Dr. Gajjar: I’d say I’m more the seeker, but I would say definitely a little bit of both, for sure. Yeah. So, my journey started being a normal GP in the UK. So, I did my conventional medical training in London and did some time in hospital medicine, and then really was drawn to general practice. I could never actually make up my mind which specialty I liked. I liked it all, and I liked what general practice offered with, you know, that talk-to-patient relationship, that continuity of care.

And yeah, so I embarked upon a career in general practice, and the model I was working in at that time, which still exists, but I was working in a busy inner city practice in London where the appointments were 10 minutes long, so it was literally just in and out. And initially, there was that excitement of being in general practice and everything, but as time went by, I just felt, you know, it was as if patients were just in and out. I was often just giving them medications, and it became, over time, quite frustrating and quite stressful as well, and, you know, this is obviously a common reason for burnout in many doctors as well.

The population that we were dealing with was also quite an, you know, area of different complex chronic conditions, ethnic minorities, language issues, addiction problems. So, a lot of quite difficult, complex, and chronic things to deal with, and I had an interest in different things. Like, I was interested in nutrition. I’d also done biochemistry as part of my medical training, so I had done a nutritional biochemistry component.

I was also interested in NLP and in coaching and a few different things, but I guess I never really knew where to take it, but I started just doing little courses. Like, I did a weekend medical acupuncture course and a CBT course for GP. So, I tried to dabble in whatever I could find that was available, and I tried to incorporate what I could into day-to-day practice. But again, even with that 10-minute model, it was quite challenging, and now and then I would try and extend the appointments, but even then it was still very much limited by time and I wasn’t really feeling that I was doing enough for patients.

But essentially, time went by and I had always loved to… The thought of travelling to New Zealand and Australia was always there. I had a lot of friends who had done six months or a year in New Zealand, Australia, and I just loved the experience. So, I thought, “Lemme just try that. Lemme just do a year in New Zealand, a year in Australia just to see what it’s like, get to travel, get to experience medicine in a different country.” And for me, the turning point came when I was here in Sydney. I was working as a normal GP, and I came across a conference in, you know, nutrition in medicine that had been organized by ACNEM, which is the Australasian College of Nutritional and Environmental Medicine.

So, I went along to that and I just loved the conference. I thought, “Well, I can’t believe there’s actually something here. This is just what I’ve been looking for.” And it was a fascinating conference looking at the role of nutrition in different chronic illnesses. And I spoke to other delegates who were doing further training with ACNEM.

So, later on, I decided to embark upon that. And then I also came across other similar organizations like the Institute of Functional Medicine that’s based in the states as well as the Lifestyle Medicine Association here. So, yeah. Coming here was definitely a turning point. The seeds were there, I guess, from being in London, and, you know, I also grew up in an Indian background where I was exposed a little bit better on herbs, hitting down then, but you know, it’s actually in the more recent years I’ve become more interested in all these other things.

Andrew: Right. I’ve gotta ask you, though, you finished your training, but then you thought, “I need to do more for my patients.”

Dr. Gajjar: Yes.

Andrew: Not common. It’s not commonly thought. And you have this openness to try different things. I’m gonna guess that you were that sort of kid.

Dr. Gajjar: Yeah.

Andrew: So, I wonder if there’s a big lesson that normal GPs can take away from this and just say, “You need to look further than what you think is the truth.” Because I was one of…though not a GP, but I was of that mindset. I totally disdained any sort of complimentary or integrative view. I used to actually tease somebody about it. Years later, of course, I had to go back and apologize profusely because I’d opened my mind. But you’ve obviously had this for quite some time. I’ve gotta ask you, you said the words, “Was I doing enough for my patients?” So, you have that constant honour to look after their best interest in whatever way possible. Did you see yourself very differently in your cohort, in your student cohort when you were learning medicine?

Dr. Gajjar: Definitely a little bit, for sure. I had that sense during medical school that, you know, in terms of that very mainstream approach in terms of just dealing with the symptoms and not really individualizing enough. So, you know, we do ward rounds where it was a case of this, it was a case of that. It wasn’t about the patient, it wasn’t their name. Yeah. It was quite odd if we’d look back to that, but it felt quite normal at the time. So, I had that sense of, “This isn’t quite right for me, but is medicine right for me?” So, I would have those questions now and then, for sure, even during medical school. And yeah, I guess I’d always kept that open mind and naturally found myself interested in lots of different things, and I’m still like that now. There’s still loads of things I’d love to learn, and if I didn’t have to work, I’d probably just carry on doing courses.

But I can certainly relate to what you just mentioned where I remember sitting in the clinic and, you know, patients who had seen their naturopath or some other naturopath practitioner wanted all these testing done and I’m thinking, “Oh, my God.” I would roll my eyes. So, you know, I was very much conventional at some point as well, but there were those seeds there. And yeah, I guess for me it had to get to that point of frustration and stress where I think something has to change.

Andrew: Yeah. It’s an interesting point what you’re saying about all these tests. And perhaps I’ll ask this now. It’ll stop me coming back and circling back to it later. What sort of lessons can we ask naturopaths to be aware of when requesting testing from GPs about the machine that you are in, about the restrictions that you face, that sort of ethical dilemmas, that sort of stuff?

Dr. Gajjar: Yeah. Yeah. So, I think it’s important to be aware that there are Medicaid guidelines, and ultimately, even though a practitioner can suggest to their patient that they see their GP and have all these tests done, it’s still up to that doctor because medical legally, they’re responsible. So, I think that’s a really important point. And if that particular GP perhaps isn’t as trained in integrated medicine and doesn’t realize the implications of certain nutrients or certain other markers that we use, zinc, homocysteine. They’re not your day-to-day ones. I mean, it’s becoming more aware. People are becoming more aware now, but, you know, ultimately, it is the responsibility of that doctor. And I think that that’s important to bear in mind. And yes, there are Medicare regulations, and if people go beyond that, then they can get investigated, and that does happen.

Andrew: That’s right. That has happened. So, for instance, you know, vitamin D is restricted from screening now unless there’s appropriate suspicion in a patient that they’re not getting enough sunlight. Vitamin B12 was taken off, I think that was 2015 or so.

Dr. Gajjar: Iron was the more recent one.

Andrew: Iron, yeah. So, there’s many things which have restrictions placed on GPs about the level of testing that they can do because of the viewpoint of orthodoxy. One that we’ll get into specifically has to do with thyroid testing, but let’s segue into that one now. What piqued your interest in Hashimoto’s thyroiditis?

Dr. Gajjar: Yeah, it was more… So, when I started working in a clinic here in Northern Beaches, which was my first job in I guess integrative medicine, I guess I started seeing a different cohort of patients than I would have in standard general practice, and at that time, I was also doing my academic training. So, not only was I getting exposed to more and more of these patients, but as I learned more through the foundation course and through the thyroid and adrenal modules and everything, I actually began to understand what was going on as well. So, I guess it was the sheer number of patients I started to see thinking, “This is actually a common issue and it’s not being dealt with.” People are coming in with, you know, symptoms of hypothyroidism or Hashimoto’s. They’ve been told it’s nothing, their bloods are normal, or they’ve been put on medication, but they’re still not feeling well, or they’ve had testing done such that the antibodies are positive, but told, “Well, there’s nothing, there’s no management for that except thyroxin in some cases.”

So, that, coupled with the fact that I was learning more myself and learning new biochemistry and physiology which hadn’t been covered in medical school, and, you know, this is all proper biochemistry and physiology of thyroid hormones and the T4 to T3 conversion and reverse T3, and I’m thinking, “Did I miss that lecture or?” But it wasn’t taught at medical school. And yeah, so realizing how common it was and what suffering it leads to, you know, people not feeling their optimal self with ongoing fatigue, and these symptoms that they’re suffering are affecting their day-to-day life in their personal life, in their work life, and wanting to really delve into what’s actually going on here. So, as I began to learn more and I was able to then impart some of that advice onto patients, yeah, I just naturally became interested in that myself.

Andrew: Right. I do take your point, and I’ll tell you what, I’m glad that you did biochem because as you say, I mean, there’s so much that isn’t covered that I’ve learned since. I mean, I love my Lehningers and my team of Flexibooks. They’re my saviour. And I love just looking up things when I thought I knew them, but it takes a new study to… I mean, this morning I was just thinking about what is a Beta-3 adrenoceptors? And what? I was like, “I thought there’s only two types.” So, things change as our knowledge progresses, but if we rest too much on our laurels, we run the risk of falling behind.

So, with regards to patients, you say you saw a different cohort. How do these patients present? You were saying that some of them were told by their… I’m gonna say it glibly again because it’s a bit of a joke, and their normal GP, and I guess I need to explain that because I laugh at myself because I was that orthodoxy. I was that sceptic, that person that dismissed complementary medicine out of hand with my total arrogance and ignorance without even contemplating that it might be useful. So, can I ask, how do your patients present both typically and atypically? Can you take us through some differential diagnoses?

Dr. Gajjar: Yeah, yeah. So, as we know, the thyroid gland controls so many functions and so potentially there can be hundreds of symptoms, but the common presentations that people will actually come in for often it’s fatigue, low energy, weight issues in terms of weight gain, or doing all the seemingly right things and still not losing weight. There may be hair loss and also gut symptoms as well, including, like, IBS-type symptoms or constipation reflux, and really nothing is really sort of found when they’ve been to their GPs.

But what we also find is on further questioning, there can be potentially many other thyroid symptoms that they may not have presented with, but on questioning they say, “Yeah,” they actually have dry skin or they do feel the cold or they have cold hands, cold feet, you know, ongoing gut symptoms. So, often a lot more is discovered on further questioning, but that’s a very typical picture.

Andrew: One of the questions I always ask is, “Are you the person at the party who’s wearing the jumper where everybody else is wearing a T-shirt?” And it’s amazing how common it is.

Dr. Gajjar: Yeah. Yeah. And it’s amazing how many symptoms that people normalize. Like, you know, many women normalize heavy, painful periods, and it’s like, “Well, no, actually that’s not normal,” but they’re just so used to it because that’s what their mom might have had, that their mom told them from the beginning that that’s just how it is. That’s just part of being a woman. Or gut symptoms and people often…you know, because they can just tolerate a little bit of discomfort here or there that they just almost learn to live with it. It’s not enough for them to present until it becomes a lot more.

Andrew: Great. And so, you know, you are used to medical management. Take us through some of the limitations that you just sort of hinted on with regards to orthodox medical management of Hashimoto’s.

Dr. Gajjar: Yeah. So, the main test for thyroid hormone is… Sorry, the main thyroid hormone test is the TSH, which is the thyroid stimulating hormone. So, that’s a pituitary hormone. So, in the guidelines that the GPs adhere to, you know, it’s the TSH that’s measured, and if that’s out of the range, then there is justification for the T4 to be measured. So, T3 or thyroid antibodies are not routine testing as such. So, there’s that reliance on TSH, and that’s partly why there are so many people with hyperthyroidism or Hashimoto’s that, you know, have not been diagnosed or treated adequately.

And the guidelines can vary. They are changing and slowly they are changing, especially in the states. But yeah, overt hyperthyroidism is whether TSH is more than 10, you know. And subclinical hyperthyroidism doesn’t necessarily need to be treated. So, the ranges are quite wide, but these are the guidelines that GPs follow.

Andrew: This is one of my consternations with orthodoxy, and that is that the condition either is or isn’t.

Dr. Gajjar: Yes.

Andrew: There is no pre-diabetes. There is no destruction of thyroid to the point where it may be affecting your body. You either have Hashimoto’s or you don’t. I should be more… You either have a thyroid problem or you don’t. There’s no decline. There’s a cliff.

Dr. Gajjar: Yes.

Andrew: Why? Why?

Dr. Gajjar: Yeah. Yeah. And as we know, there’s always those gray areas and medicine is very much…you know, it’s either extreme. And I guess the model on which, you know, mainstream medicine is built on is that acute model. It’s great for, you know, acute illnesses and emergencies. This is how you treat something. But given that we are seeing…you know. It’s chronic illness, much of it is lifestyle-related so we need a different paradigm. So, it’s a great model for acute illnesses and emergencies, but not so much for chronic illness. And this is where we need to have that shift in thinking.

Andrew: And you’re saying it’s shifting a little bit in the states, is that correct?

Dr. Gajjar: Yes. Slowly, slowly. And I’d say even here as well, you know, especially as more and more evidence is coming out. So, I think there’s a slow shift, for sure. It is happening, but obviously, it’s more so in the states.

Andrew: Yeah, way behind the times. So, are we finding that there is a shortening of the acceptable limits of normality, and then outside of that we need to be looking at or are we seeing that there’s a possible acceptance by orthodoxy that if it’s at the quite lower end of normal or the upper end of normal, that there is reasonable suspicion to look further?

Dr. Gajjar: Yeah. So, certainly, the guidelines have been changing in terms of the actual range of the TSH, so in most labs, up to about four is the upper limit. But having said that, even then we know that, you know, people can still have thyroid conditions even at a much lower TSH, and there isn’t necessarily as much appreciation of the fact that there can be, you know, other causes of hypothyroidism beyond the primary. So, you know, the TSH, for example, can be reduced because of stress, which is so common these days. So, that will suppress the TSH, and that also can mean that thyroid conditions don’t get picked up. Again, it’s in the guidelines, but I won’t say there’s as much of a pre-session of that in general practice.

Andrew: Right. From a medical-legal perspective, is it acceptable if anybody at GP, yourself, informs the patient that these other tests aren’t covered by Medicare or, you know, may cause issues professionally, and so you can ask for user pays? Is that allowed? Like, for instance, if you wanted to do a reverse T3 and a thyroid antibody test, can you say, “Look, this will get me into trouble, but you can do them if you are willing to pay for them?” Is that allowed? Are you okay to do that?

Dr. Gajjar: Yeah, that’s how most practitioners do. Yeah. And so the reverse T3 is a non-Medicare test anyhow as urine and iodine, so potentially the antibodies can be done under Medicare, but if there’s clinical indication. So, you know, when I’m investigating someone, monitoring someone, it’s important to put down that they may be on medication or they have clinical symptoms justifying that particular test. But sure, if some GPs are not comfortable with doing, for example, T3 or thyroid antibodies, that can be requested privately.

Andrew: Gotcha. Okay. But again, we get back to this issue. I’ve spoken to many patients who have been put on orthodox treatments, and they communicate with their GP or their endocrinologist that they still feel tired. They still feel like crap. Some of them are in pain. So, when is it appropriate for their medical practitioner to listen to them? That seems such a… What do you call it? A guided question. How do patients get the best outta medicine while still having the medical practitioner protected? What’s happening? There seems to be a disconnect.

Dr. Gajjar: Yeah. Yeah. And I guess this is how patients then filter onto us because patients have been to their GPs, they may have even been referred to an endocrinologist and they’re on the medication, but still symptomatic. Usually, it’s at that point where people, I feel, seek other help. So, they may go and see a naturopath, they may go and see a doctor. They start googling and looking into all the information that is out there. And I would say it’s how most patients present. It’s not initially, it’s when they’ve already, you know, had these symptoms for a long time and no one’s found the cause or, yes, they’ve been put on thyroxine and they’re still not feeling better, and that’s the point I would say people seek further help.

Andrew: Gotcha. Gotcha. Okay. So, let’s go into treatment. What can you add or use to help your patients that wouldn’t be offered in an orthodox practice?

Dr. Gajjar: Yeah. So, in terms of actual… Well, in terms of the general management, I always like to emphasize all the lifestyle things initially as a foundation because there’s so much evidence for different aspects of lifestyle to improve any chronic illness but it’s including thyroid conditions, for sure, so, you know, diet, sleep, stress management, knowledge and awareness of reducing environmental toxic load. So, all those lifestyle foundations are really important, and I think no matter whatever we are using in future, I think there always has to be that foundation. It’s something I always try and go through every consult as well.

If someone is already on thyroxine, if they have, for example, a high reverse T3 and a low T3, you know, it may be appropriate to add in additional T3 and to… There is a medication T3 Tertroxin that is available as a pharmaceutical medication, but that’s only prescribed by some endocrinologists and maybe some GPs, but it is quite a high dose. It’s a 20-microgram dose. So, if indicated, I would start very, very low on usually a compounded T3 personally.

Thyroid extract, well, it was the original treatment before thyroxin was available and that’s sort of bovine-derived natural glandular extract, and that can still be used and is still made by compounding pharmacy. So, again, that’s not for everyone, but if other treatments have been tried, then that is a potential treatment. And I find that in the majority of people who are changed over to thyroid extract, most of them do better because that’s giving them T4, T3. It’s giving them other nutrients and other thyroid hormones as well. Obviously, we’ve gotta be careful because it does contain iodine, and that can trigger autoimmunity as well, and some people can be quite sensitive to iodine as well. So, they’re the main treatments in terms of hormones.

In terms of supplements, there’s obviously various nutrients and herbs that can be used. And again, that will be very individual depending on what’s going on with the patient. Looking at the guts, obviously, that’s paramount with thyroid because, again, there’s a lot more evidence on the gut thyroid axis specifically as well.

There’s also other things that we can use. For example, there’s LDN, which is low-dose naltrexone, which has been shown to help to reduce antibodies, and it’s also been found to be beneficial in reducing pain in fibromyalgia and in rheumatoid arthritis, for example. So, again, these are not first-line treatments, but there are other considerations that we can look into as well. If people also have associated symptoms and illnesses like, you know, anxiety, insomnia, endometriosis, then there’s also some justification for potentially using medical cannabis, for example. So, the whole area of treatment is very individual to that person.

Andrew: Gotcha. Just one question about glandulars. With concerns ongoing with variant…yeah, what is it? Jakob-Creutzfeldt disease, is that right?

Dr. Gajjar: Yeah, yeah.

Andrew: Creutzfeldt-Jakob disease, anyway, mad cow disease. Are they an issue, or are we especially careful to use glands from animals in, like, Australia, New Zealand, and nowhere else?

Dr. Gajjar: Yeah. I mean, generally, I haven’t had any problems in terms of the quality and again also the compounding pharmacy that we use, you know. I would use specific ones that I know and trust. And so I think that also is important as well where it’s sourced from in terms of the local compounding pharmacy.

Andrew: Gotcha. And another one, low-dose naltrexone. There were controversies some years ago about doctors prescribing this for…you know. I mean, I think it started off with drug addictions, didn’t it? And then its use expanded and there was this pushback, there was this real resistance to doctors being able to prescribe it. Any issues there? Are you restricted in any way?

Dr. Gajjar: No, I mean, again, it’s not something I prescribe commonly, but it can be prescribed if indicated, you know, if there’s been ongoing chronic issues and, you know, many, many things have been tried. And because there is anecdotal evidence and also a lot of published research and more and more of it now that it can be helpful, then it’s at least worth a trial with the patient’s consent. And again, as with anything you’re always starting at the lower dose and working up as appropriate, and always doing it as a trial.

Andrew: Yeah. And I loved obviously what you said about lifestyle issues first, and you said earlier, right at the beginning, that you investigated cognitive behaviour therapy which it would’ve been interesting to see how many of your peers, your cohort were also investigating that, seeing how important it is and how useful it’s been shown. And I might say just even though Dr. Mark Donahue hassles me every time I say it, and he says, “It’s mindfulness.” But with regards to CBT or other mindfulness therapies, how much bang for buck do you get using them with Hashimoto’s knowing that one of the major issues or triggers of antibodies is stress?

Dr. Gajjar: Yeah. I think it’s so important for people to find something that works for them. And yes, there’s many different techniques that are available. I think, you know, there’s so much evidence now on the benefits of meditation. I sometimes quote a particular study done on a specific type of meditation where it was a 12 minutes a day, it was a mantra-based meditation which they studied over 8 weeks. And they looked at blood markers and the brain scans. They found that not only was there symptomatic improvement in mood and sleep, but it also switched on and off about 70 inflammatory genes, increased telomerase, anti-aging enzyme by about 43%. There were changes in the blood flow on the scan. So, to think that there was a 12-minute meditation and those results in an 8-week period is fascinating.

And I think you also have to bear in mind that sometimes when we’re meditating, we think nothing’s happening, but there’s so much happening in the background. And we know it feels good, but, you know, I still find it fascinating to read these studies because, you know, I mean, yoga and meditation is one of my passions, and it’s always interesting seeing all these new studies coming out because there’s so much going on in the background and it is just a case of that persistence and creating that habit, even if it’s two minutes a day, even if it’s just five minutes a day and cultivating that habit. It’s a great return on investment.

Andrew: I have to ask about the iodine and selenium, treatments available years ago, over two decades now. There was this thought of using this extremely high dose of iodine, massive doses, milligram doses.

Dr. Gajjar: Yeah. That 50 milligrams.

Andrew: Where has this led? What issues did we face? Not just medical legally, but also obviously the biggest one, patients? How did patients fare?

Dr. Gajjar: Yeah. I mean, certainly, I was aware that patients from other practitioners or through their own reading were taking high doses. I mean, I could certainly see the antibody levels go off dramatically absolutely, and people often would feel clinically worse. So, yeah, I’m quite conservative with that. I do like to measure the iodine and use as appropriate. And, you know, obviously, it’s a U-shaped curve. It is a very fine line. Like, yes, we need enough of it for thyroid, but also, you know, ovaries and breasts and, you know, all cells require iodine. But yeah, it’s about just being sensible with it as well. In fact, deficiency is still an issue.

Andrew: Yes. So, that’s where I was gonna lead to is we know that we need it. I mean, Creswell Eastman’s been tearing his hair out for years, but little he has left, but trying to get GPs to wake up to the fact that pregnant women require a supplement of 150 micrograms as well as food, because we just don’t have enough for the requirements in pregnancy. And what is it? The upper limit is 1100 micrograms, upper limit of normal. So, where do you tread there with regards to Hashimoto’s management knowing that too much might fire somebody up? Do you concentrate on foods like, you know, seaweeds, eggs, etc.?

Dr. Gajjar: Yeah. I think dietary as much as possible, and also monitoring as well. So, you know, if they are very deficient in it, then, you know, there can be justification to certainly optimize the diet, but potentially use a supplement. And as long as there’s… If we have selenium, another antioxidant on board, then that can reduce that oxidative impact of iodine. So, I don’t generally use iodine by itself but coupled with selenium and, you know, the patient having a good antioxidant status. Usually, that would be fine, but again, it’s small amounts and regular monitoring as well.

Andrew: Gotcha. I think it was a study by… I hope I get this author right, I’m hopeless with the years. I’m gonna say 2008 where selenium was used for thyroid orbitopathy. Now, obviously, that’s normally hyperthyroid, but is selenium a sort of buffer of safety margin, if you like, against iodine? Against the issues with iodine?

Dr. Gajjar: Yeah. And suddenly quite a few studies have shown that if we have adequate selenium, that can reduce the sort of the pro-ops and effects of the iodine as well. So, it’s always nice to sort of couple them and, you know, we know that selenium does reduce the thyroid antibodies.

Andrew: Gotcha. Can I also ask about the form selenium? There was, what, Margaret Rayman. I’m sorry, I’m weird on these things. Margaret Rayman spoke about, you know, the sort of accepted safer form of selenium was selenomethionine, but she also mentioned in an earlier paper that sodium selenite didn’t enter the enzyme pool, and so in some instances, it may be preferred. And I still get confused as to which one, therefore. Is it more effective because it’s more toxic? Is the safer one less effective? How do you wind your way through that one?

Dr. Gajjar: Yeah, I generally use the selenomethionine. So, I find the standard preparations, it seems to work well as well as obviously having that awareness of what’s, you know, found in the foods as well, so, you know, good old Brazil nuts. And obviously, that’s not that accurate, you know. There are so many factors there. It depends on the soil and the country. It’s not the rule that four Brazil nuts will be enough, but, you know, to still have that awareness that we’re still getting that through the diet as well.

Andrew: Wonderful. There’s so much obviously we can talk about and we can’t cover today, Amy. Thank you so much for taking us through some real practical things that we as practitioners can do to help our patients and indeed patients can do to help themselves. But where can we find out more?

Dr. Gajjar: Yeah. So, I’ve recently released a book called “Slow Butterfly: How Healing Your Thyroid Transforms Everything,” and that’s available through Amazon and other online stores. But that was written out of this experience and passion about how we need to be managing hypothyroidism, Hashimoto’s, you know, in a different way based on my experiences. So, you know, it’s really important to discuss those lifestyle aspects and have that awareness of different complementary therapies that can be useful as well.

Andrew: Dr. Amy Gajjar, thank you so much for joining us today and taking us through this. It’s very important stuff. Very common, all too common, and you obviously have a true dedication to finding out the real issues with what’s going on with your patients and helping your patients by individualized treatments. Thank you so much for joining us today on “Wellness by Designs.”

Dr. Gajjar: Great. Thank you, Andrew.

Andrew: And thank you, everyone, for joining us. Of course, you can catch up on all the show notes. We’ll be putting up a lot of references with this. It’s so important to capture as much information as we can, so the show notes and the other podcasts, of course, on the Designs for Health website. I’m Andrew Whitfield-Cook, and this is “Wellness by Designs.”