Kim Vopni (00:01.474)
Hi, Dr. Ghalmiya, thank you so much for joining me. I think I'll go with Dr. Libib, I know that's a little bit easier to say, but I really appreciate you joining me today. I'm excited to have our conversation about, we're gonna cover a lot of facets as it pertains to women's health. We met recently at the filming of Shield and you're an OB-GYN and you've worked in maternal fetal medicine and of course that's.
Labib Ghulmiyyah (00:07.566)
Yeah.
Kim Vopni (00:26.732)
where I started out working in the prenatal and postpartum world as well. And we decided we should get together and chat. So here we are. I'd love to have you start out just telling us a little bit about who you are, what got you into the field of, first of all, as an OB-GYN working in maternal fetal medicine, but now you've kind of gone into a functional medicine approach as well, focusing on women's health. So tell me a little bit about that transition as well.
Labib Ghulmiyyah (00:53.451)
First Kim, thank you so much for having me and finally we were able to do this and also, you know, thank you for the book that you you gave me when we met. I'm almost done with the book. I haven't completely finished the book, but it's really amazing. A lot of things that I learned and I think a lot of us physicians should learn from, you know, from different practitioners, different approaches when it comes to pelvic health and
the whole vaginal area and the pelvis. As far as I'm concerned, I'm yes, I'm an OBGYN and a maternal fetal medicine. So I've been doing this most of my life for over 22 years. But in the last maybe four or five years, I transitioned a little bit. I discovered
Kim Vopni (01:24.398)
Mm-hmm.
Labib Ghulmiyyah (01:43.639)
I was blinded to the world of functional medicine. I discovered it from my personal experience and I saw the power of functional medicine, especially when you combine it with conventional medicine.
And since then, I've been trying to incorporate as much as possible some of the things I learned in functional medicine to my patients, to my preconceptual counseling, a little bit in pregnancy. And pregnancy is not easy to incorporate a lot of the functional medicine things because of having two humans and such a vulnerable period of time. So it's difficult to convince people to do things. But we will try to do things in a holistic way, safe, evidence-based that way.
you know people can accept it and then there's this whole area of postpartum which also I was blinded to and which is extremely important especially when it comes to the pelvic floor so that's what I've been doing you know taking care of high-risk patients and at the same time also trying to build and educate and learn you know from patients whether they're in the pre-conceptual phase postpartum and the perimenopause and the menopause so yes a whole constellation
of women's health, but my main focus is basically pregnancy and high-risk pregnancy.
Kim Vopni (03:01.774)
Okay, I was just doing a webinar. haven't launched it yet. I was just recording yesterday and it was about pelvic floor recovery postpartum recognizing that there's a period of kind of that initial postpartum, you could say within the first few months. But really, once you've had a baby, you're always postpartum and many people don't necessarily experience, especially pelvic floor challenges until maybe even many years later. And then there's also a group of women who
are postpartum while they are also starting that transition into perimenopause and dealing with, you know, that kind of a really big exaggerated hormonal upheaval.
Labib Ghulmiyyah (03:37.881)
Yeah, what I noticed.
Yeah, lot of women that had issues in the postpartum, some of them don't really recognize it or they ignore it. And then once they reach the menopause phase, this is where things really appear and they're maybe a little bit too late in fixing things. Of course, there are a lot of things that can be done, but that time where between recognizing there's something wrong and the menopause is the time where we
have to work on this and us as physicians as OB-GYNs if you look at our residency training we
don't deal with postpartum. We see them once at six weeks, even in practice. When I was practicing back home in Lebanon, I was doing my own deliveries. And so I would see my patients six weeks, a pap smear, an ultrasound. You're good, you're not depressed, goodbye. And see her in the next pregnancy or for her next visit. we are also guilty of not learning and not being taught the right way of managing pelvic health in a functional way.
way, how those muscles function. We know their names, we know the anatomy and that's it. But we don't know how they work and synchronize. You know, we tell them, do Kegel exercises and that's it. We don't even show them how to do it. And then I know if you do them wrong, you're going to be hurting yourself more. And sometimes they're not helpful. You have to do the opposite to Kegel. So again, it's a whole new world for us, but that's what I think OB-GYNs should collaborate with people like you and you know,
Labib Ghulmiyyah (05:16.973)
because we can do everything. We can do the delivery and the C-section and then also know how to train people in pelvic reconstruction and pelvic therapy. It doesn't make sense for one person to know all of those. So I think we need to divide the work because it's such an important phase other than this the pelvic floor, the whole body changes. I wrote the book, the reframing the fourth trimester, which is
Kim Vopni (05:26.894)
Mm-hmm. Yep. Yep, exactly. Yeah.
Kim Vopni (05:46.446)
Mm-hmm.
Labib Ghulmiyyah (05:46.785)
which is inspired because of my wife's postpartum journey, which after 15 years of practicing and then my wife delivers, was like, wow, this is what women go through in the postpartum phase? And I've been ignoring all my patients until it happened at home. Her recovery took long, but eventually she made it. But that's what opened my mind to functional medicine too.
Kim Vopni (06:05.08)
Mm-hmm.
Labib Ghulmiyyah (06:14.969)
And yeah, I think it's such an important phase for the rest of woman's life. A lot of things get unmasked in pregnancy from hypertension to diabetes. So that postpartum phase is such an important phase that I think we need to even like sub-specialize in postpartum. Like how you specialize in maternal fetal medicine, I think someone should do more training just in the postpartum phase.
Kim Vopni (06:43.203)
Yeah.
Labib Ghulmiyyah (06:43.727)
It's such a complex thing that it takes time to learn and know the physiology, the changes, and all that. Especially when it comes to the pelvis. I feel really completely ignorant now. So if I have someone with some pelvic issues, I'm not going to get into giving them advice where I'm not really an expert, because there are experts out there that can help more.
Kim Vopni (07:09.294)
Mm Yeah, I couldn't agree more. And I think that it's such a beautiful mix when you have the allopathic training and the functional training and really like ultimately, that would be my dream care team, whether it's one person or a few people that have that mix of training because you there's a place for everything and
Labib Ghulmiyyah (07:17.315)
Yes.
Labib Ghulmiyyah (07:28.163)
I mean, even work as a uroganicologist or what we call pelvic reconstructive surgeon, which is a fellowship in OB-GYN, a whole three or four year fellowship. But it's more focused on surgical approaches and...
Kim Vopni (07:31.534)
Mm-hmm.
Labib Ghulmiyyah (07:43.619)
and neurodynamics and stuff, but you don't feel they are even trained, well trained in, I mean, I might be wrong, but like from what I see, they're not very well trained in the therapy itself, or maybe they don't have the time or the patience to walk women through that exercise and follow through. They're more geared more toward the surgical approach and all these robotic surgery and slings and all of that. So.
Kim Vopni (08:09.57)
Yeah, yeah, no, I agree. And I think there is a place for them. But exactly as you say, that's not it's not in their training. It's not in their wheelhouse. And I don't necessarily know if it should be. think we think it should be. We think that the doctors know everything. but really, they're what my hope is, is more and more physicians like yourself. They don't necessarily have to go and take functional training, but recognize that there are other people who they can collaborate with and who they can refer, refer on to, even if it doesn't happen to be a medical doctor.
Labib Ghulmiyyah (08:19.745)
It should be,
Labib Ghulmiyyah (08:31.693)
Yeah.
Labib Ghulmiyyah (08:36.611)
Yeah. Yeah. I mean, they can know the techniques, but they don't have the time and the experience of this. But they should learn this in their training, but then have someone that they would refer to or someone in their clinic to have a whole postpartum clinic only made to... Again, there might be issues outside postpartum later on, but have that...
know, person in the clinic or nearby to be able to coordinate and co-manage those patients. Yes, for sure.
Kim Vopni (09:07.586)
Yeah. I want to touch on, I want to come back to postpartum recovery, but first I want to explore when you say high risk pregnancies, what falls under that umbrella of what is considered a high risk pregnancy?
Labib Ghulmiyyah (09:20.793)
Yeah, so I mean it can be from simple, you know, things someone with, let's say having twins. Twins are considered high risk because even spontaneous twins without IVF, they're considered high risk because of the risk of preterm labor. Any person or any woman with a previous medical problem, hypertension, diabetes, thyroid issues, rheumatic heart disease, any pulmonary disease, infections. So all of those are considered high risk. Yes, there is the
age of 35 that women are afraid of you know we call it advanced maternal age which I don't like that word but yeah technically they're considered high risk but most of them are not because most of them are healthy but it's mostly when there's an issue with the mom or there's a or we diagnose something in the baby a genetic issue in the baby moms that have recurrent pregnancy losses
any baby with fetal anomaly or you big babies, small babies, what we call fetal growth restriction. So all these are considered you know high-risk patients.
Kim Vopni (10:25.696)
Okay, what I didn't know this but what makes you said even if they were a spontaneous twin what would what would makes an IVF twin pregnancy different than a spontaneous?
Labib Ghulmiyyah (10:38.733)
Yeah, it's a couple of things first, you because of the infertility itself, those women could have a male factor, but it could be a female factor on the metriosis or other thing that caused infertility to start with and led them to IVF. And we know with IVF pregnancies, are more risks of placental abnormalities. There's more risk of having identical twins sometimes. So there's a little bit more complication when it's IVF versus a spontaneous pregnancy. But they're both considered
high risk.
Kim Vopni (11:10.316)
Yeah, I didn't know that. Do you see people who are considered high risk for whatever reason, and maybe there are some reasons that would lead into what I'm going to ask you, but are there any correlations that you see that they have a longer struggle, longer recovery time, a different postpartum experience compared to somebody who is not in that high risk category?
Labib Ghulmiyyah (11:31.791)
Absolutely. Yeah, I mean remember those women if they let's say end up having a preterm delivery
the babies in the NICU, they had an emergency C-section or they had high blood pressure, now they're dealing with high blood pressure or a blood clot or they, God forbid, had a stroke but majority don't have strokes but anybody with let's say a preterm delivery or preeclampsia alone is very stressful on the body so her recovery is gonna be longer and of course this is gonna affect everything from her pain, from her psyche, from her mental status which I think is huge.
when it comes to our health. So yeah, definitely the course of recovery is going to be more difficult than those high-risk patients. I mean, they've struggled for nine months or shorter, and now they have the postpartum phase, which I think they need more follow-up, more care, and more alignment with how they're recovering because it's tough. You have a baby, you want to breastfeed, you're having pain, you are, you
Kim Vopni (12:17.496)
Mm-hmm.
Labib Ghulmiyyah (12:38.201)
unable to control your urine, you are not sleeping. mean, imagine all these things on top of each other. So definitely the recovery is harder.
Kim Vopni (12:46.958)
Mm-hmm.
Labib Ghulmiyyah (12:47.279)
That's why I keep saying again, you have to have postpartum doctors or postpartum teams. And I think a lot of places are doing that, trying to but again, in a hospital setting, it's so difficult because, you know, the turnover. I noticed there are a couple of centers that opened up that do that only postpartum recovery where you go in, it's kind of like a hotel where, you know, you have all the care, but again, not everybody can afford this. So...
Kim Vopni (12:50.158)
Specialty group.
Kim Vopni (13:14.562)
Right, Yeah.
Labib Ghulmiyyah (13:17.239)
Some countries do have it as part of the plan. Some Scandinavian countries, some Asian countries, but in the US, for example, no, you have to pay out of pocket for these extra care. And support from family is not always available sometimes. It's a partner who's alone and...
they might have another baby at home that they need to take care of. mean, you can add so many. Yeah, I think those high risk, it doesn't end at delivery. For us, it does end at delivery. We're glad the mom is safe, the baby is safe. That's what matters for us at the end. But that six month to a year is where they need also support. Even a normal delivery, full term, no, I mean, my wife had a full term normal delivery, no lacerations, no episiotomy.
Kim Vopni (13:40.812)
Yeah, so many layers.
Kim Vopni (13:58.201)
Yeah. Yeah. Yeah. And
Labib Ghulmiyyah (14:08.625)
mean nothing and it took her time to recover. So imagine adding more issues to that. It's unbelievable.
Kim Vopni (14:11.619)
Yeah.
Kim Vopni (14:15.948)
And you had mentioned that your wife used the epineau, is that correct? Yeah, yeah.
Labib Ghulmiyyah (14:20.249)
Correct, yes. Actually, discovered it through...
midwife in Lebanon, was talking about actually no, I discovered it from one of my patients. She came to me with epineur I was like, what is this? So anyway, I read about it and I looked up, you know, the literature there was not much in the literature except some small studies. So I wasn't comfortable, you know, like offering it to patients because there was no like solid data on it, but it made so much sense because we tell patients to do, you know, pelvic massages and stuff starting at 34, 35 weeks.
So why wouldn't that device help? So, and it wasn't available back in Lebanon. And during her pregnancy, we went on a small vacation to France, to Paris, and we bought it from there, from the pharmacy. So she used it. And I was, because my life is so like thin and like I expected to have, know, lacerations and...
Zero, I mean she used it from 34 weeks on and then she started promoting it to her friends and you know, of course some physicians were not like what why are promoting epineau? There's no data on it. I like that's correct, but it makes sense It worked with one patient might not work with another patient, but I had multiple patients use it and and it's it's it works and Yeah, I don't know and there's solid
Kim Vopni (15:16.814)
Mm-hmm.
Kim Vopni (15:39.256)
Yeah. Yeah.
Labib Ghulmiyyah (15:44.149)
studies but it doesn't mean it doesn't work.
Kim Vopni (15:46.723)
Right. And for those of you listening who don't know the epineau is really what got me into the world of pelvic health. So that was my I was afraid of tearing my midwives had recommended this product to me. I purchased one. had a great experience. And I said, why doesn't everybody use one of these? And that's then now 20 plus years later. Here we are. And I was the Canadian importer distributor of the product for a long time. So it's
Labib Ghulmiyyah (16:00.491)
Yeah.
Labib Ghulmiyyah (16:06.735)
Yeah, you told me that but I didn't know it was what triggered your career. Yeah. So yeah.
Kim Vopni (16:09.486)
Yeah, yeah, yeah, that's what started it all. didn't even I'd never even heard of the term pelvic floor. Anyway, so it's I think it's a remarkable device. Health Canada. At the end of 2018, they had implemented a new medical device licensing procedure and
that was more costly, had more hoops to jump through. So the manufacturers in Germany weren't prepared to pay the additional costs and jump through the additional hoops. So they ended up taking their product outside, take it away from Canada. And I fought with Health Canada just to, like, it was ridiculous that this was happening and many companies left the medical device market in Canada, which
We had some great products here, including the EpiNode. So anyway, it's a great product. If you can find one, it's still available in Australia. It's available in Europe. We can't get it in North America, so you have to know somebody who can get one for you. Yeah.
Labib Ghulmiyyah (17:06.425)
Yeah. We got it from a pharmacy in Paris. It was available. yeah, I think it makes sense because there is data on pelvic massaging, as you know, and why to do it. I I always try to, I tell the patients to do it, but I can imagine, it's not easy to do when you are pregnant.
Kim Vopni (17:30.966)
No, no, it's not.
Labib Ghulmiyyah (17:31.737)
your belly is in front of you, so you know, how can you do, you know, digital pelvic massage? So this device, I think, replaces it very logically. It makes sense. Yes, I cannot say, you know, it's proven because there's no study from when I last checked, but, you know, again, the functional medicine in me now, we talk about the N of one, like we treat.
Kim Vopni (17:36.003)
Yep.
Labib Ghulmiyyah (17:55.129)
people not just statistics. It does work, it doesn't hurt. You can use it postpartum, you can use it in multiple pregnancies. So why not? Why not?
Kim Vopni (18:02.712)
Yeah, yeah, yeah. In the absence of data doesn't mean that it's not efficacious. And there is some, there is some research. It wasn't huge studies, but anyway, yeah, just so that was just kind of a sidebar. But coming back to postpartum recovery, what would your recommendations be and would they be different for a high risk? So what do you think should be happening? You've already identified that ideally we would have a team of people specializing just in postpartum.
What would your recommendations be for somebody to optimize their postpartum recovery? And that may be a blend of allopathic and functional medicine recommendations.
Labib Ghulmiyyah (18:37.483)
is yeah yeah I mean if we're talking someone you know low risk had a smooth delivery is something but when they are high risk of course we have to you know add more
you know, investigations, you know, have more follow ups and then not the follow up only the six weeks and the six months. This has to be a long term follow up because we know women that have preterm deliveries or preeclampsia or diabetes, they're prone to develop cardiac disease later on in life. So you have to follow them not only a year or two, you have to really hook them up in the system with a primary care physician or someone who understands what happened with them. So I think people
separate I had a delivery and that's like
no one would ask what happened in your pregnancy because what happened in the pregnancy can unmask a lot of the medical issues later on. So that's something else when somebody is high risk. But in low risk patients, yes, the body has, other than your cardiac output almost doubling, you developed anemia, you have excess fluid, you've used a lot of your nutrients, your iron, your mitochondria are so tired pumping ATP. The delivery itself, labor,
it's labor. In French they call it travail which is like work and in English labor and really it is a lot of work. It's sometimes 12, 24, hours of induction and delivery and the pushing phase. So it's a lot of stress on the body. So you have to really replenish those and yes we can replenish sometimes our bodies naturally with time but it takes time. One, two, our food is so depleted.
Kim Vopni (19:56.76)
Yeah.
Labib Ghulmiyyah (20:21.775)
that we need to sometimes supplement. So yeah, I always like to check their minerals, their micronutrients, their thyroid because thyroid is big. It's one of the things that can cause a lot of those. Make sure they're optimized on their iron, not overdoing iron. It's a state of inflammation. So lowering their inflammation also, not to zero, but lowering it a little bit, all this oxidative stress that happened from the pregnancy.
work on those without overwhelming them without you know ordering a million dollar workup you don't have to order you don't have to do you know gut testing although of course the gut plays a huge role and it changes the microbiome changes in pregnancy so it's very important also to address it but maybe not to jump and test the gut immediately unless somebody is struggling but at least you know make sure you check their magnesium their vitamin D their iron their thyroid to make sure they are you know
the recovery will be faster and smoother. That's what I basically added in the last few years before we never checked labs. you're okay, you know, I'm super tired, okay it's normal, or you check your CBC and check your thyroid, that was it. We did not get into strengthening their ATP, their cortisol, their cortisol curve changes, I mean they're not sleeping.
Kim Vopni (21:24.142)
Mm-hmm.
Labib Ghulmiyyah (21:48.783)
So you can imagine the stress on their body. So yes, there are a few supplements that are safe to use and during breastfeeding or postpartum phase. So we can supplement with those as long as they need it, not just, you know, throw in supplements on everyone. This is very important.
Kim Vopni (22:02.796)
Right. Right.
Labib Ghulmiyyah (22:06.883)
Whereas if they are high risk, you know, they might need other things. If they had high blood pressure, you know, we might then be more aggressive with oxidative stress, with magnesium supplementation to try to avoid, you know, antihypertensives. But sometimes we have to lower their blood pressure for a short period of time before they get a stroke, but then try to get them off those medications and let them control their blood pressure naturally. It's not easy because, and especially in the US,
Kim Vopni (22:31.82)
Yeah.
Labib Ghulmiyyah (22:36.847)
Compliance is not something that many patients follow. Like I said, they might have other issues at home, another baby.
So you cannot just tell patients, take those and you'll be fine. Because I think one flaw we all have is we don't align ourselves with patients. You have patients that have help at home and you have patients that have no one. So you cannot treat both of them the same way. So you have to really put yourself in their shoes and see if she's someone who cannot afford supplements. Maybe you would give her something, just magnesium to help her and you would make sure
Kim Vopni (23:06.669)
Yeah.
Kim Vopni (23:18.796)
Yeah.
Labib Ghulmiyyah (23:19.665)
somebody follows up with them. So I think that social barriers are so huge that we ignore them. So patients are not compliant. They're not compliant for the reason because they don't have transportation to come to the clinic. So there's many social things that we have to put ourselves in their shoes.
Kim Vopni (23:34.07)
all the resources.
Kim Vopni (23:43.608)
Well, in the United States as well, it's their, the postpartum recovery, they have six weeks before they need to go back to work. And I cannot imagine.
Labib Ghulmiyyah (23:50.799)
Yes, this is another huge issue. Yeah, maternity leave. Some countries have it for a year. Yeah.
Kim Vopni (23:57.327)
We do in Canada, we do. Yeah. And I feel incredibly fortunate for a while it was six, it was four months, six months. It was a year when I gave birth to my children and, and being at remembering what I felt like at six weeks postpartum to, I can't even imagine going back to work at that point.
Labib Ghulmiyyah (24:06.147)
That's amazing.
Labib Ghulmiyyah (24:13.391)
growth work. That's crazy. even paternal leaves, think yours are longer than the ones in the US. And there's of course other countries that have the same thing. Yeah, mean, it's in Lebanon, it's like 49 days, which is seven weeks or something like that. But of course, everybody's trying to change those rules. yeah, it's how can you recover in six weeks?
from a nine months of carrying something on your muscles and your physiology had changed. mean, everything goes back to normal. Like your uterus goes back to normal, your blood volume within six weeks. So like, how can you immediately go back? Yes, maybe our ancestors used to deliver at home in the garden and then work. I mean, yes, but.
Their lifestyle was different, their food was different, their stressors were different. yes, they had the village supporting them. Yes, if she could not cook, her neighbor would bring her food for weeks. And they support each other. Now, you might not even say hi to your neighbor. It's different days. It's different days. Yeah, six weeks is no way to recover. I
Kim Vopni (25:09.816)
Yeah. They had a village.
Kim Vopni (25:25.388)
Yeah, yeah, yeah.
Kim Vopni (25:31.266)
Yeah. Are you familiar?
Labib Ghulmiyyah (25:33.039)
So if you have a C-section, I mean, C-section is a surgery. Your wound takes six weeks to really heal superficially. mean, imagine the internal parts, so yeah.
Kim Vopni (25:36.332)
Yeah, yes.
Kim Vopni (25:40.76)
superficial tissue healing you.
Yeah. Are you familiar with the book called The Postnatal Depletion Cure?
Labib Ghulmiyyah (25:49.871)
I've seen it but I've not read it. I came across while I was doing my research for my book but I haven't read it honestly.
Kim Vopni (25:52.342)
Yeah, I...
Kim Vopni (25:57.867)
It's a really good book and I read it years after I was postpartum and so much of it was, when I look at my perimenopause phase of life, I really believe that it started for me, you mentioned thyroid in that postpartum. I had good births, I had no tearing, I had no interventions, but still there was other stressors that happened in your life and we were moving and we were doing all these. So I think.
A lot of what set me up for a bit of a disruptive perimenopause journey was being in that postnatal depletion state and not at the time I really didn't give I didn't pay attention to the need to recover. I just I just kind of carry on with things and you're like I tried I remember trying to run at two weeks postpartum which is crazy.
Labib Ghulmiyyah (26:44.239)
Yeah, I mean, you're...
Yeah, and then of course your baby becomes priority and you don't care much about yourself.
And yes, the thyroid has nothing to do with the delivery process. The pregnancy itself can cause thyroiditis and it could be related to the foods, to the gluten we're eating. And then if you keep ignoring it, eventually it's going to show up later on, like you said, in perimenopause. And then it's become more difficult to diagnose because you don't know what's causing what. know, the health flashes from lack of hormones or is it my thyroid? And it becomes complicated. Yeah.
Kim Vopni (27:08.515)
Yeah.
Kim Vopni (27:16.536)
rate.
Kim Vopni (27:21.708)
Yeah. So when you're, you know, you're kind of, ideally, you're carrying people through that you've seen them in their pregnancy, they're in their postpartum, you'd be seeing them in the post in the perimenopause. So kind of transitioning to that phase of life. As you say, sometimes people would be coming in with almost like a hangover from their postnatal depletion. And what are the things that you are seeing in the perimenopause phase of life that you think need to be addressed? And what would your recommendations be to people during that phase?
Labib Ghulmiyyah (27:50.959)
Yeah, think like I said, a lot of vitamin D deficiency and all because of the food they're eating. And what I noticed is a lot of women today are just afraid of hormones. I think the women now in their 50s, like around that age, are the women that saw the WHO study coming out and they were getting close to, which is in 2002, but they were like...
They heard this and since they've heard about it, when I become menopause, I don't wanna take hormones. And some of them are really suffering because of that. And I think a lot of it is our lifestyle, the stressors. Women have careers that 56 years ago they did not have. They have more responsibilities today and...
So yeah, you want to fix the physiologically in order to help them mentally to be able to continue their career. Women live longer nowadays than in the past. A lot of things. what I see mostly is lack of exercise. A lot of them don't exercise. Now I see a trend into this wellness and people are getting more into it. maybe five, six years ago, nobody cared about that. Now it's shifting.
a little bit so yeah lack of exercise sleep is big a lot of women don't sleep and they keep you know
blaming it on age, I'm aging, I'm not sleeping well. And then that focus on career, on achievements, I think that's playing a big role. yeah, socially we're all isolated. And I think this is also not helping. Like people in the blue zones, whether people believe in the blue zones or not, because I know there's a lot of controversy that they don't live longer, that's not true, blah, blah, blah. But they are in a community. They eat together.
Kim Vopni (29:40.003)
Yeah.
Labib Ghulmiyyah (29:53.363)
They sit together, they talk together, stresses are less. Today, you go to work, you come back, you're home, you eat, you watch TV, you read a book and you sleep. I the social life is becoming less and less. I'm talking in general. Of course, there are communities that are different, but in general, yes, the loneliness that women, not only women, women and men and everybody is leading to depression, which is...
going into other causing other issues to unmask and get worse. If you have a thyroid problem and you are feeling down and depressed, it gets worse and it's more difficult to fix. So yeah, I think what I'm seeing mostly is depletion from food, lack of exercise, lack of taking care of oneself and giving yourself maybe an hour of your day to think about yourself. Not sleeping while people are sleeping less and less.
Kim Vopni (30:30.594)
Yeah. Yeah.
Kim Vopni (30:48.355)
Mm-hmm.
Labib Ghulmiyyah (30:50.295)
being always digitally aroused from cell phones and from news, which is always bad news, unfortunately. You never find good news on the news. All of that is depleting everything in their body from hormones and being reluctant to take hormones is affecting their mental status, their sexual life, because vaginal atrophy is like, it's okay, I'll use lubricants.
Kim Vopni (30:54.573)
Yes.
Yes.
Kim Vopni (31:06.36)
Mm-hmm.
Labib Ghulmiyyah (31:20.04)
This is affecting their marriage and their partnership and all of that.
Kim Vopni (31:25.612)
Yeah, something else that you in the notes that we were talking about before we started recording bone health is a part of your, your practice and something that you're dealing with. And what I'm seeing is the people who, especially people who struggled with pelvic floor dysfunction, who haven't been exercising because of that, who maybe even missed the peak, the peak zone of their their peak bone mass.
who are now also not taking hormones and who are at greater risk for osteoporosis. So what would your recommendations be from a bone health perspective?
Labib Ghulmiyyah (32:05.667)
Yeah, I think we should all know that our bone density starts decreasing from the age of 35. So we need to slow this process down.
Again, it's difficult sometimes to build more than what we're supposed to, but at least to maintain it. Like, you you maintain your car. Of course, you the body is different. The car, you you have to take it to the mechanic to fix it, whereas our body, we can do things to help. We don't have to go to the mechanic to fix our body. Our body can, if we help it, it can rejuvenate and...
help itself but so thinking in your mind that at 35 your bone density is dropping you have to think of strategies to strengthen that you know that spinal cord and the best thing is to build muscles
around those areas. Muscle strength, muscle mass, your oxygenation is so important. All these we know now they're like markers for longevity. yes, breaking your hip or your spine is one of the deadliest things when you are in your 70s or 80s. But by trying to maintain this bone density through exercise, movement, and then of course, you know...
calcium, magnesium, phosphorus, all these in our diet, but we don't have to overtake calcium just to keep our bones healthy. You can take it from your food, but strengthening the muscles I think is key and trying to avoid things that will cause osteoporosis.
Labib Ghulmiyyah (33:35.567)
things we do in our life can cause osteoporosis, know, staying, you know, laying down and not moving a lot, some medications that we take, you know, a lot of caffeine, a lot of stress, all this can thin out our bones, of course. So at the end, it's, you know, lifestyle changes that whatever you put in your body when you are below 35 or, you know, when you're young.
Kim Vopni (33:50.22)
Yeah, yeah.
Labib Ghulmiyyah (34:00.911)
young and mature because when you are very very young you might not be aware and you feel invincible but when you reach a point maybe at 25 till 35, 40 this is the age where you're a bit more mature the more you take care of your body it's gonna pay off later on I think
Kim Vopni (34:06.402)
Yeah.
Kim Vopni (34:15.458)
Yeah, yeah. You mentioned gut health and it's not maybe what you would from a postpartum recovery perspective, you wouldn't necessarily target right away unless there was something really glaring that you needed to address. what general recommendations do you offer for women from a, how do you quote unquote heal the gut or how do you optimize your gut?
Labib Ghulmiyyah (34:38.553)
Honestly, the reason why I don't offer it immediately is because of the cost of the testing and these are not covered by insurance. But ideally, yes, if we could do the gut testing on everybody, that would be great because it will give us lot of clues about what's happening in the gut. And according to what's happening in the gut, we will tailor.
protocol to help them heal because the pregnancy, I said, the microbiome changes in pregnancy. So we want we want to replenish the good bacteria. We want to, you know, avoid any of the foods that are causing this inflammation because it can be the cause of many of their symptoms or adding to their symptoms. But yeah, I am unfortunately because of the price of those tests. I mean, they're not that prohibitive, but not everybody can afford them. So that's why I don't automatically do it. But ideally, yes, I would love to do, you know,
testing on everyone. Probiotics are important, trying to replace and repair whatever damage the intestines have gone through. The digestion can change postpartum, and this is going to affect the absorption of supplements. So you don't want to supplement someone and their gut is on fire, basically. You're burning those supplements without absorption. So I'm going to try to do that. But general things I like to
I them to go to eat a lot of antioxidant food. Again, the Mediterranean diet is one of the diets that has been proven over the years and years to be good. And I'm lucky I come from that area that we eat a lot of Mediterranean diet, includes a lot of fish, vegetables, some meat. So it's a kind of a mixture. Olive oil is huge. So yeah, I I try to guide them in a...
got their diet, but again, I'm not a dietitian or an expert. We don't learn this in med school. So that's where I, you know, call in for help for nutritionists to help us in those situations because yeah, if we can test the gut, think it will give us lot of clues for sure.
Kim Vopni (36:40.92)
Mm-hmm. Mm-hmm. When you...
Kim Vopni (36:49.25)
Yeah. What I want to circle back to the the postpartum recovery and how we can optimize that and like what would you say would be an ideal team of people or an ideal practice that you would see? You talked about some birth centers maybe offering some care doulas you know that type of thing. What would be on your wish list?
Labib Ghulmiyyah (37:14.457)
Well, I think the more people the better, but of course this is not possible to have a lot of people. But it should start from the delivery room, from your nurse being supportive and then of course on the postpartum floor or wherever they're recovering also the nurses, the nurse aides.
the dietitians that in the hospital start telling patients about food, about the lactation specialist. The doula, of course, is huge in labor, we know that, but even in the postpartum. But let's say the woman went home. I think first of all, of course, the support at home.
which again, not everybody has, but at least, you know, family, friends. This is so important for her to be able to, you know, talk to someone and, you know, vent. And so really need support at home. Medically speaking, yes. Of course, the physician, a pelvic therapist, no doubt, a dietician, you know, no doubt. And then someone who will be following this patient, you know, her primary care physician that's really, you know, keen on the postpartum too.
to follow those patients along the line. Social support, of course, if they have social issues. But I think this is kind of a...
the small team, you know, and it all depends on case by case, but at least have those two, three people, a nurse that would call every now and then or every week, you know, to check on them, to make sure, you know, they're not going through, you know, depression and their blues became depression, which can be also dangerous.
Labib Ghulmiyyah (38:54.659)
and then educate them about any signs of blood clots, heavy bleeding, all of those things, which are usually done in the hospital. But I think the follow up is the, because they give them the instruction, they give them a piece of paper and that's it. I think, reminding them because you're gonna forget, you're gonna have so many responsibilities. But I think family, friends, physician, pelvic therapist, huge, doula would be great, midwife, if this is something that is available.
Kim Vopni (39:16.812)
Yeah.
Labib Ghulmiyyah (39:24.593)
to the patient and then a nutritionist of course ideally you know someone to help you with exercise and you know lead you to that if you can you know afford trainers and stuff but I think those three people are key or four people are key.
Kim Vopni (39:36.258)
Yeah.
Kim Vopni (39:42.711)
Yeah, yeah, I agree. This has been amazing. Thank you so much. I so appreciate your work. I love that you have an open mind to combine allopathic with functional. think that that I'm hoping more. I'm hoping that's the way that our healthcare system moves in the future. And, and yeah, your your your work is amazing.
Labib Ghulmiyyah (39:48.697)
Thank you.
Labib Ghulmiyyah (40:00.975)
Yeah, I'm trying to convince all my colleagues about that. It takes time, know, and change is not easy. Nobody wants to change. It's painful in the beginning, but I think it pays off and it makes so much sense. And I don't know why. I keep asking myself why we don't learn about toxins in med school, about diet, about nutrition.
Why don't we spend more time with patients? And unfortunately, because this is how the system is, you the more you see patients, the better for the system. So that's why you don't have time to spend. And then it backs files on doctors. That's why I think having multiple people, each one spending a certain time with the patient, with their own expertise, it will all add up to really comprehensive. Because one person cannot stay two hours with the patient. But if you have multiple people,
Kim Vopni (40:39.202)
Yeah. Yeah.
Labib Ghulmiyyah (40:58.417)
that are really expert in what they do and you add up the 20 minutes of each person it will end up you know that you've spent enough time and you know the patient well you know their specific personal history and you don't count them as a number I think that's what matters and hopefully you know we are in the right direction to have you know everybody you know and those two schools combined hopefully one day
Kim Vopni (41:25.186)
Yeah, yeah. Where can people find you, read your books, learn more about your work?
Labib Ghulmiyyah (41:32.419)
Yeah, my books are actually now on Amazon. Reframing your health, which is...
Sorry, reframe the fourth trimester, which is about postpartum. There's one about toxins, which from personal reason I got into the toxin world. then recently I wrote one called biohack pregnancy. After the whole biohack movement, I thought, why not you can do biohacking in pregnancy? And I found a lot of things that can be done. So these are found on Amazon, my website, drlebib.com. Not my last name, my only Lebib. I made it easier.
Kim Vopni (42:08.13)
Yeah.
Labib Ghulmiyyah (42:08.593)
So, Dr.Labiou.com. Then, yeah, same thing, you my name, Dr.Labiou Gulmi on Instagram, on LinkedIn. So, this is where they can find me. And really, Kim, I want to thank you so much for the time. The time flew so quickly, and I'm so honored and happy we met, you know, in Vegas at the SHIELD documentary. And I can't wait for it to come out so we can see the final results.
Kim Vopni (42:24.213)
I know.
Kim Vopni (42:35.884)
Yeah, I'm looking forward to it as well too. And for those of you that don't know there, there is a documentary that both Dr. Labebe and I were interviewed in called She-Shield, also She-Heeled, a bit of a play on words. Supposed to come out I think this summer, but we'll, I'll keep you posted on our socials and stuff, yeah. And I'll have all the links to everything for people to contact you and I so appreciate your time. Thank you so much for everything you do.
Labib Ghulmiyyah (42:50.807)
yeah.
Labib Ghulmiyyah (42:54.361)
amazing.
