The Functional Medicine Approach To Cancer and Cancer Recurrence

What we're talking about in functional medicine is true prevention. Whether you've already had it, you want to prevent it from coming again, or you have family history you're worried about, you actually can map out what's wrong and fix those things, and it makes a big difference.

Hey, everybody, it's Dr. Mark Hyman. Welcome to this special episode of the Doctors Pharmacy. That's Pharmacy with an F, F, a, R, M a C, Y. A place for conversations that matter. And if you've got cancer or anybody in your family has cancer, you. You better listen to this housecall mini episode. Because in this series of special episodes at the doctor's pharmacy called housecall, I sit down with the ultra wellness center physician, medical director Dr. Elizabeth Boham, to discuss how we, as functional medicine doctors tackle specific conditions that we see at our practice every day. And Dr. Boham is an incredible doctor. She's been my colleague for over 20 years. She's an exercise physiologist and nutritionist and a doctor, which is a rare combo. And I'm so pleased to have her here on the doctor's pharmacy.

Thank you, Mark. Thanks for having me.

So cancer is a very big topic, and we can't cover it all in 30 minutes. But you have a unique experience that has informed your way of thinking about cancer. Because when you're 30 and you're now. Can I say 50, 51.

Yeah, you can say it.

You had cancer, and when I first met you, you had really short hair because you just had chemo and all the treatments that cause you to lose your hair. And you actually figured out how to make sure that you weren't going to get cancer again. And a lot of people. Knock, knock. Well, it's been 21 years. I think you're good. But, you know, it's interesting. I remember these patients coming to the practice, and one of them had, like, breast cancer, and she had colon cancer and she had three cancers. And the doctor's like, well, we're just going to, like, you know, do screening. You know, we're just gonna, like, see what happens. Like, good luck. You had your chemo radiation surgery, and now there's nothing you can do except wait and we'll, you know, do a surveillance. Active surveillance, right. It's not active nothing. It's active nothing. You do nothing. And there's no plan of what to eat or how to figure out why you got the cancer or what to do about it, you know, so whether you're wanting to prevent it or you've had it and you want to prevent. Get it again. You know, it's important to do a holistic look at your biology.

It really is, because, you know, all of us are individuals, you know, and for me, my undergraduate and graduate degree was in nutrition, and I was an exercise physiologist. And I love to eat right and exercise right. So I was doing those things. But there were aspects that I needed to really focus on in terms of me being able to prevent a recurrence of cancer or another type of cancer. So, Yeah, I was 30. I had a triple negative breast cancer. I don't have any family history of breast cancer. It was aggressive. I was very lucky that I found it early as I did. But I did go through surgery, chemotherapy, radiation, and all the fun stuff. Oh, yeah, yeah.

Poison poisoning, burning and slashing. Yeah.

And then came out on the other side, and I was like, okay, I've got to really figure out, why did this happen to me and what can I do to prevent this from happening again or how can I help my patients? And when I first went to afmcp, it was after I started working at Canyon Ranch in Lenox and where I met you.

Functional medicine training program.

Exactly. And it was just like this light bulb went off in my head where I was like, okay, this makes so much sense. I want to think about this in a totally different way. We've got to look at how all the different systems in the body impact if you're going to develop cancer or not. We've got to pay attention to the terrain in the body.

Yeah.

The soil, the things that are feeding the cancer cell. And, you know, so each person, it's different. For me, I had to really focus on supporting my microbiome and detoxification and stress. But for somebody else, it might be really working on reversing insulin resistance. Right. Or diet. And so there's. So it's really important to have a real personalized approach here, and it makes a huge difference.

Yeah, it does. You know, and I think what I want people to understand is that, you know, we strongly support the use of traditional cancer treatments, whether it's chemo, radiation, or surgery. But it's not enough because it's treating the cancer, not the patient and the soil in which the cancer grew.

Right.

So functional medicine is an approach that really treats the soil so the cancer can grow back or that you won't get in the first place. And I think that's a really unique approach. It's not either or. Right, right. It's not like, oh, just have green juice and your cancer is going to go away. Forget that. You know, you need to deal with it. But using supportive treatments, it works better. We have a colleague and a friend who recently had throat cancer. And, you know, it's 50, 50 on that. But he did a ketogenic diet when he was going through treatment. Now, there's a lot of science on this. And one of the top. The top cancer specialists, Siddhartha Mukherjee, who wrote the emperor of all maladies, is doing a lot of research on ketogenic diets and cancer. And he came up to me once, he said, mark, we made an amazing discovery about cancer. I'm like, what is that? I said, is it sugar? He's like, how did you know? I'm like, yeah, well, it feeds the cancer. And he said, we're finding that, you know, using chemotherapy along with ketogenic diets, or even the fasting, mimicking diets, different approaches, intermittent fasting can actually help the chemo radiation work better and have higher cure rates. And then.

And so because it puts those cancer cells, they are stressed in those situations, so they can't survive as well. And so the chemotherapy kills those cancer cells in those. When you're. When they're on. When somebody's on a ketogenic diet or a fasting mimicking diet, those cancer cells are more at risk, and so they.

Die off because they only eat sugar. They can't live on fat.

Right.

So we can. We have like a hybrid. We're hybrid, yes. So we can. We can run on, you know, gas or electric. Right, right. Well, same thing with your body. You can run on carbs or on fat.

Yep.

And when you run on just fat, it changes your metabolism. And the cancer cells only run on sugar.

Yep.

So they don't. They starve. So this is just one example of the kinds of things we do in functional medicine to help our patients do better through treatment and actually prevent it after and to actually. Actually not get it in the first place. So people feel sort of helpless about this. But there's so much we know about what causes cancer, the things we can measure and test for, the things that you sort of discovered on your own. And I think it's. It's sort of shocking for people to understand that traditional medicine just doesn't even talk about this.

Right, right. They're so focused on the cancer at the acute time, which is important. But. But we've also got to really work on. Let's prevent. We prevent it from coming back. Let's prevent it from coming in the first place.

And the dietary advice is terrible. You get in cancer centers. I have a friend who was a top radiation oncologist at MD Anderson, which is like the top cancer center in the world. And. And he was like our nutritionist. I'm just struggling because they say if you have breast cancer, don't eat tofu, but you can load up on ice cream.

Right.

Which is so awkward. Eat the tofu, forget the ice cream. You don't say, stop drinking wine or don't eat ice cream or sugar, which is driving the cancer cells.

Right, Right. Creating a terrain in the body which is feeding cancer. Right, Right. So, absolutely, we're looking for all those things that may create a terrain that will feed cancer, whether it's high insulin, high blood sugar, high insulin levels in the body, high inflammatory markers. So high inflammation in the body, which will drive cancer.

Yeah, cancer is inflammatory. People don't realize that.

Absolutely. Right. So we look for that. We test for markers that measure inflammation and then try to figure out, why is that? Why is there inflammation and what can we do to lower it. For some people, it might be, you know, the insulin resistance that's driving the inflammation. For somebody else, it may be the gut and, you know, imbalances in the microbiome that's driving the inflammation. So we really want to look deeper.

Or toxins.

Absolutely.

So when you go to a traditional oncologist, they're just looking at the pathology and not looking at the biology. Right. And they. They don't actually look at the terrain, which is your nutritional status, your stress level, your. Your level of toxins.

Yeah.

You know, your microbiome, your genetics around. I mean, they look at some genetics, but it's not the kinds of things we look at, which are more functional things and not. Not the BRCA gene, which is.

Right.

But, you know, it's interesting. You know, the BRCA gene, you know, back in the 40s, they sort of had records around this, and then, you know, the risk of cancer was like 30% if you had the BRCA gene. Now it's like 70%.

Right.

Why is that same gene? Because the environment is different, our diet's different, toxic load is more, stress is more. All these other variables are affecting the gene expression.

Right.

So even if you have the genes, you're not necessarily predestined to get something.

Right. So we call the BRCA gene like a high impact gene. Right. It increases risk substantially of breast cancer. But so many women don't have the BRCA gene and still go on to get breast cancer. Breast cancer. So we Also look at these low impact genes, genes that we can really influence with the environment, genes that aren't going to cause a huge increase in risk of cancer, but if you've got multiple different ones together, they can influence your risk. And what's most important with those low impact genes is we can really influence how they express themselves with our environment. So we can influence, you know, the expression of some of our genes by eating a diet that's really rich in our cruciferous vegetables and sulforaphane.

The broccoli family.

Yeah, the broccoli family. And we can maybe influence how these genes work by different supplements or different changes in diet. So like I had a woman who came to see me, she was 42 and she had an estrogen receptor positive breast cancer. And she went through surgery and then they did tamoxifen. And she came to see me because she wanted to prevent this from coming back. Right. So she's like, I really want to figure out why this happened and want to prevent it from coming back. And so we did multiple different evaluations on her. And one of the things that showed up was when we did some genetic testing again, those low impact genes, we found a variation in the COMT gene. And the COMT is a gene that encodes for this enzyme, catechol methyltransferase, which.

Is mouthful, but that it has to do with what?

Yeah, it has to do with methylation. Right. But it's been found that methylation just means the transfer of these methyl groups which come from a lot of our folate, our B vitamins, like folate, which is in all of our foliage, our green leafy veggies.

You know, there's a carbon and P hydrogen that has to be shared between different.

Chemicals in the body. And if it's not working, you get all kinds of problems, whether you get cancer, you get dementia, you get heart disease, depression. So these have to be working.

Yes. And so if this enzyme doesn't work as well because of your genetic predisposition, then your estrogen in your body doesn't get broken down and gotten rid of as well. It can become more.

Cancer producing. It can change in a way that's less healthy for the body. And so, so we know that we can influence, we can influence that gene. When we give a diet that's rich in folate all those green leafy veggies, we can, we can sometimes influence that gene with, we often give like methylated B vitamins.

I think this is special forms of B vitamins. You go to the grocery Store you get, you know, folic acid or B12. It may not be the right form to actually activate these things, bypass these enzymes that aren't working so well in the body. Yeah.

I mean, we have a concern about folic acids, which is, which is the synthetic form of folate. So folate can be what we get in our food. Right. Our foliage, our green leafy veggies, lots of other foods too. There's a synthetic form called folic acid which actually has been associated with maybe an increased risk of cancer. There's some concern about this synthetic form and that's found in a lot of.

Not the highest quality, not the vitamins we use. Right. So it's found in some B vitamins and multivitamins that we're not going to choose to use because for some people, they can't utilize it in their body. What you really want to look for is a methylated form of folate. So this type of folate that's activated, that's found in a lot of our food, like when we're eating folate rich foods, it's going to be high in this methylfolate. But if you're taking your supplement, supplements, if you're taking a multi or a B complex, you want to look to make sure it's a methylated form of folate. Because the body, for certain people, that's more necessary than others, but the body is, it has an easier time utilizing it. And that helps with this whole estrogen metabolism process.

And just to back up on that, you know, some people think there's something called estrogen. There isn't. There are estrogens.

Yes. That's.

And they're all a little different. And some are more prevalent in, you know, early life, some in reproductive years, I'm in menopause. And they all have to be metabolized by the body.

Yeah.

And it's sort of like going down a pinball machine. You don't know where it's going to go. And some people don't have good detoxifying mechanisms for all this estrogen. And then they get sort of estrogen toxicity.

Right.

And I think, you know, one of the things that's really striking and about what you're saying, particularly in terms of breast cancer, is that, you know, this woman had estrogen receptor positive breast cancer. And what that means is that this is an estrogen sensitive breast cancer. It feeds on estrogen. Right, right. And so the beautiful thing about functional medicine is that we can one test for all these metabolites and figure out how to change the pinball thing. So it's going down the right pathway to be anti cancer versus pro cancer. And we use lifestyle, diet, supplements, all kinds of things to do that. But what's really important to understand is that a lot of us are out of balance and we have imbalances in our hormones and we make too much estrogen.

Right.

And maybe not a progesterone, and that leads to symptoms of estrogen overload.

Yes.

And, and I remember, you know, medical school was a very nice way to talk about patients, but we remembered. How do we remember the profile of someone with uterine cancer? Fat 40, infertile, right?

Yep. Right. Which is essentially saying high estrogen.

And if you're overweight, you make higher estrogen.

Right.

Obesity is linked to cancer. It's linked to breast cancer. You know, insulin resistance and prediabetes is linked to breast cancer and many other cancers.

We have this enzyme aromatase in our fat cells, and aromatase takes other hormones and turns it into estrogen. And this happens in men and women. Right. So when you have more fat cells, you have more aromatase and so you have more estrogen. And so that then is why, or maybe one of the reasons why, that obesity, having more fat cells is linked to estrogen related cancers, which would be breast, uterine, prostate, is definitely related to this higher estrogen level in the body, for example. So one of the things everybody can do is make sure their body fat percentage is lower. Right. Because that helps with lowering estrogen levels.

And we actually have a whole strategy for one, assessing this in functional medicine, which is not what your traditional doctor will do if you go to breast cancer treatment. And we, we have a whole strategy for how to balance out your hormones. Right?

Yes.

So things like diet, exercise, stress reduction, working on your microbiome, the right nutrients, getting toxins that screw up your hormones, all these things fixing your liver, these can all really help fiber.

Yeah, we really want to pay attention to those xenoestrogens. Right. Those are those toxins from the environment that act like estrogen in the body. So those are environmental toxins, things we know about like bpa, we plastics, parabens, pesticides, they put your sunblock on, you.

Get all these parabens, maybe you're causing cancer.

Right, Right. And they, because they can bind to their xenoestrogens, they're chemicals from the environment, but they can bind to the estrogen receptor in the body.

So they're like hormone mimickers.

Yeah.

And they, they're effective and powerful. Extremely low doses. So I'm not that exposed to pesticides or like any damage parabens or whatever, they work in a microscopic dose to have a macroscopic effect and they're synergistic. So people say, oh, this one chemical, maybe it's not so bad in animal studies, but we're exposed to hundreds, maybe thousands of these chemicals all at the same time. And our different abilities to detoxify them affect our risk. And in particularly in cancer, we know that these chemicals are associated with cancer. So how, how, how when someone comes in with let's say breast cancer, what are the kinds of tests we'll do? What are the recommendations you'd make? And you have a whole incredible dvd. I encourage everybody get tell us about the dvd.

So it's called Breast Wellness and it's tools to prevent and heal from Breast Cancer. And it looks at the functional medicine approach to breast health.

And where can they get that?

They can get it at my website, drboham.com they can also download a free ebook there. I think it's also on Amazon and Vimeo. It's everywhere, right? Actually it's on ultra, it's on our ultrawellnesscenter.com too.

Yeah, so what?

But, so you're looking at that comprehensive approach and treating that individual patient. Right. And you know, we're focusing on is there toxins that we need to lower? You are mentioning that aspect of toxic load which I think is really important, you know, because we know that sometimes it's not just one toxin, but it's a little bit of a lot of different toxins. So we can look at things, we can measure things like is there high oxidative stress? Right.

That's like free radicals, right? Yeah.

Right. Which could indicate, which would indicate an imbalance between the antioxidant levels in the body and the free radical production. So sometimes when somebody has oxidative stress, that just means that they've either produced too much free radicals because of toxins or infections or they don't have enough antioxidants right through because they're not eating enough of the phytonutrients that are the plant foods that are rich in antioxidants. And, and when we see that, when we see that oxidative stress which we can measure, we really work to lower it with a phytonutrient rich diet. Sometimes we then have to look to see, well, why is it high in the first place? Right. That's asking that question, is there some infection, is there some toxin? Because you've got to figure out why.

So that you can help with insulin resistance.

Insulin resistance? Yep. Weight, that, belly fat, gut issues.

You know, you talk about how you measure the poop of patients with breast cancer. Why is that relevant? Right.

Because there's. I know, right. You're like, how is the poop connected to.

Well, there's a microbiome in the breast.

Yes. Right. And they're finding that the microbiome in the breast is different in women who have breast cancer. So there's so much more we're going to learn here. But in the gut, we know that if there's an imbalance in the microbiome, there can be an imbalance in this enzyme called beta glucuronidase. It can increase, which can then lead the body to absorb back more of the estrogen and then put you in this situation where you're more estrogen dominant or overloaded.

So basically there's like overgrowth of these bugs that shouldn't be there that produce this enzyme, that then when the estrogen is detoxified by the liver and dumped in there in the bile, which is how your body gets rid of excess estrogen, it sort of unpacks it a little bit and then you end up reabsorbing it. And so you get this increased reabsorption of estrogen, high levels of estrogen and breast cancer.

So we're looking at that level. We can measure that and we can measure just the imbalances in the microbiome which are impacting that level as well as multiple other things in the body.

Yeah. Given the view of functional medicine, which looks at root causes and systems, the fact that antibiotics cause breast cancer is not a surprise.

No. And I had. As a kid, I was on multiple rounds of antibiotics for urinary tract infections again and again and again. And then that just was probably the thing that along with some of my genetic predispositions and, and, and some toxins, you know, really allowed allow my body to not work in an optimal way, you know.

Yeah. It's so powerful. So we actually, through things like lowering sugar and starch in the diet, through things like adding certain fibers to help with gut flora, things like certain anti cancer foods like flaxseeds.

Yep.

We can actually. And broccoli family vegetables you were talking about. We can really have an impact on exercise and stress reduction. We put together a whole plan for people.

Yes.

It doesn't leave them feeling so hopeless and helpless and like I just have to wait around to my next scan or my next mammogram and cross my fingers. And stress out for the next six months or a year.

Right.

You can actually be empowered to understand what your biology is doing, what the imbalances are, how to fix them. And is there a guarantee you're never going to cancer? No, but you're stacking the deck in your favor and you're understanding the imbalances that are driving cancer and you're changing the soil.

Changing the soil.

And that actually won't allow the cancer to grow.

Yeah.

Right. So that's a really powerful model that should be part of traditional oncology and there are some centers of oncology that are integrating this. But it's unusual. So let's take the next a little bit and talk about the next case of a patient who hasn't had cancer but was terrified because there was tons of cancer in their family.

Right. So this was a 48 year old gentleman and he had not had cancer yet, but he had a sister with breast cancer. There was stomach cancer in his family, there was colon cancer in his family and prostate cancer. And so, you know, he wanted to do whatever he could. He wanted to create that terrain where cancer was less likely to grow. And we also did genetic testing with him. Again, not the, not those, not the big genes, but some of those low impact genes. And we found a variation in one of his genes called the GSTM1 or glutathione as transferase gene.

Yeah, I got that problem.

Yeah, and me too. I'm in that club.

Well, it's interesting, you know, people who have this specific gene actually are much more likely to be in hospitals and sick and have issues. Right. And just to back up before you get too much more into it, I just want to sort of help people understand, you know, what genes are. So you have like 20,000 genes and it's basically this genetic code that is a three letter code of is your. Is a gene. So you have let's say four letters. You know, computers are one and zero. Your biology is four. Like it's four actg. So if there's a variation in that code, it may not be a mutation, it's just a slight variation. Yep. It's sort of like in America we spell color C O L O R. In the UK they spell C L O U R. So similar, but it has different effects. And, and that is something we can do something about. Right. If you, if you have the gene for down syndrome, you can't do much about that.

Right, Right.

If you have a gene like for the glutathione, you can influence its function, hence functional medicine and change the way those genes are expressed through things like diet and exercise and lifestyle and supplements and detoxification, all kinds of strategies that we use. And so we check genes that typically aren't checked and we see where this person have the potholes and how do we help them avoid them.

Yeah. So this, you know, glutathione is this master antioxidant and detoxifier in the body. And we know, like you mentioned, when people are have a defect in this gene in the GSTM one, they don't tolerate toxins as well from the environment because their body is not as able to take their, you know, to make as much glutathione and then take. Use the glutathione to get rid of the toxins.

Glutathione is like sulfur, smelly, sticky, it's like flypaper and all the nasty toxins stick to it and then your body gets rid of it. Yes, but if you have low levels, you're screwed.

Right, Right.

And one of the reasons you can have low levels is because you have some variations in these genes. And so for people like that, we really want to support. We really want to support, I mean, we want to support detoxification with everybody, but with those people, we really focus on supporting how well they can produce glutathione. And so we will really focus on things like sulforaphane. Sulforaphane comes from your cruciferous vegetables and.

It helps broccoli, collards, kale, brussels sprouts, cabbage. This is like basic stuff in food that actually has powerful anti cancer compounds. And sulforaphane is one of those. They've been studied at Johns Hopkins. They have supplements you can take. You know, we have that on our online store. It's really effective.

Yeah, that's one, that's actually one supplement I take every day. I mean, there's a bunch I take every day, but that's one I always take because it really, it helps the body with production of that glutathione. And that really, as we said, helps with pulling those toxins out of the body.

And there's other stuff that you can take, like aside from things like garlic and onions and the cruciferous vegetables, there's a lot of supplements we use in functional medicine that they're not replacements for a healthy diet, but they help to produce different molecules in the body and help different functions. So N acetylcysteine is one of the building blocks of glutathione and helps increase it. In fact, you know, When I was in the ER as a doctor, because I worked in the ER for years, I learned that if someone came in with a liver failure from Tylenol overdose, we gave him this quote drug, which was called Nuchemist or N acetylcysteine, which smelled terrible, tasted terrible. We made him drink it. Yep. I guess a suicide attempt wasn't enough.

And so they, they, when I started doing functional, I'm like, wait a minute, this is like, this is incredible. This, this is just a supplement that you get in the health food store.

Yep.

And they even are studying it for kidney failure that's caused by dye when you get an X ray.

Right.

And they actually can prevent kidney failure by giving them this, you know, cheap supplement.

I see, right.

Yeah.

Yeah. So it's, I mean, I think that's really important about supplements. You know, I think that what's, what's really, they can be so beneficial when they're targeted and used for that individual person and what their needs are. And I think that's really sort of a take home here with supplements is that, you know, we can't. Some people take the kitchen sink, they take a lot of different things and just hoping that one of them is going to be the right one for them. But one of the things we can do, especially with some of this genetic testing we're talking about and some of this evaluation that we're looking at from a functional medicine approach is we can really focus on, okay, for this individual person, what are the ones they really need to focus on? What's the first food they really need to focus on what are maybe some supplements that they need to focus on to help them get to their optimal health. And that's, I think when we see them work, even better.

Yeah. And there's amazing stuff that also is being looked at in terms of detoxification and cancer treatments like high dose vitamin C iv, which we do at the Ultra Wellness center, can be extremely effective as an adjunct treatment to traditional cancer therapy to reduce the risk of the cancer not responding to the chemo or afterwards to prevent it from coming back. So there's, there's so much that can be done. And I think, you know, one last point I want to make is that, you know, we think of the tests we do in medicine as prevention. So a mammogram is prevention, colonoscopy is prevention. The prostate exam is prevention. They're not prevention, they're early detection. So you have to actually already have the problem before you find it positive.

Right.

Which is good. It's a screening test and you find it early enough, you won't die. That's great. But it's not true prevention. What we're talking about in functional medicine is true prevention. Whether you've already had it, you want to prevent it from coming again, or you have family history you're worried about, you actually can map out what's wrong and fix those things. And it makes a big difference.

Absolutely, yeah.

So just to recap, here.

We are so inundated with cancer, there isn't anybody that hasn't been touched with it. My family I had, my sister and my dad both have cancer and they were sort of late stage when they discovered them, which is hard to do anything about. But I don't want people to feel disempowered because with functional medicine and using that lens and the kinds of work we do at the ultra Wellness center, we can map out what the imbalances are, what the risks are. We can design a personalized treatment program for you that actually tests the things that matter. Whether it's your nutritional stuff. We're looking at beta glucuronase in your poop, or looking at heavy metal levels or pesticide levels, or looking at insulin or looking at the methylated nutrients that you need or your glutathione levels. We check all that, and that helps us to create a personalized roadmap for you. Along with other things, we recommend dietary recommendations because we know so much about diet and calories. Cancer.

Yes.

And that is such a big. I mean, at Cornell where you went. And I remember I took a nutrition course and I had a book was like from the national Cancer Institute called dieting Cancer. And this was back in the 70s, and we know a lot about this. I remember speaking to my oncology attending when I was doing my oncology rotation in medical school, and I said, what percentage of cancers do you think are diet related? And I thought he was going to like 10%, 20%. He's like 70%.

Yeah.

I was like, whoa. Because that's good. Because it means we can do something about it.

We can do stuff about it.

Absolutely. If you have cancer or you know someone with cancer and you want a different approach, you know, I would encourage you to check out somebody who's trained in functional medicine again. We're happy to see you at the ultra wellness center in Lenox. You go to ultrawellnesscenter.com we have great resources on our site. You can go to drhyman.comuwc where we'll give you a handout on the kinds of things we're talking about so you can sort of get started. Started. And that's it for this week's case study in the house call with Dr. Elizabeth Boham. If you enjoyed this mini episode of the Doctor's Pharmacy, please share with your friends and family on social media. Subscribe wherever you get your podcast and leave a comment. I'd love to hear from you. And we'll see you next time on the Doctor's Pharmacy.

Thank you, Mark.