Dr Stacy Sims - the world's leading voice on why women need to exercise differently to men

29:50But it's all about using your core, as well as proprioception for larger muscle use. So if we think about a deadlift, and you might just be using two dumbbells, and that's absolutely fine. You have to work on the hinge pattern. You have to be able to pull your shoulders back and down, activate the lats, activate your core, as well as work your glutes and your hamstrings to pull up and lower down. So if we're thinking about the biggest bang for your buck, we want to do compound movements. We want to look at how we move in the day from sit to stand as a squat to bend over and pick something up off the ground that's a hinge pattern.

30:31If we're going to put something up overhead on a shelf that's a push press or shoulder press. So all of these functional movements that we use during our daily life we want to be able to mimic that movement in the gym with load. So if I were to say the top five, I definitely would go squat and squat focus. So that could be anywhere from a goblet squat, dumbbells, barbell, any of those things that you're comfortable with. And if you're just starting, maybe your air squats with a resistance band. We see Bulgarian split squats. So that's one foot up on a bench and the other one in front of you using two dumbbells and using a bit of a hinge pattern to really get into the glute and protect the knee.

31:14We see our deadlift and our hinge pattern of a deadlift. So that can, again, be with a barbell or dumbbells or even a kettlebell. And we can go single leg deadlift or maybe we're doing just a typical RDL or a typical deadlift or even a hex bar. All of that is a compound movement. So those are two and the variations within that. And then we can think about upper body. I like the idea of doing a push press because this is being able to use core and hip extension to push something up overhead. So if you're having to put something up on a top shelf or grab something off a top shelf, you have the full body capacity to be able to do that.

31:57And then we also look at how are we being able to open up our posture from being rounded at sitting at a computer all day. This is where we want to look at our bent over rows or our seated rows where we're having our rhomboid contraction. So again, it's about that functional movement. And then when we think about our core, we've used our core in all those compound movements. So then we can think about peppering a little bit of our Copenhagen planks, our Russian planks, our typical prone planks. And then we can look at using Russian twists or med ball slams against the wall to activate some of that twist and strengthen the twist motion.

32:39Thank you. You have a long list now. You're like, okay, I got to start this list. Trust me, I'll write them down. Although I'm thinking some of those plank variations I need to look up. I was going to say, I've just started getting back into doing the Russian plank. And so that's your shoulders are on one bench and your heels are on another. So you're pretty much doing a supine plank that really does get into your glutes and your hamstrings. So yeah, it's a toughie, but it's good, especially if you're trying to recover from injury. Yeah, which so many people are, even if it's not injuries induced by exercise.

33:17If somebody listening has never done strength training, how do we start out to avoid injury? And also, how do they protect their pelvic floor or adapt to routine if they have a weak pelvic floor or even a prolapse? So I always recommend someone who's going to start their strength training journey to find someone who can watch how they move. Because if we are not really aware that our movement patterns are not ideal and we start adding load, it predisposes you to injury right away. So learning how to move properly is really important. It could be working with a physio for one session just to see where some of the muscle tightness is.

33:57There are some experts online that you can have a Zoom call that can look at your form or you can supply video and they can assess it and talk you through some things. But it's really important to understand your form and where you might have sticky points that you have to modify an activity. So that's the very first point. The second is don't try to start lifting too much too soon. I was working with a woman who's been out of strength training for about 15 to 20 years. And she was like, I want to jump right back in. I was like, wait, I want to see how you move. And so this is where we're using resistance bands to give her confidence to do some lunging.

34:38So she's lunging with a resistance band to give her a little bit of an extra load, but also the ability to have a little bit more proprioception availability so she wouldn't overload her knee. So there are small steps that we take. Like I said, it's a journey into strength training, and it is relatively new because it's just now coming to mainstream. So we have to be very cognate that not everyone is comfortable in these types of movements. So if we can work with them so that they understand how to squat properly, how to protect the knee, how to do a hinge pattern, then they can go off and running.

35:15When we start looking at individuals who have pelvic floor issues, this is something that that so many women have and don't talk about. There are a couple of good experts that they can tap into online. So my friend Kim Valponi has the Buff Muff, and it's a really good app to show you how to be able to isolate and activate or relax pelvic floor. But if you have the accessibility of working with a pelvic floor specialist, then do that first because everyone is individual. So if you don't know that you're hypertonic then you go see a pelvic floor specialist they're going to teach you how to be able to relax and then be able to isolate the pelvic floor muscles and get them to contract in the right pattern because a lot of women have lost that capacity.

36:09We also see that as women get into perimenopause and we're losing the strength and power, it's not just our skeletal muscle that we think of, but it is also our pelvic floor. So we have to learn how to strengthen it. If we're looking with someone who has a prolapse, then we do see there are modifications that we can make. We see that there's a couple of really good apps that you can use that are working with devices to be able to see where pressure points are so that you know how deep you can go in a squat or what you need to do in a deadlift or what that range is before you start really irritating or perpetuating a greater stress for a prolapse.

36:54So I'm not an expert in pelvic floor, but I have worked with individuals who do have issues and there are definitely lots of options out there to get help to be able to progress. Because again, there's so many women who think that incontinence and prolapse are normal, especially as we get older, and it's not. Thank you. And do you know the name of the apps just so that we can put them on the show notes? Yeah, so one I laugh about, it's the Buff Muff. And the other is JunoFem. So JunoFem is the pressure sensor that you can use with an app to be able to determine the coordination of pressure points for coordination of pelvic floor contraction.

37:40And if you have a prolapse, where you need to stop in your range of motion, not to make it worse. Brilliant. Thank you. And we will put those on the notes. And can you talk more about what your work has shown on women and fasting? And more generally, what food and nutrition ethos do you follow? Because when we heard you talk about why women's brains work differently first thing in the morning. It was like a light bulb moment for me personally because my husband and I, we both intermittent fast and I've always been so annoyed that I'm always so hungry in the morning and he can push on with his fast for like another three or four or even five hours.

38:18What is going on there? And why is it that men can drop sugar or alcohol and their body changes? But the same often isn't true for us women. And as Mel Robbins said to you, Her husband insists that abs are built in the kitchen, but your research has shown the opposite. Yes. So this is one of the things that blows up on the internet whenever I come on and say women shouldn't fast. So we have to be very aware of the sex difference in appetite control and neuropeptide control. So if I'm on something like Mel Robbins and I have to talk very general, then it doesn't quite make sense. So I'm going to be a little bit technical here, and then I'll be very general afterwards.

39:02So bear with me. We have this appetite hormone, ghrelin, and that's our hunger hormone. When we're talking about it being active, it's called acylated, acylated ghrelin. And this has a higher circulation rate in women than men, especially first thing in the morning. So what happens is you have this hunger hormone that is upregulated and a higher amount circulating that is activating all the feedback mechanism, specifically in the hypothalamus. So in the hypothalamus, the area of the brain, there's kind of like the control center for our appetite hormones and our endocrine hormones, as well as our temperature control.

39:42And in that endocrine hormone cadre, we also have cortisol. all. When ghrelin is upregulated or high circulations throughout the body, it also stimulates this neuropeptide called neuropeptide Y. And this is one that's like, okay, I need some food. And neuropeptide Y also stimulates kispeptin. Now kispeptin is the key peptide in the hypothalamus that is really specific to women versus men. Because we have two areas in the brain where kispeptin is upregulated when we don't have a lot of food. And when it's upregulated, that means that the hypothalamus feels like it's under threat. So it starts to downregulate our metabolism.

40:30It starts to have a feedback through the entire body to start kind of conserving. So then if we are going to exercise in this fasted state, instead of being very free with free fatty acids for fuel, it signals really to start breaking down our lean mass to use more amino acids for fuel. We also see that women who hold a fast for a longer period of time, so say you're trying to hold on for another three or four hours, like your husband, then your ghrelin levels are really elevated and you're trying to avoid that feeling of hunger. So there's a compensatory where your body starts to move less. We see women that hold their fast for a long period of time tend to move less in the day and crave more simple carbohydrates.

41:23Because again, this is your hypothalamus saying, I need fuel. I need carbohydrate because that's a quick fuel. I need it for my brain. So when we start looking at fasting and the data that's coming out about fasting, there's a significant sex difference. But yet it's not being shouted out because the influencers who are promoting fasting. And then, yeah. Yeah. And then the data that's coming out to support women shouldn't fast kind of gets shut down because it's such a cultural thing when we talk about nutrition that if someone, you go up to someone and you start talking to them, they're like, I'm keto, I'm IF, I'm vegan, I'm plant-based.

42:06It's a cultural identity. So now if we're challenging with scientific data to say that you should not be fasting, it's like a dagger to their ethos. So trying to unpack it and explain, look, for women, our hypothalamus is more sensitive to appetite control and low nutrient density. So you do need to eat within a half an hour or so of waking up so that your body doesn't feel like it's under a lot of stress and can say, I have fuel to get on with all the things that are happening in the day. And one of the critical things is we have cortisol. It's an important hormone for us because we have little stress points during the day and cortisol comes up and down in response to the stress points.

42:51But if we don't eat first thing in the morning, we have an undue amount of cortisol that's released with every one of those stress points, which means that our response to something like traffic going slow is above and beyond what it should be from a physiological standpoint. So we're perpetuating inflammation and stress responses. And we can really tap that on the head by just having some food in the morning. That's so interesting because it goes against what so many of us have done for so long. And that's one thing I still do. I don't have breakfast until about 10 o 'clock. I exercise early.

43:29So again, something I need to think through. So sorry, Stacey, are you saying that women shouldn't fast at all, like even intermittent fast? Sorry to dive in. So when we're looking at the fasting data, if you exercise, you shouldn't fast. And I say that because exercise in itself is a fasting state. When we look at intermittent fasting versus time-restricted eating, two different things. Time-restricted eating is what I think everyone in the entire world should do in our first world populations. Because you're working with your circadian rhythm, especially for women. So if you wake up with your cortisol awakening response, which is normal, so it peaks about a half an hour after you wake up, and you have food and then you eat throughout the day, making sure you get protein and fiber at almost every eating opportunity.

44:21And then you finish dinner and you don't have anything else. So you have about two or so hours before bed. You end up with a 12 or 13 hour overnight fast. Not only that, if you are not eating that close to bedtime, then your body has the ability to get into deep sleep and really good sleep architecture. We see that circadian rhythm disruption happens really easily when we move our food intake. Because food and light and darkness are the two most powerful things to cause circadian rhythm disruption. So if we are waking up and we're not eating until 10 or 11, and we've been up since 7 or 6.30 or earlier, we are phase shifting.

45:04And when we're phase shifting, that means that we are disrupting our melatonin peak at night, which means that we can't get to sleep as early as we should. Our body doesn't have the ability to get into really good parasympathetic activation, so we miss out on a lot of that really good deep sleep that's reparative. So if we're looking at how do we optimize our health span, time-restricted eating is fine. But what I mean by that is normal eating, where you're eating throughout the day to fuel for the task at hand. You stop eating when you finish dinner so that you're not going to bed on a full stomach and your body can do all the reparation it needs to at night.

45:44When we talk about fasting and telomere length changes and we're talking about the cell senescence and our resilience of DNA, all of that comes with exercise. So if you're exercising, you are garnering the benefits of all the data that you hear about with fasting. And if you're doing time-restricted eating, which is that overnight fast, you're definitely setting your body up really well for a really good health span in later life. So if women want to and need to lose weight, what would your advice be in terms of how they eat? Because for a lot of us, we simply eat less. And also, what would you say to women who aren't hungry first thing in the morning?

46:29Because that's definitely me and tend to just have a cup of coffee, maybe with some collagen powder in it. And within all of this, can you explain to women how starving yourself makes you lose muscle and why women might actually need to eat more if they need to lose excess fat? Definitely. So this leads on from our fuel during the day. There are a lot of us that are not hungry first thing in the morning. Part of it is we've had a learned response with that. And the other is this disconnect where we see cortisol rising and this can have an effect on our appetite hormones where we have a dysregulation of our appetite hormones.

47:10And if we are not eating first thing in the morning because we don't feel hungry, it's like a catch-22 where cortisol keeps coming up. And then we have an oscillation of cortisol that's higher than it should, which then further perturbs our appetite hormones. So we have to relearn how to be hungry in the morning. So we can train our gut and our brain to be hungry when we wake up. But again, it's that our shift in our circadian rhythm. We need to bring the calories closer to when we wake up because if we have that overnight fast, you will be hungry when you wake up. It's just we've gotten into a sociocultural habit of eating later.

47:48And as women, I'm not hungry. First thing in the morning, I'm going to skip those calories and push it off to later in the day. And then you might bookend your calories towards the end of the day. Then you go to bed too full and you wake up and you're not hungry and it becomes this catch-22. to. So if we're trying to lose weight, there are a few things that we can do. First and foremost is our protein intake. You really need to think about the recommended daily allowance that's out there is based on a minimum amount that you need to consume to prevent malnutrition. So if we're thinking about the general active woman who is concerned about her health span and wants to age appropriately, the RDA is way too low for her.

48:31We also see that protein and exercise, we become less responsive to it as we get older. So the protein intake is really important. One, that helps us with our neurotransmitters and our appetite and appetite hormones and our endocrine system. But also because protein is responsible for metabolically active tissue, it goes to preserve our bone and our lean mass when we're looking for a slight calorie deficit. The way that I counsel women is we want to eat throughout the day and then we can take a slight calorie deficit of 150 to 200 calories away from the evening meal because one, then you aren't going to bed with a lot in your stomach.

49:13You've had a decent meal. You've had 40 grams of protein and fiber, but now we're skipping the extra snack. We might not have that little bit of extra rice or maybe we're not having a glass or two of wine, it's really easy to take away those little extra bits of calories. And then you're sleeping better. If we're sleeping better, then we have better metabolic control. The one thing that women and men tend to forget is that if you have disrupted sleep, you will not have any kind of change. Because if you have disrupted sleep, your body always feels like it's in a fatigued state. So it's going to have greater inflammation, and you're going to keep craving simple carbohydrates.

49:52And this feeds forward to, again, trying to delay food intake and it keeps in that catch-22. So ideally, we are strength training two to three times a week. We have a little bit of high intensity work in there. We are eating according to our circadian rhythm. So we're having food throughout the day and we are sleeping really well at night and we have a higher emphasis on protein and fiber. That in itself is like the baseline. And when women start nailing that, they see inflammation goes down, sleep is better, body composition changes without really trying to put too much extra effort in. And can we also talk more generally about women and cortisol and how this impacts our sleep, which you've kind of touched on, thank you, but also very much your thoughts on women and cold plunging versus women and sauna.

50:46And Sophie, I'm thinking about you here because I know that you do curl plunge every morning. Yeah, sure. So if we're thinking about cortisol, it's gotten such a demonized name across all media platforms. But cortisol is an essential hormone. It's how we respond to stress and how we become super alert. It's also really important when we exercise to allow our body's heart rate to come up, our breathing rate to come up, allow us to access more fuel for our contractile muscles. The reason cortisol has gotten such a demonization in a lot of the popular media and outside medical clinics and such is because it is that stress hormone, and we're perpetually in that sympathetic drive, that flight or fight.

51:33So if we're looking at ways to bring our baseline cortisol down, I like to explain it like your resting heart rate. As you add exercise into your daily routine or every other day routine, and you start getting fitter, your resting heart rate comes down, and that's your new baseline. So if we're looking at how do we mitigate a cortisol peak by having food first thing in the morning, how do we allow our body to have more parasympathetic activation by having really good sleep and doing some mindfulness practice. Maybe we are using environmental factors to help get that parasympathetic response. Over the course of a few weeks, our baseline cortisol comes down.

52:16So now we feel that we are no longer in that tired but wired flight or fight sensation all of the time. When we talk about using environmental stress like cold plunge or sauna, there is a nuance within cold plunging where we don't have to be in ice water to garner benefits. We see from the research that women do better in 10 to 14 degrees Celsius water, not ice. Ice water is too cold and invokes a really strong constriction response that is increasing the sympathetic drive, not what we want. If we look at that 10 to 14, 16 degree water, it's cold enough to drive some of our stress responses up, but it is not overly cold where we can't have a compensatory parasympathetic response.

53:14And that's what we're after. We also see that women don't get as much of a robust response to cold as men do, but they have a better response to the heat. and the reason for that are the specific sex differences in thermoregulation where when women go into a really hot environment we vasodilate first so we're trying to offload heat not through sweating but through our blood vessels opening up and bringing more of the heat to the skin and so So we have all of our blood flow going to the palms of our hands and our feet. And then maybe we start sweating when our core temperature comes up, and that could be 10 to 15, 20 minutes into a sauna.

54:02But a man comes in, and he starts sweating almost immediately, and his core temperature goes up really quickly. And we see that a man might last 10 to 15 minutes in the sauna, where a woman can last much longer. Part of it is the fact that we have these sex differences in thermoregulation, but the other is over the course of our reproductive life, our core temperature oscillates about one degree Celsius every month, depending on how estrogen and progesterone come into play. So we already have the ability to change our thermoregulatory thresholds with heat exposure because our body is used to that.

54:45So when we're talking about environmental stressors to increase parasympathetic response, it is an individual choice. I know if Sophie, you love cold plunge. Maybe you try a cool water plunge and see if that does a little bit more because you can stay in a little bit longer. But for me, I get such severe rain odds that the idea of getting into a cold plunge means that I'm going to have burning hands and feet for about 24 hours. so I'd much rather get in the sauna and garner the benefits that way. That makes complete sense. I actually haven't cold plunge since I moved house. My cold plunge is still sitting there empty, needing some attention.

55:24It's just not been high on the priority list. My sauna blanket however is upstairs. Nice. How can women get more protein and what are your thoughts on protein shakes? For example, what do you think about plant-based protein shakes and vegans or vegetarians trying to get more protein. Do you have any tips? Yes, I'm always food first and people have this idea that it's really, really difficult to get protein in. I had a woman ask me today, in fact, how do I get 150 grams of protein in if I'm trying to watch my cholesterol as well? So I'm not talking about big slabs of meat, I'm also not talking about go all in with our protein supplementation.

56:06It could be if you eat eggs and dairy, you're doing scrambled eggs with some feta cheese on sprouted grain toast for breakfast, and you're getting 30-ish grams of protein right there. Or maybe you're doing low-fat Greek yogurt and chia with nuts and berries. Then again, there's another 30 grams of protein right there. We try to get protein and fiber at every eating opportunity, like I said earlier. One, because if we get in the habit of looking at all the different types of protein that's out there from ediname and green peas and tempeh and tofu to our traditional eggs and lean meat and poultry and fish, then we have a wide variety of different types of proteins that we can have throughout the day and it becomes much easier.

56:54I don't think that it's really that feasible for someone to go from a typical intake of around 80 grams of protein to doubling that overnight. So just like strength training, we phase it in. We look and go, okay, well, instead of white rice, I'll have quinoa and amaranth because that has higher protein. So just little swaps here and there to increase our total protein intake. If we're thinking about supplementation for protein shakes, vegan protein shakes, if you're doing a pea protein isolate, it's just right on the cusp of having the same amount of leucine and amino acid profile as whey protein isolate.

57:32You just have to have 30 gram serving instead of a 25 gram serving. But again, if we can get more out of real food, we're not as smart as nature. Nature has all sorts of cofactors within the food that makes things work for us, our micronutrients and our macronutrients. If we rely solely on our protein supplementation that's really easy to grab, we miss out on so much of the fiber and micronutrient components of real food that a lot of people end up with some malnutrition and lack of our essential micronutrients. So again, it's real food first, and then supplementation is there to supplement. I admit I have some protein powder every day just because of lifestyle and the fact that I'm not hungry first thing in the morning.

58:18So if I put protein into my coffee with some almond milk, there's a good 30 gram head of protein and I'm ready to go. So there's lots of things that we can think about with protein. It's just not trying to get it all in all at once, and we want to phase in. And our body is in an algorithm. So there will be days where you have more and other days that you have less, but don't beat yourself up about it. It's the overall trend that we're looking for, not our acute day-to-day hitting these specific numbers. Because food's supposed to be fun. So if you don't have the fun in all of that and you're just so focused on the macronutrient numbers, then we're missing the nuance of what it means to be human and the ability to choose.

58:59Thank you so much, Stacey. And just on a more personal level, what's your daily routine, both in terms of food and meals as well as exercise? How much exercise do you do and what does it look like? I travel a lot. So I tend to, my daughter laughs, she's like, mom, when you travel, the very first thing you do is you look for a gym and wherever you're going to stay. I'm like, yep, a hotel has to have a good gym or there has to be a good gym nearby because that's my one non-negotiable. I come from an endurance background, like I said, but I take strength training with me wherever I go because it is a way of maintaining some coordination of consistency.

59:42But if I'm at home, then I tend to get up before everyone else so I can have 20-ish minutes of no noise and just kind of ease into the day while I have my coffee. And then depending on the day, I'll go to the gym and do a heavy strength class three times a week and a high intensity, what we call a metabolic capacity session once a week. And then I'll pepper it in with if I'm training for a gravel race, then I'll take out the capacity and I'll put in some more riding. Or if summer's coming and I want to do more ocean swimming, then I'll try to lean into more swimming. So it depends on season because I'm not racing per se.

1:00:28I'm not training for anything but life right now. The only thing I can say is that strength training is the mainstay wherever I am, either at home or traveling. And I am plant-based for the most part, meaning that I was vegan for a very long time, but now I do some dairy. I do some Greek yogurt and some whey protein powder, especially because of traveling. It's hard going to different places and being very specific at what you eat. So I know that those are two things I can find everywhere or I can bring with me, especially protein powder. So if I think about food and meals, I have some before I train and then I have my real breakfast when I get home from whatever training I'm doing.

1:01:12And that's usually a bowl of overnight oats and chia seeds with some berries and some nuts and some yogurt and of course more coffee. And then lunch is a variety of fruit and veg and toast. I love toast. And some sprouted grains to go with it. When my daughter gets home, we have afternoon tea and then that's a protein-oriented snack of some sort. So today was banana chocolate chip protein muffins with some mango on the side. And then dinner, the base of all of our dinner is a big plate of colorful fruit and veg. And then my husband will put on some fish or some chicken, and I'll have tempeh or tofu, and then my daughter will have a bit of both.

1:02:00This sounds very similar to what your routine is as well, Sophie. We'd also love to know if you take creatine, and if so, do you cycle it? And what other supplements do you take, if any? And And one more thing, testosterone, do you take it? What are your thoughts on that? Basically, what's your stack in terms of supplements, particularly with creatine? I am a diehard creatine user, yes. It is a little bit of a holdover from when I was racing, just because as a vegan, when you're racing high intensity and high level, it's really hard to get a lot of the muscle power and recovery without creatine because it is an animal-based thing unless it's created in the lab.

1:02:40So I do between 5 and 10 grams of creatine a day. On times where I have heavy fatigue blocks where I'm traveling or lots of brain work, then I'll do closer to the 10 grams. But on a general day, it's closer to the 5 grams. I do omega-3s on a consistent basis. And I do vitamin D3 on a consistent basis, especially down here in New Zealand in the middle of winter when the light is very low and the days are very dull. Testosterone for women, I think, is an up-and-coming thing. We see that testosterone doesn't decrease precipitously like estrogen and progesterone with perimenopause, but it does take a hit because your body's under a lot of stress.

1:03:26I have used testosterone in the past. That's because after I had my daughter, I was amenorrheic for almost four years, and it came down to very low testosterone levels. So I was on transdermal testosterone for a bit and it boosted me back up. But now I don't use any hormones. So if I were to say, what is my stack? On general, it is the creatine, the omega-3s, the vitamin D, and then I'll throw in some rhodiola and shachandra days here and there. But those are pretty much my go-tos. Thank you so much for sharing. That's super helpful. And I guess lastly, is there anything we've not covered that you'd like my listeners to hear?

1:04:10One of the things that I've learned over the past few years as I've started to get a larger profile and general community coming from a high performance background is that we tend to forget that there's a bell curve. And when I'm talking about all of this stuff, it's in the middle of the bell curve. And of course, there are outliers. So if you're an early adopter and you're like, I know all this stuff, great. Keep doing it. Spread the word. Bring some other people on board. If you're in the middle of the bell curve and some of this is new, just do some biohacking to find out what works for you.

1:04:47Because again, the robustness of science for women isn't as what we would like it to be. And if you're a late adopter and this is all brand new to you, know that it's a journey. And again, you need to find out what works for you. There isn't a prescriptive rule. There isn't a prescriptive schedule you have to follow. We're all trying to navigate this together. And the more that we talk about it and the more we empower each other, the more that we can find out what works specifically for us as women as we get older. Thank you so much, Stacey. And for all of you listening, you can find out more about Dr.

1:05:24Stacey, including her terrific courses and training at allthews.drstacy.com. And do follow her on socials at drstacyims. Thank you so much for sharing so much of your knowledge, Stacey. Thanks for having me. It's been great. And that ends this week's podcast. if you want to find out more about me and my work or maybe book a consultation head to dr sophie shotter.com and you can find me on socials at dr sophie shotter and again thank you so much for listening