HHS 08 | Waist Size

 

While the goal is to live healthy, the process of weight loss is sometimes not as healthy as we would like it to be. We can be in our desired weight yet still be unhappy. Giving a solution to understand the right marriage of health and weight is Dr. Alan Christianson, a total authority in the space of health and wellness. Dr. Christianson gets down to the heart of it by talking about liver health and thyroid. He explains how the liver governs the whole picture, while giving his take on the debate of what comes first between the leaky gut and the leaky liver. He also touches on perfect TSH, glandulars, as well as the high dose iodine supplementation protocols. Ultimately, Dr. Alan gives out a form of measurement that identifies your health, which is the waist size as opposed to weight loss.

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Waist Size Not Weight Loss with Dr. Alan Christianson

I’m honored to have this phenomenal doctor, a friend and a mentor of mine in my town of Scottsdale, Arizona. We got Dr. Alan Christianson. Dr. Christianson is a total authority in the space of health and wellness and he’s written books. He’s got a very busy thriving practice and partners and such a notoriety. He’s been on all these different national TV shows as well and a leader in the holistic health space. Dr. C, it’s great to have you on.

Thank you, Jack Wolfson. That was a lot of cool stuff. Thank you so much.

The pleasure is mine to have you on. First and foremost, I want to get to the fact that you’ve got another book that’s sure to be at the top of everyone’s most-read list and need-to-read. Tell me a little bit about the book and what’s going on.

I’ve worked in endocrine care all along. My personal story was I was that kid with cerebral palsy who came across health experts and books and it will change my life radically from that. To this date, it seems that the people that I interact with, the biggest struggles are always between weight and appetite and energy. What I hear is that people understand how they could get some of those right, but not all of them right at once. If you deprive yourself and cut your food down enough, you can change the weight, but then energy and appetite go where you don’t want. Many people find that if they do their best to eat healthily or eat clean and eat intuitively, they could feel well and have good energy and have control of their appetite but they may not have their weight change in the way that they wanted to. The trick has been how to sync those up again.

Is that pretty much going to be the premise of the new book is going to be how to get all those three factors in alignment? What you’re saying is that you can lose weight but then you wind up unhappy, your mental health suffers and you’re constantly hungry.

When you’re healthy, we never get exactly the amount of fuel we need on a given day to drive our bodies. It’s never spot on. You can try harder but it will always be a little bit over and a little bit under. When you’re healthy, when your liver is working well, that’s okay. Your body will store that extra fuel pretty harmlessly and you won’t gain a ton of weight from that. Then the days where you get a little less than you would need, your liver would pull out some spare fuel to keep you going and you feel fine. We all do that already to some extent, but people over time can lose that metabolic flexibility and get to where they’re always falling off one side of that or the other.

I know I speak about this many times before and you are well-known as a thyroid expert, an adrenal expert and as you said, hormonal, but you always circled back to the liver. Can you explain a little more about the liver’s importance in relation to thyroid, adrenal, ovaries, testes? How does the liver govern the whole picture?

HHS 08 | Waist Size

Waist Size: We are better off having more nutrient density.

 

You’re always putting out good direct information. You’re very straightforward. Let’s be totally candid with the audience. My biggest concern is premature death for people. In many cases, people are happier to talk about something or sometimes some audiences were happy to hear about things that they relate to weight. The real thing behind a message in my mind is stopping premature death. That’s why I’m happy to be here with you because the most preventable premature death is cardiac death. I’ve seen a lot of evidence saying that one of the biggest predictors of premature cardiac death can be as simple as waist circumference like height to waist ratio. It’s a simple number. You want to have your waist be less than half of your height. If it’s not that, one of the main things that affect that is the liver size.

Some might have heard about the fatty liver syndrome and it’s a sleeping giant that we don’t talk enough about. I would argue that whenever someone has that stress with their metabolic flexibility, it’s some early issues the liver is storing too much fuel and not being able to draw out fuel properly. The pitfall is that there are these toxic cells that make compounds called adipokines, which are inflammatory chemicals. They raised the risk for heart disease and chronic diseases of all types. The liver is behind all that and when it works well, it juggles your fuel. It juggles your metabolism, it’s regulating nutrients. It’s making a lot of nutrients and amino acids. In a lot of cases, it gets compromised and it can’t do that job well. We talk a lot about the gut as being the center of health and I certainly can’t deny how important that is.

It’s a funny concept because your intestinal tract is outside of your body. As a doctor, you understand this but for many people, it sounds odd. Like if you had a big tube from your mouth to your butt. If I drop a chopstick in that tube, it would fall right through, it will not affect me. Your gut is no different, it’s just longer and narrower. When things cross your gut lining and come into your bloodstream, now they’re in your body and their first stop is your liver. Your liver got these Kupffer cells that are on alert. They are immune cells that are watching what’s coming in from the outside and tell your body whether it should be inflamed or blocked. It’s covering so much behind that.

We think about what is the primary problem everywhere? Is it liver health? Does the poor liver health lead to leaky gut? Does the leaky gut lead to liver dysfunction? Clearly, whenever you listen to some health authority over then they certainly make sense in a lot of cases which came first. A lot of things that I’ve read is that food items such as gluten, for example, are not a problem for someone that has a healthy liver, therefore healthy lymphatics surrounding the gut and the gut drainage. Gluten is not the problem, the problem is liver dysfunction. Maybe the first thing to do was a liver detox and a liver cleanse. Any thoughts on which one came first, the leaky gut or the leaky liver if you will?

It’s tough to say and it’s funny you said leaky liver because that’s an emerging term amongst diabetes research too. This is a slight tangent with the word when you think about that. We know that in many cases the things that go wrong with our health and that raise our cardiac risks and the risks otherwise, your waist circumference but also your blood sugar. There are a lot of folks who just know they’re type-two diabetic and many who are on a spectrum to where they’re heading that way. We used to think that diabetes was a problem between food and the pancreas, but now it’s only the cases that they’re calling it leaky liver in research. The livers got all this fuel and it’s not holding onto it. It can’t use it right and so it’s leaking out in ways that are harmful. Someone who’s in that continuum, we think about morning fasting blood sugar. You’ve talked to your audience about how normal is not good enough. You want to be a little better than that. We think somewhere around mid-’80s is probably healthy morning fasting sugar, not higher than that. Normal we say is up to 99, then pre-diabetes is 100 to 113. What’s going on when someone wakes up and their blood sugar’s too high? They didn’t just eat. It’s not that that meal is doing that. It’s that throughout the night their liver was trying to regulate their blood sugar but goofed up. It was pouring out too much and that’s why it’s high. It’s what’s behind this issue as well.

Liver health, when it comes to cholesterol for example, either the liver is producing too much cholesterol for a variety of reasons or it’s not able to reprocess the LDL particles that are coming into it for a variety of reasons. I want to talk about diabetes and I know you see this. We’ve got elevated blood sugar so we think it’s a problem with insulin resistance, yet we check serum insulin levels and insulin levels are not that high in some cases. Clearly, it is a beta cell pancreatic dysfunction as well, so not only is the insulin is being released, you can’t utilize it well, but the pancreas is not producing enough insulin either.

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It gets even more bizarre than that. Your pancreas has the beta cells that make insulin and the alpha cells that make glucagon. When it’s healthy, glucagon tells your liver to put more sugar out and insulin tells your liver to take more sugar in and a big blast of insulin should shut off glucagon. In many cases, there’s a trickle of glucagon coming out from the alpha cells and the liver over-response to glucagon. It turns out that for most people, insulin resistance is a healthy survival mechanism. I’m looking out the window, there’s the Sky Harbor Airport down there and I think about like you got a traffic and a lot of planes, too many planes that runways are busy and they say, “Just stay in the pattern. You can’t land.” That’s how I think about insulin resistance. There’s too much fuel in the liver, the muscles and the tissues, your body can’t process it. They say, “Keep those planes in the air.” You’re leaving all that stuff in the bloodstream which is not good, but it’s better than jamming it inside of yourselves and killing all your mitochondria. Insulin resistance is a healthy adapted safety mechanism from a problem with fuel overload.

In that yin and yang of the glucagon and insulin, is that the issue? There’s this circulating high glucagon levels that are going on. Just trickling out of the glucagon for maybe some reasons you can allude to. That circulating glucagon is shutting off insulin secretion from the pancreas.

A healthy model when the fuel states are lower, then the burst of insulin dose shut off glucagon. It’s all adaptation. The body is working with too much fuel in the tank. When there’s overloaded fuel, the body doesn’t respond. Over-response to glucagon doesn’t properly suppress it, but that’s not a mistake, that’s also a strategy because there’s too much fuel in it that burns that’s got to come out. It’s harmful to us to have high levels of fuel, whether that’s glucose or triglycerides, your ketones, your cholesterol, whatever fuel substrate. When there’s way too much of that in blood, that hurts our vessels and hurts our body as bad. To have way too much of that jammed inside the cells, that’s cell death. That’s like jamming on the gas and your engine never letting it stop. That’s fatal so it’s the lesser of two evils. We have all that stuff floating in circulation than it is to pack too much in. Your body is doing you a favor at the moment.

I know you have extreme knowledge of thyroid and written books. You discussed thyroid in a lot of excellent content on your blog and on the website and everything. Thyroid and heart health, give me your take on that.

HHS 08 | Waist Size

Waist Size: Everybody refuses to admit that we’re being poisoned from our environment and our lifestyle.

 

A lot of folks don’t think about that but you might even tell this better than myself. Framingham’s work is where he’s connecting cholesterol and heart disease. I’ve done a lot of research on thyroid tests and there’s a long history of things that were proposed and implemented and didn’t pan out. One of the earlier uses for cholesterol before Framingham’s work was tracking thyroid disease. There’s not a perfect relationship, but a very tight connection between somebody’s thyroid status and their cholesterol levels. A lot of folks that have normal thyroid levels, they could still have good, high, low whatever cholesterol that could still be off. When someone does have extremely underactive thyroid function, the odds of them having high cholesterol are much higher. On the opposite end too if someone’s thyroid is overactive, that can push their cholesterol levels lower. The connection there is the liver because the liver is a big part of producing the cholesterol.

People used to think that cholesterol was how many eggs you ate and as you’ve talked about with your audience, it’s a lot more than that. It’s how your body regulates the cholesterol circulation. Thyroid hormones are big regulators and they work via the liver and its production and circulation pathways. There are also a lot of data independent of cholesterol level saying that people who are bizarre thing but normal range but slightly on the hypothyroid side have much bigger risks of atrial fibrillation, also stroke, also congestive heart failure and early heart disease. The thyroid being still normal but just a little bit on the higher side. You can also see risks of overstimulation to the heart, especially more so the atrial fibrillation.

If we’re going to look at lab tests and thyroid, is there a perfect TSH that the holistic health practitioner and the holistic health patient should be aiming for? Is there a magic number that you like?

Some lab values are pretty well-thought through and the ranges are put intention into and some are more so just population averages. In thyroid scores, they tried to reform this back in 2003 and they proposed making it based upon targeted ideals and for a while, it was going to happen but it did not. To date, they’re still based upon population averages and the drawback about that, we got the Phoenix Suns, I’m in Phoenix and you go in their locker room and measure how tall the guys are, you can make an average out of that. You and I are normal enough size guys, but we would look like shrimps based on that population average. With thyroid scores, when you average the blood test, if everyone who gets thyroid tests, most of them get them because they’ve got thyroid problems. There’s not that many healthy people who go in everyday to good thyroid tests, it just doesn’t happen.

The biggest study that I’ve seen that carefully excluded those with thyroid problems, they saw that funny thing, you’ve got the TSH, the thyroid stimulating hormone then we’ve got the free T3 and free T4 levels. Free T3 and free T4 levels in healthy populations end up being about the same as they are for most reference ranges. However, the TSH is quite different. The TSH, it’s a goofy thing but it’s backwards when your thyroid’s underactive, the TSH gets higher. When it’s overactive, the TSH gets lower. In healthy people, the TSH runs a lot lower than it does in that normal range. Most labs say that 0.4 to 4.5 is normal. I’m not that old but when I started practicing, twelve was normal for the upper end so it’s changed a lot. In the study that I was referring to, there was nobody in this healthy population that has a score over 1.9 and even the 1.9 was an outlier. Almost all the scores fell between about 0.4 and 1.5. There may be some nuance for someone’s age or cardiac health. As far as general, what is optimal look like, that’s the best numbers that I think about.

It’s certainly interesting coming from a medical background and medical training. To see those different ranges and you would see people that are in the normal range yet seemed to be suffering profoundly from underactive thyroid symptoms. The cardiac ramifications go into your book as far as metabolism reset is concerned. This is all about thyroid, about metabolism, regarding cardiovascular health, cardiovascular markers, inflammation back into the lipids. If you don’t have enough of that thyroid hormone circulating around and it being able to be utilized by the cells, that’s where you’re going to have just circulating LDL, dysfunctional LDL particles, circulating around, becoming oxidized, damage and then targeted for immune destruction inside of the blood vessels.

Thyroid is so important. When it comes to thyroid health and thyroid supplements, what are your thoughts about the glandulars? My thinking before I ask you to chime in is that our ancestors used to eat the glands, like animals in the wild would eat the glands and now nobody does. I can stand up there and you can stand up there on stage and say, “We need to eat thyroid and adrenal and kidney and heart,” yet people aren’t necessarily going to do it. Maybe tell me about some supplements for the thyroid support and about thyroid glandulars.

You bring a good point that we’re better off having more nutrient density. People often focus heavily on foods that have maybe calories or macronutrients but don’t have that full range of micronutrients. The whole thing of nose to tail and broader range of organs can be a useful thing. Thyroid tissue in terms of food, it’s odd. We see reports being on then where this happens that we saw from the Middle East, sheep’s head, how this comes up, so sheep’s heads will be cooked and boiled. Some people end up getting a lot of thyroid tissue in a small amount of food and it’s like taking thyroid medicine as they get signs of over-activity. You hear about that now, but in general for sure the more you can have nutrient-rich liver itself, talking about the liver or organs in the diet. With the thyroid, there are a couple of nutrients you need that you can run lower in. Selenium is a big one. Selenium is odd, is that iodine is an essential nutrient, but it’s a double-edged sword. You can have too much or too little. People who are on thyroid treatment, they’ve got a lot of iodine in their thyroid meds. That coupled with some of the diets, there are a lot of times where they’re at risk for too much.

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What do you think about some of these health authorities that recommend massive amounts of iodine? I know you’ve got just a tremendous amount of experience in this arena. Those people that I would say certainly with my old medical hat on is an iodine overdose. That being said, these people, they’re well-published, they’ve got lots of credentials at the end of their name. What do you think about these high dose iodine supplementation protocols?

It’s sad, but I’ve learned about them because of all the people that were pushed into more obscure forms of thyroid disease and came to see me because of their high dose iodine supplementation. I end up doing tons of research and education with doctors on these topics. There are many that have taken high dose iodine and not get harmed for sure. Most smokers don’t get lung cancer, but it’s clearly a risk factor and this is a hard thing. It seems so intuitive that if your thyroid needs iodine and more iodine must make your thyroid better, but the body is so complex and so self-regulated. We always talked about like the C-shaped curve to where more of something can do something different than what little can do, and then more or a small amount might have completely different. In the case of iodine, I think about it like you’ve got a circuit breaker in your house, you’ve got to have fifteen amps going through the wiring. I’m not an electrician, that might be totally goofy but say fifteen amps were gone, your lights are out. You’ve got nothing going on.

Let’s say that same circuit has now got 100 amps, you’ll blow the fuse. That fuse is there so you don’t burn your house down. Your body has a thing called the Wolff-Chaikoff Effect in your thyroid. If you didn’t have a fuse and for some reason, you’ve got a lot of iodine, you would just pump out so much thyroid hormone that your heart will quit. Of all the things your body can triage, that’s the last thing it’s going to let happen. When there’s so much hormone that it hurts your heart, it’ll just shut off your whole thyroid and it’s off for weeks at a time. There’s a thing called Graves’ disease, which is where the thyroid is overactive and the most severe version of that is the hyperthyroid storm. The only way you can stop the thyroid when it’s bad or overactive is by giving mega dose iodine. It’s well-established that above some threshold, it stops the thyroid.

In your opinion, what is the reason for the thyroid crisis that’s going on right now, why so many people suffer from thyroid dysfunction?

The nuance always comes up is do we have more of this? Is there more awareness? Are we diagnosing it better? We’ve got a lot of numbers on autoimmune thyroid disease and also the thyroid cancer. Thyroid cancer has tripled in the last 30 years and new cases are not better diagnosis but definitely new cases. Autoimmune disease across the board is going up radically and we don’t have definitive answers, but your thyroid seems to be a canary in the coal mine in the story of environmental toxication. Pulling up iodine again, your thyroid needs more iodine than your bloodstream normally carries, so it pumps it in, all is good. The problem is, that pump snags a lot of junk floating around too. That can be perchlorate from your drinking water. That can be DPA from the nice new car smell from your car that you’ve got. That could be mercury from the albacore tuna that you’ve had or lead from the water supply.

Anyway, it’s never good to have these things anywhere, but your thyroid concentrates them. The cycle is that there’s some level of genetic susceptibility towards autoimmune disease and you’ve got some junk in your thyroid and then something stresses your immune system that might be exposure to mold or that could be another airborne allergy or an acute infection, hepatitis C. Now your immune system’s amped up, your thyroid is dirty and funky and you’re genetically susceptible to this and you’re attacking thyroid cells. That’s how the cycle holds together. We think there’s more disease because we’ve had more environmental exposure and it’s a pretty slow process. It’s pretty much like something that comes on most commonly for us in the 30s, 40s, 50s and 60s. We look back at what exposure we had 30, 40, 50, 60 years ago and we’re just now seeing the tip of the iceberg as far as how that plays out in thyroid disease.

HHS 08 | Waist Size

The Metabolism Reset Diet: Repair Your Liver, Stop Storing Fat, and Lose Weight Naturally

While that idea of the thyroid being the canary in the coal mine. That’s a fantastic analogy and how often do we hear this from the mainstream medical doctors that our diagnosis is getting better whatever the subject is, whether it’s a thyroid cancer or autoimmune, we’re just better at diagnosis. It’s like everybody refuses to admit that we’re being poisoned from our environment and our lifestyle but you’re right, I know you’ve seen this as well. Just the amount of young women with thyroid cancer is absolutely scary and we’re better at diagnosing, it is just craziness. One thing I know that my wife and I always get on is people using chemicals on their neck, whether it’s perfumes and colognes and how does that get into the thyroid? I understand the capillary drainage of the skin may not take it, but let’s say that it’s got to be some amount that’s there. The other is that as a huge proponent of sunshine like I am and you are. That’s one of the reasons why we live in Arizona versus Minnesota, I came from Chicago. The reason why we live there is the importance of getting the sun. The energy from the sun gets in there and jazz up the mitochondria and the fuel pumps create the ATP and all the magic that the sun does directly on that thyroid. Tell me more about the book. The Metabolism Reset Diet is coming out and tell me about it. Where’s your next bestseller? Where are we going with this?

I’m pretty excited because people have thought forever that they’ve got to live as dieters and that this is just what their lot in life is. The message here is that you can make a change in your body. You can flip the switch, now things work differently. I would never advise anyone to eat junk. Your diet is always hugely important, but you can reach a point where you don’t have to micromanage every bite. You’ve got some leeway to eat healthy food. Stick with the things that Dr. Jack was telling you about, but you can reach a point where if you have a few bites more, a little more here, a little less there, it wouldn’t have to affect your weight and your waist size. That’s the real promise and the transformation behind the book is it’s going to get to where you’ve got not so much like it’s a ramped-up metabolism, but a healthy, flexible metabolism that can maintain waist size, energy and give you a reasonable appetite. The book has a four-week program that walks someone through how they can take their bodies and understand if this is relevant to them and then come out on the other end too where they got that leeway back.

Typically, it’s targeting waist loss as much or more than weight loss and that seems to be a better predictor of health outcomes, cardiac health and better longevity. People often have a lot of weight loss too, but my real excitement is when they tell me that I was down like three and a half inches over the course of 28 days. That’s huge because I know what that means for the long-term health and the long-term arc of their life. Then afterwards they can have good foods and not be stressed and not living life like dieters anymore and to be able to have a better variety of healthy, good and clean foods. It’s a beautiful thing to see. We kicked it off first off for treating diabetes in our practice and so many had the side benefit of this whole reset to metabolism. We watch, we measure resting metabolic rate and we’ve seen that shift and it got to be a popular thing amongst the staff and patients who are not diabetic. We realized this is something that a lot of people struggle with. If they’re aware of fatty liver or not. If your waist is more than half of your height, this is probably happening to you. If your appetite and energy and weight don’t sync up, this can be one of the big reasons why and you can change that.

As far as the importance of waist size as opposed to weight and weight loss, we’re looking at waste lost because we’ve all seen people that, “I’m following the plan, I’m doing great, but I’m not losing weight.” What they’re doing is they’re gaining healthier body morphology and therefore their weight stays the same but their waist decreases. How do people follow their waist? Is this as simple as like, “My jeans are smaller size,” or are you recommending people get the tape measure out and take a look? I’m sure you make some recommendations in the book as far as how that’s all going to be monitored.

It’s super important and you’re spot on and in the book, I encourage to track the metrics. One of them is resting heart rate too. I’ll come back then you second because this is all your field, that the protocol there is our adult height doesn’t change a lot. You probably know your height pretty close off at the top of your head. It might have changed since you measure it’s been a while, but know your height and your waist. Wake up in the morning, have a good bowel movement, empty your bladder, before you had food or anything, let it out. Take a deep breath in, don’t hold your belly in and just measure your waist circumference right around your belly button. Take that number and compare that to your height. Now the other thing I have people track and we see change during this for many is their resting heart rate. In a lot of cases, cardiac stress can be from just stress through the liver.

Your body is pushing your blood out and it’s going everywhere and then it’s coasting back. In that coasting back, your liver is the bottleneck. Those that have liver disease, we can see that there’s a lot of back pressure and veins conform and whatnot, but for many that are not at that point, there’s still enough fuel buildup and physical structural change in the liver where it ends up making their heart rate change and there’s poor lymphatic return as well. We’ll see a good shift for those who have morning heart rates, resting heart rates that are not as low as they ideally would be. I’ve seen a lot of data saying that that’s also a big predictor of long-term mortality. Of all the many other things that can affect that related to cardiac health, a lot of people see that improved just from having their liver get freed up again and getting a better metabolism back.

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In order for the body to maintain blood flow, to get the job done in the body, you need good pumping, you need good cardiac output, squeezing the blood from the heart to the rest of the body. The blood has to come from somewhere and it’s coming back from the body through the venous system and that bottleneck is the liver. If the liver is not healthy, therefore you’re not getting enough blood flow coming through the liver back up into the heart and therefore the heart has to increase its rates to get things going. Before we started the show, you talked about how do you bring this all back to heart health? It summarizes that all of us get pigeonholed into, “It’s heart health and liver health and it’s thyroid health. Yet the principles that you mentioned in all of your writings and all of your teaching is about the natural way to get your body healthy. When your body is healthy, all these things start to recover.

The big goal is to have a long, healthy, enjoyable life. Maybe in our lifetime, we’ll see some radical technology that changed the discussion, but the short of that the main way to do that is to hit your genetic potential and not die young. There’s this whole mixture of metabolic syndrome issues that involve diabetes, cardiac risk factors and they eventually lead to heart disease as far as the way people are cut short. This is one more way to think about how to cut that pool of stressors on that metabolic risk.

Fantastic information as always, Dr. C as he is affectionately known by millions across the world. Dr. C, tell us how to find out more about you and about the book and anything else, all things Dr. C.

The easiest source for all that is DrChristianson.com.

From there, they’ll get information about the book and your practice in Arizona. I know that the associates you have who are working with you, the other doctors that are there, just a stellar group of people. I can’t even imagine how many people want to work at your clinic and in your office. Yet you seem to select out the best of the best, people that care, people that are like you, just looking at you aesthetically, people that talk the talk and walk the walk. That is so important.

I’m blessed to have an awesome team and we focus on thyroid care. It’s wonderful to see changes that are possible when someone can get their health back again.

Thank you so much, Dr. Alan Christianson. Thank you so much for tuning in.

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About Dr. Alan Christianson

HHS 08 | Waist SizeI’m Dr. Christianson, NY Times best-selling author & Naturopathic physician, father of 2 kids, and happily married to the woman of my dreams for over 20 years. You can call me “Dr. C” for short.

I believe:

  • Vibrant, joyous health is your birthright. Even if you’ve been at a dead end for decades, things can still get better. I’ve been through that. Never give up or never settle for anything less.
  • Your health is in your hands. Conventional medicine is there to help trauma and acute illness. It is not effective for reversing or managing chronic diseases.
  • You can heal more than you might think possible. Radical health transformations are possible because your body is always regenerating itself. To change every atom of your body, you just need to improve the nourishment you take in and maximize your ability to eliminate wastes.

Your health is a matter of fact. Your treatment is a matter of opportunity.