SPEAKER_02: 0:01

Welcome to the Healthy Matters podcast with Dr. David Hilden, primary care physician and acute care hospitalist at Hennepin Healthcare in downtown Minneapolis, where we cover the latest in health, healthcare, and what matters to you. And now here's our host, Dr. David Hilden.

SPEAKER_01: 0:19

Hey, everybody, and welcome back to episode 19 of the podcast. I am your host, David Hilden, and let me ask you something. Have you ever tried to concentrate on work or school with a little rumbling in your stomach? Imagine doing that every single day. For thousands in our community, that's not just a passing moment, it's a daily reality. So on today's episode, we're tackling an issue that's as vital to our healthcare as any prescription I could ever write, and that is food insecurity. We'll talk about what it means, why it matters, and what we here at Hennepin Healthcare in Minneapolis are doing to make sure make sure no one has to choose between filling a prescription and filling their pantries. Joining me today are two powerhouse voices in this conversation. We have Dr. Diana Cutts, Chair of Pediatrics here at Hennepin Healthcare. She's a nationally recognized leader in connecting the dots between child health and nutrition, and she's been championing this work long before it was on anybody's radar. Also joining us is Amy Harris. She is the Population Health Director at Hennepin Healthcare, and her work is all about building healthier communities, one program, One partnership and, yes, one meal at a time. Diana, Amy, welcome to the podcast.

SPEAKER_04: 1:24

Thanks, David. Glad to be here.

SPEAKER_01: 1:25

So maybe you could start us out, Dr. Kutz. What do we mean by food insecurity?

SPEAKER_04: 1:29

Well, it's a little bit of a bulky term. We used to say hunger, and we would talk about hunger in America or childhood hunger. But with time, we realize that hunger is really an individual sensation, and it's hard to measure that. So instead, we have moved to this term, food insecurity, which is something we can measure. And we measure it every year in national surveys using an 18-item survey. The USDA does it. And what it is looking for is limited or uncertain access to adequate food for health. And it measures it on a household level.

SPEAKER_01: 2:08

That's probably a term that might be new to some of our listeners today, but that does make some sense. But isn't it also, hunger kind of does resonate. People know what that means.

SPEAKER_04: 2:17

It does. And I think that's what's made the term a little bit more bulky for communication. But we continue to do education about it. And I think we are able to talk about how hunger can be a consequence of food insecurity. So they do go together.

SPEAKER_01: 2:33

You're a pediatrician. You're the chair of pediatrics. You've been doing this for 25 or more years. Frankly, Diana, how long have you been doing this?

SPEAKER_04: 2:41

Over 30

SPEAKER_01: 2:41

years. Okay, over 30 years. We'll say. Over 30 years. How does food insecurity show up in the life of a pediatrician in the families you serve?

SPEAKER_04: 2:50

Well, I think... Honestly, it shows up before we even meet a child, that all too often it happens as a prenatal experience and that hunger for children often begins even before their birth. How does it show up clinically? I think we can talk about lower birth weight. We can talk about anemia. We can talk about more frequent illnesses because we know poor nutrition impacts the immune system and we see children who have more ear infections or more pneumonia or when they get sick, they're sick more severely and for a longer period of time, take longer to recover. We can also see it in probably most concerningly in development. So as children are going through rapid periods of growth, particularly in the first three years of life, their brain is growing, growing, growing, making connections and brains need calories and good nutrition to grow well. So that's the most powerful kind of negative consequence of food insecurity. How do we see it clinically? We see it in a child who may be more apathetic and less interactive. Or we may see it in a child who appears hyperactive or to have ADHD. Behavioral issues in childhood and then sort of moving on along the continuum, merging into mental health issues in older children, I think are the clinical manifestations. The last one is the one everybody thinks of first is about growth. And the truth is that children who are experiencing food insecurity can be overweight, can be underweight. and most are normal weight. So the idea that we can see it visually or diagnose it based on a weight, on a scale, is really a fallacy.

SPEAKER_01: 4:49

Yeah, that's interesting, the weight thing, because I bet a lot of people are thinking, well, you see an underweight kid, that's what they think of when they think of someone who's not getting enough to eat. So that's fascinating to me. The majority don't look that way. No. But the majority don't. That's true. Yeah. So before I move to you, Amy, I'm going to ask you about the population level meanings of food insecurity. But I'm going to ask one more question of you, Diana. Is this normal in pediatric clinic visits? I mean, do pediatricians routinely talk about food at the visits?

SPEAKER_04: 5:20

So, pediatricians, we believe in preventative care, and nutrition is a foundational piece of healthy growth. So, I think our interest in nutrition has been from the beginning of time. But in In 2016, the American Association of Pediatrics recognized food insecurity as a health problem and issued a statement and advised there be screening for food insecurity at every clinical visit. And that's been altered. Maybe it's not every clinic visit. Maybe it's every year, every six months. But the idea, again, was to screen recognizing that we couldn't visually diagnose this condition. Makes sense.

SPEAKER_01: 6:05

It really does. So I'm going to turn to you, Amy Harris. You're the Population Health Director at Hennepin Healthcare. First of all, tell us just a little bit what that role means. And then if you could transition into what are the population or community level impacts of food insecurity?

SPEAKER_03: 6:20

Sure. So when we think about population health, we're really talking about broader groups of patients and how do we think about the needs of those patients to get to better health outcomes. Healthcare is built on an individual basis, a provider working with a patient, and we're not trying to get in the way of that. But when we think about broader groups of patients or groups of community members, how do we understand the health indicators of broader groups? So it is a relatively newer role in healthcare systems. And when we think about population health at Hennepin Healthcare, we're not just thinking about clinical problems, but we're really thinking about health needs as whole people. And so food insecurity is one of the factors that contributes directly to health and wellness, like Dr. Cutts has explained. And so when we are doing our work here to take care of people, we want to think of processes that help us understand the needs of people as whole people. So not just what are your clinical needs, but what are the other factors in your life that contribute to health? And food and access to food is such an essential part of that equation. We've built programs here to be able to better understand and recognize where there is food insecurity, but we've also built programs here to to help be able to address the food insecurity. So what's our resource response when we know someone is food insecure?

SPEAKER_01: 7:35

How do you measure food insecurity at a population level? I mean, we kind of know it's got to be out there. Dr. Cutts sees it in her clinic. How do we know where the needs are greatest?

SPEAKER_03: 7:45

Well, we've built an actual screening question into the way we do our work here. It's built into the standard work across our clinics. It's being used now in the hospital in a standard way. Like Dr. Cutts noted, There's been some development, really good development across the country to come up with more standard ways to ask about food insecurity. So we actually use a two-question indicator here that helps us understand the presence of food insecurity. And really it's asking whether you have in essence, run out of food in the last 12 months, or you've been worried your food would run out and you wouldn't have the money to cover that need. And so that two question indicator is used as a way to measure food insecurity. And what we see that same question or the structure of that question is actually used a lot of other places. One of the better data sources from a community level is that Hennepin County does a survey, a public health surveillance survey called the SHAPE survey. And in the 2022 SHAPE survey, they surveyed residents of Hennepin County and asked a whole variety of questions of which a couple were related to food insecurity. And so within that survey, you can see the rate across the whole county is about 10% of people are food insecure across the whole county. But there are certain groups of individuals and certain pockets of communities or neighborhoods that have much higher rates of food insecurity.

SPEAKER_01: 9:05

So for listeners, Hennepin County is where we all work, where Amy Day and I all work at the big safety net hospital in downtown Minneapolis. It is the county which contains the city of many Is this done nationwide? Are counties and states measuring this all over, or is this something that we're doing specifically?

SPEAKER_03: 9:23

I think there's examples across the country where food insecurity is being measured. I think the survey within Hennepin County is a standard practice from the public health team. And what you see inside that data is although the rate across the whole county is 10%, we see some of the neighborhoods where many of the patients that we serve here at Hennepin County, those neighborhoods can have rates somewhere in that 20 to 30 percent. And what we also see inside the data is that it disproportionately infects communities of color. And so the food insecurity rates in our American Indian and Black African American communities are greater than 30%, whereas other communities have much, much lower rates. And so it's an issue that really disproportionately affects certain individuals, and it really disproportionately affects the patients we serve here at Hennepin Healthcare.

SPEAKER_01: 10:11

And then it ought to drive our policy and decision-making, I would imagine. I don't know if it does to the degree it should, but it ought to. So I'm going to delve into that a little bit more. Do we know then how health care utilization is affected or how health outcomes are affected based on the levels of food insecurity in your particular community?

SPEAKER_03: 10:33

So we can see in our data that we know for individuals who are food insecure, and we've screened them in our clinics and identified that they're food insecure, those individuals have higher disease rates. burden, so they have more chronic conditions, we can see that they use more healthcare resources. And I know there's a lot of literature across the country that could sort of validate that, but we see it here too within our own patient population.

SPEAKER_01: 11:00

Diana, you and your team of pediatricians, how do you approach a parent or a caregiver in that clinic when you have identified somebody as potentially experiencing food insecurity? What do you tell that parent who's struggling to feed their child?

SPEAKER_04: 11:17

Well, I hope what we do is first listen to what they're telling us and in a neutral way because really disclosing this for a household is... It's a shameful experience, and parents really suffer. We hear things from parents like, I let them eat, and then I eat whatever's left over. Or, you know, it's fine with me. As long as they're eating, they're happy. I'm okay. I just drink coffee. Or I use a measuring cup and we each get a cup. I mean, life is hard when you're hungry because when you're hungry, you can't even think to do nothing else. Those are direct quotes that we've heard from parents in clinic as they describe the environment that food insecurity creates. And, you know, as focused as I am on children as a pediatrician, we really have to think to generation and we have to remember that parents are doing everything they can to protect their children, as those quotes illustrate, and that they are suffering, therefore, the consequences of food insecurity, the chronic disease, the lack of a prescription filled as they trade off that expense, and the depression. So we want to go at it when we do approach it as a household issue. How do we help households? And I think the first thing we want to do is make sure that a family that's eligible is participating in every program for which they're eligible.

SPEAKER_01: 12:53

Food assistance programs, things like that.

SPEAKER_04: 12:56

Yes.

SPEAKER_01: 12:56

So I see their parents. You see the children, and those are profound quotes that you just said, because I think that that must be a universal truth, that the parents are going to make sure their child is fed first. But when the sum total of what is available isn't enough for that family, that's got to lead to long-term consequences for that whole family.

SPEAKER_04: 13:17

I think it does, and the research shows it does, and for the community. You know, as Amy pointed out, the increased cost in healthcare utilization is for every member of the family. And as you think about who's most vulnerable in the family, it's probably the very young. And the healthcare utilization dollars that go into the consequences of food insecurity have been estimated to be billions of dollars.

SPEAKER_01: 13:46

We're going to talk a little bit more in a few moments about the solutions and what we're doing. But it strikes me is that, Amy, you've told us about what we know. about the communities. You've told us where we ought to be focusing. And Diana, you have told us this is what families are telling us. So all I can think of is I'm a clinician. I'm sitting there one-on-one with a patient and it's almost overwhelming. So I can't imagine what your pediatricians, you've got some pediatricians been practicing medicine, went in there to help children and is dealing with that, dealing with a family that doesn't have enough. And then you've got Amy, you're telling us, we kind of know what the solutions are. Either one of you, what should be the next steps to addressing it.

SPEAKER_04: 14:26

Well, I'll speak as a clinician. You know, when I find myself in that situation, I'm extremely grateful for our population health program, which provides us bags of emergency food to provide to families so that any family who discloses this information doesn't walk out empty-handed. So there's the immediate need. I think the next level is how do we find resources for a family? And that's a discussion with a provider or a social worker or a community health worker to say, how do we connect a family to resources in the community? So that may be assistance programs, but it also may be programs of food shelves or food serving programs in our community. And, you know, I think we're fortunate. We live in a community that has many different offerings. So the trick is how do we connect the family to those resources that'll help meet their needs?

SPEAKER_01: 15:25

So that's what you can do in that clinical setting. Critically important. What about further upstream, Amy? What steps are you taking? Is our healthcare system taking to move upstream a little bit?

SPEAKER_03: 15:37

I'd say one of the things that's happening on a broader level is that there is some good movement across the country to make screening for food insecurity just be part of the way in which we do health care. So it's really about trying to normalize. You know, we ask people all kinds of questions when they come into the hospital or they come into a clinic. And we're used to answering all those questions around health and weight and prescriptions. And so making it more normal and standard to ask questions around what are the other things in your life that might be contributing to health is a really important So there's been good movement happening across the country to sort of normalize the asking of these questions.

SPEAKER_01: 16:13

Because as Diana said, it's embarrassing or there's a stigma to it and you don't want to bring this up. I'm failing as a parent. So normalizing the asking of it sounds like a good step.

SPEAKER_03: 16:22

And I think people even at the beginning were like, why are you asking me this question? What does it have to do with why I'm coming to the clinic? And so trying to help people understand these things are all interconnected and we care enough to ask and know. That's been an important part. I would say it's still a work in progress, but we're making good progress, I'd say, on that in the healthcare industry. I think the other is the critical way in which you ask the question. It sounds strange, but the way in which the question is actually asked to someone can really make a difference in their willingness to be more honest and truthful.

SPEAKER_01: 16:53

Can you give me an example of that?

SPEAKER_03: 16:55

Well, what we've learned is that if people are given the chance to answer the question on a piece of paper, They're more honest than if they have to answer the same exact question face-to-face by someone asking them verbally. It's just one more step for a chance to be a little more anonymous, a little more respectful. And so we know that the method for how we ask people these questions really matters. It makes a big difference to be asked the question in the context of a trusted healthcare relationship. And so when your provider, like a pediatrician that you see all the time, asks that question, that can be safe. But if you've just sat down with someone in a clinic and you've never seen that person before and they're saying, do you have enough food to get you through the next 12 months? You might be more hesitant to give a more honest answer. So the method of asking really does make a difference.

SPEAKER_01: 17:42

Yeah, that's helpful. That makes sense. Okay, Amy and Diana, thank you for laying the bedrock of what food insecurity is and some of the interventions we're doing both on a population level and on an individual clinic level. We're going to take a short break and when we come back, we'll talk about the impact of food insecurity on health, what can be done When Hennepin Healthcare says, we're

SPEAKER_00: 18:15

here for life, they mean here for you, your life. and all that it brings. Hennepin HealthCare has a hospital, HCMC, a network of clinics in the metro area, and an integrative health clinic in downtown Minneapolis. They provide all of the primary and specialty care you'd expect to find, as well as services like acupuncture and chiropractic care. Learn more at hennepinhealthcare.org. Hennepin HealthCare is here for you and here for life.

SPEAKER_01: 18:52

And we're back talking with Dr. Diana Kutz and Amy Harris about food insecurity. They both work with me here at Hennepin Healthcare in beautiful downtown Minneapolis. So let's talk a little bit about systemic solutions. What might we be able to do next? Who wants to take that?

SPEAKER_04: 19:08

Well, I'll jump right in here because I think we have a wonderful example here in Minnesota, and it's called universal school meals. We have known for ages that there are children who are in school and they need food to learn. And we have addressed that by making people eligible through their income for free school meals. But In 2023, we changed that and we made a universal policy that took out the stigma, it took out the paperwork, and it really encouraged all children to eat together without different colored stamps or different colored cards that indicated who was paying for their meals. And the uptick of what the food and the meals that were being consumed is noteworthy. The most important thing I think that's been noted, though, is that children are healthy. There's better attendance in school. There's less behavioral problems in school. There's less use of the time out room. That there's more learning that can happen when children are fed and particularly using this strategy. So shout out to the state of Minnesota for that legislation. And I think we were the fourth state to do it. I think there are now eight states in the country and others considering it. You know, you can say, what's a better use of funding than feeding children so they can learn every day? I'm

SPEAKER_01: 20:35

not sure I can think of one, one thing that is a better use of money than that. And yet it's a little pathetic. that 42 states don't do this. So I have memories just about four or five years ago of news reports that say some kids go through the lunch line and they don't have any money on their account so they don't get to eat. And this is a six-year-old.

SPEAKER_04: 21:00

Yeah, there were literally stories of the lunchroom staff taking a tray and dumping it out in front of a child who didn't have enough money in their account or instead giving them a peanut butter and jelly sandwich Well,

SPEAKER_01: 21:15

all the other kids are getting the whole hot lunch.

SPEAKER_04: 21:17

Exactly. So imagine the stigma of that and the kinds of feelings that it does for a young child. You know, when we talk about the importance of our relationships, what does that do to our relationships? You know, that kind of communication as to what that experience was like, that was part of the effort to pass this kind of legislation.

SPEAKER_01: 21:39

And it took till 2023 to get that done. And I, too, am very grateful that the state of Minnesota has done that. I can't believe that that's not a universal thing nationwide. So that is a perfect example of what some of the challenges are.

SPEAKER_04: 21:53

Well, and I think it's rooted in an idea that we have the deserving poor and the undeserving poor. And that's a mindset that too many hold on to that gets in the way of the greater good for our communities and for our families, that there's something about some children where they don't deserve that breakfast.

SPEAKER_01: 22:18

I'm just going to let that sit. I've not heard that term stated with such clarity as that. And I hope listeners are giving that some thought. The deserving poor versus the undeserving poor. And especially as those terms relate to a child.

SPEAKER_04: 22:32

Yeah, and I think you overlay that with what we know about generations of racism and what that has done for the opportunities for people. And you really start to, I hope, clarify what is systemic inequity and how do we perpetuate it in ways such as this.

SPEAKER_01: 22:55

Amy, in your job, what do you see as being done at the policy level that might be helpful? Or maybe that isn't being done, but ought to be done. I

SPEAKER_03: 23:04

think that there is some movement in understanding how in the broader healthcare policy and healthcare payment spaces, we can better understand the whole needs of people. And how does that start to come into, you know, one of the challenges we have, of course, over the years is that when we can identify someone who needs food resources and food supports, it's like, how do we pay for that work? If it's not sort of paid for under a traditional healthcare payment model, we do run into challenges of being able to fund the So I think there is some good movement happening across the country. You can see examples in certain states where they've done some really innovative things within their Medicaid program to think about how could you not only identify food needs, but actually be able to pay for some of those food resource responses. Because food and health are so tied together. It's all we've talked about in this episode. And so the movement of being able to not just identify it, but actually have the mechanism to pay for some of those resource responses within the healthcare department. That's really an interesting space that's, you know, State of Minnesota at a time was pursuing, you know, a waiver within their Medicaid program that would have allowed some of these kinds of advances that stalled out. But it's an example of some of the movement from a policy perspective that, again, allow us to not just identify the need, but think of it in a more holistic fashion when you can start to encompass it into the Medicaid program, for

SPEAKER_01: 24:28

example. And yet, I'll just say it, Medicaid is under some attack right

SPEAKER_03: 24:32

now. Yes. Yes, it is.

SPEAKER_01: 24:34

And so that worries me.

SPEAKER_03: 24:35

Yeah. I would hope it would worry all of us. Some of the policy decisions that are being made at this time, like A great example was that there was and is existing now a standard to screen for those health needs and housing factors and other things for every patient across the country that's in a hospital. And right now... it's actually being proposed to roll back that requirement. So we would no longer have to screen for those things in the hospital. And that's an example, I would say, of a policy decision that is sort of stepping us backwards from this work, not

SPEAKER_01: 25:06

moving us forward. Seems so short-sighted.

SPEAKER_03: 25:08

But there's plenty of other examples that are happening right now in Washington where there's decisions being made about funding and priorities around that funding to roll back some of the coverage, some of the funding structures underneath Medicaid. Within the same bill that passed out of the House, there were cuts to the SNAP program. SNAP is Supplemental Nutrition Assistance Program. It's one of those foundational food resource support programs. It's a federal program. And so the bill that was passed out of the House, and now it's being debated in the Senate, would have cuts to SNAP as well. And so it's a really concerning time, I'd say, for some of these decisions that are being potentially made in Washington that will sort of And as Dr. Cutts

SPEAKER_01: 25:55

said earlier, there are longer-term consequences to health of that individual child in front of you, but also that individual child's family. And that then expands up into communities. And in the long run, even from a policy level, even if you put aside the face in front of you, isn't it just kind of short-sighted economically? Yeah. to not invest earlier. To not invest early. Yeah.

SPEAKER_04: 26:18

You know, and I think we need to think beyond the individual. You know, it isn't about the individual child who is hungry in the classroom. It's how that affects the entire classroom. Every child is impacted by that child being hyperactive or acting up or needing to be taken out of the classroom for poor behavior. So I think we need to look at how it impacts absolutely every person. Even those who feel they are safe from this kind of hardship are impacted by the hardship of their peers. And, you know, for children, again, my focus, I admit, we're talking about the future workforce of America. What are we looking for? What kind of minds do we want to grow to solve the kinds of problems we have? We need every mind on board here on deck. And we're leaving stuff on the table by not providing providing really good nutrition to children and to the parents who need to bring their best selves to parenting, and I think to our community.

SPEAKER_01: 27:22

As a wise Minnesotan once said, we all do better when we all do better. What tips would you give our listeners for how to get involved?

SPEAKER_04: 27:30

Well, there are lots of ways to get involved. Every way from donating food or volunteering with organizations to supporting policies that you believe in that will be beneficial. And there's certainly, as Amy pointed out, plenty of opportunity right now to be doing that. There are a lot of very active organizations in Minnesota. to tie into. Any internet search will give you choices of the food group or hunger solutions or second harvest heartland, all involved in policy work to strengthen the safety net that holds us together.

SPEAKER_01: 28:07

And listeners, we can put some links to those sites in the show notes. Maybe you want to get involved with either with your time or your energy or your money. And at a policy level, I think it matters that we let our elected officials know that we're concerned about it, don't you think?

SPEAKER_03: 28:24

Yeah, this is a critical time for people to raise their voice. Right now, the Senate at the federal level is considering some really big systemic changes to some of our safety net programs, whether it's Medicaid or SNAP or many other things. So it's easy to reach out to be able to just express your concern and your hope for supporting the sustaining the programs we have today. Lots of ways to do that, but everybody's voice matters here in making your concern heard.

SPEAKER_01: 28:51

So I'm going to give each one of you an opportunity to leave our listeners with a thought. As we close off this incredible episode, I do have to say it's been an amazingly profound episode for me. Each one of you, if you could leave our listeners with one thought about food insecurity, maybe a message of hope or a call to action or one take-home point, what would that be?

SPEAKER_03: 29:11

Well, I would ask people to think about how they can support not just the work and the changes on a policy level, but the local work we do here at Hennepin Healthcare. You know, we offer food resource response programs, so when we identify someone who is food insecure, we have sort of two-pronged response. We have the immediate response where we can make these pre-packed food bags available to people. You know, last year, we had almost 50,000 food bags available. And at the same time, we also have ways to make it relatively easy for clinicians and care teams to connect people to community partners or WIC, which is Women, Infant, and Children Nutrition Program. Through our medical record, actually, we can make a referral through that record. We can get people connected to an external partner or to WIC. The WIC referral's new, so this is a great advancement for us here to be able to make that easy connection. But last year, we sent 3,800 referrals to our community partner to help people understand if they're eligible for SNAP and get them connected to SNAP. And those programs are an essential part of how we do work here at Hennepin Healthcare. And we fund that work almost exclusively through philanthropic donations. And so if you're interested in supporting this kind of work, the Hennepin Healthcare Foundation website. It's an easy way to make a donation and you can put in the comment you want it to support the food program.

SPEAKER_01: 30:33

Easy one, folks. It's at hennepinhealthcare.org and click on the donate and just signify food insecurity. Dr. Diana Kutz, what are your thoughts?

SPEAKER_04: 30:43

You know, I think I would just add, you know, we have said for many years, food insecurity is a national problem that can be solved. We are the richest nation in the world. We have food resources that we grow here. We have the means to do it. We just need the will. And I think we need to keep that in mind and keep pushing the rock up the hill until we achieve this goal of making sure every family, every person has access to healthy nutrition. And I would say part of that is, again, this view that this is not an other problem. This is an all-of-us problem. The ripple effect affects us all economically and socially. So this is a problem that together can be addressed. We have the means to do so. We just need the will.

SPEAKER_01: 31:35

Diana Cutts, Chair of Pediatrics, and Amy Harris, Director of Population Health at Hennepin Healthcare, thank you both for being on the show and for providing us an inspirational message today on something that truly does affect us all. Thank you for being here. Thanks, David.

SPEAKER_04: 31:49

Happy to be here.

SPEAKER_01: 31:50

Listeners, this has been a great episode, in my opinion, on a topic that affects us all, our families, our communities, and our whole nation. I hope you are inspired to take action. And if so, check out the links in the show notes. And I hope you'll join us for our next episode as well, which will drop in two weeks' time. But in the meantime, be healthy and be well.

SPEAKER_02: 32:11

Thanks for listening to the Healthy Matters Podcast with Dr. David Hilden. To find out more about the Healthy Matters Podcast or browse the archive, visit healthymatters.org. Got a question or a comment for the show? Email us at healthymatters at hcmed.org or call 612-873-TALK. There's also a link in the show notes. The Healthy Matters Podcast is made possible by Hennepin Healthcare in Minneapolis, Minnesota and engineered and produced by John Lucas at Highball. Executive producers are John Lucas, and Christine Hill. Please remember, we can only give general medical advice during this program and every case is unique. We urge you to consult with your physician if you have a more serious or pressing health concern. Until next time, be healthy and be well.