Podcast Episode #186: Women’s Health, PCOS & Body Image with Stefani Ruper

Topics:

1.  What’s new for you from Diane [2:08] 2.  Introducing Stefani Ruper [4:50] 3.  Managing hormones on paleo [11:10] 4. PCOS causes and solutions [21:59] 5. Endometriosis [31:41] 6. Body image talk [44:15] 7. Liz’s Baby Making and Beyond tip of the week: fertility superfoods [1:01:25]

Links:

Archived Balanced Bites Episodes with Stefani Ruper – #45 and # 133

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Subscribe to DianeSanfilippo.com

The episodes are also available in iTunes, Stitcher & Blog Talk Radio. 

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Diane Sanfilippo: Hey everyone! Welcome to episode 186 of the Balanced Bites podcast. Diane here, Liz over in the middle of the country on maternity leave. We’re wishing her well, and hopefully we’ll hear from her pretty soon here. In the meantime, I’ve been having a really great time with a whole bunch of awesome guests, and this week is no exception. I’ll talk to Stefani Ruper here in just a minute. Before we get into the episode, let’s get a word from our sponsors.

Liz Wolfe: We’d like to thank Vital Choice for supporting our podcast today, and we encourage you to visit their online store at vitalchoice.com. You’ll find an amazing array of some of the world’s best seafood, including wild Alaskan salmon, halibut, tuna and cod, as well as sustainably harvested shellfish. These foods are not only delicious, but vital choices for your health. You’ll also find grass-fed organic Wagyu beef, live fermented foods to promote gut health, wild organic blueberries, and dark organic chocolates. Eat better, think better, and feel better with deeply nourishing foods from Vital Choice. They’re offering our listeners 15% off any order using code BALANCEDBITES. Remember that orders of $99 or more ship free.

1. What’s new for you from Diane [2:08]

Diane Sanfilippo: Alright. I just want to give you guys a quick update now. I can’t really tell what’s going on {laughs} but a couple of people have reported to me that it’s not an issue, and a couple of people said they did need to resubscribe. But if you’re tuning in this week and you’re not seeing past episodes show up in your iTunes feed or your podcast app on your phone or wherever you’re looking for it, just be aware that we did recently switch podcast hosts. Yay! I wish we had a little round of applause sound effect we could put in there. {applause} Whatever that sound is {laughs}.

But basically we’re having some issues as you guys reported to us. We had a few random ads that were tacked on to some of the episodes that people thought were a joke, and they were not a joke. However, they were not our sponsors. So we hustled really quickly to get away from where we were and made sure that we cleaned everything up for you guys so that the episodes would be just straight up with our beloved sponsors that we invite and love having on the show. So there’s that. So if you’re seeing any weird issues there, make sure you resubscribe.

I think just a couple of other really quick notes. First thing, the 21-Day Sugar Detox Coaches program; I know a lot of you guys have joined the Facebook group that I have for that. If you haven’t joined it yet and you’re interested in becoming a coach, definitely join in that group because I will be opening enrollment probably sometime within the next couple of months. I’m waiting on some website development to get completed before I can go ahead and open enrollment. We need everything on the back end to be working really smoothly before I invite a whole bunch of new coaches into the program.

But, it will only be open either once, maybe twice a year in the next coming months and years. I’m not going to have it open all the time. So if it’s something you’ve been thinking about, definitely get into that Facebook group, because that’s where I’ll announce it first, and those are the people who are going to get first dibs on even enrolling, because it will be again for a limited time, we may even have only a limited number of enrollments, because it’s a lot of support from myself and my staff to help everybody through the beginning stages of the program, so we want to make sure that we’re there to support you. So, long story short just jump over to that page. I think we have a link to it right from 21DSD.com/coaches, so you can find that Facebook group.

The last thing I want to mention is that at the end of this month, April 24th to 26th, right before my birthday, which is on the 28th, we’ll be in Austin, Texas. Well, I’ll be there, and Scott will be there with me, and a bunch of my friends, and today’s guest, Stefani Ruper will also be there, so definitely if you’re coming to PaleoFx make sure you find us, find us to say hello, get your book signed, come to my talks. I think a bunch of what I’m doing is on Sunday, so hopefully you’ll be there through the end of the event, and we will see you there.

2. Introducing Stefani Ruper [4:50]

Diane Sanfilippo: Alright, Stefani Ruper is the author of the bestselling book on paleo and women’s health, Sexy By Nature, the Whole Foods Solution to Radiant Health, Life Long Sex Appeal, and Soaring Confidence. She’s the voice behind Paleo for Women blog, and the first ever body image and self love podcast, Live, Love, Eat, and the brand new podcast, The Paleo For Women podcast. Stefani holds a degree from Dartmouth college and Boston University. She is currently writing her next books, and is working on a PhD in philosophy at Oxford University.

So you’re just sitting around doing nothing, Stefani, basically? {laughs}

Stefani Ruper: You know {laughs} you know what’s funny, I kind of am.

Diane Sanfilippo: {laughs}

Stefani Ruper: I’m in a little bit of hang out time right now, transitioning between projects, so I have watched shamelessly an enormous amount of TV in the last 7 days or so.

Diane Sanfilippo: I like it.

Stefani Ruper: Yeah it’s been really awesome. I really believe that when you’re well rested enough, you automatically and naturally become more productive, and I’m sort of swinging up into productivity again. So I really like rest for that reason.

Diane Sanfilippo: {laughs}

Stefani Ruper: I think it’s got a really good productive use.

Diane Sanfilippo: So that was why I went on vacation for a long weekend two weekends ago to Mexico, and I thought, great I’ll come back, I’ll be roaring to go, I have all these great ideas. And I got sick while I was on vacation. I was like, of course, I would get sick on vacation. I feel like its nature’s way of telling me, Diane you thought that was enough rest? But you’re going to take a whole nother week and not do anything this whole week. So that was me last week.

Stefani Ruper: Mm-hmm.

Diane Sanfilippo: Anyway. So for those of our guests who haven’t met you before, which we definitely have in the episode in the archives, we’ll link to it in our show notes and you can go back through. I don’t actually have it at my fingertips, I’ll grab the episode number so people can look for that. But why don’t you give the listeners a little bit of background about you and just kind of introduce yourself?

Stefani Ruper: Yeah, well, I guess it has been a while. At least the first podcast was a couple of years ago, now. So, I’ve been working in the paleo world for a few years now, and I got into paleo and specifically focusing on women’s health when I sort of realized coming into the blogosphere that there were not a lot of female voices. And that would be totally fine, I guess whatever, that’s how the whole world is, right? So no big deal, everything’s the same. But I also began to realize that this had health consequences. Personally, I lost my menstrual cycle in 2009. I was diagnosed with PCOS, that’s polycystic ovarian syndrome, and I went paleo after that. I “went paleo”, air quotes, after that diagnosis, but it didn’t fix anything.

At the time, everybody just assumed that once you started eating a paleo diet, everything would be magically better. The solution to fixing that was to get even more paleo, which at the time, was to get even more low carb, to eat more meat, to exercise more, to maybe do some intermittent fasting, all of that stuff. And the more and more I did those things, the worse and worse my infertility condition got, and the worse my acne got, my mental health deteriorated, my sleep got really bad. So I eventually realized that all of those things that we had that were supposedly paleo back then were actually more like, well they were a little bit male.

If you go back and look at the studies, and stuff, you find that we were citing studies about male fitness, and nothing about female fitness. So I started writing about this sort of thing, and a lot of women were like, oh my goodness, that makes sense! Yeah, maybe I should eat a sweet potato from time to time, or maybe whenever I want. And thus the whole thing was born. I’ve been doing that for a couple of years now.

Sexy By Nature is perhaps my biggest baby; right, we all have books, and we call them babies, and that’s weird that we do that. But we don’t have children, except for Liz. Yeah, so it’s one of my biggest babies, and I love it, and it’s not just about specifically the foods we eat, but how you do it. Right; as women, we have to be a little bit more careful, and a little bit more nurturing only because our bodies are a little bit more sensitive, and because evolution. So that’s me and that’s my shtick here.

Diane Sanfilippo: Awesome. Yeah I think it was funny when Liz and I started podcasting a few years ago. I did dig up the episode numbers from your previous episodes; 45, back in the day, year 1, and 133. So that was probably just about a year ago. That was the last time you were on. Was that when Sexy By Nature came out?

Stefani Ruper: Oh, yeah.

Diane Sanfilippo: I think it was.

Stefani Ruper: That’s so funny, because in my head I knew that I had come on twice. I was like, why would I come on the second time? {laughs} Not like there was a book or anything.

Diane Sanfilippo: Yeah. And when you first came on, I remember we were talking a lot about mindset, and just a lot of the emotional stuff. We’ll get into that today, too. But yeah, I remember last year we were at PaleoFx and I remember the book had just come out around then, because you were definitely signing it then, too.

Stefani Ruper: Yep.

Diane Sanfilippo: So people can dig back for 45 and 133. And this is my chance to remind everyone that the archives are amazing. Somebody posted something in a review that they were annoyed that I would refer people to the archives instead of reanswering a question, but you know, 180-something episodes later, they still hold true. We have amazing content back from the past few years, and we actually revived some of that last week, an episode with Chris Kresser. And it still holds true. Of course, there’s new information coming out, but what we were talking about before isn’t then also not true. So, I love for people to listen to something new and then go back to number 1 and kind of alternate. Anyway, if you’re new to the show, I definitely recommend doing that.

3. Managing hormones on paleo [11:10]

Diane Sanfilippo: So we have a whole bunch of questions from, I posted on Instagram, which I love posting questions for people on Instagram and getting them to respond. They posted a whole bunch of great questions, definitely come follow me over there @DianeSanfilippo, and Stefani, yours is @StefaniRuper.

Stefani Ruper: Yeah.

Diane Sanfilippo: So, definitely come follow us over there. We love interacting with everyone. So we’ve had some great ones, and I think this one kind of dovetails on what you were just talking about with your story and how you got into this, which was, she says, “Please ask her about how women can better manage their hormones, and how we can do this with food and supplements.” So you mentioned a couple of things in your evolution of paleo, but can you talk a little bit more about what you discovered, some of the standard overarching “paleo rules” that, I think now we’ve come away from some of those a little bit more, but I’m sure there are folks who are diving in and who don’t know what the current conversation is around all of this. Can you talk about some of that?

Stefani Ruper: Yeah, absolutely. I appreciate the opportunity to, because you’re right. There has been a lot of progress, I would call it, in sort of opening up the paleo template. Things you’re “allowed” to eat, and again I’m using air quotes. Sometimes I get emails from people, and they say, well I want to eat corn sometimes but that’s not paleo. Or I want to have dark chocolate sometimes, whatever.

There’s been a lot of progress opening that up, and I think particularly with respect to carbohydrates, right? That was a big hot button issue for several years. I’m pretty sure that most of the leading thinkers these days are on board with the idea of carbs being a healthful part of your diet. We may disagree as to how much it should be a part of your diet, but that is one thing that obviously we need to take into serious consideration, especially as women.

So paleo did, and today sometimes does, admonish us. {laughs} It has focused more on a low carbohydrate approach to eating. For women specifically, that’s a little bit unwise, and that’s for a few big reasons that I can point to.

The first is that you kind of need carbohydrates to healthfully and with as little stress as possible manufacture thyroid hormones. Thyroid hormone is really important for just about everything {laughs} literally everything, and most especially for us as women, it has a really big impact on reproductive health. When your body sort of starts shutting down when things aren’t working well, the reproduction system is always kind of one of the first ones to go, because it’s one that if you’re using, it can be stressful for the body.

That’s kind of the first thing we need to think about when we think about women’s health in particular, what were the health consequences of a pregnancy in the stone age, or whatever. Pregnancy is a very stressful time, it demands a lot of energy, and your body doesn’t want you to be pregnant, or nursing, or whatever, in a time of famine, or war, or stress, or what have you. So your body will try to shut down, kind of at the drop of a hat, honestly. It depends for different women how sensitive you are to different stimuli.

Anyway, one of the things that can happen is your thyroid hormone can plummet pretty easily. One way to help keep your thyroid gland working well is to make sure you have a steady supply of glucose to your liver and your blood to help you manufacture thyroid hormone. So that’s one thing.

Leptin and insulin are two satiation hormones that are pretty important for telling the hypothalamus, which is the part of the brain that sort of runs the hormonal show. Anyways, leptin and insulin are secreted when you consume carbohydrates. And they tell your brain and your body that you’ve been fed. And the female body needs to feel like it’s been fed, for the reasons I just stated, otherwise it’s going to shut down hormone production.

As a matter of fact, when hormones are produced in the body, it sort of happens, we call it a cascade, or it’s a ladder or something, and it starts at the top. And your body has to decide, am I going to make stress hormones or am I going to make sex hormones? And if you are stressed out emotionally or physically; physically obviously can happen a number of ways, but I’m talking mostly in terms of calorie restriction or carbohydrate restriction, or excess exercise, or something that’s depriving your body of the energy it needs. It will interpret that as a stress, and it will choose to make stress hormones instead of sex hormones, and that’s just bad.

So, this applies to carbohydrates in particular, like I mentioned, so that’s one thing as women in particular we need to manage, and I like to tell women to start with 100 grams of “dense carbohydrates”. I’m using air quotes again; this is the third time, I’m going to keep a tally. “Dense carbohydrate” everyday. And that would include something like fruit or starchy carbs, but I don’t mean greens. I want a real carb in there. Start with that, and play with it. You can go a little bit lower if you want, but I think that’s probably a reasonable minimum for a woman who maybe has some stress on her plate and is physically active some of the time. So carbs is one big thing.

Because of the thing that I mentioned about pregnancy and the body not wanting to starve, intermittent fasting is probably not a great idea for women. Being sure to refuel after workouts with some carbs and protein, at least an hour after a workout I think can be a really great way to help women make sure that they’re feeling fed, getting adequate calories is really important. Even if you’re trying to lose weight, again, because we want to feel like we’re being fed.

And then there are all sorts of hormonal foods, foods that have estrogens in them. Soy and flaxseed are the really big offenders there. Nuts and legumes, to a lesser extent. If you consume these foods, you need to know that they have a hormonal effect, and maybe monitor it. Some women are much more sensitive to it than others. When I eat; oh god, about a month ago, I had two bags of cashews over the course of 3 days, and I lay in bed and cried for like 4 hours. I was horribly depressed, because they elevated my estrogen levels just enough, and I was particularly sensitive to that.

So those are some really important things. Obviously exercise and proper context is really great. You want to keep your insulin levels low, because that will keep your testosterone levels in check, and when testosterone levels are too high in women, that can be really problematic as well.

So there’s a whole lot there, Diane, but I think I covered the major basics, and I don’t want to do it for another 20 minutes, {laughs} I’m sorry.

Diane Sanfilippo: No, I think that’s great. And I think, one thing I want to mention, this is a pretty common topic we get about women can do hormonally. The first thing you mentioned about not being afraid of carbs; I think we see so often, I see blood work numbers; I don’t have one on one clients these days, but still people are constantly showing me their blood work {laughs}.

Stefani Ruper: {laughs}

Diane Sanfilippo: Whether it’s friends or colleagues or whoever. I’ve never seen someone who eats paleo who eats carbs that are appropriate for them, for their energy level and their needs, I’ve never seen somebody come back with blood work that’s showing negative signs if they didn’t have some other issue going on. I’ve got folks who are showing me their blood work. Triglycerides are the number one thing I tend to look at when it comes to how your carbohydrate intake is working for you. And I think this is a good number to know about, because I think it can help women to put their finger on; am I doing this right, in a sense.

Because if you do get blood work often, especially if you’re concerned about your hormones, and PCOS, and all that, and you are getting blood work done; if your triglycerides are healthy, and I would say a healthy number for triglycerides is 75 and below, if it’s right around there I wouldn’t freak out about it. Your doctor may say 150 is healthy, or 100-150. But if you’re seeing that number come back under 100, maybe more ideally around 75, but anything under 100 then whatever your eating for carbs is fine. If it comes back really low, then that may be an opportunity for you to see, I’ve got some space to eat more carbs.

That’s not to say that you have to be that nit picky about it. I don’t get blood work done that often. I don’t have a condition that I’m trying to manage. I just think it’s an interesting number to look at, because I’ve never seen someone who eats paleo carbs, and does that to whatever degree, come back with unhealthy blood work. I think it’s just this misnomer that eating too many carbs is bad for everyone, and a lot of people I work with are active, or they’re athletes, or they’re women who need more.

The other side of this, too, is I think what you were saying, when people first go paleo what the “rules” were that they were supposed to follow, and people end up eating really low carb. I think they just accidentally do it because they don’t know what to eat.

Stefani Ruper: Mm-hmm.

Diane Sanfilippo: Having carbs available that aren’t fruit; sometimes people feel like, I don’t want to eat fruit all day, because I feel like I shouldn’t. If they don’t have something made, they don’t eat them. Because you can’t just eat a potato raw, or a sweet potato. So it’s like you have to think ahead. I think a lot of people accidentally go low carb. Or they accidentally or spontaneously become hypocaloric. They drop their calories way too far. So if you're listening, and you’re like, well I didn’t go too low carb but I’m still having this problem; if you’re under eating, as Stefani said, just calorie restriction, that’s going to put you in that same state where it’s just your body thinks you’re hungry all the time, and that’s not a good place to be.

So for fertility now, like you were saying, stone age, hundreds and thousands of years ago, we weren’t in the same situation where people are thinking about getting pregnant in the same way, dealing with fertility issues and all of that. It’s really different in a modern world, and we also deal with modern stressors, and I think that’s kind of changed the landscape.

4. PCOS causes and solutions [21:59]

Diane Sanfilippo: So, we’ve got a bunch more questions here. Let’s see; there’s a couple of people who are chiming in together that they’ve got a similar question. They’re interested in what to do when paleo appears to have caused, or exacerbated symptoms of PCOS. She didn’t know until switching to paleo that she even had it, and she gained weight and she experienced some issues with acne, which is the opposite of what most people experience when they go paleo. So have you seen this happening, and what can you say about that?

Stefani Ruper: I’m so excited you picked this question! I was really hoping you would. Ok, I see this all the time. It’s so common. It’s going to be hard for me to answer this question with real specific detail, because I don’t know anything about this particular woman’s own physiology. I think it can happen a number of different ways, and I think that’s generally because I describe PCOS, I think of it this way. Most people don’t, so don’t run to your doctor and tell them you know these things, because I made them up. But I have these ideas of thinking about PCOS that I think are really helpful.

In general, women tend to have PCOS if they are insulin resistant and kind of overweight, and deal with an insulin type gut issue, and that will cause testosterone levels to rise. Because insulin, {laughs} really it’s so simple. Insulin tells your ovaries to make more testosterone. And this will cause testosterone levels to rise, which will cause PCOS. And you have insulin resistance, and that’s sort of your problem. I call that type 1 PCOS.

But then there’s another type of PCOS, and it’s the type that I had, and I call it type 2. This is the PCOS of women who, you may have elevated testosterone levels, but your bigger problem is that your estrogen and progesterone levels, and some other pituitary and sex hormone levels, have fallen, and testosterone levels are normal or stress hormones are high, and that imbalance is what’s causing more of the PCOS type symptoms. Acne, facial hair, low libido, no menstrual cycle; those are some of the biggest symptoms. This kind of PCOS is caused more by starvation, and under eating, and low carbohydrate, and excess exercise, and sort of the problems that I listed earlier that a lot of women run into.

So anyway, when you come to paleo and you have either one of these kinds of PCOS, it’s also possible that hypothyroidism is playing a role with PCOS, but I see less problems with that in paleo than in these two types. So anyway, you can go paleo and say you go paleo for example, and you stop eating carbohydrates. That could, A, that could tank your thyroid, which could cause PCOS. It could cause a bit of a stress hormone response, because you’re under eating carbohydrates, and that would cause your stress hormones to go up and your female sex hormones to go down, so that’s like type 2 PCOS. And so dramatically reducing your carbs, if you go paleo, can cause PCOS type symptoms.

Losing weight at a rapid rate can also cause PCOS type symptoms, because it’s probably a little bit stressful for your body, and you might be exercising a lot, and you might be under eating calories. Again, I don’t want to broken record this, but we’re bumping up again against that female problem of denying the body the nourishment and the fed state that it’s looking for. So under eating carbs can be big, under eating calories or dropping weight on paleo can be big, over exercising can be big.

There’s a few other things that I think can sometimes happen. If you jump to eating really high protein levels {laughs} when you go paleo, because sometimes women do that. And by really high, I mean definitely in excess of 1 pound of protein a day, maybe 1.5, that sort of thing. Your homocysteine levels can jump. Homocysteine is sort of a byproduct of protein metabolism, and it needs to be cleared by the body. It’s a little bit toxic, and the body has natural mechanisms by which to do that, but if you throw your homocysteine up too high too fast, high homocysteine is associated with PCOS.

And there’s a little bit of a question of chicken and egg; which causes which, and there are good arguments on both sides. But if it happens to be the case that you did do this, you went super high protein right away, just sort of cut it down, I think below 1 pound, maybe greater than half a pound, but definitely below 1 pound of protein every day, that’s 16 ounces, I think that’s probably a good place for most women to be.

Another thing that might cause PCOS symptoms is really high saturated fat intake. Some women’s hormone levels are really low, maybe from being on a vegetarian or a vegan diet, or a no fat diet, and then you go paleo and if you start eating a lot more fat, you’re giving your body more substrate out of which it can make hormones. If your hormone levels are going to be imbalanced because you're inflamed or any of the other reasons we’ve discussed that you might have hormone imbalance, all of a sudden your body can make more of them, and your symptoms might escalate. Your body might find it easier to make more testosterone.

I mentioned saturated fat in particular only because, well it’s a particularly good substrate for making hormones, and also, if you’re eating saturated fat from animal products, and they come from, specifically if they come from industrial raised animals, and dairy products, then there’s a good chance that there’s a fair bit of hormones in there, and so that can sort of play a role too. But there’s no real clear science on that; there’s no statistics I can point to. So that’s a little bit more hypothetical.

But in general, the vast increase in fat intake could be a part of the symptoms. And that’s not necessarily a problem, so long as you’re eating protein and carbohydrates as well, but it does mean that there’s probably an underlying health problem that you now need to address, whether it be insulin resistance or inflammation or some sort of gut problem. Any of these things which can, in their own way, cause PCOS.

I think those are; I don’t know, that’s a lot of reasons, but I see women coming to PCOS in paleo from different directions, so I kind of wanted to hit all the bases.

Diane Sanfilippo: I think one of the big kind of overarching topics that emerges from what you're talking about there, and from even looking at a lot of the questions, is that when women make really big changes to their diet or lifestyle, it has a profound effect on our hormones. Sometimes positively, but generally not. Generally, any major change is going to shake things up.

We see it all the time with people who do a 30-day paleo challenge, or even they see it on the Sugar Detox sometimes, if you go too hard too fast, which is why I created levels for that program. I don’t want somebody who currently eats cereal and bread and pasta to just go strict paleo on that program, because I think it’s too much for the body.

We’ve talked about this on a few other episodes with different women. I think we talked about it with Sara Gottfried, who is a hormone specialist. She’s a gynecologist, and kind of had that same feeling, that when we shock the body as women, it’s not really a good idea. It’s just too intense for our bodies, and the hormone balance that we’re looking for, it’s delicate. And when we try and shake things up like that, it’s not always going to give us a good result.

I think a lot of what we’re talking about, it’s not that everything that Stefani is saying that this will happen to everyone, but it’s like, if you’re struggling and if there’s something going on, these could be things that you’ve done or you’re experiencing right now. You know what I mean? Somebody who goes paleo who increases their fat and their protein, drops their carbs, and feels great and has no issues? Great. {laughs} We’re not saying that’s going to cause PCOS for everyone, but like you just said, Stefani, if there’s kind of an underlying issue there, making these changes and having that drastic increase or decrease in one way of healing yourself versus another could totally throw you out of whack. And that’s really what we’re talking about here.

Stefani Ruper: Yeah, definitely.

Diane Sanfilippo: I just think it’s important to note that. Because these questions really are coming from women who are dealing with these imbalances. I don’t like to create hypochondriac. {laughs} I went through nutrition school, and it’s like, you go through school and you feel like, I’m sure medical doctors have this experience sometimes too. You go through, and you’re learning about something, and you’re like, do I have that? I’ve come through all of this, and I’m like, I don’t have those issues, and I’m very fortunate. But I think for a period of time, {laughs} we all think, I have this or I have that going on. It’s really interesting stuff.

5. Endometriosis [31:41]

Diane Sanfilippo: So, let’s just see if there’s one other quick question here on the hormonal stuff, because I know you and I love to talk about body image and the mentality we have around that, so I definitely want to make sure we leave time for that. Let’s see, there’s a question here; “I’m curious about Stefani’s take on endometriosis. I read a blog post of hers which seemed to recommend the autoimmune protocol, though I haven’t been able to find a clear consensus on whether the disease is autoimmune in nature. It seems like a topic under debate. I’m wondering if Stefani has anymore thoughts or information regarding endometriosis and natural approaches to managing it since she wrote that post. Great guest, I’m excited to hear this episode.

Stefani Ruper: This makes me want to leap to my computer and find the post and read it so I can respond adequately. So, it’s funny, there is a lot of debate on endometriosis, and my first opinion on the matter was that it is not an autoimmune disease. I was feeling pretty good about that, and there’s a lot of debate in the medical community as well, but Sarah Ballantyne was like, nu-huh, that’s an autoimmune disease. I was like, alright. {laughs} Sarah Ballantyne, she’s the queen of autoimmune diseases.

I have seen an autoimmune protocol work for women with endometriosis, or who come to me and tell me they have endometriosis. That’s just something that has been reported to me that that happens .I personally don’t have endometriosis, so I can’t report my own experience.

My favorite theory on endometriosis, honestly; I recognize that it may be an autoimmune condition, but I prefer to think that rather it’s a state of immune insufficiency. And it’s tough, because autoimmunity and immune insufficiency can very well go hand in hand, and that’s why researchers have had such a hard time pining down how much antibodies are playing a role in endometriosis and what specifically that role is.

So, endometriosis, for everybody out there who does not have this condition, and/or doesn’t know what it is, is when tissue, reproductive tissue, gets planted in places where it’s not supposed to be. This is not a whole lot of fun for women who have it, because it means that all of this tissue becomes inflamed and sort of does the whole reproductive dance. And so it gets inflamed at the time of the month, it can cause really bad cramps. That’s the primary negative symptom that women experience, but they can be really debilitating cramps. And they can show up all over the place. Anywhere in the abdominal cavity, really.

Ways to treat this are to support the immune system. One, you could try an autoimmune protocol and see if that helps get your immune system back on track. You could support the immune system, vitamin D is great, fat soluble vitamins A, D, and K. Zinc is fabulous, copper is important, as well if you're supplementing with zinc, if you chose to supplement with zinc.

Zinc is found in meat products and seafood; you know, oysters. So most paleo dieters tend to get adequate zinc. But supplementing with it has been shown to be really helpful with a lot of things, the least of which being acne. That might be the one that I’ve seen the most success in, though it’s not quite related right now. It’s great for supporting the immune system, it’s important for some molecules in the immune response. I’m not just, I don’t want to throw supplements at you, I hate doing that when somebody has a health issue, but those are some ways generally to support the immune system.

Of course, I love sleeping, I love stress reduction, I love hugs. There have been studies that show people who hug a lot are much more resilient to illness. Some body contact, some hugs and some sex could not do you wrong there. So you could support the immune system.

It’s also up for debate the role that estrogen plays in endometriosis. Does high estrogen cause endometriosis? Or is it a result of endometriosis? In either case, doing whatever you can to restore estrogen/progesterone balance, and sort of getting estrogen levels in line, because estrogen levels tend to be elevated with women with endometriosis, will definitely help. And there are a lot of ways that you can do this.

Smart exercise, a couple of sprint workouts a week, some weight bearing exercise, that’s really helpful for clearing estrogen out of the body. Perhaps switching birth control or getting off hormonal birth control; that could be a really big help. Although, many doctors to prescribe birth control to help control hormone levels in endometriosis. So, that’s complicated.

You can also help clear excess estrogen out of the body by eating a lot of leafy greens. Make sure you cook them so you don’t get too high a dosage of goitrogens, which are in raw greens. But if you cook them, it tends to even that out. If you eat a lot of cooked greens, that can help support liver detox; that’s actually pretty important. So greens can be really helpful for moving estrogen out of the body.

Then perhaps one of the most important things you can do; I’ll tell you to reduce stress all day long {laughs}. Sometimes I wonder if that’s the only thing I should tell people to do; I don’t even, just reduce stress. I just read an article about the women who lived the longest ever, and she smoked cigarettes all the time, but she was happy.

Diane Sanfilippo: {laughs}

Stefani Ruper: Obviously that’s not proof, but it does sit in my head. There’s a lot of research about stress; so reduce stress. And finally, reducing inflammation is really, really good for managing endometriosis. And we can do that a lot of ways, right? We can help balance our omega-6 fats by reducing them, and perhaps increasing our consumption of healthy omega-3 fatty acids from wild fish or some fermented cod liver oil, reducing stress, reducing sugar, right? Probiotic foods are great; anything that will help reduce inflammation will be helpful for managing endometriosis.

And I say manage because, really, again, supporting the immune system will help. So the immune system is supposed to get rid of this excess tissue. It’s supposed to prevent it from implanting itself in your abdominal cavity in the first place. If it doesn’t do that in the first place, there’s debate about how much strengthening the immune system will help get rid of it. But if there’s anything, that’s a good bet for getting rid of this endometrial tissue around your abdominal cavity, it’s strengthening your immune system.

It’s not easy, and I don’t think it’s very common. Most women just end up managing the inflammation and the hormone imbalance, whatever. Managing those things to control the negative side effects of endometriosis. And that’s sort of what I think. Again, the literature is not super clear one way or the other. I have seen autoimmune protocols work, but I also haven’t. Which is why I like to treat it more in a way of supporting the immune system.

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Diane Sanfilippo: So, a lot of what you were talking about with immune system support, if folks listening have a copy of Practical Paleo and you flip to the autoimmune protocol or the autoimmune meal plan that I have in there, where you were talking about ways to get different nutrients in like zinc and copper and all the immune supporting nutrients, I have a whole list of supplements that you can consider if you want to.

I generally like for people to do that if they’re working with a practitioner; I don’t generally like for people to create a cocktail of supplements for themselves, but I wanted to put that information in there so you would know what they do, because if you have a practitioner who recommends them, 9 times out of 10 people would come in with a bag of supplements, and they don’t know how long they’ve been taking it, why they’ve been taking it, what it does. I really wanted people to understand what these nutrients do in the body, and specifically for that condition, that type of condition, but also there’s a whole list of supportive nutrients and foods that contain them. So some of what you were talking about, I think people will be able to find it right there in the meal plan. So that should be really helpful.

I’m with you on the stress thing. I think 80% of the stuff that we deal with, it’s not just about the food. I think so much our food is, it’s so easy for us to control sometimes, and I think that especially as women, we are quick to say, well what can I change about my diet and my exercise, and we don’t want to give up those things that cause so much stress in other parts of our life. So the thing that we’re doing with food choices that may or may not match up to what we want our body to look and feel like and how healthy we want it to be, if they’re not helping us, they’re stressing the body, right? So if we’re eating too much sugar, it’s a stress to the body. But you know that there’s plenty of people, like you said; we know that smoking is a stress to the body. But what’s the rest of the capacity, or the insult of stress that that person has.

So this woman that you were talking about; the rest of her stressor impact was probably really low. And so for her to smoke on top of nothing else being a stressor, it was probably no big deal. But for those of us in a modern world dealing with, I’m sure there are folks taking kids to a million different types of activities and over committing ourselves, over committing our own activities, saying yes to everything and wanting to be superwomen or supermom or superdad even. Whatever we have going on, I think that those are stressors that people just don’t want to own up to.

It’s easier to take responsibility for the food on our plate, for this community. You know what I mean? There’s plenty of folks out there who do not want to take that responsibility {laughs} and are not ready to change what they’re eating, but for people who are listening to this show, we love that when we give you recommendations, you’re so quick to say, ok I’m going to change my food, I’m going to try this new superfood, I’m going to try the cod liver oil, I’m going to try the sardines. I love watching people eat more sardines.

But, I really do want to continue to create that environment where, taking time off from things, watching more TV than you should, or taking more walks than you feel like you have time for, or whatever it is that relieves stress for you. I don’t have a problem with someone watching TV to relieve stress. I think, whatever. Whatever you like; do what you like.

Stefani Ruper: Mm-hmm.

6. Body image talk [44:15]

Diane Sanfilippo: So let’s talk about some body image stuff, because this is huge and it really goes hand in hand. We’ve got women who are maybe dealing with PCOS right now, or just weight loss resistance, so something that’s confusing. We’ve definitely had some questions. What are some tips that you have on how to love and accept your body without trying to change it all the time. Or I think, loving and accepting it right now, whether you're on a journey and it’s in the process of change or not, whatever is going on. What do you want to say to people about that?

Stefani Ruper: Wow, what an enormously open ended question!

Diane Sanfilippo: That’s a big question.

Stefani Ruper: Yeah. So, where to start.

Diane Sanfilippo: Let’s take it from the perspective of the woman who is dealing with the stuff. She’s trying to figure out if she’s got a hormonal imbalance, is it PCOS, what type is it, this woman who’s in that scenario right now, and is just feeling uncomfortable in her own skin, whether it’s an extra 5 or 10 pounds, or 20, 50, or more. It’s just, you're dealing with the stuff and trying to figure it out. {laughs}

Stefani Ruper: Ok, cool. {laughs} So, there are a lot of things that I could tell you that I would encourage you to think about. As a preface to this conversation, if you haven’t noticed this already, I’m a real, like in my head, kind of person, and it’s very hard for me when people say, give me practical tips! I’m not good at that. I’m like, write stuff down. So I will give you some ideas to help you think about some things. And this is a mental shift that needs to happen, so it’s all about cultivating these ideas, thinking about them, deconstructing the bad ones you have and building up the good ones. It’s a mental practice, so it really does take time to rethink things, and to continually shut down the bad stuff and learn how to build up the good stuff.

So here is some of the good stuff. In this particular situation, for any particular woman who is struggling with a health issue, with weight, with appearance issue, with any kind of issue with your body. Me personally, I am always, always frustrated with my body. It’s much better now than it used to do, but I deal with a lot of crap. {laughs} I deal with a lot of crap. My body doesn’t sleep very well, it holds weight really easily, it gives me migraines. It’s not really good at a lot of stuff. But here’s the thing; for everything I think my body does wrong, it does about a million other things right. I can’t even. I can’t even begin to label to tell you all of the things that your body does right.

For example, it breaths, right? That’s really remarkable. You have a respiration system that works. And your heart beats, and all of these different things. And you’re probably capable of moving, even if it hurts a little bit, or not as much as you would like, and that sort of thing. And you can laugh, and you can think, right? You have a mental life. So your body does some really amazing things. And this is because your body is doing its best.

I think this is the number one rule for women to learn, and internalize, and just know so naturally and intuitively, it’s the most important thing. That our bodies are doing their best. They’re natural bodies, and they’ve got a set of genes, and they were born into this world. And maybe the genes put us at a little bit of a handicap or whatnot, but the world is not easy. {laughs}

The world is not easy for a lot of reasons. Because of the foods that we were fed growing up. Because of the stress we may have endured as children, or as adults. Because of all of the messages we get from the media. And you end up getting to a place where your body is a little bit beat up; it’s rough around the edges. That’s what happens. But it’s constantly doing its best to be healthy. That’s what bodies do; they repair themselves. That’s literally the function of every single cell in your body, is to make itself run as well as it can and help other cells do the same. It’s all about repair. And your body is doing its best.

It’s not it’s fault, necessarily, and it’s not yours, either, that things have sort of gone wrong. Even if you’ve eaten poorly your whole life; that’s not your fault. You didn’t know better. And even know that maybe you know better and you still kind of eat bad sometimes, that’s ok too. All of these things are because of things that have happened to us. Bad things, painful things, psychologically and physically. And your body is doing its best.

When you think about your body as this organism that’s trying to make you healthy; you almost can’t help but be grateful. It might not be winning the game, but it’s doing its best, and it’s making an effort. And I can’t help but appreciate that, no matter how many migraines I get a year, no matter how hard it is for me to travel because my sleep is messed up. All of these different things.

Then you get to a state in which you can look at where you are right now in this very moment and be like, ok, so I’m 50 pounds overweight, I might have an autoimmune disease, I don’t really know what’s going on, and that’s frustrating. But my body is doing its best, and my body and I are going to work together to figure this out.

So you don’t have to be trying to heal things if you don’t want to. Maybe the best thing for you right now is to chill. Stop trying to fix things. But maybe you do want to fix things, and you’re like, ok this is obviously going to take some time, it’s going to take patience, and it’s going to take healing. But my body has got a code written in it for fixing, and healing, and all of these things, so I’m going to figure that out. And it can take time. But when you acknowledge that your body is trying, you can forgive it for not being perfect, because it’s doing its best. And you can accept where you are, because it’s done its best. And you can have patience, because it’s still doing its best!

Diane Sanfilippo: {laughs}

Stefani Ruper: And that’s kind of like the groundwork. I think that’s a really good place for us to start with this case study woman we’ve created. And then a lot of the positive things can come out of that thought.

Diane Sanfilippo: I love that. You’re bringing the balance, the thought process balance that Liz usually has on the show.

Stefani Ruper: {laughs}

Diane Sanfilippo: And I’ll bring the practical, what I think, what is something very specific that I think women can do to help this, and I’ve seen this work for me, and I have my own struggles with all of that stuff too. Not so much with an issue of a disease going on; I don’t know what will be in my life at some point, but body image issues and just kind of my own struggles and stress and all of that.

I think the best advice I have on that is to stop criticizing and judging other women, or just other people in general based on how they look in the body they’re in. Because you just don’t know their journey. You don’t know how far they’ve come, you don’t know what they’re dealing with or where they’re going. I think that’s huge, because any moment that you catch yourself criticizing or judging, or even wanting to compliment another body that you like.

It’s not a bad thing to give a compliment, but recognize that you don’t even know what’s going on behind the scenes 99.9% of the time. Because you might think someone looks great, and they’re sick on the inside. You just don’t know. It’s not that I want to tell someone not to compliment someone, but I almost do. I almost want to say, don’t say anything. Because you don’t even know. You don’t know what might be offensive to somebody, or feeding into a negative habit that they have. Somebody who is starving themselves, and constantly getting praised for looking great if people think they look great, and who knows what that’s going to do. I kind of feel like, mind your own body, and just leave it at that.

It’s hard; I’m not saying we’re all going to be great at that, but I think it’s really important. And any time we get down on that, I think like what you said about all the great things that our bodies are doing. If I ever catch myself in a moment where I’m not feeling great about it, I have to just be so thankful for being well, or so thankful for what I’m able to do.

I was cursing my foot for having a splinter in it for a week, or two, or however long. I was like, I’ll never take walking without pain for granted again. Just being able to put my two feet on the ground and walk normally, one foot after the other. The day I got that splinter out, I was like, oh my gosh, I’m so thankful to be able to do this. I don’t know, it sounds crazy, all your heady internal stuff. But it’s true. I think it just changes things.

My other thought there is, if you’re in a community that makes you feel not good about yourself, get out of it. If you’re somehow surrounding yourself with people who are constantly making you feel bad about your body. I don’t mean that they’re saying things to make you feel bad; I just mean, your head is getting in a bad place about it. Just remove yourself, and that’s the thing that kind of goes back to what we’re willing to do. So often we’re willing to add something; we’re willing to eat more of this, we’re willing to take a supplement, but we’re not quick to say, ok, I’ll stop doing this thing that’s hurting me. And if it’s hurting you emotionally to be in an environment that doesn’t work for you, emotionally or physically. I think that’s kind of important stuff to think about.

Stefani Ruper: It’s like the most important stuff to think about. It really is, and there’s a lot of debate in feminism and body image and stuff whether it’s a better idea to mindfully practice how much you love your body, which is sort of what we were just talking about, well, what I was just talking about; or to help you stop thinking about it so much. When I am feeling ugly {laughs} when I’m feeling bad about the way that I look, sometimes it’s good for me to be like, oh, yeah, my body is just doing her best, and that’s pretty awesome. But it’s also so important for me to think about the things that I value in the world, and my purpose, and all of the amazing things that I identify with and that I do, and that removes me from being stuck in the particulars of my tiny, you know, pinching the fat on my hips or you know {laughs}.

Diane Sanfilippo: {laughs} Yeah.

Stefani Ruper: Squeezing zits in the mirror, or whatever. But you also care so much about love ,compassion, and justice, whatever. And you’re working towards helping advance those things n the world, {laughs} can we just compare those two things for a second.

Diane Sanfilippo: Yeah.

Stefani Ruper: A zit on my chin to justice?

Diane Sanfilippo: Yeah, sometimes it’s like everybody just needs to get over themselves about this, right? There was an article, I don’t think I read it, I saw it going around just kind of your body is not your masterpiece.

Stefani Ruper: Yeah, your life is.

Diane Sanfilippo: Yeah, I just thought this was such a great concept. I’ve seen some stuff with images of women post pregnancy where they’re like, I have this loose skin, or I have these stretch marks, and they’re like, whatever, my body just made this whole other body. You know?

Stefani Ruper: Mm-hmm.

Diane Sanfilippo: Gaining perspective on it in that way. I have not had children, it’s not in my plans either, but even taking one to two years to create my book baby, I sacrificed a lot with my body that I still haven’t gotten back to how it was before. And it sounds crazy to compare those things, but the mothers who are authors have told me that it’s ok to compare them, because they’ve said they’re very similar {laughs} although you are not then raising a child.

But, there was sacrifice that happened physically from me, not just emotionally, and knowledge wise to get Practical Paleo done. It was like, it was a physical breakdown for me. And I’m not putting that on a pedestal to say, oh I’m so great; I sacrificed… No. I wasn’t great at managing my time, I’m terrible at it, I procrastinate, I do things when they need to be done. I’m just not the best at that. You know what, I’m good at other things. {laughs} But that is something that, instead of my body over the last few years being my masterpiece, it’s like, whatever. I put out this thing that’s helping hundreds of thousands of people get their lives back, and that’s more important. It’s like, come on. This is not the most important thing to see my abs. it’s more important that I do what I’m called to do to help other people, and that each of us really takes inventory there. I’m not against people wanting to work on how they look, I just think we have to really balance that. And if we’re getting too caught up with it; just check yourself there. You know what I mean?

Stefani Ruper: Mm-hmm.

Diane Sanfilippo: Just don’t do that, especially if it’s digging a hole for you. Because that’s definitely been a struggle that I’ve had, where one picture that I see of myself. I could have been feeling great that day, and I see a picture that I feel like, that’s me? That’s what I really look like? And I think I look not great, or fat, or something. Some stupid; I can say it now, it’s like crazy to think that. But it can send me into a hole. It can be tough. And I think all of this stuff feeds together, like you said. What if you eat some things that just don’t work well for your hormonal balance, and you eat too many cashews and it makes you depressed {laughs}. All of that can feed into each other, but at the same time, I think getting out of our own way is really helpful.

Stefani Ruper: Yeah.

Diane Sanfilippo: We’re coming up here on a whole hour of discussion. Anything you want to leave our listeners with here, as we wrap up?

Stefani Ruper: Oh goodness, I don’t know. I think we ended on some pretty good notes. Love is awesome, and reducing stress is really important .And also paleo. {laughs}

Diane Sanfilippo: {laughs} You’re hilarious.

Stefani Ruper: But be happy. But also paleo.

Diane Sanfilippo: {laughs} Also paleo. So, alright, we’ll wrap it up there. This was a fun episode; it’s always fun to talk to you Stefani.

Stefani Ruper: Thank you.

Diane Sanfilippo: I’m excited for a little reunion that we’ll have at PaleoFx, we’ll get to see each other.

Stefani Ruper: Mm-hmm.

Diane Sanfilippo: That will be a good time.

Diane Sanfilippo: We have a brand new sponsor joining us this month and that is Tin Star Foods Ghee. As any of you who have been following me on social media know, I’m a huge fan of the product. I don’t generally talk a lot about products that I’m not a big fan of, so I wanted to invite Tin Star to come on and be a sponsor. I’m really excited to introduce those of you who haven’t heard of it yet to this ghee.

For those of you who aren’t sure what ghee is, it’s a clarified butter. So if you’re sensitive to dairy proteins, it’s a really good option. For people who are highly, highly allergic, it maybe for you, it maybe not. I know that Tin Star Ghee is certified as casein free as well as lactose free, but there are some folks who will always be sensitive. So if you’re a little bit borderline and feel like you can handle a tiny bit, which that’s where I am at, I would definitely recommend it. I definitely don’t do well with butter, and the Tin Star Ghee is fantastic for me. Ghee has been clarified, so the dairy proteins are gone, and I have no problems with it whatsoever. It tastes fantastic, and it’s a very healthy cooking fat. It’s my number one go-to choice for cooking.

So if you’re looking for an alternative to something like coconut oil or other animal fats that have different types of flavors, ghee is a fantastic choice. I just used it this morning to scramble my eggs, and it’s one that I highly recommend. The flavor and texture of Tin Star Foods ghee is fantastic. I absolutely love Hima, who is the owner of the company. She’s is just a really hard working gal getting her company off the ground, and I love supporting her. So I’m excited to have them join us as a sponsor, so welcome Tin Star Foods Ghee.

You can save 15% off any ghee in your order from http://www.primalfoodpantry.com/, that’s the website. So anything that you add to the cart that is a ghee product, she’ll get 15% off for you there. The code is BALANCEDBITES, so check them out. http://www.primalfoodpantry.com/

7. Liz’s Baby Making and Beyond tip of the week: fertility superfoods [1:01:25]

Liz Wolfe: Hey everyone! Liz back with a Baby Making and Beyond tip of the week, of course here with my BMB partner Meg the midwife, Meg Reburn.

Meg Reburn: Hey there, how’s it going?

Liz Wolfe: Hey there. Everything’s good. Last week we talked about coffee and caffeine during pregnancy, and today’s tip is about our top fertility foods. Remember, as usual, we’re not doctors, nor are we giving medical advice or offering diagnosis or treatment. This is just information for you to take to your health care provider.

So as far as fertility foods go; we’ve talked about this a little bit on the Balanced Bites podcast in the past, and I’ve said that as far as building up your nutrient stores, that preconception fertility building time is really, really critical for just transitioning right into a healthy pregnancy. So these are the foods we eat even before pregnancy to really shore up those nutrient reserves in preparation for the early weeks of baby building where a lot of really critical stuff is laid down.

We talk about pregnancy foods and all that type of stuff in Baby Making and Beyond, but we’re talking mostly about fertility foods right now. I think a lot of folks know the basics of what we like to recommend, but for me sometimes we can get into things like the combinations of foods that we eat. For example, for me I really focused on combining iron rich foods with vitamin C rich foods. Vitamin C enhances iron absorption; so that was really effective for me, not just from an energy standpoint. But it was also helpful for me later in pregnancy because I actually ended up with slightly low hemoglobin the very end of the third trimester, which was really interesting. But I knew exactly what to do about it; just get some iron rich foods in with some vitamin C, and all was well. What are your thoughts on this one?

Meg Reburn: I think what you did there was incredibly smart, because it’s not just about what we’re eating, it’s about what we’re absorbing.

Liz Wolfe: Yeah.

Meg Reburn: And by far iron and vitamin C is really important for pregnancy. Having low iron is actually the number one complication in pregnancy. There’s a factoid for you.

Liz Wolfe: Oh my.

Meg Reburn: Anemia. But my tip would be, in terms of fertility, good high quality, if tolerated, grass fed dairy. So if you can do dairy, studies have recently shown that high fat, not skim, not 2%, we’re talking full fat, well sourced grass fed dairy, has been associated with higher levels of fertility. So if you are trying to grow a little baby, this would be a really great thing for you to do. Can I add another fertility food?

Liz Wolfe: Duh.

Meg Reburn: A good old bottle of wine. {laughs}

Liz Wolfe: {laughs} I can vouch for that.

Meg Reburn: A good old bottle of wine and a romantic dinner for two, that is how you make the babies.

Liz Wolfe: I love it. We’ll just leave it at that.

Meg Reburn: I think so; I don’t think there’s much else you can say.

Liz Wolfe: Ok. So that’s the Baby Making and Beyond tip of the week. Hop over to BabyMakingandBeyond.com to sign up for program alerts, and we’ll talk to you again next time. Your homework assignment; a bottle of wine.

Diane Sanfilippo: Alright, well that’s it for this week. You can find Stefani at http://paleoforwomen.com/, right?

Stefani Ruper: Yep.

Diane Sanfilippo: Yep. You can find Liz, she’s still got some stuff coming out over at http://realfoodliz.com/, I think they’ve got some new podcasts out from the, what are they called, Modern Farm Girls? {laughs} I don’t remember the name of all of Liz’s other podcasts. And you can find me at http://dianesanfilippo.com. Don’t forget to join our email lists for free goodies and updates you don’t find anywhere else; you won’t find them on social media or on our blogs. We share lots of exclusive stuff with people who are subscribing on our list, so you can subscribe right on our websites. And, while you’re on the internet there, leave us an iTunes review. We’ll see you next week.