Does the thought of managing pregnant patients with Type 1 Diabetes give you the chills? In this episode, Colleen is joined by Lemma Brown, a Registered Dietitian, mother of two, and type 1 diabetic herself, who shares her invaluable personal and professional insights to ensuring a healthy pregnancy . Lemma Brown is living proof that it's possible to have a healthy baby while managing this chronic condition as she provides us with a trimester-by-trimester blueprint for pregnant diabetics.
Today, you'll learn:
You won't want to miss the end with Colleen's Nutrition Notes segment where she reveals 3 of the most frustrating nutrition recommendations that make dietitians cringe. This might be a gut-check for some of you, but it's crucial to tune in. You definitely don’t want to be the one spreading misguided nutrition advice to your patients.
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Welcome back to the Exam Room Nutrition Podcast where each week, I'm giving you answers to common nutrition questions to help you become a more compassionate, confident clinician. I'm your host, colleen Sloan. I'm a registered dietitian and pediatric PA. Type 1 diabetes poses its own unique nutrition challenges, but today we're going to be talking about a specific group of people with type 1 diabetes, and that's pregnant women. According to the American Diabetes Association, in 2019, nearly 1.9 million Americans have type 1 diabetes, including about 244,000 children and adolescents. Today, you'll learn how type 1 diabetes affects pregnancy and specific nutrition tips your patients should know for all three trimesters. I'm super pumped about this topic and this conversation Today, and my expert is not only a registered dietitian, but she's also a type 1 diabetic who has navigated to pregnancy successfully. So it is a joy to welcome Lemma Brown with me today. She is a registered dietitian diabetes expert and holds a master of science degree in nutrition, with over 10 years of clinical nutrition experience. She's lived with type 1 diabetes for over 15 years. Struck by the lack of pregnancy-related resources, she embarked on her own pregnancy journey, realizing the need for support. So today she aids individuals virtually, both individually and in groups, navigating type 1 diabetes during pregnancy. You can follow her on Instagram at type 1 diabetes nutritionist and we will link up to her website and Instagram page in the show notes below. Lemma, I'm so excited to have you here. Welcome to the show. Thank you, colleen, for letting me be here with you. I'm so excited for this topic and I love when my guests not only have professional experience in the topic we're discussing, but also personal, because it really really helps make your suggestions and guidelines that much more impactful. So I'm super pumped to get into it today. So, real quick, give us kind of a little diabetes 101 and break down the difference between a diet and the differences for type 1 diabetics versus type 2 diabetics and why we need to counsel these patients differently.Lemma:
Sure, I actually think there can be several differences between someone who has type 1 diabetes and type 2 diabetes, but there can also be a lot of similarities too. When it comes to type 1 diabetes, these patients are taking insulin In some way. They might be taking it through injection or they might have an insulin pump system that they're using. Type 2 diabetes in some ways is a little more complicated, because these patients could be taking an oral medication, they could be taking a combination of oral medication and insulin, or they could be taking insulin, which actually makes them a little more similar to people who have type 1 diabetes. And I feel like, when it comes to diet for type 1 diabetes, if the patient has a good grasp of how insulin works and has a good grasp of carbohydrate counting and a good understanding of how nutrition and different types of food can impact their blood sugar as well as taking insulin, they can really eat pretty freely. I think it really depends on the patient, but I really think in my experience working with patients who have type 2 diabetes, it really depends on their medication routine, really how their diet maybe needs to be reinforced or even educated, because sometimes oral medications may not keep up with or cover the types of foods that they're eating or the amount that they're eating. So sometimes diet has to be, I think, a little more strict in patients who have type 2 diabetes, depending on the medication they take. But if they have a combination of medications, diet can maybe be adjusted, or maybe they can be a little bit freer, or we can even play around with things, or providers can play around with things, depending on the medication. So I think that something is actually more challenging about type 2 diabetes, because it can actually be a little more complex than maybe it seems.Colleen:
Which is interesting. You say that because I feel like most clinicians kind of are a little bit more nervous and with a lack of a confidence around managing type 1 diabetics. So that's really interesting that you said that type 2 kind of has a little bit more nuances, because it makes sense when specific medication isn't really targeting that food that they're eating at that moment. So very interesting. All right, so you're the pregnancy expert in type 1 diabetics. So how does pregnancy affect our blood sugars?Lemma:
Gosh. Well, it really depends on the trimester, pregnancy, I think. I think we often hear about gestational diabetes and that during pregnancy because it's definitely more widely known Type 1 diabetes and pregnancy is definitely affects a pretty small group of people. But when we're talking about just type 1 diabetes, pregnancy and blood sugar can be different depending on the trimester. So I think we often hear about high blood sugar during pregnancy. It's something that my clients bring to me that they're most fearful of high blood sugar during pregnancy. But usually in the first trimester of pregnancy with type 1, we may actually see lower blood sugars because there's a lot going on in the first trimester. A lot of things are happening and it actually causes sugar in our blood to be used more effectively and that can actually cause low blood sugar more often because we're actually using glucose and actually using insulin a little bit better than maybe we normally do. So sometimes insulin needs need to be cut back, maybe even quite a bit during the first trimester in type one diabetes and sometimes during the second trimester. That actually levels out quite a bit. I hear from many clients that they weren't expecting that the second trimester at least some of it might feel sort of easy. Now, it's not like this for everyone, but there are times that my clients will say I don't have low blood sugar and also I'm not experiencing this high blood sugar. I thought that I was going to experience things feel a little bit predictable and easy, maybe for a short term during the second trimester, and then during the third trimester, that's when this insulin resistance that maybe we hear quite a bit about or patients bring into offices talking about. I'm really fearful of this insulin resistance during pregnancy. It usually starts mid to end to beginning of the third trimester and that's when things really get kicked into high gear as far as blood sugar management, because insulin resistance can be such a bear during pregnancy and it really is a short time during pregnancy. What type of diabetes? But when you're in it it feels long, it feels forever and it often means that insulin needs may have to increase double, maybe even triple, maybe even more. I've even had clients who have gotten to the end of the amount of insulin they can take and they've had to switch to a stronger dose of insulin. That's a little bit more high impact. Or they might have to take an oral medication to help combat this insulin resistance, because you never know how your body is going to react to pregnancy, and it just gets so difficult that in order to manage a tight blood sugar range, they just might have to take a different medication or more medication. And it's certainly not any fault of the patient I'm sure that they're doing their best to manage it. It's just our bodies are in this high stress situation and the third trimester of pregnancy can often be very stressful because of this, not only on their body, because a lot is happening during pregnancy, but it's stressful because patients may be working really hard to manage this condition, plus manage all the changes of pregnancy, and it can be quite challenging.Colleen:
Hey, we'll get back to the episode in just a moment, but I wanted to give you a gift for hanging out with me today. I wanna give you access to a free guide that gives you a step-by-step strategy to navigate a talkative patient. You know the one who rattles off 10 different concerns the minute you say so how can I help you today? I've been there, trust me. So I created a simple framework called STEER that will allow the patient to feel heard and keep you on time. The patient will feel respected, their concerns will be addressed and you won't be constantly running late. In this free PDF, you'll learn this simple acronym to guide your conversations and I have included useful phrases you can use that will completely transform the way you talk to your patients. It's all free and it's my way of saying thank you, so check it out in the show notes below. Now let's get back to the episode. Yeah, I mean, pregnancy in and of itself is a true miracle. You know you're just a human that is literally creating a human inside of you, and now we have that added component of blood sugar management and I can imagine that it's quite overwhelming for patients. You mentioned that insulin resistance and elevated blood sugar is kind of a big concern among type one diabetic either people who are trying to get pregnant or who are pregnant. What else are some concerns that we should be aware of as a clinician that we can just be a little bit more compassionate to and just help walk them through that in the first stages of pregnancy or maybe in the pre-pregnancy planning stages?Lemma:
I think providers often throw a lot of factual information related to risks of diabetes and pregnancy at clients and patients and it's scary, and of course it is and I'm not saying to not share this information, because of course it needs to be shared. It's incredibly important. But I think there's also this other piece that's sometimes missing, like hey, I know this sounds hard and this sounds scary, but I'm here as the provider. I'm here to help you and help support you through this, because I'm sharing this and you tell me how it sounds and what you're thinking and what you think you need to get over this hump of this potentially like scary sounding information.Colleen:
Oh, I love that. That's a really, really good take home piece of advice for some wording that we can use, because, you're right, it's really important to present the risks to patients so that they can make an educated decision. We don't wanna shy away from that, but doing it in that compassionate, open dialogue way that's powerful, all right. So you mentioned that the different trimesters affect the blood sugars differently, so let's move into those three trimesters of pregnancy, starting with the first trimester. So, specifically, we wanna get into the nutritional aspect and foods that these patients should be eating, shouldn't be eating, what is happening to their blood sugars and specific things that clinicians need to be aware of.Lemma:
regarding the first trimester, Sure, some things to consider with the first trimester are some things that we already know. Typically, calorie needs don't necessarily increase during the first trimester, but there are some things to consider. Of course we want blood sugar management to stay as close in range. So the range I'm referring to that I use is from the American Diabetes Association, which is 65 to 140 at the highest milligrams per deciliter for blood sugar. That is typically the range that is encouraged to stay within 70% of the time or more during pregnancy. But during the first trimester of pregnancy there are just so many other factors to consider. There's potentially nausea during the first trimester or potentially even vomiting. So of course we want to try to encourage this staying within this range as much as possible. But there are other factors to consider. Potentially the patient could be throwing up everything that she's eating and she's really trying her best to maybe eat more protein and to manage her blood sugar and to eat a wide variety of foods that include lots of nutrients, but she may be throwing up everything she's eating or the site of a particular healthy food maybe fruits and vegetables just turns her stomach. So we have to also remember to be flexible, like yes, of course we want blood sugar to stay within this range as often as possible, because we know that typically leads to better outcomes for mother and baby. But this person is having a hard time eating anything and we know that nutrition is vital during pregnancy. So really just navigating how to help this person eat the right amount of nutrients certainly take a multivitamin daily if they're not already but also focus on foods that maybe don't make her, don't make her not feel well. Maybe she needs to focus on foods like smoothies for a while, or foods that don't have an odor that turns her stomach. Or maybe there's comfort foods that like a peanut butter and jelly sandwich that maybe isn't the most helpful for blood sugar management in this patient. Maybe it is, maybe it's okay, but it makes her not feel sick. So sometimes you have to be a lot more flexible in the first trimester and, like I said before, sometimes blood sugar is a little more forgiving in the first trimester if this patient's dealing with lows. So a lot of times things even out. So it's something else to consider too. I know often we're very focused on the blood sugar numbers, but sometimes you have to look at the whole picture too. Like this person that eating anything. Of course, her blood sugar maybe either lower, within range, but then she's not getting the nutrients that are the most helpful. So hopefully that answered your question about the first trimester.Colleen:
Yeah, super helpful, and I mean I've had a child. First trimester is a beast for whether you've got diabetes or not, and that you know that nausea, that vomiting, that is not fun. So I can see that it's a big impact on blood sugars too, so that was really helpful. All right, let's jump into the second trimester. So what are some target points that we need to be paying attention to? What types of things should we be asking our patients? And then specific nutrition interventions that we might open discussions with our patients.Lemma:
Definitely. I feel like with the second trimester, like I mentioned before, sometimes during this time there's a little bit of some breathing room for a few weeks. It seems like it's a little bit easier to keep this blood sugar in balance, in range, sometimes a little bit easier, but it often is really short because insulin resistance can sometimes start kicking up around week 20. So in the middle of pregnancy it could be earlier for some patients it could be later. So certainly, supporting patients wherever they are in their journey, because it's really different for everyone and just continuing to encourage if they are continuing to have nausea and vomiting which sometimes it subsides during this time, which is nice if someone was dealing with it before and then encouraging maybe that catch up in nutrition. If they weren't able to take their prenatal vitamin, definitely start taking it again or potentially continue taking that. Plus. Make sure that you're taking in the right amount of nutrients, the right amount of calories, fluid as well. All of those things can also help keep nausea at bay if it's something that might creep back in, but also to ensure that they're taking in enough nutrition to support healthy self but also a healthy baby. As far as I was saying before, sometimes blood sugar can be a little bit easier to manage during this time, but it's often short-lived. I often encourage patients to just take each day as it comes during this time and prepare for the storm, because the resistance is coming. I think it's better to be prepared than not prepared, because sometimes the resistance is not as scary and yucky as we think and sometimes it's easier. I often think it's because patients prepare better. Maybe. Prepare for this. Resistance is coming, we know it is. Get ready for it. We're here for you when we need to make adjustments as far as your insulin, as far as, potentially, your eating. Know that we're here for you, but get ready for it. Rest now and then get ready for what's coming.Colleen:
That's excellent. I love that piece of advice. Now a lot of moms deal with some food cravings, especially first and second trimesters. I'd like to linger here a little bit and talk about managing some food cravings. Is it okay that if she wants some ice cream, can she have ice cream? Talk to us about maybe some of those high sugar foods and things that they're craving and help us educate them if it's okay for them to have it or not.Lemma:
Absolutely. I think this is a great question. I definitely talk about it a lot in my line of work when it comes to cravings. Sometimes they pop up, sometimes they do for a variety of reasons. When I talk to clients about cravings it comes in stages like okay, well, what are you craving? If you have a really specific craving? I know when I was pregnant with both of my kids, I had specific things that I wanted. Sometimes With my son, I remember, because he's my youngest, I remember this really clearly I just really, really wanted a cheeseburger. I wanted a specific one from a specific place and nothing was going to change my mind. I really wanted this. I did the best I could with it. I managed my insulin and my blood sugar the best that I could. I corrected as needed. I understood that things might get a little bit hairy as far as my blood sugar, but I was ready for it. But I also knew if I didn't honor this craving, it was going to keep bugging me. I think in that situation, if a patient has a specific craving, I just really want this specific thing. I just really want an ice cream cone from this place. I want this flavor. I'm going to get one scoop. I think there's a way to manage that and get out and skate, though when it comes to I just want something sweet, a lot of times we can explore other options. I want something chocolatey. It's like well, do you want chocolate or do you want something chocolatey? Because there are a lot of chocolate options that are actually pretty easy to manage. As far as blood sugar, like chocolate-covered almonds, like a chocolate frozen yogurt bar there are lots of options available that are pretty mild on blood sugar. If it's a general craving, there's probably something else we can fulfill it. But if it's that specific cravings, I had a patient who was like I just want a cheese, danish from the specific place. It's like, okay, that's a different story. Let's honor that and move on, because a lot of times we can work through that craving, that specific food, and, of course, get out of it pretty unscathed. But if it's something general, there's probably a way to honor it in maybe a more blood sugar balancing way.Colleen:
That's awesome. Yeah, you got to still live and enjoy food and enjoy life too at the same time, because, you're right, those cravings then just don't go away. Now you're just a miserable pregnant lady, so I think that's super important. So, again, I want to stay here for just a minute. We really understand blood sugar control regarding those foods that are maybe sometimes that we try to avoid or that we want to really monitor closely for those spikes in blood sugar. Now, with the same recommendation I hold true for a type 1 diabetic pregnant woman as others who are managing their blood sugar. So if we're going to have a really sugary snack or a high carbohydrate, should we also recommend that they still pair it with a protein just to prevent that spike in blood sugar? Or is it okay because we've got insulin on board?Lemma:
I think absolutely. I think food pairing across the board is really helpful for anyone who is managing or dealing with diabetes in daily life. I think it's incredibly helpful and, of course, as providers, we all know that spikes and blood sugar are not helpful and they're not healthy if you have diabetes. So trying to prevent them or try to mitigate them is definitely something that we should encourage, and food pairing, which is pairing a carbohydrate with a protein, fat and fiber, or maybe just one of those things, can potentially be helpful in preventing a high blood sugar spike. We'll still probably see a rise in blood sugar, but it might be a more steady rise that doesn't drop back down, just kind of rides itself out very smoothly, and that's often really ideal for managing diabetes, not just in pregnancy but in everyday life in general, excellent.Colleen:
Thank you, because I think that's a really important educational piece that clinicians can provide to their patients when they are trying to figure out snacks or sweets or something like that to really better maintain their blood sugar control. All right, so we're going to move into the beast of pregnancy, like you've keep referring to. The storm is here. It's the third trimester, so help us navigate this tricky area and just give us the nutrition facts and educate us on how we should educate our patients during the final hump of pregnancy.Lemma:
Absolutely. The third end of the second and most of the third trimester is usually when insulin resistance really kicks up into high gear, and that is a normal part of pregnancy. It is what we see in gestational diabetes as well. Some people are able to get through this period and it doesn't impact them the same way as if a woman or a person has diabetes. But because of the natural processes of pregnancy and surging pregnancy hormones, it causes insulin to just not work as well as it would normally and it's just something to consider that does occur during pregnancy. It is very normal. It's something that is challenging for most, but maybe isn't challenging for all. All the patients I work with are super scared of this and I was too and, like I said earlier, I think it's really important to share the facts of. This is probably something you're going to deal with in some level. Some deal with that and really struggle and maybe have to take lots more insulin or maybe add an additional medication. Some only see a mild difference in what they're typically doing. Some things to consider are that it is manageable if you're aware of it and you're prepared for it and, of course, you have the right support system behind you with your provider. You also as an expert in it and can handle whatever is needed. Something to consider nutritionally from what I found and working with clients and with myself, is it doesn't necessarily mean that you have to change your entire life in order to manage insulin resistance. You may have to do some swapping and switching throughout the day, but I found in both of my pregnancies, once I sort of got a grasp on what was happening, I could actually eat fairly normally, like I normally would, didn't necessarily have to cut out carbohydrates or eat a very low carbohydrate diet, but I did notice that there may be there are some trends maybe to the surge of hormones that might be going on during pregnancy. For me I had more of a surge in the morning and then things sort of leveled off during the day. So I kind of changed what I was eating in the morning and ate less carbohydrates in the morning because I knew that it was easier for me to spike in the morning. But throughout the day I could be a little more lenient with myself because things had kind of calmed down a little bit in my system. So that could be something to look for. Is there a trend with your hormone surges? Maybe it's later in the day. Like I said, food pairing is something that can be really helpful during this time, because sometimes what we see during insulin resistance is blood sugar will spike and it will just stay high for hours. It's really frustrating to see. Providers don't like to see that either. Patients don't like to see it. It's scary. So if we can try to prevent that spike by pairing, potentially like if a patient likes a slice of toast or half of a bagel in the morning, pairing that with an egg and maybe some greens and maybe some cream cheese as a fat source could potentially prevent that spike from happening and certainly blood sugar will go up, but maybe not as much, and stay steady, but more in range, rather than having a high for several hours, which is just not ideal in pregnancy.Colleen:
We have survived the first, second and third trimester of pregnancy Thanks to you. You have been so informative. I think this has been so helpful and I love how you approach it with such ease and calm, because when we're dealing with a pregnant mama, that's really important right. They're already super nervous, super anxious, excited, so there's all these emotions involved with it. So I think that is so beneficial and so helpful to just be prepared for what's to come and constantly educate them and like okay, we've made it through this, this is what's coming next and I'm here for you with that. So I love that you made that suggestion throughout every trimester. Now I love to finish our discussions with like kind of a worst piece of nutrition advice that clinicians can give to their patients. So I love to hear that from you, like what is the worst thing that maybe some of your patients have told you, that their doctor told them, or just something that you think every clinician needs to stop saying this to patients who have type 1 diabetes and are pregnant or are planning to get pregnant. Thank you.Lemma:
I think, as far as and this has probably been said before, maybe on this podcast, but definitely on social media just in general, I think one of the worst pieces of advice often providers are sharing are just cut out this specific suit and it will make everything better. Cut out all white suits. Every time I hear that I just can't help but it makes me cringe because it's just not true. It's just not true. I think, and I'm sure you might agree with this too the longer that you work with patients, clients and working in healthcare, working in clinics, things are just not as simple as they seem. I think it's best to maybe, if something seems simple it's usually not Maybe just restrain. We all want to give that simple piece of advice to take home, but it rarely goes very far. Maybe, if you're feeling that, just restrain and share something else or potentially refer if you have a dietitian you're working with, just refer to the dietitian, because those simple pieces of advice, they just really aren't helpful for hardly anyone. It's hard to hear, as a dietitian as well, when I get patients coming into my office like, oh well, that's not true. I wish people would stop saying that because it's just again, it's too simple and they're complex conditions, so simple advice just isn't going to cut it.Colleen:
I can't agree with you more. It really does make me cringe when I hear that too, when patients will be like, oh, but the last clinician said I should stop eating this or I have to completely avoid carbs. You said and it's just wrong, bad, inappropriate, really harmful advice. Thank you so much for that. You're right. I think as clinicians we do that, really not trying to harm patients, but because it is simple. It's like an easy piece of education. It makes sense. People can understand, like cut out all white things. We know what those things are, but in reality it's really not appropriate and not helpful. I think the take home point today, especially if you're going to try to be managing blood sugars and carbs, would be like what you had said Pair those carb foods with a protein, fiber or fat. If you want to give any educational piece, I think that would be the best. Like you said, patients are complex, with or without diabetes, with or without being pregnant, and put those two together. They're extremely complex. Every patient is different. Every patient needs a case by case guideline and education and 100% if you have a dietitian work with them. If you don't find one like Lemma, you can follow her on Instagram at type one diabetes nutritionist and I highly recommend you do. Her content is so super helpful and so valuable. Lemma, thank you so much for being with us. This has been such a joy. I can't give this time back to you, so thank you again for being here.Lemma:
Thank you so much for having me. I love being here.Colleen:
All right, guys, now it's time for my nutrition notes. In this section, I will leave you with a nutrition tip and encouraging quote or an interesting case that I think might add value to your day. So I thought it would be fun to leave you guys with a few nutrition myths or nutrition recommendations that are out there that drive dietitians crazy. So Lemma had alluded to one of them that says that, oh, just cut out all white things in your diet and you'll be okay. So many of these things that are out there, whether it be on social media or any kind of health gurus that are recommending, drive dietitians crazy. So I wanted to leave you with a few more to maybe gut check yourself, because if you're the one saying these things, please stop. So number one that I hear a lot is that fruit has too much sugar. That is completely false. That is a horrible recommendation. Please don't tell any of your patients, whether they have diabetes or overweight or not, that they need to stop eating fruit because it has too much sugar. Fruit has naturally occurring sugar in it, called fructose, and we all hopefully remember from school that our body needs sugar to function properly. Our body utilizes sugar for energy. That is a fact. So the sugar that's found in fruit is not all the same as the sugar that's found in your sugary coffee drink or in a donut or in a pastry. It's not the same. Would you be recommending that your patients avoid refined sugar or processed foods? Absolutely. Those things can add to excess calories, it can increase their risk for diabetes and overweight and all the other things. But fruit has so many additional beneficial components in it and nutrients in it that you're recommending your patient just completely stop eating. Fruit is loaded with potassium. It's loaded with antioxidants. It's loaded with vitamin C that can help your immune system. So please stop telling all patients that they need to stop eating fruit because it has too much sugar. This is just false. All right, the next myth or the next nutrition recommendation that I hear out there that just makes me cringe inside is that juicing is a great way to lose weight. Please stop recommending juicing. It is not a great way to lose weight. It is not healthy, it does not provide long lasting results and it might potentially be very harmful for your patient. Number one it doesn't provide enough calories. If you've listened to any of my podcasts before, you know that you need calories and you need to be eating well if you want to lose weight and you need calories from all three of the main macronutrients carbohydrates, protein and fat. What is juicing? Juicing is a very high carbohydrate diet because it is literally just juice which is just a carbohydrate. So talk about blood sugar spikes and what follows a spike is a significant crash. So these patients are gonna be having mood issues, they're gonna be having headache problems, they're gonna be having gut issues. So it just opens Pandora's box to cause a lot of other issues. So please stop recommending juicing, because it is not safe, it is not beneficial and it is not healthy. All right, I got a couple more for you because, as you can tell, I'm really passionate about this. So the next one is that gluten-free is the healthiest diet, or that everyone should go on a gluten-free diet, and this just isn't true. Again, please stop giving blanket recommendations to all patients, because all patients are different and they all don't need to be following a specific diet like a gluten-free diet. But just because of food is labeled as a gluten-free, it doesn't automatically mean that it's healthy or better for you than the counterpart that has gluten in it. So think about the processing of foods when a manufacturer has to remove the gluten from a product, well, they have to fill it up with something else and to improve the taste, to improve the texture, the shelf life. So in order to do that, oftentimes gluten-free foods will tend to have higher amounts of sugar, higher amounts of fat and sometimes higher amounts of salt as well. So, again, not everybody needs to be on a gluten-free diet, and just because you are following a gluten-free diet doesn't necessarily mean that you're eating any healthier than someone who's not following a gluten-free diet. Well, guys, thank you so much for being here with me. I really cannot express just how grateful that I am that you're listening, that you're hanging out with me, and I hope that I'm presenting really valuable information for you. So if you have any questions that you would like me to have a dietician feature on this podcast, I would love to hear from you. You can send me a message at Xamarinnutrition If you haven't already. Please share this podcast with your colleagues. I would love for more people to gain some valuable insights that would impact the way that they practice and then the way that they care for their patients. As always, guys, let's continue to make our patients healthier, one Xamarin at a time. I'll see you next time.