Ep. 564 "The 40% Battery!” – The Shocking Truth About Mitochondrial Loss & How To Reclaim Your Energy with Dr. Elizabeth Yurth | Menopause & Cellular Health

Welcome to Everyday Wellness Podcast. I'm your host, nurse practitioner, Cynthia Thurlow. This podcast is designed to educate, empower, and inspire you to achieve your health and wellness goals. My goal and intent is to provide you with the best content and conversations from leaders in the health and wellness industry each week and impact over a million lives. to add the honor of reconnecting with dr elizabeth yurth easily one of my favorite conversations i've had on the podcast in 2026 dr yurth is a double board certified physician in physical medicine and rehabilitation as well as anti-aging regenerative medicine she has more than 30 years of clinical experience and continues to stay on the forefront of orthopedics cellular medicine, regenerative medicine, and the future of aging. Today we spoke at length about the impact of mitochondrial health and how this is a huge driver of energy changes in middle age and beyond, the value of hormone replacement, the impact of chronic pain as well as mitochondrial dysfunction, specific fuels that can be helpful for the mitochondria, why we need to start with energy production and then repair the mitochondria, how intricately interwoven muscle and mitochondria health are, and two specific labs to help demonstrate poor mitochondrial health, both uric acid and low triglycerides, the role of peptides, the impact of peptides on immunity, as well as seasonal cycling. Again, one of my favorite recent conversations. I know this is one you will listen to more than once. Dr. Yuro, it's so good to reconnect with you on the podcast. Thank you for joining me today. Cynthia, thank you for having me back. We had so much fun the last time. I'm really excited that you and I get to talk again because you're one of the really good, sensible, level-headed voices in this field. So I love talking to you. Oh, well, thank you. And before we were recording, we were talking about how there's become this overly simplistic approach to managing middle-aged women. And yet what we're leaving out of the conversation is conversations about cellular health and our mitochondria. And so what are some of the things that you think are important for women to understand about mitochondrial health as we're navigating this perimenopause to menopause transition? So the first thing I want to comment on is if we look at the number one thing that happens to every single one of us, I don't care how great you are and how many supplements you're doing and making no-cheral hormones, we will all start to get a little less energy over time. It's just, you know, we just feel a little bit like, oh, it's a little harder to get up and go. It's a little harder to do everything that I thought was, you know, I could get done in a day before. And that's even if you have everything replaced and you're taking all the perfect supplements, right? So why is that? Why do we see this kind of loss of energy? And we could say, oh, well, it's all hormone related, but no, we can replace hormones very nicely and still see our women coming in and saying, you know, I feel better, my libido is better, but I just don't have the energy to do what I used to do. Or I work out and I'm not putting on the muscle that I used to be able to put on. So what do all those things have in common? It really comes down to it is dysfunction at the mitochondria. And you guys all know mitochondria from high school, right? They were the powerhouse of the cell. They make all the energy of the cell, but they're really so much more important than that. Now we'll say the energy production is a really major thing. Well, let's talk about first really how significant the loss of mitochondria is. So this is okay. You're doing everything right. You're taking hormones. You will still, about the age of 30, start losing mitochondria. And by the time you're 65, 70, you've got about 40% of the mitochondria you had when you were in your 20s. So if you think about your mitochondria as your batteries making energy, if I'm running on a 40% battery, I just can't do as much, right? So it's not our fault. It really is a little biologic. And that's going to be something that is not that easy to fix. And again, doing all the right things is helpful. Exercise is one of the best ways to restore mitochondrial health. But that fatigue, that's ATPs, just not being manufactured as fast, this loss of muscle mass. So think about muscle is your most metabolically expensive tissue. It takes a lot of energy to build muscle. So if I am low on energy, do you think my body is going to prioritize putting on muscle? No, it's going to prioritize keeping my heart beating and keeping my brain going. It's not going to prioritize putting on muscle. So if I don't have enough ATP, even if I'm taking anabolic steroids, I am not going to put on muscle, right? So I think it's such a neglected piece in everything we're doing. I think we address everything and we forget that at the root of all of this is the mitochondria. Even when you look at hormones, to look at estrogen, testosterone, progesterone, cortisol, they all require, so if I give you guys these hormones, they all require these series of enzymatic reactions that occur inside and around the outside of the membrane of the mitochondria, okay? So they require all these little specific cofactors and they require of the electron transport shape to actually get those hormones activated to do something. So in the case that I have half the functioning mitochondria, is my estrogen going to go very far? Makes sense not, right? So I think that we got to refocus that this needs to be now kind of top of our list. I think you've got to fix all the easy things to fix. It's easy to fix hormones. it's easy to throw in the nutrients you need. But where are we still losing function that I don't think we're addressing? And I would tell you, I think even in the functional medicine world, there's a big lack of understanding and lack of how to treat getting these mitochondria healthy again. Well, and I would imagine like the average American is not metabolically healthy. So if we're talking about averages, by the time we're 40 and we start seeing more and more dysfunctional mitochondria, just about any chronic disease we have here in the United States or abroad for that matter, is a facilitation of this dysfunctional mitochondria. So when women come to you and you're kind of going through your algorithm of how you want to approach their energy issues, the pain they're experiencing, because how many women have chronic joint pain? And I'm not just talking about the a little bit of stiffness when you get up in the morning, you have a little bit of osteoarthritis that have chronic pain issues that are preventing them from being able to exercise more vigorously or preventing them from feeling like they can get through their activities of daily living just by virtue of the degree of mitochondrial dysfunction they're experiencing. I was talking to you just before this about a couple of DMs I got, and I get this at conferences too when I'm lecturing, because we see, we hear all these lecturers out there, and they're like, you know what? Exercise is, you just have to exercise. You've got to exercise. You've got to exercise your guidelines. And you and I would agree, exercise is critically important. It can build mitochondria, it can support hormone function, it can do all that. But let's say you now have run out of so much gas, or you have so much pain, that it's actually impossible. I think we spend a lot of time in our world, sort of maybe chastising people a little bit, saying, just go exercise, just go work a little harder, just go do a little bit more, you'll be okay, walk, do something, and without sometimes realizing that maybe that's too difficult at this stage in the game. I think this is a really neglected group of people, especially women. I think if women, they see all these influencers and even physicians lecturing about, you've just got to go lift heavy weights, right? That's not going to work for everybody. And if you don't have any kind of energy function to support muscle mass and I have you go just lift heavy weights, you know what's going to happen? You're just going to get fatigued and get injured. So we have to have a little bit more awareness that this is all not just in my head. I just need to go exercise more, at least walk more, whatever these people are telling me. We actually need to give them the support to be able to do that. And I don't see that happening very much. So think about how we make our energy. Basically, you've got three ways of getting energy. We have basically glucose, protein, and then ketones. And so glucose is your main source of energy, right? So you eat food, that's your fuel. And then basically the mitochondria take that fuel and through a process called oxidative phosphorylation, they make ATP, which is a series of complex steps. And I know you had Scott share on your episodes just before me. And so basically these electrons that come from the food get passed from one little guy to another little guy to another little guy five times. The last little guy here, which is iron-dependent factor, really critically important, iron-dependent factor, then spins around and makes ATP. If any of those complexes aren't working, I can't make energy. So that's where things like, what can we do to support those complexes? Also remember that as those electrons that we took in as eating food get passed down this chain, what happens? We make these free radicals, right? If we can't get rid of all these free radicals, so they start collecting, the mitochondria is like, oh, things are bad here. There's way too much going on. No matter what I do, it's going to shut down. So the mitochondria are really smart. There's too much bad crap. It's going to shut down production. It doesn't want to make more reactive oxygen species. So we have to be aware that we need to basically look at how else can I support for a while people's mitochondrial function without making more free radicals, making more damage until I get them supported. There's a couple of ways to do that. One is to bypass oxidative phosphorylation. And this is, I think, one of the first things you can do. You guys who are really struggling with energy, you've been sick, you have long COVID, you have other viral influences. Most of those people are in this very stressed state. The mitochondria don't want to work in a stress state. They want to quiet down, not create more stress. But you need energy. So what are you going to do? The best route to bypass oxyphosphorylation that makes clean energy without you having to make any reactive oxygen species, because you don't have to go through that process, are ketones. So ketones use less oxygen and make more ATP, but they don't have to go through this passing electrons down a chain. It's a more direct path. So what I can do is take these people who have no energy, who I don't really want to stress their mitochondria yet and tell them to go exercise a ton. I can give them fuel by giving them a lot of ketones, right? It's the perfect answer because now I've made a bunch of ATP, but I've made no reactive oxygen species and I can give them as much as they need. There's no toxic dose of ketones. I guess if you're a diabetic, there could be. But in general, it's not a toxic dose of ketones. So what we use is, and I love a product called Kinetic that actually has, what they did is they separated the ketone esters. Because if any of you guys have eaten ketones, they taste like, blech, horrible, taste like gasoline. So what they did, ketones are generally a salt and salts are bad because they actually give you too much of a salt load. But the second ones are ketone esters. And ketone esters work well. They're a combination of two things, 1,3-butanediol and beta-hydroxybutyrate. The beta-xybutyrate is the big push to up the ketones initially, and then the 1-3-button-diol kicks in through the liver and makes more ketones. If you give it ester, so you just drink your bad test in ester, you'll get this big spike and then a pretty fast drop. So for about two hours, you'll get this ketones, you'll have some energy, and then it's gone. So what Kinetic did is they separated out those two compounds. So you get the nice spike and then a slow drop, and then you could hit it again. So I feel do that like three, four times a day, taking 20 grams of ketones. What that's going to do is supply back some energy. So now they can start moving a little bit, doing a little bit. As they're doing a little bit more, they're encouraging their own mitochondria to become healthier. But I had to give them that energy boost first. Does that make sense? It does. And I mean, I think for people that are listening, I think we've gotten to a point where, like when I'm doing an intake or talking to a patient, it's like they don't have enough energy so they start over-caffeinating. Right. And then they get a slump in the afternoon and so it's either more caffeine or it's something sugary. Like they make for a snack, a salty, sugary snack, right? So creating more oxidative stress and there's the mitochondria that aren't working anyway. So it's not giving them energy, it's giving them a little, you know, mini spike. Yeah. As we can, so now while we're doing this, giving another source of energy, now we can actually go back and start repairing the mitochondria. And, you know, so I can't, you know, for me to ask somebody to do anything while they have zero energy becomes impossible. And you've seen it, right? And your patients, you've seen where, you know, they're like, you told them to take five supplements. I'm like, I can't do that. It's just too much, right? Their brain is not working. Their body is not working. And they're just exhausted with this. So we have to be able to give them some energy first. I always start there. Now I can go back and sort of reason with them. They actually have a little energy. They feel like they can move a little bit. I can get them walking. I can get them moving a little bit. And now you can start giving them back a few things that will help the mitochondria. And there's some big fancy ways to do that. And there's some simple things that I think really have a lot of power. One is iron. So look at the number of your women who have ferritin levels that are less than 65. And you haven't been in this world as long as I have, but ferritin kind of became this evil foe where it's like, oh, you want a really low ferritin. That's much healthier. There were some doctors really spread that. You want low ferritin because if ferritin is high, it's increased risk of cancer. You don't want too high a ferritin. That's a sign of oxidative stress. But if you do not have at least 65, and some would say between 80 and 100, then the last complex five, which has four iron molecules that actually, it's a really cool complex. When they're filled, the complex spins and it spits out ATP. It's really interesting, right? It's actually a little spinny thing. And so if you don't have a ferritin level of 65 to 110, that complex can't move. So the first thing I'm always going to do, and your women, your perimenopausal women, lots of times have low iron. They have heavy periods, right? They have low iron. And somebody says, oh, you need a little iron, but they haven't been taking it because it makes them sick to their stomach and they feel horrible. So everybody should know what their ferritin is. You absolutely need to check your ferritin. If it's below 65, then you need to supplement. So I like using what's called proferrin, much less irritating to the stomach, but I'm sure you guys all have your favorites of things. There's ways to increase iron without healing horrible and getting constipated. But I really want to emphasize that because I see, I would say in my perimenopausal women and in my young women, I would say at least half, if not more, do not have adequate ferritin for mitochondrial function. If you're in your 40s and 50s and feel like your body suddenly stop responding the way that it used to, you're not imagining it. Bloating, weight gain, sleep disruptions, food sensitivities, and unpredictable energy are incredibly common in perimenopause and menopause. But here's what most people aren't told. Your gut microbiome is changing right alongside your hormones. And those changes can influence everything from how you store fat to how well you sleep to how your body processes estrogen. That's exactly why I wrote my new book, The Menopause Gut. In this book, I walk you through the science of how the microbiome, metabolism, immune system, and hormones are all connected during midlife. 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If you're a woman in midlife or beyond, you'll probably notice those changes in energy, strength and recovery just don't feel like they used to. And what's frustrating is that for many women, this happens even when you're eating well, lifting weights, prioritizing protein and doing all the right things. You're not lazy, you're not unmotivated and you're not doing anything wrong. A big part of what's changing actually starts inside your cells. As we age, our mitochondria, the energy producing structures inside our cells become less efficient. And when mitochondrial function declines, it can show up as lower energy, slower recovery, reduced muscle strength, and feeling less resilient overall. This is a normal part of aging physiology, and it's one of the reasons midlife can feel so different. And that's why I've added MitoPure gummies from Timeline Nutrition into my daily routine. 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Again, that's Timeline.com slash Cynthia and use code Cynthia Thurlow for 20% off your MitoPure gummies. And ferritin for listeners is the best marker for storage of iron. So really important to understand that in like my world, I would have people say, oh, their iron's high. So that means there's a lot of inflammation. And what Dr. Irith is saying is there's this kind of Goldilocks effect. We want to make sure it's greater than 65, probably under 100. Like somewhere in between is that Goldilocks effect. And so really important, irrespective of whether you're still menstruating or not, because I see menopausal women that have low ferritin too. Right. Yeah. Well, some people who really literally don't intake enough iron, right? If you're a vegetarian, very much more likely to have low iron. If you just hate your red meat, you're going to have lower illness. And then always have to think about the gut here. Everything always comes back to there are a lot of people who do not have healthy guts, who have microscopic colitis, who have things where the gut is really not handling these foods well to actually absorb them. So when you see low ire, you've got to look at the gut as well, especially in somebody who's not having heavy periods, who's not losing blood, right? You always want to go back and look at the gut. But I think it's certainly not in the traditional markers. I don't even see it in all of the longevity markers. So it's really something that's powerful. And I see people attending a lot to high ferritin and going, oh, this is oxidative stress, and not attending a lot to low ferritin. I have people all the time coming with a ferritin of 35 and somebody says, well, that's fine. It's not. Not for energy, at least. So then I think there's, I always try and make things simple because it's funny. Most of my staff is young, like late 20s, early 30s. And they always have the conversation with me that they will do like five supplements and no more, right? So I always think about that when I'm seeing my patients because, you know, you and I and a lot of your listeners are the exception. But most people really don't want to be taking 20 things, right? It's fatiguing. It's tough. You know, and I will say not always all that healthy to be doing that much. So I always like to simplify it down to what can I do that's really powerful that I can take as simple approaches. So I think there's three things besides iron and besides having adequate hormones because hormones are necessary for mitochondrial function and the mitochondrial functions necessary make the hormones work. So got to have adequate hormones there and thyroid. But the three supplements I think are really useful that I think sort of have been performed a little underwhelmingly, partly because I think they've been heavily underdosed. And one is alpha-ketoglutarate. A lot of you guys know AKG. I think it's a really powerful longevity molecule. It's so much more than just kind of energy function. It's this really powerful epigenetic regulator. It's a cofactor that's really responsible for turning genes on and off for methylation patterns. But it's also really key in the process of making energy. So a lot of people are low in it, particularly as we age, particularly if you have any methylation defects, but it gets neglected that people have methylation defects will oftentimes have low alpha-ketoblutarate levels. So the dosing, if you look on every bottle out there, is 500 milligrams. The studies show that the dose needs to be closer to two to three grams. Wow. And I want to say that this is, I think, a place where if you look at supplements, supplements have to stay within a generally recognized as safe status, right? So when you look at the dosing, it's not necessarily the dosing that was found to be therapeutic. If you look at the studies, it's a dose that's safe for just anybody. And with the understanding that a lot of people are going to say, oh, I'm going to take extra of that, right? So they have to dose it very conservatively. It's a little bit like the RDA, right? None of us would say the RDA of vitamin D, you know, what the recommended dose is, right? 800 IUs, right? But we don't look at some of these other supplements the same way. And so alphagate of glu-ray is one of those. If you go back and look at the research, it is very powerful, but getting up into that two to three gram dose. So I really want people to be cognizant of that because I find this to be very, very powerful and helping with energy production and helping with methylation, but it has to be dosed appropriately. So then you start looking at, okay, now I've got to take like six of these pills, right? So that becomes the problem unless somebody... And so there are like new bio-ages doing some work to try and develop, make supplements that are more dosed towards the providers to basically dose them at a dose that we think would be a more appropriate dose for really helping people get well, right? Not just staying alive. The other thing that I really use a lot for mitochondrial repair is urolithin A. And I know a lot of you guys are familiar with this one. Urolithin A comes primarily from pomegranates. I think walnuts also. So pomegranates and walnuts are the big sources of urolithin A, but you have to have the enzyme to convert the pomegranate or walnut into urolithin A. And only about 30 to 40% of people have that enzyme, right? You could test for it, but it's expensive to test for it. It's sort of silly. So urolithin A is a big controller of mitophagy. So remember, we have these damaged mitochondria now. I just said these mitochondria are stressed. They have all these reactive oxygen species. They've been damaged beyond repair. We got to get rid of them. So urolithin A is really vital for getting rid of those bad guys so that I can now take my nice healthy mitochondria. What will happen when there's sort of now space, the nice healthy mitochondria will divide. It's called fission. And they make two nice healthy mitochondria. And we kick out the bad guys. So urolithin A is really a good player here. We know that we collect bad mitochondria just like we collect those zombie cells we age. We also collect bad mitochondria as we age. So I love urolithin A here too. But again, initial dosey on urolithin A was 500 milligrams. If you look at the studies, it's a gram, right? So again, a great supplement. but you need a little bit more than what the traditional bottle is. And then pulling back into line, one of my old favorites, which is spermidine, because spermidine is really helpful for not only getting rid of damaged cells, but also for rebuilding those, helping that mitochondrial fission, helping these mitochondrial to divide and conquer. Because we want to get rid of the bad guys, form some new guys. But now, if you look at the more recent data on spermidine, and I've been guilty of this, this is where you have to keep following the research, because I dose spermidine at a high dose at six milligrams. The data that's coming out shows that probably a therapeutic dose is like 20 milligrams. Wow. Yeah. Big difference. Yeah. And hard to get. There's one company, and I think New BioAge has the sole contract with them. They do a fermenting process to make a natural spermidine out of it. And I think they're the only ones who have that kind of dosing. So I was dosing spermidine at two milligrams on a regular basis, six milligrams to really get autophagy going. So I would cycle six milligram doses. And then I start looking at this research and I'm like, oh my God, I've been really not probably doing much. Now maybe a little bit, right? Particularly if you're healthy, you can get by with these lower doses of things. But probably what we need is much more. And then you could cycle that in. If I need to do mitochondrial repair, mitochondrial biogenesis, I definitely want to hit somebody with a 20 milligram dose. So if you look at those three supplements, along with getting your other stuff a little optimized, right, that you've got enough coenzyme Q10 and all the basics, you're going to really help mitochondria repair, right? So I've given energy first, and now I've gone back. I've really focused on mitochondria repair. And are you using these concurrently, or are you cycling them on and off? I mean, I know I'm asking for the tools to the toolbox, but out of curiosity, when you're working with patients and really working on the repair piece. It kind of depends on how bad they are. Sometimes if people are really sick, I don't want to hit them for too much at once. So I might first start with just some alpha-ketoglutarate, spermidine, clear out, and then add urolithin A. Sometimes I will use all three at once. If that's just too much, both financially and a lot of pills, then I will actually do like a six-week cycle of each of those. With the exception of alpha-ketoglutarate, I will add the alpha-ketoglutarate in with both of them. So I'll do maybe a six-week cycle of alpha-ketoglutarate with spermidine and then alpha-ketoglutarate with urolithin A. The studies, you guys, if you've not seen them on urolithin A for muscle building for older people, and why is that? Why is it some magical molecule for muscle building? It's because it's so helpful for mitochondrial function. And so that's what we come back to. Hormones are, you know, all the antigens in the world. That's why when you're 35, 40, it's not so hard to build muscle if you take anabolic steroids. When you're my age, 65, and you take anabolic steroids, you still don't build muscle very easily unless you repair mitochondria. I think that's an important distinction because one of the questions that I've been receiving with greater frequency is I'm on HRT, I'm lifting weights, I'm eating enough protein. Right, I'm doing everything you say. Yeah, I'm doing all the things. And now I'm looking at peptides. Like, do I need to add peptides in order to build muscle at 45, 55, 65 or later? I think that there's a lot of emphasis on body composition, which I think is great. You know, I think you and I certainly grew up in an age where it was like thin is in. And, you know, that's being strong. And so I think now there's a lot of emphasis on strength. And so everyone's much more concerned. And I think for listeners, you know, I always bring this up. And I think it's from, you know, 20 plus years of working in hospitals. What people forget to realize in middle age is the reason why you're building muscle. Yes, for metabolic health. Yes, for all these locomotion. But the piece about frailty, you see it. It's huge, right? Frailty is coming for us if we are not working against it. And frailty leads to a loss of independence. And I think for a lot of people, they don't think that next step. They're like, yeah, you know, I see my grandmother and she's kind of tiny and she's not very strong. But that then begets falls and falls leads to a lot of independence. Right. So you can't get yourself above the floor. It's a problem, right? So, you know, muscle is, yeah, we call it the metabolic currency of life. Totally agree with that. But we have to help people because it's not so easy. I get a little exasperated, quite frankly, Cynthia, because, you know, I'm on all these social media gigs, right? You see them all the time with your Instagram. and I get a little frustrated by the constant, constant, constant preaching that seems great if I'm 20, 30, 40, and maybe not if I'm 50 or 60, that it's not the same rules and that it's not just go out and exercise harder and make sure your hormones are optimized and make sure your thyroid's optimized. It's more than that. And this is really the missing piece that you guys need to look at is that your mitochondria will fail even if you're doing all of that stuff right. So you've still got to focus on that. So my longevity plan, fixing the mitochondria is one of the tiers, right? It's one of the pieces that I look at just like everything else. And one of the hard things is we don't have like a perfect marker for mitochondria. So it's not like I can test your testosterone level and tell you, oh, this is low, let's give you more. So how do I decide that your mitochondria aren't working? It's not so easy. There's fancy tests we can do. You can do pyruvate lactate levels. We do have kind of a fancy phospholipid test that tells us how the mitochondrial membrane is doing. but it's not easy. There are a couple of simple things you can look at in your labs that might give you a clue. One is if your uric acid levels are really low. So uric acid we always think of as gout, right? We always think it's a bad thing. So if somebody's overfed, over energy, they have high uric acid levels. They're metabolically unsound. They have high uric acid levels. We think about that, you know, gouty people, fat people, high uric acid levels, right? and uric acid levels cause all sorts of problems when they're high. Well, what we forget is that low uric acid levels are equally as bad. In other words, a U-shaped curve to uric acid is just as bad to be low as high. And the reason is because it is a sign of an under-energy state. And if I'm under-energized, I lose brain, I lose muscle, and I lose cardiac function. Those are the three tissues that are the most dependent on energy. So that's a little clue. If your uric acid levels are less than 4.5, there may be a sign of some mitochondrial dysfunction going on there. Other thing is to look at your triglycerides. Like we always think low triglycerides, great. Triglycerides get under 65. That's also a low energy state. Your liver is stressed and it's, you know, so we're trying to conserve. So those are kind of two little markers that are simple that every one of you guys tests. If your triglycerides are a little on the low end, your uric acid's a little on the low end, this is mitochondrial dysfunction. Now, I will tell you that there are a lot of those values are normal where I can just tell you they have mitochondrial dysfunction. Quite frankly, if you're tired all the time, if you're having trouble building muscle, if you have brain fog and you've corrected the other things, you have mitochondrial dysfunction. It's as simple as that. Because almost, I will say, probably everybody after the age of 50 probably has mitochondrial dysfunction. Yeah. Yeah. To me, I'm literally, I was teaching a class last night and we were talking about markers of metabolic health and uric acid came up and I was saying, you know, this is where your uric acid levels should be if you are metabolically healthy. And I'm realizing if they're that low, you also probably have some mitochondria. Right. There's an energy deficit problem, right? And I love like, you know, Dave Perlmire has this drop acid and drop it as low as possible. It's not good, guys. Look at the studies on cognitive decline with low uric acids. There is direct relationship between low uric acid and cognitive loss. So we know that these are signs of something going wrong. And yet we ignore these signs. We always look at everything being too high. We don't want you to be fat. But we're missing the under energy piece. And we're seeing that a lot now, right? Like people, even when you look at some things like intermittent fasting and things like that, sometimes we can get into these sort of, we're just not getting enough energy. We're not even supplying enough fuel. You know, in our day, it was I'm older than you, but it was everybody dieted to an extreme. We're kind of gotten people a little bit out of that. But I will tell you that now people are fasting for seven days. And you know what does that do especially if you a woman and you don have a whole lot of reserves Those are things I think we have to be really careful of what we preaching right Are we always preaching to this one group that the general male you know who has adequate muscle mass and has a lot of energy stores versus me, who is a skinny little female who doesn't have those stores, right? You know, so I think that that's really important. And then we can go into, so now you're like, okay, I've done all these things. What else do I need to do? And I do think, quite frankly, and you know, I love peptides. I've been teaching peptides for as long as they've been around. And I do think this is a place where, quite frankly, if we really have to repair mitochondria, we have to go to peptides. I don't know that when mitochondria get severely damaged, and I will tell you COVID did a big number on mitochondria, that we're going to repair them without using peptides. And I'll tell you why. So if you think about your mitochondria shape, right, the inner mitochondrial membrane, You guys have all seen it looks like a flower, right? That's a kind of flowery shape inside. So it looks like this and it's got this little flowery shape inside it. And that inner membrane is where all the action's happening. That's where these cytochromes are passing electrons through. It's really critical to have that shape because if I want to create a force, an electron force, I have to collect electrons. If my membrane looks like this, I can't collect the electrons. They need a shape like this so that I get what's called a proton motive force. and it forces energy so I can transfer electrons from step to step. So what happens both as we age, and I will tell you viruses, there's a big number on this, especially COVID, is that that membrane, that what's called cardiolipin that makes up that inner membrane gets destroyed. So now the membrane looks like this. So I never can make that proton motor force. So if I take that person, I put them on methylene blue and all this stuff that's going to speed up that electron transport chain, it's not doing any good because I can't create a gradient. So first and foremost, and what I think is everybody who's getting older or who has a lot of mitochondrial issues, brain fog, fatigue, muscle loss, I think they probably a couple times a year need to do a peptide called SS31 or a lampertide. And the reason is because it's the only peptide that can actually reshape that inner mitochondrial membrane. All right. So binds that inner mitochondrial membrane and sort of replaces the cardiolithin. So now I can reshape that mitochondria because I can't really reshape this mitochondria. How can I get these energy forces to go? And it's not really like you could take, you know, urolithin A and mito-Q and all these things. They won't actually reshape the membrane. Does everybody need that? I mean, obviously, if we would have all died at 60, if we didn't have some way to fix those mitochondria. But I would tell you that it is pretty critical. And especially now in this day and age, I think mitochondrial dysfunction has become much more of an issue than it used to be. I will tell you, our post-COVID world, and I'm sure you've seen this, is a completely different world from pre-COVID. And we have a lot more people walking around with significant dysfunction and a lot more people who feel worse than before they ever got sick with COVID, even mild diseases. So I do think in my longevity program, I almost always, as people age, or if I can't, you know, I know there's mitochondrial issues, I almost always hit with a course of SS31. And I'll do a six-week course of a pretty high dose. Now what I've done is I've fixed those mitochondria, right? The hope is now I've used my other things, urolithin A and those other things to get rid of the bad mitochondria. 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Again, that's CozyEarth.com and use my code Cynthia for up to 20% off. Experience the craft behind the comfort and make every day feel intentional. Do you find that in our current climate that you're having greater challenges trying to access high quality peptides? And I say this being very conscientious about the language that I'm using because I feel like there's a lot of pushback, whether we're looking at the traditional allopathic space versus the functional integrative space. I feel like there's kind of like a war over peptides and the semantics around them, which to me is kind of silly. No doubt peptides are the wild west. You know, I counted at the A4M conference, no less than about 20 peptide companies selling their wares, some of which I know very well don't work. There are formats that we know very well don't work. So it's kind of wild west. Anybody can make them. I did recently, there's a group of us who got appointed to an FDA advisory board. So we actually just put together a big paper to submit. So the FDA now at the government level is trying to look, and they're really actually trying to help out the more legitimate use of these, quite frankly. So, you know, right now, we actually submitted all this paperwork. It'll go into a first stage vote here. The hope is we actually will, our goal is to move a lot of these peptides from what's called category two, which is not really considered a safe category, into category one, which will give much better access. They're also working to control, and we say, well, control is bad and good, but they're also working to keep peptides a little bit more in the hands of people who are, they know are doing it correctly and legitimately, and where there's some control of them. I think that's a good thing. I do worry about access for people. I do like everybody to have access to peptides, but I also worry about bad things that we're going to see happen if we continue to let this go. And then it's going to be, none of us can get these. And they really are such life-changing things. It's a complicated world. Again, I honestly, I started using peptides. There was a little group of us in a room that started working with this one little compounding pharmacy, like now, I don't know, 10 years ago, and started, you know, designing these peptides and getting them to compound force. And there was probably, I don't know, 10 of us who were doing peptides and using them. And it was fun because we had, you know, we had easy access to them and could do them. And now look at it, like everywhere. By my son, who's 18, who's in a frat, like, you know, he's showing me all the conversation about everybody doing the retitutide, you know, like, this is a stupid drug for a frat boy to be taking more. I've been taking retitutide. So they're all over. One of my friends showed a picture from his gym where the cafe in the gym had an entire cabinet full of peptides. And this is not okay because peptides do really need to be used appropriately, not just for safety, but honestly, to make them work well, right? So I don't want to be a leas. I know a lot of people are like, you know, the doctors just want control of it, blah, blah, blah, blah. You know, I think they need to be just we need to bring rain things in a little bit to make it safer. And so we don't lose these for all of us. Well, I'm so glad to know that you're involved in, you know, kind of this evolution, because I think that's really important. I mean, you've had a long breadth of experience. You're incredibly knowledgeable. Quite transparently, I had not heard of SS31. So that's new for me. But I think that there's so much to learn, but it really needs to be in the hands of people that understand the way that they work. And it's not just a peptide. It's going to be expensive wastes of money if you don't use them right. And I see that all the time. For instance, there's another peptide that's kind of, you know, out there a lot called MottSC. Well, MottSC is great. What it's going to do is sort of rev up that oxidative phosphorylation pathway. It's going to move the electrons faster, right? So that's great. And make more energy. Well, not if I don't have functional mitochondria in the first place. So I have to make sure I've got healthy enough mitochondria to tolerate beefing them up, making them work. So I think that SS31 becomes sort of a key peptide. I do think, you know, for the people who can't exercise, there is exercise memetic peptides, one of which is called 5-amino-1-MQ. It has a supplement version called 1-methyl nicotinamide or 1-MNA. But what these two, the peptide 5-amino-1-MQ does and 1-MNA do is they block an enzyme that's depleting all the NAD. So those can be used as exercise memetics in a sense. Modest C as well. So again, those are places where I have somebody who's like, oh my God, my arthritis is so incredibly bad. I need to exercise. I can only do so much. What am I going to do? I'm going to actually use these peptides and I'm going to help them with things like BFR bands, body weight exercises and BFR bands. Blood flow restriction bands go so far when you're injured because you can do, in our ALS patients, we have them do blood flow restriction bands and do nothing but try and move their arm a little bit, right? And you can still put on muscle. So blood flow restriction can be used. So there's a lot of things we can use for our people who say, I can't exercise. It's too hard. It's too hard on my joints. There's a lot of tricks we can do around there. Using peptides to help with pain, like BPC, Thymus and Beta-4, help with pain. Using peptides that simulate exercise. And then using tricks, like blood flow restriction bands, to make exercise much more tolerable to our bad joints. What do you think about immune-supportive peptides? I'm thinking about the fact that immunosenescence is such a large aspect of acceleration of aging and how the more now that I humbly know as much as I do about the immune system aging and how that impacts everything in our body, the more I think about peptides just for immunosenescence and supporting women because, you know, just with our physiology as women, we're so much more prone to autoimmune conditions. And with all the changes that happen in the gut microbiome with the loss of estrogen and increase in leaky gut and, you know, just the propensity for developing autoimmune conditions. I'm just thinking selfishly from the perspective of, you know, we have thymus involution, we have all these different things are much more T helper one dominant and, you know, the kind of the cascade of how that all occurs are using a lot of peptides for immune support. So you're, you're, I mean, you're right on. So if I say, okay, mitochondria at the root of aging, But it's the mitochondria that are also really important to immune cell function. And so, you know, like not having the mitochondria is not what kills you. It's everything the mitochondria are supplying. And one of those really important things that honestly is probably the number one thing that's going to kill you is immune dysfunction. If you look at some of the work coming out of Buck Institute, like David Furman's lab, where they're looking now at just looking at immune markers. like they have a new test called I-Age test that they think is a much better test for your sort of biologic age than all these age tests out there, because really, if you can look at immune cell age, that's going to be the key trigger. That's going to be the thing that fails first. So I-Age test looks at something called CXCL9, which is a marker of immune age. So I think we're going to see this next era being focused a lot more on our immune system, right? Where we've sort of put the immune system is down kind of here. We fix this other stuff, immune system gets better, it probably is put up here. And if you look at viruses, if you look at cancers, cancer is an immune system failure when you don't have these vigilant cells watching out for cancer. Now, that's why if I riddled with herpes viruses and EBV and COVID viruses, my immune system is so taxed by that that it gives up on trying to make natural killer cells against cancer. So when you look at treating immune dysfunction, number one, I would say go back to your mitochondria, but do I use mitochondria or thiamine peptides? Yeah, I love them because you're exactly right. My immune system is at its very best, believe it or not, at puberty. So our thiamine gland is doing really well. It's huge when we're born. It functions really well until puberty. So around 13, 14, it actually starts to involute. It turns into fat. By the time you're my age, it doesn't do anything anymore. So my thiamine gland is at the root of teaching my immune system what to do, fight this guy, don't fight this guy, respond to this insult, and I don't have a thymus gland anymore, then I'm just not going to function as well, right? So some of our immune system memory cells remain, but some of us think we need to be able to kind of respond to new things, right? Like I never saw COVID before. So how can I do that? Well, you can give back what the thymus gland isn't doing anymore. So in France, they eat sweetbreads. That's eating thymus gland. Who knows? Maybe. There are some wacky people in the longevity field that are actually looking at transplanting thymus glands from aborted infants to keep us alive. So there's a lot of focus on if we could get thymic regeneration, we could do a lot for longevity. We do know that the growth hormone secretagogues do help with thymic function So if I have any remaining thymic function the growth hormone secretagogues will help with that So as I get to be older probably it minuscule but it will still help a little bit But if I give back the peptides that the thymus gland makes the main two being thymus and alpha-1 and thymus and beta-4, then I'm kind of substituting for the fact that I no longer have a gland. Just like your ovaries aren't making estrogen anymore, but you can take estrogen. My thymus gland is not making the thymic peptides anymore, but I could take thymic peptides. So I kind of think, and we keep looking at this organ failure that goes on in our ovaries and our thyroid and we replace all those things, but we're not thinking about organ failure in things like our thymus gland and should be part of our longevity focus to replacing those as well. So in my perfect world, yes, if I'm targeting a longevity protocol, I would replace thymic peptides periodically through time as well. So using thymus alpha-1, and one of the hard things is thymus alpha-1, hard to get. I'm hoping that some of these new things we're working on will actually make thymus alpha-1 much more accessible. Because it is, guys, if you want a peptide that has a ton of human data, it has a ton of human data. Everybody says peptides have no human data. That is a valid complaint. But thymus alpha-1 is a drug in other countries. It's the Daxan. It's widely used to support cancer patients, to support people with viral illnesses. Widely used in India, Asia, and cheap, easy drug to obtain. I had a patient with cancer who moved to India just because she wanted her Zadaxan. But here, not easy to get, right? Thymesulfa-1 is Zadaxan, the same exact drug, a lot of human studies, antiviral studies, cancer studies. There's a lot of human data on this. It certainly is. It's well-tested, and it's super safe. No complications that have ever come up with thymesulfa-1, even at very high doses. So if you can access it, it's really a useful thing to do, number one, whenever you get sick. But I like to say, if I'm replacing things like my mitochondrial with SS31, why don't I a few times a year, four times a year, let's get some thymic peptides in there, right? And then thymus and beta-4, think of it more as you're a sort of repair guy. So it's kind of coming to action to help with the repair side of things. So again, as that diminishes, I can't repair injuries that are done, including the immune cell injury. If I do the same thing with thymusin beta-4, we always think about thymusin beta-4, people think about as part of the Wolverine pack with BPC and thymusin beta-4 to heal from the injury. It has a lot more function than that. It's really important for stem cell mobilization, so these immune cells to get to where we need them to go. So it's really still a critical player there as well. So think about it in your illness realm, or again, replace what you lose. I'm going to replace my thymine peptides. So I like at least a few times a year, most of my patients will replace thymusin beta-4, thymusin alpha-1, SS31. on. The same way I would replace your thyroid or your hormones, your estrogen, progesterone, right? Why are we looking at these differently? These are endogenous peptides that are made a lot when you're young and a lot less when we're older. Maybe we should start thinking about them the same way we do our hormones. I really like that because I just about cried when the peptide pharmacy that I was working with that I couldn't get thymus and alpha because of the amount of travel that I do. Yeah, great. Gave me an additional like level of support as I was traveling. And so I love the idea of replacing what our bodies are no longer making. And I really think that that's the right way to think about this, whether it's cyclical, you know, several times during the year. Right. You know, the other thing that I think is really interesting when we're talking about mitochondria and I use this as like one example. I was doing a little bit of research before our conversation today, and it was specific to progesterone, which I think is like the bastard stepsister of estrogen, not really spoken about in this level of importance. And I was looking at this paper saying mitochondrial dysfunction can reduce things like GABA synthesis. So main inhibitory neurotransmitter increases glutamate. So when people talk about how, whether it's replacement with progesterone that makes them feel like they're overly stimulated or progesterone intolerance, increased sympathetic activation, and then the other worsening anxiety and insomnia. And so that's just all from mitochondrial dysfunction. So you could be taking the hormone as a replacement, and you might still, because of this mitochondrial issue, and I think what everyone should take away from our conversation is we need to be thinking about the mitochondria first and foremost, and that needs to be addressed. Otherwise, replenishing hormones may not be as effective or even helpful. And especially, again, as we're getting older, where that mitochondrial dysfunction becomes much more, you know, much more a significant factor, right? which is why you said I have all these women on testosterone and they're like, well, I'm not building muscle. My libido is still not great. Why is that? Well, if I don't have mitochondrial function, none of those things is going to work either. And you're right. Neurotransmitter synthesis is very mitochondrial dependent. Almost everything to do with the brain is very mitochondrial dependent. As I said, the three tissues that cannot survive without a lot of energy are your brain, your heart, and your muscle. If my brain and heart need a lot of ATP, my body is going to sacrifice muscle for that. So if I only have so much energy to go around, the first thing that's going to try and keep alive is my heart because my body's goal is to just stay alive. So brain goes, right? So first muscle goes and then brain goes and then finally your heart will go too and you'll get reduction in cardiac output and things like that, which is why we see cardiac output decline with age. We start to see people just have less cardiac efficiency. VO2 max is decreased. And we're talking about all this VO2 max stuff and we're not talking. We're talking about exercise, exercise, exercise, radio, food, two backs, and your zone two training and whatever. Or you can't do that without adequate mitochondria. Yeah. And I think, you know, it's interesting. I know that I've had guests on that'll say, you know, VO2 max once every 10 years. And I was interviewing Dr. Andy Galpin and he looked at me and he goes, oh no, Cynthia, it's once a year. And then someone in the audience said, oh no, it's every three months. And I was like, wait a minute, once a year, maybe not every three months. I was like, not in my world. I was like, that was done. Yeah. We have to start being a little realistic with these biomarkers too, right? We've gotten a little overboard with what true biomarkers do we absolutely need, right? And I agree, VO2max is a useful piece. There's a lot of genetics to VO2max. So it is a little bit when people are like, okay, well, if you have this VO2max, you're going to live forever. If this VO2max, you suck. There's actually a lot of genetics and there's a lot of data that supports this. Some people with very low VO2maxins who are doing very well at different cultures, right? So we don't actually know all the logistics behind that, right? We know if you started here and now you're here. So it's a good parameter to follow over time, not every three months, but over time. And if it's declining, I know I'm losing ground. But if I'm low and I'm kind of staying steady there, that might simply be me, right? So there's a little piece of, I think, we put everybody into these categories. This is good. This is bad. It's not necessarily the case. Like I said, there's cultures where their VO2 maxes are much, much lower. Some of the African cultures where the VO2X is much lower than ours, and they do great. They actually have great endurance. So I think we have to be a little careful with how many biomarkers we're measuring and how we're interpreting those biomarkers, right? I think you can get a lot from some simple biomarkers. I think that not everybody needs to have biologic age testing. I don't know that we even know where we're at with biologic age testing. It doesn't mean anything. I was just at a conference where somebody was presenting their data from, you know, four different biologic age companies. The variance was 15, 20 years between the different companies, right? So we know we don't really have a good handle on this. It's really why I'm kind of liking the IH test. I'm like, well, at least I can one thing I can say, okay, immune function is sucky. I'm probably not going to do well, right? So at least it's something I can say and, you know, and say, okay, I can really target this. I do think there will come along. We'll get better and better with these things. But I do think we also have to be a little overload. Something posted a great, I think I read it on LinkedIn or Substack, but just when are we just increasing anxiety to people and not doing anything that's particularly more beneficial than that? Orthorexia. I mean, how many people are paranoid to eat? You know, they go to a restaurant, they can't even enjoy themselves because they're pretty used to seed oil. Or, you know, I think sometimes we get, maybe with good intentions, we become a little bit alarmist. And then people can enjoy, like I was having a conversation with someone the other day. And I said, if you go out to dinner once a month, I want you to enjoy the dinner and not stress about. Right. And it's just about what exactly all this crap. Right. Yeah. Right. And if you guys do it every day, that's probably an issue. If you're doing it once a month, it's probably good for you. And you could look at this one influencer who literally sort of her job is to just do all these longevity things. Right. And it literally takes that's her day. I mean, it is get up to do this, this, this, this, this. That's her day. Fortunately, she has a huge Instagram following. And, you know, so she can afford to just do nothing but these longevity tools. Like I sometimes find it tedious to find time to go to the bathroom. You know, it's like there's no way I'm going to do all these tools. So we do have to find these simple things. I mean, you know, that do work for us. And it is where, to me, a little bit where some of these peptides and things can be a little bit of a cheat to me and that they can support me in some of those things that if I can't do this perfectly, I can still support my immune function. I can still support my mitochondrial function. So I think simplifying the routine but being really pinpoint about what we're doing each time. It's why when I treat patients, I cycle a lot of things. I actually do what's called seasonal cycling. I rotate what they're taking. I rotate their peptides. I rotate things, their growth hormone levels based on seasons because that's what our body is designed for. So four times a year, we make little changes, right, that fit more with what should be going on in those seasons. Like in winter, we're actually designed for IGF levels to drop. We're designed to have lower IGF levels. We're designed to hibernate. We're designed to like not be out there aggressively exercising. It's okay that testosterone levels maybe drop a little bit during that time. That might not be the time you want to hit with big anabolic load. But then springtime, that's when your body, because our bodies will adapt better when they're meant to adapt. So you can do things like, okay, now I'm going to hit with an anabolic steroid or higher-disc testosterone or really hit my mitochondrial function at springtime. So there's ways to do this sensibly where we don't get so overwhelmed. Well, I love your thoughtfulness because I would imagine that really benefits your patients. You know, you're so thoughtful, so methodical, very reasonable. I do want to end the conversation selfishly because I'm curious. You are an orthopedic surgeon by training. Lindsay Vaughn, obviously 40 years old, just, you know, went to her last Olympics, obviously went there with an ACL tear and obviously had that horrific crash and a significant injury. From your perspective, knowing what you knew about her prior to that most recent injury, what is it about 40-year-old bodies, even in conditioned athletes? Because clearly she's an exceptional, probably one of the best alpine downhill skiers that's ever lived. But even in a 40-year-old body, what are some of the things that make us more prone to injuries overall? Number one, we know Lindsay probably has access to the best and the greatest. But even we have a lot of high-level athletes in our practice, and I'll tell you, a lot of them aren't able to get the tools they need. Number one, water testing limits. You can't be doing androgens and things like that, right? So hormones become much more deplete in a 41-year-old who is being water tested and can't be doing things like that. They can't be doing peptides. They can't do a lot of the things that, and there's ways to kind of work around that a little bit, but not as aggressively as you might think. And so we know that she's dealing with a 40-year-old bi that is going to be lower in a lot of the repair mechanisms. And that her ability for her muscles to recover and respond after just having, you know, she had the hemiarthroplasty of her knee, and then she has this other injury with the ACL tears, that her ability to recover and respond was not going to be as quick. I think that I can never criticize her for choosing what she chose, because if it would have turned out another way, we'd all be cheering her, right? But the risk is high. Her body was definitely, especially having been through the stress of your travel, all those things that just are a little easier when you're 20 than when you're 40, like I said, her mitochondria are not as good. So all this stress that's kind of put on these athletes, they're overtrained. When they're in the Olympic Village, they're actually not fed that well. There's a lot of pieces that go into this. It made her likelihood of getting through this much lower. And I don't know how much she considered that, right? That if everything was perfect, everything was going to be fine. You know, and as a physician, looking at some of the catastrophic things that we can see happen when people have, you have an injury and then an injury on top of that, it's scary. I mean, if she was my kid, I would have said, no, you can't do that. You have to argue that like she had to do this from her mental state, right? It was not, she was not going to have closure without doing it. So, you know, somebody said that, but it is where I think athletes get a little bit screwed. And we do, we have them in our practice. We have pro football players who we try and help heal from an injury and we can't use the tools that you or I could use, which is a little bit unfair because most of these tools, quite frankly, are not going to make them some super athlete. They're just going to help them heal faster. And yet we can't use them. I mean, I just think from the perspective of, you know, and from my perspective, I'm very much a, you know, live and let live kind of person. But it was interesting that, you know, my college age son was asking me questions about it. And I just said, I honestly, I said, I tried to find out which bone she broke. And I'm not even sure. I haven't seen much about it. Yeah, I do know she had to have a second surgery, you know, so I'm not sure. But I, you know, I will tell you, when you fracture around a partially replaced droid, it is not as easy to fix or heal. So we hope, yeah, wish well, I hope she does great. Hopefully now she can get all the peptides and everything she needs. Exactly. Exactly. Well, Dr. Yerth, such an honor to reconnect with you. I keep hoping our paths will cross at the same event and I'll get to meet you in person. I know you're lecturing everywhere. I lectured everywhere. At some point, we'll be in the same places at the same time. Please let listeners know how to connect with you outside of this podcast, how to learn more about your work or become a patient. I believe you are still taking patients. I have a limited access, but we've got great providers who work with me who are exceptional. Dr. Deck, Dr. Hussain, incredible doctors. Dr. Hussain is our functional cardiologist, but he does all kinds of medicine. He's incredible. And Dr. Deck knows if you want to treat things like long COVID and all these more complex diseases, she's a pro at that. So that's BoulderLongevity.com, just www.BoulderLongevity.com. You can go to sign up as a new patient and then one of the girls from her office will call you and figure out what you need and what the best path is for you. So we try and handhold you through all that. Please follow me on at Dr. Yurth at Instagram. We also have a learning academy called Human Optimization Academy. You can go to boi.academy. It's really inexpensive and we have a lot of fun. I put out educational material. My goal is to make everybody their own doctor, right? You know how to interpret your labs. You know how to do everything. But the Q&As, it used to be that it was more of a layperson thing. Now there's a whole lot of doctors in it. But the Q&As are, I think, the most mind-blowing Q&As with any Q&As I listen to because people in this group are really smart and they ask such amazing questions. So it's talking about cases and talking about protocols and, you know, and so it's really a fun group. So if you join that academy, you have access to these Human Oblivion HK. So follow me on Instagram, follow my YouTube, please. I'm not great at content there, but I try hard and I hope to see you guys join us at the academy. Yeah. I mean, I feel like I learned so much through you. It really is an honor. And I feel like there are not enough female longevity experts and clearly your knowledge and how much you share how generous you are is really appreciated. I appreciate that. Yeah, we need to get out there and be a little stronger in the world, huh? Absolutely. Absolutely. Go female longevity expert before. We haven't done so well with the other side, so we've got to decide for a change. That's right. Right. It's a changing of the guard. It's a changing of the guard. if you love this podcast episode please leave a rating and review subscribe and tell a friend