Episode Transcript
[00:00:00] Speaker A: From Riverside Health System. This is the Healthy youy Podcast where we talk about a range of health related topics focused on improving your physical and mental health. We chat with our providers, team members, patients and caregivers to learn more about how to maintain a healthy lifestyle and improve overall physical and mental health. So let's dive in to learn more about becoming a healthier you.
[00:00:26] Speaker B: I'm really excited to have with me in the Healthy youy studio today, Dr. Tasmia Ahmed. She is a geriatrician with Riverside Lifelong Health. That's a mouthful. Hi.
[00:00:38] Speaker C: Hello.
[00:00:39] Speaker B: This episode we're going to be talking about protecting your mind, Alzheimer's prevention and future of treatment. Welcome.
[00:00:49] Speaker C: Thank you for having me.
[00:00:50] Speaker B: I'm a excited, I'm excited to have you and just to explore more about this condition, treatments and ways to stay well. I'm Frankie Myers, your host today and we're focusing our conversation on Alzheimer's disease. With millions of people affected worldwide, Alzheimer's remains one of the biggest concerns as we age. But what if we could slow its progression down or even prevent it? Today, we're diving into the largest research on prevention, early detection and cutting edge treatments as well as simple steps you can take to protect your brain health.
Joining me I've already mentioned is our guest and so, Dr. Ahmed, thank you again. Tell me a little bit about this science and how you ended up in this field.
[00:01:43] Speaker C: So I'm a geriatrics fellowship trained physician. So I did my fellowship at University of Colorado and that is really what led me into dementia care.
I got a role with the Martha W. Goodson Center. I've been with them for about nine months. And for that role you need to have dementia experience and experience dealing with older adults. And prior to this, I was working in the nursing homes where I had lots of patients with dementia, older patients with dementia. So it was a good transition into the Martha W. Goodson center, such an important field.
[00:02:25] Speaker B: And thank you for what you do in this space. We're going to start our first segment. We're going to dive into understanding Alzheimer's disease.
So let's start with the base basics. What is the term Alzheimer, what does it mean? But can you break down exactly what happens in the brain when someone has this particular disease?
[00:02:49] Speaker C: So there's actually a lot of debate now in the field about what exactly is Alzheimer's and what the definition is going to be. So typically, traditionally, the definition of Alzheimer's is if you have amyloid plus and hyperphosphorylated tau tangles in the brain and you need to have symptoms from that.
So that's what we look at the Martha W. Goodson center is, you know, we do cognitive screening and a battery of tests to figure out, okay, what's the functional and physical decline that the patient is facing?
And then that helps us determine if the patient has Alzheimer's. Now with the. And we're going to be talking about this later in the episode about the biomarkers and the blood tests are now available.
And with the introduction of that now, the Alzheimer's association has introduced a concept of really just defining Alzheimer's from a biological standpoint. So if a patient has amyloid or tau, they will automatically be diagnosed with Alzheimer's. As a geriatrician, I don't know if I agree with that, but we'll get into that later. But basically, amyloid, if you think of the brain as like this vast interconnected city, and the neurons are like the roadways or the highways, and the signals are traveling down this highway. And in a normal brain, they're flowing freely. Your thoughts, your emotions, your experiences are being stored and processed. But when amyloid, an amyloid, certain type of amyloid, is actually normal in the brain. It is what is in the blood brain barrier. You can find it in the cerebral vasculature.
But when it becomes misfolded, and we're not exactly sure what exactly causes it to become misfolded, but once it becomes misfolded, it becomes longer and stickier. So then it starts to clump together and it forms what we call the amyloid plaques. And it kind of just inserts itself all throughout the brain and can really dampen or weaken the signals between the neurons. So then the signals are not being transmitted the way they should be. The tau tangles are actually within the neurons themselves. So tau is another thing that is normal in the brain. It makes up the microtubule. So the structure, structure of the neurons, and also it helps transport materials around the cell. And for some reason, it can break down and just like collapse into these neurofibrillary tangles in the neurons. And then that causes the neuron to die. And then that's when you see a brain atrophy.
[00:05:36] Speaker B: Great information.
Many people associate Alzheimer's just adding to what you just said with memory loss. But what are some of the less common early signs and symptoms that people may need to watch for?
[00:05:50] Speaker C: So some of the other things we may find is word finding difficulty. So a patient may start to substitute words with vague things like a watch they'll call, like a hand clock.
Refrigerator, they'll call it. Oh, it's a food box.
So that can be an indication that they're.
[00:06:10] Speaker B: Is it because they no longer remember either?
[00:06:12] Speaker C: They no longer remember it? Yeah. They're not processing the information.
They just can't retrieve that information.
So then they're trying to substitute and figure out how to get past that limitation.
[00:06:25] Speaker B: Okay.
[00:06:26] Speaker C: Also, they may be unable to follow conversations as fluidly. Again, a processing limitation where they just can't take in all the conversation.
And then because of that, you may start to see social withdrawal. You may start to see depression and anxiety.
So those, like, unexplained personality changes, they may become more irritable because they're having to process all this information that they're having trouble now doing.
Also forgetting known activities. So I've had patients who are fantastic cooks, and then their loved one is telling me, like, they can't even follow a recipe anymore, or they have forgotten what a pie is, and even though they make it every Christmas, forgetting to pay bills, or I have some patients where they will just continuously, every week pay the same bill because they can't remember if they have or haven't.
Also spatial awareness issues. So tripping and falling. Studies have shown that patients prior to receiving a dementia diagnosis, there is more frequency of trips and falls and ED visits. So that's like a red flag for us. If we see that in a patient's charts, like, what's going on? Is there a cognitive impairment happening?
And then as dementia progresses, patients may have trouble even recognizing known faces, even, like, their. Their family members.
[00:07:53] Speaker B: Yes. Should someone be concerned if, you know, some things happen because you may be tired or exhausted? So to differentiate, those things wouldn't get better if you really were experiencing this.
[00:08:06] Speaker C: Yeah. So it's gonna be progressive.
[00:08:08] Speaker B: Right. Okay.
[00:08:09] Speaker C: So one of my.
[00:08:11] Speaker B: I'm getting worried about myself, you know, because that happens sometimes when you may look at something. I know what that is, but the word is not. Not coming to you at the time.
[00:08:21] Speaker C: I have two young kids. I'm always sleep deprived, and I was like, oh, I wonder.
[00:08:27] Speaker B: Start diagnosing yourself.
[00:08:30] Speaker C: But, yeah, patients are going to see it's more progressive. And a lot of times with patients who are having cognitive impairment, they don't realize it. When I have a patient coming in to me saying, I'm concerned about myself, that makes me a little bit less concerned where I'm just like, okay. Like, if you're concerned, that means you have awareness, you have insight, do you have good judgment? But it's when, like, the daughter or the son or the spouse is coming in. They're like, yeah, things are going haywire at home, and they just don't seem to understand. That's gonna really raise my. My spidey senses. Be like, okay, we need to dive deeper into this.
[00:09:06] Speaker B: That's good. That's good. All right, so this next section, we're gonna talk about prevention. So. So what we can do now.
So we know there's no cure for Alzheimer's yet, but research is showing that lifestyle plays a significant role in the brain health. And you've alluded to some of that already. And what are some of the most effective ways to reduce the risk of developing Alzheimer's? I'm really interested in this.
[00:09:31] Speaker C: So this is my favorite part, because prevention is key.
So what we found in autopsy reports, they find brains that show amyloid and tau, but when you look back at the history, the patient was not showing any symptoms. So there's something happening that can change the course of the disease or at least prevent, you know, prevent the delay of progression.
And what we found is that it's lifestyle changes. It helps build. Build resilience in the brain, and it helps build a cognitive reserve, and it promotes neuroplasticity. So neuroplasticity means that the brain's ability to adapt and to be able to create new connections and how you live and what you do really helps to foster this. So we have the six pillars of brain health. So I'm going to go through one each one quickly. Okay, so the first one is exercise. So it's the American Heart Association.
[00:10:34] Speaker B: Exercise doesn't help.
There's no way around it.
[00:10:38] Speaker C: Exercise is, like, the standard.
[00:10:40] Speaker B: Yes, absolutely.
[00:10:41] Speaker C: So we. We follow the American Heart association's recommendation for 150 minutes of exercise. Five throughout, you know, five days.
[00:10:51] Speaker B: Okay.
[00:10:52] Speaker C: Or over the week. So that. That correlates to, like, 30 minutes of exercise every, like, for five days, for.
[00:11:01] Speaker B: An hour, for three days. Right?
[00:11:04] Speaker C: Yeah, exactly. So especially in my patient population, 30 minutes can be a long time. So we've found that 10 minutes at a time is really what's needed for benefit. So for those patients, you know, 10 minutes throughout, you know, 10 minutes in the morning, 10 minutes in the afternoon, 10 minutes in the evening, to get to 30 minutes is okay. And then, you know, what is exercise? You know, for us, you know, exercise can be really strenuous, but for someone who's in the 80s and 90s, you know, I'm not expecting them to go to the gym and lift weights and be on a treadmill. So really, you know, exercise is a continuous repetitive motion with intention. So, so that is walking. Walking is a great way to do that.
And it's been shown that especially if you're walking outside, getting that sunlight, that's even better. The next one is diet. So there is a diet called the mind diet, and it's an acronym for the Mediterranean DASH diet Intervention for neurodeth. Delay. So a mouthful.
But basically it takes those two diets, a Mediterranean and a DASH diet, kind of combines them and adds more recommendations about nutrients that we know is good for brain health.
So there are actually 10 foods that are recommended, and that's going to be your extra virgin olive oil, your green leafy vegetables, other types of vegetables, berries, whole grains, seafood, at least one serving a week, chicken, two or more servings a week, beans, other legumes and nuts.
And then there are five groups that we want to limit, not get rid of, but limit is fried and fatty foods, sweets and pastries, butters and trans fats, whole fat, cheeses and red meat.
And it's been found that the close adherence to this diet can lead to a 53 reduction in the risk of dementia.
[00:13:13] Speaker B: Wow.
[00:13:13] Speaker C: Yeah. And even just a moderate adherence, because let's be honest, we're probably all gonna be more moderately adhering to this. It's a 35% reduction. So you still get benefit even if you're doing it sometimes.
But you know, all of us want or ice cream, especially in the summertime, and it's fine.
And then the next one is cognitively stimulating activities.
So that is going to be like reading, learning a new language or doing puzzles, anything that's really going to get the brain stimulated and be challenging. And this is where I kind of want to put a plug in for cognitive rehab.
So. So I refer to speech language therapy very often for my patients to get cognitive rehab. And the best way to explain it is like physical therapy for the brain. And they will develop an individualized plan around cognitive stimulating activities, memory strategies, and how to more efficiently retrieve information from the brain. And studies have shown that patients who get cognitive rehab earlier in their course of disease preserve their memory and their abilities much longer.
[00:14:30] Speaker B: Good to know.
[00:14:31] Speaker C: The next one is social engagement. So studies have shown that patients who are socially isolated, they have a 30% higher risk of developing dementia.
And it can also increase stress and also lead to bad habits. So patients who are isolated, they may eat poor diets, they're probably not getting physical exercise, they may be drinking more, smoking more. So we really want to encourage patients to come out of their bubble to get engaged within the community, their families, their friends, to help their brain health. Next one is sleep. And sleep is huge.
Sleep is not just restorative. It's been shown to consolidate your memory. So everything that you've experienced throughout the day, that's really when it's processed by the brain and also prunes. So things like what you ate three weeks ago at 2pm for a snack is not important information.
So the brain will prune that out so it makes more room for other activities.
Insomnia. Poor sleep has been linked to a 19% increase in dementia risk.
So at the Martha W. Kutzen center, we're always asking about sleep and we're talking about sleep hygiene. So what does sleep hygiene mean? So it's like keeping a consistent sleep schedule.
[00:15:52] Speaker B: 10:00 every night or 9:00? Yeah.
[00:15:55] Speaker C: Okay. Having morning sunlight. So when you get morning sunlight, that stimulates your body to produce melanin and keep your circadian rhythm intact, limiting blue light. So that's all screens, tv, tablets, cell phones, that blue light is stimulating. So a lot of cell phones now have like a blue light modifier. So I have that on my phone. And you really want to limit screen time before bed, avoiding caffeine and alcohol, especially in the evenings. So that cup of coffee, you really want to have it before 2pm and alcohol, even though initially it might make you relaxed and sleepy, it actually disrupts the sleep architecture. So you want to avoid having alcohol in the evenings. No heavy meals before bed.
Exercising is great. It's been shown that exercise in the morning or afternoons is better for sleep. Now I am an evening exerciser, so you got to take it, you know where you can.
Keeping your bedroom cool, dark and quiet. Avoiding working, watching tv or eating in bed. You really want to correlate bed with sleep, not work or anything else.
And then if you can't sleep within like 30, 40 minutes of being in bed, get up, get up, do something else.
Not watch tv, but read a book and then try to go back to bed. And then the last one is mindfulness. So mindfulness, it basically means awareness to the present moment with kindness.
And imaging has actually shown when you practice mindfulness, whether it's just taking a pause in your day and taking a deep breath. I do that sometimes. Or I like to go outside and I like to listen to the wind rustling through the leaves. That's very calming for me. Or if it's a more intense practice, like yoga, whatever it is, imaging has shown that activates, like the Prefrontal cortex and other areas of the brain that are good for a good mood and your attention. And it can also decrease cortisol.
So stress levels. Exactly.
[00:18:09] Speaker B: Great information.
[00:18:11] Speaker C: I just want to talk really quickly about hearing loss and some comorbidities. So hearing loss is one of the largest modifiable responses factors for dementia.
Everyone, at some point in their life goes through hearing loss.
So by age of 60, 2/3 of people are dealing with hearing loss. And it's been shown that untreated hearing loss increases your risk for dementia.
So it does that through a couple ways. It increases the cognitive load on your brain. So if you're having, like a garbled sound signal go through your ear and into your brain, your brain is spending a lot of energy to try to figure out what you're hearing. So that takes resources away from other areas of the brain, like thinking and memory.
So that's one way. And the other one is atrophy. So when you're not stimulating your brain in the same way, that part of the brain may atrophy, so there may be shrinkage and then isolation. People who are not able to follow the conversation, they're not hearing well, they're becoming frustrated and they'll socially isolate. And we also know social isolation itself is a risk factor. And hearing loss is fairly easy to fix. You go to the audiologist. Exactly. You get your hearing checked, they tell you you need hearing aids, you put those things in and. And it can reduce your risk of dementia by 50%.
[00:19:40] Speaker B: Great, great information.
[00:19:41] Speaker C: Yeah.
[00:19:42] Speaker B: I wouldn't have associated the two.
[00:19:44] Speaker C: Yeah. And then, of course, then we have, like, hypertension and diabetes and smoking and, you know, all the other things our primary care doctors are talking about. All of those relate back to dementia risk as well.
[00:19:58] Speaker B: All right, good stuff. Good stuff. So there's a lot of buzz about certain things, foods and supplements and even brain games. We talked a little bit about that. Prevent Alzheimer's.
Are there any that are actually backed by science or research?
[00:20:15] Speaker C: Well, the food part, I think if you're sticking to the Mind diet, you're doing it right.
[00:20:22] Speaker B: Okay.
[00:20:23] Speaker C: Anything else is just noise. Supplements is huge.
I have patients who come in with a suitcase full of supplements, and it's dangerous. So there are some supplements that I do recommend, but I test for the deficiency first. So that's going to be your B12 and your vitamin D and your folate. So studies have shown that when those are deficient, it can lead to cognitive impairment. So I will test for those and I will recommend supplementation.
Everything Else needs to be avoided.
[00:21:02] Speaker B: Now, will the folate come in a multivitamin?
[00:21:05] Speaker C: Potentially it can, yeah.
[00:21:07] Speaker B: Okay.
[00:21:07] Speaker C: Yeah, absolutely.
[00:21:08] Speaker B: Okay.
[00:21:10] Speaker C: So for the other things like ginger, ginkgo, babola, ginseng, turmeric, what else have I seen? I think those are the big ones, vitamin E. So all of those have been advertised as being helpful in cognition. The issue is that older patients also tend to be on aspirin and anticoagulation, and all of those are platelet inhibitors.
So it really increases a risk for catastrophic brain bleed or a GI bleed in a patient who was already susceptible to that.
[00:21:51] Speaker B: And then you really need to consult your primary.
[00:21:55] Speaker C: You need to consult your primary care.
[00:21:56] Speaker B: Doctor before you start taking these supplements.
[00:21:58] Speaker C: So at the Martha W. Gooda center, one of the biggest things we do is deprescribing recommendations. We have a clinical geriatric pharmacist, Jennifer Purdy, who works closely with me. We go through everything, all their medications and look at, like, look at it from a geriatric lens. So when we're looking at these bottles, a lot of them, especially the combination ones, a lot of them have the same vitamins in them. And then patients are taking like five different ones of these combinations. So then there's a concern for toxicity as well.
[00:22:29] Speaker B: Absolutely, absolutely.
[00:22:31] Speaker C: In regards to brain game, so the one we see the most of is Lumosity.
So it's kind of mixed there.
I know our cognitive rehab people, they like to use Lumosity and I think in that context of them already getting brain stimulating activities within a care plan is great. And it can also, I think, probably help them build that habit of doing something.
But, you know, the caveat is that it's been shown that those brain games, you're really learning to play the game, but it may not be actually cognitively stimulating in the same way as learning a language or learning a new skill. And Lumos Labs, the developer of Lumosity, was actually hit with a lawsuit, a $2 million lawsuit for deceptive advertising. So you got to kind of take it with a grain of salt.
[00:23:31] Speaker B: Right. Great stuff there. So now we're going to talk a little bit about early detection and why that matters.
It can be life changing with many things. Right. Really understanding your family history. Right. And identifying early, what advancements have been made as it relates to early detection for Alzheimer's.
[00:23:54] Speaker C: So that is a exposure exploding field.
So early detection is like the name of the game right now. And that has been really brought on by biomarkers.
So biomarkers really means like a biological clue, something that we can measure in the body that's going to tell us if a disease process is occurring. So in Alzheimer's, the biomarkers that are being used right now is the beta amyloid like we talked about. So we're able to measure that in the body. Hyperphosphorylated tau and other like neurodegenerative mouthful markers like brain atrophy. And then there's some more that are in research, like neurofilament, like change the glial fibrillar acidic proteins and then the snap 25. So those are still. I don't think they've come to the market yet. I think they're still really clinical trials.
So the amyloid and the tau, before the blood biomarkers, which I'll go into a little bit, you had to test those through either imaging or spinal taps testing for the CSF fluid. So obviously very invasive and, and very expensive, whether you're looking at imaging or the spinal taps. And recently now we've gotten the blood biomarkers, so it's a blood test. So much easier and not as expensive. So the blood biotest, we're looking at the ratio, the beta amyloid 40 to 40 ratio. So like I mentioned before, you have good amyloid and then you have the bad amyloid. So the bad amyloid is that 42 version and the 40 version is the good amyloid. So the blood test is able to figure out that ratio and it's been found that when that ratio is low, it means a higher risk of dementia.
Same thing with TAU. So there's two different TAUs that we test for. One is TAU181, that that's been helpful for staging. And then TAU 217 is a really important one because it's been shown to be strongly correlated with Alzheimer's dementia and it can actually be found in the blood many years before clinical symptoms appear. So that's going to be one that's going to be really important for early diagnosis. And more Tau 17 in the blood means that there's been more acceleration of damage.
[00:26:36] Speaker B: All right, great stuff. If someone is concerned about their memory or a loved one's, what should they do next?
[00:26:44] Speaker C: Talk to their doctor.
[00:26:45] Speaker B: Talk to their doctor.
[00:26:46] Speaker C: They gotta talk to their doctor.
We are actually working on dementia clinical guidelines for primary care to help our primary care colleagues get comfortable with the diagnosis and management of dementia and then also when and how to refer on. So neurology, the Martha W. Goodson Center Geriatric Assessment Clinic. These are all the specialists that are Involved palliative care, hospice and so on. But the specialists, there's few of us. So we really want our primary care doctors to be comfortable with starting the management and diagnosis until we're all able to get involved together. Yeah.
[00:27:28] Speaker B: All right, great. So we're going to move on. This next segment. We're going to be talking about the future of treatment.
New hope on the horizon. In the past we didn't have many options for treating Alzheimer's, but that's changing. What are some of the more, you know, the most exciting advancements in treatment right now?
[00:27:48] Speaker C: So the big one are the infusion therapies. That's your lecanemab and Donanemab. Those are both being done by Dr. Rajan at Riverside.
So these are anti amyloid therapies. So they go into the brain and they clean out the amyloid.
So for leqembi, which is the lecanemab, it's a bi weekly infusion and studies have shown 27% reduction or slowing of the disease over an 18 month period.
Now the, I know we're going to talk challenges later. It is huge. But we're also wondering like what the actual clinical significance is going to be because the statistical analysis, analysis that they've done on it shows that that correlates to like a five month delay.
So, you know, we're still trying to figure that out, but it's a huge like step forward. You know, we went from having like barely anything to like now being able to have this really disease modifying treatment that's only going to get better with research.
[00:29:00] Speaker B: Give people hope.
[00:29:01] Speaker C: Exactly. It gives people hope, yes. And the donanemab showed a 35% reduction over 18 months in progression. And statistical analysis showed that correlates about a six to seven month delay in symptom progression.
[00:29:18] Speaker B: Good stuff there.
How close are we to having an effective treatment or even a cure?
[00:29:28] Speaker C: I think we got a while to go.
We know that Alzheimer's is a really complex disease process. So we've got the amyloid infusion therapies now on market and it's only going to get better. But there's tau as well. So tau is in the pipeline. There is therapies being made for tau, but there's probably other pathophysiology involved that we haven't tapped in. Two and then also true, just purely. Alzheimer's is actually not that common. It's usually like a mixed dementia. So Alzheimer's plus vascular dementia is a big one.
So along that line, I know that there is research being done on Immunotherapies and blood pressure medications that might be more specific to cerebral vasculature, anti inflammatory agents. I think at the end, for a cure, it's going to be kind of like how cancer treatments are, where it's going to be like a whole multitude of different combinations that's really going to create effect. I think it's going to be the same thing.
[00:30:39] Speaker B: That's great. That's good, Hope.
[00:30:40] Speaker C: Yeah, that's good.
[00:30:42] Speaker B: So now moving on to empowering listeners, what you can do today. So with all this incredible research that's going on and innovation and care, what are the most important steps for our listeners and what they can do to protect themselves today and their brain? Health care.
[00:31:01] Speaker C: So, you know, it's those six pillars, it's all lifestyle. You got to get to the crux of the issue, which is really, you know, making sure that you're living the best life that you can and that you are following your primary clinician recommendations.
And dementia care is all about quality of life. So just live your life.
[00:31:23] Speaker B: Yes, absolutely.
For those who may have a loved one or someone already living with Alzheimer's, what advice do you have for supporting them?
[00:31:37] Speaker C: So now there's a big push for interdisciplinary team collaboration. And the way I describe it is like we were just giving a big hug around our dementia patients and their caregivers because we have, you know, at Martha W. Goodson center, that's what we do. So, and we're really focused on the caregivers. The caregiver, the care partner is the backbone of dementia care.
[00:32:03] Speaker B: Absolutely.
[00:32:03] Speaker C: And if they are not looked after, everything just crumbles.
So that's what we do is like, we look at what resources can we connect them with, you know, what do they need to continue on this long journey that they're on with their loved one.
So, you know, if you're struggling, if you are feeling overwhelmed, if you're worried, please, like, come see us. Talk to your doctor. I know some of the Riverside primary care clinics have social workers.
Neurology has a memory care clinic, Palliative has a dementia clinical pathway. There are so many resources available at Riverside and we are. I learned recently on another podcast that we are one of the few health systems that has that, that gamut of options.
[00:32:56] Speaker B: See, the podcast is educating us all.
[00:32:59] Speaker C: Yeah.
[00:33:01] Speaker B: Well, Dr. Ahmed, thank you so much for taking time out of your busy schedule to come and talk with me today. It's clear that this treatment is really making a difference and the information on prevention is making a difference as well. And so thank you for your commitment and all the work, great work that you're doing in your team in this space.
[00:33:22] Speaker C: Thank you for having me.
[00:33:24] Speaker B: Anytime you can come back and how does someone connect with you or the center?
[00:33:31] Speaker C: If you want to, just go ahead and so Martha W. Goodson Center I would just go through a Riverside site and it'll have our address and our phone number. They can just give us a call. It can be a direct referral for families and patients. They don't have to go through a clinician for the referral.
[00:33:49] Speaker B: Okay, very good, very good. Thanks again and to our listeners, if you found this episode helpful, please share with someone who could benefit from learning more about Alzheimer's prevention and treatment.
And you can also visit Riverside Health's blog for more articles and resources on brain health. Don't forget, subscribe as well as share with someone.
Until next time, stay healthy.
[00:34:21] Speaker A: Thank you for listening to this episode of Healthy Youth. We're so glad you were able to join us today and learn more about this topic. If you would like to explore more, go to riversideonline.com.
