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We know that life after cancer treatment is not always easy. Maybe you don’t have as much energy as you’d like, or still dealing with side-effects, or maybe you’ve put on weight. And today, I’m talking to Lauren and Elise, they’re nutritionists who specialise in oncology and they share fantastic advice on getting your nutrition right after cancer. Here are some things that we cover today:
- How good nutrition can make a huge impact after cancer
- Why metabolic rate is a crucial factor when it comes to losing weight
- The truth behind organic food and how it affects you
- Real metrics to understand progress you’re making
- and much, much more!
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Joe: Thank you so much for taking the time to talk with me today, I really appreciate it, I loved our conversation before on nutrition before and during cancer treatment. Now, I’m really excited to get your insight into really eating well after treatment. Tell me, first of all, what I want to understand is your perspective and maybe we can start with you, Elise, is why nutrition is so important after cancer treatment?
Elise: That’s a great question, Joe. Nutrition, as we spoke about last time, is hugely important during treatment, but equally as important after treatment as well. Often, some of the anti-cancer treatments of therapies or surgeries. That could be chemo, radiotherapy, even immune therapy obviously damage the cancer cells and kill off the cancer cells, which is exactly what we want them to do. What they also unfortunately do is damage some of our healthy cells, as well. Good nutrition and eating well helps to repair and heal our healthy cells.
It also helps to keep us stronger during treatment, the stronger we are during treatment, this improves our management of side-effects, after treatment, as well. It provides our bodies with the energy that it needs to function efficiently and effectively. By achieving and maintaining a healthy weight, this actually helps to reduce our risk of cancer recurrence in the future. As well, maintaining a healthy weight helps to reduce our risk of other chronic diseases such as heart disease, diabetes, kidney disease, liver disease, etc. I guess because of all of these factors, it really highlights how important nutrition is after treatment as well.
Joe: Yes, that makes so much sense, Elise. You know, Lauren, because most people, we don’t really think about cancer and nutrition in the same space. Is there a science behind it?
Lauren: Yes, heaps of science behind it, Joe. We wouldn’t be here if there wasn’t. We only practice when there’s really solid evidence to support the advice that we’re giving. What we’re really fortunate to have is a really strong community of wonderful researchers and scientists and health professionals out there, who are really dedicated to making sure that they look into the best nutrition advice in the cancer survivorship space, not just generally for people who have undergone cancer therapy, but specifically for different types of cancer as well.
The nutrition advice for someone who’s gone through breast cancer treatment could very well be different to that of someone who’s gone through pancreatic or lung cancer treatment. Huge amount of science to support the advice that we give. One really useful organisation is the World Cancer Research Fund, who have a wonderful report that summarises the evidence that’s available to us to provide recommendations to eating and drinking after cancer treatment.
Joe: I think it’s so fantastic that it’s targeted toward people who have gone through a specific cancer treatment or a specific cancer, because that means that your advice is really specific to you. I know that when you are helping me and there were specific recommendations for things to keep in mind for testicular cancer, which is incredibly helpful, because that means you can look at things that are specific to you and your health and where you’re at right now. Tell me, Elise, again, I want to zoom out and talk about the biggest obstacles that we really have in creating a healthier life after cancer, what are some of the things that really get in the way for us?
Elise: Yes, and, Joe, you would know first-hand that going through cancer treatment changes your life profoundly. We have lots of clients and patients tell us that their life is actually never the same after cancer treatment, which I’m sure you can vouch for. One of the biggest obstacles I find, which is challenging for patients to overcome is the ongoing side-effects after treatment. It’s very well-established that there are a whole host of side-effects as a result of anti-cancer therapy. That could include nausea and vomiting, fatigue, ulceration of the mouth or the oesophagus. Issues with your bowels, so constipation or diarrhoea.
A lot of these side-effects are not only present during treatment but after treatment, as well. It’s really difficult for patients to actually get back into normal life, to get back into work and relationships with their loved ones and families after they’ve been through this sort of treatment and after they’ve experienced all of these side-effects. Often, a lot of these side-effects result in patients not being able to eat well or enough, which can lead to weight loss, but also what’s important for us to note is that it can lead to muscle wasting.
Now, what we know is that after treatment, patients who have actually lost their lean body mass and their muscles actually have a slower metabolic rate. Now, this slower metabolic rate can often result in compensatory weight-gain after treatment, so this, again, makes it a really challenging obstacle because patients are often being told during treatment to eat high energy, high protein foods, which are often good, but sometimes they are encouraged to eat foods that are more energy dense.
Not necessarily as nutrient rich to help maintain their weight during treatment. When they continue with these behaviours after treatment, they end up gaining weight, which can be a really challenging obstacle to overcome. When you’ve just gone through a really difficult time going through chemo radiotherapy, and then trying to transition back into normal life.
Joe: Yes, I can completely agree with you, that it changes your life completely. Maybe, Lauren, you can talk to me about what is a metabolic rate and what is a good metabolic rate?
Lauren: Metabolic rate really is a measurement of how your body processes fuel. If you’re someone who, for example, has a high metabolic rate, it means you’ve got a fast metabolism, which means that you might break down and burn through fuel more quickly than somebody else. If you’ve got a slower metabolic rate, you might burn through fuel more slowly and you’re more predisposed to putting on weight. Storing fuel as fat. What we know and what Elise is talking about before is that if you lose muscle mass, you end up with a slower metabolism, and a slower metabolism means that you’re more likely to gain weight as fat.
That can be detrimental to our long-term health, as Elise mentioned, but also, we know that if you’ve finished your cancer treatment and your energy levels are low and you haven’t been exercising or moving or working as much as usual, your whole body system isn’t working as it used to. Simply reverting back to what you used to eat might not necessarily be the best way forward for you. You’re now in a new body to some extent. It’s been through a lot; a lot of trauma and it’s got different needs to what it did when you first started your cancer treatment.
Joe: Yes, I love that you talk about the fact that we can change it and influence it. I think when it comes to nutrition and your metabolism, I always thought that it was just, my mistake, but I always just thought that it’s something that you are basically born with and you have to live with. You can’t really influence it in any way. It sounds like what you’re talking about is, we can actually influence it and change it so that it works for you and not against you.
Lauren: Absolutely, and we can do in many ways. We can do that by altering body composition. For example, putting on muscle mass and losing body fat will change your metabolic rate. Certainly, there are different ways foods are processed in our body. If we choose foods that are broken down and absorbed really quickly, versus foods that are really slow release energy, that changes the way your body functions, as well. It changes the hormones that are released, the inflammatory markers that circulate, and there are lots of links between the fuel that you eat and how your body will function from an energy point of view and from a health point of view.
Joe: What are the best things that you can recommend, in terms of the things that you can keep in mind, in terms of importance? When it comes to eating well after cancer treatment. Slow release?
Lauren: Joe, look, the best foods to eat and what Lauren and I always recommend are whole foods. Foods that are not packaged or processed. Usually, these sorts of foods are fruits, vegetables, wholegrain breads and cereals, nuts and seeds. Quality protein. Poultry, chicken, turkey, lean meats, fish and sea food. Also, legumes, so things like lentils, chick-peas, kidney beans. Really, anything that comes in a natural state is a really valuable addition to your diet. It’s about finding balance in how to separate which portions of each thing is right for you and your body.
That’s going to be different and unique for every individual, but one thing that’s really key in terms of promoting a strong and healthy metabolism is ensuring that your meeting your body’s protein needs. We do find a lot in cancer survivorship. After cancer treatment, there is a shift in the way that people eat to be really convenient and easy foods, that tend to be rich in carbohydrates and quite quickly absorbed by the body. As dieticians who work in cancer care, we know that the advice that we give someone during cancer treatment is quite different to the advice that we give someone after cancer treatment. It’s really key to speak to a professional in the field to transition your diet form your during treatment advice, to your after-treatment advice, so you don’t hang on to some of those habits that are no longer suitable for you.
Joe: What about organic foods? Is that something that you guys recommend focussing on?
Lauren: Not necessarily, Joe. There’s lots of research done into organic foods and whether or not they’re more health-promoting than others. What the research generally shows at the end of the day is that individuals who eat an organic diet, in some studies, have shown that they’ve got fewer health conditions in long-term studies. What we also know about people who eat organic food is that they tend to be of a higher income level. They tend to be better educated, have good jobs, they can afford good healthcare.
Making a direct link between eating organic and being healthier isn’t possible, because there are too many other factors associated with eating an organic diet. In terms of recommending organic food, we absolutely wouldn’t, eating any fresh produce is very beneficial, if you can afford organic food and it’s your preference and it makes you feel good. We are 100 percent supportive of that because we know that there may be some benefits, but it’s not essential in order to be healthy.
Elise: One thing that we often get a lot of clients ask us, Joe, is the nutrition composition of the organic food superior? Again, what the research tells us is that actually it’s not that different to normal fresh-produce. One thing we always recommend is, if you do want to eat normal fresh produce, it’s just to make sure that you give it a really good wash before you eat it, to make sure that it gets rid of any herbicides or pesticides.
Joe: I think that’s great advice because it really also, you just shine the spotlight on the fact that it’s affordable and doable and that it’s all realistic. I think there’s a lot of stigma around eating well, that it has to be expensive and that it has to change your lifestyle. Whereas, I think what you guys are saying is that it’s really something that you can do quite naturally.
Lauren: For sure.
Elise: One other thing with organic produce, too, Joe, is that during cancer treatment, so if you’re undergoing cancer therapy and your immune system is compromise, so with some chemotherapy, for example, there is a theory that organic produce is a less safe option for you. If we think about the normal processing of other produce that uses chemicals to help rid that food of any bacteria or germs, that’s really important for someone with a poor immune system, because that bacteria that might be present on perhaps more likely on organic produce, could be a risk for infection for that individual. There is an argument that organic food during cancer treatment is not a good idea and we should be having the foods with the chemical processing having been done to it.
Joe: Wow, I did not see that coming. Cool, I think that’s really important to know. I think I want to jump in with the body composition thing. I think we’re talking about changing the body composition. The first time I heard that phrase, I think my oncologist said that your body composition has changed after treatment. I was like, what does that actually mean? I think I realised that it was a polite way of him telling me that I got fat.
It’s important to know where you’re at, which I think leads me to really my next question. I think one of the things that is incredibly important when we’re talking about changing the way you eat, changing your lifestyle, maybe doing some exercise or movement, well, what are the metrics that you can keep in mind so that you can focus on getting the right results for your body, for you and your life?
Elise: We can probably even use you as an example for this, if you feel comfortable?
Joe: Yes, by all means.
Elise: If all we did in your care was measure your weight, we would have seen no change. Would you agree with that?
Elise: Your weight hasn’t changed. What we’ve known through other measurements that we’ve taken, looking at your fat mass and your fat stores, is that your bodyweight hasn’t changed, that your fat mass has significantly decreased, and your muscle mass has increased.
Elise: Which is a huge achievement, and certainly an important think to report back to your oncologist to say, “Yes, my body composition has changed, this time perhaps in the right direction.” Certainly, it’s very important that we look at different metrics of body composition. We can do that certainly through weight, but there are lots of limitations to that measure. There are some really clever machines that we can use that will help to measure body composition in terms of fat and muscle mass, your water percentage, the weight of your skeletal mass, so your bones. These are often available in a clinical setting. You might have heard of Dexa-scans, or BIA scales. They’re sometimes available and really useful to have a more accurate measure of what’s happening in your actual body.
Joe: Is this something that you would recommend as part of the practice of someone who is working with you, you establish a baseline and then you would work towards some sort of a target, right? Towards where you want to be?
Lauren: Absolutely. The challenging thing is, Joe, that often scales like the BIA scales of the Dexa machines, they’re very expensive and they’re not often accessible. Therefore, using different metric system like your waist circumference, there’s another measure called mid-upper-arm muscle circumference as well. There are different options and other metric systems that we can use when specific body composition analysis machines are not present.
Another screening tool we use is something called the PGSGA, which is a patient generated subjective global assessment. That’s a screening tool that assesses a patient’s nutritional status and that’s, again, a specific tool that’s validated in the oncology population. A tool that I’d say we pretty much use for every patient.
Elise: Part of that tool, Joe, is that we look at different muscle stores and fat stores across the body. When I poke and prod you, I’m doing it for good reason. That’s to identify any change in your muscle mass and fat mass compared to previous consults.
Joe: Yes, I’m glad to know that there was actually a reason to the madness. That’s good. Well, I think it’s incredibly, like, all of those metrics, guys, that you touched on, I think are incredibly important from the perspective of being motivated. I know that when it comes to getting results. I think it’s no secret that when you go to work with a nutritionist, such as yourselves, who specialise in oncology, you’re going to have to make some changes. I think that’s true for any area of life. If you want to get results, then you really want to be prepared and you want to be focused on the results that you want.
I think that is one of the things that was really important for me and this was important when I caught up with you today, Lauren, is to know that we measured where I was at and to know that I was making progress. I think for all of us, when it comes to whether that’s losing weight or having more energy or decreasing other side-effect, whatever that might be for you, you really want to know that you are making steps forward, that you are making consistent progress that is right for you and your life, because that’s what keeps you motivated. Otherwise, it’s very hard to stay on track, right?
Elise: Absolutely, for sure. What we spoke a lot about today was not just the measurements in terms of your body composition, but really how you’re feeling and what you’ve noticed in the change of your energy levels, your function and how you feel in your own skin. The ability to be able to track that and report that back to somebody and make sense of it and relate it to the food that you’re eating and how you’re fuelling your body is so motivating. What’s not so motivating is a simple number on a scale, it’s just a number. For a lot of people, it means a lot, but I think what perhaps means more is how you actually feel and how your body is functioning.
Joe: Yes, absolutely. Elise, what about when we’re talking about healthy weight or healthy body composition? What are some of the things that we should keep in mind when we’re thinking about that? What is healthy?
Elise: Look, Joe, healthy is different for everyone. One measure that we often use, again, it’s not gospel and certainly not the best measure, is the body mass index. That is based on a healthy weight range. The equation is your weight divided by your height in meters squared. Then it gives you a specific number that fits you into different categories, be that underweight, normal weight, overweight, or obese. Again, while we know that your weight on the scales is not always going to be the best indicator for your progress, it is a good general measure to know if you are within the healthy weight range. Where this gets a little complex is for patient who do have a large volume of muscle mass.
We know that muscle weighs more than fat, therefore, for a male that has a really strong physique, that has a lot of muscle, they actually might fall into the overweight or obese weight range, but for us as dieticians, by eye-balling them, we can actually tell that they don’t fall into that weight range. I guess that is a good general measure of your body composition for the general population.
Lauren: You’ll know, Joe, that similarly with your weight, your weight didn’t change, so your BMI wouldn’t have changed. It doesn’t give you the whole picture. When it comes to looking at body composition, it’s important for a qualified health professional to look at certainly different stores, whether it’s your muscle and fat stores and your fluid status. I think more importantly doing a really thorough assessment of your nutritional intake and identifying what links there are to what you’re eating and how that’s fuelling your body.
Regardless of someone within a normal or even an underweight category, they might be eating all of their nutritional needs, but are of nutrient poor foods. They might be meeting their caloric needs or energy needs just with ice creams all day. They could be weight stable and their BMI could be healthy, but that’s not a reflection of health.
Elise: I do think it’s a good starting point for someone who might be starting out, who wants just a baseline measure, they maybe don’t have access to the IA scales or a Dexa scan. They want to know what their starting point is, it might be at the beginning of their health journey. BMI is a really simple and easy equation to measure to have as a baseline. As Lauren mentioned, obviously, making sure that you’re taking into account the foods that they’re eating but also their visual muscle status and body composition, as well.
Joe: Yes, absolutely, and as someone who’s going through active treatment, I know that this whole fear of cancer coming back is a pretty big deal because before every check-up, you’re thinking, well, is it going to come back. You get all of these worry thoughts into your head. What about when it comes to nutrition after cancer, and I know we touched on that earlier, but could you talk more about how can nutrition help to minimize the chances of cancer recurrence, minimize the chances of it coming back?
Elise: There’s strong evidence to support that our nutrition certainly does play a role in the risk of cancer recurrence. The biggest evidence exists for our bodyweight, and an individual cancer survivor who might be holding extra weight and be overweight or be in the obese category, has a high risk of recurrence than someone who is at a normal weight. One of the biggest things that a cancer survivor or someone who’s finished treatment for cancer can focus on for their long-term health is making sure that they reduce their weight to be really in a healthy weight range. That’s where it’s so key to have support to be able to take those measurements and review your diet to make sure you’re preserving your health as best you can.
Joe: Is it about body weight or is it about a specific, say, body fat? Fat in a particular area of the body?
Elise: Unfortunately, the research hasn’t been able to pinpoint what that is, all the research shows, and there’s strong research, but it’s not specific research, is that weight classification that’s key. While we have predictions and hypotheses that it is the fat stores that are contributing to longer term cancer recurrence risk, the research isn’t yet strong enough to support that claim.
Lauren: I think, Joe, with heart disease, diabetes, certainly that central adiposity, there’s a significantly increased risk of those chronic conditions. As Lauren said, as far as cancer goes, I think there’s a lot more research in that space that needs to happen before we can make those solid claims.
Joe: I know, this is the case for me, and I think it’s the case for many other folks, as well, that after going through cancer treatment, particularly if it’s chemotherapy or radiation, sometimes it can really dramatically increase chances of heart disease. Definitely that’s why having a healthy weight can also make a big difference. That’s one of the reasons why I am concerned. I think one of the things about cancer, at least in my experience and in my journey is, I couldn’t really do anything about getting cancer in the first place. Now, having gone through the experience and now,
luckily, I’m cancer-free now, but I’m thinking, if I can do anything to minimize the chances of it coming back or getting some other cancer or getting some other nasty conditions such as heart problems and stuff, that I’m at a higher risk of, then I really want to be in control of that. I really want to do my best to try and influence that. I think when it comes to exercise and when it comes to nutrition, and to getting some proper advice on this front can make a huge difference because it puts you back into control of your life, right?
Elise: Joe, that’s one of the amazing things about nutrition. You said it beautifully. You had no choice, you didn’t choose to get cancer, but you can choose the way you’re going to live your life in the future. You can actually control the food that you’re eating to minimize your risk of cancer recurrence, which I think is amazing that nutrition can be that powerful, that it can have such a profound impact on our health.
Lauren: Yes, the other thing that’s really exciting for us as dieticians, Joe, is that there’s certainly lots of advice depending on the cancer diagnosis that you’ve had, as to different types of foods and nutrients that are most beneficial for you to reduce, not just your risk of cancer recurrence, but reduce the risk of your cancer recurring. The advice that we might give someone who’s finished their treatment for breast cancer, could be quite focused on looking at their alcohol intake and their intake of antioxidant-rich foods. If we compare that to somebody who might have had treatment to their throat cancer, we know that there’s strong evidence that increasing their intake of particular vegetables is particularly key. Depending on the different cancer types, there’s different nutrients and different foods that play a really key role.
Elise: Lauren and I had a great time when starting our business, doing comprehensive literature reviews of all of the different tumour strands and also, nutrition interventions and building some really robust resources to give to our patients, so that they had specific information and interventions that they could implement to reduce their risk of recurrence of their specific cancer in the future.
Joe: Yes, that’s fantastic that you guys are doing this work that is very targeted towards folks in this specific situation they are in. I was wondering if you could share top three strategies that someone could incorporate into their daily life. Having gone through cancer treatment.
Elise: Absolutely, so first and foremost is, eat more plants. Load up your plates with heaps of non-starchy vegetables, so things like spinach, tomatoes, mushrooms, I could go on forever. There are heaps and heaps of non-starchy vegetables. They’re not only really rich in fibre but really rich in powerful antioxidants that actually help to protect ourselves, which are really important in the context of reducing your risk of cancer recurrence in the future. They are also quite low in kilojoules and also fill you up. If you have a diet that’s rich in plants and vegetables, you’re much more likely to be of a healthy weight.
Fruit, as well, so aiming for two pieces of fruit per day, again, that’s to ensure that you’re getting the valuable micronutrients, vitamins, minerals, antioxidants, and fibre, as well. Another food group that we love is the legumes, lentils, and pulses, as, again, they’re really rich in fibre. They also contain a particular starch called resistance starch that actually helps to nourish out gut microbiome.
It acts as a food source for the good bacteria that live in our gut, which we know has a really positive impact on our immune system, but also keeping our gut nice and healthy and reducing our risk of bowel cancer. We always recommend eating the rainbow, so the more vibrant colours of the fruits and vegetables, the better.
Lauren: That’s number one.
Elise: That was a long one, sorry, guys.
Elise: That was a very colourful one, I loved it. I’m going to go a bit more of what not to do. Number two I would say to be to try and limit your intake of processed foods. In particular, processed meats. If we think about processed meats, we think about ham and salami, bacon, hot dogs. What we know is that having an intake of processed meats of any amount, but particularly of a high amount, can increase our risk of colorectal cancer and damage to our colon cells.
We would encourage you to minimize your intake of processed foods, processed meats, but also takeaway foods and packaged biscuits and cakes that are often prepared with particular types of fats called trans fats, which can increase the levels of inflammation in our body and can increase our risk of health problems. Number one, eat the rainbow and include those beautiful legumes, but number two is trying to minimize your intake of processed foods. What’s number three?
Lauren: Number three, I think we’ve spoken about this quite robustly throughout this podcast, but it’s achieving and maintaining a healthy weight through proper nutrition but also complimented with exercise, as well. Joe, you’re a perfect example of what a good approach of a really good exercise program and fabulous dietician, how that can really help to improve your symptoms and make you feel better and ultimately improve your health outcomes.
Joe: Yes, that’s fantastic, guys, I love this advice. Talk to me about alcohol because I think it’s something, again, that you touched on, that might even affect cancer recurrence for some cancers. What’s your advice on this front?
Lauren: Yes, there certainly is evidence that alcohol consumption at higher levels can increase the risk of certain types of cancers, in particular, we know that if somebody has undergone treatment for breast cancer, there are particular recommendations to reduce alcohol intake to below that of what the general population would be recommended. Alcohol, unfortunately, can cause damage in our body, which can predispose us to health concerns of all types, cancer being of them. The recommendations for alcohol intake for a cancer survivor would be to aim to have no more than two standard drinks per night and to have two alcohol-free days per week.
Elise: We actually try to add on an additional goal for our patients, I usually say aim for three to four alcohol-free days a week. just to improve your health, but also reduce your risk of chronic diseases.
Lauren: Yes, the other thing that’s important to know is that certainly in the case of breast cancer, those recommendations are lower. It’s actually recommended to have less than one standard drink per day in breast cancer. About half a drink is the maximum recommended intake after breast cancer. We know that people live a life and balance is really important. While these recommendations are certainly worth striving towards, it’s not going to be achievable in every case all the time. That’s something that’s important to understand in the context of your whole world and your whole life. Any progression towards that recommendation is going to benefit your health.
Joe: Yes, I’m really glad that we keep coming back to this theme of finding the right balance. I think it’s no use and I know we’ve talked about this before. It’s not use of just doing something where you’re forcing yourself to do it because it’s not sustainable, it’s not going to stick and ultimately, you’re just going to feel like you’re torturing yourself. Whereas, I think if you’re setting yourself some goals that are specific to you and your life, and I think it is important, of course, to have someone like yourselves to guide the person through it, I think it’s really important for you to find a sustainable way of living a healthier lifestyle that isn’t some pretty picture or isn’t some imaginary thing. It’s very real and tangible for you and where you are.
Elise: Look, Joe, we don’t expect someone to go from drinking a bottle of wine every night with dinner, to go to not drinking at all. As you mentioned, it needs to be short and small attainable goals towards the recommendation. We don’t want you to go cold turkey. We want you to enjoy your life, but obviously working towards those recommendations.
Lauren: One thing, Joe, you alluded to multiple times in our conversation is that it’s so important that those goals are not our goals, not the dietician or the doctor or the exercise physiologist goals, that it’s your goal as the individual that’s going through this. You’re only going to change your behaviour if you’re motivated to do so. If you come into our office and say, “This is what I eat, this is what I drink. Don’t touch what I drink because I’m not going to go there, but you can improve my health through what I eat.” Great, then we’ll work in that space. Otherwise, there’s no point us providing advice that doesn’t fit into your world.
Joe: Yes, absolutely, I love that because I totally agree with you. I think there’s a huge difference between what you need to do and what you want to do. I think we all know that we need to do so many things, but it really comes down to what you want. If you want something, then you’re really going to put the effort into it. You’re really going to strive to achieve that. We all know that we need to do this, we need to do that. It’s important to focus and do the things that are right for you. Sometimes it’s all about reaching out and finding I think someone like you guys to help to facilitate that process. I guess if someone wanted to work with you individually, whether that’s face-to-face or online, so how would they find you?
Elise: Yes, no worries, Joe, we’d be very happy to hear from anyone. People can reach out to us certainly via our website, which is: www.oncorenutrition.com. Spelt: O-N-C-O-R-E… nutrition. The email address, our phone number, that’s all available on our website there. Certainly, we’ve got two soon-to-be three locations in Melbourne that we practice out of, but we also offer phone consultations through our tele health service all across the world. It doesn’t matter where you are, what time zone you’re in, we’ll find a way to be able to support you if that’s something you’re interested in.
Joe: Fantastic, thanks so much, guys. Thank you for your energy and your time today. I really appreciate it.
Elise: It’s always a pleasure, Joe.
Lauren: Thank you for having us.