Hello, ladies and gents Roberts like sceeto Savage.com., And today I'm get special guest. Dr. Abdullah Khan. The line and we're going to talk about all things pregnancy. He has been in the OBGYN field. Giving births hundreds of thousands of births, lots of births and he knows his stuff.
I have not given a single birth, but my wife crystal is pregnant, so I'm excited to learn more, dive deeper and just kind of pull the curtain back on that world and see what I can dive deeper into and hopefully, take with me. In our own personal pregnancy. So, super excited about having the conversation here. I learned a ton. I've got no doubt that you will as well, so that for their do, sit back, relax. Enjoy the conversation with dr.
Abdullah. Ma'am, and you want to talk about pregnancy, especially as it relates to diet or nutrition and carbohydrates throughout the pregnancy. And while I am not pregnant, my lovely wife is she's about 22 weeks in now, so, this is a topic that is incredibly relevant to us. And I'm excited to dive deep and learn more. Yes. I actually did. I listen to the crystal updates. Every once awhile. You do a trimester update on, you got your pregnancy, and I'm really happy for you guys and
happy that it's going well. No, thanks, man. Appreciate that. We're super excited about it. We found out the sex just a few weeks ago. So yeah, we're kind of we're doing things Supernatural. Like, we're not doing most of what mainstream Society puts on you as from a pregnancy standpoint, but from what I gathered just in talking with you briefly, before the recording you tend to kind of go against the mainstream recommendations toward pregnancy as well. Yes. I'd like to preface it.
I so I am very educated in the box, right. I went from Go school in State University of New York. I did a residency in OBGYN. I did a fellowship in Maternal, Fetal Medicine, which is the high-risk subspecialty of obstetrics. NYU, you know, I am of the mindset, you know, you read in the book and it has to be true. But over the last 20 years of my career. I have veered dramatically from conventional thinking especially
about. Carbs and sugar and pregnancy because not I'm not coming at this from a health point of view. Because, you know, I think a lot of your listeners, you know, already really into Quito and then are able to, you know, expand it into other areas. I'm not one of these guys that lifts weights. I mean sometimes my remote control might be the heavy thing
your list. Uplift all day, at least you're honest, but I know I mean I like to play tennis and I generally am maybe 10 pounds or so overweight, but You'll never lose, but I'm my whole philosophy and moving towards what I would say Akito or napkins or a low-carb diet, is really from just experience and is not, there's no bias is no reason for me to have come to these conclusions except for the fact that when you do the same thing every day for 20 years,
you start noticing things and you start getting better at it. Well, I put a whole lot of weight in that man. Like there's so many there's so many text books out there. There's so many National schools of thought when it comes to in the right, macros the right protein intake, that the, you know, dietary fat, and what that does to your cholesterol in your arteries, and for me, like I don't have any acronyms behind my name, I don't have any MDS and phds.
I just do things like experiment with things. I see when I can, you know, find my clients. And I feel like there's a lot to be said with pattern recognition, over time and working with hundreds and hundreds of individuals, and I've had the opportunity to do that, you know. Staying with the clients that I've coached and, you know, people like yourself that have the formal schooling as well, but then have just worked with patients day in and day out like that to me holds more weight
than anything else. I 100% agree and it's actually ironic because I did a fellowship in MFM and that's usually an academic Pursuit. Most of the people that have gone, that route are climbing the academic ladder division, directors, chairman, their writing papers. It's, it's almost as if you choose to have a less of a Hands-On approach, you're spending your day in an
ultrasound unit. You're doing consultations the most Maternal. Fetal Medicine, doctors are On spending a tremendous amount of time in labor and delivery. They're not in the trenches. They are really more back at headquarters, you know, looking at that. And that's a really It's a major detriment because you are able
to see and understand things. Could you do it everyday and if all you're doing is crunching numbers and looking at other peoples dump and reading other papers, you're just regurgitating the same thing over and over because there's no reason for you to think differently. You have you don't experience anything differently.
So unfortunately for you know, Academia after I did my fellowship, my choice in life was to open a private practice and all I wanted to do. Was be the guy that could take you from the beginning of the pregnancy to the end of the pregnancy to postpartum and include all the ultrasounds and you don't have to, I don't have to send you anywhere else for anything. Everything is done in house and
I spent just so many. Countless hours, getting women, delivered that over the years, things became clearer and clearer to me. And at this point, they're so clear. I'm like, walking around wondering if everybody's, you know, everybody's high like what? Why is a cog wise, modern abstract? Metrics.
Not realizing this huge problem that we're having with interesting man, because when I when I started doing the ketogenic diet about seven years ago, it really kind of opened my eyes to the fact that you know, hey, what what mainstream society says what conventional thinking says may not be the most optimal path for you and when I started diving into then I kind of really pulled the curtain back on what you know farmer was like what the you know, the heavy Farm.
Agriculture industry was like how all these biases exist with regards to funding and the median? What is promoted and that that sounds like really far-fetched conspiracy theories, but it's not really when you actually start looking at the data and the cash flow and where money is and incentives are going and coming from but once I realized that with regard to nutrition I started asking myself. Okay, what other avenues can this apply to?
And when it came to pregnancy, you know, crystal is like a very, very hardcore devout, you know, motherly. The type. She's very nurturing just as her personality. So she when we decided to get pregnant she'd of super deep and all things pregnancy, learn as much as she could. And when she started pulling the curtain back on that, it was obvious that you know, many of the conventional trains of thought.
Towards pregnancy. We're not necessarily in line with what you know is best for the human body, the best for the environment through a pregnancy, just from like a Stress and Anxiety standpoint alone from a, you know, a medical intervention
standpoint. When it comes to Conventional and He's so knowing what I know about nutrition really opened my eyes to the possibility that the same principles could probably apply with regard to pregnancy and since doing then it's like I've really changed Direction on what I view to be the right and wrong way and I'm still totally ignorant towards princi. I'm learning as I go. It's been our first one, but I'm excited to hear what you got to say, man. Right. And believe me.
I'm not a conspiracy conspiracy assist this Furious. I'm not sure if it was the right worthy. But you know, if you ask me who killed Kennedy, I'll say Lee, Harvey Oswald pretty simple, but you're right. Big Pharma has really perverted the landscape for medicine and getting back to basics. Might be the greatest thing anybody could do for themselves as far as living a healthy life. So One is I want to open up and I want to talk to the audience because this is not my regular audience.
You probably don't have a lot of pregnant, you know, related issues out here a lot. Probably probably, are you male. Dominated your audience or little bitty little bit split. I honestly have no idea what my podcast demographic is because I don't even know how to look up the stats on that. But I feel like a pretty broad audience. Okay. So everybody in the world of Obstetrics and academic obstetrics even in the media has
his talk. Talking about this is Aryan section epidemic and to get an idea of what's going on with these sections, in 1970. The C-section rate across the board with about 5% and inlets, a peaked, you know, like 10 years ago, finally starting to come down a little bit but Peak somewhere around 35 percent. So, that is completely crazy.
I mean, there's like seven times more C-sections than one, there were in 1970 and a lot of factors if somebody Google's and they say, you know, why are there so many stairs? Sections are going to see many of the same reason than very a lot of them are legitimate. Like one major reason is, you know, there is so there are lawsuits, you know, you can't afford to have a bad baby and doctors are overly cautious or,
or sometimes. There's just the overly in a hurry and it's easier to do C-section than the way forever for baby to come out. So that, you know, one reason everybody agrees is a major problem.
Another problem with in the beginning of 19 in the 70s is when they started something called fetal, monitoring, and I don't know if you You guys haven't gotten there yet because you're still early in the second trimester, but soon, crystals going to be something, you know, going to the doctor's office and sometimes if she's not happy with the movement, they might put her on a tracing and they look at the baby's heart rate
over time in labor. That's very common, almost all pregnant women while their labor. There's continuous monitoring the heart rate and if the heart rate acts up, the doctor has to be able to interpret it and make a decision about if, you know, labor can go on or if it's cesarean section is needed. And and, of course, once you start a fetal monitor Ring. It was much more common to have to intervene the middle of a labor and do a C-section and everybody agrees on those two reasons.
And then there's other reasons that are kind of obvious, like skills skills have deteriorated. It's unlikely to find, you know, a general, OB who's willing to do a breech delivery. It's unlikely the, you know, it's sometimes it's hard to find their General. OB who's willing to deliver twins vaginally as opposed to doing it, you know, just scheduling a C-section. So there's, you know, the skill
set. That's kind. Of Wayne because because of this, he sections, but I my whole practice is geared towards avoiding C-section, so I came out of my fellowship and I went into an area where there was a patient population that wanted to have large families, and I'm not talking about like, four or five.
I'm talking about, like, in the double digits, and those women don't want these, and if they don't want peace, they don't see second day because, you know, you got to go back and take care of a kids and it's hard to do. That after you've had major surgery and it can really handicapped you in the future from continuing to have more and more children. So people come seek me out because they don't want
C-sections. And, and very often, they've already had a C-section and they don't want another one. So initially, I started really thinking about, like, what is the problem? I'm having, why are people having these C-sections? And what's the best way to avoid them? And it became obvious that babies are too big and the average Baby is too big and that that sounds odd. But if you think about it, right? If you say, like, what's is, if somebody says, I am average. If any United States, I am
average weight, right there. Heavy right there because the average person in this country is overweight. So the average baby is overweight and if you look back I was able to find some data from 1920, you know, the internet is a wonderful thing unless you're looking for historical data because you nobody was nobody was putting anything on the internet 1920, but I was able to find some dad and 1820 about the average weight, and it was about 1 pound
five ounces less than today. So today, the average baby is about 7 pounds 5, ounces and pounds 4 ounces. That's, that's, that's the that's the median. You go back to 1922 average, baby was 6 pounds. So when you think about that, that's that's pretty impressive. Now, you know, you're going to our, somebody could argue. Well, you know, we're healthier, we're taller were bigger today than they were 100 years ago. So maybe that's why babies are
bigger, but we're not. 80% bigger and we're not 20% taller. And we can and the average woman cannot handle a 20% bigger baby. So the reason why we have such a C-section epidemic is because babies are getting bigger and bigger, and the reason they're getting bigger and bigger. It's because carbs are just a staple of our diet. And for some reason, there's this idea that when you're pregnant, you get to eat for two, which is probably the worst expression ever and pregnant.
Women are less. Probably even less careful about how they're eating. Then when they're not pregnant, I mean, you know, some people are always careful. Some people are never are but generally pregnant women be like, you know, well, you know, I'm growing a baby. It's okay. And if they expose themselves to too many carbs, it's just simple as that. The baby is going to get big and tell my patients. When you eat ice cream. Your baby eats ice cream.
I when a person eats ice cream, their blood sugar is going to spike. And that means the baby's blood sugar is going to spike and the human body is programmed not to waste calories. So if you get too many calories and you don't have anything to do with them, you store them and we store them. In fact, so babies. Get bigger and bigger because mothers are feeding their babies cars. Is there any definitive evidence that I don't guess you probably wouldn't be.
But is there any evidence that shows that it's just simply a caloric Surplus issue as opposed to a carbohydrate issue? Like have there been studies done that compare pregnant women that eat more carbohydrates versus lower carbohydrate approach with Cal acquainted for so I don't think so. You know, the sad part is, there's almost no real literature on diet and big babies.
There's a lot of literature on, you know, if a baby small and how the calories effect that like, well what's called fetal growth restriction, which is a, you know, the opposite problem. The babies are growing well and you're worried about the baby. So what we do know is that babies tolerate poor diets really? Well. I think there was a study that came out of Norway or Finland, one of these countries and World War Two was occupied by the Germans, and there was a food rationing.
And I think women were like all given, like 500 calories a day with only a very strict, very regimented diet. And they were able to look back at these children, born during that time and they looked at their, you know, military entrance test. Cause it was like mandatory military service in that country and they don't look at their IQs and their physical makeup and they found, oh, look at that.
They did not suffer at all. From this, you know, very carb restricted diet, that was First on their mothers during you know, they're not your patient. So there is a lot of thought about how you know, how come babies are small and how to avoid having a small baby. But very little about what do we do about big babies? Except for just a tional diabetes and that is actually the most obvious proof of the problem. Everybody knows every
obstetrician. Every academician knows that if a woman has just a tional diabetes, her baby has a good. Chance of being oversized. And she has increased chance of having a c-section, right? Because it just a tional, diabetes simply means your blood sugar is running High. The mother is insulin resistant and she can't pull that blood sugar out of her blood and into the tissue but the baby can't.
So even though the mother's blood sugar is running high and she might not be able to get those blood numbers down. The babies seem the same levels of sugar and is no problem
whatsoever. Pulling that Sugar out of circulation and turning into fat and The benefits, one of the major touted benefits of controlling gestational diabetes is a trying to avoid a C-section because you know, your baby's 9 pounds and really chubby at the end of the pregnancy and everybody agrees to that but very few people have said, okay. Well now that that's obvious. Let's just talk about people that don't have gestational diabetes. How about their blood sugar and how they eat?
How does that going to affect her baby? What is a medical risk marker for a woman? That's pregnant. It's likely going to have just a tional. Diabetes. You mean the risk factors being overweight, family, history of diabetes twins, family history, like hyper history of hypothyroidism, being older as a woman gets older, the risk of diabetes goes up to the judge. Those General risk factors and every pregnant woman across the country.
Probably every every decent, you know, country that is screened for diabetes. They're screened at 28 weeks or so with Sugar challenge test and if they're overweight or bad history of diabetes, with the previous pregnancy, or you have some medical Factor, like they have PCOS or or some other medical factors that put them at risk, you screen them even in the beginning of the pregnancy these Freedom twice.
When I want to I want to ask you one quick thing about C-section is I think that's going to provide some more clarity and context for listeners. Hear. What, what is the main adverse effect for C-section versus a typical vaginal birth? Like what is the baby missing? Out on when they go to C-section round. So that's that's a very difficult question to answer because there's so many different ways to approach it.
So some women will say, the word thing is the recovery because you know, it's major surgery and instead of enjoying your baby, you know, you're spending two weeks groaning and moaning every time you try to sit up and some of them would say, you know, you miss out on the birth experience, you know, that that whole experience of have be able to push a baby out and just like
your mother did and her mother. For Millennia, has that other people would say that it could be, it's more complications. Like from a medical point of view. You have a higher risk of hemorrhage. You have a higher risk of infection. If you ask me, it's going to limit your family side. If I know women want to have, you know, a huge family. They better get off the C-section train because that's
going to eventually limit. How many children they have uterus, doesn't always feel perfectly and you can get to a point where you just can't do it anymore. But for the most part C-sections are safe, people shouldn't think, oh no, I'm going to have a C-section.
It's terrible is probably one of the greatest changes or or Advance In Obstetrics that, you know, women don't die and labor anymore because the baby doesn't fit or they could they're bleeding, you know, there's a plan B, which works really well, but it's overused and most women that have a normal delivery and have had a C-section will tell you how much nicer it is to avoid the C-section. And a lot of the babies that are birth, you know, vaginally. They typically have better
immune systems. Is that correct? Due to all the natural bacteria mucus that come through a vaginal birth, though. There is a lot of speculation on that about being exposed to the vaginal flora and how that if, you know, and not just that but that's the baby comes out of the birth canal. The chest is squeeze really tight and that expels all the fluid from the lungs out, the baby's mouth. So that the breathing the transition to breathing is easier.
C-section babies, they don't have that same expulsion. There are benefits and many people struck feel strongly about them. I'm coming out. This I don't come at avoiding C-section from, I think it's better. I come out of waiting. C-sections is that's what my patients want and women should be able to choose how they want to deliver and there's very good reason to avoid a C-section and if somebody comes to my office and says, I don't want have a C-section.
I'm always thinking about how we can avoid that. You know, if it doesn't matter, if it's Windsor to preach, or she had a C-section, or she had two C-sections, I'm trying to figure out how to get her the birth that you want. So from my perspective, a woman who says, I want a C-section, I don't want to go through Labor. I will talk to her about, you
know, pros and cons. And if she still feels that way, I'll say, alright, well book a C-section I'll be done in 45 minutes will be a good day for both sexes. Gotcha. Gotcha. When it comes to, you know, in taking taking patients in Taken pregnant women in that. Run the risk of having gestational diabetes. Is there like a particular Baseline blood glucose that they should try and strive below?
Because I know the general average that mainstream Society especially in America and like their typical blood, glucose levels are higher like that. The quote-unquote healthy range is probably a little bit skewed towards what is actually optimal. Right? Right. So, I listened some of your podcast where you had some physician guests and they all they all going to say said, basically, The same thing I'm going to tell you. I don't remember covering much
in nutrition and medical school. I might have you know Skip that day. I don't remember, you know, even discussing it. My nutrition knowledge comes from you know, mostly things. I picked up along the way but when when when you tackle OBGYN there's very little or nothing in there about like, okay. This is the right way for women
to eat. It's about not having diabetes and and the way to check that is, you know, you give them a glucose Challenge and you Make sure the blood sugar say is under 130. And if the above 130, you give them a second Challenge. And then you see, you know, over a few hours how it runs. But if you pass that sugar challenge, nobody's giving you a kind of like, okay. Now, you know, avoid carbs or eat this, nutritional balanced meal and if a woman wants to do that, she's going to do it on
her own. She's going to find a nutritionist or maybe she already. Just used to eating a very nice balanced healthy diet, and then she'll continue that way. But it's not part of the OBGYN. Lexicon about you know nutrition as far as you know in pregnancy at how to counsel a woman catch him catch him. Yeah. That that, you know, we're doing
the whole midrash Midwife route. So we're not even going through a traditional setting and we opted to just skip the oral glucose test because Crystal would probably fail anyways, but it wouldn't be because she was, you know, running the risk of being diabetic. Just because she hadn't eaten carbs or sugars, especially in 67 years. Yes, you mean her body would react. Anjali to it. Yeah, that that's very possible. Yeah. I'm I'm not sure. I've never had that never had anybody fail.
But even if she felt the first one, she would still choose to do finding the second one bit. Besides the fact that even if she failed, all they would do is tell her to, you know, cut back on the carbs dramatically, which he's already doing. So, it's hard to imagine that would change anything. Yeah, interesting. So, like I said, we're doing the whole Midwife round. So we've got a pretty different setting than most people. Going through a traditional
hospital setting. What does that look like a play-by-play for traditional OBGYN settings, you know, for pregnant, women going through, you know, week to week to week. Like what what is, what is this standard of care as it currently says, well, that's a tough one because you know, every every medical office is is different and definitely we're free practice their different, generally a woman finds out. She's pregnant. She makes it a point with her OBGYN. Going to confirm it with some
blood work. They're gonna possibly do it early ultrasound to get the correct dates. Make sure that, you know, they're she seven weeks and I did eight weeks. Make sure there's viability and then she's going to come every three to four weeks initially. Now, there's more and more genetic testing that's done early on to see that the baby's healthy and then the ultra second trimester is ultrasound the anatomy scan and then you get me hands off just regular visit, check her blood pressure
and her urine. For preeclampsia answering questions until she goes into labor. But you know, I don't want that kind of practice. It's kind of a totally die. Have it the holy different operation going. Because I'm so paranoid about size of the baby. I want to go back to what we were talking about with with the C-section epidemic. Yeah, for sure. So 1970 comes along, you got fetal. Monitoring.
You got an explosion of attorneys that are looking, you know, to represent somebody within unhealthy baby. You have lack of Physicians that are learning how to do forceps and and breach the liveries and we start seeing C-section go up and up and up. One thing that nobody talks about is the Obesity epidemic that completely perfectly parallels. The caesarian. Epidemic. And the Obesity epidemic is also
paralleling, the sugar epidemic. So I think one of your guests and probably with dr. Jacoby talk about sugar and the history of sugar in this country. So cane sugar table sugar will recall table. Sugar is not natural. It was not part of our diets. If somebody wanted to get something to eat, you know, and back in the day, you know, they had honey. They had dates there was there was no not, there was no drawer,
full of cookies and cakes. And you know, these were rare items you might have at a wedding. What happened was they discovered, you know, sugar cane sugar and I started in the Middle East and then they wanted, they wanted to plant it and they, you know, the new world turned out to be a perfect climate for planting cane sugar. And then once you had the whole European New World, African kind of triangle, this, you know, the same Scourge that that we associated with slavery, brought us sugar.
And I say that just uses sugar skirt, just like it was a slavery Scourge sugar was being slaves, were being brought in Sugar would being exported and sugar exploded and in the in the 18, you know in the 19th century through the beginning of the 20th century sugar became just really popular but you know, we still we had an industrialized that much. So wasn't like everything you bought came from a supermarket.
You're still eating, you know, food that was locally grown or from your house, but then in the last 50 years all the sudden than everything was processed to as fast food and women were eating or all of us were eating probably five times as much sugar as nature would have intended and not just five times as much sugar but unnatural sugar, so it wasn't there wasn't sugar coming from fruit or any type of whole grain that we just plain sugar that was processed sugar and that Explosion of
sugar, really correlates well with the how baby started getting bigger and bigger. And at the same time, you know, we moved from a society that had a farm and, you know, milk cows and raise chickens to going to the supermarket and buying are you know your eggs. Here I come in a little cart and your milk comes in a carton and I'm saying this because not just women but the vast majority of us, not you Robert. You're working out too much but most of us.
Are just sedentary, you know, we you know are going to work means going somewhere sitting on a commute and then sitting behind a desk and typing. I mean, the word work is actually a misnomer double. Nobody's working in the sense of spending calories were working because we're working our brains, but you take the combination of explosion of sugar and processed sugar, and a sedentary lifestyle, and then you get pregnant and no question.
There's no question that the baby's going to get to Big and actually multiple Studies have shown women that are workout really vigorously? Have smaller babies healthy, completely healthy. Nothing wrong, but just thinner, they weigh less and women who don't work out, have you know, who don't exercise have larger Bates. So for about 15 years now, not because I am a person who, you know, I'm, I love good candy bar.
I Don't Preach this. I know it's not healthy, but, you know, I got to have Addiction and it's better than cocaine. So I have is it don't know what you do. I don't know Robert, but I don't think I should find out. So when patients come to me and they say, okay. I had a C-section. I don't want another one. And, you know, of course, you know, yeah, my baby ain't have pounds it for four hours in the kid didn't come out or the baby's heart, rate was really
bad and like to see. No, no within the baby was too big. It was just a heart rate. You know the heart rate issue. I'm like, it's almost the same thing. If a baby is not coming out in labor. If it labor is slow, the baby will only take so much many times. The way a baby gets, you know, tells you I don't fit is because the heart rate goes down the baby cannot tolerate labor anymore. The heart rate starts acting up.
Your doctor says you need a C-section of the baby's heart rate is not doing well, but Now my phone's in something weird. But really what happened was the baby didn't fit. So I get all these patients and you know, they're all desperate to avoid a C-section is okay, cut out all the processed sugar. Minimize your sugar's, go to a maybe 100 grams a day, which is probably that more than the keto diet even allow or yeah.
More than we do like 15 grams total a day like carbohydrates in general, not just sugar a total carbohydrates part, right? So I tell them 100 grams a day because I Really hard for people to completely cut out. I mean it's it's almost in everything. Yeah, but the average person is on about 500 grams the day. So, you know try to try to cut down the sugar down to the bare barest amount that the patient can handle life. I've gone lower and then I've gotten like, you know patient come back.
My shit. My nutritionist said that it's not healthy to do this. I'm like, okay. She don't know what you're talking about. That's the way people live 4,000, you know, from for Millennia. Now all of a sudden that helped me to healthy to cut out your carbs, so So Ike. I had them really be careful with the guard and I don't start them till 20 weeks because as Crystal my tell you, you know, the first half the print, the first trimester is about nausea
and not eating. You don't want to restrict some of these diet when they're having a hard time getting calories in it all. I mean at that point, you know, you eat whatever you whatever is going to stay down and doesn't know and doesn't look not nauseating and then the second trimester is when the baby's growth is much more. Influenced by the environment. It's not just genetic say
anymore. It's environmental factors, especially the maternal exercise because of a woman does even like 13. I'm not time, I going to gym, I'll talk about a 30-minute vigorous walk, a pregnant woman who was walking for Vicki to 30 minutes is going to come home huffing and puffing. I mean, there's that that's a lot of stress on the body, 30% of the blood flow during pregnancy. Go straight to the uterus. So now your love is 70% that has to, you know, take care of
everything else. If you, if you put your, if you put your muscles to work, your hearts going to feel it, and it's going to start beating and you're going to breathe heavy. And if a woman, does that for 30 minutes a day, it's not just okay. She burnt to a few extra calories. Her metabolism is going to run better the whole day. She's gonna burn fuel at a
better rate and the blood sugar. They're going to stay in a better Zone and the baby's not going to get as much sugar and then the whole pregnancy, I washed them. And okay. This is gonna blow your mind here because this is a little crazy.
Easy, but at the end of the pregnancy I'm doing, I do ultrasounds on my patient practically every visit because I'm not only trying to understand the way that the baby I'm charting it. I want to, I want to see how it's growing if the baby's big or getting big, especially for the mother because not in a vacuum, you know, as five foot eight woman, can have an 8-pound baby, much easier than a 5-foot woman. If I see a 7 pound baby in a woman is 5 feet, I'm starting. Okay.
That baby might be too big for this woman. So it at the, the maternal pelvis is correlated to the maternal height more than anything else. So vote woman is taller. She has the ability to deliver a larger baby. So yeah, he's kind of have to factor that in. When you're looking at the big picture, then when I get to the end of a pregnancy, is in a patient that is very motivated to avoid a C-section.
If the baby's getting big and, you know, they might they might be doing their job, just fine, but the baby still getting too. Take. I introduced them because it's pretty simple. You have a window of opportunity. You have a window where this baby still fits and then at a point the baby gets too big and no matter how long you labor. It's not going to come out. And you can't just, you know, babies don't grow to a
predetermined size. Those babies that are overdue, are bigger than the ones that are a little early. So very often with my vbacs. Are you familiar with the term? Be back? I'm not be back is vaginal birth. Birth after cesarean. It's a very common acronym. Any woman who's had a C-section that probably was familiar with it.
Most women are because it's easy to remember, you're going to be back and those women that come to me because they had a C-section or two C-sections and they want to have a normal delivery and you know, especially if they like, you know, if I find out their first baby was six and a half pounds and they couldn't push that baby out their second baby, you know was was was the same size. Pushed into can't get that baby out. Then. I have to figure out how to keep this baby even smaller and get
the baby out earlier. So it fits because we're trying to get, you know, back off of the EC section train. Now, if a woman had three C-sections, I will not try to deliver vaginally more because that's kind of my cutoff. Is there a point where you have to be worried? That the uterus cannot tolerate that labor, and that those previous scars in the uterus, a womb will not hold up, and the uterus will rupture Which is scary sounding topic but
happened during labor. If you turn if a woman, you know, is laboring in the baby, is not coming out the uterus, eventually will give out, can't you so? So the might the concept that I've been, you know, practicing now for 20 years, watch your carbs exercise.
I watch the baby and it's a baby's getting too big, you get induced and it's very counterintuitive because most of you If you ask your Midwife, right, if your wife, crystal says to her Midwife, what's the best way a person could avoid a C-section? Her Midwife will tell her don't get induced. Like that is the worst thing you can do is get induced. Right? And that is like the gospel for Midwifery.
And for many years, the data supported that and now it doesn't and it's like one of the and you don't hear about it because midwives are just like, you know, they just want to talk about anymore. They don't want to talk about the last 10 years of data that says induction to actually decrease. She's a cesarean section rates as opposed to the other way around. But I want to clarify because I think I don't want to give the
wrong impression. The best way to avoid is he section is to keep your baby small, eat healthy live, a healthy lifestyle and go into labor naturally a week early. That's the best way now. Most women cannot conjure up labor, you know, a week before their due date. It's not an option. So then the question is, is it better? Keep going, even go over do or is it better to get induced? And when you look at those two choices, is it just leave everything?
Because it didn't happen or get induced shockingly getting induced has lower. See secretary what all goes into getting induced. Like how is that entire process? Roll down? So getting induced is the artificial stimulation of Labor. If the cervix is closed, if the cervix is not open at all. It's a longer process, medically you use Pro. It's a gland and that caused the cervix to soften and to dilate and to thin out.
And then after 12 hours, that you break the water with, you know, today on the hook, you artificially rupture, though, the membrane and you give pitocin, and labor, and suits, and labor, and you're off and running. Sometimes if a woman might be already open, she doesn't need to hold prostaglandin precept, and then it just break the water and give pitocin and then watch and what. Wait and watch. Baby to come out.
That's, that's the induction process and most women, especially midwives, especially anybody who's very granola will tell you, induction is a terrible idea it because it increases C-section rates. And and I'm going to, you know, this is this is the, the funny background story. So from 2000 to 2010. I am preaching. You need to get induced to avoid a C-section. And everybody else is saying you need to avoid it and getting induced to avoid C-section right now.
I'm taking no note that it's not the way it works. Babies are too big. You have to get them out early. We don't have the luxury of waiting for this baby to continue to grow into up till 2010. There were countless studies that showed randomized, trials, medically scientifically. Well done. Study that showed that. If you get induced your risk of a C-section is elevated. And I was still saying, I don't care. They're wrong.
I'm in the trenches. I know that's not true in 2010 to 2020. All the studies show the reverse look like all the sun. It was 180 degrees, every study showed something different, it showed, if you get induced, you have a lower risk of the C-section. Now, this is a big question, what happened in 2010 because Evolution or not. It didn't happen in the year, right? The human body did not change in the year 2010. What happened in the year 2010
that changed every study. So what happened was somebody who finally step back? And looked at the big picture said these studies are ridiculous. We are comparing women who go into labor at 39 weeks with women who get induced at 39 weeks and the women that went into labor naturally, at 39 weeks, had a lower C-section rate than the women who got into East, but that doesn't make any sense because he alternative to getting induced is not going
into labor. You can't take a group of women until half of them to go into labor and half of them, you know, you're going to get induced the alternative to getting induced is Getting induced. So that means that if we want to do this study correctly, we are going to do some women at 39 weeks in this group. And in that group, we're not going to do some, unless there's some strong or, you know, bona fide, medical reason that they
have to be delivered. And when they did that study over and over on 39 weeks at 40 weeks and women whose Services were ready to be induced and several women who had services that were closed and women that were older. Every time they do this study. It always comes out with the same result. It's getting induced, decreasing your C-section rate. And the reason why a lot of people have a hard time with this is because how can it be that induction, is better than nature.
That makes no sense. And the answer is simple. We don't live in nature, right? When a woman comes to me and she says I want to have a natural birth and I want to have a natural delivery. I say, well you better go back to the 1800s because, you know, it's really hard to do that here, right? You don't live on a farm.
You work on behind a computer? Are you eating processed food, you know, if a person that lives that lifestyle and then wants a natural delivery is making the mistake of thinking that, you know, the delivery is all you got to do is just, you know, avoid the epidural not going to do stuff and you're going to have a natural delivery because that's the way it was intended to be. It was intended. You were intended to live in a different world than your
living. In the human body was not designed for 21st 21st century, you know, first world living. And if If a woman wants to have a natural pregnancy, I tell her you better get on the nature train in the beginning of the pregnancy. Imagine going to Penn Station, you know, Grand Central, you go to Grand Central Station, you randomly jump on the train and then while you're on that train, you start trying to figure out where you want to go, right?
Guess where you're going, You're Going wherever that train is going. If a woman, does not think about these things in the beginning of the pregnancy, if she just goes about her normal day, and then, at the end of She starts reading and thinking about, okay. Yeah, I want a natural birth. She is already on a C-section trade. She's been eating carbs. She has been exercising. The guy she married is like, you know, 12 inches taller than her. So there's a genetic problem right there.
She is headed towards cesarean section and it's very hard to jump off a train in the middle and get on another train. So, you know what I preach and I'm writing a book. I'm calling it nature back, which is this whole theory about avoiding C-sections. Get on the natural birth, train in the beginning of the pregnancy, not at the end of the pregnancy because it's too late at a certain point.
Your baby's already getting too big and you are not going to get, you're not you're not going to achieve your goal. Even if you know, you read every book and you choose a good provider. And that don't, that don't make sense to me. I'm picking up what you're putting down. So, best case scenario. They have a natural birth. The baby's. Not too big. They've been active. They've been healthy. They've been eating quality foods that that's best case scenario.
That is if that's what nature intended. Yeah, if that's not the case. If someone's been, you know, inactive sedentary eating a lot of crab, lot of processed food, too many calories in general, not active at all, and the baby's too large. You're saying that the induced labor pre, 40 weeks is better than the C-section.
And in the worst case scenario would be the worst-case scenario would be, you know, complication to childbirth, but before that you get the C-section as kind of the next viable option, Now what if like in Crystal situation? She's you know been active and been eating healthy has been for the past several years. So I'm not really worried about the baby being abnormally large in that regard with her being a first-time mother though.
It is pretty common to see them go a little bit longer than the typical 40 weeks. Right? No, not necessarily 40. Weeks is an average and the and most one will go somewhere between 37 and 42. Probably even 43, but nobody really Anybody go past 42 and more but yes, she'll go to 40 weeks, give or take two to three weeks and not not, it's her first.
Being a first-time mother is not the factor, just everybody's a little different but you know, when she gets close to that 40-week Mark, she's gonna be pretty antsy about going being going into labor. Right? Right, but just because she goes a little bit longer than 40 weeks with her with her lifestyle being like it has for the past several years. We shouldn't automatically jump
to induction. No. No, so if the fluid is good and the baby is, you know, the baby looks happy and baby's not getting too big. There's no reason to jump in and do it. Especially if you know that, you know, she looks the baby looks like it's in a good Zone as far as size. Understand, you know, I have a philosophy but I, my job and it's to take care of my patient. I have plenty of patient to come in and say, I don't want to be reduced. You know, I don't like the idea. I want to know.
We'll just go wherever I go and for whatever reason and thats cool. Also, this philosophy I have is when somebody says, you know, okay doc you've been doing this for 20 years. I've delivered over 22, thousand vbacs. I mean I might be able to claim, you know, u.s. Title in that. If somebody says what, what do you recommend? I say, getting induced, you know, at 39 weeks to avoid a C-section, but if somebody says I, you know, I'm like to go natural. I don't want to be induced like,
Thing to happen. I see that's fine. If the baby's a good size, not too big. And, you know, you've been doing your, you're working out your Healthy women who work out, have shorter labor. They have healthier laborers. It's probably not a big deal at all to go even a week overdue. The biggest problem with going over do is the placenta has a life to it. And when you go too far over do sometimes it doesn't work
optimally. And the placenta has to work really well in labor, because what happens during labor is during Fractions, baby doesn't get good. Blood flow. And the baby has to hold the breath for like a minute, you know this. It's a expression not all babies, actually, not breathing, but it's not getting blood flow for a minute and then there's two minutes between contractions and the baby gets blood flow.
And then another minute minute, the baby is the, you know, the uterus contraction babies like has to deal with that. And and if placenta is aging, then you're going to be more likely to have less oxygen. Transfer to the baby between contractions and that's more likely Lee to cause a C-section because the heart rate is acting up.
So there's other reasons to avoid going over, do besides, you know, the baby not fitting sometimes the placenta is not working, right, but even, you know, even a midwife that that really doesn't believe in induction will advocate for inducing, what a woman is a week or two weeks overdue. Now the the pleasant is it like a specific time frame? That that reduction and oxygen capacity, typically starts like
one week after. We get like that a pretty standardized thing, know, sometimes, you know, I don't know. Anybody goes 42 week, you know, past two tests or do they cause I would never let anybody do that and it's not standard. Anyways, let anybody go past two weeks, past your due date and the old days women. Sometimes we deliver four weeks past your due dates, and, and, and, and the police and minute, sometimes the send them to be
just fine. And sometimes we do an ultrasound that, you know, at 36 weeks, four weeks before the due date. We look at them to send say, wow. This thing doesn't look good at all. So, Yeah, it's like everything else. There's a whole bell curve to it. Some of them can handle. Some of them are great even Way Beyond the due date and some of them are aging even early but you know, you can't standardize it to any one person and say, you know, this placenta looks
good. Also, we don't have a really great way of assessing the placental function. We really have to look at the reflection of how the baby's growing in the fluid around the baby to get an idea of the placentas function can change. And that's what you're really checking out. When you do them, the frequent ultrasounds, you're looking at all the electrics and everything. Is there any risk to them is their ultrasound? Is there a risk to doing too
many ultrasounds? No, so it's been, you know, it's been around for 50 years, use regularly ultrasound has no radiation. It sound waves early in pregnancy. There's there's high-frequency ultrasound. Will you listen to the heartbeat or look at the ultra, you know look at our Pete and and most people feel like oh, well that can create those sound waves can
create some heat. So maybe use that very sparingly but today So there's like just innumerable studies, then none of them have found any negative long-term or even short-term effects from ultrasound and pregnancy. Gotcha. I gotcha very interesting stuff. And what about pitocin? So, like, when people are very hesitant to take any pitocin and what is the mechanism behind that? Exactly? So pitocin, is the exact chemically identical hormones in
the body produces? That's called oxytocin, oxytocin is produced by the posterior pituitary. It's it gets into the bloodstream in a pulse style fashion. And at the end of the pregnancy, the uterus is very receptive to it, because it up regulates receptors up regulate and it will cause contractions pitocin has a lot of other cool effects. It's very important, milk letdown and it's also called the hormone of love, because it
makes people feel close. Like, you know, people feel very close to their partner, their doctor or, you know, They just said well, you know, when a woman's pregnant or just even when you like, take something like MDMA, like ecstasy, it stimulates pitocin release or oxytocin release and that gives you this kind of a warm cuddly feeling and also it actually makes you more Fearless. So which is nice because, you
know, pregnancy is scary. Labor is scary, and it's bit of a woman, has some hormone going on. That's helping her overcome that fear, but when we use pitocin, it's not having any really of those. Mental effects because that's on the other side of the blood-brain barrier. I will give you directly into the IV. The fact that we're having is that we're going to cause contraction because it's it's going to stimulate those Blues receptors on the uterus and each
person responds differently. So pitocin has to be given in a tiny amount. And then upped at intervals until you, you know, you get to a safe Zone. You can you just try to give everybody the same amount for some women. It would be not enough and for other one would be way too much dangerous. Catch him, catch him make sense. So, when it comes to, you know, as you're tracking all these metrics of the fetus, when you start recommending people reduce their carbohydrate intake.
Are you seeing a measurable impact on them? The growth rate of that fetus, as you're doing these ultrasounds, so, I haven't crunch those numbers. I hope so. And also I would never write a patient, right? I would never like, oh my God, your baby's getting too big. You're not listening to the thigh, right, you know. You can't. I have a hard time dieting and I'm not even pregnant. Right? So, you know, it's hard. It's very hard to to want to judge anybody or reprimand them.
I get patient advice and if they, if they're able to use it, it's great. And if not, I still were still have the same goal right there. Coming to me. And saying, I don't want a C-section, right? And they didn't stick to the diet. I'm still, you know, we're still on the same. We're still on the same path. We trying to figure out how to avoid that, that C-section. So the car restriction.
Exercise. And then I monitor the size of the baby and then depending on what reason she had four previous C-section, who big the mom is, you know, what her? What her own feelings about induction are very often. I recommend inducing a week early. There's another very good reason to, you know, to induce early women will often say I want to have a natural childbirth, right? It's been done for centuries, for the forever. It works. I don't need medical intervention.
I just can I could do this myself and there's a flaw a flaw with the logic. The flaw, is that forever childbirth has been associated with maternal death, right? You know, the old days if you didn't like your wife's just keep getting her pregnant. Yeah, that'll take care of itself because they're what pregnancy is a metrical Hemorrhage situation. There's a high risk of hemorrhage for many reasons, and a lot of bad things can happen. During pregnancy. So let's go back to the 1800
when we gets pregnant. No doctors. No, ultrasound, no blood test. Right? Basically, she just Waits until the baby comes out. If the baby is sideways, then, baby's not gonna come out. And she's gonna have a really horrendous labor, and her uterus going to rupture. And she's going to Sanguine. 8 is going to be disaster. And if the baby's too big, which it shouldn't be, because she's living in the 1800's. So what is she eating? But the baby's not going to come
out. At a conservative level, there was a one to two percent infant mortality rate with even full-term babies meaning 1 or 2 and 101 and 50 babies is dying. And labor are not babies. I'm sorry that 10% mother's one in one in 50 or 100. Women are dying in labor in the old days. Now, if you had a hospital that had a 1% maternal mortality rate. It will be shut down faster than you can imagine.
It would be no. As the, you know, the labor of death and nobody go there, the government would jump all over the state would jump all over it. We deliver 6,000 babies at Hackensack Medical Center a year and we have seen one, maternal death. I think in 10 years, right? Because it just doesn't happen anymore. If we had a two percent mortality rate. We would be having. I don't know was 120 dead women a year.
I mean that we'd like, you know, to two women dying a week and And delivery, it would just be the worst place ever. So a woman says, I want to have a natural labor. Right? But she doesn't say, I want to have a natural labor, and if I don't make it, that's okay because that's natural or if my baby doesn't make it. That's okay. That's natural. They say, I want to have a natural labor and I want to be safe and I want my baby to be safe.
That's reasonable. Once you factor that into the equation whole many C-sections you have to do to avoid that maternal disaster or that fetal disaster. Not you're not Like every time there's a problem you can see into the future and say oh, well, this is not going to kill the mother. This is not going to kill the baby. We can we can ignore it.
So now you're doing 40 or 50 C sections because that passed that one might be the one that may not come out a lot and that's acceptable because you can do 40 or 50 C-sections to save a mother or baby that everybody would agree. That's a good trade-off. So the idea that a natural pregnancy is been around forever and And you want to go back to it is flawed. Even if you're able to completely emulate, everything that nature does, we are not accepting dead. Babies are dead mother's.
The acceptance of that level is 900 except zero tolerance for a dead baby. And once you get to zero tolerance for a dead baby, you have to do things. Different meaning, don't have a long labor because it's a baby's heart rate starts acting up or the labor goes, too long. Your doctor can't say. Well, it's only a 2% chance. You're going to die. So what? Watching, right? You can end up with a C-section. So even if a woman is doing everything correctly, and the
baby is not big. She still has to take those precautions. That allow that baby to be delivered? When it's not when it will come out easier because that is the best way, not to get into the zone of you are in danger and your baby's in danger, and the doctor has to act. Yeah, that makes total sense. So you probably think we're a little bit crazy planning on doing a home birth to All right. No.
No, I'm very open-minded and I do, I have told many page that I think home births are better for second babies because my philosophy is, you know, your high risk until you prove yourself, right? Nobody should be. Oh, I'm high risk because I had a placenta previa because I have hypertension. You should be high risk, because nobody knows until you go through a pregnancy. You do not know what your issues are, right, but that being said,
Crystal has been eating. Well, you are, if you're going to do a home birth close to a hospital with a hospital backup experience with wife. No, not crazy. Not crazy. They're actually the statistics are better than expected with, you know, the lack of morbidity
from home births. I just think that women have to be chosen carefully to, you know, who, who is most beneficial from a home birth, you know, you wouldn't want to do that on somebody with our previous C-section, or somebody who has met, Complications. But if everything's going well, not at all. I don't think that's crazy. Okay, cool. That's reassuring for sure. I mean, I'm kind of going in blind with all this man.
Like, some of the stuff that Chris has been like, this is what we should do. And then she presents it to me and I'm like, I didn't even know this was a thing. But okay, let's let's let's roll up our sleeves and learn learn a little bit here and see what happens. So, yeah, this is definitely Uncharted Territory for me. I always advise my husband's to impress, your wife by reading and watching YouTube videos and reading about Labor. Because, you know, during the whole process, there's two
factors. There's a physically uncomfortable factor, which, you know, you're going to be there. Massaging your back and helping her physically, but they're the, the anxiety factor. And if you could be the guy that said though, I read about that. Don't worry. That's kind of normal. And I and that happens, you know, you are a hero. You're keeping your wife Medley At Ease and she's like, oh my gosh. He actually prepared for this delivery. That is a good way to score some points.
Yeah. No fisherman. I mean, we're actually reading a book on it right now. We've I mean I've gone to every single one of the Midwife appointments. We're actually going to start this like couples birthing class in January. There's like several weeks of that. So I feel like I'll be setting myself up for success in at least somewhat knowledgeable about what to expect from the time comes. Yes, we got that. All of that is really good stuff. I do want to actually my kind of plug.
My podcast is like yeah, most semen. So I start podcast about I think six months ago, it's me and me and my colleague who's a midwife Tristan Malvern and we talked about just pregnancy related topics. Some of them are really hardcore, like placenta previa and some of them are a little freely like how to choose a poet pediatrician. But do we try to cover these like so much to talk about? And, and the real gist of it and call it true birth? Because we really just give a
give a really honest opinions. I wish big farmer would try to bribe me because I'm open to bride, but nobody ever does. You know, when you are an obstetrician. Nobody is peddling drugs. I mean, who, which obstetrician is giving drugs out there, you know, the prenatal vitamin
people aren't bothering anybody. I don't get, I've gone through a whole career where big Pharma has ignored me, but the, the concept of the podcast is those things that have become obvious to me as a physician really in the trenches. Day after day for 20 years. I mean there have been several,
you know, a stretch of 15 years. I've been on call every day, you know, except for an occasional holiday, you know, 24/7 in labor and delivery and certain things become clearer and clearer and and and the you know, it's sad because I go through school and and and you were you're hungry to learn and everything you read is Gospel. And then after, you know, practicing you start getting like why is why are they saying that? This makes no sense?
It's like and it's so Obvious that, you know, in a few years eventually people realize how silly, you know, some of this stuff some of the recommendations are but we try to preach what's really healthy for a woman? What really makes sense? What works. And you know, we like to also call ourselves on that unedited and unprepared which is maybe not the best logo, but we don't I don't really have time to prepare.
So, you know, we sit down Kristen and I sit down on a Wednesday night and we spitball some ideas for Or what we're going to talk about and then we just you know hit record and we let it roll. So very similar to this podcast that you and I are doing because Robert and I did not have one actual conversation before we started podcast.
Yeah, no fisherman. I think you know, I think it's great that you put in that this information because you know, I've only just started dabbling in this this path. And you know, what I've learned over the past few months is totally counter to what I had thought previously.
So the more information is getting out there and you know getting in people's ears that that And just that a little bit deeper than what, you know, the conventional wisdom kind of like the mainstream society says, I think, you know, the more, you know, the better. So, I think what you're doing and putting out, that podcast is great stuff, but I'll be happy to link out to it. Thank you. Give me an example of things that have open your eyes.
I mean, honestly, just like the whole the whole concept of home birth a midwife and I'm doing all this stuff more naturally like we've kind of gravitated towards, I mean that in itself like I never even entertained That as a as a possibility because I was born in hospital everybody. I know my family's born in a hospital. I mean when you start looking at Generations way back like great-grandparents, they were often times born at home.
And then we had this generational thing in which everybody just went to a hospital. That was the normal thing. But like you've mentioned in this podcast, people are not living natural, normal lives, so to speak, because all of this Innovation that we've had with processed, food, overconsumption, lack of activity, that's not really natural in The evolutionary
sense, either. So, you know, you really Kind of be software and look at your own lifestyle patterns, but you know, for us like Crystal and I said specifically that are very active eat, very healthy and have for so so long. I feel like we're pretty good candidates for the route that we've decided on going. But, you know, I think I think people need to dive deeper into this and also from like a
epigenetic standpoint. I've learned a lot about epigenetics and how the decisions that we make directly impact our Offspring and I feel like not enough people give that enough attention because the decisions you make I have a direct impact as opposed to this genic factor that you don't have control over. Yeah, I listen to one of your pocket here with dr. Seaman talked about that.
I made a mental note that I wanted to put a little more thought or Research into that because that is even as a high-risk obstetrician. It's something that really hadn't been exposed to. Yeah. Yeah. It's interesting stuff man. It's it's empowering though because it makes you have a lot more of the responsibility because you realize that your life choices, you know, directly impact your Spring in there. I'll spring for like three generations hints.
So it makes you, it motivates your, it should motivate you to get your stuff together and make the right choices, you know. So you're 100% right? I find that there's nothing more motivating to a woman than the health of her unborn child. And that is for it is a wonderful time for women to give
up smoking. And if the only thing that comes out of getting a woman's, you know to restrict her carbs and eat healthy during pregnancy, is that there's a carryover afterwards that would be that would still be a home run because that you know, that is the best time though. That's when Women. I'm saying women because I'm an obstetrician and Men generally aren't pregnant but I'm saying that is the best time for people to really change the lifestyle because the motivation is so strong.
And they're so incentivize that and what, you know, like everything is the the hardly the first step. The first step is always the hardest and then once once you do it for a little while. Oh, not that bad, not been lady them. Then after a while. It's actually I, you know, I actually like, you know, when I switch from from regular soda to D2. Two diet, there was a period of crap diet and now I don't even like regular soda anymore and I should give up dying because
that stuff is all so terrible. But you know, I'm slow on the evolutionary Health tree. Hey, man, you move in the right direction here. For too long. We'll get you holding some dumbbells instead of some remote controls and increase the resistance there a little bit. Maybe maybe that'll be give me. I really do appreciate you reaching out and jump on the show man. Like I've learned a lot. So I think this is this is great information. One more time.
What is the name of your podcast for people listening to go? Check it out. True birth true&height 530&width. All the major podcast carriers and the you don't have to worry about any commercials because we're so small. Nobody will sponsor us. Hey, that's the way to do it, man. I don't even do any sponsorships on my podcast. I feel like, you know, people aren't jumping on podcasts listened to several minutes of pre-roll ads mid-roll ads post
show ads. So I just try and keep it crisp as well. Robert. It was a pleasure talking to you. I really, I really enjoy your podcast style. And when I look at the I don't know you've had several hundred. I mean, it was so many topics and your guest, I can see why so many people are inspired to change their life because it seems that people jump onto the ski Tow and they are thrilled with themselves afterwards. And that is certainly to go man. I appreciate you taking the time.
I'll definitely want to keep in touch. We're liable to have some more questions as she gets further along in this. Currency, so I might be reaching out here soon. Robert. You are on the friends and family program. You have my cell number. You call me anytime. Appreciate you man. Take care. Have a great day. Happy New Year.