How to Die Young as Late as Possible with Dr. Michael Roizen

Hello, I'm Dr. Mark Hyman. Welcome to the Doctor's Pharmacy. That's F-A-R-M-A-C-Y, a place for conversations that matter. And today we have a great conversation with a very good friend of mine, Dr. Michael Roizen, who I've known for quite a long time. I'm gonna give you his bio in a minute, but Mike and I first really got close when we were tramping around Washington trying to get health reform done so we would pay for lifestyle treatment for chronic disease.

And you even forgot your license one day to get in all the I did.

I somehow was still able to get in.

That's right. It was an amazing time.

Well, actually, you were a key part of that because I forgot, I was in a rush to go see the Secretary of State who was helping us get in the right meetings in Washington with the head of the health committees in the Senate and Congress and the Health and Human Services. And I managed to finagle my way on the plane, but I had no money. When I got to Washington, I met you in the airport, and you gave me 100 bucks, and I put it back in an envelope after I sent it back to you. So thank you for that. So Mike and I go way back. and he's been the chief wellness officer at Cleveland Clinic. He was the first chief wellness officer of any major academic medical center, any medical center for that matter, and was really a pioneer in thinking about how we change healthcare and how we change health. His work really is focused around aging and healthy aging. His book, Real Age, was a massive bestseller. He's partnered with Sharecare and is doing great work around that. I think you've had, I don't know, 40 million people fill out the Real Age questionnaire or something like that.

It's actually 66 million.

Okay, I can't keep up. Keep up. Now, Mike is 72 years young and he looks like he's about 12, which I don't even know how he does it, but I want to take what he's saying. You too, you look very young. I'm doing okay. He's a smart dude. He went to Williams College, UCSF School of Medicine, residency at Harvard. He's worked with Nobel Prize winners at the National Institute of Health. He's board certified in internal medicine and is the ology and really an extraordinary guy who's, I think, publishes more books than I do, which I don't even know how he does that, but somehow he does. He's got four number one New York Times bestsellers, nine overall top 10 best sellers, really a great man. And he's the one who helped me come to Cleveland Clinic. He invited me to come here to try to bring a different way of thinking and replace him because he was trying to go on- and thank you for coming.

And I came.

It was really a breakthrough. I really, Mike has been a key part of the advancement of what we're doing here in functional medicine.

So Mike, welcome to the Doctor's Pharmacy. It's great to be here. Thank you.

It's always great to be with you. Yeah, well, I remember first being on shows with you with Dr. Oz. When you, before there was a Dr. Oz show, there was the radio show. which you and he did. And I remember being in that studio.

And it was actually fun. yeah, the Oprah radio at that time.

That'S right. And the producer, Robin Burzin, is now a good friend of mine. She was just an undergraduate and then she went to medical school at Columbia and she invited me to speak on functional medicine there. And now she started a whole company to bring functional medicine to millennials, which is pretty awesome. So it all goes around. So Mike, you wrote a new book called what to Eat When, which is.

Not just about what we eat, but when we eat. Right, so most of the books that have come out are about what we eat. And that's important. But what we started doing was asking people when they eat. And as you know, nighttime eating is common.

Yes.

But that's a real problem. And when we got delved into the science, and it's really new science, we found out that circadian rhythms, you know, your metabolism goes up and down as the day goes through. And it, the, your metabolism is highest in the morning and lowest in the evening. So if you've got a normal blood sugar in the morning, by the end of the day, you're pre-diabetic. And so you, in fact, produce fat when you eat at the end of the day. So what we learned from this new science was that when you eat is really important and you want to eat when the sun is out. So if you need a light bulb like these lights to eat, you shouldn't be doing it.

There you go. Well, it's fascinating because it's such a controversial area. I remember when I was at Canyon Ranch, advising people not to eat late at night. And we found that these studies that showed that if you ate 2,000 calories throughout the day, you actually burn more calories and didn't gain weight, whereas if you ate them all at dinner, you would actually gain weight, same calories.

Right. So, in fact, there's been a great study from Spain where they took people who were trying to lose weight, women who were trying to lose weight, and they had them eat before 3:00 p.m., their biggest meal. Spain, the biggest meal is at lunch time. So they ate their biggest meal before 3 PM or after 3 PM. The group that ate before 3 PM lost 25% more pounds over the 16 weeks, 25% more, huge difference.

So here's a question, we hear now a lot about time restricted eating, intermittent fasting, fasting and making diets. Because that's like basically like skip breakfast, right? And what you're saying is that may not be right or is it?

Well, the meal you wanna skip is dinner. So in fact, one of the parts of the plan is cook at dinner, but eat it in the morning. So in fact, we don't want you to spend extra time cooking in the morning. So a lot of things should be cooked in the evening.

Have dinner for breakfast?

Have dinner for breakfast and breakfast for dinner, if you will.

How do you reconcile that with the whole intermittent fasting thing?

Well, in fact, you wanna eat, you know, time restricted period. So 10 a.m. is when I have breakfast and then I have my biggest meal around 1:30 and then very little salad at 6:30. So it's changed my way of eating, you know, it used to be, I mean, this is, you know, can I tell you something without anyone hearing it?

Maybe.

So my wife used to get these great raisin cinnamon breads at one of the local bakeries, right? when she brought it home, you know, she'd come home at seven with a with the bread, I would go through the entire, I would eat the entire loaf by the time, I mean, you know, whatever, right? As my late evening, midnight snack. And so she would have to hide it. Well, now she doesn't have to do it. She can bring it home and I don't even feel hungry for it. Yeah. So in fact, it really, when you, once you change, It changes your hunger pattern too.

So can you talk more about the research behind this? 'Cause this thing is, you know, I think we know that if you eat before bed, your metabolism slows down, you gain weight, and all the hormones are different, right? So what have you learned recently about this emerging science that sort of teaches us that we should be, you know, not eating late?

So there's a whole raft of science, and some of it is, you know, in animals, mice that eat during their active period as opposed to just before their inactive period, they lose weight compared to it. Fruit flies, they fly better, they don't develop heart fruit flies are actually the best model of heart disease we have in humans. Really?

That was a little artery. You see their little arteries.

Little arteries. In fact, there are people who do this full time, obviously. And it turns out if you eat more just before your sleep period, the fruit flies, if they eat 24 hours a day, for example, they develop heart failure. whereas the ones who eat in the beginning of their active period, for us 10:00 a.m., they don't. They end up living 30% longer. So it is a form of intermittent fasting, if you will. So we have some rules, if you will.

What are the rules?

One is eat only when the sun is up, eat more early, less later. I already talked about breakfast for dinner and dinner for breakfast, stop stereotyping foods. So my favorite breakfast food now is salmon burgers with some sweet potatoes and broccoli, which is really, I love it. And so, you know, so, you know, I'm, I usually have a salad with a little salmon on it for dinner, but that's really, I, I've changed the way I've eaten. So.

And what has that done to you?

I, you know, this is, this is, I was actually thinking about that this morning. I have more energy. I have the energy of someone who's 30 years younger.

I know. Now, I can chase them down the hall.

But it is true. But But it is, you get more energy and you feel, you know, it's like a new lease on life. You feel really energized. It really, to me, I was a skeptic going into this. I thought, what the heck? I'm just gonna, if you will, ruin my schedule, you know, by eating more in the morning and not skipping breakfast. I used to skip breakfast, you know, and would eat lunch and then dinner as an intermittent fast, if you will.

Yeah.

And if you will, get ketogenic. Well, this gets you ketogenic without having to sacrifice anything, you know, by eating, if you will, more in the morning and less in the evening. When you eat in alignment with your metabolism, you gain that tremendous advantage. It's like you crack the code for health and weight loss.

So why does this work in terms of your metabolism? Why is it sort of better to eat in the morning. What is happening from your circadian rhythm?

What happens is you become insulin resistant during the day. So insulin, for those listening who aren't docs, insulin is like a postman or the FedEx delivery man who takes glucose from your blood and puts it into your cells. If you have more glucose staying in your blood, which is what happens when you eat at night, you turn it into triglycerides, that's fat, but you also denature your proteins or, if you will, stick a glucose on your protein. So hemoglobin A1C, which we measure for diabetes, is just a hemoglobin with a sugar in the A1C position, which is very inflammatory. Very inflammatory, and if you will, so it does it with a lot of proteins, like the proteins that are the grout proteins holding endothelial cells, holding your blood cells together in your blood vessel, your artery cells. weaken those. When blood pressure comes down, you get small tears. That's when you put in the LDL cholesterol and get atherosclerosis. So it's really, you know, you pointed out in a number of your books that insulin is a major factor. And, and you really taught me that way back when, when you were at Canyon Ranch, if you will. So, in fact, when you look at that, it is we become insulin resistant. We change our insulin It's as though there's a clock hanging off your liver. So think of a clock on your liver and when that clock hits whatever it is, 7:00 or 8:00 p.m., it says, come on in, I'm gonna make triglycerides. And when it doesn't, it says, go into the muscle cells, go into the brain cells, be productive. So I look at my image, I have two images I think of. One is a light bulb. If you're eating and you have to eat by a light bulb, you shouldn't be eating. And the second one is, it hard.

In the winter you have to eat like before four o'clock.

Well, only if you're in Cleveland.

If you're at the equator, you can eat later.

Right. And, but yeah, if you're in Alaska, real problem. But anyway, but- Pretty much just starve all winter. Like the bears do. So they may do it right. But in any case, and the second image is of a clock hanging off the liver, because your insulin levels and your insulin resistance changes as the day goes on. So that's really the science in the book. In addition to it, we found a lot of things out about what you eat for certain situations. What should you eat on a first date? Oh. And what should you eat? Now you don't have to go on a first date. No beef. And no little things that stick in your teeth.

No chia seeds.

But anyway, the book is filled with 30 scenarios like that. But the real basis, the real plan is how do you switch from eating at night to eating in the morning so that you can, in fact, eating while the sun is out, eating less early, less later, more early, and in fact, not stereotyping food. So you don't have to clean out your pantry, you can change by what's in your pantry now.

So in terms of the whole intermittent fasting craze, because it's a big craze now, everybody's doing it, talking about it, a lot of science about how it actually helps reverse a lot of the aging phenomena, helps with weight loss, and could this be done within that framework?

In other words, could you- oh, it's gotta be done within- I think it.

Should be done within that framework. So you could have like a late breakfast, early dinner, and still be in the intermittent fasting. So you give your body 12 to 16 hours to not eat.

Yeah, you want 14 or 15 or 16 hours that you're not eating. That's right. So it's a good thing. Walter Longo, you had him on your pharmacy, if you will.

I'm going to, I actually, I haven't had him yet.

Oh, he's wonderful.

Yeah, I had him scheduled.

But he did a lot of these studies on intermittent fasting in periodic intermittent fasting.

Fasting mimicking diet, he calls it.

Right, but it really is, calorie restricted five days a month.

Yes.

And so he really did those studies accidentally. But there are a lot of people who've looked at time different studies and shown that again, whether it is the Spanish study, there's a study, you know, I don't know how the people at the Peter Bent Brigham get people to go and not look at a clock or TV, if you will, just Netflix for 20 days and they feed them, but they get them in if you will, they get a group of people.

Who will- Metabolic ward.

Yeah, who will eat whenever they tell them to eat. And again, they showed that the people ate the same calories. If you eat 70% of your calories for breakfast versus 70% for dinner, you lose weight when you eat them for breakfast and you gain weight when dinner. Who would do that? And it doesn't depend on, you know, it is the chronobiology.

So- Right, so the whole idea of calories is, all being the same doesn't really work. And even when you eat the calories matters more almost sounds like.

Well, when you eat them really matters. And we were really, you know, we were really surprised. And so we road tested it with a bunch of people, you know, you know, the publisher and the editor are pretty stiff critics and they rarely read, the editors will read the book for, you know, grammar, et cetera, and flow. But they actually went on the diet and lost weight, you know. And so, so we've got friends at National Geographic so we're much thinner now.

Now, the whole issue of rhythm is what you're talking about because in biology, most of us and doctors ignore rhythm. And yet we know that people who have sleep cycles that are disrupted through various kinds of night shift work are much higher risk of heart disease and death. We know that a lot of your hormones and biology is driven on a biological clock. And yet with a light bulb and with the having of screens and with our kind of 24/7 life and being engaged, we don't actually live in a rhythmic way anymore. We don't wake up with the sun and go to bed with the sun. We don't eat in a rhythmic way. And that's what you're talking about is.

Getting back to a certain rhythm that is essential for health. Right. You got a little place in your brain, 20,000 neurons out of whatever it is, 10 trillion or 1 trillion neurons in your brain. I don't even know, but it's a lot of brain counting. Brain counting. But there are only 20,000 of them. that do the rhythm, that do the chronobiology, and that really makes a difference to sleep. It really makes a difference to health. And we were surprised it makes a difference to your metabolic rate and whether you develop heart disease, whether you develop obesity, or what you call diobesity is really, we get diabetic, if you will, at least pre-diabetic, as the day goes on. so you think, I don't want to be a diabetic, don't eat at night.

Yeah, I think that's really true. So what is a perfect day look like in terms of an eating plan?

So, you know, the perfect day is probably close to what Dr. Crouse does, who is the co-author on this, Mike Crouse, who worked at Consumer Report, was their food guy for a number of years and now is the the medical guy, the chief of medical staff at the Dr. Oz Show, he really embodies this. So if you will, he will cook, he's a foodie, so he loves food and he cooks at night. So he will often have for breakfast and he has it at 10 a.m. Much like I do, he has avocado toast. So you like avocado toast, it's whole wheat bread, 100% whole grain and avocado. and then he'll eat his biggest meal and he'll cook something special for lunch at dinner. But he's developed a whole group of recipes, are going to be on our website, winway.com, he's developed a whole group of recipes where you cook at night and just can eat in the daytime without even re-thermalizing, without even reheating. But so he does that, and so it's salmon and it's- I'm not sure.

I like cold salmon burgers.

Really good until you try him, don't knock it. But in fact, salmon burger, but he doesn't eat, he cooks a walnut crusted salmon or a pecan crusted salmon at lunch. And then he'll eat almost nothing. He'll have just a little salad and some wine at dinner. So he loves wine, but that's his dinner. You know, a glass of wine is his full 20% of calories, if you will.

No antioxidants.

So he does like red wine. that will be his dinner and then he'll do it again. But he will cook something different every day. I'm very stable. So you ask me, I have, I cook four salmon burgers at dinner. I will eat one at dinner, usually two at breakfast and one at lunch, and then I'll have, you know, something vegan at lunch in addition. So that's, that's a typical on a, on a weekend, I'll have a, at at dinner, this is crazy, right? I'll have an egg white veggie omelette at 4 p.m. as the last meal. So that's the only thing I change on weekends, if you will. So I love what I, you know, you've gotta love what you eat.

Speaking of your routine, you're going strong. You're 72. You never stop. I don't even know how you do it. I know you always have a cup.

Of coffee in your hand. Coffee, if you're a fast metabolizer, it makes you younger.

Yeah, it's impressive. Awesome. So how do you live your life? What's your routine that allows you to stay so vibrant and looking young and barely having any gray hair at 72?

Well, the key is having a great partner. So my wife is magnificent, wonderful, and so that's what I consider the key is having friends.

And I saw a beautiful quote that you gave on an article that was about you and how you live to be, want to live to be a hundred, is you wake up every morning and you kiss your wife.

That's exactly right. First thing.

That's a very good thing.

So great partner and that helps me manage stress. So I do do six minutes of deep breathing morning and night as my meditation if you will. So that's part of my life. No tobacco obviously, but then if you will, I don't go to bed, you can look at my pedometer, I don't go to bed. I don't know if you can catch it on, so Bill is a superb cameraman. I don't know if he can catch this, but this is yesterday. You see I just made 10,000.

10,000, look at that.

This is the day before. I just made 10,000.

There you go.

This is the day before. I don't go to bed without 10,000. So if I'm close, I get 10,000 steps.

And you basically have a desk, I've seen it in your office, where you're on a treadmill on the phone, on conference calls, where you're doing your work. It's like the slow treadmill, you're just gonna walk all day.

Right, so I can, if you will, I write at 1.7 miles per hour, two degrees, I type at 1.8, I read at 1.9, and you can do conference calls at 3.3 miles per hour. routinely.

You might be breathing heavy.

Well, the problem on that is if you're doing that is if you forget you're on the treadmill, which if you get an excited part of the conference call and want to, you know, say something important and you forget you're on the darn thing, you get flipped out pretty fast. So you gotta have a chair at the end of the treadmill to catch you. I get to do my passion during the day, which is helping Cleveland Clinic employees and Cleveland Clinic patients and Cleveland Clinic, if you will, we spread it wide to our communities and other companies get healthy. So I get to do the wellness program. I get to see patients a couple days of the week in executive health and the premier program, which I love doing. And then I get to spread this and get to do shows like yours, which you know, it's as good as it gets to be with you here.

Well, you really love what you do.

And one of the joys of being at the Cleveland Clinic is that the other people are so good. I had a patient last week who had a rare disease, and believe it or not, there's a guy who specialized who knew more about that than anybody else in the world. And that's typical. If you find a person with a problem, you can find someone who knows more about that and who's dealt with that more than just about anyone else. So it's a joy joy to be here. And, you know, I refer you patients, too, when they get too complex. You get them.

I worked at Canyon Ranch, which is a health resort. So I used to call myself a resort doctor, the doctor of last resort. So one of the things you've done, which is remarkable, is to come into a place which is one of the best hospitals, Health Care Systems in the world, but it's focused on acute care, like the sickest of the and you said, wait a minute, with the leadership of Toby Cosgrove, who's a former CEO, that we need to rethink healthcare and we need to rethink how we're going to deal with our own employees. Because now there's what, 100,000 employees and.

Families as part of Cleveland Clinic that are self-insured.

109,000, but who's counting? You're always good with the numbers. And the remarkable thing is you took a problem that seemed insoluble, which is dramatically rising healthcare costs within businesses and companies and organizations like Cleveland Clinic and with very difficult to change behaviors like diet and exercise, smoking, stress, and you implemented a program here which is really a national example of what could be done around creating wellness and organization. So can you share a little bit about how that came about and what you did in the results that happened as a result of that? Because I think it's an inspiration.

Well, you couldn't do it without great leadership. So Toby Cosgrove and now Tom Mihaljevic who is into it even more have been the leaders, and they kept, if you will, the financial guys at bay for a while because it took a while for this to show a return on investment. So we knew from the Medicare database studies that we did that if you did five behaviors, you decrease your risk of chronic disease over the rest of your life from age 40 to 50 for the rest of your life. by 90%. And since 80% of all medical costs are due to management of chronic disease, you can really change that. So we went to our employees and Toby said, just pay them, if you will, we're a capitalist society, pay them to stay healthy, as well as make some environmental changes and culture change. So we made the culture change, which is really important. So we're down from 15.4% of people smoked to under 5%. We're in fact 43.6% of our employees now have, if you will, what we call six normals. We changed the behaviors into, if you will, outcome measures that we could measure by, and the employee would go with a piece of paper to the primary care physician and say, Where am I on these six normals? And then- Those blood pressure, blood sugar, blood pressure, blood sugar or hemoglobin A1C, body mass index, LDL cholesterol, cotinine, which is tobacco end products, and then are they managing asthma? We've learned that managing stress is more important when we've worked with other corporations, so we're bringing that in now. But in fact, if you get those six normals in the nurse's health study, you decrease chronic disease by 90%. in the Swedish men's study by 87%, but only 1% of the Swedish men did it and only 4% of nurses did it. We're at 43.6% if you will.

How did you do that?

Well, it wasn't me, you know, it was the employee health plan team, Bruce Rogan and Paul Terpilowski and Dave... You.

Guys did something unusual. You actually gave people financial incentives.

Right.

In other words, they got more money back from their health insurance, in other words, they had to pay the premium.

Well, in the Obamacare, which we You and I and Dean O'Neill lobbied on together. And we hit 66 senators, you know, Republicans, Democrats, we got everyone, if you will, covered. And the point was that if you have money, if you can reduce your premiums by 30%, we're now at $1,440, goes back to a family of four if they get six normals. They save that, they work at Cleveland Clinic for 30 years, it means $200,000 extra retirement. Wow. So it's a huge amount of money, if you will. That doesn't even include co-pays and being healthier and not having to take time off, et cetera. But in fact- More productive. More productive, in fact, yes, the whole thing. But we did it by focusing on those six normals, normal blood pressure, normal LDL cholesterol, normal body- it isn't even normal body mass index, it's just not in the obese range. no cotinine greater than secondhand smoke, et cetera.

But you offered smoking cessation programs, weight loss programs, exercise classes.

And we offered- and we offered- exercise classes.

Yeah, so- so there- Team memberships.

I mean, there was a lot of.

Things that seemed to be a cost center, but actually ended up saving, what, hundreds of millions of dollars?

We saved- the CFO will say we have not spent, I have to put it in, we have not spent 665 million so far, 168 million the last year for the 101,000. And that doesn't include the employees have gotten well over 100 million. I calculated around 200 million in reduced premiums in addition.

So it's a win-win for everybody.

It's a win-win for the organization.

The organization pays less.

And the government, if you will, we're healthier so we can serve other people with more vigor. And in fact, it is, you know, I'll say one funny thing when we were writing the book what to Eat When, It hit me, we don't serve meals after 3 p.m. in most of our restaurants. We do it perfectly when we- It's true.

I went over to the new food emporium. I was like, I want to have dinner. I'm like, There's nothing left.

I'm like, no, they stop at 3 p.m. so it works. But in fact, that wasn't- we didn't know about that at the time. But in fact, so by motivating the employees and giving them programs, we are saving you know, if you just replaced our nurses and didn't have to when they're not sick. So we have reduced the, what we call unexpected sickness days from 1.07% to 0.77%. That 30, that 0.3%, if all you did, because we got so many nurses, that would pay for the entire program.

Wow.

And that says us docs and administrators are useless. So all it is is replacing the nurses. So in fact, over time the program, I mean, it's a huge pay for itself. And so we've spread it. So one of the companies we spread it to is another health care organization that took 11 of their hospitals and didn't do it, and 10 that did it. They're saving 32% in the 10 that did do it. They can't actually believe it.

It's kind of a no-brainer. Why isn't this being done all across the country in various organizations?

How easy was it to to convince those senators. Even after we convinced them a bunch wouldn't vote for it. Even after they said, you,'re right.

Well, they were into it. I think it just got on the cutting room floor.

So in fact, there is a great benefit to this for society. If we did this, if Medicare did this for everyone in America, you could pay every Medicare recipient the same percentages did it for Medicare. You know, 69% participate and 43.7% get normal. You could give every Medicare recipient $2,000 more per year, huge amounts, more than 10% of their average take home for the Medicare population, and save the government between $300 and $400 billion a year. So what you're advocating is exactly what we should do. you and I know that, if you will. And so, as you know, I'm science based. And so that's what the data is there.

The data is there. Okay, so knowing everything you know and being in this space for a long time, if you could change something in terms of health, health care, environment or society, and you were king for a day and you had autocratic power, could do anything you wanted, what would be the thing or things that you would focus on to make the most difference?

I'd focus on getting people voluntarily, as we do, giving them big enough incentives. You know, the Rand study on wellness says incentives doesn't work, except there's an asterisk. I think it's on page 36, which says unless they're large. Well, health care costs enough that we can make, you know, you flat instead causing, if you will, income inequality. If you stop having an increase in medical costs, you all of a sudden make income much more equal.

Yeah.

Because the lower level employees get much more of that benefit, if you will. So, in fact, I would say let's offer large incentives and have a cultural revolution like we had in World War II. Everyone pitched in in World War II. to help the country win. We should in fact all pitch in to have everyone stay healthy and that reduces our budget deficit tremendously. If you do it for just imagine veterans and Medicaid as well as Medicare and all the government employees you have a tremendous budget if you will dividend that you can then make society much better. So that's what I would do. and I'd close all the restaurants after 3 p.m.

So pay people to be well.

Pay people to be well. And because of medical costs, you know, we could shut down a number of the Cleveland Clinic hospitals.

Well, we were talking about this in terms of a project we're working on at Cleveland Clinic and other people around the country of food pharmacies where you actually give people free food, three meals a day, two meals a day, whatever, and you see the cost go down by 80%. than diabetics.

Right, no, no, no, food is so key, both what, avoiding the sugar, making sure that you don't have simple carbs, added syrup, simple if you will, sugar. Sugar, starch and sugar, yeah. And also making sure you eat early enough when you eat is important because you become free diabetic as the day goes on. So you're absolutely right, you know, pharmacy is a great name for a podcast. I'm envious as heck. All right.

So anyway, Michael Roizen, Dr. Michael Roizen from the Cleveland Clinic, former Chief Wellness Officer, Bravo Rouser. Dr. Roizen, should I show the book? The book is what to Eat When, which you should all go check out. It's full of scientific information and great practical guidelines on how to actually eat according to your metabolism, which is what we all need to do. And I really hope you've enjoyed this conversation. I think it really matters. If you like this podcast, please share with your friends and family on social media. If you liked it, leave a comment and review. We'd love to hear from you and we will see you next time on the Doctor's Pharmacy.