Lifestyle medicine; take the steps to improve your health! with Dr Suneel Dhand

today’s guest, Internal medicine physician, Dr Suneel Dhand.  In addition to being a practicing medical doctor, Dr Dhand is also passionate about lifestyle medicine. He is a very active content creator, with an online course, a youtube channel, and a has built a community on locals.com.   What I love about Dr Dhand is he is on a mission to help Americans live healthier lives, and he speaks authentically and honestly about his feelings.   

website: https://suneeldhand.com/
online course: http://www.suneeldhand.com/method
youtube: https://www.youtube.com/c/DrSuneelDhandMedStoicLifestyleMedicine
locals community: https://drsuneeldhand.locals.com/

Also, in February, Dr Jessica Hochman will be offering an online, interactive 4 week workshop to help parents worry less about their toddlers.  The topics covered will be the most common concerns she hears from parents— from picky eating, to behavioral concerns—all with the goal to help parents raise their children with more information and with less stress.  If you are interested hearing more details— send a DM to Dr Jessica's instagram account "AskDrJessica" or send an email to askdrjessicamd@gmail.com

Dr Jessica Hochman is a board certified pediatrician, mom to three children, and she is very passionate about the health and well being of children. Most of her educational videos are targeted towards general pediatric topics and presented in an easy to understand manner.

Do you have a future topic you'd like Dr Jessica Hochman to discuss? Email Dr Jessica Hochman askdrjessicamd@gmail.com.

Follow her on Instagram: @AskDrJessica
Subscribe to her YouTube channel! Ask Dr Jessica
Subscribe to this podcast: Ask Dr Jessica
Subscribe to her mailing list: www.askdrjessicamd.com

The information presented in Ask Dr Jessica is for general educational purposes only. She does not diagnose medical conditions or formulate treatment plans for specific individuals. If you have a concern about your child's health, be sure to call your child's health care provider.

Transcript

Unknown: 0:00

Hi everybody, welcome back to ask Dr. Jessica the podcaster My goal is to give you quality medical information to help you worry less about your children. I'm your host and paediatrician Dr. Jessica Hochman. I am proud to introduce today's guest internal medicine physician Dr. Sunil dand. In addition to being a practising medical doctor, Dr. Dan is also quite passionate about lifestyle medicine. He is a very active content creator with an online course a YouTube channel and he has built a community on local.com. What I love about Dr. Dan is he is on a mission to help Americans live healthier lives, and he speaks authentically and honestly about his feelings. Also, I wanted to share some exciting news that for the very first time I will be offering an online interactive workshop to help parents worry less about their toddlers. I'll be covering a range of topics of the most common concerns that I hear as a paediatrician from parents from picky eating to behavioural concerns, all with the goal to help you parent with less stress. It will be a four week course starting in mid February, so stay tuned for more information. Also, if you'd like to hear more details, be sure and send me a DM on Instagram, ask Dr. Jessica or send an email to ask Dr. Jessica md@gmail.com. Welcome Dr. Cindy. Oh, Dan, I'm so excited to talk to you. Hello, it is fantastic to be here. I am such a big fan of yours. I really commend how you speak with courage. And I'm so excited to pick your brain on some important medical topics. Thank you. I'm very much looking forward to it. Yeah, it's been a rough ride the last few years, as you know, but we're all doing our best here and happy to talk to you today, Jessica. So tell me about yourself. What kind of doctor are you? Do you practice medicine? Yes, I certainly do practice medicine. I am an acute care hospital physician. I grew up as you may tell, not in the United States. I grew up in the UK, I went to medical school over there worked for about a year in the National Health Service, and then hopped across the pond, did my residency training in Baltimore. And since then, I've worked up and down the East Coast, in a variety of different settings. I've done both inpatient and outpatient work. I'm currently settled in Massachusetts, where I work in a couple of different hospitals. And I would say about three or so years into my life as an attending physician, that's when I developed a big interest in health, wellness And preventive medicine, which is the basis of a lot of my work. Obviously, it's been very much focused on the COVID pandemic over the last two to three years. But my main area of interest is lifestyle medicine. Amazing, which I think, as you talk about is really the root of health care the most important aspects of health care. Exactly. Yes, it is. It is the fundamental of health care, which unfortunately, we have completely forgotten about. Was it not Hippocrates, who said 2500 years ago, the father of medicine, Let food be thy medicine and let medicine be thy food. But we have got completely and utterly lost over the last few decades. And we need to swing the pendulum back over boy, we need to start thinking seriously about preventive medicine. And I know that's something that you're big on as well. So let's talk about that some more what, when you talk about preventative medicine, what exactly does that mean? Preventive Medicine is basically it should be the bedrock of the training for all medical doctors, it is trying to get to problems before they happen. And there are various fundamentals that will determine anybody's level of health. The big ones are very obvious to everyone. Diet, number one, our activity levels, our other lifestyle factors. And all of those will determine to a large degree our risk of getting sick. And we're in an absolutely abysmal position right now, in 2020. I was gonna say two, but we're now at 2023. And the United States is probably the worst offender. Out of all countries, we are completely a sick care system. We are entirely focused on treating people when they get sick. We have soaring terrible rates of lifestyle related diseases which are going through the roof. And what got me into this area. A couple of years after being in practice was seeing the degree to which lifestyle so making people sick. And then as a doctor, I don't want to be someone who simply writes prescriptions and tells people what to do after they are sick. I would rather be the one guiding them beforehand, but our whole system is topsy turvy, soaring rates of diabetes, heart disease, other lifestyle related diseases and merely gear our whole system And towards treating them is a vicious circle which has spiralled out of all control. And we will eventually reach a breaking point we can't keep going down this route. It's true. I do think there's so many reasons for this. But if a patient comes to see us, it's much easier to say, here's a medication, it's so much faster than to say, here's what we need to do to get you to lose 20 pounds, which everybody knows is a very tall order and a tough task. It says, yeah, it has to change, it has to change. And the crazy thing is those prescriptions that you allude to have a very marginal fractional benefit, compared to the lifestyle related changes, which will make a difference, I have no doubt that this is something that could be achieved. But we need a complete and utter radical overhaul to get back to basics and root causes, because there are too many different players involved, that want to keep the system the way it is key people focusing entirely on medical therapeutics as a way out, and it's utterly ludicrous. It's ridiculous. It's not backed up by science. And if nothing else, it will ultimately bring the whole country down. I know, you love this country as I do, but it will eventually lead to the complete fall of the United States. Look at statistics now 20% of children are obese, we have for the first time, we are seeing conditions such as fatty liver disease, type two diabetes, almost in babies at this stage 70% of intake of both adults and children is ultra processed food from which food companies obviously benefit from all of these things are leading to the statistics that we're seeing. And we have to absolutely have to for the sake of people and for the sake of our country, get out of this mindset, that Big Pharma is the answer, it is not going to be the answer. And if we can achieve miraculous things to people like us probably sat here in the 1940s and 50s, and said, What the devil can we do about smoking? Two thirds of adult men and 1/3 of adult ladies smoke? How could we possibly reverse this, it took a massive public health campaign. And we are going to need the same thing in the very near future. And we need leaders to actually do that and take this problem seriously. My husband always says that 99% of medicine has nothing to do with going to the doctor that has everything to do with how you live your life at home, how you're eating, how are you taking care of your body? Are you exercising? Who are you surrounding yourself with? How's your stress level, and there's such an emphasis on primary care, which obviously believe in as a primary care doctor. But it's an interesting perspective that health care really doesn't have as much to do a doctor's as we all think it doesn't know. And anyone who is in this field for the right reasons should want to stop problems before they get to that stage. And unfortunately, our societal culture also perpetuates the fact that people think it's okay to pack on the pounds, it's okay to not exercise, it's not your fault. And then you get everything else we mental health is a huge other issue that we could touch on as well. But all of these problems are linked together. And when we have a society that says it's okay, we want to disempower you, in a way, we don't want to say that you're in charge of this, it's not your fault. If things are this way, if you have this disease, we'll simply help you treat it as opposed to not getting the issue in the first place. I mean, there's so many different factors involve, basically, when you have a society like we do, which is encouraging thought processes, which are constantly taking away the mindset that you are in charge, and you can beat everything, and it's wrong to be a certain way. And you don't have to go down an inevitable path. Everything around us is geared towards making us that way sick and dependent. So I think yes, I think there are many different players involved. I mean, you look at big food, a trillion dollar industry controlled by 10. Companies, why would they want people to come out of the system and get healthy, make better food choices, they have no interest in doing that? None of those big players want us to get into this self empowered mindset. So okay, let's say Dr. Sunil Dan is in charge of the new public health campaign to help make Americans less sick, healthier. What would you do? What how would you start off this campaign? Well, the very first thing I would do is I would insist if I was given that position, and I had someone above me presuming a presumably a president, say you have to immediately get rid of all conflicts of interest in our top agencies. Of course, maybe it is wishful thinking to even say that, but I would say I wouldn't be able to do a job in that risk. Fact with all of these different forces working against me, but if shall we say, I'm in charge and want to design my own programme, I would have a massive, huge, monumental public health programme on the level of what you saw with big tobacco, discouraging people from eating processed foods and sugars. Number one, processed foods and sugars go hand in hand. Number one, why not put warning labels we do with cigarette packets? We do say this causes harm. Why don't we do that and processed foods, I mean, one could argue that processed foods will actually kill you much faster than somebody who smokes for a long time, they'll give you diseases much faster, because often people who smoke don't end up obese because they're smoking instead of eating, of course, they get a whole host of other problems like lung cancer, but to me processed foods is on that same level. So I'd start off with a massive public health push. And then I would invest in primary care your field and say that every doctor will get a certain amount of time, and enough resources allocated towards speaking to every family, and making this unacceptable in many ways, all of these people who basically live off junk food. And I don't think there's anybody out there that wants to be unhealthy have to make it not acceptable. Again, just as it was all I'm doing is talking, talking as somebody would 40 or 50 years ago, I'm just going back to where things used to be in our parents and grandparents time. But now, and I'm sure you see this every day, you can't tell the child who is obese, that they have an issue and you can't tell their parents, they must immediately reverse it. And, and society makes it okay, as well, we've made it acceptable. And our whole system does that. And I totally do blame the medical profession. Totally. Because let's take another example, if you had, say, an education system, supposing you had a country where, where 50% of people by age 18, couldn't even read a sentence, you would blame the education system and say there's something seriously wrong. So when you have a situation where 40% of people are obese, you have the soaring rates of diseases, what exactly are the medical profession doing here? We're actually going the opposite way, this is more sinister than we could ever imagine. medical societies now are pushing for doctors not to even talk about weight, let's abolish the BMI. That is the current mindset when you're faced with a problem. Let's just change the definition. And maybe the problem will go away. Absolutely. It doesn't go away. things just keep getting worse and worse, because we're not focused on these root causes. So that's my long answer to your question, what would I do? Not easy for one person to do? But I would start with those things. No, and you're right. I think we're so afraid of being insensitive and offending people that now the pendulum has swung such that we're worried we're going to offend somebody if we say that they need to lose weight, or be more mindful of their diet or make some changes. And that's unfortunate, because I don't think that's honest. It's not honest. And it's the worst thing you can do as a doctor is perpetuate illness and not be honest. I would say when I'm talking to patients, even patients who clearly had a problem when I've said blade when I've put it to them, upfront, would you like me to be honest with you? Or do you want me to sugarcoat things I've never heard anybody say sugarcoat things. Everybody says, Give it to me. Honestly, people are yearning for that. Jessica, you know, this, children, especially parents, they are yearning for a massive cultural change. And for us to really be honest with people and say, We have a huge problem here. No pun intended. We cannot keep going down this route. If nothing is going to bring the entire country down. I'll tell you when I was in college, you know, they call it the freshman 15 where it's very typical to gain weight during college. Well, I gained the freshman 40. This was over a few years, I gained 40 pounds. And I remember I knew what's happening. I didn't know what to do about it. And where I really made the change and where I was motivated to lose the weight. I went to my doctor I went to my OBGYN and she said to me, Jessica, you've gained 10 pounds every year for the last four years. This is what you need to do. I want you to cut out desserts. I want you to watch her sugar. I want you to watch her carbohydrates, cut out the pastas. And she really was what got me to change that doctor's visit unequivocally was what motivated me to start losing weight. So I agree with you. I think people are yearning for honesty and direction. Now okay, let's talk about what people can do on their own. So what what advice can we give people what actionable steps can they take to improve their health and the health of their children? Do you have any advice on what like let's say somebody goes to the supermarket today, or they have a fresh day a fresh start? What advice would you give them? Don't listen to any authorities. Um, can Today, okay, you it's not I'm all for that. That is a wonderful question. And as you know, you never come to the table with a problem without a solution. And I think people want to make the right decisions at a micro level for themselves and their families. And what I would say, keep it simple. There are lots of different things that will determine your level of wellness, diet, exercise, stress, sleep, attitude to life mindset, we can talk about all of those things. But if you were to ask me, What's the number one thing that you can do, what should you start with? It is what you put into your body. I started with a quote from Hippocrates. So in terms of what you can do, okay, eat real food. What is real food? Real Food is similar to what your grandparents and great grandparents used to eat. It is food in its purest form possible. We have a huge problem in the United States with food production with what our companies do to food products, they completely toxify everything. What you want to do is eat food as close as possible to coming out of the ground. Where wherever it is you vegetables, fruits, meat, dairy, eat it in its unadulterated form. Stay away from ultra processed foods, stay away from packaged foods, stay away from canned products. And if you buy them, look at the packet, you want as few ingredients as possible. Okay, ideally, two or three. That's it. It is so difficult in the United States. And there are some shocking videos and articles out there about the difference between food products in the US versus Europe. But what you want to look for is food if you're buying vegetables and fruits, organic from a good source you want if you're buying processed and packaged foods, as I said, few ingredients as possible. The big things to look out for sugar, sugar is absolutely everywhere. There are 56 different names for sugar that companies use to hide the fact that sugar is in your food. And you can research all of those names. Fructose Corn Syrup is a big one other other syrups that are added which are secretly sugar, and then the fundamentals of a good diet. You mentioned earlier, carbohydrates, you want to minimise those carbohydrates are frequently the most processed foods within our diet. Bread is a massive offender. Cereal is another big offender. I mean, most children or a huge percentage of children right now are being fed dessert first thing in the morning. And it is an abysmal situation that we're loading children up with sugar which is going to set them up for illnesses, both physical and mental. So processed foods, carbohydrates, especially the refined carbohydrates, I could go over the fundamentals of like different micronutrients, but I want to keep it very simple. That would be my main advice to people eat real foods, as pure as possible minimise sugars and minimise those refined carbohydrates. And actually, if we're talking about weight loss, most people who are trying to lose weight they do those three things, they will lose weight. Absolutely. I think if people ate mostly food that was unprocessed, grown from the ground, we would not be having the obesity epidemic that we are. Oh absolutely not. And it's actually delicious. Once you know how to eat it, you don't want to eat the rubbish anymore. Your taste for it is just completely lost. And there's so many great ways you can season the food you can spice it up. It's absolutely delicious if you do it, but the answer will ultimately lie in your kitchen. You being your own chef is you being your best doctor. Absolutely and I highly recommend everybody listening to check out Dr. Sunil Dan's YouTube videos he has many videos on what to eat and how to eat. I love the videos you've done on olive oil, blueberries, fresh fruits and vegetables. You know many super foods out there blueberries are my favourite they are loaded loaded with antioxidants. You want a diet which is which is full of as many antioxidants as possible. I eat blueberries every day, I consider that my morning medication. It is a great snack. You can mix blueberries up with almonds, walnuts, you can throw in a few raspberries, I would take that snack over a bag of chips, or a protein or cereal bar any day. Just give me something nice and pure. And what I also love about your videos is that you make you give us some medical evidence as to why it may actually be beneficial. I don't know if you can recall but you talked about how eating more than five fruits of vegetables a day will make a meaningful difference as as opposed to eating fewer than three servings a day. Oh, absolutely. And this was actually one of the things when I was first getting into health, wellness And preventive medicine my first book, which was called high percentage wellness Steps was based on the premise, it sort of touched on absolute and relative risk reduction. But basically, the fact that most lifestyle changes you can make have magnitudes greater improvements, or result in a magnitude greater improvement to your health and well being over the long term, then most medical therapeutics out there. And there are lots and lots of studies out there. And they clearly show a relationship eating more vegetables and fruits, you can cut back on processed foods, they will have way higher changes to your health, and reduce your chances of getting sick more whether we're talking about heart disease, diabetes, cancer, then most medications out there. So why would you not do that? Why would you want to be addicted to a pill, which comes with a whole raft of side effects and is also very costly in the United States as well. I think we have to recognise that it's important to be dubious, with the idea of a quick fix, whether it's a medication or an intervention, that the big picture, lifestyle changes are really where the meaningful differences will come. Exactly, well, perfect. Yet, I couldn't have said it any better. We are a quick fix society. Our whole culture right now encourages it, the establishment encourages people to think that way. There's a quick fix here, you're obese have this pill, hey, you have piled on the pounds, we can refer you for gastric bypass surgery. I mean, it's ludicrous. When you look at what all of these things are doing. Whether you take an obesity medication, or gastric bypass, you are playing around with your internal entro endocrine system. And you could have achieved exactly the same result actually a better result by simply eating real food. But we refuse to address those root causes. This problem pervades our medical way of thinking it's how we're taught as doctors, it's how our medical journals operate, if you look at the articles and the protocols that they are pushing, it is all based on pharmaceuticals, and interventions. And I think you're right that we are were afraid to be without compassion to be insensitive. But I can tell you from my own experience, nothing feels better than feeling good about your health. And we're not going to get there if we stay overweight. We're not We're not permitted this culture, right. And actually, even among our own profession, I have to say the statistics are abysmal in terms of obesity, that's a whole other issue. How are we in any sort of position to preach this, it's like somebody who's financially bankrupt, going and telling other people how to make money and how to invest. It just adds a level of lunacy to the whole situation. And I think you're right, you touched on this earlier that nobody wants to be overweight, we all feel better when we're wearing shave, and we're taking care of ourselves. So I just think, again, it's being we're being dishonest because I think we all know that it's hard to lose weight, that it's very challenging that a lot of people that attempt to do it fail, but I do think it is possible. And I feel like as somebody's physician, I'm there for them. So I encourage anybody listening to start today, you know, start today by buying some unprocessed foods, try to get those whole fruits and vegetables into your body. What I was saying may have sounded very blunt, but people need to hear it. Now. It's not easy to lose weight. But people know if they're overweight and obese. And if you were to ask anyone who's overweight or obese and say, here's a pill that will make you have a normal body shape. Is there anyone who wouldn't take it. But show me someone who has a normal body shape and say, here's a pill that makes you obese, nobody would take it. They know everybody knows if there's a problem, but it requires hard work and determination and understand that the whole set system is working against you. Everything around you from what's advertised all the food you see, you are going to have to make sustainable choices that enable you to lose weight over the long term, but it is very possible and nothing feels better than being in shape. Everything improves not only in terms of your blood parameters, how you feel every day, your concentration, your energy levels, you will sleep better, you're less likely to get other chronic complications of obesity and mental health. Don't forget the link with mental health and being overweight or obese. It is a very very strong link that is not discussed at all such important work that you talk about and I think I'm so I'm so proud that you're not afraid to speak your mind. No, I'm not and I really don't sugarcoat again even though I sound very blunt, I would say people I speak to about this directly one on one are very grateful. And they like what they have to say and I'm there for them. I will guide them through their weight loss journey. And one of the biggest pleasures of my career I would say are the numerous times that I have sat down with someone had a plan with them they've initially Ah, read the plan, they have gone on to lose weight. And then lo and behold, they don't need their diabetes medication anymore. I cut back on their antihypertensive their blood pressure medication wanted to add what you do, dealing with these problems with children. I don't do that. But I have full respect for anyone who is facing these problems, trying to deal with it in a diplomatic way, especially in today's political environment is very, very tough. And it's all the more sad when it's a child, because actually, they are one group of people who I don't blame for being obese. I mean, how can you blame a six month year old, six months old for having fatty liver disease? You can't. It is because of the environment they're in and what their parents have done. I blame their parents, but I don't blame them. Well, I think parents are just I think parents honestly want to do the right thing. But they don't. They're lost. A lot of parents come to me, commonly starting around two years old. concerned, because their children are picky eaters, and they're worried and they're worried their kids aren't going to eat and what will happen if they don't eat dinner, and they don't eat the broccoli and the salmon that they provided. So they ended up making them pasta, and pizza and mac and cheese because they just are so desperate to see their children eat. And I constantly remind them that I've never seen a child starve, that it's so important to provide quality foods, because if you provide the quality food, you just trust that the child will take what they need, and they won't starve. But I see it starts from the very from a very young age or parents are I think it's their they're insecure, or they're they have they have some fear that maybe it came from their own parents that their children will not eat. And it's not. Yeah, it doesn't happen like that. That's true, yes. But it has to start early. I mean, what are the statistics now, only 13% of the US is metabolically healthy. It's terrible. And it's been going down for a long time. And we are fast approaching the stage. In fact, I think we're already there, where the average child and adult in Sub Saharan Africa now has better metabolic health than in the United States. And that is what I would like everybody listening to think about, I am certain that we're faster we are at that stage now. Because metabolic health has got so bad in the United States, Africa, has overtaken us, because they don't eat Johnson. It's that simple. And they're active. If you went to Africa right now, and did a slew of blood tests on every adolescent there. And then obviously, I'm not talking about the extreme Africa like, you know, a starving or war ravaged place. I'm talking about the average African country, and you did the same in the US. The African ones would have far better blood parameters. Far better. I'm sure you're right, is what we have done in the United States. Shame on us. You know, what else I found really sad was during the COVID 19 pandemic, we were so afraid to talk about the relationship with obesity and poor outcomes. I've read that after age in terms of predicting poor outcomes from COVID-19. But after that it was being obese. And we hardly talked about lifestyle changes during the pandemic. It was almost the contrary, we talked about staying home. Not playing sports, staying at home being an active we were promoting really unhealthy lifestyles. I saw this from the beginning. As you know, from my own personal story, I had a mild case of COVID March of 2020. I've worked at the frontlines ever since I've treated 1000s of hospitalised COVID patients, all adults, I've worked in different hospitals. I've worked in different states, as you said, majority over 65 By far the biggest risk factor, we saw that right from the beginning, we knew that before COVID had even arrived on our shores. I did see a handful of under 40 year olds, every single one of those was obese. Every single while I've read that over 80% of hospitalised patients for COVID-19 were obese. That's tremendous. That doesn't surprise me at all. And there's some very interesting science behind that. In terms of body fat acting as an immune suppressant. There are some interesting theories with regards to ace that that's a substance within the body. We won't get into that. But needless to say that the science is there of how obesity affects the immune system. And unfortunately, if the last couple of years wasn't a chance to grab the bull by the horns and say this is it, we better address this problem. We never will have another opportunity. This was it, Jessica and we failed abysmally on all levels, individual doctors failed medical societies failed leadership at top level failed mainstream media. Everybody failed, because this was it. And not only did we fail, inexcusably, we went in In reverse gear, we made people's metabolic health worse, we didn't let them work out. We didn't encourage them to eat good food. They went and ate Doritos and chocolate all day, childhood obesity got worse. We made the whole system worse. And you're laughing Yes, it is funny, it would make a good comedy. But at a very serious level, it is a complete joke. And it makes a mockery of our system. It makes a mockery of science, it makes a mockery of why we're even here, if we have seen this from the very beginning, and we were not seriously addressing it. Look at these countries like Japan and Korea, and how they have stayed away from severe COVID. The elderly are not badly affected by COVID. They've got great statistics. And our conclusion is it's because people wear masks. How could you call yourself a doctor and draw that conclusion when it is so obvious that the main reason that they haven't got badly badly affected by COVID, whereas the United States has is the fact that we have this rampant lifestyle related disease issue and obesity, that's the number one factor. But most of the doctors you see even on TV will never mention that. And it just makes a joke of this entire situation. Sorry about it. But I am I feel very passionately about this issue. As a doctor that wants our country to do well, I want people to be well, I want people to be healthy. And we've completely dropped the ball on this and made the situation worse. There was just a study that came out showing that life expectancy for most for many countries during the beginning of the pandemic went down. And in the last year many countries have rebounded now the life expectancy is on the up. But the United States has continued to drop. And we have a very well vaccinated country compared to many countries. And it begs the question, why are we still dropping? And I think we'd have to look at all these lifestyle decisions. Yeah, how can we not be aware that we're the most overweight country I'm sure that's playing a role in this overweight over obese and over medicated don't neglect how that plays into it. We are way over medicated. This is the hard truth. It is hard, hard truth. People need to hear it though. Thank you so much your I appreciate how honest you are how I like your bluntness, I think a lot of doctors I talked to we're scared to talk in reality because I think we're afraid to upset anybody. And I appreciate that you are honest. Oh, I'm happy to be that way. I'll continue being that way. I'm well past the stage of diplomacy on this. I have seen what's happened over the last three years I'm past that stage, I will tell the truth to any member of a top agency, I will tell the truth to any top physician who is debating me quote unquote top physician in their field, because we have had a crazy last few years that has exacerbated a lot of big problems. And we're still not talking about health and well being and I came into this profession to help people get healthy and I will continue to do that. Thank you for listening and I hope you enjoyed this week's episode of Ask Dr. Jessica. Also, if you could take a moment and leave a five star review wherever it is you listen to podcasts. I would greatly appreciate it. It really makes a difference to help this podcast grow. You can also follow me on Instagram at ask Dr. Jessica See you next Monday.