SUMMARY KEYWORDS

Concussion recovery, neuroendocrine system, hormone disruption, functional neurology, functional medicine, brain health, cognitive symptoms, neuroinflammation, neuroendocrine changes, hormone testing, Dutch test, thyroid panel, iron levels, B12 status, microglia activation.

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Dr. Tatiana Habanova  00:00

Now, you know, doing a little more deeper research, you can see even recently articles in, you know, 2023, 2024, 2025 are really coming out with some real powerful statements and delineating a lot more clarity on what actually is going on in the neuroendocrine system, post concussion, you know, in the acute phase, and then even months to years later, welcome

 

Dr. Ayla Wolf  00:23

to life after impact the concussion recovery Podcast. I'm Dr Ayla Wolf, and I will be hosting today's episode where we help you navigate the often confusing, frustrating and overwhelming journey of concussion and brain injury recovery. This podcast is your go to resource for actionable information, whether you're dealing with a recent concussion, struggling with post concussion syndrome, or just feeling stuck in your healing process. In each episode, we dive deep into the symptoms, testing treatments and neurological insights that can help you move forward with clarity and confidence. We bring you leading experts in the world of brain health, functional neurology and rehabilitation to share their wisdom and strategies. So if you're feeling lost, hopeless or like no one understands what you're going through, know that you are not alone. This podcast can be your guide and partner in recovery, helping you build a better life after impact.

 

Today, on life after impact, we're diving into one of the most overlooked and misunderstood aspects of concussion recovery, hormone disruption, and we're doing it with one of the most accomplished minds in Brain Health, Dr Tatiana habinova is a powerhouse in both functional neurology and functional medicine. She is a board certified chiropractic neurologist with over 24 years of clinical experience and more than 1800 hours of advanced training through the Carrick Institute, a global leader in functional neurology. She is also a certified menopause coach, a functional medicine practitioner and a Bredesen protocol, certified clinician, bringing together cutting edge neuroscience and hormone health in a way that few practitioners can. She is an international speaker, a published researcher and an award winning co author of concussion discussions, a groundbreaking book that brings together top experts in the brain injury field in today's conversation, which is part one of a two part series, we explore the hormonal ripple effects of concussions, why they're so often missed, and how they can dramatically impact recovery. We talk about what types of labs and tests are most valuable for assessing hormones. So whether you are a patient practitioner or someone supporting a loved one through recovery, this is a conversation that everyone needs to be having in the concussion recovery landscape. Please welcome the brilliant Dr Tatiana habinova, welcome to life after impact.

 

In this episode, I am here with Dr Tatiana habanova, and we are going to talk about hormonal changes that can happen after a concussion or a brain injury. And I'm very excited to have you on the show, Dr Tatiana, and I love the work that you're doing with brain health and the cognitive performance consulting you do, you're really shedding a light on the importance of the brain and in a way where people feel comfortable being able to come in and open up and talk about some of the cognitive symptoms they may be having. So I wanted to maybe have you start out by giving a little bit about your background. You're the director of the Palm Beach brain center, and so tell us a little bit about kind of how you got there and how you started focusing on the brain specifically.

 

Dr. Tatiana Habanova  03:51

Oh, great. Thank you. Well, I so appreciate being a part of your podcast. Thank you for this opportunity to have this conversation with your audience, and I agree it's an important topic. And, you know, it came really because of a little bit of my own journey. And I think of many times people who are in the concussion space, generally, have had previous experiences. I know you have as well. So you can relate to this and and through that, you know, we start learning things and discovering things. So I have always been fascinated with the brain. And in fact, my mom, embarrassingly, will still share the story. If we're somewhere gathering, she'll, she'll talk about how I had this teddy bear called Charlie, and he was a stuffed teddy bear that I absolutely adored. I was, I don't know, 345, something like this. And of course, Charlie, Charlie always had to have some kind of brain surgery, right? So never, never, never had a broken elbow or broken ankle or broken breast. It was always brain surgery. Now there's always bandages on his head.

 

Dr. Ayla Wolf  04:54

I love that. I love that.

 

Dr. Tatiana Habanova  04:56

Yeah, oh my gosh. My mom had to watch Charlie so many times. Because I would not let Charlie go. So, but interesting enough, though, like, even though, you know, she benches, I was trying to do surgery on on his brain. I had never wanted to get into brain surgery. I always was fascinated with neurology, and I think that's what led me into the world of chiropractic, initially, because of the nervous system, and I was also an athlete when I was younger in high school, and, you know, played a lot of volleyball, paid for the Canadian team, and then went off, you know, and things like that. So I loved, you know, sports and athletes and muscle skeletal injuries, but I was always fascinated with the brain. But again, you know, my gosh, over 40 ish years ago, there really wasn't much information, you know. But I remember specifically one day being maybe a second, third year university up in Western University of Western Ontario in Canada. I remember walking across the Thames bridge and walking to class and thinking, oh, you know, we're learning about doing physical therapy and stuff like that. You know, in the some of the courses I was taking, and I was like, I wish I could do this for the brain. I wish we could rehab the brain. And of course, that time, I still didn't know really much. I was very focused into biochemistry and molecular biology and genetics and things. So I was, you know, really pigeonholed into going into a PhD route and doing research, and so that was kind of the trajectory. But again, being an athlete, just really loved that I was playing varsity volleyball. And of course, we're having all these injuries and everything, and I just keep thinking about this. Little did I know at the time.

 

Now I can look back and realize that Dr Carrick, you know, the godfather of functional neurology, actually was already speaking about functional neurology and this ability to rehab the brain in the world. I just hadn't come across him yet. So fast forward, I finished school, you know? I opened up practice, I moved here to Florida, etc, and I ended up developing viral meningitis out of nowhere, and that was really earth shattering for me, really life altering. Honestly, it took me two and a half months to just be able to get back to work where I could literally only work for one hour, and then that was it. So it took about two and a half years to recover to a point where I could somewhat do a typical 40 ish Hour Work Week and maintain the cognitive load without crashing. But I really didn't have much more of a life. And then it still took several more years. I don't speak about this much, it's, it's, and I should probably, because I, at the time, I was so confused of what was going on, and so I dove deep into functional medicine. I was always really into health, you know, ate well and being an athlete, you know that with nutrition was always important. My mom always grew a garden in her backyard, so we were always eating fresh vegetables and herbs and things. So I kind of had that background of that healthy living. So I was like, All right, it's probably again, not thinking functional neuro. I was thinking, Oh, I must have had some kind of deficiency or something, so I went knee deep into functional medicine. And I'm really grateful I did. I learned a ton, you know, start to, you know, support myself a little bit more in various things, but still some of that cognitive piece for me I was still struggling with, and again, not realizing that could be a phenotype of, you know, a post viral, even a post concussive, you know, post concussion is very similar to a post viral manifestation, with some of those changes in neuroplasticity and inflammatory pathways that kick in. So I really dug deep into the functional medicine side, and I'm grateful I did, because then I really just specialize in neuro inflammation, neuro autoimmunity and things like that.

 

But somehow, through a curious path, I luckily stumbled upon the Carrick Institute and found the work of Dr Carrick and this amazing community of functional neurologists. And it was just like, oh, this is exactly what I was looking for. This is what I would thought about when I was walking across that Thames River, you know, in undergraduate and and so I, you know, began my the process of the Carrick Institute, and that helped put the missing pieces that I was still struggling with, post viral meningitis, right? So that was in 2004 and I began the Carrick Institute in 2018 so again, you know, a lot of time had passed. I was better, but I still wasn't great. Still wasn't great. And so finally, as I started taking the courses and began learning. And I, you know, I'm very excited about learning things. So I do have knee deep and just consuming everything. And the cognitive load was incredible. I don't know how I did it, but I just like just, I guess, you know, needed to learn and needed to understand, and started putting the pieces together and applying things I was learning to myself. And so. To see the improvements, and then began working with people as well. And that was it. You know, I found I found my place, my love, my passion. It all came together. And I'm grateful for the years of, you know, training and muscle skeletal injuries and rehabbing the body, understanding pain and various things, learning the functional medicine side of things, and, you know, staying on top of new developments today, and then bringing in that functional neurology piece, which, as you know, is a constant, never ending journey, yes, of discovery, which is phenomenal. So that was really it. I did have a couple of concussions in there, in between those time periods which re rocked my world. And so, again, I think, from my own personal experiences of understanding, you know, when you get to a good place and then you have a little concussion, of little like, what's really a little concussion, right? How, you know, a small little fender bender, is what I'm trying to say. Can just take the wheels off the apple cart and the whole thing can start all over again, right?

 

So I can appreciate the delicacy and the importance of consistency and the importance of a lifestyle approach, especially of a history of any type of brain injury. Everyone's unique. Everyone needs their unique approach. We're all literally unique cellularly too, so we have to really personalize it. But that's, that's really kind of my mission, passion is to help others, you know, have a better grasp understanding of what's going on. I had wonderful medical care. I'm grateful for everything that has occurred to me, but there were gaps, and at the time, I didn't know that. I just sort of somehow carried on like I think we all do. We just somehow carry on. But you know, as I look back now with the knowledge I have now, I was like, Oh, wow, so much more could have been done. I wished more would have been done for me. I could have decreased the suffering, the years of just crawling to work every day and crawling back home so fatigue, just trying to treat people and take care of people as best I can. But, you know, it was, it was difficult, you know. But somehow, you know, we we get here, we arrive to a new place, right? Exactly. So I feel like I haven't walked in everyone's shoes who's had a concussion, obviously, but I feel like I've straddled it on both sides, where I've myself, have had various situations that I've had to work through, and I get to be on the other side as a clinician, you know? So I feel like I can bring compassion, and that's that's to me, very important as well, that compassionate approach to helping patients, because many are misunderstood when they're seeking care. And again, sometimes they're looking for a particular symptoms, results, they go to a particular position, and we're not getting that integrative, you know, whole body approach, or a whole systems approach, at looking at a variety of things. So that's sort of how I've molded myself into what I do now at the Palm Beach brain center, where it's a very whole body integrated approach to brain health and longevity,

 

Dr. Ayla Wolf  13:11

yeah, and such a powerful combination to be able to blend functional medicine with functional neurology. I feel like I've had a lot of similarities with my, you know, my background in the sense that I felt like I was able to use functional medicine to get myself kind of like 50% better from a lot of the brain fog and cognitive symptoms that I was having with my concussions. But I really needed the functional neurology to then come in and get me that much better. And so the two of them were so powerful. And what was funny was that before I got into practicing Functional Neurology and finding the Carrick Institute, my background was in fertility, I was helping women get pregnant. And so after specializing in functional endocrinology and restorative endocrinology and diving into the whole world of female hormones for eight years, what I found was that a lot of my concussion patients that were women, a lot of their hormonal such hormonal symptoms would get worse after their concussion. And so that it really opened my eyes to the fact that, okay, well, this makes perfect sense. You injure your brain, and your brain is the orchestrator of all of your hormones and your endocrine system and and the whole intersection between the endocrine system and the immune system. And so there's so much there, and I didn't really have any resources to lean on, other than my own personal experience with the fertility work that I did, which ended up being incredibly helpful. But then, you know, as you and I were preparing for this, you sent me this amazing research paper that just made me so happy that people are finally looking at the effects of, you know, the hormonal changes after a brain injury and so. That's why I wanted to bring you on the show, so that we could talk about this. Because I think that, again, a lot of people, it's very easy to not see the connection and to just, you know, be experiencing the symptoms, and maybe think that it's two separate things, when really it's all one system. And you know, our concussions don't occur in a vacuum. They occur in the context of what we already had going on our entire lives. Yes,

 

Dr. Tatiana Habanova  15:26

very true. And I think it's so powerful that you've had that background in functional endocrinology, and, you know, working with women on the fertility and probably seeing those correlations, you know, is so powerful. And you're right, the world of research in neuroendocrine changes have significantly advanced in the last I say, but even five to seven years from my perspective, I was asked to write a paper about maybe seven years ago on the exact topic of what are some of the neuroendocrine changes that are experienced as a sequelae to concussion. And basically, at the time, the consensus was like, Well, we think maybe there's going to be something happening in the pituitary, and there could be some, you know, altered function, but no, you know, like, whatever. Like, you know, you could get it looked at if you want, but you know, so it was really just kind of like low hanging, you know, they're just not really putting it on the radar to now, you know, doing a little more deeper research, you can see, even recently, articles in, you know, 2023 2425 are really coming out with some real powerful statements and delineating a lot more clarity on what actually is going on in the neuroendocrine system post concussion, you know, in the acute phase, and then even months to years later, and giving more guidance to physicians and clinicians on you know, how best to approach care, or if someone's come to you who's had a post concussion that maybe happened multiple years ago to realize, okay, hold on, if no one has actually, at this point, for whatever reason, you know, done a full workup on the hormonal side. Excuse me, on the hormonal side of things, maybe that would be a good recommendation to do or to refer out. If you're, you know, not able to draw labs or whatever, but, you know, get that done. The other thing to think about, too, is, again, if you're working with someone, or someone's come with post concussive symptoms that, you know happened years ago, when they're they're still having those symptoms. You know, if neuro rehab stagnates, right, if all of a sudden you hit a plateau, and you're not moving any further in there, in the abilities of the neuroplasticity and the changes, because we know how rapid those can be and how profound they can be, right? So it's really clear when, when those things occur appropriately in that functional neuro side of things. But if there's that stagnation, that should be a little green light to say, Hmm, maybe I need to be looking at those neuroendocrine changes a little bit more if, again, if it hasn't been done or, you know, you don't overwhelm a patient the beginning with, oh my god, let's get all of this assessed. It could be a lot. So you can take it in phases and stages, right? That's totally fine. But again, just little, maybe gems of recognition that this is an important aspect and a major piece of the puzzle. Yeah,

 

Dr. Ayla Wolf  18:22

one of the things I see a lot is that a cycling woman who I'm working with in their concussion recovery all of a sudden will find that a lot of their symptoms are improving, but now that when they do get worse, there's it's always at a specific time in their cycle. And so now we see, okay, well, maybe my headaches are now not every single day. Maybe they're all just clustered right around this particular like week of the month, right? And so now we start to see, like, okay, the symptoms are improving. They're not there constantly, but they sure do get worse in relationship to changing hormone levels. So now we really need to do a deeper dive into this piece of it to get you that much better.

 

Dr. Tatiana Habanova  19:04

Absolutely, absolutely. I see the same correlation as well. And as you mentioned too earlier, about with your own journey, saying that you felt you were able to through Functional Medicine and herbs to get about 50% better, and then kind of stalled out. And I see the same thing generally. You know, when patients are coming for some of these and they want to come from the functional medicine side, then they come to my office with that in mind, I'll honor their request of the approach they want to take. And then again, I generally will see about that 50% improvement mark. And then we don't seem to get further that functional medicine side of things. That's the time to say, Okay, let's get into some functional medicine.

 

Dr. Ayla Wolf  19:42

the functional neurology

 

Dr. Tatiana Habanova  19:46

excuse me, sorry, yeah. So the functional medicine, you know, just gets you so far, which is fabulous. I mean, that part is so important, there's the other piece too. So it's almost like the yin and the yang to be, you know, the functional medicine, the functional neuro are very important. Yeah. Yeah, yeah. And

 

Dr. Ayla Wolf  20:00

I think it's also like, one of the ways I look at it is what is the right tool for the job. And as you know, someone who practices Chinese medicine, if I have somebody with a lot of brain inflammation, you know what? There is animal research to say that when you do acupuncture, you can modulate inflammatory pathways and potentially reduce inflammation in the brain. But personally, if someone's only coming to me once a week for acupuncture, I would much rather lean on my things that people can do every single day to decrease brain inflammation and to improve the health of those inflammatory pathways and regulate that through diet, lifestyle, maybe some different supplements and herbs. So it's like, what is the right tool for the job? Is also kind of the way that I'm looking at it's like, maybe I'm attempting to change a system in one particular way through my neurological rehab, and then in another way through my herbs. And so it's all working together to, just like you said, not hit a plateau,

 

Dr. Tatiana Habanova  21:00

absolutely. And, you know, as we kind of alluded to, or spoke about, I think you mentioned earlier, that in the hypothalamus, specifically, that is, you know, the location and only location in the brain that we're currently aware of where the three major systems, you know, crosstalk, or can have the opportunity to, you know, interlink with each other, right? So normally, that immune system is sort of a separate system, the hormonal system is separate and the neural neurological system is separate, but in the hypothalamus, those three can cross talk. So now we're dealing with neuroinflammation. That's an immune side, right? Upregulation of the immune side, and we have the endocrine the hormonal are also now interlinking, so a lot of teasing out of neuro inflammation and neuroendocrine changes, and then the effects on the nervous system, because that's the third piece I find when when patients recognize that that's like a three legged stool there, and that those you know, neuro inflammatory processes can have an effect on the neuro endocrine system and affect the neurology, right? So really untangling those three bits become, you know, a really important, maybe even a starting point, perhaps, of patients understanding of like, okay, what trajectories and what avenues do I need to consider, and how can that all play into it? You know, what gets confusing as a clinician is a lot of those symptoms, neuroendocrine changes, have the similar symptomology as a concussion. And so it can be sometimes challenging from a clinician's point to try to untangle which is which you know, what symptom is truly from a concussion, which is a new just a neuroendocrine change? Maybe an endocrine change due to a concussion. What is the person bringing to the table prior to this concussive event happening, and what's their history, and how were they neurologically, most people are not getting baselines, neurological baseline even so, maybe functional medicine, blood work baselines, or hormonal panel baselines, and that is something that I've started to really, really implement. I know in the moment, it's not going to give me much help in this current situation, but I'm setting people up for success for the future. So should there be future events? You know, at least you have a hormonal baseline to start with, for example, and then we can use that obviously, through treatment as well. But I think this is a practice that's starting to become more prevalent and to be integrated a little bit more, especially on the hormonal side, to just even for you know, a teenage gal to have that hormonal panel, or even for you know, a young boy like to have these hormonal panels, and to just every so often get documented, like, where are you, you know, hormonally, and what's going on there, well. And

 

Dr. Ayla Wolf  23:47

what a great concept, too. To say, you know, right now I'm feeling really good. Why don't I run a bunch of labs that I know? What labs equate to me feeling really good. I mean, I've had, what a concept, right?

 

Dr. Tatiana Habanova  24:02

Yeah, benchmark it. You know, benchmark it. So if anything now dips or changes, you know, you there's a reference point. Not that we're trying to chase something from the past, but at least that's a guide, right? It gives us a sense. It's like a map, right? So,

 

Dr. Ayla Wolf  24:16

and when we talk about functional lab work, we understand that, you know, a normal, you know, TSH number, like, the reference range is pretty wide. And I've certainly had patients that have said to me, when my TSH is 1.0 I know that I actually feel the best. And so I've also had people who have had to pay lots of close attention to their thyroid numbers and really try to understand, you know, where do I fit on this scale, and what feels you know the best, as far as my energy levels and metabolism and all the things. So why don't you get into a little bit of the the testing that you do, and are you doing blood work? Are you doing like a Dutch test? What types of hormone tests are you running? And then are there certain. Patterns or interesting things that you're really paying close attention to. Yes,

 

Dr. Tatiana Habanova  25:04

absolutely, so definitely, a person's history will dictate some of that. Course, obviously. So just asking, you know, a little bit about menstrual cycle, and just do they, you know, they cramp a lot, you know, generally, will indicate some low progesterone, most likely, in their history, they have a history of just really painful periods. For example, I'm assuming we're just going to mostly speak about women at this moment, so I'm going to just frame it up from that, we'll

 

Dr. Ayla Wolf  25:30

do a different episode on men. How does that sound? That

 

Dr. Tatiana Habanova  25:33

sounds fabulous. So that, again, gives you a little clue of, sort of, maybe what their history was, a little bit going in, because we know if, and I'm assuming this woman also has had a concussion, so we know again, that the time of concussion, for example, matters in the woman's cycle if she is cycling right. So definitely asking some really good, pertinent history questions are key. So I always encourage women to try to keep a better log of their monthly cycles and symptoms and things like that. So, but the test that I really love to do, I'm a huge fan of, definitely the Dutch test, the urinary hormone test. I've used that, gosh, I don't know, 15 ish plus years. So I do love that over blood work. I find the Dutch test gives us a little more information, especially if the add the adrenal component to it as well. So we can get some of the cortisol levels and the circadian rhythm of the adrenals too. So it gives us a little bit more information from that perspective. And the Dutch just gives us all those metabolites. And just the way they lay out their report is very useful. And even with just seeing how the estrogens are metabolized, and then c o m, c o m, t enzyme. So it gives us a lot of wonderful markers that just stand alone. You know, let's test estrogen, let's test progesterone, testosterone. These are just such standalone tests and blood that I feel that's limited. And price point wise, it's actually a little cheaper to do Dutch. So I think, for the value, that would be the way to go, I've also recently started using vibrant wellness labs, or vibrant America is the parent company, and then vibrant wellness would be that laboratory component, and they actually have a little more data on their urinary hormone tests. They actually will also have a neurotransmitter panel that will also pair up nicely with the urinary hormones. And they go into a little bit more detail than the Dutch does.

 

So, you know, one half dozen of the other there, I think they're both pretty amazing to use, you know. So, yeah, so that is key there for the thyroid, definitely will just send out for blood work there, and I like to do a full thyroid panel. So beyond just th, TSH and t4 we really want to do all seven thyroid markers, and especially looking at TPO antibodies and TG antibodies, because, as we know, with a concussion within 24 hours, research tells us that we're going to start to get, like a leaky gut syndrome. We're going to get gut permeability, and so we know for getting gut permeability, we're getting probably a breach of the blood brain barrier, probably possibly some of the other barriers, sinus barriers, inner ear barriers. So we're wanting to look because generally, my experience has been within about a year, a person will develop some type of autoimmune or food sensitivities or something like that down the road. So if I'm seeing someone who's had a concussion multiple years ago and coming to me now, because the symptoms have just gotten so bad at this point I'm also considering a gut panel as well. So, you know, looking at what might be going on on that level too. So I know this takes a little bit out of hormones, but again, it's all integrated, but generally, definitely thyroid penalty seven, very important, that's blood work. So generally, when I do send people out for blood work, I will look for a few other things as well. I tend to do a bit of a comprehensive panel in that sense.

 

But some of the key things I'm really interested from a neuro perspective, is looking at the iron, and not just serum iron. That's fine, that's a good marker. That's easy to look at, but that's really just 1% of stored iron in the body. So it's not a great, great marker. Ideally, we would want to add saturation iron saturation. That is much better. So sometimes you have to ask for that. The pendulum that I do, thankfully, it's included in there. But if people are listening to this and taking some notes and then going to their primary care physician and saying, Hey, next time we do blood, I'd like iron saturation. I would like ferritin. Ferritin is another great marker, a surrogate marker for iron. It's 22% of stored iron. So much better than just serum iron alone. It's also an inflammatory marker, so it allows us to take another peek into the system. Um, and look at maybe some levels of inflammation. So those are really key for iron, especially for neurotransmitters. I also like to look for B 12 again, B 12 theorem. It's okay. It's not the greatest, but it's okay. What I really ultimately like to look at is methylmalic acid, and that gives us a much better indication of B 12 status again, looking at that from a neurological perspective. And, of course, you know, a complete blood count. Let's go ahead and look at, you know, red blood cells, white blood cells, you know, how's the hemoglobin? How's our MCV? Is the size of the blood cell. A lot of times people have a normal MCV, so the size of the blood cell is good, but, but if you have low iron, your red blood cell will be small. If you have not enough, be 12, your red blood cell will be too big. So actually, they it ends up looking normal,

 

Dr. Ayla Wolf  30:53

yeah. And you have to get that whole complete picture to understand all the pieces. You

 

Dr. Tatiana Habanova  30:57

really do. And these aren't super expensive tests. The methyl molecule might be a little bit more on the pricier side, but I think it's well worth it. So again, there's a few more things that I do like to look at, but just from some basics, if we're looking at exactly what I'm looking for, the iron the B 12 is key. And then what is the red blood cell profile looking like, and then also the white blood cells. I really do like to, you know, look at the breakdown, and a lot of times we can maybe infer if we're getting a little bit of microglia activation going on there as well. So take a look at those macrophages, which is the in the body. These white blood cells will kind of be, I kind of be, I kind of think of them like Pac Man, and they go along, and they just sort of eat up all the debris and things like this, cellular debris and viruses, bacteria, etc. They're just like little gobblers in our brain. We have the cousins of the macrophages, which are called the microglia. And so we have cells in our brain that also kind of do the cleanup, you know, act as well. So sometimes, if I see really elevated macrophages, it just gives me a Hmm. That is like, Hmm, like, could there be some microglia activation, which is going to cause neuroinflammation? Is what I'm getting at right, which will affect hormone, not just production, but activity. Right, receptor site activity. So that's why that neuroinflammation pieces is important in this whole puzzle. Yeah. So, yeah. So those are kind of some of the tests. The Dutch the vibrant wellness of the urinary hormones, possibly a neurotransmitter profile. Don't always do that one, but then the blood work, iron B, 12, red blood cell panel. So complete blood count, yeah, at least the start. Yeah, there's so many to choose from. I know, right? Yeah, that would be at least the bare minimum of what I'd like to see, sure, and

 

Dr. Ayla Wolf  32:48

this might be getting into the weeds a little bit, but as far as ferritin goes, you mentioned that it can be, you know, like the technical term is an acute phase reactant, right? So if there is an inflammatory state, I also know that a lot of times the normal reference range for ferritin is also pretty wide, and a lot of people, if they have very low ferritin, it can maybe still be flagged as normal. But when it's on the low end of normal, are you also still saying this is a little lower than I'd like it to be? Even if it's normal, this might still be something we have to pay attention to.

 

Dr. Tatiana Habanova  33:18

Absolutely. And actually, I do look at the lab values that come from LabCorp. Is the lab that I primarily use, or quest is another option, but I transpose all the values of the patient's receiving into another document that I have that are functional ranges. So I do look to see if something is flagged lab high or lab low, because those lab ranges are pretty broad, so if they're flagged high or low on lab definitely red flags something really important to consider. But even if some of the values on the LabCorp report are in normal ranges, according to LabCorp, I transpose everything onto another document that has tighter ranges, which are more physiological functional ranges of the body, of the human body. And I use those to, you know, see if something is in the high or the low, to get a much better clinical picture. So it is a little bit extra work, but it goes a long way. So that's where, again, a kind of normal low ferritin actually, on the functional range, it's low, yeah, and we can proceed forward from that moment.

 

Dr. Ayla Wolf  34:28

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