's just as important, if not more, than getting screened for breast cancer. And as we mentioned in the beginning of the show, one in four deaths in women is due to heart disease, and we want to be proactive in preventing this.

Dr. Drew Sinatra: One important number to know is your blood pressure. Sometimes this can be falsely elevated in the doctor's office, which is also known as “white coat hypertension,” and so women may not know their true number. We recommend getting a measurement on your own. And did you know that you can do this at your local pharmacy or drug store and they have these self-serve stations, or you can purchase your own electronic blood pressure device and measure in your own home when you're in a relaxed state.

Dr. Drew Sinatra: Remember everyone, if you liked what you heard today and you want to be an active member of the Be HEALTHistic community, subscribe to our podcast on Apple podcasts or wherever you download your favorites, and subscribe to the Healthy Directions YouTube channel. You can also find more great content and information from us and the Healthy Directions team at HealthyDirections.com.

Dr. Briana Sinatra: Thank you so much for tuning in today. I'm Dr. Briana Sinatra.

Dr. Drew Sinatra: And I'm Dr. Drew Sinatra. This is Be HEALTHistic.

Narrator: Thanks for listening to Be HEALTHistic, powered by our friends at Healthy Directions, with Doctors Drew and Steve Sinatra. See you next time.