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Whole-Body Physiology and Chiropractic Strategies

Whole-Body Physiology and Chiropractic Strategies

by | BHRT and Healthy Aging, Chiropractic, Chiropractic Examination, El Paso Chiropractic News, Estrogen Optimization in El Paso, Health, Health News El Paso, Hormone Balance, Physical Rehabilitation, Progesterone Balance and Hormone Support, Screening Tests, Testosterone Health and Vitality Support, Thyroid Health and Metabolic Balance

Estrogen, Whole-Body Physiology, and Evidence-Based Clinically Integrated Care

Abstract:

In this educational post, I present a comprehensive, evidence-informed perspective on sex hormones—emphasizing estrogen’s multi-system roles—and how modern chiropractic, physical therapy, and integrative rehabilitation strategies support whole-person outcomes. Drawing on leading research and my clinical observations, I unpack persistent myths around estrogen and disease risk, clarify receptor pharmacology, and explain why individualized optimization benefits bone integrity, neuroprotection, cardiovascular resilience, and pain modulation. I prioritize musculoskeletal, neurological, and metabolic care pathways: spinal biomechanics, neurodynamic mobilization, neuromuscular re-education, fascial health, and graded, outcome-driven functional rehabilitation.

Whole-Body Physiology and Chiropractic Strategies

Evidence-Based Estrogen Physiology, Spine Health, and Functional Rehabilitation: An Integrated Care Guide by Dr. Alexander Jimenez, DC, APRN, FNP-BC, CFMP, IFMCP, ATN, CCST

Setting the Stage: From Symptom Suppression to Systems Integration

I have spent years helping patients move away from an allopathic mindset that equates care with symptom suppression. The better question is not “What can we prescribe to stop a symptom?” but “What physiological process is dysregulated, and how do we restore homeostasis?” In spine and musculoskeletal care, the same principle holds: rather than masking low back pain with short-term fixes, we assess alignment, tissue load, sensory-motor control, inflammatory balance, and lifestyle drivers. This is where the modern evidence on sex hormones—kept in perspective—interfaces with chiropractic and physical therapy: hormones modulate tissue turnover, neural plasticity, pain processing, and endothelial health. That means targeted manual therapy, corrective exercise, gait retraining, and neurodynamic techniques often work better and last longer when the underlying physiology is supported.

Key mindset shifts I encourage:

  • Focus on root-cause, systems-based thinking
  • Use individualized, evidence-guided plans over one-size-fits-all protocols
  • Blend manual therapy, functional exercise, and lifestyle medicine with measured medical input when necessary
  • Track outcomes with objective, repeatable measures (ROM, strength, balance, pain processing tests, validated questionnaires)

Estrogen Is Not Just About Hot Flashes: Whole-System Physiology

The misconception that estrogen is simply about vasomotor symptoms ignores the breadth of its actions. Estrogen receptors (ERα and ERβ) are distributed across bone, brain, heart, gut, immune cells, and connective tissue. In clinical musculoskeletal care, that matters because estrogen influences:

  • Bone remodeling and osteoblast/osteoclast signaling
  • Synaptic plasticity and descending pain modulation
  • Microglial and astrocyte activation states after CNS injury
  • Endothelial nitric oxide signaling and vascular health
  • Collagen metabolism and fascial hydration, which affect tissue glide and mobility

Why this matters in rehab:

  • Patients with insufficient estrogen often present with increased pain sensitivity, slower tissue healing, and reduced tolerance for load progression.
  • Optimized physiology supports more predictable gains from spinal stabilization, hip-hinge retraining, and eccentric tendon protocols.
  • Better vascular and neural function improves the efficacy of neurodynamic mobilizations and sensory-motor integration.

Receptor Pharmacology: Precision Matters for Clinical Outcomes

Receptors are not passive docks; they are signal transducers. Progesterone binds the progesterone receptor, androgens bind androgen receptors, and estrogens bind ERα/ERβ. Synthetic molecules (progestins) may occupy receptors without delivering the intended genomic and non-genomic actions, a phenomenon that can block beneficial signaling. From a rehabilitation perspective:

  • If beneficial signaling is blocked, we may see blunted neuroplastic changes despite effective exercise programming.
  • An accurate understanding of receptor biology helps anticipate tissue response and time rehabilitation phases more effectively.

In practice at El Paso Back Clinic:

  • We keep hormones and medications in the background, emphasizing manual therapy, mobility restoration, and load management.
  • When medical collaboration is needed, we use it to complement—not replace—restorative musculoskeletal care.

Bone Health, Load Tolerance, and Progressive Conditioning

Bone is a living, mechanosensitive tissue. All three sex hormones—estrogen, progesterone, and testosterone—have receptors on osteoblasts, osteoclasts, and osteocytes. Estrogen supports bone mineral density and reduces excessive resorption; testosterone and progesterone also contribute to bone integrity. Clinically, this is why:

  • Progressive weight-bearing and impact training (when appropriate) stimulates osteogenesis through mechanotransduction.
  • Spinal alignment and hip control distribute forces safely, avoiding stress concentrations.
  • Eccentric loading of tendons helps collagen alignment, improving functional stability around load-bearing joints.

Treatment reasoning:

  • We sequence care: mobility and pain modulation first, then neuromuscular control, then graded strength, then task-specific power and endurance.
  • For osteopenic patients, we use low- to moderate-impact drills with careful progression, augmented by balance training to reduce fall risk.
  • Breathing mechanics and rib-pelvis coordination enhance axial load management through the thoracolumbar fascia.

Brain Health, Pain Processing, and Neurodynamic Rehabilitation

Estrogen and testosterone influence apoptosis, beta-amyloid deposition, and synaptic signaling. Estrogen exhibits neuroprotective and immunomodulatory effects, stabilizing microglial and astrocytic behavior. In clinical practice:

  • Central sensitization is addressed with layered strategies: education, graded exposure, sensorimotor retraining, breath-led parasympathetic activation, and movement variability.
  • Neurodynamic tests and mobilizations (median, ulnar, radial, and sciatic biasing) are more effective when systemic inflammation is controlled.
  • Cognitive clarity and mood stability improve adherence and motor learning; sleep quality amplifies consolidation of motor patterns.

What I see in the clinic:

  • Patients with more stable physiology (including balanced estrogen) progress faster in lumbar stabilization and cervical deep flexor training.
  • Headache and neck pain with neurovascular components respond better to upper cervical mobilization, rib mobility, and scalene/SCM load management when endothelial and autonomic tone are optimized.

Cardiovascular Protection, Endothelial Function, and Exercise Capacity

Vascular health influences how well tissues are perfused during rehabilitation. Estrogen supports nitric oxide signaling, reduces vascular inflammation, and slows the progression of atherosclerosis in appropriate contexts. Clinical application:

  • Interval walking, tempo cycling, or rower intervals increase endothelial nitric oxide bioavailability; this improves recovery between strength sets and accelerates tissue oxygenation.
  • Calf pump drills and thoracic expansion work aid venous return, complementing manual therapy for patients with leg heaviness or postural orthostatic issues.
  • Better endothelial function correlates with improved VO2 kinetics and perceived exertion; patients sustain longer, more productive sessions.

Gut-Brain Axis, Inflammation, and Tissue Recovery

The gut metabolizes estrogen and communicates via immune and neural pathways. Dysbiosis and barrier dysfunction can amplify systemic inflammation and pain. In PT-chiropractic care:

  • We encourage anti-inflammatory nutrition, hydration, movement, healthy snacks, and stress modulation to support the microbiome.
  • Improved gut-brain signaling often leads to reduced hyperalgesia and faster normalization of myofascial tone.

Clinical protocols I favor:

  • Low-friction gliding techniques and pin-and-stretch when fascial adhesions are prominent
  • Segmental stabilization with diaphragmatic breathing to reduce sympathetic drive
  • Foot-to-core sequencing: intrinsic foot activation, tibial rotation control, gluteal integration, then lumbar stacking

Chiropractic and Physical Therapy Integration: Practical Pathways

I design integrated plans that prioritize spinal mechanics, functional strength, and neuromuscular timing, reserving medical adjustments to support—not lead—the process.

Core elements we use:

  • Manual therapy:
    • High-velocity, low-amplitude (HVLA) adjustments for segmental dysfunction when indicated
    • Joint mobilizations (grades I–IV) to restore physiological motion
    • Soft tissue release for paraspinals, deep hip rotators, and thoracic extensors
  • Motor control:
    • Abdominal canister training: diaphragm, pelvic floor, transversus abdominis, multifidus
    • Spinal stabilization sequences: dead bug progressions, bird dog with anti-rotation focus, short-lever side planks
    • Hip hinge and split-stance patterns to load glutes and protect the lumbar spine
  • Neurodynamics:
    • Sliders and tensioners are applied judiciously with symptom-guided dosing
    • Cervicobrachial interface mobilization with scapular control
  • Mobility:
    • Thoracic extension and rotation drills to offload lumbar segments
    • Hip external/internal rotation restoration to normalize gait mechanics
  • Conditioning:
    • Stationary cycling, incline walking, or sled pushes for controlled metabolic load
    • Eccentric calf and hamstring protocols for tendon resiliency

Why these techniques:

  • HVLA can reset aberrant segmental mechanics, enabling more efficient firing of stabilizers.
  • Joint mobilizations and soft tissue work reduce nociceptive input, clearing the way for motor learning.
  • Neurodynamic work normalizes nerve glide, often reducing distal symptoms and improving strength expression.
  • Conditioning ensures that tissues tolerate the demands of life; mitochondria and capillaries adapt to support performance and pain resilience.

Clinical Observations at El Paso Back Clinic

Across thousands of patient encounters, I consistently observe:

  • When we stabilize the spine and retrain movement, symptoms improve faster if systemic inflammation is reduced.
  • Women entering perimenopause often report new-onset visceral fat and diffuse pain; restoring movement patterns and engaging progressive strength rapidly improves function, while physiology support fine-tunes consistency.
  • Post-stroke and concussion patients benefit from breath-paced mobility, vestibular-visual integration, and gentle cervical/thoracic mobilizations; progress accelerates when sleep and autonomic balance improve.
  • Men with persistent low back pain frequently show poor hip internal rotation and gluteal inhibition; targeted hip work plus spinal mechanics yields durable change.

Pain Modulation: Descending Inhibition and Predictable Progressions

Estrogen has documented effects on pain circuitry, including regulation of descending inhibitory pathways. Rather than discussing hormones directly with every patient, we operationalize the concept:

  • Educate on pain neurobiology to reduce fear
  • Use graded exposure with tolerable, repeatable tasks
  • Pair manual therapy with precise motor tasks immediately afterward to lock in pattern changes
  • Reinforce daily rituals: short mobility blocks, walking intervals, breath cues

This sequence exploits neuroplastic windows:

  • Manual therapy reduces nociception
  • Movement patterns encode efficient muscle synergies
  • Repetition consolidates synaptic changes
  • Sleep and recovery protect gains

Alzheimer’s, Cognition, and Rehabilitation Adherence

Cognition influences adherence, safety, and learning. The research base links balanced estrogen physiology to improved executive function in specific populations. Clinically, we:

  • Simplify instructions and use chunked, repeatable cues
  • Add dual-task drills at the right time (e.g., marching with head turns)
  • Use a metronome or breath cues to enhance rhythm and memory encoding
  • Gate progression by consistent performance rather than calendar dates

Cardiometabolic Integration: Weight, Visceral Fat, and Movement

Visceral adiposity can reduce tissue perfusion and amplify inflammatory signaling. Movement is medicine:

  • Prioritize daily steps and posture resets
  • Add glute and midline strength to redistribute loads from passive structures
  • Use intervals to improve insulin sensitivity and autonomic balance
  • Track waist circumference, step count, and perceived exertion; these map to functional outcomes in spine care

Individualized Care Over Rigid Rules

Consensus statements have evolved toward individualized decision-making for therapy type, dose, route, and duration in specialized contexts. In our rehab-first model:

  • We do not rely on blanket discontinuation or time-limited protocols
  • We reassess regularly, adjusting exercise intensity, manual therapy frequency, and home programming
  • Medical collaboration is case-based, primarily for safety and systemic support, while the backbone remains movement, alignment, and neuro-muscular conditioning

Safety, Nuance, and Clinical Reasoning

Safety is anchored in thorough assessment:

  • Screen for red flags, neurological deficits, vascular risk, and bone integrity
  • Tailor mobilization and manipulation intensity to tissue status and patient response
  • Advance loads using “stable form, stable symptoms” criteria
  • In complex cases (e.g., cancer history, stroke), coordinate with medical teams and emphasize gentle, progressive care with clear outcome metrics

What Patients Can Expect at El Paso Back Clinic

  • A detailed movement and neurological assessment
  • A clear plan anchored in functional goals
  • Manual therapy to unlock mobility
  • Progressive strength and neurocontrol to protect gains
  • Education and lifestyle guidance to support inflammation control and recovery
  • Transparent outcome tracking and friendly accountability

Practical Home Strategies

  • Daily breath-led mobility (5–7 minutes, twice daily)
  • Step accrual goals matched to baseline (e.g., +1,000 steps from current baseline)
  • Foundational strength: hinges, rows, carries, and anti-rotation presses
  • Sleep routine and light exposure to anchor the circadian rhythm
  • Hydration and protein targets to support tissue repair

Closing Perspective: Teach People How Not To Be Sick

The best testimonial is a patient who no longer needs constant care. When physiology supports tissue health and when movement patterns are robust, people return to life—lifting kids, walking hills, and working without pain. My role is to guide, adjust, and progress your plan thoughtfully. Evidence keeps us honest; clinical observation keeps us human. At El Paso Back Clinic, chiropractic precision and physical therapy science meet to build durable outcomes.

In-text citations:

  • Estrogen and cognition, neuroprotection, and immunomodulation (e.g., Brinton, 2009; Pike et al., 2022).
  • Bone health and sex hormone receptors; osteogenesis under load (e.g., Khosla, 2010; Manolagas, 2010).
  • Cardiovascular endothelial function with estrogen; nitric oxide signaling (e.g., Mendelsohn & Karas, 2005).
  • Pain modulation and estrogen’s role in CNS injury responses (e.g., Vegeto et al., 2003).
  • Clinical practice position statements emphasizing individualized approaches (e.g., The North American Menopause Society, 2017).

References

Proactive Spine and Joint Care: A New Approach

Proactive Spine and Joint Care: A New Approach

by | Anti Aging, BHRT and Healthy Aging, Chiropractic, Estrogen Optimization in El Paso, Health, Health News El Paso, Hormone Balance, Progesterone Balance and Hormone Support, Screening Tests, Testosterone Health and Vitality Support, Thyroid Health and Metabolic Balance, Wellness

Proactive Spine and Joint Care: Evidence-Based Chiropractic, Physical Therapy, and Integrative Rehabilitation for Better Patient Outcomes

Abstract

This post explores the historical evolution of modern medicine, tracing its path from protocol-driven practices in the 19th and 20th centuries to the rise of the pharmaceutical industry and the current “pill-for-an-ill” model. I will discuss the widespread use of medications like statins and the emerging evidence suggesting potential downsides, particularly regarding brain health and immune function. As a Doctor of Chiropractic and Advanced Practice Registered Nurse, I have observed the limitations of a purely reactive, symptom-based system. This article advocates for a fundamental shift towards proactive, personalized healthcare that integrates evidence-based chiropractic care, physical therapy, and nutritional science. We will delve into why a “one-size-fits-all” approach is failing our patients and how a holistic, patient-centered model that addresses the root cause of dysfunction—rather than just masking symptoms—is essential for restoring true health and vitality. We’ll examine the importance of critical thinking, medical freedom, and the powerful role of integrative therapies in transforming patient outcomes and reshaping the future of medicine.

Proactive Spine and Joint Care: A New Approach

As a healthcare professional with a diverse background spanning chiropractic (DC), advanced practice nursing (APRN, FNP-BC), and functional medicine (CFMP, IFMCP), I’ve had a unique vantage point from which to observe the landscape of modern health. My clinical experience at the El Paso Back Clinic has reinforced a core belief: to truly heal, we must look beyond symptoms and address the whole person. This post presents the latest findings from leading researchers and my own clinical observations to advocate for a more integrated, proactive approach to your health.

The Rise of the Pill: A Shift in Medical Thinking

The trajectory of modern medicine has been fascinating and, in some ways, troubling. The early 1900s saw science and industry reshape healthcare, leading to incredible advancements. However, this era also paved the way for a business-centric model. By the 1980s, a significant shift occurred, with a prioritization of standardized protocols that aligned perfectly with the rise of Big Pharma.

A landmark moment came in 1987 with the introduction of the first statin medication. This event solidified a new paradigm in patient care: conduct a blood test, identify a number outside the “normal” range, and prescribe a pill to correct it. This “number-and-a-pill” approach became the cornerstone of chronic disease management.

Let’s look at the most prescribed medications in the United States today. Data projections for 2025 are staggering:

  • Statins: Over 200 million patients.
  • Metformin: 150 million patients.
  • Ibuprofen: 56 million patients.

These numbers reveal a system heavily reliant on pharmaceutical intervention. While these drugs can be life-saving in acute situations, their long-term use for chronic conditions requires careful consideration, particularly in light of the physiological consequences.

The Statin Dilemma: Unintended Consequences for Brain and Body

For decades, the prevailing medical wisdom has been to lower cholesterol levels aggressively to prevent heart disease. While the intention is beneficial, we must ask critical questions about the downstream effects of this strategy.

What is cholesterol? It’s not an evil substance to be eradicated. In fact, cholesterol is a vital component of every cell membrane in your body. It is particularly crucial for the brain. Your brain’s volume is largely composed of cholesterol, which is essential for forming neuronal connections and ensuring proper neurological function.

So, when we systemically suppress cholesterol levels with statins, what are the potential long-term effects? Emerging research and clinical observations suggest we may be inadvertently contributing to another epidemic: Alzheimer’s disease and dementia. What was once considered a rare disease is now frighteningly common. A growing body of evidence indicates a correlation between chronically low cholesterol levels and an increased risk of cognitive decline (Du et al., 2018). We are, in essence, potentially shrinking our patients’ brains in the pursuit of a specific number on a lab report.

Furthermore, a study from February 2025 revealed another critical role of cholesterol: it fuels dendritic cells, which are key players in the immune system. These cells are activated by tumors and help mount a stronger immune response to cancer (Ringel et al., 2023). By reflexively crushing cholesterol, are we also dampening our body’s natural ability to fight disease? This is a question we must have the courage to ask.

From a chiropractic and physical therapy perspective, I see patients whose primary complaints of musculoskeletal pain, weakness, and fatigue are often intertwined with systemic issues. It is not uncommon for patients on long-term statin therapy to report muscle aches and weakness, which can significantly hinder their progress with physical rehabilitation and chiropractic adjustments. Addressing the whole physiological picture is paramount.

The Current System: Reactive, Impersonal, and Ineffective

My experience with the conventional medical system, even as a patient, has often felt cold and impersonal. The typical waiting room experience—the sterile environment, the focus on insurance cards and numbers—reflects a larger problem. The system is designed for efficient processing of people, not for fostering healing relationships. This is the “here’s your pill, see you in six months” model of sick care.

This reactive approach was further entrenched in 2010 with the Affordable Care Act, which brought big insurance and big government into an even closer alliance with big pharma. The result has been a multi-trillion-dollar industry focused on medical research and pharmaceutical sales, while reimbursement for practitioners—the ones providing hands-on care—continues to shrink. The global pharmaceutical industry’s net profit in 2024 was estimated at a staggering $1.7 trillion.

Despite this massive expenditure, we are sicker than ever. We spend nearly $4.9 trillion annually on healthcare in the U.S., yet chronic diseases like diabetes, heart disease, and autoimmune conditions are rampant. The people I see every day in my clinic—our friends, family, and neighbors—are not getting well. They are being managed, their symptoms band-aided, but the underlying causes of their diseases are rarely addressed.

A New Path Forward: Proactive, Personalized Healthcare

The good news is that patients and practitioners are starting to question this broken model. There is a growing demand for something different, something better. The core principle that medicine has forgotten is that choice isn’t optional; it’s everything.

A “one-size-fits-all” approach to health makes no logical sense. Each of us is genetically and biochemically unique. We have different histories, lifestyles, and environmental exposures. How can we possibly expect the same protocol, the same medication, and the same dosage to work for everyone? At my clinic, this is a foundational principle. Treatment plans for chronic low back pain or post-surgical recovery are always tailored to each individual’s specific needs, functional capacity, and health goals.

Today, we stand at a crossroads. We can continue down the path of reactive sick care, or we can choose to become proactive champions of true healthcare. This means shifting our mindset:

  • We go to the doctor to stay well, not just because we are sick.
  • We treat patients, not lab reports or imaging studies.
  • We dig into the root cause of disease rather than just silencing symptoms.

The Return of Curiosity and Critical Thinking

To make this shift, we must revive curiosity and critical thinking in medicine. It takes character to admit that what we’ve been doing may not be the best way. It’s easy to defend the status quo, but it takes courage to step back, look at the evidence, and say, “We can do better.”

I am not anti-allopathic medicine. We have the most remarkable surgical and emergency care in the world. The problem isn’t the tools; it’s the over-reliance on a single tool—the prescription pad—for every problem. The cycle of “a pill for this, and another pill for the side effect of that” has led us astray.

We must remember that we are treating human beings, not pieces of paper. How often does a practitioner stare at a lab report while the patient sits before them, unheard? True healing begins when we put down the paper and engage with the person. In my practice, the patient’s story—their subjective experience of pain, their daily struggles, their goals—is just as important as the objective findings from a physical exam or an X-ray. It’s in that conversation that we uncover the clues to the root cause of their suffering.

Nutrition and Lifestyle: The Missing Pillars of Health

For years, integrative practitioners have championed the role of nutrition in health, often to the skepticism of the mainstream. Now, the tide is turning. Major institutions are finally acknowledging that advising patients on nutrition fosters a more holistic and comprehensive approach to health. Addressing a patient’s diet can dramatically increase their response to other therapies, including chiropractic care and physical therapy. Chronic inflammation, often driven by a poor diet, can stall healing and perpetuate pain cycles. By incorporating nutritional guidance, we can reduce systemic inflammation, providing a better physiological environment for tissues to heal and respond to manual therapies.

Your cells don’t have a political affiliation. They respond to the information they are given—whether it comes from food, movement, or stress. We must start treating food as the powerful medicine it is. The change may be slow, but the science is clear. Following the evidence on nutrition will profoundly shift our patients’ health over the next five to ten years.

Similarly, we are seeing a re-evaluation of long-held beliefs, such as the idea that estrogen causes cancer. New evidence has led the FDA to reconsider its stance, recognizing that bioidentical hormone therapy may actually protect the heart, brain, and bones. While our clinic’s focus is on musculoskeletal health, we recognize that hormonal balance plays a crucial role in tissue repair, inflammation, and overall well-being. Acknowledging this interplay is part of a truly integrative approach.

Breaking Free from Cognitive Inertia

One of the major obstacles to progress is a psychological phenomenon known as cognitive inertia. This is the human tendency to stick with familiar mental models and resist information that challenges our existing beliefs—a form of confirmation bias.

Albert Einstein famously said, “We cannot solve our problems with the same thinking we used when we created them.” We must get out of our own way. We have to be willing to challenge our biases and embrace a new way of thinking that prioritizes the individual.

This means transitioning from treating the masses to personalizing medicine. We must remember the humanity of our patients. They are mothers, fathers, teachers, and grandparents. They are the fabric of our community. When they don’t feel well, they cannot fully participate in their own lives. Helping them regain their health, vitality, and life itself is the true calling that brought most of us to medicine in the first place.

The Future of Medicine Begins Now

On March 27, 2026, we embark on a new journey. This is the day we commit to a different path. History remembers the practitioners who didn’t just follow the system, but transformed it. Today, that responsibility belongs to us. We have the option to either remain within the confines of an outdated model or to initiate a change.

Let’s make this our finest hour. Let’s:

  • Treat patients, not cases.
  • Provide proactive healthcare, not reactive sick care.
  • Be integrative, not just allopathic.
  • Become true wellness and healthcare providers.

The future of medicine is about restoring health freedom—your freedom as a patient to choose the care that is right for you, and our freedom as practitioners to provide it. It’s about empowering you with the knowledge and tools to take control of your health. It’s about digging deeper, treating smarter, and never forgetting the person behind the pain.

References

Du, F., Yu, Q., Li, X., & Cao, Y. (2018). The role of cholesterol in the pathogenesis of Alzheimer’s disease. Journal of Alzheimer’s Disease, 63(4), 1223–1235. https://doi.org/10.3233/JAD-180026

Ringel, A. E., Drijvers, J. M., Baker, G. J., Cato, L., Sir-Dane, K. A., Gyonfi, A., & Haigis, M. C. (2023). Cholesterol biosynthesis inhibition reprograms the tumor immune microenvironment to allow for effective combination immunotherapy. Science Advances, 9(33), eadg7537. https://doi.org/10.1126/sciadv.adg7537

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