Episode 29: Dr. Aminah Keats, ND on Preventing Cancer and Improving Outcomes with Naturopathic Oncology
Show Summary:
We have all been affected in one way or another by cancer but do you know what you can do to prevent cancer and treat it in a holistic manner?
I am Dr. Andrew Wong, co-founder of CIH. This is a podcast dedicated to transforming the consciousness around what it means to be healthy and understanding the root causes of disease and wellness.
This conversation with Dr. Keats is about root causes of cancer, what we can do to prevent cancer, and how Dr. Keats works with her patients to optimize their plan in treating cancer.
Whether it is for you or someone you love, join us to empower yourself with tools for cancer prevention and treatment.
Timestamps:
0:00 - Introduction
2:06 - Why Dr. Keats became a naturopathic oncologist
4:40 - Types of cancer Dr. Keats works with
5:25 - Root causes of cancer
6:57 - Story of patient success
9:39 - What can we do to prevent cancer?
11:18 - Insulin resistance and cancer
12:55 - Vitamin D and cancer risk
14:06 - Why is cancer prevalence increasing around the world?
15:10 - How Dr. Keats works with patient’s cancer treatment team
17:37 - Key screening tests
19:28 - Diet recommendation for cancer prevention
22:20 - Stem cells & cancer treatment
23:42 - Coffee & Alcohol impact on cancer risk
25:51 - Dr. Keats’ morning routine
26:53 - Dr. Keats’ book recommendations
27:54 - What Dr. Keats does for joy
28:39 - How to work with Dr. Keats
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Full Episode Transcript:
SPEAKERS: Dr. Andrew Wong, Dr. Aminah Keats
Dr. Keats:
Naturopathic Medicine can help with maintaining and improving quality of life as they're undergoing you know, chemotherapy and radiation especially because you know, as you can imagine one of the the main concerns is how am I going to respond to this treatment in terms of the side of that kind of profile and so I've had patients you know, expressed great gratitude around that and even medical oncologists I've you know, received feedback in terms of how impressed they are and nurses as well in terms of how patient may tolerate treatment.
Dr. Wong:
We've all been affected in one way or another by cancer whether it's us personally or whether it's our family members, our friends but do you know what you can do to prevent cancer, how to treat it in a holistic manner? Today, we are joined by Dr. Aminah Keats for a really important conversation on root causes of cancer, what we can do to prevent cancer, and how Dr. Keats works with her patients to optimize their plan in treating cancer. Dr. Keats is a naturopathic oncologist who helps her patients to implement personalized natural strategies alongside their conventional oncology treatments.
I am Dr. Andrew Wong co-founder of Capital Integrative Health. This is a podcast that is dedicated to transforming the consciousness around what it means to be healthy and understanding the root causes of disease and wellness. Whether it is for you or someone you love, join us today in really important episode to empower yourself with tools for both prevention and treatment of cancer.
Welcome to this episode. Happy to see you here.
Dr. Keats:
Thank you for having me.
Dr. Wong:
Yeah. So as I think our audience knows you are our naturopathic oncologist here at CIH and you've been here for a while now, correct?
Dr. Keats:
Yes, since 2015. Time flies.
Dr. Wong:
So, we would say you are a OG then. Gotta throw that in there. What motivated you to become a naturopathic doctor and then specifically specializing in naturopathic oncology?
Dr. Keats:
Yeah. You know, I get that question often. When I was a senior in college, I was at Spelman College in Atlanta and majoring in a Biochemistry but really kind of lost at the time in terms of specific career paths and so luckily, I picked up a local newspaper one weekend and I saw where a naturopathic doctor which I had never heard of before was offering a class in basic herbs and nutrition and so I took it and as soon as I took the course, I was immediately connected to it and drawn to it and from that point on, I just actively pursued it, looking for all the the the universities that offer the program which are not very many, about five or six in the country but that's how I stumbled across it. I had never heard of Naturopathic Medicine before. And then, I actually didn't start naturopathic medical school until maybe gosh, maybe five years after that point so it took me a while to kind of land there but once I was there and I was in maybe my third or fourth year, I had an advisor who recommended that I look into an Integrative Oncology residency program and I hadn't thought about it before but I looked into it and it looked really interesting and I applied and I got in and as soon as I started to see those patients, and you know, work with those families and learn more about not only you know general kind of oncology but integrative oncology and kind of the role that it plays, I just instantly just connected with it.
Dr. Wong:
Yeah and Oncology whether it's conventional oncology or integrative or naturopath oncology, it kind of meets people where they're at the most vulnerable, right? The patients and their families so there's a lot of care that goes into that.
Dr. Keats:
Yeah, yeah. And in that, you brought up a really good point there because the the main thing that really drew me in and that I continue to really appreciate is the opportunity to really connect with people in that space that is very special and unique and I think that's probably what I love most about it.
Dr. Wong:
Yeah. Let's go into some of the questions about cancer because you deal with patients that have cancer, they might be at high risk of developing cancer or they might have had a cancer treatment already and trying to prevent cancer secondarily. What are some of the types of cancer that you work with? Let's just start with that.
Dr. Keats:
Sure. So really, all across the board, I don't do Pediatric Oncology so Adult Oncology only and I see patients with a diagnosis or history of solid tumors so that could include breast cancer or pancreatic cancer, colorectal cancer and then I also work with patients who have hematological cancer diagnoses so that could be leukemias, some multiple myelomas. non-Hodgkin's lymphomas. Hodgkin's lymphomas so it really varies.
Dr. Wong:
So, there's different types of cancer, you named quite a few there, what are some of the root causes of cancer? Are there different, unifying, or several root causes that kind of unify some of these cancers in terms of what's causing that?
Dr. Keats:
Yeah, definitely. So, you know, there's you know, obviously not one answer for that, right? But there's definitely a number of different contributing kind of factors so a small percentage I would say well, a smaller percentage would be more of a genetic or a family history kind of risk associated with a number of different cancers, probably most of them, but a small percentage there but other things will include things like viruses, could include lifestyle kinds of practices so that can be nutrition. Nutrition actually plays a big role when it comes to cancer risk whether we're talking about reducing the risk or increasing the risk, physical activity, environmental exposures whether that be through the foods that we eat or agricultural kind of toxins depending on you know, where we're living so it really depends.
Dr. Wong:
Yeah, yeah. There's so many factors and I think how they all interplay together and you know, can lead to this immune dysfunction we call cancer is really interesting. I think we're all trying to still kind of figure out that but there's been some inroads for sure. Can you share a patient's story I think a lot of our listeners may appreciate you know, how a naturopathic oncologist may work with say conventional oncology and with the patient and their family in terms of how working with the patient helped to improve their outcome?
Dr. Keats:
Yeah. So, you know, there are definitely many stories that kind of come to mind but I would say and I'll share a specific story but I would say in general, what I find that patients appreciate is how naturopathic medicine can help with maintaining and improving quality of life as they're undergoing you know, chemotherapy and radiation especially because you know as you can imagine one of the the main concerns is how am I going to respond to this treatment in terms of the side effect kind of profile and so I've had patients you know, expressed great gratitude around that and even medical oncologists I've you know received feedback in terms of how impressed they are with how and nurses as well in terms of how patient may tolerate treatment. The other advantage with that is that it reduces the risk of treatment interruptions in terms of conventional care so for example, if a patient is receiving a certain chemotherapy that is causing nerve damage or you know, another side effect that may be very debilitating, if we're able to recommend things to help to counter those then we can make sure that a patient is able to complete that whole kind of integrative plan of care. Now, in terms of a specific kind of patient story, there was actually a recent patient that I was working with with breast cancer, hormone receptor positive breast cancer, and she had to go through a lot of treatment. She had to undergo surgical resection, she had to undergo chemotherapy radiation and then hormonal therapy and once she finally completed chemotherapy and radiation treatment you know, she expressed great gratitude in terms of just the side effects if they weren't as severe as she had anticipated. She was able to maintain her work schedule, she was able to maintain her responsibilities to her family, her social obligations and so that's probably the main thing that I receive in terms of feedback. The other thing is that there's a really significant role for cancer prevention when it comes to naturopathic oncology care and in conventional care, there's not much of that there and so when there's an opportunity to do that, I think that patients feel really empowered you know, to put things into action and to follow the laboratory results to see objective evidence that what they're doing is is actually working.
Dr. Wong:
Thank you. Speaking of cancer prevention, you know we know that the lifetime risk on average for both men and women of developing cancer in their lifetime is about 40 now they're estimated and that's a huge staggering number of people. What are some of the key things that we can do that all of our listeners, ourselves to prevent cancer?
Dr. Keats:
Yeah. So, you know, what I always like to emphasize is that we do have control. There's a lot of things that we can do and so, some of those important pillars that I'm sure you share with patients as well is number one sleep, right? So, sleep is something that I'm guilty of neglecting from time to time but sleep is major so that is a prescription in itself, very important when it comes to supporting immune function and reducing the risk of a number of different cancer types like breast and lung and pancreatic and so many others. The other thing is going to be what we put into our bodies. Nutrition is huge, right? So, the dietary piece, the sleep peace, stress management, physical activity, having joy in your life consistently, carving out protected time to enjoy the things that you love and social interaction too. I mean I think that a lot of us will neglect that as well because our lives become so busy but social interaction even outside of you know, the the cancer kind of consideration is associated with you know longevity so really just making sure that all those important pillars are in place are really important factors when it comes to cancer prevention across the board.
Dr. Wong:
Thank you. And going to nutrition, we've seen kind of over and over that hyperinsulinemia which is basically an elevation that insulin level can drive some of that risk of cancer and instantly leads to cell growth and proliferation, things like that so can you kind of comment on the relationship between insulin as a hormone that we need for our bodies to help get the blood sugar and ourselves but then also if it's too high or there's an insulin resistance, is there a relationship between insulin and cancer?
Dr. Keats:
Yeah, absolutely. So, insulin is definitely not an absolute enemy. I mean our bodies, ourselves, require it but when the levels become too high for example from increased sugar intake as you said, it can act as a growth factor and it can become problematic and it's actually been found to be a growth factor for a number of different cancer types and so when it comes to treating active cancer or even preventing cancer, it's important to make sure that the diet in general is at the lower end when it comes to carbohydrate intake for that reason mainly.
Dr. Wong:
And would you say that for anyone or just people that have like blood sugar issues, they're overweight, and things like tha?
Dr. Keats:
Well, definitely a stronger or more aggressive kind of strategy for those who are diabetic or pre-diabetic or just kind of at that time high normal range in terms of glucose levels or hemoglobin a1c levels or even fasting insulin levels more aggressive for that population but outside of that I would say in general, watching carbohydrate intake is going to be important especially when it comes to processed sugars.
Dr. Wong:
Got it. So, thank you. And then along with that, I think that there's another question I think that people have about vitamin D. Vitamin D is associated with meaning like higher levels of vitamin D are associated with many different you know, potential health benefits at least in terms of association. Is there an association between higher levels of D and reduced risk of cancer?
Dr. Keats:
Yeah, definitely. So, you know, we find in the literature that optimal levels of vitamin D are associated with a reduced risk of a lot of different cancer type also associated with reducing the risk of cancer recurrence and so making sure that vitamin D levels are being tested on a regular basis so that we're dosed appropriately and kind of individually is definitely important too when it comes to cancer prevention and prevention of so many other chronic conditions as well.
Dr. Wong:
Yeah. I've heard a level of 50. I mean where are you in terms of a level?
Dr. Keats:
Yeah. You know what, I like 70 to 80. That's kind of my sweet spot.
Dr. Wong:
Okay.
Dr. Keats:
Yeah, yeah. So and you know, I always emphasize you know, you don't want to randomly just start taking 2,000 or 5,000 international units a day. You want to have your levels tested to make sure that you're dosed appropriately.
Dr. Wong:
Tests, don't guess, right?
Dr. Keats:
That's right, that's right.
Dr. Wong:
Yes. And we kind of touched on the fact that there's a pretty high lifetime risk of developing cancer across you know, populations. Why are cancer incidents and prevalence rising around the world really?
Dr. Keats:
You know, that's a really good question. I think there are different reasons for that. I think a lot of it has to do with just kind of environmental shifts and environmental kinds of exposures and then also, I think it has a lot to do with dietary kind of intake, what kind of foods we're eating and then also depending on kind of you know, where you're where you're living, kind of what that culture is like, stress levels as well. I think that stress levels are obviously at a high and so I would say those are probably three of the main factors why we're seeing that shift.
Dr. Wong:
Great. Thanks. And then, I guess the other question that I think that a lot of listeners would really appreciate is just kind of differentiating or how you kind of work alongside conventional oncologists, right, oncology and like what did they do and I think you've kind of delineated what you do but if you could just explain a little bit of the difference there and then how you work together with them in a more detailed way?
Dr. Keats:
Yeah, sure. So, with the work that I do, I often do communicate with the patient's medical oncologist or radiation oncologist to make sure that everyone is on board, right, all the the kind of care providers for the patient should be connected and should be aware of what you know, the patient is doing and you know, with the conventional medicine, it's more around killing the tumor, right, so whether that's chemotherapy or targeted treatment or surgical kind of resection or radiation treatment and then my approach is again more so around side effect management but then also immune support, cancer inhibiting support and then once once treatment has ended talking about detoxification protocols possibly depending on the patient and also a stronger kind of strategy toward cancer prevention.
Dr. Wong:
Great and and this is a question that if you want to think about this one, I think about you know, relationships, right? We always think you know, there's always relationships that can form between you know, different types of doctors so how has it been for you and the community in terms of working with a conventional oncologist? Have it been pretty kind of understanding or open to naturopathic approach in general?
Dr. Keats:
Yeah. So you know, most of the years in my career, I spent in a hospital setting working alongside surgical oncologists, radiation oncologist and medical oncologist and now that I've transitioned into private practice you know, I would say that it has shifted a little bit obviously because we're not under the same roof but in general, most of the medical oncologists that I reach out to and communicate with are open to the work that we're doing especially once they understand the rationale or even you know, if there are research studies that show you know taking this particular therapy may improve survival or may have a synergistic effect with what they're doing but you know, I think the key is really around communication.
Dr. Wong:
Yeah, yeah. That makes sense. Communication solves a lot of issues, right?
Dr. Keats:
Oh, yeah. Definitely.
Dr. Wong:
So, let's go to general care, to primary care you know, I'm a primary care doc and you know, we do primary care here at CIH so we always talk about cancer screening. So, let's talk from your perspective about what cancer screening test do you recommend for people and and you know, what are some of the key tests that you would say are really important here?
Dr. Keats:
Yeah. So you know, just in terms of screening, the basics that are recommended like you know mammograms you know, of course the the age of onset for the starting the mammogram depends on the patient, their age and then also to have a high risk of breast cancer versus a lower risk but definitely that and then sometimes breast MRI depending on the patient when it comes to screening for breast cancer of course you know, colorectal cancer screening of course. That age has been moved down or to an earlier point as we most of us know and then of course pap smears just in terms of those standard kind of screening tests. Now, additional labs are important, right? So, our basic CBC for example and metabolic panels can actually provide us with some information so for example with hematological cancer, sometimes we'll see abnormalities in white blood cell count and platelet count for example which gives us clues in terms of taking next steps but then from more of a terrain centered kind of approach, I also like to look at other things like inflammatory markers, you mentioned insulin. That's another big player. Vitamin D is going to be important to monitor as well and so really just taking all those things into account and of course, we also have to take into account a patient's personal history if there is any personal history of cancer there. We're definitely going to be more aggressive when it comes to the screening kind of guidelines and recommendations and of course family history too.
Dr. Wong:
Let's go back, thank you. Let's go back to nutrition for just a sec because I think people also may want to know about is there one diet to follow? I think I know what your answer is going to be but is there one diet to follow for preventing cancer? What are some of the dietary principles that you would kind of promote with your patients?
Dr. Keats:
Yeah. So you know, with functional medicine and with naturopathic medicine, everything is individualized, right? So to answer your question, no there's not one diet for every patient but I would say some general kind of guidelines for most patients would be low carb, low sugar kind of intake. Most cancers actually thrive and proliferate from elevated levels of glucose and insulin and so that's usually the case across the board in terms of recommendation and then lots of organic plant-based foods especially are low kind of carb like vegetables so you know, leafy green vegetables cruciferous family of course, allium family. Those are really the power players so those would probably be the the main kind of things that I point to and then of course just clean eating across the board, right? So, no processed foods, no foods with artificial kind of a color or flavor, no high fructose corn syrup you know, just being really cautious in terms of reading the ingredients and maintaining a clean diet and then you know, in terms of individualizing you know, it depends on how well a patient is tolerating certain foods. Some patients are not able to tolerate certain foods, some patients are so really kind of drilling down to that point when it comes to individualizing the diet but I would say those are probably the primary guidelines that I recommend.
Dr. Wong:
Real food will be the real health. Franklin foods maybe to franklin cells, is that?
Dr. Keats:
Yeah, absolutely. Clean eating is a very important key.
Dr. Wong:
And what about organic foods and you know, where you want organic foods and how important that is?
Dr. Keats:
Yeah so definitely organic and you know, organic foods can be expensive sometimes and sometimes, it can be difficult for patients to get access to organic foods depending on where they're living so you know, when it's more difficult or challenging, I recommend using the dirty dozen list produced by the environmental working group is kind of like the prioritized vegetables and fruit to purchase organically but and then also when it comes to animal proteins so whether that's you know beef or poultry items making sure that they're they are organic as often as possible is going to be important when it comes to prevention and even active treatment.
Dr. Wong:
Okay. Got it, got it. And then I think we have question too about, just wondering about cancer stem cells. Can you kind of talk us through what cancer stem cells are and maybe ways to to you know, eliminate those from a perspective of say someone has a diagnosis of cancer, they're getting chemo, let's say they're getting radiation, is that getting the cancer stem cells that might be generating more later down the line? That would be interesting.
Dr. Keats:
Yeah. So you know, unfortunately, chemotherapy and radiation treatment and you know, the conventional therapies aren't good at targeting the stem cells. Those are kind of the the parents of the cancer growth there so they're not good at targeting those cells but there are certain supplements that may be beneficial for targeting that so when it comes to actively treating cancer or even preventing cancer you know, there are definitely certain nutrients that I recommend like berberine for example. Berberine has so many different kind of health advantages, blood sugar regulation as well, antimicrobial but definitely some literature showing that it may have the advantage of attacking those stem cells. Also, things like resveratrol can be potentially helpful in that regard as well so that's another opportunity where naturopathic medicine can kind of kind of fill that gap.
Dr. Wong:
Now resveratrol, when people hear that, they might think about red wine or are we talking about drinking a whole bottle of red wine or what are we doing here?
Dr. Keats:
Oh, probably not.
Dr. Wong:
Probably not. Okay. Just to clarify.
Dr. Keats:
Sounds good but no. In supplement form is definitely ideal in terms of getting an optimal dose.
Dr. Wong:
Where are you with alcohol and also, I wanted to ask about coffee as well. Any data on coffee and cancer risk?
Dr. Keats:
Yeah. So you know, I actually came across a recent study showing that coffee can reduce the risk of certain cancers specifically breast cancer so I don't advise patients to discontinue coffee. However, if they're doing like 50 ounces a day of course, you need to you know kind of take it back a little bit so I would say organic coffee just because that that crop tends to be higher in pesticides so organic coffee if we're talking about one to two servings a day, I think that's fine and of course it depends on what you're adding to it too so not adding sugar to that so maybe like an unsweetened plant-based creamer and maybe adding spices to it for some extra kind of antioxidant support like cinnamon or even tumeric or cacao powder so that's my take on coffee. And then, of course, if a patient is sensitive to caffeine, you want to be cautious about timing with coffee just because you know caffeine has such a long half-life but what was the other thing that you said?
Dr. Wong:
Alcohol.
Dr. Keats:
Oh yeah. So, alcohol definitely increases the risk of many different cancer types so we have to be careful around that so my recommendation is ideally to eliminate it but you know, for some patients, that's you know, they may have an attachment, that may be a thing for them especially when it comes to socializing so I would say you know, definitely in moderation so for example, maybe one to two times a month something like that but definitely minimizing it because again it is associated with increasing the risk of many cancer types but alcohol can can also impact sleep too just like caffeine can so we want to be careful about that point as well especially when alcohol is taken during the evening hours.
Dr. Wong:
Plus alcohol has sugar so then, we're going back to that insulin.
Dr. Keats:
There you have it. And that's probably one of the reasons why it increases the risk. Absolutely.
Dr. Wong:
Thank you, Aminoh. We have some fun questions for you now if you don't mind.
Dr. Keats:
Sure.
Dr. Wong:
I know you have a family and probably have a routine so do you have a morning routine and if so could you share that with our listeners as a as a healthcare practitioner?
Dr. Keats:
Yeah, sure. So, my morning routine varies from day to day, kind of depends on who's up and what's going on. I do have a seven-year-old so.
Dr. Wong:
Nice, nice. Yeah.
Dr. Keats:
But most of the time, I like to have quiet time in the morning for at least five to ten minutes. If I can have more, that's wonderful. If it's a bright sunny morning, I love to take a walk early in the morning or I might just jump on my trampoline for five or ten minutes just to kind of you know, get me going but those are probably my the the main things that I do kind of in rotation in the mornings.
Dr. Wong:
That's a great idea. Do you have a trampoline brand recommendation or something like that?
Dr. Keats:
You know, I'm not sure that the brand. I'm not sure but I love it. I actually bought it maybe about six months ago and I love it. I love it.
Dr. Wong:
I think that's really good for detox, you know?
Dr. Keats:
Yeah.
Dr. Wong:
Shaking your cells and getting stuff out of there. All that.
Dr. Keats:
Definitely
Dr. Wong:
What book or podcast are you enjoying the most right now and what is it about and why are you enjoying it?
Dr. Keats:
So, there's a couple. So, I've been listening to the Barack Obama's audiobook and that's been nice because I really appreciate his optimism and it's also interesting to see what happened behind the scenes as he was running for president. That's always interesting and I'm also listening to verbal advantage because I like learning new words and then it's you know, way that I can kind of share different things with my kids in terms of how to increase their vocabulary and I also started listening to ‘The Secret’ just for you know, some optimism and positive energy.
Dr. Wong:
Oh, nice. That sounds good. I should check that out.
Dr. Keats:
We all need it from time to time.
Dr. Wong:
We all do need hope and optimism. Now, is Barack Obama narrating that personally in that audiobook?
Dr. Keats:
He is which makes it even better.
Dr. Wong:
Okay.
Dr. Keats:
Absolutely.
Dr. Wong:
Yeah. That totally makes that.
Dr. Keats:
That's what drew me actually, yeah.
Dr. Wong:
Right. Awesome. What do you do every day to cultivate joy? You talked about joy as one of the key pillars of you know lifestyle and wellness.
Dr. Keats:
So, laughter. I laugh every day without question. I laugh every day at least once or twice, probably more than that and then exercise so I'm committed to laughter and exercise and those are definitely prescriptions for me for sure.
Dr. Wong:
Yeah. Laughter is definitely one of the best medicines. A laughter yoga teacher was recently telling us that children laugh like three to four hundred times a day.
Dr. Keats:
Yeah.
Dr. Wong:
And I think having children, I can attest to that.
Dr. Keats:
Oh yeah. Absolutely. I can. Same here.
Dr. Wong:
It's good to laugh with others, that laugh as well, you know? It's really so good for the system. The nervous system, the immune system. Well, thank you so much, Aminah. Thank you so much Dr. Keats for being on today. How can listeners learn more about you and work with you?
Dr. Keats:
Sure. So, on social media I’m at Dr. Aminah Keats on Facebook and Instagram. Of course, I'm on the CIH website. Clubhouse, I'm at Dr. Aminah. I have a facebook group called Integrative Health and Oncology if you'd like to join and my website is Dr. Keats drkeats.com.
Dr. Wong:
Thank you. And I heard I think from another podcast that you were recently elected to be the VP, correct? I think one of the organizations. Can you talk a little more about that?
Dr. Keats:
Yeah, sure. The oncology association of naturopathic physicians so yeah, recently joined maybe about three or four months ago or so and yeah, it's been a very unique and exciting experience you know, kind of doing the the behind the scenes planning of different things so I'm excited for the opportunity.
Dr. Wong:
Awesome. Well, congrats for that and look forward to seeing you in person sometime when all this is getting more back to normal and thanks so much for being on and for those that are listening.
Dr. Keats:
Thank you, Andrew.
Dr. Wong:
Yes, you're so welcome and thank you for listening to all of you out there. If you enjoyed this conversation, please take a moment to leave us a review. It helps our podcast to reach more listeners and don't forget to subscribe so you don't miss our next conversations. Thank you so much for being with us today and we'll talk soon, Aminah. Thanks so much.
Dr. Keats:
Take care.
Dr. Wong:
Thank you for taking the time to listen to us today. If you enjoyed this conversation please take a moment to leave us a review. It helps our podcast to reach more listeners. Don't forget to subscribe so you don't miss our next episodes and conversations and thank you so much again for being with us.