Addressing The Underlying Causes Of Infertility

If you're thinking about getting pregnant, you want to be on that prenatal with all that folate before you get pregnant. You don't want to wait till to start it when you get pregnant. It's really important.

Welcome to the Doctor's Pharmacy. I'm Dr. Mark Hyman and this is a special episode called House Call where we dive deep into different issues that people suffer from that are very difficult to treat using traditional medicine. We use approach called functional medicine here at the Ultra Wellness Center in Lenox, Massachusetts, and we help so many people with so many different kinds of problems. And today I have my colleague, my friend, and my partner at the Ultra Wellness Center, the medical director, Dr. Elizabeth Boham, who you probably know well by now, who's shared so much about so many cases that are tough to deal with with traditional approaches. And today we're gonna dive deep into infertility, which affects one in seven couples. couples and is getting worse. So what does infertility have to do with anything we do in functional medicine? What is the typical approach that we do in traditional medicine and how is that different from how we think about this with functional medicine?

You know, I think that one of the most important things we do in functional medicine is we ask that question why. And that's very important. with infertility as it is with everything we're dealing with. Because for each, if we had multiple different people with infertility issues, there'd be multiple different reasons for why they're having a problem. So, you know, it's really critical to get that very detailed history that we always get with functional medicine, get a really careful physical exam, do some evaluation to try to determine for that individual person and that individual couple what's going on with their fertility?

So you're saying, there's not such a.

Thing as infertility, there's infertilities.

There's infertilities, yes. And everybody's different and you have to dig in. And they're common patterns for sure. But we do a method of evaluation that helps us really figure it out.

So tell us, what is the definition of infertility? How many people have it? And what's the deal? Yeah, so infertility for a woman, you're considered having problems with fertility if you've been actively trying to get pregnant for over a year. and have been unable to get pregnant. So, you know, that's considered infertility. And about, like you mentioned, a lot of, it's very common, about 10% of women in the reproductive ages are struggling with infertility. And there's multiple, multiple reasons, but you're right, we are seeing an increase. We're seeing an increase maybe because of some of the toxins in the environment, poor diet, you know, we're gonna get.

Into things- Wait, wait, wait, did you just say that what you eat plays a role in fertility?

Huge role.

Wow, we're gonna get into that.

Yeah, a huge role. So there's lots of different reasons for why that can be going on for that individual person. Hormonal imbalances that we need to evaluate, toxin exposure, thyroid's not working optimally, things like PCOS that we're gonna be talking about. There's so many reasons that people can have issues with fertility that we need to delve into. Nutritional deficiencies. I mean, I think that so often, we're thinking everybody in the United States, if we're just in the United States, there are people in developing countries, they're just doing fine nutritionally. But when we actually start to look, we start to see nutritional deficiencies that can have a huge impact on somebody's fertility.

It's really true. I look back my 30 years of practicing and 25 years of practicing functional medicine, and I can't tell you the number of patients that have struggled with infertility that once we work with them in functional medicine, they get pregnant.

Yeah.

You know, and it's like, it's, I'm not an obstetrician or gynecologist. I'm a family doctor. I'm not a fertility expert. But just following the principles of functional medicine and optimizing people's health allows them.

To kind of reset their hormones and their immune system and actually get pregnant. I mean, we always start with those lifestyle factors because for so many people, that makes a huge difference, right? We make sure that the person is sleeping enough, getting enough rest, because if the body is under stress, it's less likely to get pregnant. We make sure that you're managing stress. We make sure that you're doing some exercise daily because that helps in so many different ways. We make sure that somebody's eating the right diet because as I mentioned, if somebody is having some nutritional deficiencies or not eating enough calories, we often see that people are under-eating or not eating enough calories, or maybe they're over exercising, we know that can impact.

If you're too low body fat, or feel like that.

Yeah, and even if body fat's okay, but you're putting too much stress on your body with excessive training or not eating enough calories, that can cause.

Now think about it, historically, if you had no access to calories and you were under stress, your body is like, I'm not getting pregnant right now. This is bad news for me to get pregnant. It's a dangerous environment, but our body doesn't realize that we're living in the 21st century and it's a little bit different. I just want to kind of come back to a traditional approach because I think it's really instructive. Most of the time when you go to a fertility doctor, they don't find anything.

That's true.

Sometimes you have a tubal problem, sometimes there's low sperm count, sometimes there's some obvious structural issue or some hormonal thing going on that's fixable, but most of the time it's unexplained infertility.

Yes.

And so what do they do? They pump you full of hormones, they extract your ovaries, I mean your eggs from your ovaries. They create a test tube baby, they put it back in, hopefully it sticks. It's enormously stressful, enormously expensive, like I don't know if it's $15,000, $20,000 a pop each time you wanna do it. And it often doesn't work.

Right.

And so we're batting a far better average here with functional medicine in terms of getting families started and helping women and couples get pregnant than with traditional fertility treatments. And why is that?

I think that it's because we're asking that question why. And when we ask that question why and get some clues as to why there's an imbalance in somebody's body, so much more likely to be successful in our treatment approach, right? Because if we just treat everybody the same, it might work for some, but it's gonna miss all these other reasons that people are having issues. So you have to ask that question why. And like you said, a lot of times many of these other approaches are less expensive, less toxic, and easier to do than that hard-hitting approach that of course works for some people. But we've gotta really ask that question why. so that's one of the things with this first woman who came to see me. Yeah, you know, she was 33. She was 33 and she had had irregular periods her, you know, when she started to get her period in puberty, they were irregular. And so she went on birth control pills.

Now what is with that? Doctors like, oh, your periods are regular. Take the pill. Is that a thing? I never, like, where's the randomized controlled trial on that?

Right, right, right. Right, right. So it regulates them, but it never asks the question why they were irregular in the first place. So she went off of the pill when she was 32, over a year ago, because she wanted to get pregnant. They were ready to get pregnant, she goes off the pill, well, what happens?

Nothing.

Right, her periods become irregular again, because she's off the pill, they're all irregular, and she doesn't get pregnant. So they tried actively for a year, and then she came to see me because she was like, you know, I really want to get to this underlying root cause here. I really want to try to figure out what's going on and why we're not getting pregnant. And, you know, I had got one clue early on with my evaluation with her was what happened, you know, when she first walked in the door, our nurses check, a waist to hip ratio on all of our patients.

How big is your belly and how big is your hip?

Exactly. And she was, this patient Clara, was just like five pounds overweight, maybe 10. She wasn't really over, she was not largely overweight, but we did a waist to hip ratio and when we did that waist to hip ratio, we saw that she had too much weight around her midsection.

She wasn't really overweight, but she was over fat in the wrong places.

In the wrong places. so, you know, hers was about 0.86, I think, 0.86 about. For women, we want it to be less than 0.8. You don't want as much weight around your belly as you do around your hips. And so to me, that was a sign I was like, and with these history of irregular periods all her life, I said, you know, we need to look deeper at what's going on with insulin resistance. and it made me wonder, did she have this syndrome called polycystic ovarian syndrome?

That's an easy test you can do at home using a tape measure. Measure around your belly button, the widest part of your belly, and measure around your hip bones at the side, and see what your hip ratio is. And then you can just do the math. It's waist divided by hip, and you get in a number, and if it's.

Over 0.8, you know you might have a problem.

Yep, for women. Or you can just do the mirror test, which is look in the mirror, jump up and down. If your stomach jiggles, you probably have it.

So for women, we want it to be less than 0.8, for men less than 0.9. There's some differences depending on your ethnicity where, you know, of certain ethnicities we.

Want it even a little bit lower. Wait, wait, wait. So that's important because what you're saying is that, you know, we think of traditionally people who have prediabetes or insulin.

Resistance and having a big belly. But you're saying certain cultures don't. Which are those? Like the Asian cultures. India, China, Asia, that you can have signs of, you can have the symptoms and the repercussions of insulin resistance and prediabetes even at a lower weight. You could be able to quote a.

Normal weight, 125, but you're still having a belly.

And your belly might not be as big as the Caucasian person, but you can have signs of insulin resistance, prediabetes at a smaller increased belly.

Yeah, that's interesting.

Is that am I saying that right? So we are stricter with certain populations. We want their waist to hip ratio even lower because they've noted with research that if their waist to hip ratio is for women even at 0.8 that that's too much, they have signs of all of the sequela of insulin resistance.

It's more about body composition and where the fat is than your weight.

Absolutely.

It's not something we really focus on in medicine.

That's so important, right? The weight tells you one thing but really The most important thing is where that fat is, if it's around the belly, that then is a sign that there's signs of insulin resistance pre-diabetes. And we know, right, that that causes, of course, heart disease and type 2 diabetes and hypertension and dementia, right? But, and cancer, but it's also associated with infertility. And I think that's one reason, one reason we're seeing this rise in infertility. because we've got so much more insulin resistance, pre-diabetes in our younger people in this country.

I mean, think about it. 75% of Americans are overweight. 42% are obese. That's 80 million people who are obese. Not just overweight. And even if you're just a little overweight, like you said, you can still have insulin resistance. In fact, probably most of the 75% of people who are overweight have insulin resistance. And if you look at even deeper, there's the skinny fat people. So of the, you know, 25% of people who are normal weight, probably a quarter of them have pre-diabetes. And it was a study that came out recently that only 12% of Americans are metabolically healthy, which means 88% are not. So we're talking about 88% of the population that has this problem.

Right, because, right, we're just eating way too many refined and processed carbohydrates. starch and sugar. And simple carbs. And starch and sugar.

And starch and sugar.

Yep. Yep.

I've been talking about that for a while.

Back from the days of ultra metabolism 15 years ago. And I think what's important for some people is, you know, like you said, they don't necessarily look obese sometimes or they might not even have a huge belly, but when you really look in more detail and you do either the waist to hip ratio or look at percentage of body fat, which you can do, you know, they are They might be thin on the outside, but fat on the inside.

So Clara had other symptoms of insulin resistance, even though she wasn't overweight.

She had acne.

Acne.

Yep. And the belly fat. A little bit of belly fat and she had these irregular periods.

Yeah.

Right.

And so how did she get hair growth sometimes?

A little bit on her abdomen.

Yep.

Yep. Which is associated. So for women, if you get hair growth on your abdomen where you don't want it, or on your face where you don't want it, or you've lost some hair on the top of your head, that can be a sign of insulin resistance.

You lose it where you want it and you get it where you don't. You don't want it, right? And that's a problem. And the other thing we found was her insulin level was high. Now most doctors don't check insulin levels.

It's an easy test. It's an easy test. You know, we did a fasting insulin on her and her fasting insulin was nine. Now officially, officially the literature will say anything a fasting insulin greater than 12 is considered too high. But we really like that fasting insulin more like five. So we know people around that 7, 8, 9, 10. They're definitely- what's yours, Liz? I haven't had it checked in so long. I don't know. I'm guessing four.

Mine's two.

I bet yours is two. I know yours is two. I had to be more careful.

Now with the quarantine, I'm eating way more. We just cook a lot. It may be a little higher, I don't know. Maybe a little more wine, I don't know.

We don't have to compete here, though.

Hey, everybody, it's Dr. Hyman. Thanks for tuning into the Doctor's Pharmacy. I hope you're loving this podcast. It's one of my favorite things to do and introducing you to all the experts that I know and I love and that I've learned so much from. And I want to tell you about something else I'm doing, which is called Mark's Picks. It's my weekly newsletter. And in it, I share my favorite stuff, from foods to supplements to gadgets to tools to enhance your health. It's all the cool stuff that I use and that my team uses to optimize and enhance our health. And I'd love you to sign up for the weekly newsletter. I'll only send it to you once a week on Fridays, nothing else, I promise. And all you have to do is go to drhyman.com/picks to sign up. That's drhyman.com/picks, P-I-C-K-S, and sign up for the newsletter and I'll share with you my favorite stuff that I use to enhance my health and get healthier and better and live younger longer. Now back to this week's episode.

So a fast, but a fasting insulin is an easy test you can get done. We also often do a glucose tolerance test where you check fasting insulin, one hour and two hour blood sugar and insulin. So because the insulin part is important because a lot of times people will have normal blood sugar but if their insulin is jumping up too high after that you drink that sugary drink, you know that's that sign of insulin resistance.

Well, that's really important. Let me break that down for a minute because I just remember this one patient I had years ago at Canyon Ranch who was very overweight. She had a giant belly. It wasn't like just a little bit. And I said, well, let's do a glucose tolerance test and see what your blood sugar is. Sugar was perfect. And her average blood sugar was perfect. So she didn't register as a pre-diabetic or diabetic according to traditional criteria. But I said, let's do a glucose tolerance test. Her blood sugar fasting was normal, one hour was normal, two hours normal. And that wasn't even normal, it was great. It was like 110. Like it wasn't even like when it went over the line.

Right?

No, no. At two hours it was 110. So she never even spiked. But her insulin level, fasting was like 30 and it went up to like 200. And so what was happening was her blood sugar was being controlled because her body was pumping out so much insulin. That insulin was making her gain weight and causing all those other consequences.

And so it's important to do the.

Right test and often you don't get the right test. They'll check one minute, 28 weeks for pregnancy. If you think you have diabetes, they might check you, but it's like way too late by then. And the early signs you can pick.

Up with the glucose tolerance test that we do here at the UltraWellness Center, right? Yeah, because that high level of insulin causes us to gain weight and gain weight around the belly and it makes.

It very hard when people have high levels of insulin, it's very hard for them to lose weight. Or get pregnant.

Or get pregnant.

And so back to fertility, what was interesting with this patient was not only did she have one problem, but she had many problems and another problem with hormones too. What else did she have going on?

So we did further testing and saw that she had these thyroid antibodies. So she had antibodies against her thyroid. Now her thyroid levels looked fine. Her TSH was okay, her free T3 was okay, her free T4 was okay. but she had these thyroid antibodies.

And so, by the way, we did another podcast on thyroid, so if you want to go back and listen to the one that Dr. Baum and I did, you can learn more about the thyroid, but this is a really important point. You can have normal levels of thyroid. You go to your doctor, check, oh, they're fine. But if you check the antibodies, which they mostly don't do, you'll find that.

They'Re often elevated and that still causes thyroid dysfunction. And very important to check when you've got somebody who's trying to get pregnant and not being successful. So we saw these thyroid antibodies, so we said, okay, we've got to get you off of gluten. Why? Because gluten is a cause of autoimmune disease for some people. So it doesn't cause all autoimmune disease and it doesn't cause all thyroid antibody issues, but for some people it does. So it makes sense, okay, let's try it.

Let's just pull it away. You can check gluten antibodies too. We did. And I often find about 30%, 35% of my thyroid patients with antibodies, it's gluten. Yes.

They also have gluten antibodies. But for her, we wanted to take away the gluten anyway because it's a common cause of, you know, it's a common food that's in refined and processed foods, right? So, it's a carbohydrate that's in a lot of our refined and processed foods. So, we said, you know what? Let's pull away gluten. But also, I don't want you to substitute with gluten-free products because a lot of times people pull away gluten but then eat, you know, gluten-free cookies. gluten-free cookies or gluten-free cake, or gluten-free bread, or gluten-free.

Right, but all of those foods spike.

The blood sugar too. Worse, actually some of them are worse than sugar. Absolutely, right, because they're lower in fiber a lot of times. So for her, that was not the answer.

So we really worked to pull away the gluten as well as any gluten-free.

Products, any refined starchy foods. I always say gluten-free cake cookies are still cake and cookies. They are, they are, and you know, people fall into that mistake all the time. They pull away gluten and then they replace it with some really not good healthy processed foods. And so for her it was really important that we made that point. We pulled away all of the flours and grains, gluten containing as well as gluten free, really focused on balancing her blood sugar with high fiber foods, lots of vegetables, protein, good healthy fats at every meal to help with balancing her blood sugar. And that really made a difference. And you gave her thyroid too.

We did give her thyroid.

So, that's an important point, even though.

Her thyroid levels were normal, but because the antibodies were elevated, it's sometimes important to replace the thyroid hormone. You can try to get off the gluten and that might fix it sometimes or give nutrients like selenium, iodine, zinc, but often you'll need to replace it. And I remember at a conference I was at years ago at Harvard where there was an endocrinologist, and he said, you know, look, most people don't measure antibodies, but if you measure antibodies and they're elevated and their thyroid levels are.

Normal and they're symptomatic, you want to treat them. And especially in this case, because she.

Really wanted to get pregnant soon. So, you know, and low grade thyroid problems are often a reason why women don't get pregnant.

Huge reason. And their levels might be normal when they go to the doctor. Huge reason. Huge reason. And often why, you know, if your periods are irregular. So she had two reasons for why her periods were irregular. She had the Polycystic Ovarian Syndrome going on, the insulin resistance, right? So as we talked about, that insulin is connecting to all your hormones and can throw off your female hormones and result in these irregular periods. And she had her thyroid being out of whack. So she had two reasons going on for why her periods were irregular. And so when we first pulled away the gluten, cleaned up her diet, her period started to get more regular. But you're right, it wasn't until until we added in some thyroid hormone that she actually lost a little belly fat.

She lost the belly fat and her.

Period started to regulate, but then when we added in, we added in some thyroid hormone and a few months later she got pregnant and had a healthy baby. Yeah, so we help a lot of.

Women get pregnant here at the UltraWellness Center using functional medicine. It's pretty amazing. I got a picture once of a baby from one of my patients, says Dr. Hyman, thanks for helping me get pregnant. And I'm like, I don't know if that sounds right exactly, but I get what you mean. So I think that it's so rewarding. I just had a patient I've been treating who was almost 40, been struggling to get pregnant for years back and forth with fertility doctors and just not getting pregnant. And then we did all this stuff, we optimized her health, and she just got pregnant and had this beautiful baby. And it's so so satisfying.

Yeah.

Yeah.

So what was the second, second, you.

Know, this is, this is, I think, is really interesting and something we do see also very often. But this was a 28 year old woman who was also had been trying to get pregnant, actively trying to get pregnant for over a year and not being successful. And so her, her vital signs were really different than the first, for first woman. So when our nurse did her waist to hip ratio, it was But her weight was low. She was underweight. And what was interesting when I got a good history from her, she had.

Had- what was that quote? You can't be too rich or too thin. I think the answer is you actually can be too thin, right?

You know, definitely. Absolutely. And for so many reasons, but hormonally too. And she had had digestive issues her whole life. So she was a good eater. So she wasn't somebody who was restricting her calories. She was a good eater. You know, you ask her all those questions, you want to make sure somebody's not, as I said before, under-eating or over-exercising, but she was not. She was a good eater. She was doing well. Did she have a tapeworm or something? I know, right? You want to think about that. But so we did a workup on her. We looked at a lot of nutritional markers and we saw that she was low in between She was low in zinc, she was low in iron, she was low in some of her protein markers, some of her amino acids, which make you go, why would this cause that? Right, right.

Because she's eating. So why is she low in these?

She's not absorbing them. That's exactly right. So we did some further tests and found out that she had celiac disease. And celiac disease is an autoimmune disease where the body, because of wheat gluten, starts to fight off the villi in your intestines. So, you know.

So, this isn't just like, oh, I have a little gluten sensitivity. It's actually a real serious problem where.

She'S got real damage. Celiac. Which is kind of interesting because it had never been found before, which is not uncommon.

And by the way, she didn't have a lot of terrible symptoms that you'd often see along with it.

She had some digestive symptoms, but it.

Was like irritable bowel, right? Yes, it wasn't crazy bad.

She was having diarrhea and just miserable symptoms. Right. Because, you know, what's interesting about celiac disease, I think, is when it develops in somebody's life. So sometimes when kids develop celiac disease, so, you know, some people have a genetic risk for developing celiac disease.

And then- About 35% of us do.

Yeah, and then at some point those genes get turned on or for some reason, right, for some reason the body starts to develop these antibodies against the and damage the villi in the intestine. So that can happen when you're young or it can happen when you're older.

It creates a leaky gut. And then you get inflammation throughout the body and inflammation, you can't get pregnant and it's like a whole downward spiral.

Those villi and intestines are so important, right? They always say, like, if you take your intestines and stretched them out, right, with stretched out those villi, they would be the size of a doubles tennis court. And so those villi, it's kind of think of it as an accordion. It squishes together and it gives us so much surface area. So we have this large, large surface area in our intestines. That doubles tennis court is smushed together in these villi in our intestines, allowing us to absorb all of the nutrients that we're eating. So if those villi get damaged, as they do when somebody has celiac disease, the villi get attacked and they get flattened. So that surface area goes away. So you don't have all of that surface area to absorb all your nutrients. So with people with celiac disease, they get a lot of nutritional deficiencies. But if it happens later in life, like not as a child, we often don't see the growth deficiencies that we see with children. So when children get celiac, yeah, with children get celiac, you see that, oh, they stunted. stop growing and they have belly pain, you go, oh, I should check them for celiac. But sometimes when it happens maybe for her, maybe it happened in her late teens or early 20s, so her growth didn't shift.

That's an important thing that people realize. You can get a lifetime of being okay and maybe when you're 50 something happens. It's like a stress or a trigger.

Or an infection, right?

Infection or you get traveler's diarrhea and boom, you get celiac disease and you don't know it. And the average time from the onset of symptoms to diagnosis with celiac is 11 years. So, there are so many people running around with this who have no idea. And that's just full-blown celiac. That's not even gluten sensitivity, which is a whole other subject. But I think that the identification of these nutritional deficiencies like B12 deficiency, iron deficiency, zinc deficiency, these are really important nutrients that regulate fertility and protein, protein malnutrition, which is like critical. I mean, your body doesn't want to.

Get pregnant if you're starving. Right. Because your body was under stress, right? Right.

Yeah.

And so it was not getting pregnant. And so what was interesting is when we pulled away the gluten, right, we said, okay, you can't have gluten anymore and we want to put her on a good healthy diet. You know, it's going to take some time for those villi to regrow, but they do. The villi in your intestines will regrow if somebody has full-blown celiac, right? They do come back. And so she's then, and we put her on some really good nutritional repletion because she was deficient. Making sure there was enough, you know, was a good prenatal so there was enough folate in it, which is really important to be on. If you're thinking about getting pregnant, you want to be on that prenatal with all that folate before you get pregnant. You don't want to wait till to start it when you get pregnant. It's really important in that early, early first trimester time. Take the right nutrients.

Yeah.

So we got her on a really good multi and she started to absorb her nutrients well. I mean it was about a year or so before she got pregnant but she got pregnant and had a beautiful baby.

It's interesting, I have another patient who reminded me of who had that. She came in and she was a fan and she had celiac. She knew she had celiac but she was on a gluten-free diet but she.

Was still not better.

And this is a phenomenon I see very often. Doctors say, oh, you have celiac, just stop gluten and everything's gonna go back to normal. It's not true. You have to rebuild and repair the gut, which traditional medicine doesn't really know how to do. And then functional medicine and the Ultra Wellness Center, that's exactly what we do. So we not only get them off gluten, but we help them rebuild and repair the gut with the right prebiotics, probiotics, right nutrients and so forth. So we actually help them restore gut health, restore their immune system function, and get out of the cycle. And this woman, she was very thin. She was trying to get pregnant. She couldn't get pregnant. And I fixed her gut and did all this sort of tweaking of everything and she got pregnant. And that was a few years ago. Now she has like a beautiful five-year-old baby boy and was like, it was actually such a great story. And I just see how often people suffer needlessly and I think that's what's so stressful for me, knowing that we have these solutions for patients.

Yeah.

And we have, it's not that hard if you know what to do, but unfortunately, the lens that we look at these problems through with traditional medicine only looks at a few things. In functional medicine, we have a much wider net we cast to look at things, and we have a much different set of filters through which we analyze the data. And then we can come up with a personalized approach that helps people most of the time. Not every time, not with everybody, but most of the time we see such incredible results from patients. using this approach of functional medicine. And it's just so satisfying, especially with these patients who are struggling with infertility, who are stressed about it, who are spending so much money on infertility doctors. And there's a role for that. And yes, they provide a service and I don't want to diss them, but I do think you've got to start with this first. And if you fail, then okay, then you can get an in vitro or whatever. But I think most of the time you don't need that. And it's just just literally dozens and dozens and dozens of women I can think of over the last 30 years who've successfully got pregnant when they've suffered from infertility. So if you're out there and you're listening, if you've struggled as a couple, I mean, yes, the mandates to get checked and there's a lot of interesting research on male infertility and the nutritional levels that we have that are deficient and taking even a multivitamin or fish oil can help men getting rid of toxins. We know that there's an increase in infertility in men because of environmental toxins like pesticides. But you can work on those things as well. But I think for women, it's so satisfying to do this as a doctor because we see we can identify these issues, we can do the right kinds of tests, we could customize their lifestyle and dietary plan, the right supplements, fix their gut if needed, balance their hormones. And it seems like it's a miracle, but it's really not. It's just good science. It's just good systems, functional medicine. Yep, absolutely. So, I think if you're listening and if you struggled with infertility as a couple, as a family, there is a way out. And, it's the Ultra Wellness Center, we focus on that. And, what's great now is with COVID-19, we've transitioned to be able to do everything virtually. So, we can do virtual consults, it doesn't matter where you are in the world, we can figure out how to get you the tests, and we can actually customize this approach. And, we have a great team approach here. We have doctors, naturopathic physicians, assistant, health coaches, nurses. It's just a really great team. And often, one of the problems I have in this practice is that often we'll see people and then we'll treat them and then we never hear from them again. And I'm like, what happened to you? It's like, well, I got better. I didn't come back. I'm like, oh, okay. So often we lose people because they're... and that's good. we don't want to be in the annuity business. We want to treat people, find out what's going on, teach them how to take care of their bodies, and then graduate them. And then come back once in a while and say hi. Is that it? If they have any issues. So it's really, it's very, very satisfying. So I encourage people to check out a different way of thinking about this. Read some of the articles we've written. There's a lot in the show notes, some references and articles to how you can think differently about this. You can go to alterwellnesscenter.com and learn how to become a patient, go to get started. tab. We do all things virtually now. If you love this podcast, please share with your friends and family on social media. Leave a comment. I'd love to hear from you and subscribe wherever you get your podcast. And we'll see you next time on the Doctors Pharmacy.

Thank you, Mark.