Transcript 

Are Functional Lab Tests Real?! Unpacking The DUTCH & GI Map Tests with Jillian Greaves

Michelle Shapiro [00:00:00]:
Welcome to the pod. I can't wait to explore the magic of functional nutrition and medicine together. On this special episode of Quiet the Diet. We have a very special guest, Jillian Greaves, who is one of my closest friends. She also was one of the very first guests on this podcast and it has been way too long since she's been on, so I'm so excited to have her back.

Michelle Shapiro [00:01:31]:
On this episode, Jillian and I talk about functional lab testing and what that kind of looks like for a client experience, what we're seeing on social media, what we're seeing in the functional medicine world regarding functional lab testing. When we talk about functional lab testing in this episode, we're referring to the GI map test and dutch hormone test. A lot of functional practitioners now are having practices where they're sending people these tests. You're completing these tests at home, and then they're prescribing supplement protocols based on those lab tests. These lab tests are not meant to be diagnostic in nature. They're not meant to provide direct solutions for patient care. They are informative in context, with symptoms, and with a client experience to understand more about root causes that are happening. And what we're seeing a lot of is people are getting lab tests and then kind of being sent on gut protocols or supplement protocols.

Michelle Shapiro [00:02:31]:
And this is what we believe is really not functional medicine at all. So we really wanted to lay the groundwork of what these lab tests are, what they aren't, if people already have interest in them or have completed them before, kind of talking about their experience. And Jillian and I are so passionate about this topic because we are what I would call functional nutrition medicine purists. We believe that functional nutrition and medicine are practices that take into account the whole body and whole life of each and every client. So we don't believe in one size fits all protocols. We don't believe that one lab test can tell you everything you need to know about a person because the person and the client is the most important piece of the equation. In addition to that, Jillian and I are so excitedly launching a functional nutrition mentorship and training program to help to support practitioners, nutrition practitioners, and healthcare professionals on how to approach functional nutrition problems. How do we look at a client in a truly holistic way? And how do we embolden practitioners to help their clients in the best ways possible? This episode is for both practitioners and clients.

Meet Jillian Greaves

Michelle Shapiro [00:03:48]:
If you want to learn more about Jillian and my mutual offering to help practitioners to deliver the best nutrition services possible to leverage all of the academic knowledge they have and really be able to help people, we have a waitlist sign up in the show notes that you can check out. I wanted you to learn a little bit more about Jillian as well. Jillian is a functional dietitian and women's health specialist that provides comprehensive nutrition and lifestyle counseling to women. With a special emphasis on PCOS, hormone balance, and digestive health, Jillian helps identify root causes in her clients and address root causes of hormone and digestive symptoms naturally. Using advanced lab testing, personalized nutrition, and supportive lifestyle therapies as their first line of intervention. Jillian runs a virtual practice and is the creator of the Empowered PCOS program. She has two incredible staff dietitians as well, Izzy and Courtney. And you're going to learn about them and you're going to learn about how they leverage and use functional lab testing as well as how do we myth bust all this information about functional lab testing in this episode? I can't wait to see you in there.

Michelle Shapiro [00:07:24]:
I am overjoyed to be here with one of my closest friends, one of my definitely closest colleagues also, and someone who's already been on the podcast because I cannot get enough of her. Jillian Greaves, I'm so happy to have you back.

Jillian Greaves [00:08:05]:
I'm so happy to be here. I can't believe it's been. I don't even know when I was on originally, season one, like season one, third or fourth episode, literally.

Michelle Shapiro [00:08:16]:
I think it was actually episode four, like of the entire podcast you were on. Exactly. Because I would never, ever have a podcast and not have you on immediately. Because what would the point of it be, Jillian? What would be the point without you? There's none I can't wait.

Jillian Greaves [00:08:30]:
So I'm so excited to be back.

Michelle Shapiro [00:08:33]:
She's back. Jilly, we talk about on a daily basis. We talk about everything we're seeing in the nutrition space. We're talking about everything we're seeing on social media, what our client experience is like. We have one of the most rare and beautiful gem of a relationship because, of course, we talk about life stuff all the time, but we have the opportunity to really go through clinical cases together. We have the opportunity to go through kind of what we're seeing again out there in the nutrition space, too. And so it's always special to have you on because we can talk about, again, speak from that client experience perspective and also from a practitioner experience perspective and what we've been seeing. So the topic we're going to talk about today is something that is very, like, huge part of your practice, but not by any means the only part of your practice, which is functional medicine and functional nutrition testing.

Michelle Shapiro [00:09:26]:
So I'm going to kind of, like, lay the groundwork of this conversation. And then, Jillian, you're going to, you know, really steer the wheel for us today. But there are certain functional lab tests, and many of them are at home tests, where a functional medicine doctor or a functional nutrition nutritionist will send you a test that you will receive at home. You will then submit the test through the mail and receive results back, which your functional medicine nutritionist or doctor will go through with you. Essentially, the tests that we're going to kind of zero in on today are dutch testing and GI map testing. You've been using these tests for many years, Jillian, beautifully. I think you use them in the most nuanced and at the same time, specific way that is the most supportive for clients of anyone I've ever seen, which is why I wanted you to be the person to talk, talk about this. There's a lot of talk on social media about how these tests are not scientifically validated or these tests are, you know, anything in the functional medicine space is snake oil.

Michelle Shapiro [00:10:25]:
These tests are fake. There's nothing like a blood test. And your blood's boiling, as I can see. As I'm looking at you, Jillian, lay the groundwork of what you're seeing around these tests and then just. Just tell us a little bit from that high level of how validated these are and how valuable these are.

Are functional labs valid? How valuable can they be?

Jillian Greaves [00:10:41]:
Yeah. So there's just so much talk about functional lab testing in general, a lot of talk about dutch testing, GI map testing, a lot of controversy, specifically in the social media world and in the health space. So what I will say right off the bat is that, you know, functional lab tests in general, they are different from conventional lab tests. They are very different things. Conventional lab tests are often used to make a diagnosis, to prescribe a medication. It's a much more black and white way of thinking when we're looking at labs and there's a place for both of these things. You know, mind you, in terms of functional lab testing and conventional lab testing, when it comes to functional lab tests, like a dutch hormone test, a GI map stool test, these are essentially advanced specialty tests that are really designed to gather more deeper, more comprehensive information about what's going on in the body. And we're using these to effectively identify root causes or the why behind symptoms.

Jillian Greaves [00:11:45]:
We are using these to assess the impact of nutrition and sleep and stress on what's happening in the body. We're using these to pick up on early indicators of potential disease or to reverse the progression of a disease state. We're not using functional lab tests in this black and white way where we say, yes, you have this diagnosis, or we need to adjust or prescribe this medication. We're really using functional lab testing data alongside a deep clinical assessment, alongside critical thinking skills, treating that unique individual to understand why are we experiencing these symptoms and how can we really support the body using a lot of these natural modalities to bring the body back to balance.

Michelle Shapiro [00:12:34]:
I think the main message that people need to leave with is that if you are not using functional testing with a functional perspective, the tests are not usable. So if you're using functional testing and you're looking at it like conventional medicine, and you're looking at it like you get this thing and you get prescribed this supplement based on this test, you are not actually using the tests effectively. So for people who are very concerned, you, quote unquote, can't balance your hormones, and this is a big, like, contentious phrase these days, there's no such thing as balancing your hormones, which, jilly, we're definitely going to talk about. Um, I think that, again, if the approach is wrong, yes, these lab tests can be leveraged in the wrong way. Starting with that idea. Oh, go ahead. Yeah, starting with that idea. The balancing hormones are the talk a little bit into that.

How do functional lab tests play in balancing hormones?

Jillian Greaves [00:13:29]:
Oh, man, so much controversy there as well. And I think I just have to say, your point about how you use these tests being the most important is I could not have said that better. And that's a big problem where I think both you and I are seeing functional medicine, functional nutrition gain a lot of popularity, which is exciting in one sense. But we're also seeing the overuse and abuse of things like functional lab testing, where it's no better than certain conventional approaches that we often talk about when individuals are over treating the test and getting too zoomed in on a marker that's high or low, focusing on supplements, and entirely neglecting the bigger picture of why. Why are we seeing this? What's happening in the body with the nutrition, the lifestyle. But in terms of the hormone balancing piece, this is another thing that you and I have talked about this a lot outside of this podcast and how frustrating it is. And I will say I see both sides of this. In terms of when certain practitioners are saying you can't balance your hormones outright, that's incredibly dismissive, and I wildly disagree with that statement.

Jillian Greaves [00:14:50]:
But I do understand where certain practitioners get aggravated by this sort of like, broad statement that kind of makes it seem like hormone balance. Is this like standalone black and white destination of like, you flip a switch and your hormones are balanced, or they're imbalanced. And at the end of the day, you know, hormones are complex. They operate on different cycles. We produce different amounts of hormones at different times of the day, at different times in our cycle. And I sometimes the way hormone balance is talked about, it's so overly simplified that I think that grinds the gears of many practitioners. But we cannot deny that hormone imbalance, imbalance is an incredibly real thing, right? A hormone balance, in kind of the simplest way we can put it, is really alluding to the fact that we're producing too much of a hormone. We're producing too little of a hormone.

Jillian Greaves [00:15:46]:
We're not processing certain hormones properly that can drive symptoms. And I think what gets lost in this conversation is just like the complexity of what hormones are and how they operate. But I don't think anyone can deny that imbalances with thyroid hormone production or conversion, that's a hormone imbalance. And we have the ability to effectively balance these things or correct these things. High testosterone, low progesterone, high estrogen issues with estrogen metabolism, low cortisol, high cortisol. These are imbalances that are going to look unique for each individual, but can drive symptoms. And if we can effectively support balancing these things in a targeted way, you know, in a way that makes sense for that unique individual, we can eliminate symptoms, we can prevent disease progression. The idea that balancing hormones or imbalanced hormones is not real makes no sense at the end of the day.

Michelle Shapiro [00:16:52]:
I think if you have the basic understanding that hormones are overproduced or underproduced or poorly metabolized or poorly detoxed. If you want to use that phrasing, you can understand that you can impact change on those things as well. It's not only taking those hormones that can impact them. You definitely believe this, too. But I really view hormones as, like, the end stage of many. Sorry. I really view hormones and where we see them in the blood as the end stage of a lot of different body processes that lead up to that point, which we will definitely touch on today as well. But really, these tests, even a lab or blood lab test, they're snapshots of potentially the overproductive production or under production.

Michelle Shapiro [00:17:41]:
But again, they don't necessarily tell you until you get a functional lab test why the body's doing that. So you. I think it's really interesting to say that you can actually learn from a dutch test why someone might be under or over producing hormones. It doesn't fix it to know that then you have to take the steps to actually do that. But that in and of itself is quite fascinating, I think, for people.

Jillian Greaves [00:18:05]:
Absolutely. And I always say that I think one of the biggest benefits outside of, you know, one of the biggest benefits of functional lab testing, outside of how we use them as practitioners, in terms of being able to deeply personalize recommendations, is the validation for clients and being able to actually see, okay, you know, this isn't all in my head. You know, a lot of our clients have been, you know, chronically symptomatic for a long time and have been told over and over by various providers that all of your labs look normal, it's all in your head. And to be able to take a deeper look and say, okay, this actually makes sense. Let's connect the dots with how this individual is feeling. And it's so validating for individuals that we work with to be able to see that and to have hope for, okay, this is what I can start to do and start to support to effectively address these things.

Michelle Shapiro [00:19:04]:
You know, when I first went to Doctor Kochko, which all of you will have known was like my first toe into naturopathic or functional nutrition at all, he was just repeatedly telling me, your main vice in life is overworking and stress. It is your problem, it is your burden to bear, and it is going to cause much of the health issues you're going to experience in your life. And I didn't believe it until I got a dutch hormone test. And then I looked at it and saw what my stress output was, saw my cortisol output was. Saw my metabolized cortisol was, and I was like, oh, my God. Like, you can visually see stress. I think that is so profound for people outside of just sex hormones. Just the cortisol piece in and of itself is so, so profound.

Michelle Shapiro [00:19:52]:
And what you're looking at when you're looking at cortisol is also the pattern that your body's taking, not only what it is that day, but you can see the subtext of that, too.

Jillian Greaves [00:20:01]:
Absolutely. And I think that's the benefit of something like the dutch test, where you can actually see that diurnal pattern, get a sense of what's happening throughout the day. And it's also not just measuring free circulating cortisol. We're using urine metabolites to actually assess total cortisol output or production from the adrenal glands themselves. We just get a more complete picture of things. There's a lot of talk about the dutch test in particular in terms of the validity of it, but ultimately, which I just think is wild at this point. We can talk about that in more depth if we decide to. But ultimately, when it comes to the concepts with what the dutch test is looking at and testing these things have been around in the literature and research for a very long time, like looking at things like estrogen metabolites.

Jillian Greaves [00:20:59]:
The big difference with the dutch test is that it's using dried urine samples versus a spot urine or 24 hours urine. And because of that, that's where the controversy's been. You know, it's been dismissed, you know, by many conventional providers. Despite the evaluation of these hormone metabolites being well established in the literature, which is just very interesting.

Michelle Shapiro [00:21:20]:
Okay. There's so much that I have to unpack from what you just said that's so critical. Jillian, before we even. I even dive in, what does Dutch stand for? Just so people know, if they've never heard of this test before, if they've kind of heard of it, what does it stand for?

What does the DUTCH test stand for? And what does this test do?

Jillian Greaves [00:21:34]:
Yeah, so, um, Dutch literally stands for dried urine testing. Comprehensive hormones. So it's a dried urine test that assesses sex hormone and adrenal hormone production and also hormone metabolism. When we say metabolism, essentially we're talking about how these hormones are broken down and processed in the body, which is a really, really amazing and interesting thing to be able to look at, because these hormone metabolites are not inert. They have significant impacts in activity, and they interact with hormone receptors in the body, and they can tell us a lot of information about an individual's symptoms. So that's kind of the dutch test in a nutshell, and it's really a valid clinical lab test. Precision analytical. The company who created the dutch test extensively has validated their testing, and there's been several published studies in peer reviewed journals looking at the validity of the dried I urine collection versus the spot urine or the 24 hours urine.

Michelle Shapiro [00:22:47]:
So, yeah, so the dried urine part is extremely fascinating, and what I think differentiates it. And I think, you know, what's really, really cool, Jillian, is just from this really high level conceptual level, a lot of the hormones that are studied in the dutch hormone test are not active in what we're looking at. Like, cortisol doesn't mostly. I don't know what the word I want to use. It doesn't mostly live in the blood, so to speak. So when you're getting a blood test of cortisol, you might be able to, like, you're saying, do a spot urine test or a blood test, but it doesn't really tell you anything else except for in that moment, that's what was there, right. What I think is just, like, can't be overstated from a coolness factor, is that when you're looking at the urine, you can basically, like, almost. You're almost, like, seeing the past, right? You're almost seeing, how did this breakdown get to this point? So that's what it is, these end stage metabolites.

Michelle Shapiro [00:23:43]:
So that's what I want people to really understand and hammer in, is that, um, I don't know what the validation would need to be on. This is quite literally showing you, basically, if you can look at the end, what happened to get from point a to point b, and that's really what a Dutch looks at, is for all of these hormones we're talking about, it looks at, it started here because it ended here. So you can say, oh, it might have done something funky in the liver, or you didn't have enough of this vitamin to take it from this point. So you can see if it's built up, and if your urine is built up in one thing, it tells you a story of what happened along the way, which is really, I think, just fascinating on an overall level.

Jillian Greaves [00:24:23]:
It's so fascinating, and I think a great example of that on the dutch test is with this kind of dynamic can happen with women that have pcos. Don't have pcos, but it's something that we'll see commonly in women that have pcos or polycystic ovarian syndrome. You could have normal testosterone production or even low testosterone production. But if we are processing or breaking down our testosterone in a certain way, it can create very androgenic metabolites that can lead to androgenic symptoms like cystic acne, particularly along the jawline, hirsutism or unwanted hair growth, head hair loss, oily skin irritability. And if we're just relying on a one off blood test to look at testosterone or we're just measuring free testosterone and that looks normal or low, and someone's experiencing all of these androgenic symptoms, they're often dismissed like, everything looks normal, try birth control or try spironolactone or accutane or whatever it is. And if we can actually assess some of those endpoints, those downstream metabolites along with the production, we can say, okay, this isn't a production problem. This is a metabolism problem. Why are we converting high amounts of this testosterone into a more potent androgen? Is it related to inflammation? Is it related to insulin issues? Is it related to stress? Just to give an example of what that might actually look like, I love that.

Michelle Shapiro [00:25:59]:
I think it would be helpful for people to even understand how hormones work, because I think that a lot of times we're just like, oh, you take bio identical hormones that goes into your blood. That's it. Can you take us through a little bit of the lifespan of, like, estrogen, through the cycle, through detox, and just like, kind of walk us through, like, estrogen? Let's grab estrogen as an option and a thought in a woman's body.

Describe the lifespan of the hormone estrogen and how it works

Jillian Greaves [00:26:23]:
Yeah. So to. I'll try to make this not, you know, 45 minutes. Not overly complicated. Yeah. So in terms of estrogen, we have estradiol, which is our main, most potent estrogen. We also have a couple other types of estrogen that we produce as well, estriol and estrone. Estrogens are produced from androgen hormones, and they are produced predominantly in the ovaries.

Jillian Greaves [00:26:53]:
Estrogen is also produced by adipose tissue, but predominantly estrogen is going to be produced in the ovaries. A lot of hormone production across the board. It starts in the brain, right? So we're talking about the hypothalamus, we're talking about the pituitary gland, and kind of communication happening between these glands in the body and messengers or signals that they're sending out to other organs and systems in the body to produce hormones. So estrogens are going to be produced in the ovaries. And this production is not just something that looks the same every day, day in, day in, and day out. We produce increasing amounts throughout the menstrual cycle as women, and we sort of hit a peak amount of estrogen that we produce mid cycle, which stimulates ovulation. We get a decrease with estrogen right after that, and then a little bit of an increase with estrogen again throughout the remainder of the cycle until we get our period. So that's just total hormone production.

Jillian Greaves [00:27:58]:
What else is happening here is that the estrogens we produce, these estrogens have to be broken down and processed in the body. And this is going to involve a lot of different kind of systems and factors in the body, but this is really predominantly going to happen in the liver. Estrogens are going to be broken down in the liver, and they're going to be broken down into various metabolites. Do you want me to talk a little bit about the metabolites, or is that getting too into them?

Michelle Shapiro [00:28:28]:
I think definitely, yeah.

Jillian Greaves [00:28:29]:
So estrogens are going to be broken down into one of three metabolites. We have two oh metabolites, we have four oh metabolites, and we have 16 oh metabolites. Two oh metabolites are considered the safest or most preferred or protective estrogen metabolites. We have four oh metabolites, which are more inflammatory, more proliferative. So we don't want as many of these four oh metabolites. And then we have 16 oh metabolites that are. It's kind of a Goldilocks metabolite, where we do need some of these metabolites for growth in terms of things like bone density. But we don't want too much of these 16 oh metabolites because they can contribute to the growth of things like fibrocystic breast tissue.

Jillian Greaves [00:29:19]:
16 oh metabolites are a really big factor in endometriosis. Heavy periods, painful periods. Our estrogens are broken down into one of these three metabolites when we can take a look at what's happening with estrogen detox, this first phase of estrogen detox in the liver, we can consider, what are we seeing here? How is the body breaking down estrogen? How does this correlate with what my client is experiencing? What do their periods look like? What does their skin look like? What is happening with their mood? What's really happening throughout the entire menstrual cycle? It can help us to identify opportunities where we might be able to actually shift or optimize estrogen metabolism. What a lot of people don't realize is that these things aren't set in stone. We actually have really a profound impact on our body's ability to metabolize and detoxify and break down estrogen and other metabolic waste products with nutrition, with lifestyle. If we identify that, okay, this person has endometriosis, they have gnarly, heavy, painful periods, really clotty, and they have a super high preference for 16 oh, metabolites, we can start to support this and we can start to think what in our diet might be lacking that's creating more of this preference. What does our exposure to endocrine disruptors look like? Or chemicals in the environment that mimic estrogen? What does our stress look like and how might this be impacting estrogen? Detox. So does that make sense?

Michelle Shapiro [00:31:07]:
It sure makes sense to me, and I'm definitely thinking it's making sense to the listener. This is where that balancing hormones piece comes into play, right, where it's tangible. So there's a very big difference into you trying to shuffle into one type of estrogen metabolite or kind of direct the body no go this pathway, this is the way that's going to help you the most. And there's ways to do that. Then just arbitrarily saying, oh, so you need to eat broccoli. I mean, that's a little, it kind of would help a lot of this to eat broccoli, but. But then just saying eat broccoli, or, you know, take a dim supplement or something like that to specifically help break down or, you know, shift estrogen, you don't really know which pathway the estrogen's going down, why it's building up in that metabolite, unless you really see that dutch lab test. And that's really the value of it, is that there are arbitrary get rid of estrogen dominance sentences on social media.

Michelle Shapiro [00:32:05]:
And that is not true either, because you don't even know what estrogen dominance looks like in what metabolite. Where is it going? Jillian? From a visual perspective, I guess I view the liver as kind of this repackaging factory, essentially. Why would it matter if we weren't able to effectively get rid of estrogens or if we were shunting into the wrong type of estrogen metabolite? Why does that matter?

Jillian Greaves [00:32:31]:
Right. Great question. So, you know, if we're not kind of effectively efficiently breaking down estrogen. So I described kind of phase one estrogen detox or metabolism. There's going to be another phase, you know, that these metabolites go through in terms of getting broken down in the liver or phase two estrogen detox. And then ideally these are going to be packaged up to Michelle's point nicely, and they're going to get eliminated from the, the body predominantly via stool. If there is a breakdown in this process at any point, it can lead to symptoms of high estrogen because we're not breaking these things down efficiently. We could have, for example, maybe the breakdown is actually in the gut and we're getting like the reabsorption and recirculation of estrogen waste products.

Jillian Greaves [00:33:19]:
Maybe the breakdown is with that phase one estrogen detox that I described, where there's actually an issue with what metabolites we're producing, and we're way overproducing metabolites that are driving a lot of symptoms, inflammatory symptoms or symptoms related to those growth metabolites I mentioned. We really need every piece of this process to be working properly. Otherwise, we essentially, for a very simplistic way to put it, we create like an estrogen backlog in the body. And exposure to estrogen waste products, high levels of estrogen is not a good thing from a day to day symptom perspective, but also in terms of thinking about long term health, right?

Michelle Shapiro [00:34:06]:
So just want people to really hammer this idea and that the existence of having estrogen end products and metabolites floating around between different parts of your body can create symptoms. So that is really what the problem is. It's not only having too much estrogen produced in the first place, it's that if you're not effectively removing it, you can have symptoms. There's something so frustrating about the body in this way, Julian, the complexity of this machine, by the way, sometimes where it's like, why can't it just be that the brain just senses, oh, we need more estrogen or less estrogen? Why does the brain do this? And why don't we have the materials then to break things down? Tell me a couple of the ways why this process can get so murky and why we're seeing these crazy rises in not only conditions like PCOS syndromes, like PCOS, but also in all autoimmunity. Like, where can this whole thing get wonky?

Why are we seeing a rise in conditions in PCOS symptoms and autoimmunity?

Jillian Greaves [00:35:05]:
Oh, man. I think some of the biggest factors that are impacting the body's ability to kind of, like, self regulate, you know, first thing I think about is just stress, right? Which is, you know, so pervasive for most of us, you know, in our modern world, physical stressors, emotion, emotional stressors, environmental stressors, and these things are going to, you know, interfere with this, like, orchestra and symphony that hormones are, you know, stress is going to impact communication between you know, the brain and the ovaries, the brain and the adrenals, the brain and the thyroid. So, you know, don't, don't get me wrong, the, you know, the body is incredibly intelligent and designed to be able to adapt and to be resilient. But I think in our modern world, there's just a lot kind of working against how our bodies natural, naturally operate. So I think stress being a, you know, huge one and then, you know, a couple other really big factors that come to mind for me are things like, you know, disruptive circadian rhythms and, you know, lack of sunlight exposure, you know, too much exposure to blue light, nutrient depleted diets and just not having the basic raw materials that the body, the liver needs to actually produce adequate amounts of certain hormones and then to process those effectively. But I think the point here being that we can support the body with these things and provide the body with these things and it's not always as complicated as it sounds like we're getting into the weeds talking about this hormone physiology and the dutch test here. But ultimately, at the end of the day, a lot of it can come back to the foundations of what we are supporting the body with, nutrition, lifestyle wise. At the end of the day, yeah.

Michelle Shapiro [00:36:58]:
I'm winking at Jillian when she says foundations because, you know, Jillian and I love the nerdy, nerdy deepest science, like most, you know, specific study you could ever find, but both of us who work with totally different client populations over our careers, we always found that no matter what, what you're going to find in that dutch test, what you're going to find in that blood lab, what I'm going to find in my client's symptoms are going to come back to foundations of health. So while, you know, again, when I see those posts online that are like, you can balance your hormones using, you know, whatever it is, like some, if those things are targeting a foundation, they'll probably actually help with the hormones that they're trying to balance because it really does the biggest bang for your buck in ways of. Jillian runs these tests with her clients once every few months, so she will see the direct result of interventions. Jillian, of course you're using supplements, but wouldn't you agree that a majority of your interventions come back to that, like, just becoming a human again, foundational support, 1000%.

Jillian Greaves [00:38:02]:
And I will also confidently say that is why, you know, both, both you and I are so effective and our teams are so effective at getting results for clients because we're not overlooking those key foundations. And, you know, I think that's one of the biggest problems that we see. And I, you know, I just talked to a potential client yesterday that had done some of this functional lab testing and had been done some gut testing, was put on herbal antimicrobials, was put on estrogen specific supplements, cortisol balancing supplements, and yet no one had talked to her about blood sugar regulation. No one had talked to her about eating, hygiene, circadian rhythms, these kind of basic things. And certainly an individual might get a little bit of relief in some capacity from some of these band aid approaches, but if the foundation isn't there, we're only going to get so far. So, yeah, absolutely. I think a lot of it boils down to having a really solid foundation in place and helping individuals customize that. And the test data can be very validating and motivating to kind of, you know, work on those shifts in addition to some of the micro strategies with supplements and which are fun and we like them too.

Michelle Shapiro [00:39:27]:
I mean, I think the message that I want people to hear also is hormone balancing is a brain game. It's a body game, but it's a brain game because the body's like knowledge of how many hormones to produce is going to start in the brain. It is going to be the thermometer for the rest of the body for how should I turn this up or down? How many hormones should I produce? Now, what happens again after production, or the amount of production is going to be a signal that's then going to go to your ovaries to produce the estrogen, but you're not going to change your brain function by simply adding in a supplement. So if you're, if your game is balancing hormones in the long term, it's a lot more complicated than just, um, taking one supplement. It's actually less complicated than taking a supplement. It's really about, um, aligning yourself with earth again, kind of honestly, so that your brain knows it's safe to produce things and the wiring to your brain to tell you how much hormones produce is being sent there. So when I think of a dutch test, I really do think of the brain also the whole way through and, and how it's like, that's the top and the bottom is the end stage metabolite. What's going on in between those two stages?

Jillian Greaves [00:40:41]:
I couldn't agree more.

What are you trying to find out when you're looking at cortisol on a DUTCH test?

Michelle Shapiro [00:40:43]:
Yeah. And then, you know, Jillian, I know what's been a very hot topic recently is cortisol. Cortisol. Cortisol. It's been for years, but it's always been a thing recently. There's been so much talk on cortisol. Cortisol, cortisol. It's been a thing for a long time that was on people's radar, especially in the functional medicine world.

Michelle Shapiro [00:41:00]:
It used to be we were talking about it from an adrenal fatigue perspective. Then we were talking about it from an HPA axis perspective. Now we're talking about cortisol belly gain. We're talking about moon face. Give me, like, on a dutch test, give me some basic information you're looking at when it comes to cortisol. What, what are you really trying to find out when you're looking at cortisol on a dutch test?

Jillian Greaves [00:41:20]:
Yeah, I love that question. Cortisol is just hot right now. So when. When I'm looking at a dutch test, I am specifically looking at cortisol production and cortisol clearance or free cortisol in the body. And, you know, everyone is unique in these cortisol dynamics are not always perfectly clear cut, but there's a lot of different kind of imbalances that can occur with cortisol. So I'm often looking to see how much cortisol are we producing? Are we producing healthy amounts? Are we not producing enough cortisol? Are we actually over producing cortisol? I think there's a lot of talk about lowering cortisol in the social media health space. It's all about too much cortisol. Too much cortisol.

Jillian Greaves [00:42:11]:
But ultimately, at the end of the day, like all of our hormones, cortisol is a Goldilocks hormone. We certainly don't want to be over producing it, but we also do not want to have too little cortisol. Cortisol serves many, many important purposes in the body. So, you know, how much cortisol are we producing, and what does free cortisol look like in terms of the free circulating active hormone in the body? And what's happening with that cortisol clearance? We could be overproducing cortisol, and that is really well matched with having high levels of free cortisol in the body. That tells us we have a very excited HPA axis, which I think is what people are predominantly talking about. But even more often than I see this high court, you know, cortisol production, high free cortisol, I see cortisol tanked. So low cortisol output, low free cortisol, where we're in a very, very depleted state, and we actually don't want to implement interventions that are geared towards lowering cortisol. And again, that's where.

Jillian Greaves [00:43:17]:
Where we think about, all right, if we're actually not producing that much cortisol, what's going on here? I think about the brain, first and foremost, what's happening with circadian rhythms, what's happening with also the vagus nerve, with the health of our mitochondria and our ability to produce these hormones like cortisol, I also see dynamics where maybe our cortisol production is low or it's normal, but our clearance is very sluggish, which means we're not producing a ton of cortisol. But our free cortisol, our exposure to that free active hormone, is very high. What's driving that? Is it an issue with the thyroid, which we'll see commonly? Is it related to under eating, fasting? What's going on here? I feel like being able to look at cortisol fully with production clearance free cortisol is where we can get a sense of just, like, where the body's at, where the HPA axis is in sort of this, like, stress spectrum, I guess. But, you know, in the social media, online health space right now, it's all about high cortisol, and that's just not, you know, realistic in terms of assuming that all problems are related to high cortisol, really, there's a lot of different dynamics, I guess, is what I'm trying to say in terms of what could be going on with cortisol in the body that might indicate different types of support needed.

Michelle Shapiro [00:44:53]:
If you also don't have access to or can afford a dutch test, which is, like many people, I'm certain of that, if that is the case, then you can just also do really good stress practices. It's just that you don't want to take specific HPA axis supplements or specific cortisol supplements that target bringing cortisol down or bringing cortisol up, you really just want to focus on excellent blood sugar regulation, excellent circadian rhythm control, excellent stress practices, stress reduction practices, as opposed to let me get HPA adapt or whatever. That one cortisol manager, that one cortisol supplement is. Quick question for you, too, Jilly. Can you explain the process of how cortisol leaves the body and how it's a little bit different than estrogen, obviously? So I wanted you to differentiate, like, what's cortisol's detox process?

How does cortisol leave the body and how is this detox process different than estrogen?

Jillian Greaves [00:45:46]:
Yeah, yeah, great question. So cortisol is. Is going to be processed very differently than estrogen, where we're not estrogen, I mentioned is, you know, getting broken down. The liver, we have all these different metabolites that are doing different things in the body to kind of simplify the way that cortisol is processed. So produced in processed cortisol is, you know, going to be produced by the, the adrenal glands, those little glands that, you know, sit on top of the kidneys and, you know, regulate the production of cortisol. But again, just like with our sex hormones, with Our estrogeN, it's going to start in the brain. So our hypothalamus, our pituitary, you know, communicating with our adrenals in terms of regulating the output or the production of cortisol. Cortisol is going to be processed in both the liver and the kidneys.

Jillian Greaves [00:46:41]:
And the simplest way to think about the processing of cortisol and cortisol metabolites is thinking about active free cortisol or inactive cortisone. Our body has the ability to keep cortisol active as its free circulating hormone, doing all the cortisol y things in the body. It also has the ability to deactivate cortisol into an inactive metabolite called cortisone. That's sort of like dead in the water. And that kind of speaks to the idea too that we, it's not just about overproducing or under producing, it's about what we're doing with that hormone and its ability to actually do the cortisol things in the body or nothing.

Michelle Shapiro [00:47:29]:
Totally. So again, this just the reason I wanted to ask you that question is because I knew you would lead us in that direction of saying that the differences with cortisol, which is important to acknowledge, is that it's not that just the existence of the cortisol is necessarily wreaking havoc. It's are you getting that active form of it or is it cortisone? And what's that effect? And it could be that you have a great production of cortisol, but you're not getting any of the even positive benefits of having cortisol in the body if it's on its active form. So that's a different thing. Everyone to know. On the dutch test, you can literally see cortisone versus free cortisol versus metabolized cortisol versus cortisol output. Like it literally gives you all that information. So that lets say again, if Jillian notices, oh, this person is shunting into this estrogen pathway, that could mean a b twelve deficiency or that could mean it literally can tell you what nutrients because you need at each stage.

The importance of having a provider who understands how our bodies utilize, detoxify, and drain hormones

Michelle Shapiro [00:48:21]:
The important part of all this is that going into having a dutch test, you need a provider who has a deep understanding of the entire process by which our body utilizes hormones and detoxifies and drains them. Because if you don't have that understanding, you're not, they're not going to get that information. They're just going to look at it and be like, well, your cortisol output's high. Once you actually understand this has to happen in order for this to happen in the body, then you need this nutrient for this to happen. Then you need glutathione for this to happen. It kind of lights up like this big puzzle where you can see, ooh, boom, b six there. And, oh, this means that melatonin production is low. Great, we got to get the circadian rhythm.

Michelle Shapiro [00:49:04]:
You can, with that understanding, that baseline understanding of the human body, you can put those pieces together with what you're seeing in front of you and then test where I think Julia. And now I'm going to be a little critical where I think a lot of, not of us, never of us, I'm kidding. We're critical of ourselves all the time. Where I think conventional dietitians or people who are like dutch tests don't do balancing of hormones is, I don't think they understand those mechanisms because we did not learn them in dietitian school, by the way, in our d schooling, there is no understanding of the complex detoxification and drainage processes of hormones production. It's not mentioned, I mean, it's really not mentioned once, to be honest with you. Maybe in like a pregnancy class at some point. But I think if you don't understand those mechanisms, it does look like pseudo scientific mumbo jumbo. And once you do understand those mechanisms, the interventions are very clear from that.

Michelle Shapiro [00:50:00]:
Would you agree with that?

Jillian Greaves [00:50:01]:
I could not agree more. And I think across the board, the lack of understanding we see often, whether it be conventional providers, MDs or RDs, whoever it is, the dismissal of these things comes from a lack of understanding often, which is so unfortunate because I think one of the best things a practitioner can do is acknowledge, like, hey, that's not my area of expertise, or I'm not super familiar with that, but I think what we're seeing often is like, if I'm not familiar with that, then it doesn't exist or it's not real or it's pseudoscience, which drives me nuts.

Michelle Shapiro [00:50:39]:
Yeah, you know, there's been, I mean, this is just something I want to mention, too. There's been really strict regulations against dietitians ordering dutch tests and GI map tests in New York. State. So Jillian's had the experience of ordering these tests for ten years. I have an amazing practitioner in my practice, Nina, who works with these tests in coaching programs as well. Nina Pacero. Hi, Nina. But I, Jillian, I don't analyze them alone.

Michelle Shapiro [00:51:03]:
I've always worked with my colleague Carrie also does these tests with me. I work with Jillian, I work with Amanda Montalvo because even I, who has self taught on these tests for eight years but hasn't ordered them myself, if I'm not doing them day in and day out and I fully understand them, I don't think I'm the best person to analyze them. I consider you a very serious specialist in these tests as well. And I just want to say, like, there's functional dietitians who listen to this podcast, there's conventional dietitians who listen to this podcast. And I love, you know, every nutrition practitioner and it's okay for me to say that my clients know that too. I say if you want to bring me a dutch test that another practitioner has done, I can extract more information from it. But you have to go to someone who knows these in and out and it's a huge part of their practice because they are complicated tests and I really can't overstate that. And I am comfortable admitting that there are people who are better at these tests than I am.

Michelle Shapiro [00:51:59]:
And I think for your client population, Jillian, where you're working with clients who have been diagnosed as infertile, unexplained infertility for years, for you to finally have answers to that unexplained infertility, like these tests are essential in the work that you do. And in addition, you have to be really damn good at them. I just think you have to be really good at them to use them.

Jillian Greaves [00:52:21]:
I agree. And I think it's important as practitioners to really always have the client's best interest in mind and to put the ego aside and to always, you know, act, act with integrity. And, you know, at this point, you know, I have, you know, interpreted so many dutch tests in my day that like, you know, experience and exposure was a huge part of this for me. But like, early on in my career, I was getting so much help, so much mentorship, you know, 2nd, 3rd, 4th opinions to really make sure that I was, you know, giving, giving clients the best support possible. And to this day, doesn't matter how many dutch tests I've interpreted. I'm still talking to Michelle, I'm still talking to our close friend Amanda and getting their thoughts on things because these tests are complex. There's a lot of nuance there. And I think it's just really important to always be leveraging experts in the field to make sure that we're, you know, providing clients with the.

Jillian Greaves [00:53:28]:
The best care possible.

Michelle Shapiro [00:53:30]:
You know, I have my own team of four other practitioners. Like, we review every single session that any of my clients have with each other. Jillian, her team do that. And then just so you all know, you know, if you're a client listening and you're a client of me and Jillian's with complete HIPAA protection, just so you know, if we're ever needing support on a case like, we have each other, and it's just a really special thing. And I always tell my clients, too, I'm like, I'm going to bring your case to someone who all they do, day in and day out, is review dutch tests. I'm going to. With your consent, I'm going to show your dutch test to Jillian, too, because I think that there's just such an advantage to saying what we excel at and what we don't. I think if people are also looking at these tests and saying there's no way they could provide any information because I don't understand them, that's really, really silly and really ego driven.

What is a GI map test and what does it look for?

Michelle Shapiro [00:54:14]:
So, Jill, really quick, let's just go to do a little bit on the GI map test, too, because I know we wanted to talk about that also. So generally, stool tests have been used in doctors offices, usually for diagnoses of major infections like C. Diff. You would go to the doctor's office, submit a stool test. This is an at home stool test that you can do. Send it in. Is this a diagnostic test? Is this looking at disease state? Tell me. I'm asking a leading question, obviously.

Michelle Shapiro [00:54:41]:
Tell us about the GI map test and how. Just tell us about the GI map test.

Jillian Greaves [00:54:45]:
Yeah. And I'll say there's a number of different types of stool tests out there, all use different technology of different pros and cons. GimaP is, I would say, probably one of the most popular out there with practitioners, and it's what we use in practice regularly. But essentially, it's a DNA based stool test. It's a quantitative PCR test, which essentially means that this test was designed to identify and quantify organisms in a stool sample at very low levels. So it's really, it's a very sensitive test, and ultimately it's assessing, you know, for a variety of pathogens, so, you know, viral, parasitic, bacterial. It's looking at commensal species in the gut. So healthy beneficial bacteria, it's looking at, you know, bad bacteria or dysbiotic bacteria.

Jillian Greaves [00:55:41]:
It's assessing digestion or an individual's digestive capacity, immune function, inflammatory markers. So it's really giving us the ability to kind of understand more deeply the gut ecosystem, what's going on in the gut. It's definitely not. We're not using this for the purpose of achieving a diagnosis, really, with any functional lab test. We're not using them in a diagnostic sense. Certainly with a GI map, you can pick up on things that a pathogen or a parasitic infection or something that needs a specific type of treatment. But ultimately, the GI map is so, so helpful for understanding that gut ecosystem, the digestive capacity, the gut immune function, the inflammation, all of that. Does that kind of answer your question?

Michelle Shapiro [00:56:38]:
I think it totally does. When you say PCR test, people are thinking, that sounds like a COVID test. So tell us what that means when you're saying it's a PCR test.

Jillian Greaves [00:56:49]:
That's just the type of test. It's a polymerase chain reaction. That's the type of test. I think the reason I point that out is because it's a. It's a quantitative test. It's. It's not a perfect test. None of these tests are perfect where, you know, there's certain tests that are designed to maybe, okay, you know, we're.

Jillian Greaves [00:57:12]:
We're looking to assess for various pathogens or certain, you know, certain levels of a microbe in a gut. In the gut beyond a certain level or beyond a certain threshold, if that makes sense. With this quantitative PCR test, essentially, it's picking up on low levels of microbes for a reason. So we can really see what's going on with these gut dynamics. Is there a lot of depletion or insufficiency with healthy beneficial commensal bacteria? These numbers aren't perfect, I guess, is what I'm trying to say. There's no perfect stool test out there, and I think that needs to be acknowledged. But the purpose of a test like this is not to, again, treat the test and get overly fixated. With this value being, you know, low, this value being high, we want to assess for patterns.

Jillian Greaves [00:58:05]:
What are we seeing here? And. And why. Why are we seeing this? Um, Michelle and I were just talking, you know, I think, like, last week or the week before, about kind of the. The over treating with stool tests. That happens, you know, very often wherever clients are being thrown on herbal antimicrobials, which, yes, they're herbal, but they're still potent if there's sort of any level of overgrowth seen on these tests often. But ultimately, that's not the right use of these tests. We actually need to ask the question, why? Right? What's going on with our digestive capacity and stomach acid or gut acidity? What's happening with, you know, bowel movements and gut, you know, gut motility? What's happening with, like, cortisol in the nervous system? So, you know, these, the stool test, like all of these other tests, it's nuanced, and it's really designed for us to, like, zoom out, look at the big picture, assess for patterns, think about the individual's habits, their unique symptoms, think about what we know about, you know, physiology, and to kind of tie all of this together to help people get better.

How do you use the DUTCH test and GI map test together?

Michelle Shapiro [00:59:17]:
Do you see, very interestingly, because you run a dutch test and a GI map test on all of your clients, do you see things that line up very clearly where you're like, oh, the cortisol in the dutch test matches the fact that there's a stress problem on the GI test. There's inflammation here, there's inflammation there. Tell us about that.

Jillian Greaves [00:59:33]:
100%. And that's where I really like to utilize both of these together. Just as, again, a tangible example here. If we're looking at a stool test and we're seeing really low levels of digestive enzymes, so our, you know, the enzymes our bodies produce to break down food properly, we're seeing a really low gut immunity or suppression of the gut immune system, we're seeing, you know, lots of, you know, low levels of healthy commensal species that are really important. You know, we're. We're already starting to get, you know, some information here that we're likely going to see some significant stress dynamics pop up with, you know, the dutch test. From the other end of the spectrum, with the dutch test, if we see big issues with estrogen on the test, we also want to know what's going on in the gut, because we know specific species of microbes in the gut actually help to regulate estrogen in the body and impact the elimination and excretion of estrogen in the body. So there's a lot of interconnectedness between the gut and the hormones, which is why, you know, we often run these, these tests together.

Jillian Greaves [01:00:47]:
But it's so, so fun and interesting to be able to, like, really connect the dots for people.

Michelle Shapiro [01:00:53]:
Yeah, I also, if we're saying, like I was saying before, that hormone issues are brain issues while brain issues are gut issues. So it's almost like, you can. You can see the circle. If there's, like, a cycle of life that happens in the body with your hormones, if there's a cycle of life that happens with your gut microbiome and your gut bacteria, you can almost see the cycle that happens and where that cycle is creating symptoms for people, as opposed to when people use these Dutch, these more so, the GI map test. Using the GI map test to be like, oh, you have parasite. We kill parasite now. It's so not the point of the test. That's why it's looking at it in very.

Michelle Shapiro [01:01:34]:
That's why I'm harping on the PCR piece. It's not looking at the total load of those viruses. It's not looking to say, hey, this is at a level in your body where this now causes symptoms. It's letting you know that when this highly infectious kind of or symptom causing bacteria is present and you have really poor gut integrity and not a lot of the good bugs, that creates an environment where this is going to happen. It's much less about, let me diagnose H. Pylori off of this, even though you can get a. Some pretty significant hints from it, but it's much more about what's the conversation in the gut? What's the conversation with the brain? What's the conversation with the hormones? I think that's what the dutch test and the GI map hormone tests are, is you're learning the dance, you're learning the conversation, you're learning, why is the body doing the thing it's doing? And when we look at blood tests, we're often just looking at what's it doing. We don't look at why or what that dance or communication is.

Jillian Greaves [01:02:37]:
I love that you use the word environment because that is like the ding, ding, ding that I think is missing for so many practitioners often that are running these tests is, you know, we're not just treating elevated Candida here. We're asking, you know, the question, why? What in this gut environment created an opportunity for Candida to grow in excess? Candida itself is likely not the problem. Right. You know, we need to think about all of the factors that created the environment for elevated Candida to occur in the first place.

Michelle Shapiro [01:03:11]:
If you almost think of, like, our gut as a battleground, not the most pleasant visual, but if it is like, a battleground again and we see that there's some enemies that come up or whatever, I don't know, it's such a ridiculous visual. Whatever. Let's roll with it, guys. You see the enemies coming up. And when we think of practitioners who are like, let's just do a parasite protocol for the enemies. Right. Well, then as you're killing the enemies, there's debris, there's violence that happened in the area. There's energetic violence, there's spiritual, there's physical violence that happened.

Michelle Shapiro [01:03:44]:
Right. There's debris, there's afterthought. There's, like, again, like, dirt that's happening as a result of all this happening. Well, then the environment has changed a lot. Right? And so we need to make sure we have seeds that can regrow in that environment, and we need to make sure that we have people who are available. Maybe that is the gut bacteria to come fix things up after. But it's much more about the scene than it is about the one thing. And it's usually when it comes to your gut, it's usually when it comes to your hormones, it's not one thing.

Michelle Shapiro [01:04:13]:
That's like. That's why those interventions on Instagram are a little silly. When it's like, this one thing will balance your hormones, which is just them doing, like, sales strategy, by the way. But it's never the one thing. The only thing that might be the one thing is any of that foundational stuff. It might be that you're too stressed. It might be that you're not getting sunlight. It might be that you're not eating with really strong blood sugar regulation.

Michelle Shapiro [01:04:36]:
Any of those things just have to be foundations. But a lot oftentimes, for that environment to change, for that brain communication to change, you have to put those foundations all in place, I feel, to get there.

Jillian Greaves [01:04:50]:
Totally agree. Yeah. Couldn't have said it better.

How can someone work with Jillian's team?

Michelle Shapiro [01:04:53]:
Okay, Jillian, tell us also about the process of working with your team. If they want to. If they want to have this experience that we're talking about working with you. I just have to say, like, anytime you tell me of a new discovery, call if you're watching on YouTube. You'll see me holding my hands over my heart and my chest. The way I feel about the people who get to work with your team, the joy I have for them, the unbridled joy I have and excitement I have for them. I'm just like, these are the luckiest woman in the entire world. That's literally how I feel.

Jillian Greaves [01:05:22]:
Like, I feel the same way about clients that work with you. And I feel like it's because we're both such fierce advocates for our clients, and I feel like there's just so much trust that. All right, they're in the right hands.

Michelle Shapiro [01:05:36]:
We'Ve probably sent each other hundreds of clients over the years, and I have never sent you someone and not felt like, a deep feeling in my gut and heart. Thank God for Jillian. Like, thank the universe that this person is like, I'm so glad when people come to me and I'm not the right fit and you are, because I'm like, I'd rather work with Jillian than me. So how do people work with your team? What does the process look like? Are you accepting new clients? Tell us, how do we work with you if it's not even one on one? How do people work with you?

Jillian Greaves [01:06:03]:
Yeah, great question. So to work with us one on one, to speak to that, first you can head to my website, jilliangreeves.com. you can fill out an application, and that gives you the ability. And there's a lot more detail there in terms of, like, how we work with clients, what that looks like, definitely, as you can probably tell, the way we work with clients is really comprehensive, but you can learn about it on the website and then fill out an application. We can hop on a call and really chat through your case and kind of get into the weeds and determine if. If we'd be a great fit for working together. As part of that process, I match you with the best practitioner on our team. I have incredible team of dietitian shout out to Courtney and Isabel and you get matched with that practitioner, and that kickstarts your health and healing journey, your gut and hormone healing journey.

Jillian Greaves [01:07:00]:
So that's the best way to learn about working with us and to apply. We also have a group program for women that have pcos. We also have a foundational, hormone self paced course for anyone that's really looking to dive their teeth into. Just a lot of these nutrition foundations related to supporting hormones. So those are options that you can check out on the website as well and kind of explore at any time.

Michelle Shapiro [01:07:26]:
Yeah. I also just have to say that Izzy and Courtney are completely fantastic. And the level of training that they all did together and the level of mentorship that you put into working with your staff, it's really incredible. Jillian. So I could not recommend Isabel and Courtney more. In addition, you can work with Jillian in those group programs as well. Okay. So that's important to know.

Michelle Shapiro [01:07:49]:
I just also want to mention that while your team has historically worked with PCOS, I just have to mention Jillian, and you also do a bang up job working with any sort of complex immune conditions. When I have clients with mcas, I am always referencing your work. We are always working together in the background. So if complex immunity and fertility especially are something you're working on, like you really, there is, I'm telling you, in this country, I don't know, in the world, probably. There is no better practitioner in my. And no safer, more compatible, passionate team, in my opinion. And I know it makes Julian uncomfortable when I compliment her, so I'll cut it out. Yeah, exactly.

Jillian Greaves [01:08:27]:
Thank you.

Michelle Shapiro [01:08:28]:
Thank you so much, Jillian. Love.