Dr. Jen Ashton on Unimaginable Loss, Mental Health, and Post-Traumatic Growth

Your first husband committed suicide 18 days after your divorce was finalized. How did you manage that? On the day he died when three police officers knocked on my door, my entire world shattered. My son said the most incredible thing to me, not even two weeks after Rob's death, which was, you know, mom, dad had a disease like cancer. And he said, if he died of cancer, we wouldn't keep that a secret. This should be no different. Now I was dealing with this life-altering, unimaginable tragedy that was a headline. It was a national headline. My book, Life After Suicide, I did not want to write. I said, no one cares about my story. 47,000 plus people in this country die by suicide every year. I'm one of those families. It taught me that you can be vulnerable and strong at the same time. You can be broken and still be a leader. We all have learned to prioritize our mental health and well-being as much as our physical health and well-being. Do you think that that's missing now? Oh, big time. What got you through? Now you're really going to make me cry. Dr. Jen Ashton, welcome to the show. Thank you so much for having me. I'm so excited to be here. This is unbelievable. You are so well-respected and you've done so much. You're Ivy League educated. You are one of the OG medical correspondents and OBGYN and just truly inspiring woman. So I'm really glad to hear. Thank you. Ditto to you. There are many things that we're going to talk about. And the first thing that I think is really important is happiness. Very important and unhappiness. Your first husband committed suicide 18 days after your divorce was finalized. He was a world-class thoracic surgeon. So I want to open with that because suicide, unhappiness, depression, all. Yeah. You, first of all, thank you for having the courage and the bravery to talk about something that most people don't want to talk about. You know, I'm always, I wouldn't obviously say happy to talk about it, but very willing to talk about it because every time I do, it is a guarantee that it will help other people, but it also helps me and it helps me heal every time I talk about it. Where do you want to start? Well, number one, I guess personally, how did you manage that? Well, I think first of all, I still feel like I'm managing it. I feel like I will continue to manage it for the rest of my life. Rob did not have any of the typical, in air quotes, signs of mental illness or depression that we learn about in medical school. We had been married for 22 years. In retrospect, now there were some red flags like there always are in hindsight, but if you had known him, he did not have any of the glaring DSM criteria of depression or mental illness. And we had gone through a very amicable divorce. We had texted each other the day before he died. We had seen each other at our daughter's ice hockey game three days before he died. We lived across the street from each other. I mean, to say it was amicable, is really an understatement. We did not have the type of marriage or divorce that was War of the Roses. In fact, it was the opposite. We were like best friends or great co-parents or roommates. There was no fighting. We had just grown apart. And on the day he died, when three police officers knocked on my door, my entire world shattered into thousands or millions of pieces. And I was absolutely in the clinical definition of shock. I mean, I was unable to dial my phone to call someone to come and help me. I was incapable of driving an hour to get my daughter at boarding school to bring her home, which is something I will never forgive myself for. I had to send my brother to go and pick her up. I mean, I was literally in shock. And what got me through, and to some extent what continues to get me through, by the way, my children were 17 and 18 at the time, was them. And you know this as a mother, any parent listening knows this, that something happens to us when we become parents. I don't want to speak for the dads, but I think I can speak for the moms, that I think there's something about being a mother that literally makes you, if you're going to draw your last breath, it would be to save your child. And I just knew at that moment that I had to put every single molecule of energy I had into making sure that my children not only survived this, but could heal through this devastating tragedy. And that's what got me literally step by step, day by day, through that initial period and continues to. Is that one of the reasons why you started a podcast or you spoke out about it and you wrote about it? Do you feel like it was out of obligation? My book, Life After Suicide, I did not want to write. And in fact, about six months after Rob died, my publisher called me into Harper Collins and there were a lot of people in the room and they said, we'd really like you to write a book about your experience. And I said, no chance. I said, there's no way I'm going to do that. No one cares about my story. 47,000 plus people in this country die by suicide every year. I'm one of those families. No one cares. I'm not ready to do it. Thanks but no thanks. And I walked out. It wasn't until I had to or was asked to cover Kate Spade's death by suicide for Good Morning America that my daughter Chloe called me and said, you have an obligation with the platform you have to talk about something that no one wants to talk about. And in this day and age where optics are so deceiving because everyone has a great filter on their Instagram and everyone has a great story or post about how great their life is, you know, on the surface, my life looked that way also. But through all the great things that the public saw in my life, which was a great career, great children, great health that I was all blessed to have, all of those things, which of course, as you know, came with a lot of hard work. But that was just what people saw as the product. What they didn't see is that for over 10 years, I didn't have a loving, fulfilling relationship or marriage. Now I was dealing with this life altering, unimaginable tragedy that was a headline. It was a national headline. You did and you do have a very public life. You know, when I was researching for this episode, initially when I met you, I was like, this woman's amazing. She's the OG medical correspondent, right? Studied nutrition, studied OBGYN, menopause. But then when I started reading more, I realized that there was a whole underbelly of really an intense life, but that also that you really wanted to help and be of service. I just, I felt like always, but my daughter and my son really helped coalesce this kind of mission for me. In my opinion, I don't think you can have all of the perks with things without, you know, some of the knocks. And I think that I've had a lot of amazing things in my life and do have a lot of amazing things. And I've kind of been at the highs as well as the lows, literally that are imaginable for most people. And I just didn't feel like it was honest and authentic to only show people the good things and not discuss the hard things and the horrible things and the ugly things. The whole thing is real to me. So it was really my children who encouraged me to speak openly and publicly about it. And since writing that book, which was, I think, my fifth or sixth book, I can't remember, and doing a brief, limited podcast about life after suicide, to this day, to this day, we hear from people who say that they had lost a loved one from suicide and the podcast or the book helped them heal. And I think at a time where mental illness is not as sexy as longevity, we can't forget that you can't have a healthy body without a healthy mind. And not everyone who is a successful cardiothoracic surgeon is okay on the inside. And men physicians, particularly surgeons, face a much higher suicide rate than the general population. And veterans. And veterans. Unfortunately, like most people had known friends and loved ones who had died by suicide, but we never expected to be part of that statistic. You've heard me say before, muscle is the organ of longevity. Now I'm putting the playbook in your hands. My new book, the Forever Strong Playbook, is your roadmap to building real strength, not just in your body, but in your health, your energy, your life. This isn't theory. Inside, you'll find the exact workouts, protein for recipes, recovery strategies, and mindset tools I use with my patients and live by myself. This book is for anyone and everybody who wants to age powerfully, stay vibrant for their family and show up strong every single day. When you pre-order, you're not just getting a book. You're joining a movement. The links in the show notes and I cannot wait for you to dive in. When you look out now, there is a lot more exposure. And when I say exposure, there's social media, there's just a lot more information. And I think a lot more comparing. For example, you said the things on the outside, the shiny objects. Do you think that now there is a lot more emotional volatility and mental health challenges? And maybe it's not the spectrum of full blown depression, but maybe it's the anxiety and the dysthymia kind of arena. Absolutely. And statistics bear that out and data bears that out. I think that in the world of psychiatry and psychology, we are literally in the process of the largest human real time experiment ever with how media and social media are changing our neurochemistry, our mental health, our children's brains, adult brains. I'm sure you've read The Anxious Generation by Jonathan Haidt. I mean, if I had children, your children's age today, there's zero chance I would put a phone in their hands till they went to college, not just wait until eight. No, no, we're with you. College. Yeah. We're with you. And I think that while that book and a lot of that data obviously focuses on children and adolescents, you can't be a human in this world without being subjected to unusual and really heretofore unknown stressors. And so how that manifests, I think, is not really known well now. I know that from what I learned and my children continue to learn, we were so fortunate because we were in our therapist's office on a Sunday, 24 hours after Rob died. And we learned so much about healing and mental illness and suicide from that experience, but we are very fortunate that we were already plugged in with a mental health professional and we don't have enough mental health professionals in this country, not even close. So people dealing with these kind of issues, dysthymia, depression, stress, anxiety, whatever you want to call it on a whole spectrum, they don't really even have the resources to know who they should turn to for help. But we learned a lot. We learned so much through this. What got you through? Oh, God, so many things. I mean, for me personally, it was the role that fitness and exercise played and has always played in my life. I was actually hoping that you were going to say that because looking back at all these pictures, you know, you're in people and again, all these very public places throughout the immense tragedy. And then on the other end, this happy story of your marriage to this extraordinary man, you were extremely fit throughout. It's been probably a foundational principle in practice of my entire life. You know, when I was recovering from the immediate shock and trauma of Rob's suicide, when I say I was clinically in shock, I mean, I lost nine pounds in just over a week. I was at a dangerously low weight because I was so in shock. The only thing that made me feel not numb in those initial days and weeks was lifting weights because it actually, I felt it in my body. It was the only thing that snapped me out of that numb shock feeling. It also throughout my entire life, residency, medical school where I had both my babies in medical school as president of my class. I don't know how that happened. I mean, it was the thing that was a through line that gave me the message subconsciously and consciously that as erratic and crazy as life can get, I can always go back to the faith and confidence that I have in my body and my fitness. If I can't give myself an hour a day, which of course sometimes happens, but it's rare, something is seriously wrong. It sounds contrived because it's been so overstated, but that line on the airplane puts your oxygen mask on first before you help others. I could not do my job as mother, chief medical correspondent, private practice physician, sister, daughter, wife, friend if I did not put my fitness first. It's as simple as that. That was a major way that I got through. Your kids, now you're really going to make me cry. My children were and are the most emotionally mature and their emotional intelligence was high before their father died. They instinctively and instantaneously made a conscious decision to do several things. One, live their life in a way that honors their father's spirit, which they do every single day. To not hide the fact that he died of suicide. My son said the most incredible thing to me not even two weeks after Rob's death, which was, you know, mom, dad had a disease like cancer that killed him. That is so wise. He said, if he died of cancer, we wouldn't keep that a secret. This should be no different. They have just taken that on full force. The last thing is that they have this experience has made them and me through the process of post-traumatic growth, which most people don't know about. They only think of the negative. It's kind of the opposite of a trauma. You can think of it as two forks. You can have post-traumatic distress or post-traumatic growth. They have, through the process of post-traumatic growth, we have, you know, we have a lot of achieved greater balance, greater sensitivity, greater perspective. It's hard for them or me to say, oh my God, this is the worst day ever because we've lived the worst day ever. That has given them such an incredible sensitivity. You know, when they have a friend or a significant other or a relative who's going through a hard time and they ask, how are you? They really wait to hear the answer. It's not a flyby. We all have learned to prioritize our mental health and well-being as much as our physical health and well-being. Do you think that that's missing now? Big time. Big time. Does that start with home conversations with family? Yes, 100%. It starts with, I say we need to check up from the neck up or the other line. I love that. I love that. It's true. The other line is it's okay not to be okay. You know, your body doesn't feel good every day. Why should your mood, your spirit, or your mind feel good every day? We just are so conditioned to not thinking or to thinking that if you can't see something, it must not be as serious or it must not be as important. That's just not true. Yeah. I really love what you said that if someone dies of cancer, you talk about it and mental health is, and especially as significant as depression, it is. It's a disease. It's not something that someone can think their way out of. Finally, I love that you used your body, your musculature to be able to cope with such immense trauma. I didn't know any other way, any other thing to do. I just, to me, being physically strong, it's not just everything. It's really the only thing. You can't do anything else unless you're physically strong. I knew I was going through a mental crisis, so I didn't want to compound that by also adding a physical crisis to it. Again, as doctors, we know the human body is an incredible, miraculous machine. Whether it was having my babies in medical school or doing triathlons when I was 42, I've always been athletic and it's always been important to me. I would have never imagined that it would be my lifeline in a setting of crisis. Whether that crisis is something like what happened to us or it's losing a job or getting a divorce or whatever, a natural disaster, it's something that I really think everyone could tap into. I fully agree with you and I know you. I'm on board with that. In fact, we're probably going to be doing some sit-ups after this. Oh, sorry. It's time to record an ad for the show. Thank you to one of the sponsors of the show, Timeline, and listen, my kids still sleep with me and after 470 nighttime snack requests, bathroom breaks, my husband snoring, my cells, they're like, yo, gee, we're tapped out. Enter Mydopure. Timeline Nutrition is one of the most thoroughly researched products I have come across in over a decade. 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I recommend trying their starter pack with all three different formats and of course their gummies, which are incredible. You found love again. Yeah. I mean, just file that one under, you know, miracles do happen. I used to walk around all the time, all the time, even before my divorce. And I used to say to myself, you know what, I'm really lucky. Even when I had no good marriage relationship, I would say, I'm really lucky. I have two incredible children who are healthy. I have two incredible careers, full-time careers as practicing physician and on national television speaking to millions of people every day. Which we're definitely going to talk about. And I loved it. It was literally under the category of do something you love. It doesn't feel like work. And I have my health, so I don't have a relationship. I didn't draw that card. Like, okay. And I'm happy for my friends who did. I'm happy to see the people around me who do have that. That just wasn't in the cards for me. And I would say that to myself, Gabrielle, every day. Why? Because it was so important for me, even in that last 10 years, 13 years, you know, even after my divorce and Rob's death, to live with gratitude. So I did. And I never, you know, I had dated after my divorce and, you know, the last relationship before I met Tom, I think I was 50. I'm 56 now. And I mean, I know this is going to sound melodramatic and crazy, but I literally thought I was going to be single and alone for the rest of my life. And I was like, okay, you know what? Again, go back to those three things I was grateful for. I have great career. I have great kids. I have my health. Okay. I have a great dog. Unfortunately, the dogs don't last the whole time. I had a dog for 16 years. How did you meet your husband? And also I want to touch on, because he's extraordinary. I expected the person that you chose or that chose you to be amazing. However, I didn't expect him to be a Harvard grad who then went on to win, was it like Emmys, which by the way, you have four. We were set up by a friend and my husband is even more high profile than I am. I did not know his name or who he was. I mean, because people weren't Googling other people. That's right. That's right. I mean, I don't know. No, I mean, it's not even that. I just, my husband's in sports and television. Do you want to share a little bit about him? I mean, it's public. His name is Tom Warner and he's created some of the most successful American television of all time. He created the Cosby Show and Roseanne and Third Rock from the Sun and the Connors and that 70s show and that 90s show in a different world. I don't know. He sounds like a real underachiever. He really is. Just do something. I mean, he's legend and a Titan in sports ownership. He's involved with Liverpool Football Club, which is probably the largest football club in the world and the Boston Red Sox and the PGA and chairman of Fenway Sports Group. I didn't follow those sports. I never watched those TV shows. I didn't know who he was. Furthermore, I actually told my friend, I don't think I like businessmen. I'm a doctor. I like healers. She was like, no, no, no. Just go on a date with this guy. He said, look, he's an amazing person. He's fun and funny and who knows if you'll find love, but I think you guys would just enjoy each other and Tom's 19 years older than I am. When my friend, our friend, described him to me, I said, he sounds too good to be true. How old is he? He said, well, he's 70. I said, well, I'm 51. He said, I know you're 51 and I know he's 70. I said, you know what my greatest fear is? What if I fall in love with him and I have to live 20 years of my life without him? He said, something could happen to you too. Maybe he'd have to live without you. I said, you know what? You're fricking right. We went on the date and we were engaged like 10 months later and married about a year and a half later or almost two years later. He is the most incredible person. I've ever met and thank God he's 19 years older than I am because I can't keep up with him today. So if I can't even, he literally is out of bed before I am in the morning. He works out harder than I do. He does more in one day than I do in four days. But most importantly, he, this is going to push me over the edge. With his huge and powerful heart that is so gentle, he really helped me heal by loving me. So it's been an incredible, incredible love story. I mean, just incredible. Now you've done it. Makeup. No, no, you're looking good. Very sharp. You know, I typically don't talk about personal stories, but I think there was just so much and is so much to learn from yours because as a physician, as a media person, as someone who is married to someone so public and, you know, and also having been through some drama, it was, it's like, it's a story that everybody can learn a piece from. I hope so. And, you know, I think that we all have a lot that people can learn from. It's just that today it's so easy to be so self-absorbed and so focused on appearances and, you know, things that I don't know in five years, 10 years, 20 years, or even tomorrow really are not that important. And when you deal with real lives like we've done and continue to do as doctors and you've been through and seen horrible, horrible tragedies, if you're not living with a sense of responsibility to pass that information along to help other people, there really is a big problem. And it's why I went into medicine to help other people. And even though that may take different forms for us as kind of public figures, it's still at the core of everything I do. And everything I want to do is, you know, whether it's to tell someone about, you know, a FOPO hair ponytail that I'm wearing or the greatest tragedy of my life, it's all to help people. And I just don't know any other way than to be honest and transparent about it. And that is probably what drove you to become a correspondent. Yes? Yeah. And that and the fact that I could literally talk to this coffee mug about medicine and health and, you know, be interested in doing that. I always liked talking. I never wanted to have a television career. How did you get to take us through? It fell on me, you know, file this one under be open to new experiences. This was 2009-ish. It was 2009 when I went to network television at CBS. 2006 when I started at Fox News Channel. I was two years out of residency. I had a six-year-old and a seven-year-old. I was, you know, two years into private practice. I was delivering 150 babies a year. I was doing close to 300 GYN major surgical cases a year. I just was so busy and never wanted to be on TV. It was just was not on my to-do list. Other things might have been. That was not one of them. What happened? And then I was asked by a friend who was into television. She actually said to me, you know, I think you'd be great on TV. And I said, you're so sweet. And she goes, yeah, I'm really not saying that to be sweet. I'm saying that because this is what I do. You know, one thing led to another. I found out that Roger Ailes, who at that time was the president of Fox News Channel, wanted to meet me. I went in and talked to him and he said, would you like to work with us? And I said, do you want me to like take care of your female employees? I, what do you mean work with you? And he said, no, I think you'd be great on the air. And I was, you know, booked to be on for a segment. I'd never been on a live TV set before. I went in and did it a week later. I was offered a contract and I was at Fox for three years and then went to CBS for two years and then was at ABC for almost 13 years. And I just found that it's a real skill to be able to talk about medical and health and scientific information in general. As you know, doctors are pretty shitty communicators. To do it on live national television is kind of the iron man of communication, medical communication. There are no do-overs. And when five to 10 million people are listening to you, you better not, like there's no oops. I forgot that wasn't the right word or stat or whatever. And I loved the kind of perspective task of it of saying like, well, okay, this is the headline, but what do I think are the three most important things that someone watching in, you know, Tennessee needs to know? And it definitely being current in what was coming out every single day made me a better practicing physician. And what I was doing in my office and my clinic absolutely made me better on the air. Wait, $3,000? Wait, is that number right? I spent more money on skincare. My pores should be tax deductible, maybe even have their own trust fund. Thank goodness that I found one skin because one skin, it doesn't just make empty promises. It's research driven, minimalistic and tested for beauty, skin health and longevity. One skin is the first topical skincare backed by peptide science that targets skin aging at the molecular level. I slather this on all day. They have a peptide that is designed to reduce the accumulation of dead cells or zombie cells that drive inflammation, tissue breakdown as we age. Now this isn't about cosmetic quick fixes. It's about changing the biology of your skin, strengthening the barrier, improving firmness, hydration, elasticity with clinically tested ingredients. So if you are focused on aging well from the inside out, it's time also to think about your skin. It should get the same level of care. Go to oneskin.co for 15% off, use the code Dr. Lion. It is amazing and it will not break the bank. And how about now? Because now, so as physicians and I think as medical educators, there was a lot, so 20 years ago, there was less information. We were not Googling, we were waiting for these papers to come out and then we would go and we would get the medical journal and learn. Now we're almost at the opposite end of the spectrum. So true. And for someone who has been there from the very beginning to where we are now, if someone is listening to this and they're like, okay, well, I love nutrition and I love physical fitness and I don't even know how to distill the information. What would you say if we start with nutrition? Oh, God. Well, first I would say credentials matter, right? I'll tell you a funny story that I think illustrates this really well. And it kind of brings together all of these issues that you're asking about, which are so important. There was a book written by an economist professor from the University of Chicago, I'm sure you have it. It came out maybe 10 years ago. When her book, it was about pregnancy and all of the myths, you know, exist in obstetrics and midwifery and that pregnant women have to kind of navigate. The author, as I said, was a full professor of economics from the University of Chicago, not an unintelligent or uneducated woman. I did a segment on Good Morning America about the book coming out of a tape piece and I did the segment with George Stephanopoulos. And in this book, the author says, you know, I've evaluated the data. I can look at data. I'm an economist. I know how to look at numbers. And for example, there's no reason why pregnant women shouldn't be able to have safely three to five alcoholic beverages a week. Okay. As a board certified OBGYN and as a doctor who's board certified in obesity medicine and has a degree in nutrition, I, you know, I really believe in the motto, stay in your lane. So I did this segment with George about her book and I was, you know, did it the same way I've done every single television segment in my life, balanced. People will never know really how I feel about something unless the anchor or host asks me to share my opinion. So we came out of the piece and we went into commercial. I said, you know, George, I can read English. I think I'm going to write a book about the constitution. I know I'm not a constitutional attorney, but what the heck? Now today, and that was 10 years ago, today you have people who, because they can read, think that they're in a position to make black or white edicts about all kinds of things, and being probably near top of the list because we all eat. And while I will say that having a master's in nutrition does not certainly mean I or anyone else knows it all about nutrition because quite frankly, the level of sophistication of nutritional science is pre-poor compared to like medical science. It's better than nothing. And I think that, you know, that is a perfect analogy for where we are with all kinds of things in wellness and fitness and nutrition. People think because they can read or because they try something themselves, which in medicine and science we call an N of one, that that is written in stone. And I always say, whether it's nutrition, food science, women's health, obesity medicine, weight management, menopause, you name it, I don't care. The same principle applies. In my medical professional scientific opinion, it is not only wise, but it is also a very essential for us to have a humility as individuals and scientists and doctors and public figure, whatever you want to call us, to recognize that we do not know it all. And things can be learned tomorrow that we swore today, where we know this hard and fast. We have a long historic precedent in medicine of being proven wrong, like the Women's Health Initiative, which, by the way, you were in residency when this came out. Can you touch on that and have you? Obviously, I'm sure that you've been staying up to date with the FDA. Touch on that as being someone who was there when it happened. So first of all, I'm the daughter of a registered nurse and the niece of an OBGYN, my mother and my aunt. They both, when I was a resident and WHI came out in 2002 with the so-called shot heard both my mother and my aunt were on hormone replacement therapy, big believers in it, feeling amazing, etc., etc. When that headline came out, I was not taking care of my own patients in menopause because I was a junior resident. But it was a topic of grand rounds. Obviously, most people know that literally, like light switch, the prescriptions to patients were discontinued. Women were taken off there, but immediate. Due to not only the media misinterpreting the data, but the study authors misrepresenting flawed data. So it was, I have a saying in medicine that I think is so true, and I don't know if you've heard it. It's often not the first mistake that kills a patient. It's the second, third, fourth, and fifth. It's usually like a lot of things have to go wrong. Same thing with this. This was flawed methodology. This was a flawed press release that the authors didn't even approve. It was flawed media coverage. It was flawed interpretation by practicing physicians. That's actually the surprising part. Yeah. I mean, but again, it was a series of errors that led to 20 years of women largely not getting the management options and treatment options and counseling that they should have gotten. So fast forward now to the last couple of years, and I actually see a somewhat precarious situation that we're in right now because the pendulum, we have such a problem with moderation in life in this country, such a massive problem. And so we tend to do things at the extremes of a spectrum. And menopause care right now is no different, just like obesity care is no different. It's at an extreme. And the reality is that the sweet spot exists in a much more nuanced, moderate position, and hormone replacement therapy is no different. You know, you said that we're in this kind of precarious situation. Where do you think we're going wrong right now with menopause therapy? Oh, I love that question. If you listen every week and feel like we are in this together, which I believe that we are, learning, growing, and building strength, then I created a way for us to get connected even more closely. It's called Forever Strong Insider, a premium community for listeners who want to go deeper. You'll get ad-free episodes, which I know you'll love. Bonus Q&As, where your questions shape the conversation. Behind the scene moments because let's face it, I'm hilarious from my daily life and written takeaways to keep at your fingertips. But more than that, you'll be supporting the show so that we can keep creating content that matters. If you've ever wanted to feel part of the inner circle, this is your invitation. Join us at foreverstrong.supercast.com or through the link in the show notes. Let me take one word off your question if I could. Where do I think we're going wrong with menopause before we get to menopause therapy? And where I think we're going wrong with menopause is, and this is not something that's discussed, so I'm so glad you're asking this question. It's a brilliant question. We have over swung our response to this stage in a woman's life to such an extreme hyperbolic degree that I think there's a real risk in putting out a message that women are passive victims once again, that we have been pushed into a corner. We're adults. So if we're put into a corner, we have some responsibility in that you can choose not to go into the corner or you can be led like sheep. I don't believe that women are easily led like sheep to be put in a corner, nor do I believe that women are so passive that we need to be presented with everything on a silver platter for it to be able to be utilized by us. Let me give you some pretty hard and fast examples of why I think that's not true. Puberty. What did we know about puberty? Did you ever take a class or read a book about how to insert a tampon? Actually no. No one barely told us what a period was because who unfortunately don't even get me started on how we teach kids health and puberty, but for me it was taught by a gym teacher who I'm quite sure did not want to be teaching that class to begin with. So we didn't learn anything about puberty. Somehow I figured out how to insert a tampon and I learned about puberty just as my children did, just as your children will, hopefully better. It's just as millions and millions of women have done forever. Pregnancy. How much did you know about being pregnant before you were pregnant? I mean a little. And I still didn't even know what was happening while I was pregnant. Correct. Okay, I didn't know. I was a medical student. Did I know, was I an expert on pregnancy until I peed on a stick and saw two dots and was like, oh my God, I'm pregnant. Like no. And then, oh my God, I'm pregnant again. Yeah. Okay, I learned about it. When I went into menopause at 52, Gabrielle, as a board certified OBGYN, I didn't even recognize my plethora of menopausal symptoms until one of my best friends, who's a car cardiologist, said, why don't you go on hormones? And I was like, oh my God, you're right. Okay, so I bring up those three stages because I think they powerfully illustrate the fact that the narrative that we're hearing about menopause, like we haven't told you, women have been kept in the dark, you know, is just, I think it's actually insulting to women. I think it's disrespectful, insulting, and demeaning. And I don't think we're that meek and passive and timid. And I think ultimately it paints women as victims. I think it's well-intentioned and poorly executed. And I think instead we need to say, yeah, look, has menopause not been taught well to doctors and in medical school and covered in the popular press? Of course that's true. Has it not been legislated well? Of course. Has it not been researched? Of course. But that's very different than pointing this finger of blame because I will tell you one of my favorite sayings, and feel free to use this with your children. It might come in handy, is no, oh, well, aside from that, that's a capital, I know, is I think we should be careful when we point a finger of blame of no one ever told us about menopause. As the saying goes, when you point a finger at someone else, there's three pointing right back at you. I don't believe in blaming anyone for what it is what it is, it was what it was. Let's focus on today and what's ahead of us before we paint the menopause out to be a horrible thing that has victimized women. I just think that's so negative and I am a glasses half full type of person. Clearly you are. How do you see a positive way of thinking about it? Let's say, because there's lots of information out there on hormones, hormone replacement, what we know, what we don't know, this resurgence, they just took the black box warning off. Which is amazing. Which is amazing. How do you see it done well now from a practicing, just like a practicing perspective? I think that the key and the way it's being done now well is when it's holistic. I don't mean holistic like I'm going to swing a crystal over your head and chant. Please don't. But I do have a lot. I'm going to central oil with crystal. I love a good crystal. I mean a holistic way that says what we're actually supposed to do as credible and credentialed physicians, which is talk about all options, including no treatment as an option. And those options now, fortunately for women, are more numerous and more effective than ever. And it's not one size fits all. It's not robotic. It's not cookie cutter. Women should not feel, whether you're talking about menopause or obesity management, no one should feel that it's either a GLP one or nothing. That's one option. For menopause hormone replacement therapy is one option. There are a zillion options that are FDA approved, off-label, behavioral. You name it. For both of those conditions, but we have such a hard time in our world of being tempered and nuanced. And we just want like an easy quick fix that conveniently fits in one box. And I just don't believe that the overall health of an individual and organism as complicated and complex as human beings are fits neatly into one box. Yes, because that would be really foolish. It would be really foolish. And people are very multi-dimensional. In your professional opinion, do you feel that hormones are relatively safe? Yes, I do. And I will say, I can talk about treating, again, because I joined my aunt's practice right out of residency. So my aunt was a real, she was one of the first women OBGYNs in her area, New Jersey. And she had an incredible reputation and a very busy practice. And I was the fourth doctor to join her practice right when I finished residency. I really just wanted to take care of real people, real women. I had grown up the daughter of a cardiologist. So I saw my father have those special relationships with his patients. And I really wanted that. And my aunt and her partner had always prescribed hormone replacement therapy to a patient. And how was that done? Is it the same that what we're seeing now? Patch. There were patches. There were patches. The knowledge of having to balance estrogen with progesterone was obviously known then. Mostly it was in pill form. Plates and creams were not really a thing in 2004 when I joined her practice. And bioidenticals, even though that's a marketing term, as you know, not a medical term, were a thing. But my aunt and her partner were very pro hormone replacement therapy. However, interestingly for me, I was really interested in adolescent gynecology. So while I did a lot of the obstetrics in our group, I was really interested in taking care of teenage girls. So 50%, half of my practice were girls and young college age women under the age of 21. So obviously I didn't have a strongly perimenopausal or menopausal practice until I had been in practice for 18 years. And those college age women who were coming to me as their first gynecologist then started to go into perimenopause. And as my patient population got older with me, I obviously started to see a lot more menopausal symptoms. How did you manage that at the time? Because prior to that, it's difficult when you have a practicing physician, so your aunt and then the other partners who had already been prescribing hormones and then seeing the benefit, having them pull off of that and then your patients going through perimenopause. It actually was not a difficult thing for me because I put it into the category that I practice, used to practice and still do in terms of the medical information that I produce in a form of content for people and for agenda, which is my women's health company, is what are the risks, what are the benefits, what are the options? And so when I would talk to a woman in perimenopause or menopause, I would say there's three tiers of options. There's hormone replacement therapy. There's non-hormonal prescription medication because we've been using off-label prescription medication to treat menopausal symptoms. For example, which one's what you were referring to? Efexer is the brand name of a drug that's an antidepressant in higher doses and in lower doses, very effective for treating vasomotor symptoms. And we had been doing that for decades. It's not a new thing. And then I would say, then there's some behavioral things. You can do cognitive behavioral therapy. You can try acupuncture. There's cytosolic B-polynextrac that's been used in Europe for, again, over 20 years that can help with vasomotor symptoms. And I would give a menu of options. There's even more of a menu of options today. And again, whether it's menopause, weight management, if anyone is listening and you go to a doctor who doesn't, who only gives you one option, you should find another doctor. That's just not medicine. I always would say it's my job to inform and educate. It's your job as a patient to make the decision. It is very empowering for patients when you provide options. And then I don't know how, so we, I still practice and I'll usually lay out what I believe. Here are the options. And then you know what, if this were me, this is how I would approach it. Exactly. That's perfect. And we do prescribe hormones. We think that they're very valuable. And remember, because I finished fellowship 2015, and obviously it was very difficult to get information on how best to prescribe estrogen, progesterone, and testosterone especially for women. I mean, I will say personally, when I started taking HRT, I felt like a new person in 48 hours. I mean, that's fast. It's pretty amazing. My kids were like, mom, you need your ABP. I go, what is that? And they go, your anti-bitch pill. And you're like, actually, it's a patch. No, I actually, I actually went for the pill, but I was like, okay, fine. How bitchy was I? And they were like, pretty bitchy. I mean, it was really, for me, it was and is a great option. Is there a form that you like the best? If we're talking about estrogen, progesterone, testosterone, do you have a favorite delivery method? No, because I think it has to be right for the individual woman. I don't have a problem taking my pill every single night before I go to bed. I've coupled it with brushing my teeth and the whole science experiment that I have to do now, like the lashes, the skin, the hair, the teeth, I mean, like working my way head to toe. My hormones are part of that. For some women, they don't want to do that. And so a patch, which also lowers the clotting risk is a better, you know, it's a better option for them, whatever. But I think it's an exciting time. And at least there are these options. I couldn't agree with you more. You also have been doing obesity medicine and have a master's in nutritional sciences, which is, I would say my first love. And you remember when GLP ones were not available. And then all of a sudden, GLP ones, which had been used for 20 years, for 20 years, these are not new medications, which I think that this is really important if you were to say, what are the top three myths that you see with the use of GLP ones? Number one, risk benefit, because just as we always talk about with our highly polarized, hyperbolic kind of way of life today, you either see a headline that says, this is the best thing on the planet, or this is the worst thing on the planet, and it will kill you. And the reality is it's neither. It's somewhere in between. So I think when people hear or talk about GLP ones, the first, second, or third generation, whatever class you're talking about or generation you're talking about, it's really important to, as I like to say, think like a doctor. So what does that mean? What does that mean? How do we stratify risk versus benefit? And as you know, it's not just what are the risks. You actually have to ask four questions. What are the risks of the medication? What are the risks of not taking the medication? What are the benefits of the medication? And what are the benefits of not taking the medication? And in some cases in medicine and life, you can actually put real numbers with that, which then makes it very easy. You can say if something's 1% risk versus 5% risk, you're going to go with whichever is higher or lower, depending on the question. In some cases, it's not going to be a number, but it'll be a statement. So that's really important because it's not like, should I take it or should I not take it? It's why are you taking it? What does the data show? And you know, I've heard you talk about it. I hope most people know this right now. There are so many non-weight-related proven benefits to GLP-1s that I don't think we've even seen the tip of the iceberg with their use, their indication, and their benefits yet, but cognitive protection, cardiac protection, renal protection, body composition differences, cancer, immune system. I mean, the list keeps going on and on. I'm sure they're testing it for nail growth because... Sign me up. Yeah, me too. And so I think that's a big one, risk benefit. I think people need to understand some very simple math, and I am by no means a statistician, but you and I know because we read medical and scientific studies that it's all about how you get to that number. And when you talk about something that, let's say, has a 1% risk of a bad side effect, which would be high, by the way, in the world of medication and medicine. If 10 people are on that medication, you're going to see one of those cases. If 100 people are on that medication, you're going to start to see more of that. If 100 million people are on that medication, something that happens 1% of the time is going to affect a lot of people. And that's what we're seeing a lot of times with these media headlines of GLP-1s. And the last thing... Meaning they're painting it in a very negative perspective. In a difference between an absolute risk and a relative risk, and they're profiling a worst case scenario that is still, as the saying goes, an increased risk of a rare event is still a rare event. And I just think people need to understand that. It's numbers and math. These are now probably the most widely used drugs in the world. So when you have a couple of billion people taking something, you're going to see a rare side effect more than if only a few people take something. What are your thoughts on safety of these medications? I'm happy to share mine. Long-term usage. Go first. I think that number one, what I'd love to see is more mechanism of action. For example, I agree with your statements on it being good for cardiovascular or cognitive. I think that there are a whole host of things that we're going to see from a positive lens. My question is, is it because of the improved body composition? Is it because of this reduced inflammation that we're seeing? I don't know, but what I'd love to see, so do I think that they are safe? I think overall they're very safe, and I think that they've been used for 20 years. We'll probably move into the ultimate mix of optimization, which will be low-dose GLP 1 with low-dose hormone therapy. I had to pause for a second because definitely there's going to have to be some kind of anabolic agent or something to affect muscle, whether it's an anabolic agent or a myostatin inhibitor, something like that. I can't wait for the myostatin inhibitor. Yes, but I think that they are safe medications. I just don't think it's going to be something like FENFEN. No, no, no. You agree. For the listener, FENFEN is a medication that people put on to address obesity, and it caused pulmonary hypertension, valvular heart disease. I think here's the thing that people need to understand, and again, whether they're talking about GLP 1s or hormones or any other medication, including an over-the-counter medication like aspirin. You have to know what the data is. You have to know what the numbers are. What's the incidence of pancreatitis? What's the incidence of blah, blah, blah, whatever. That's nice to know that number, but understanding that if it happens to you, you really don't care whether it's 0.1% or 1% or 4%. It's 100% happening to you. You need to make your decision about whether or not it's worth that risk and how high that risk is. Yes, I do think there's going to be a lot of interesting and exciting data that comes out in the future, including the short-term future, about mechanism of action, about the use of these drugs for prevention, about maintenance protocols. Right now, physicians are literally DIYing maintenance protocols on these medications, which is fine, but it would be better if we had some actual data to say, this is how you maintain on it. To understand choosing a candidate for it, especially in your sphere of interest, body composition, muscle changes, bone changes, people hear like, you'll lose muscle mass in these. What they're not hearing is, if you have obesity or overweight, your muscle is dysfunctional. Yes. Tell me about your concerns or if you have concerns with GLP-1 use and you just mentioned muscle. I have a big concern with, specifically with the higher percentage of weight lost from muscle than for people who are not on GLP-1s. Now, again, what you do not hear when you hear this topic discussed by anyone anywhere usually is, who are you talking about? Are you talking about someone with obesity or with overweight who's on a GLP-1 or are you talking about someone who's already at normal body weight and is maybe taking a low dose of a GLP-1 for other off-label longevity benefits, body composition? I believe there's going to be a role of GLP-1s for women going into menopause. We're seeing a lot of those things occur on a DIY basis. When you hear a headline like, you're going to lose muscle mass, that is true. First of all, it's not true for everyone. It depends. There are a lot of women who take GLP-1s and don't lose weight. Why do you think that is? Oh, God. I think that it's really because of that hypothalamic set point. Can you expand on this a little bit? As you know, there is a reason why 90% of diets and extreme weight loss fail at the two-year mark. That is not because people lack willpower or discipline or drive or determination. It's because our brain, and I love this because it's so easy and it could be a Hollywood movie, an explanation of the physiology, but our brain wants us in the most stable condition for the organism, which is us. Unfortunately, that most stable condition is often our highest weight. The hypothalamus senses a loss of weight as a threat to the organism. What happens when you lose five or 10 or more percent of your excess body weight is your brain starts saying, holy shit, we must be in a bad situation. So I'm sensing this as a threat to my survival. I'm going to compensate and restore to that equilibrium by making this organism feel less full. It drops the satiety hormone leptin. It increases the hunger hormone ghrelin. It slows your basal metabolic rate by about 15%, sometimes more. You're burning fewer calories at rest. What does that do? It drives the reward seeking behavior of eating so that the organism regains that weight many times more than the weight lost. That leaves that person feeling, I'm such a failure. I lost all this weight. How am I now at the two-year mark gaining it back? By the way, any diet short-term can be successful. Any diet. The key is at the two-year mark. That's what the medical literature and the obesity medicine literature looks at. That set point, I think, is so powerful and I think we do not understand every aspect of it by any stretch of the imagination yet. But I think when people who are already near or at their ideal weight take a GLP-1, it works differently. The parallel for this, and I'm really going to geek out, but you will love it, is in the world of pain medicine and the nociceptors that are pain receptors in someone who has true pain get upregulated. If they take, now I think few people should be on opioid narcotics, but if they did take an opioid narcotic, that opioid works at those pain receptors. If someone does not have pain, what do those opioids do? They make someone high. I think there's a direct parallel to that. We just don't know what to do. That's interesting. I haven't actually thought about that. With the use of GLP-1s, I've only seen, we've been using them in our clinic for a long time and then there was a medication before that. It was, do you remember SIXSENDA? Yeah, of course. One of the other FDA approved drug-based medications. I've only had a handful of patients not be able to lose weight on a GLP-1, like one or two. I don't necessarily know that it's a matter of failing to lose weight, although of course I think that's obviously a metric that I'm sure many of your patients are looking at. I think though there is a role for people who are at their ideal body weight, let's say within five pounds or so, and will take a low dose of a GLP-1 and they won't continue to lose weight. Why is that? Again, it goes to that set point. Why? Because they're where they should be. That GLP-1 is likely acting on other parts of the body to help improve body composition that we don't know yet. We haven't studied it yet. We haven't really, we don't have that many people in that category of a patient population who are using it in that way. The last thing that I think to get back to your brilliant question of what you think people don't know, I still think we have a massive societal problem with GLP-1s, particularly for people with overweight and obesity. We put people who are struggling with weight issues in a near impossible position of being damned if they do and damned if they don't. What do you mean by that? I think that society and medicine clearly has a fat-shaming bias and stigma and we look at people who have weight problems like that's, they must be lazy, they must be undisciplined. For 10 years I treated patients for medical weight management in my practice. I never saw one patient who came in and said, yeah, Dr. Ashton, I start my day with maybe a couple of waffles with some whipped cream and then I move on to a couple of Big Macs and then I'll have maybe a pizza for a snack and then I don't know, like some lasagna or something. Everyone comes in saying, I don't get it. I'm eating pretty well. Of course, we can always eat better. That died sounded like my husband. He's obviously an exception to that. People know what they should be eating and what they shouldn't be eating. I think that in general, even in the medical field, we look at people with weight problems like you're clearly eating all the wrong things. Now, sometimes they are. But most of the time, it's a failure for everyone to realize that obesity is a complex chronic disease and there's not just one cause. When you were doing the medical weight management, tell me a little bit about the nutrition plan with that. So the whole reason that I went back to Columbia and got a master's in nutrition is because I found myself, it was the light bulb moment for me as a physician where I was talking to women, every single patient about food and diet and nutrition. And I was like, it goes back to what I said earlier about credentials. I was like doing my own little research on the side. And I realized I'm just way too type A for that. I really wanted to get some formal education and credentials in it. And when I then started incorporating that in my practice, it was because I kind of had the epiphany of something that I may have actually created this term I hadn't found it anywhere else, but who knows, called nutritional gynecology, where I realized that at every major reproductive stage in a woman's life, puberty, pregnancy, perimenopause, they all start with peas. But there is an associated significant metabolic and weight aspect to that. And so I used to be the type of doctor that would refer my patients to a nutritionist or dietitian to work with me. And what I would find is that they knew a lot about food, but they didn't know endocrinology and gynecology. And I knew a lot about endocrinology and gynecology, but I didn't know anything about food. And so I really wanted to connect the dots on that. So when I would see patients for medical weight management, it started with actually listening and not talking and finding out what is the person's relationship with food and eating been like? What is their life like? What do they like? What don't they like? What works for them? What have they tried? And then trying to work with something that, as I say, meets the four S's, safe, simple, sustainable, and low sugar. And that's not technically an L, but not an S by S. Yes, a little, like in parentheses. When I started nutritional science, you know, there's this, you start somewhere and then you end up somewhere totally different, right? And when you started with your prescription for nutrition, what, where was that? Meaning, let me ask specifically. So there's the protein sparing modified fast. There is the ketogenic diet. There's all kinds of nutritional formulas out there. So again, this is probably not going to come as a surprise to you knowing me a little bit. It was not the same for every patient, just like their menopause plan was not the same for every patient. I would really after assessing the patient, which means knowing about their background, their ethnic background, their whole life, as well as their experience with food and eating and dieting and their weight trajectory, it would be different for everyone. And sometimes it was more of a paleo keto-esque approach. Sometimes it was an intermittent fasting time restricted eating approach. Sometimes it was something more structured. Sometimes it was something less structured. Sometimes it was as simple as figuring out what their psychological drives were to eat and working on that, not this. And that's what I really loved about it and continue to love about just the approach. You know, anyone who says there's only one way to do something, I think is missing out on a lot of the fun and the potential that exists. What about foundational principles? So for example, in my practice from our perspective, we believe that the data would suggest that protein would be foundational for everybody. Agree. In weight management, in any kind of the P processes, so puberty, perimenopause, post-menopause. What are your thoughts? Because again, I want to paint the picture that you've been involved in the information landscape since 2006 as a correspondent. So you have seen the gamut. So the question is, where do you think from a foundational perspective protein fits in? I think it's everything. I think it's everything, but it's not the only thing. And again, it speaks to our problem with avoiding the extremes, right? And now everything is protein. Thank God. I mean, I'm just saying, I mean, I've been talking about this for 20 years. Finally. I mean, I feel like I have played a role. I'm ready to move on. You have. You're going to talk about something else now. We're going to move on to anabolic. But yeah. But that's, I think that, again, we haven't even scratched the surface of the principle of food matrix, which is that the same food can act differently in our organism, depending on whether it's a smoothie, whether it's a solid, a liquid, a baked, grilled, whatever, whether it's mixed with something. We really haven't even gotten there yet in the world of nutrition. I think that's a really interesting, exciting kind of area. But I think in terms of foundational principles, again, the data is not iffy on this. I mean, it's protein is not just about muscle mass and body composition. It's literally every process from a cellular hormonal immune function level in our bodies. And there's constant, it's just like bone. There's constant turnover. And so we need to fill the tank constantly. And I think just like we celebrated the FDA removing the black box warning from hormones, I cannot wait for the day. I'm sure you can either and you can finish my sentence, but I cannot wait for the day where we revise the minimum recommended amount of protein, which most people don't know, is the amount needed to prevent disease instead of to promote wellness. That is long overdue. It's coming. It's coming. It's coming. Yes, it's certainly is. I'm probably not even supposed to say that. No, I know it is too. Of course you do. It is coming. And I'm excited for that. What do you think are some of the biggest myths just out there now in the nutrition space? One of the biggest myths is that women should never do intermittent fasting. I think there's a place for it. I think there are people for it. I think it doesn't have to be all or none. There's a massive amount of peer reviewed data that supports its metabolic and cellular benefits. And I think we need to pan out, so to speak, to use a camera, TV term from one little slice of an endpoint in terms of intermittent fasting to an overall, you know, again, holistic endpoint. Let's start with, do you like it? How does it make you feel? I know those were important questions. Right. Let's talk about something novel. Like, does it even work for you in your lifetime, in your lifestyle? And I think that we have a real problem with moderation. I think I am a big believer both in terms of obesity medicine and women's health in the concept of metabolic and physiologic confusion. I think our bodies on some level like habit and stability and on another level. And I get this from my athletic kind of fitness behaviors. Like to be thrown, you know, a curveball every once in a while. I think it's good for us. I think that adaptation from us as an organism is very healthy. And I think when our body sees the same thing over and over again day after day, it starts to not do what our bodies really want to do, which is adapt and be nimble and flexible. And so I'm a big believer in occasionally doing a span of intermittent fasting. I do that in my own life and I love it. And then there are times that I don't do it. So basically what I'm hearing you talk about is hormesis. Is applying pressure to the system to disrupt the current balance so that the body can go back to financial balance. Strategically, intentionally, deliberately and mindfully. You know, just so that you're not doing it like as a knee jerk response or out of panic or desperation. And I think leaning into a sense of curiosity with your own body is the most important thing we can do. And you know, I don't think people do that enough. Again, I don't think people do that enough intellectually and I don't think people do that enough physically. You know, it makes me think about this concept of a stoicism. I've just been very interested in it lately, this idea of it's almost a level of neutrality and the comfort crisis. People are talking a lot about that. But the perspective seems to be largely male. I don't hear a lot of women speak about it from a sense of, okay, well, what does it mean to be strong? And just listening to you talk, I can't help but think that you must have some kind of mental framework for your internal strength. First of all, I agree with you. I think it's more of a male narrative now. I think you're totally right about that. I went into women's health because I actually believe that women are more stoic than men. It's just that we don't often talk about it. And by talk about it, I don't mean to other people. I mean to ourselves. You know, whether it's what I learned after my ex-husband died by suicide or what I learned today as a woman 56 who is stronger and more fit than I was at 36. It's about kind of the line that I say to myself almost every day is resilience is not really a trait. It's a practice. So strength and power, I don't think is a trait. I think it's a practice, a habit, something that can be cultivated, something that can be expanded and grown. And I think that we don't have that conversation with ourselves enough. Do you think is there a way to add that in? If someone was listening to this and go, you know what, Jen Ashton has been through the ringer, but yet here she is doing amazing things in the world. What is her practice of mental resilience? I think there is something that a listener or a viewer can take from it. And that's have gratitude, have curiosity and have faith in your own strength. You know that saying whether it's Nietzsche or Kelly Clarkson, what doesn't kill us makes us stronger is really true. And I don't think that, look, if I had never gone through the suicide death of my children's father, I would have said, you know, it was the hardest thing I ever did, gave birth to two humans. And after that, I felt like I could split a nail between my teeth. And then I had three kidney stones and I thought, oh, oh no, this is even more painful. Gosh, I agree with you on that. Right. And then I really thought that, or I thought, actually, I thought I was strong. I'm really not so strong. But I think we all, it doesn't have to be the suicide loss of someone. It doesn't have to be a kidney stone or a vaginal delivery or a pregnancy or a triathlon. It literally could be something as hard as something that someone is doing today. It's different for everyone. But I think that we, how we talk to ourselves needs so much resuscitation and we're just not getting it. And we're in control of that. Right? I mean, you know, how often do you look in the mirror? I look in the mirror in the morning and we start with the, this isn't looking good. This isn't looking good. I don't do, you know, whatever. No, I'm like, okay, who is screaming at who right now because this is ridiculous. Right. That's how I usually start the morning. That's right. And, you know, whatever it is, it's just, I think we could all improve that. I like that. I think that you're right. You know, I've been, quite frankly, I've been thinking a lot about that. I'm working on my third book and it's, you know, part of thinking about that is, is how we frame things up. There is a long way to go. And I think that there's a long way to go for the sisterhood of women. Yeah. To be able to come together and go, you know what? I got your back. You have mine. How do we begin to think about this together collectively? Collectively. Community is really important and not community that's, again, superficial and not transactional. Not because I'm going to help her so that she helps me because helping her helps you. That's actually, you have a, you do have a community. I have an incredible community that was really unexpected, unanticipated in agendas. And that's, as you know, agenda like Jennifer in our wellness experiment that is really, it's women, 50s, 60s and 70s that really love and inspire and support each other and learn together. And it's been unbelievable to watch it grow. But I have a personal community that has helped me and that I hope I've helped them as much as they've helped me, whether it's former patients, patients at the time who literally Gabrielle helped me heal from my children's father's suicide. My patients helped me heal. And did they help you by just? They helped me in some cases by crying with me. One helped me by arranging my two dogs that were really my husband's dogs to be transported from New York to Florida to live with his best friend after he died. They helped me by remembering the anniversary of my husband's death. So they were really in it with you? Because, yeah. You know, in OPGYN, you are the doctor that people go through these phases, just these life phases with. That's extraordinary. They are extraordinary and they, I will never, ever forget them. I didn't know that I would be able to literally go back to my job after that happened. And I was now suddenly a single parent. I was financially the sole supporter of my children even before their father died. And I literally didn't know whether I was going to be able to continue working. And it really taught me, talk about strength or resilience. It taught me that you can be vulnerable and strong at the same time. And it taught me that, you know, you can be broken and still be a leader. Wow. And I was broken. And I still, after six weeks, I could not go on the air for six weeks. And when I went back on television, I think women, we are naturally good at compartmentalizing. And multitasking. And that's what I had to do at the six week mark. I had to do it at the two week mark in my office with my patients, because I didn't have the luxury of taking more than two weeks off. But when I realized that you can be broken and still be a leader, it was very freeing. Perhaps your next book. Oh God. That's like saying have another baby. Hey, anything is possible. Anything and everything is possible. Dr. Jen Ashton, where can people find you? Love you. On my Instagram at drjashton and on our incredible website is joinagenda.com and agendaslakejennifer. Thank you so much for spending the time. It is, it's just a privilege and just thank you. Well, thank you. And thank you for making me cry. But I will say the credit goes to you because if you are not the kind of person that provides a safe space to have these difficult conversations that no one wants to have, I wouldn't have gone there either. So I hope a lot of people were helped by it. I know that, that you do incredible work. And this was just an example. You're not a psychiatrist, but yeah. You know, I trained in psychiatry for two years. There you go. Well, this is why you're so talented at establishing this kind of safe environment and you do an incredible job of it. Well, I will actually take that compliment coming from someone who has been on air for an extraordinary career. So thank you. And also just a side note, thank you to you and your husband for the work that you do. I would love for you very briefly to just touch on home base. It's his greatest proud legacy. Home base.org is a an organization that he started over 16 years ago to provide state of the art care for traumatic brain injury and the invisible wounds of war that our veterans face. And they are based in Boston, Massachusetts. As you know, they have an incredible partnership with Mass General Hospital and home base, which started from the Red Sox Foundation. Has cared for over 30,000 veterans, has saved countless lives, and they really do unbelievable work that is now international and they have centers all over the country. But Boston is really the flagship and they've, as you know, they've done incredible, incredible things, which really are not being done anywhere else. That is very true. So if some if there's a veteran veteran family listening to this, should they go to home base.org. Home base.org. Absolutely. They can also look out there. I mean, they can all the information and they take a new class of veterans and their families every two weeks, intensive two week program to help people really at their lowest point, struggling from from what these veterans have gone through. And it's a real honor for Tom to be at the head of that mission. And I'm so proud of him. That's just a real indication of the kind of person he is. Well, thank you and him for that. It's very important to you.