161 | The Art of Inviting Patients Into Treatment

I have a confession to make. I cringe every time I end the visit and I ask my patients, do you have any other questions? Because 99% of the time, they do have more questions. And don't get me wrong, I want to answer their questions. I want them to feel heard. But also I know I'm running out of time and I truly don't have the time to address three new, very specific questions. So today's guest gave me a brilliant way to answer that question without thinking, what did I just do to myself? Welcome back to the Exam Room Nutrition Podcast. I'm your host, Colleen Sloan. I'm a PA and dietitian, and today I'm talking to Maya Feller, the founder and lead dietitian at Maya Feller Nutrition, where her team provides medical nutrition therapy through an anti-biased, culturally humble, patient-centered approach. She's a nationally recognized nutrition expert, a regular contributor on Good Morning America and the Today Show, and the author of Eating From Our Roots, a gorgeous cookbook celebrating healthy, home-cooked favorites from cultures around the world. In this conversation, we talk about culture. And Maya gives such a beautiful framework for helping patients preserve flavor and familiarity of their foods while still working toward better blood sugar, blood pressure, and lipids. But what I really love about this episode is the way Maya talks about inviting patients into treatment. She shows us what realistic negotiations sound like, how you can help a patient who maybe doesn't like to cook or has no desire to start, how we can use frozen meals, canned foods, and packaged foods without shame. And probably my favorite part at the end when we talk about how to ask permission in nutrition conversations so the patient feels safe, respected, and part of the plan. This episode is literally a masterclass in patient-centered nutrition counseling. So get comfy or drive safe and enjoy my conversation with Maya. All right, Maya, thank you so much for coming onto the podcast. I'm so glad we connected through a mutual friend. So thanks for being here and welcome to the show.

Thanks, Colleen. I'm thrilled to be here.

Now I want to get into something that you're really passionate about because you've spoken about the way that we label some foods as healthy and then others are ethnic. And so I'm curious how that language shapes the way patients think about their own food traditions.

I think that there's general consumer confusion when people leave their homes and they go out into the world and they have to interact with the foodscape, whether or not it's coming from what they read on social media or something that they read by someone who is what I refer to as like partially credentialed and like a little bit of knowledge is a dangerous thing, right? So people go out into the world and they look at the front of packages and they look at all of these claims. So I think that consumers don't understand how to actually place a value on what the label claim is. And there are these buzzwords in the wellness industry that get a lot of traction. And then people think that they should shop in line with the buzzwords because of this one size fits all healthy way of living. And that doesn't really mean much. So I always say to people, it's important, especially for providers, to help your patients understand what their baseline is and what's important to them in the grand scheme of their health trajectory and journey. So if there's someone who's coming in and they're dealing with two comorbidities, right? So they're trying to navigate hypertension and perhaps they have uh pre-diabetes, well, then the conversation needs to be shaped for them. Maybe you have somebody who's coming in who has an autoimmune condition and they're really thinking about how do I navigate flares and inflammation, not from the trendy sense, but triggers in certain foods that can cause a flare based on the condition they have, then what they're looking for on those packages, that's a whole different conversation. So I often tell people, talk to your patients about flipping that package over, understanding the ingredient list, understanding that whatever's the first ingredient makes up the majority of the package good, regardless of what it says on the front of the package. So helping the consumer to become an informed shopper and also informed in relation to their own health.

Now, talking about culture and ethnic foods, I'm curious why do you think certain foods get blamed for chronic disease?

I think that there's an Anglo-American, Anglo-European lens that goes on wellness in general. I think that because we live in an English-speaking country and in the West, that that's what gets prioritized. Even though this is a country that has people that come from all over the world and there's a wide variety of ethnicities and cultures and social norms, we still tend to prioritize the Anglo-American, Anglo-European food ways as the benchmark. I think when, you know, we're talking about nutrition, people are thinking, okay, brown rice, grilled chicken, steamed broccoli, yes, healthy, but not something that everybody relates to as being a culturally affirming meal.

Oh my gosh, yeah, it's so true. And you know, I'm thinking back to school. I think it this even begins when, and how we were taught. I think about some exam questions who will be like, you know, a Mexican American consumes a lot of, you know, Mexican food and his cholesterol is elevated. What type of dietary strategies would you suggest? You know, they kind of paint that picture already that in your mind you think Mexican food equals unhealthy. Correct. Right? We as Americans have that Americanized lens to it, thanks to Tex Mex and Chilies and Taco Bell, right? We think that's Mexican food when in reality it's not true. Is that true for other cultures as well?

100%. I say often that cultures are not a monolith, right? Depending on the regionality of a food or a person or an ethnic cuisine, it shifts, right? Like if you're having Southeast Asian food that's very different than Western Asian food, right? And I really mean when you're looking at the continent of Asia, it spans a large swath of land. And so you have to understand that there's going to be different herbs, spices, cooking preparations. And as you said, many cultures from outside of the US, they all have plant-based ways of eating that use a lot of herbs and spices, aromatics, all of those things that are incredibly phytonutrient-rich and allow for the reduction of added sugars, salts, and fats. It's just that we haven't been well versed in that, to your point, right? And so we're thinking whatever the Americanized version of that food is. And we also think that our way is better. And that's not always the case. That's an opportunity for the provider to unpack their implicit bias, talk to the patient about what do you know about your condition? What are the foods that you eat? Talk me through it. You put your science, your nutrition, your health lens on that. And then you help them to make choices within what they know that actually benefit their clinical outcomes.

All right, that's a gut check right there. So if you're listening, I need you to check yourself and find out if you do have some of those implicit biases, like Maya was talking about, because that's really important when we give education and advice to our patients that we are not being biased and we're not automatically judging them for whatever type of food that they are consuming. And I love, Maya, your approach of being curious before corrective. And I talk about this all the time on the podcast is asking good questions to get to know your patient, their struggles, their culture, their day in, day out before you can even give any advice. So talking about comfort foods, and Americans will often think like rice, tortillas, plantains, noodles can be quote, like unhealthy. And I've often heard providers tell a patient you need to stop eating those or cut those out. And then what they do, you know, replace it with is like you had mentioned, grilled chicken, broccoli, brown rice, quinoa, yogurt, things that other cultures aren't really familiar or comfortable with. So, how do we educate our patients without making them feel like their foods are the problem?

So when we have the plate method, and let I'm thinking about my plate, for example, there's a starch area, right? You can literally swap any starch in and out of that spot, even if it's a refined carbohydrate. And people are often up in arms saying, Well, how is that the case? How could I put a white potato there? How could I put white rice there? And what I say to people is remember, you still have three quarters of the plate left. So if you want to help your patients make choices that are actually beneficial to them, then start with things that they know and then ask them to expand, especially in the non-starchy vegetable area with those with other types of produce. But I often say noodles, tortillas, white rice, they're all starches. So they can fit into that one quarter of your plate. It's there's no issue or challenge. And maybe the conversation is around what's the portion size, what's your serving size, how do we modify that? And then how do we modify the types of fats that are showing up if you're using animal proteins, the amount of fat that's in the animal protein, and what are the types of non-starchy vegetables that are showing up on your plate?

I have a love-hate relationship. I love it more than I hate it, but the with the my plate, I think it was yeah, I think it was like such a useful tool, a very quick, easy to understand, easy to teach type of tool that I keep coming back to and I do use it and I love it for that. I hate it for the cultures you know that are not American. It it doesn't work. A lot of them eat bold meals, right? Like all their food is mixed together. So even portion sizes then, or when you teach, you know, half the plate is non-starchy vegetables and then cut it at, they don't eat like that.

So I no, nobody very few people eat like that, Colleen. Sorry to cut you off. I mean, think about a lasagna, right? So it's like, how do you quantify how many noodles are in your portion of lasagna? But that's where I do think that's the provider-patient conversation. And where is there an opportunity if you really have someone who needs to make their plate prescriptive? How do you say to them, okay, can we use like a wheat-based noodle? And is there an opportunity for you to use zucchini or an eggplant in place of a few of the layers so that we're cutting down the starch and then increasing the non-starchy vegetable while staying true to the dish itself? So I think that it takes, as you said, curiosity. And it really takes us as providers to slow down, listen to our patients, and actually trust that they do know their lived experience and they do know their foods, and that it's okay for us to not know all the answers.

I love that. I think a lot of people, when they're trying to make health changes, you know, maybe they got a scary diagnosis or they have high cholesterol now and they really are determined to bring it down, go from zero to a hundred. It's like all or nothing. And I want to linger on what you had just said. You can do half and half. Don't cut out the noodles altogether. Maybe do half zucchini noodles, half regular noodles. Or, like you had mentioned, eggplant. It is such a great way to add in veggies instead of completely cutting something out. And I really, really like that approach of what you had mentioned. Now I want to pause here because we've been talking about MyPlate. Dieticians are very well versed in MyPlate. We are very familiar with it. A lot of us are sad that now the new dietary guidelines have switched over. I don't even know if we have a visual yet, because that was our teaching tool. I guess the teaching tool is now the flipped pyramid. Um, so if you're PA, you know, we've got the new dietary guidelines where it's an upside-down pyramid and animal products are on the top. And Maya, I would love your take on that. What do you think about it? And how do you use that to teach your patients?

So we actually don't use the new dietary guidelines because we find them quite problematic from a research and health perspective. So the body of evidence does not support prioritizing animal proteins as the center of the plate. I want to be crystal clear. We do know that there's some things like protein recommendations that are outdated, right? And that some people can have more protein than the 0.8 grams per kilogram of body weight. But in our practice, we actually still say you want to vary your animal proteins. You want to have lean proteins as the main source of the animal proteins that you're consuming. We talk about consuming beans, we talk about consuming nuts and seeds, a lot of non-starchy vegetables. We talk about whole and ancient grains as great sources of fiber. So we're not using the new dietary guidelines as we counsel our patients, mainly because we actually work with folks who have diabetes, hypertension, cardiovascular disease, chronic kidney disease. So our patients, it's prescriptive nutrition. We're not working with a population that's just focused on general wellness.

Yeah, I think that's an important distinction too. The guidelines are have been for population-wide and for policy. I think it's been narrowed down now to very much like wellness. And you're right, it is not appropriate for all medical conditions, especially the chronic medical conditions that need medical nutrition therapy. Correct. So I appreciate your honesty there. Um, I think a lot of dietitians might be scared to say, like, oh, we don't like the new dietary guidelines because now we're bringing politics into it. And politics have been there all along. But I think it's great to hear what other dietitians are doing because we we do have really good evidence about the importance of a plant-forward diet. And these guidelines really went against that. So thank you for sharing and being honest with that.

Of course. Listen, I feel like uh it's my job when I'm working with a patient to make sure that I'm providing them information that's actually going to help manage their condition. I don't want to engage in sharing information that could be harmful. I'm not, and I'm not talking about the dietary guidelines. I'm talking right now about how we work with our patients who are marginalized communities and living with diabetes and high blood pressure and cardiovascular disease. Like we have to have real, honest conversations about if nutrition falls into the spot of being prescriptive, these are the recommendations, right? And so that's how we talk to our patients with deep care, respect, and honesty.

Yeah, I think a lot of people forget that access is really a big factor when it comes to what and how patients can consume and prepare foods. And I think the dietary guidelines took a very elitist approach to that. And they forgot that a lot of the patients we work with are on the poverty level, are marginalized, and those guidelines don't necessarily reflect what is possible for them. Now, we went on a little bit of my soapbox about the guidelines, uh but I actually did a whole episode on culture and the dietary guidelines with a panel of a multicultural dietitians. It was really fun. It's episode 146. It's titled When Culture is erased from nutrition guidelines. If you want to listen to that and dig more into kind of cultural perspectives, go listen to that episode after this one. All right, Maya. So I want to hear, you know, when you work with some of your patients, what are some of the tips and strategies that you help them with when that can improve maybe blood sugar, blood pressure, lipids? But at the same time, and this is really your specialty, preserving the flavor and familiarity of their traditional foods.

Yeah, so I wrote a cookbook um a few years ago, Eating from Our Roots. And I talk about that cookbook as being a love letter to the globe. And one of the things that I did in that cookbook was I actually worked with seven chefs who are all women or people of color from different regions around the world. And as I was working with the chefs, I said to them, listen, I want to be flavor forward and also think about having foods in their whole and minimally processed forms that are reminiscent of home. Right. And so when I'm working with patients, I always start the same way that I started with those chefs. How do we think about flavor, replicating the flavor, and how do we put another layer on and really think about your desired health outcome from a clinical perspective? So I usually say to people, what are the plants that you know, like and love, and that you have access to on a regular and consistent basis? The reason I use that language is because it is very specific, because it is what's something that you know, so they know how to prepare it. Do you like it? Do you actually want to eat it? Because they're gonna have to come back to this again and again. And do you have access to it on a regular and consistent basis? Because if you don't have access to it, we can create the most nutrient-dense meal. But if you can't replicate it, it's not actually gonna become a part of your repertoire. So I asked those questions. And then we think about how do we actually reduce the added sugars, how do we reduce the added salts, and how do we reduce the saturated and synthetic fats? And as I mentioned, because I'm working with MNT, it's MNT, right? So we have to think from that perspective because we're looking for a clinical outcome. And then that's where spices and aromatics come in to really achieve the flavors that the patients are looking for. Colleen, I'm so careful with this. I do not expect anyone to stand over their kitchen for eight hours making some meal. So then the question is how do we use the frozen aisle? How do we use the boxed aisle, the jar and the canned? How do we go through the center of the grocery store, learn how to incorporate the products that are better for you and have a great nutrient profile and a nutrient dense into those dishes so that you can actually prepare them regularly and they can support you.

You just said something, the center aisles of the grocery store. And I've been a dietitian for like 15 years. I remember we were taught, and I taught my patients to shop the perimeter, right? Totally. All my dietitians listening are like, yes, but I said that all the time. And even during that time, I'm like, wait a minute, I feel like we're missing some great stuff in the center of the store. Like, what is wrong with the center of the store? So, can you share what are some of the things, maybe food items that you are looking for or that you encourage your patients to include that might not be found on the perimeter of the grocery store?

Absolutely. So I went on a trip recently and I, I mean, I've always encouraged folks to use canned goods, right? And I say, look at the ingredient list. And if you're, let's say you're looking for canned peaches, then you want it to be canned peaches, right? If you're looking for asparagus that's frozen, then you want it to be frozen asparagus. If you're looking for a mixed dish, then that's when I say you've got to go up and you have to look at the nutrition facts panel and start to check the sodium and the fat and what other additives are in there based on your personal preference and your health. But I do tell people, you know, if you see single ingredients foods that you like and you know you can use, get them. They're likely to be shelf stable, more cost effective, and also help you add nutrients to your dish. I definitely encourage folks to look at packaged goods that are plants. So dry beans, canned beans, dried fruit, freeze-dried fruit, frozen fruit, canned fruit, jarred fruit. I have Colleen lately, I have no affiliation with these people whatsoever. I have become the biggest brahmi lover. It's a lupini bean mixed with wheat, cooks up so al dente in a pasta. And it is really nice because you get a little bit of fiber from the bean, a little bit of protein, and it's wonderful. It's two ingredients. It's like it's very, very, very easy. And so I talk to people about how do you vary the types of pastas that you have, right? Of course, you can have wheat pastas, you can have chickpea pastas, you can have lupini bean and wheat pastas. And that's what I do with my patients is how do you curate a pantry that has a variety of foods in there that are tasty and maybe, if you need it, a functional benefit.

I love that so much. Now I want to back it up and push back a little bit and pretend I was a patient who does not like, does not know how to cook. Where do you start with that individual?

Oh, I love that individual. This is where I say, okay, how are the foods coming into your house? Right. And if you say to me, I cook nothing and I'm buying frozen foods only, and I say, awesome, let's start by taking a look at the nutrition facts panel and let's choose some frozen foods that have better for you nutrition facts panels. So a little bit less. Sodium, we're going to lower the saturated fat. We're going to search for options that have no synthetic fats. And then we're going to also lower the added sugars to little or none. And then I say you're going to take your frozen meal, now the better for you option, and you're going to eat it. And then we're going to get a side of veggies or a fruit that you like and you enjoy them together. And I'm not going to shame you because my whole thing is how can I get you to engage in behaviors that actually shift your numbers?

Yeah. That's such a good strategy and really the only one that will work. Because if you try to take someone who doesn't, doesn't like to, doesn't know how to, and you tell them all these wonderful recipes to try, it's really overwhelming. They don't have the confidence to do that. So they're not even going to try. And I love that you incorporate canned foods, frozen foods, prepared meals, because there are wonderful options that you just have to equip the patient with the knowledge of how to choose them.

That's right. And and I'll also say this sometimes people will say, you know, oh, I'm interested in dabbling, right? Like I want to do like a little bit of cooking. And then I'll say, let's start with the low-hanging fruit, because low-hanging fruit is still fruit. So, all right, let's start with some of your grains. Can we do a mixed dish of grains? Can you do a white rice with a quinoa and like an orzo and a pearled barley? Because those things cook about the same time, right? And then they're like, oh, now we've got a grain dish that has a little bit of flavor, and then they can put whatever they want on it, but it's a low lift. And so I'm very, very cognizant of really helping folks to engage in positive behaviors when they're interacting with foods. That's really, you know, it's like a gentle nutrition approach. I'm not there to scare anyone. Cause listen, if you eat by mouth, you eat up to three meals a day or more. And so my goal is how do I help you have those things be delicious and beneficial for your body?

You mentioned something earlier, and I want to go back to it because I think this is kind of a tricky place for a lot of patients to correct. And that is added sugars and that sense of a sweet tooth. What are some of your suggestions or strategies for lowering the added sugar content or the foods that the patients are consuming?

So that's an area that we're pretty particular about, Colleen, I have to say. So I usually talk about added sugars as sugar interactions. And I say to people, this is an area where I'm going to ask you to decide how you want to interact, right? So this is like you have to, patients have to take their own responsibility. But with the added sugars, I say, do you want to have a daily interaction with added sugar? And how often, like, is this once a day? Is it twice a day? Is it three times a day? I'm going to recommend one or less because of the population that we work with. And then I say, in that interaction, you now have to say, I'm going to have the interaction in its entirety, and then I'm going to stop and move on from it. Right. So if you decide that you're having one added sugar interaction per day, then my question is, how do we get it to the appropriate portion size? And how do we get it so that there's a beginning, a middle, and an end that you are aware of? Right. Because if you do it walking down the street or in your car or on the go, it's a transient activity that sometimes doesn't register. So how do we get you aware of it? And then it culminates and it's done for the day. And we're very particular about that with added sugars.

How would you implement that type of strategy with a beginning and an end for someone who really does have a sweet tooth and they enjoy sugar?

Yeah, totally. So let's say you want to have a piece of cake every day. We're going to talk about the size of the cake, the size of your slice, and we're going to talk about when you're eating it. I prefer added sugars to be backed up against a meal because that kind of helps modify how it enters into the bloodstream. So let's say you've had lunch and you want to have a, you know, a piece of cake, then I'm saying, okay, let's look at the portion size of your cake and you have it after lunch. It's a little bit easier for the body to navigate because there's some protein and a little bit of fat and a little bit of fiber that has already been eaten so that you're not going to get so much of a blood sugar spike. It's still going to go up, do not get me wrong. But we talk to the patients about this. And then let's say there's someone who's like, we've I've had lovers of juice, lovers of soda. And then we start to talk about okay, what does it look like if you have four ounces instead of 12? Okay, maybe you don't want, maybe they're like, sometimes they're like, Maya, that's too much. And then I'm like, okay, how about 10 ounces split into twice a day after a lunch or a dinner? Right. And so those are the negotiations that we have so that it becomes realistic within their life. And it doesn't feel like punishment because if they feel like I'm punishing them, they're not going to come back and they're not going to be honest.

That word right there, punishment, is why so many diets fail and why patients keep going on and off, on and off, back and forth between sticking to a plan and then coming off of it because they're so restrictive and you feel like you're being punished because you can't have the things that you love. I love your strategy of kind of trying to adjust the portion size so it's smaller and/or spreading it throughout the day, like you said, with the juice, tacking it onto a meal, because I've talked often about the importance of pairing a protein with a carbohydrate to minimize that effect of the glucose rise. So those are really, really effective strategies. We should never be telling our patients that they cannot have blank. Talking about that on the line of punishment, how do we invite our patients into the conversation instead of just prescribing or assuming we know what needs to change?

I have taken so many workshops and read so many books exactly about the art of inviting a patient into the treatment session. And one of the things that I've learned over time and from working with a variety of populations is really starting by asking the patient what's on their mind that day. It allows them to say what they're concerned about for me to respond as the provider and acknowledge that I hear what's on their mind, and then say, would it be okay if we also talked about this, this, and this that I had planned for the session? So I'm now taking what they want to talk about and the two things that I want to talk about. And then we have three things to talk about over the session. And one of the things that I always do with patients is co-creation. I make sure that I understand what they've said and I say it back to them in a responsive way. And not, do you understand what I'm saying? Because people often say yes, because people nobody likes to be in the I didn't understand camp. So I say what I understood back, and then I say, does that sound like what you meant? And so I'm very specific with my language in the sessions so that patients know that they can always clarify. And I ask them, is there anything else that you'd like to add? And I all and I always, always end every session with, Do you have any other questions for me? So that they know that it is, it's an open conversation.

I'm gonna pause and ask you if this happens to you, because it happens to me as a PA. I end with, Do you have any other questions? And I sort of cringe every time I ask that because I actually do know they're gonna say yes. And they sort of open up a whole nother box of problems that unfortunately in American medicine I don't have time for and I probably did not get to throughout our discussion or our conversation. So that's why I cringe because I'm like, oh no, I just opened up so many more things. So does this happen to you? Number one. And number two, if it does, how do you handle that without dismissing these new concerns?

So I usually do it within 10 minutes of the session ending so that I can answer one of the questions and then I can say, okay, we didn't get to these two questions. I'm gonna put it in the notes section so that we can start with it next time. And then I go back to my notes and I'm like, oh, but the end of our last session, you had this and this question. Is that still relevant today?

That's great. Thank you, because you've saved my anxiety from asking that question. I love asking that question because it does validate the patient. It makes them feel like I actually do care about what's going on and I want to help. But at the same time, for me, in my mind, I know I have five other patients. I'm already an hour behind, people are mad at me, right? And so it gives me a lot of anxiety. So that is a really helpful. I also wanted to back it up to what you had said in the beginning. I love your approach. And I do this and I teach my students at the PA program that I teach at to start the visit by asking them, like, what are your top two or three priorities or concerns you wanted to address today? This ensures that the conversation or that the patient leaves with their questions answered. Yes. Because sometimes you might take a left turn with what you think is important, but it's completely opposite of what the patient wanted. And regardless of how good your advice or information was, they're gonna leave unsatisfied. But you actually take it a step further. And I really like how you acknowledge their concern, address it, but then you also bring up your concerns as the healthcare professional because we do have different concerns. We see the patient through a different lens. We can interpret labs differently, their diet recall differently, their weight history differently. So I really love how you mold and mesh the two. It's a beautiful way to address both concerns. Very well done, Maya.

Thank you. I appreciate that.

Yeah, I think my listeners are going to really appreciate that technique and that strategy. So, you know, if you need to rewind and re-listen to what she had mentioned before, that's the gold in this episode. I think probably your biggest takeaway would be to ask the patient their priority and then mention a few things that you would like to address. And you sort of snuck it in there. But I am a huge fan, proponent, and advocate of asking permission. And you had said a little line that said, would it be all right if we also X, Y, and Z? Why is asking permission so important?

So, number one, so many of my patients come to me where they've experienced trauma from a wide variety of sources. And marginalized communities often report in healthcare settings that they feel overlooked. They don't feel that they've been taken into consideration. And many people feel traumatized by healthcare situations. And so I feel by asking permission, I'm actually asking for their consent and I'm bringing them into the conversation. And my job really as a trauma-informed provider is to make the session as stress-free as possible and not to, yeah, not to put them on the defensive.

Yeah, I couldn't agree with you more. Thank you for explaining that. And I think providers, especially PAs listening, will understand permission equals consent. Because before I even examine a patient or put my hands on a patient, I am asking, is it okay if I listen to your heart or touch your stomach or whatever I have to evaluate? It's the same thing when we're talking about diet and weight. You have to get the patient's consent or permission to make sure that they are comfortable and that they feel safe in the conversation.

Well, I love that, Colleen. Also, the other thing that I'll say too on the safety in nutrition is because, especially if you're working with marginalized communities, and this can be from a racial, ethnic, or socioeconomic standpoint, this can be from a gender identity perspective, any marginalized community is under fire, right? Because they're like people who are poor also are made to feel like at fault for being poor. So folks are already coming into our sessions feeling a particular way. And if we're gonna make them feel safe in that space, we have to cultivate that environment. And so I really appreciate that you use the word safety.

Maya, this is probably one of my favorite conversations. We are so aligned in how we think, how we speak to our patients. And I'm just so grateful for all of the wisdom that you shared with us today. I know you have so many resources and you have got a big online presence. So, where can people connect with you online?

So, providers and patients can connect with me at MayafellerNutrition.com, and I can be found on Instagram at Mayafeller RD. And my cookbook, Eating From Our Roots, is available everywhere that books are sold.

And I will link down to all of those resources below in the show notes. So be sure to connect with Maya, grab that cookbook, and help your patients start to eat healthy. Maya, thank you so much for the gift of your time today. I really appreciate you being here.

Colleen, thank you so much for having me and sharing me with your audience.

And thank you guys for carving out some time for nutrition today. I will see you next week.