Why Cancer Comes Back Somewhere Else with Dr. Nasha Winters

I'm really excited about today's podcast with Dr. Nasha Winters. She's a nationally renowned naturopathic doctor who specializes in integrative and metabolic oncology. She's the author of The Metabolic Approach to Oncology, a brilliant person, great heart. Her story is amazing. She was diagnosed with stage 4 ovarian cancer at 19 and survived, and it's changed everything about her personality, who she is, and how she practices medicine. I think you're going to really enjoy this conversation today. If anybody you know of who has a history of cancer dealing with it, or if you're worried about your own personal risks, lots of great tidbits and information in this podcast today, which I think you're really going to enjoy. So I hope you enjoy this conversation today as much as I did. What if cancer isn't an enemy to attack, but a messenger telling us something about the terrain it grew up in? My guest today has handled stage 4 terminal cancer of a diagnosis when she was 18 years old. More than 30 years ago, and she's become one of the world's leading voices in metabolic and integrative oncology. Dr. Nation Winters is a naturopathic doctor and board-certified naturopathic oncologist who spent more than 30 years reframing how we understand cancer. At 19, she was given a diagnosis of terminal ovarian cancer, and she's still here today. She's the author of The Metabolic Approach to Cancer, Mistletoe and the Emerging Future of Integrative Oncology, She also hosts the, um, Tend Your Terrain podcast. She's a wealth of information on all things integrative oncology and the way she looks at the terrain, your body, how things interconnect is an amazing view perspective. Welcome, Dr. Nasha, to the podcast today.

So good to be here. It's been how many months now we've been trying to meet? We've been on like text threads for a while, but I've been really very much looking forward to meeting you and, um, Becky.

Yeah. So it's, and we were going to meet you in Arizona, but unfortunately, you know, Life happens. Yes.

Yes. We decided to have a really good, um, upgrade to our immune system with some type of a food poisoning or something. We're not quite sure what it was, but it was a good one.

So, you made it. I did. I did.

I'm on the other side of that one. Thank God. Yeah.

So I, you know, one of the things, I think one of the most impressive things when I first started learning about you, following you, reading your books, learning from you through, I mean, we talked before we started recording about the training you've done in integrative oncology through the, um, A4M, which was some of the suffocation stuff I did early on. Like, can you tell us your story? Because it's actually like an amazing story about how you dealt with stage 4 ovarian cancer, which is almost always fatal, how you survived that, you know, and now you're thriving and you've actually become an expert in integrative metabolic oncology. So could you just walk us through, introduce yourself to my audience and kind of walk through your absolutely amazing story?

Oh, well, again, I'm super honored to be here with you and your community. So thank you for that. And, you know, a lot of folks will often ask me right away, like, how did you get into this field of oncology? As if it was just a vocation choice, you know? And, and to your point, um, I was, I was pre-med at the time of my diagnosis. I was the summer before my sophomore year in college. I was having increasing health issues that everyone kept telling me were more of the same. So in full transparency, By the time I was 9, I was menstruating. By the time I was 11, I was put on birth control pills to deal with endometriosis and polycystic ovarian syndrome. By the time I was 14, I was dealing with cervical dysplasia. And again at 16, um, somewhere between those 2 years, I was diagnosed with irritable bowel syndrome. I was also diagnosed with juvenile rheumatoid arthritis. And it just, it was like a Petri dish, a collection of things. But the weird part is I hear that now as a clinician and think, oh, that's a problem. But it was completely normalized. So there was just like a pill for that ill. Everything they gave me was just like, yep, just take the script. Yep, just take the script and just carry on. 'Cause I was really a high functioning person, you know, head of my volleyball team, student body president, top AP classes, like just showing up in the world with my all. Um, for your listeners to understand, that was also a good mask because there was a lot of trauma and, um, things I was trying to avoid. During that time. So me being hyper-effective out in the world was a good way to protect what was happening on the other side of that wall. So by the time I was 19, just a few, like 10 days shy of my 20th birthday in 1991, my roommate came home and found me unconscious. And I'd been in and out of the ER all summer saying something's different, something's wrong. And they just kept saying, it's more of PCOS, it's more endometriosis, your IBS is flaring. By the time I landed in the emergency room, another doctor that I'd never seen before took one look at me and was like, this is not more of the same. And he went down a different rabbit hole. He did some proper imaging, some proper evaluation, and it was a doozy. About 7 and a half hours later, comes in and delivers the news in tears because he had a daughter my age to let me know that they weren't certain yet that the materials were being sent off. It could take a few weeks to get the final biopsy results. But from the imaging and from the fluid and from the things they were seeing, it was definitely cancer. They presumed primary was ovarian. I had metastasis in my liver, all throughout my abdomen. My lymph nodes were filled. There's something called carcinomatosis, which is like a kind of a carpeting with little tiny bits and pieces, like stardust of, of tumor all over my abdomen. I had fluid in my lungs. I had fluid around my heart. I had 100% bowel blockage. The tumor in my right ovary was the size of a grapefruit that had pushed my right ureter off, and I was in kidney, just, you know, shut down. My liver had stopped functioning and my oxygen levels were in the high 70s. So nothing I was experiencing was conducive to life. And at that time they told me, I, and you mentioned earlier when you did the intro that I was given 1 to 2 years to live. It was actually given less than 3 months to live. And the doctor at that time, I said, well, what can I do? And he said, you're too sick to even get a single dose of chemotherapy. I'm afraid it would kill you outright. And I said, well, if I could take it, what kind of time do I have? And he said, 3 months. And I said, okay, so if I don't do anything, what kind of time do I have? And he said, 3 months. And so that moment was very eye-opening of realizing if I did absolutely nothing, I'd have the same outcomes if I did everything. And so that was one of those first aha moments. But yeah, it was a crazy time to be, you know, where you should be at the height of your youth, um, experiencing, you know, life as a young adult. Um, in my pre-med glory and the, the, the, I took a very hard turn at that time.

And so what was like, what were the steps? 'Cause like being 19, being invincible. Yeah. Uh, you know, I remember being 19 years old and literally telling my friend, you know, we walked into this downtown Richmond at night, you know, midnight saying bullets will bounce off my chest. I literally said that when people said, you know, they might have guns or whatever. I, I was like, you know, the hubris is actually this. It's striking, right? And, um, but how do you, you're 19, you're, you're, you're a young lady, you got your whole future and all of a sudden you're like, you have 3 months. Like what was your mindset? Like what made you not give up? What made you like, what inspired you? 'Cause obviously you didn't give up. You obviously figured out some stuff. Like how did that, how'd that process even play out for you?

Yeah, I should preempt a little bit more context here because in the very moment the doctor told me what was going on, There was actually a moment of relief at that very moment. Part of that story was that, that we now have information, cuz I knew something was worse than everyone was telling me. So there's part of relief that finally someone's listening and believing you. There's that side, which is very compelling. The other side is on 2 different occasions prior to that moment, I had actually tried to take my own life. I was in some pretty dark places. And so for me, I had this like flash of, well, this will be a little bit more savory way to go. You know, it seemed a little bit more martyred instead of like doing it by my own hand. But then something else happened that surprised even me in that moment. And so when he said, there's nothing we can do for you, go home and get your affairs in order, what that did for me was super interesting. It lit a pilot light of sorts that said, really? I, okay, I'll take that as a double dog dare and I will show you. And I wanna say that I didn't have the expectation that I was going to fight it or go into battle with it or treat it. That wasn't my mindset. My mindset became immediately that I just wanted to understand it. And so that has been my journey. It'll be 35 years on October 21st, 2026 that I was given 3 months to live. And it was that moment, my birthday's September 30th. And so this was around the 17th of September. When I landed in the emergency room and was given this news, and the official diagnosis wouldn't be for almost a month out before I got that. But in that window of waiting, I was fully expected to die any second, nor, and same with their belief systems around it. So with that, there were 3 things that I would love to share with you and your audience that I think were instrumental in my very survival. One of them, I just wanna have context, is that there was no Dr. Google. It was nothing at that time. In 1991, I was doing work study, working in our library at our liberal arts college in Durango, Colorado. And so the only research I had access to was through the Dewey Decimal System in books in a small liberal arts school that didn't have a lot of funds, and also the good old microfiche for my research. So the amount of research that was out there about young people with cancer was almost nonexistent, and about young women with ovarian cancer. Also almost nonexistent because the average age for a woman diagnosed with ovarian cancer was 68 years old back in 1991. So I was a zebra, what we call zebras in the medical field. It was, that's why people missed it because you're not looking at a 19-year-old expecting to see this. Sadly, fast forward to 2026, we see this a lot more often, still not normal, but unfortunately much more common. So the first thing. I mentioned in my diagnosis was I had 100% bowel blockage. And in the 2 weeks leading up to me landing in the emergency room, I literally couldn't eat anything. It caused such extreme distress, such extreme pain that I would just throw up and it was just awful. By the time I ended up in the emergency room and get— got that probable diagnosis, I'd already not eaten for 2 weeks. It would be almost another 2 full months before I was able to eat. And so in standard of care, we know the best treatment for a bowel obstruction is bowel rest.

Mm-hmm.

But we're typically in a hospital environment, still getting IV fluids and getting support. I had none of that. They didn't quite know what to do with me, but I managed somehow to be able to take little small, small sips of water. What we know today that we certainly did not know back then, and that I would actually stumble across about a year into my diagnosis, was that fasting alone had a very profound effect on lowering inflammation, on lowering a process known as angiogenesis, which was the driver behind this Oh, I had a major ascites, which is malignant fluid buildup in my abdomen. And so it started to help dry that up. And then it also helped shrink the tumor. So a study I ran across from Dr. Mureshi's work from 1909 showed that just water fasting alone could debulk a tumor, meaning make it smaller. So some of the things that were accidentally happening out of just necessity I had valuable real estate taken up so I couldn't eat without extreme duress, led me to an accidental support for what was going on. So that was number one. Number 2, you know, I mentioned my sort of mental health or my ideology and my sort of lack of like life, the desire to live. I came from a very, very toxic traumatic upbringing. So for folks who know, and maybe your community knows this, but the adverse childhood event score is actually a A, a model of assessment based on a questionnaire of 10 different things that you're exposed to before the age of 18. And the more yeses you have, the higher incidence you will to have a chronic illness or a cancer at a very young age. So when we start to hit 4 out of 10, we start to see exponential increases in things like cancer in young people. I had 10 out of 10. So now looking back on what the research was telling us all the way back from the 1980s, It was inevitable that it would have a process because that type of trauma at such a young age rewires your body. It rewires your mind, your nervous system specifically. It rewires your microbiome. It rewires your metabolic health and it rewires your immune system. And all of those are really integral for maintaining health and vitality. And basically all of mine were off, like off. Just off. So there was that piece in the, and so the fasting was one, and then knowing my ACE score, part of what I also fasted from, which was, I think, a strategy that helped was what I call the family fast. So the week after I graduated high school in Wichita, Kansas, I hightailed it for Colorado thinking just the change in geography will save me.

Yep.

But we know that wherever you go, there you are. And so I might have left the situation, but I didn't leave the impact it had on me and I hadn't started dealing with it yet. And so a family fast was just an opportunity to give me a little bit of a buffer so I could start to work on the unmetabolized trauma of my youth. And so I was very, very lucky. I was in fact the very first client of a therapist in our college university. like psych center who I was her first client to ever do EMDR. And I believe that was a very powerful tool. It's so funny. It's been around so long now, but in 1992, it was brand new. I was literally her first client and the first one at my college. So that was really profound. So the family fast, I think, was very helpful to just give me a new container of support. And then number 3, in those first few days after my diagnosis, leading up to my 20th birthday on the 30th of September, I was kind of in a eff it phase because I'm thinking I'm gonna die. So I was supposed to have a big birthday party for my 20th birthday. And cuz we didn't have cell phones and whatnot, I canceled it. I was definitely in a Debbie Downer pity pot place. And, um, I just didn't wanna have any social interactions whatsoever. And I was really sick. I was not feeling well. And so somehow I'd had my, but by that time, by my 20th birthday, I'd already had my abdomen drained 3 different times for the fluid. Buildup and I would have a moment of relief, but then it would fill up within a few days and I'd have to go back in. So I just wasn't up for a party and I still couldn't eat anything or drink anything without being violently ill. But some people showed up at my house anyway, and they showed up and the essence, I'll fast forward, is basically they offered mushrooms. And because I was in a little bit of my eff it phase, I didn't know what they were. I didn't wanna drink. I didn't wanna do pot. I'd never smoked weed in my life. And they'd have that offering as well. But something made me a little bit curious about the concept of mush— of these magic mushrooms. Now, this is 1991. No Michael Pollan has let anybody out of the closet at this point. And so it just seemed like something so unique that I thought, why not? I'm dying anyway. Let's give this a whirl. But I also knew I couldn't just swallow them because I was really sick and I wasn't telling anybody. I was very, very secretive about what was happening in my life. And so I was asking these guys, what do I do with them? And they pulled out this giant Ziploc baggie full of small Ziploc baggies and they said, oh, you eat them. So while they're over chatting in the corner, I opened up one of the little Ziploc baggies and just basically crammed all of them into my mouth and started chewing them, like chewing my cud, not planning on swallowing them, just chewing them, macerating them down. And by the time they turned around seeing that I just took an entire baggie of mushrooms, the look on their face told me everything I needed to know. That I likely made a very big mistake. And let's say it was probably the best mistake I ever made because again, fast forward in about 2011, 2012, all these years later, I have a handful of patients, all of them ovarian cancer, all of them hospice eligible, meaning they are not expected to live past 6 months and they're no longer seeking standard of care, who all initiated into a study that was happening at Harvard. on the use of psilocybin for end-of-life care, for facing your mortality. All but one of those patients are still here today. And one of those patients died 4 years ago, 5 years ago now. And so that was an accident. And me trying to convince these very conservative people into this clinical trial was a lot, 'cause I wasn't telling anybody my own story at that time. My own story didn't start being somewhat told until 2012. So 1991 till 2012, it was very much in the vault with me and maybe 3 or 4 other people in my life knew what I was going through. So the accidental fasting, the accidental family fasting, and the accidental mushroom— heroic, beyond heroic dose of mushrooms. I think I literally rewired my brain, completely changed my perspective that life could in fact be different. I didn't have that reality prior to that diagnosis and prior to that particular evening of the eve of my 20th birthday to have that experience. But what I will tell you is that I could not ever go back to the experience I had before that night. My mentality could never be what it was before that night. And so I very much credit those 3 happy accidents to my very survival. That bought me enough time to keep digging and to keep evaluating and to keep going.

So I'm kind of curious, because when you first started talking, I just wrote down my paper here, trauma, you know, cancer underlined, trauma underlined. And you were talking more and I'm like, oh, and then like the mushroom part, like you're doing literally a psychedelic experience, brain rewiring. I'm curious with that amount of mushrooms, can you share what your actual experience was when you did that?

It was a death. I actually witnessed my own death. And so, and it was a complete death of my identity and it was a complete rebirth into something entirely new. And so it was a moment of realization that I don't have to go back to where I was and that I get to construct exactly my future to how I would want it to be. And that part has never really left me. I've had moments, I've had other experiences and traumas that have really shaken my identity in other times in my life. In fact, one even in the last year or so that was really, really challenging. In fact, I would say more challenging than that cancer diagnosis because you create more, I think at 19 and 20, your identity is not yet established, but by the time you're almost 55, it is. You have a very big construct of who you are and how you should be and who you think you are in the world. And so a lot more to break down at 55 than at 20. So those are some really interesting things. So for me, it was very much a very intense experience of witnessing, experiencing my own death and rebirth.

So talk about, yeah, to put mildly.

Yeah.

I mean, obviously you've done a lot more since then. I don't want to like Yeah, yeah. I'm going out too much, but like you, you became a naturopathic doctor who specializes in metabolic cancer therapy. Like when you work with patients, how many, how often do you see trauma, childhood trauma? Because like, yeah, I have a hunch here, but how often do you see, because it's one of those things like really having bad things happen to you when you're 1, 2, 3, 4, 5 or whatever, or seeing bad things or Meaning 10 of 10, which is pretty impressive in a bad kind of way.

Yeah. Like, like you don't really wanna strive for that, you know?

No, you don't. That's not, that's not the goal. It's like, you know, you wanna scale 1 to 10, you wanna be 0 on the scale, not the 10. Um, how often when you see a cancer patient, um, do you find out there's some kind of distant trauma that's a part of their healing journey?

Mm-hmm. This is such a profound question. In fact, I'm getting ready to speak at the IMMH, which is the Integrated Medicine Mental Health Conference. It's like a Super Bowl of mental health. in San Diego in October. And my whole topic is this. So I'm, I've got my, I just turned in my slides even. So I'm very much looking forward to it, but I will tell you clinically through my lens, through my experience of practicing, I would say it's 100% of the time. And I will say that it's not necessarily always big T, meaning big trauma. So it doesn't have to be abuse and neglect and all of the things that can be under in the ACE score questionnaire, right? It can be little traumas. And when we did a study a few years ago with over 400 patients, we had a weighted questionnaire that we brought forth. And what we came at the end was 76% of those patients, the common theme that those patients most often experienced that led to quite a sensation of isolation or trauma was not being seen and heard. That seems pretty small on one level, but it is profound on another, in that we are here to be relational beings. And when you are blocked from that, from whatever ways, whether that happened as a young child, Or in a more adult situation, in a work environment, in a friendship environment, in a romantic environment, that can really deconstruct who you are and leave you very, very vulnerable. And so there's been so much compelling evidence around what trauma does to our physiology, which is just extraordinary to me. It really does change your resilience to all disease.

Yeah, I remember, I forget where it's— I'm sure you're similar to this. I read so much stuff, so many places, sometimes I forget where the data point comes from. But it was one thing I read sometime maybe 5 or 6 years ago, and it was talking about women being diagnosed with breast cancer within 2 years of divorce.

Yeah.

And the, and the, like, it's, and, you know, 50% of marriages end in divorce, that's 50% of women and men, but women having A massive, you know, 3 most stressful life events are death of a loved one, divorce, and moving. And in many ways, divorce is the death of a relationship.

Yes.

You know, you have to move. And then, so it's really kind of almost like all 3 of those put together.

Yeah.

Like, could you speak to that, the idea of a life stressor or relationship loss, like in different cancers? Like, could you give us a little insight? Like, is this a real thing? Am I making that up? Or, and how do you see that play out?

I love this question. There's a gentleman who actually passed away just a couple years ago at the age of 100, Dr. Lawrence Lachande, and he was a little bit controversial in his later years, but in his early years in the 1950s, he was a major researcher in this very field of what you're just— what you're asking. He has a book called Cancer as a Turning Point, and it's gone through multiple editions. And Somewhere about a decade or, or so into my process, this book was gifted to me, and when I read it, it just blew my mind, which is where he was able to find both in his own practice as a psychotherapist, as well as going through all the literature, that a cancer diagnosis falls on the heels of 6 to 2 years after a traumatic event. That seems to be a common pattern or theme. So that whether that's a death of a loved one, a death of a relationship, a death of an identity around maybe a career. Um, a big, huge move, a major illness or accident or injury, something that shakes up the very core of your, like, identity and who you are and how you are in the world can really strip you down to become very, very vulnerable to something like cancer. And so his work has got some really big legs behind it still to this day. And then in fact, I just the other day had an interview with Bruce Lipton, whose new book Beyond Darwin just came out on the 18th of August. And I start— I mean, crazy, when I was early on in my own diagnosis, I was reading about the research. So early on in my diagnosis is kind of an interesting piece to answering your question. I was initially, at the time of my diagnosis, I was pre-med biochemistry and biology dual major. After my diagnosis, um, so I took the rest of that semester off, and when I came back because I started reading prolifically from September until the end of the year of 1991. I started running across the work of somebody named Robert Ader, Dr. Robert Ader, who is considered the father of psychoneuroimmunology. And then that took me down to the rabbit hole of another researcher of the time, still be years before her book came out, which was the work of Dr. Candace Pert. She later had a book called Molecules of Emotion. So literally the chemical changes in our bodies secondary to emotions. And then that took me down the rabbit hole of a microbiologist, or excuse me, molecular biologist by the name of Bruce Lipton, whose work would not come out until 2004 in the book Biology of Belief. And yet here we are in 1992, '91, '92, '93, and I'm reading all these folks and it is resonating so heavily. For my lived experience. And now I've switched my major to a psychology biology major. And now I'm like knee-deep in abnormal psychology and every psychology course and sociology course. And my advisors allowed me to construct my own psychoneuroimmunology major. And this is where I started learning that in fact, my trauma did, for lack of a better word, impose itself on my body to allow for cancer to arise. In a pretty significant way. So the more I started learning about that, the more I started applying new things to my body. Like I mentioned, the EMDR, all kinds of other tools over decades that I've applied. But now we have so many studies and the work of Dr. Bruce Lipton, what was so intriguing to me. And he said this on my podcast as well, recently on Tend the Terrain podcast. He talks about that what we are exposed to before the age of 7 imprints on us and is basically the programming of our lives, all of us. And suddenly I'm thinking about what was happening in my life, in my body, in my lived experience, in my household before the age of 7. Now that trauma continued long beyond age 7, but significant amounts happened before the age of 7, which meant that it literally set the foundation of how my body meets the world. Like I said, the immune system, the metabolic system, the endocrine system, the neurological system, how I meet the world was based on experiences before the age of 7. That's true for all of us. So when I start to explore, every one of the clients I've ever served takes an ACE score, takes an ACE questionnaire. And then I also do a deep evaluation of little t's as well. Like, talk to me about times in your life when you really felt your identity was shaken. And it's really intriguing, or tell me about what's going on in your life 6 months to 2 years prior to this diagnosis. Inevitably something major is there. And my experience has been, if that part isn't handled, if that part isn't made aware and addressed, the outcomes are never as good.

Gotcha. So with your— that's all, that's super interesting. I'm kind of want to take a step back real quick with your story, you know, cause when I see patients that come in with neurological issues or Typically, I'm seeing them after they've had the cancer diagnosis and already done the chemo and the radiation. Now we're dealing with all the complications from those therapies and neuropathy and prevention of secondary cancers and stuff. And part of what I do is I'm— my knee-jerk reaction is almost to be like, where is the toxin, the chemical? Where did you grow up? Which part of the country? The zone, et cetera, et cetera. Yeah, exactly. There's lots of those around the country. When you obviously went back and as you were kind of learning this and doing this on yourself, Did you find, you know, the trauma, the mind-body connection, super huge? You know, was there anything else that you could attribute to your cancer diagnosis? Or for you, was the trauma like the one big thing?

Um, such a good question. I mean, for me, I think it was, I think for me it was both exposome because I lived where I lived was near 3 Superfund sites, which I would learn later in life. I lived in the flight pattern of both an airport as well as an Air Force base. At that time, my region where I grew up a lot—it was a cancer hotspot. In fact, a lot of my classmates—I mean, I graduated in 1990 from high school—a lot of my classmates have had cancer or even died from cancer. Their family or parents all have had cancer or died from cancer. Like it was a hotspot for that. So I think there was that. Plus, we lived near. So in that area of Wichita, Kansas, in the surrounding beach, Learjet, Boeing. Air Force bases, a lot of industry. But then I also spent all my summers on the farm. And so a few, an hour, hour and a half away in Southeast Kansas, Pratt Sawyer Medicine Lodge, Coldwater, Dodge, that area, just, I witnessed growing up in 1971 until I stopped going probably around 16 years old. So I don't know, like late '80s is when I stopped going, but I watched the farming industry change. I watched my aunt and uncle go from having their own little garden and goats that we milked every morning to put our Ovaltine in.

Whoa.

Um, to, you know, going out and tending to the livestock and always having one cow that would become dinner at some point. And, you know, just that whole experience to suddenly family farm is gone and now the land is leased out to bigger corporations and now, you know, there are airplanes flying over spraying chemicals. Watching that change within a blink in a very short period of time was something that was happening that was getting much more exposed to in that part of the world. And so this area that was known as the breadbasket became anything but at that point, it became increasingly more difficult to find real food. When I went back for my grandmother's 90th birthday in 2013, my husband and I had to pack up and bring all of our food because there was nothing there. In the grocery store in Coldwater, Kansas, there were super hard tomatoes that were chemically sprayed to make them look nice. But there was no flavor, terrible. And there was some really wilted iceberg lettuce. That was basically the vegetables. Otherwise you had canned creamed corn and canned green beans where I'd spent my childhood snapping beans and shucking corn. You don't even have that anymore in that part of the world. So it changed in what seemed like an instant. And with that, our health changed alongside. Yeah.

So that's, that's interesting though, but yeah, it seems like so, but I guess You know, trauma is a huge part, obviously, or chemicals, environment. Yeah. And so I think it's interesting because every person has their own story. There's like the big, big trigger, little trigger, micro triggers. And I'm always curious with individuals, like you might have, I had this one big thing and this is the thing that got me over the edge. But as you kind of dig under the surface, you're like, well, maybe it's not just that. Maybe it's these 20 things, but this is the big, the big thing that kind of gets you over the hump. That's really intriguing.

Yeah.

Switch gears here a little bit and talk about individual cancers. And I'm partly a little selfish because I have patients and for some reason I've got a lot of prostate cancer patients right now.

Okay.

Yeah. It's, it's, I'm kind of curious, you know, go through a couple different types of cancers and get your, as someone who's been in this world for a long time, from an integrative, you know, looking at the terrain, looking at all the different things, you know, for prostate cancer, for example, what are some like key things you've noticed that when you've dug under the hood and work with these patients that have things going on related to their cancer?

So some of the first conversations I have with men around prostate cancer, so when I was in private practice still, and now I do a little consulting, but I've also trained, you know, 1,400 clinicians in 46 countries on this topic. And so we go through case studies and we're often talking about a lot of prostate cancer. There are a few common themes to certain cancer types, and for prostate cancer, One of those common themes is the, so just even where the cancer lands, I call it, it lands on the bowl, right? So think about just everything kind of just anatomically lining up that all the residue's gonna kind of settle into the bowl. So I think about it being a lot of sediment in there. So if I have a man who's not very physically active, the prostate's very difficult to, to bring energy to, to bring nutrients to, to bring medicines to, cuz it's very isolated. It's like this tiny little almond. Trapped in a lot of anatomy and very difficult to get blood flow oxygenation to. So if I have someone who's very, very inactive, that's very much a po— an issue. So hypoxia to the region is very, very common for these folks. The other common finding is infections. I cannot even tell you, there was a time when all of the men that I worked with, we could send them to a, a urologist or to a doctor and milk the prostate and send off Um, a, a sample to have it be, you know, evaluated for infection. I've never not seen one come back positive. They always come back positive and oftentimes undiagnosed latent STDs that just hung out there. 'Cause again, difficult to get to, difficult to penetrate. So there was that piece, but there was also just other like fungal overgrowths and whatnot. So some co-infection. aspects would show up. The other thing does come to the mental-emotional of just men carry a lot that's in the very 1st and 2nd chakra. So it's very much about security and safety. So whether they felt safe or secure, or they needed to really be creating safety and security for others, a lot of that burden landed on them. And then the 4th, one of the big, big, big ones, which This one is so weird to me, and this one's gonna probably get you some hate mail, but every single time I've tested for men for their hormone balance or hormone metabolites and how they're processing hormones, all of them are estrogen dominant. Every single one of them, more so than even the women. Okay? And so we then treat prostate cancer, which is knuck and futs in my opinion, with basically female hormones. We suppress testosterone and we increase estrogen. So suddenly these men are having gynecomastia. They're having symptoms of emotional lability. They're, they're becoming feminized when they're going through the standard of care treatment. And what's really interesting is once they go down that road, that is the only time I've ever seen prostate cancer then move into a stage 4 process because where it shows up is into areas like the bone. The liver, the lung, the brain. Those are the places that prostate cancer likes to migrate to. Those are also organs with extreme estrogen sensitivity. So when we then put this estrogen, this androgen deprivation hormone therapy into their bodies, you're now like whack-a-moling and creating signal in other parts of the body and vulnerability in other parts of the body. So when I See someone, especially if they've not started an androgen deprivation therapy, we go diving in and look at their estrogen carry, at their estrogen load. And then we deal with that first. It's not a testosterone problem because when estrogen is high, testosterone is low. That's why we've given that therapy. When testosterone is high, estrogen is low. My colleague, Dr. Gio Espinoza, is a prostate cancer specialist in New York City. Works in a very conventional environment. And he and I have had some really interesting conversations that, you know, we're really, we're blaming the wrong material for the problem. We're blaming testosterone. And so it's really, really an interesting dance here. But I think if men deal with their metabolic issues and their estrogen issues, they change the signaling in their body significantly. And then they deal with the emotional load they're carrying, making sure they're being able to have that heard. And seen and dealt with. And then look for any of those co-infections and look for the, you know, get, I like to get men hula hoops and I like them and they're doing like pelvic floor exercises and things to bring a lot of good blood flow and oxygenation to the pelvic region. That's where a lot of my colleagues will use things like rectal ozone, cuz that can actually also bring quite a bit of good information that can be antimicrobial.

Mm-hmm. But can also bring good oxygen to a very That's kind of interesting, some of those things you said, because in my world, like, I'm, you know, a regular doctor, transitioned to functional integrative medicine over years. And it's interesting, in the regular world, guys come in, elevated PSA, one of the first things you do is take doxy for 4 to 6 weeks and see what happens. All the PSA goes down. It's just, you know, prostatitis.

Yeah.

What's that caused by? Well, it's a sterile infection. We actually know now, we know there's other things going on. So it's interesting how Like that low-grade and, and chronic infections can cause, you know, cancer as well. So it's really interesting. Like I hadn't connected those 2 dots before, but I've seen it and now I'm like, oh, that 100% makes sense. 'Cause literally we recognize that, but we just use doxy or whatever. Yeah. We don't actually try to see what else could be there that we could treat, you know?

And then it's funny you mentioned doxy because it's been used now as a good off-label drug in the cancer space. So you're using it to both go after this potential latent infection. But then it also has some really powerful, if people wanna do like go down the rabbit hole and just go like a PubMed search on doxycycline as an off-label drug for cancer treatment. Pretty interesting there. So, yeah, I just think it's maybe got maybe more of a, of a dual purpose or, you know, than we might have given it, uh, credibility for, credit for.

And when you do, and this is just a, a, a question, when you're doing the, in the history, doing like the, um, Prostatic massage to mark it or using something like Microgen DX on the urine or—

That's exactly. So my colleagues, you know, and I could still sometimes get a urologist to be willing to do this, but it's weird. I'm like, it's, you know, when I was in practicing in an unlicensed state where I was for a long time, I literally could not enter a body cavity. Like there was no way I could do this, but I did a million of them when I was in med school. So in a state like Arizona, my naturopathic colleagues there, this is part of our scope of practice. So. I was lucky to get exposed to this, to understand how prevalent and relevant this type of testing was. So if you are a gentleman listening to this and you're having chronically elevated PSAs, that might be a really simple place to start is to find a willing clinician to get that information because it holds volumes of information of what could be the simplest underlying driver. of both BPH, benign prostatic hypertrophy, or prostatitis, or prostate cancer. It's like a continuum. You know, it's like you start with a kind of a little inflammation and then more inflammation and then bada bing, bada boom, cancer. It's a continuum that can go bidirectionally.

And just, you, you breezed over something. I just want to state this. Yeah. I'm practicing in Virginia and I'm on the East Coast. And one of the things in the state of Virginia, Nature paths, though you've went to 4 years of college and 4 years of medical school, and many times we'll do like a fellowship afterwards. There are states that don't recognize that. And it's more political stuff. So Virginia, for example, is one of the states where, to your point, you can't, if you're a naturopath here, you can't touch a patient. Right. Right. You can't diagnose. You can, I think you should try this. Yeah. But you can't.

Yeah. You could be a tour guide.

Yeah. Yeah. Well, yeah, 100%. Like the, um, there's a health food store locally here. It's being, it's, um, the naturopathic doctor is a person who runs it and it's like, but you're like in the hospital and doing all this cool stuff in Arizona and California and other places, but here you can't touch people.

Yeah. It's kind of kooky. And you know, Arizona is interesting because in Arizona, MDs can perform acupuncture, can give dietary advice and give homeopathy. Naturopathic doctors can do minor surgery, deliver babies, give you chemotherapy. And you know, those like all the things in between. It's such a state that allows like a we play well with each other. You know, like the D.O.s can kind of do everything as well. So it's it's like you said. I really appreciate that it does need to be a buyer beware market since it's not 100% legal in every state of the union, and even where it is legal, like in the state of Colorado, we're registered basically by title protection only. Where in Arizona, we're primary care physicians covered by insurance. So you know it will vary. place by place. So I think that's a great point to bring up, Dr. Hartman, because it is, it will vary for sure.

And it's also like coming from a place like Arizona, you know, I, I tell people routinely, I feel like I was 10 years into practice after I'd finished my residency in medical school, um, was out practicing in a hospital setting, seeing patients in the ICU, in the hospital, and outpatient. So I felt really comfortable working with really complicated patients. And it's like, If you don't do that, it's literally the state you're in says you can't touch people. It's like, it's going to stymie to a certain degree your practice of medicine and ultimately your professional development a little bit as well. So.

That's a great point. Yeah. Yeah.

Um, so breast cancer. I love what you said about prostate cancer. So I'm looking for a few pearls about pearls, because these are the 2 most common cancers I'll see in my clinic are breast and prostate cancer.

Oh, that's great to hear. So, Or not great to hear, but good to hear that, to know that you might have some tools come tomorrow to support folks. So there's a common kind of thread among breast cancer, which has become more and more understood, which for me, I look at 3 things. I look at number one, their vitamin D level, and actually I do this with all patients with cancer. Um, you know, standard of care says if it's above 30, we're good. I'm telling you right now, if you're at 50, you're just basically big squeaking by. To be preventative of disease, it needs to be upwards of 80. And to actually be in therapeutic doses to actually treat a disease, I have to be careful of that language, but you'd catch my drift. It needs to be somewhere between like 80 and 120. Now we look at their serum calcium to make sure they're not overdosing it. We also look at the 1,25-hydroxyestrone to look at what is the active versus what is in circulation. So we look at a 25 as well as a 1,25. That is number one that I would say across the board. And this is probably true for all cancer types, but breast cancer in particular is very, very vitamin D deficient sensitive. So that's one. So we want to get that as a baseline. Number 2, insulin. Insulin's a biggie. So you can't look at someone anymore today and think that their body type will tell you if they're insulin resistant. That actually doesn't fit anymore. You know, when Dr. Hartman and I were in med school, you could probably just look at someone and be like, oh, they're diabetic or they're not. You can't do that anymore because studies show that upwards of 93% of us are metabolically broken. That includes you, what we call TOFIs, you thin on the outside, fat on the inside, people who are walking around looking good on the outside, but the inside has maybe got a nice little bubble wrap of fat around organs, which is making you very insulin resistant. So insulin is a big one, specifically insulin growth factor. So when insulin is elevated, insulin growth factor, which is what tells tumors to grow, is also elevated. That is prevalent, by the way, in about 80 to 90% of all cancer types, but it seems to hold really, really true for breast cancer. And then, um, the, the third one is people talk about hormones and they talk about excess or deficient. But it's more nuanced than that. It's about how is your body endogenously dealing with your hormones? How do you build and use and excrete your own? Not even looking at what's going on outside of you. And that comes down to certain single nucleotide polymorphisms, these SNPs, these genetics that we can test for that are our blueprint that we're born with, but there are the things that we can change. They're the things we have control over. And so I find that if people have SNPs like CYP1B1, COMT, these are SNPs of how you metabolize estrogen. 70% of the population is walking around with hiccups on how we metabolize our own endogenous estrogen. Then let's add insult to injury that all of us on the planet today, especially in the West, are in a swimming pool of xenoestrogens or endocrine disrupting chemicals. So this is why I say that men today are often more estrogen rich than women today, thanks to glyphosate, pesticides, hormones in our animal products, plastic, plastic receipts, other chemicals in the environment are feminizing men and emasculating women. And so it's, or masculinizing women. So these are the things that are happening there. So we'll look at their SNPs, but I find that a lot of these women are not properly metabolizing what they do make. And then they're getting exposed to so many more, especially if they went through birth control pills, because that's what our culture told us in the '60s on, this is your freedom of choice, which is great on one level, but it's caused harm on another. Then we look at things like copper pipes. in everything. It sequesters estrogen. All of our anti— all of our pesticides are copper sulfate rich, which then sequesters estrogen. So suddenly you're eating non-organic foods. You're probably getting in a lot of copper sulfate, you know, in the antimicrobials and anti-pesticides that are there. Those really build up in our tissues. But then we also have now like Fed every woman a storyline that they're a shell of themselves without hormone replacement therapy. So we're throwing kindling on a fire and then pouring more gasoline on top of it when we just keep adding more to a system that's not already processing what it's doing naturally inside. So I go through some deep testing to see how are they metabolizing their hormones? And how do I need to support them to metabolize them better? Because I don't believe that hormones cause the cancer. I believe how we're metabolizing them gums up the works. So things like detoxification and methylation, which are very critical for life, get bogged down with these things. So we can do an evaluation to know how we can best support that, cuz standard of care will come after breast cancer with something like tamoxifen.

Mm-hmm.

which is a selective estrogen receptor modifier, or postmenopausal aromatase inhibitors, which are things like the aromasin, letrozoles, those drugs, class of drugs. And what happens with those folks is it will maybe turn off one part of estrogen metabolism, but it's like a whack-a-mole game and it stimulates another. And specifically, It will turn off one maybe in the breast tissue, but then turn on another down in the uterus. So a lot of women who might get on tamoxifen for breast cancer are now much higher risk for estrogen, for uterine cancer. And so, and standard of care always says, oh, that's not very common. I've seen it literally hundreds of times in my practice. So I'm always screening these women. But the point is, is we need to be more nuanced about the way we look at Our hormones and our hormones, including our insulin levels. So with that, that is another hormone, a signaling agent. Estrogen tells things to grow. Insulin tells things to grow. Cortisol tells things to grow. And they all dance. I call it the 4 S's: sugar, sex, stress, and sleep. Sugar being the insulin, stress being the cortisol, Sex being the sex hormones and sleep, because when we don't sleep, our cortisol is higher, our insulin is higher, and our hormones are more imbalanced. So when I look at across the board for breast cancer, I'm dealing with those 4 S's across the board.

And it's, I really liked how you start with the vitamin D. It's interesting. I read, um, Dr. Paul Merrick. He's got the book Cancer Care and it was really interesting. It's got like 1,400, um, Citations in the back of it. But I remember one of the things that really struck my head was in women with breast cancer, if you were to get their vitamin D level up to the range you mentioned, like that 120, it was as effective as a— it was actually more effective than aromatase inhibitor for preventing either recurrence or metastasis. I'm thinking, okay, I can give you something that's not standard of care, but not going to give you all these other crazy symptoms that's more effective than the standard of care.

Yeah. Like, yeah.

Why is this not on every, you know, oncologist's radar?

Well, it was like when Dr. Argovall from MD Anderson was being really attacked for his studies showing that curcumin was more effective than the Taxane drugs with, with treatment of breast cancer. And they tried to say that he falsified his data despite dozens of, of well-reputed Institutions around the globe confirming the same findings. And they still tried to ridicule him because think about it, Taxotere is what's given to every single patient with, with breast cancer and many other cancers as well. And if you're starting to say, hmm, we actually have a natural therapeutic intervention that shows just as good of efficacy, that kind of turns things on its, on its head. And so it's a similar thing with the vitamin D. Vitamin D really shouldn't be called a vitamin. It is a hormone modulator. It modulates our cortisol. It modulates our immune system. It modulates our metabolic system and it modulates our sex hormones. And so it's a really key player. Melatonin is another one. And so melatonin in high doses is a natural aromatase inhibitor, is a natural SERM, you know, selective estrogen receptor modifier. So these are things that We have loads of studies. I mean, any one of these things we're talking about, I'm careful with what I say. If I can't back it, I'm not going to say it. So it's easy to go down the rabbit hole and put any of these things we're discussing into a PubMed study to read about it.

Yeah. So, um, the last cancer, I, I, hundreds of cancers, but the last cancer I see a fair amount of in my clinic is colon cancer. Yes. And I've got several stage 4 colon cancer patients I'm working with right now who, um, At different, different levels. One's, she's like 9 years into her stage 4 diagnosis. Amazing. Um, you know, she's struggling with some different things right now, but, you know, she's 9 years into it, right? So I'm kind of curious, you know, what insights you have for colon cancer, like unique things like this that you think about when you see those kind of patients.

Cancer itself was always considered a disease of the aged. And now we have over 12 different cancers that their fastest growing is under the age of 50. And no one's asking why. And we keep trying to point, you know, the conventional folks are trying to point that it's a genetic issue. It's not. Less than 5% of cancers are truly genetic. And even those have some ability to modify with your diet and lifestyle choices. So this looks at the collective thing. So when we look at the history of humans, we've really made some major changes to the world around us, to the terrain in, on, and around us just in the last 150, 200 years. So we went from the first several thousands, however, whatever your belief systems are, thousands, tens of thousands, millions of years as hunter-gatherers. And then about 11,000 years ago, that abruptly changed. We then moved into the Neolithic farming era. That's also the time when we moved into that era where we started to put down some roots and start to raise our own animals, but we were still in small communities and we all leaned on each other. But it's also the time when the HLA gene first showed up. So that big change brought forth a gene that is very, very vulnerable to the exposome. It's very, very vulnerable to infections. It's very, very vulnerable to autoimmunity. It's very, very vulnerable to things like molds And other toxins. So the first time ever showed up about 11,000 years ago. The next big change happened at the Industrial Revolution, which was in the early to mid-1800s. That's when we started to mill sugar, flour, and salt. And we took it from something that we ate very minimally, and it was a lot of work to grow it, to harvest it, to process it. We expended a lot of energy to get access to it. So we very much minimized our use of it. To suddenly making it more ubiquitous and available to us. Our bodies changed further. People like Dr. Weston A. Price started sounding the alarm saying, things are changing here, folks. The dentition is changing. People's health is changing. He'd be rolling in his grave today to see what we have. The next big change happened after World War II. In World War II, we had a ton of leftover ammo and we were like, what do you do with all this stuff? And we did 2 things with it. We put it into big ag and big pharma, and that was the next big change. And by the 1960s, we suddenly start to introduce hormones. Well, actually we started introducing hormones in the 1940s. Basically, if you were a child born between 19— I think '42 or '44, all the way up to the early 1960s, your mother likely took a hormone to prevent miscarriage. That particular hormone has been associated with higher risks of vaginal cancer in their daughters. And in the next generation, both breast and prostate cancer in those children. We are still seeing downstream effect. Now we're getting into the 4th and 5th generations since that exposure to that particular medication. Then we started putting hormones into our food systems. And then we introduced things like birth control pill and IVFs that started coming into the '70s and '80s that never experienced before. These were changes. In 1969, we started doing studies on things like glyphosate in a lab, looking at ways we could help feed the world, right? This was a big concern. And people like Dr. Huber, who's now well into his '90s, started sounding the alarm saying, we are gonna regret this someday. And boy, do we ever. It's now ubiquitous in every drop of rain, in every umbilical cord you see is loaded with glyphosate, which is carried by water, air, and soil within 2 miles of exposure. So even if you're in an organic field, if it's within 2 miles of sprayed field, it's got glyphosate. And so that has now become the biggest travesty to humanity we've ever seen. It is Literally changing us at the molecular level and up. And so it's just incredible how these things have changed. So when people are like scratching their heads saying, I don't know why we're having younger and younger people with cancer, let me get really to the point. Our mitochondria are our longevity. They are our fountain of youth. And our aging happens When our mitochondria age. So what in essence we're seeing today are babies are being born with old mitochondria, with aged mitochondria. And our mitochondria are the little beings in our system that take up over 20%, up to 20% of our constitution is made up of these mighty mitochondria that do 3 major things besides make ATP to make energy. They are receivers of information. So they take in all the stuff we put in, on, and around us, including people, places, and things like the exposome being one of them. Then they translate that information. Like, what is this? What does it mean? And then they signal back out to the surrounding organelles, tissues, organs, structure, and beyond. They're overwhelmed today. They're being stewed in an environment while they're even in the egg. So remember, your grandmother holds your mother who holds your daughter. We are 3 generations in 1 woman. And so all of these things accumulate over time and we've introduced things very quickly in the last 200 years in our bodies and our mitochondria specifically have not yet adapted.

It's really, you know, I tend to learn things a little slow. I tend to like, the first time I hear something, you know, chemicals, I'm like, yeah, whatever. And I usually have to hear it 3 or 4 or 5 times before I'm like, you know, the joke I tell people is I'm a slow learner. But I, because I read so much, I learn things quickly, you know? I mean, it's really interesting because I finished reading a book recently called Project Paperclip, and they actually mentioned thalidomide in there. And the scientist Which is the drug you're referring to.

Wash.

That actually came over from— and a lot of the scientists that were pulled from Germany related to the chemical warfare stuff did get into agribusiness, did get into pharmaceutical business. And they took some of the things they had created over in Germany with them. And thalidomide is actually one of those products that was actually synthesized in the '20s or '30s. And so, you know, if I'd heard that, you know, 8 years ago, Nate, I'd be like, man, geez. Now she's cuckoo, but it's like—

Where's her tinfoil hat?

I know, it's like, but it's like, it's, you know, you don't have to make stuff up because reality is crazier than anything I can make up, you know? And it's, this is one of those things that I think the typical person, if this is the first time they're hearing, wait a second, what do you mean? It's like, no, if you're not a believer, read Project, you know, the Project Paperclip, but then read Blitzed because then you'll really be, that'll make you scared of other things that got created at that same time.

Yeah, it's, it's, it's real.

And, um, knowing that and working on detoxification, and if you have a cancer, you know, making that a big part of it, um, your protocols can have a massive, massive impact on, on the outcomes.

Huge, huge, huge. No, I appreciate that. And I, I appreciate you, like all these things we're talking about. I mean, this is very well, again, I'm very careful of what I say because it's one thing if I was an MD saying this, but as an ND saying this, people just assume. that I'm somehow, I don't know, less than, um, despite that 70% of my students are conventional medical doctors and oncologists who take my courses historically. You know, we, we learn from each other, but I learn, I'm a historian. That's like how I like to learn. And so it's not difficult for people to go and understand that most of our chemotherapies today also came outta that chemical warfare of World War II.

Yeah.

So all, you know, that's the thing is this isn't a stretch, right? Like these are, they sound so preposterous, but we've, They've become so insidious into our culture, we don't even question them. So I think that's the piece is if you want to, you just have to be able to question everything, including our conversation right now. Right. But everything we're sharing, people can do their own homework and go down the rabbit holes and read on and on with this. So I appreciate you saying you too are a voracious learner. I feel like I'm a lifelong learner in this. And each time I learn something new, I'm like, can't be possibly right. You're right. Like you said, the fiction is often far, far less crazy than reality.

If you ever end up meeting my wife, one of the things she like, she'll, she'll routinely tell me, like, I'll be like, I had this great brilliant insight. I've read this thing. And she's like, I told you that a year and a half ago. I told you that 3 years ago. Yeah. She got, she had to walk me through not telling me that stuff. Cause she was like, yeah, but there's so many things that in her research and she's a pediatric occupational therapist. So she's a clinician background as well. And our daughter was one of her patients.

Yeah. Amazing.

It's an interesting world, but I want to respect your time because I'm looking at it. We've already been talking an hour here.

Oh, good.

And so, yeah, this was an amazing conversation. I want to keep on talking. I'm sure a lot of the listeners want to keep on listening. If people want to learn more about you, what would— because my focus is patients, educating patients. So from a patient perspective, if someone has a loved one or once more know about what you are doing, integrative oncology, what would you, what, what ways can they follow you, learn more, or just learn more about this topic, which is actually, it's a real topic and there's people can change the, um, can have a massive impact on their outcomes by taking control of their health.

I love it. Well, first of all, people are far more powerful than they've been led to believe. And I think you teach that very much in the work you do. Um, simplest place to start, cause it's kind of the umbrella that carries it all, is drnasha.com, D-R-N-A-S-H-A.com. And under there, you can actually find my little free questionnaire to kind of do a quick assessment of your own terrain, get a sense of maybe what your priorities are. If that intrigues you, you can go a little deeper. I have a really inexpensive ebook called Tend the Terrain, which just kind of gives you more of the understanding, the concept of what is terrain. And then if that tickles your fancy, you can go down the deeper dive, which is my Metabolic Approach to Cancer book. You don't have to have cancer to read this book. It takes all of those concepts And expands on it much further. It's more of a reference book. It's juicy. It's not a light read. Um, and then if you get intrigued by that and you wanna learn more about integrative oncology itself, then, um, my book, Mistletoe and the, um, Emerging Future of Integrative Oncology, written with 6 other colleagues, including conventional oncologists. We really dive deep into what type of testing to do and what treatments are really valid outside of standard of care. We go into that. But I also have a podcast myself called Tend the Terrain. Dr. Hartman's going to be on there with me shortly. So have a watch for that, but really interesting conversations. I feel like I'm a story collector because everyone, as you mentioned early on in this discussion, has a story to tell. And for me, the concept is very simple. We have a biography that dictates our biology and a biology that dictates our bio— biography. And I try and help meet at that crossroad where both of those are interfacing and help people Optimize at that level. That's all great information.

That will be included in the show notes. Thank you so much for your time. This was awesome. I'm sure we're going to talk again. I'm sure we'll meet again, at least here. But thank you so much for your time. I really appreciate it. This was an amazing conversation. And I know my audience is really going to enjoy this conversation we had today.

Lovely. Thank you so much, Dr. Hartman. And thank you everybody for listening.

Thanks. All right. Take care.