Author: Nicole Maxwell, NMD

Arthritis: A Naturopathic Approach

By - Aging

By Nicole Maxwell, NMD

Arthritis is the most common cause of disability in older people as cited in a recent article in the American Journal of Public Health1.  The article states, “Arthritis will play a large role in the health-related quality of life, functional independence, and disability of older adults in the upcoming decades.”

In this article, I focus on Four Foundational Principles for those suffering from arthritis.  Even for those without symptoms or who are younger, these preventive measures are critical to maintaining joint (and other aspects of) health into the later stages of life.  

What is Arthritis?  

From Mayo Clinic: Arthritis is the swelling and tenderness of one or more of your joints. The main symptoms of arthritis are joint pain and stiffness, which typically worsen with age. The most common type of arthritis is osteoarthritis which causes cartilage – the hard, slippery tissue that covers the ends of bones where they form a joint – to break down.

Learn More:  Mayo Clinic article about Arthritis  

Foundation One: Hydration and collagen.

Many seniors tend not to drink as much water because of urinary urgency or incontinence.  However, our joints need hydration (water and oil) to stay mobile and to aid repair.  As simple as it sounds, consider drinking at least 6 glasses of water daily.  Aim to finish hydration by 5 or 6 pm so it doesn’t impede sleep.  One can add a pinch of salt to a large water container to aid absorption.  The next level of optimal hydration is to invest in a water filter that removes harmful pollutants.

Joints also need to be oiled, just like in a machine, and the oil for humans is in the form of essential fatty acids or EFAs.  Consider a tablespoon of fish oil, like cod liver oil, once a day to increase the good fats in your body and decrease inflammation contributing to arthritis.  Since EFAs increase blood thinning, if you are taking a blood-thinning medication, be sure to let your physician know so they can monitor.  

Joints are also made up of collagen which is the rubbery end part of joints and aids cartilage repair.  Consider taking a collagen hydrolysate supplement to support your joints.  Collagen seems to be mostly effective with osteoarthritis and may not be as significant in rheumatoid arthritis.

Foundation Two: Inflammation

Arthritis is essentially joint breakdown and often occurs because of inflammation.  Therefore, reducing inflammation is paramount.  This includes discovering if one has a food intolerance and then avoiding the food or foods creating inflammation.  https://boisenaturalhealth.com/are-foods-causing-your-symptoms/, https://boisenaturalhealth.com/the-carroll-food-intolerance-test/

Other ways to reduce inflammation associated with food: avoiding and/or decreasing refined carbohydrate intake.  Consider limiting net carbs to 150 grams a day.  Check out this article on carbs and arthritis: https://www.medicalnewstoday.com/articles/324810. Consider replacing carbohydrates with colorful vegetables.

It is also important to check one’s gut health and see if one’s microbiome is helping or hindering the healing process.  https://boisenaturalhealth.com/test-your-gut-microbiome-with-a-simple-stool-sample/

Foundation Three: Repair

You may have heard of glucosamine and chondroitin – these two nutrients are great for arthritis pain reduction.  To be effective, these supplements must be taken regularly for at least three months to notice the benefits.

Foundation Four: Pain Management

It is important to stay active.  Mild to moderate, regular aerobic exercise, including water exercise, helps to reduce pain.  Consider your local YMCA as they have many options for different ages and abilities.

People regularly ask me about pain supplements and my preference for arthritis pain is curcumin from the turmeric plant.  I recommend a bioavailable form of curcumin like Theracurmin. 

Naturopathic Medicine Treats the Whole Person

Do you or someone you know have arthritis?   If you need more help, consider scheduling an appointment with Dr. Nicole at Boise Natural Health Clinic.

1  Am J Public Health. 2012 March; 102(3): 426–433

The Carroll Food Intolerance Test

By - Digestion, Food and Nutrition

By Nicole Maxwell, NMD

The Carroll Food Intolerance test, also known as FIT, helps us to understand the digestive and metabolic capacity of a patient’s body by identifying foods that are not compatible with their system.  

The History: Dr. Carroll practiced from 1917 to 1962 in Spokane, WA.  He was a busy and successful naturopath, however he couldn’t help his chronically ill son Bill.  In his search for better treatment methods, he learned about the work of Stanford physician, Dr. Albert Abrams who had been experimenting with new diagnostic techniques.  Dr. Carroll modified Dr. Abrams’ work to devise the FIT. Dr. Carroll discovered that his son was intolerant to fruit, removed fruit from his son’s diet, and for the first time his son recovered.  The FIT as devised by Dr. Carroll is similar, in some respects, to the bioelectronics testing of Voll, from which many biofeedback mechanisms have evolved.

What is it testing? This new method evaluates foods that are not well digested or metabolized by the body.  Those foods become a source of dysbiosis and can lead to inadequate breakdown of food, intestinal toxemia, and chronic irritation of the body tissues.  Dysbiosis means an imbalance between the types of organisms present in a person’s natural microflora, especially that of the gut, thought to contribute to a range of conditions of ill health.

Diagnosis? The Carroll test does not diagnose a disease, nor does it diagnose an allergy.  It is a determination of a patient’s incompatibility with food groups or combinations of those food groups.

The nitty gritty: A sample of blood is collected and evaluation is done using a specific electric circuit exposed to various foods in contact with a reagent. Fluctuations in the current are detected. Most people evaluated intolerant to one of the following foods or food categories: milk, egg, meat, sugar, fruit, grain and potato. In addition, he discovered that most people had a problem with one or more combinations of food, similarly not well tolerated.*

It works! I have used the Carroll food intolerance test for the last 17 years and have had great success.  I estimate 95% of my patients experience significant improvement when following their results. Do you experience a variety of health complaints and are unable to figure out why?  Do you seem to have multiple food intolerances from other food sensitivity testing or from observation? The Carroll Food Intolerance Test is often the game changer for people to help resolve a variety of complaints, heal their gut to be able to eat more foods, or lessen the load on the body so that the body can move toward health more easily.

We over this modality at Boise Natural Health Clinic to help you have optimal digestion and health.

*http://www.songofhealth.com/carrollhistory.html

Tis the Season … To Overindulge?

By - Food and Nutrition

By Nicole Maxwell, NMD

During this joyful and sometimes stressful season of office parties, family get-togethers and general celebration, it is possible one might overindulge in food and/or alcohol.  What can one do to help mitigate the effects?

  1. Drink lots of water to get things moving through the kidneys and out of the system.  Target 64oz a day of filtered water. If the overindulgence is alcohol, take commercial electrolytes (Nuun Sport is a good one), coconut water, or diluted juice and table salt.  
  1. When eating foods you normally avoid, take a digestive enzyme that works for your issue.  For example, if you avoid gluten and dairy then consider GFCF by Integrative Therapeutics to help digest those items.  We have many types of digestive enzymes and your provider can help you select the best one for your situation.  
  1. Homeopathic Nux Vomica 30c is great for that post party hangover. The morning after the over-indulgence, take five pellets under the tongue every 15 minutes up to three doses.
  1. Sign up for my 4-Week Clinical Detoxification Program the end of February – we’ll do a thorough clean-up of the system getting you ready to start the new year right. 

I hope this season treats you well and wish you the best of health.

– Dr. Nicole

Catching Too Many Colds?

By - Immune System

by Nicole Maxwell, NMD

Teachers, school-aged kids, frequent travelers, and those under chronic stress may be more susceptible to getting every cold that passes.  Here are some things to do to stop the trend.

First and foremost, it is important to maintain a Whole Foods Diet, which means to eat foods in their least-processed state.  Nutrient-rich foods include foods in their unrefined state, such as: apples instead of applesauce, eggs instead of Egg Beaters, oatmeal instead of a granola bar with oatmeal in it.

And let’s Review the Basics that you hopefully already know about and follow: get plenty of sleep, decrease or eliminate simple carbohydrates, drink plenty of fluids, and get your exercise.

Frequent illnesses can also be a sign of an underlying Food Intolerance.  We offer a variety of food intolerance testing at the office.  Here are some ways food negatively affects the immune system.  

  • The continuous intake of reactive substances causes local micro-inflammation in the intestinal tissue, which spreads insidiously and can manifest itself in other tissues, including reduced immune status against infections.
  • The gut contains an estimated 70-80% of the immune system.  With almost 400m ² (or 4,300sq feet – a very large house!) it is the largest contact area with the external world. There is extensive lymphoid tissue around the intestine and forms the largest immune organ in our body.

Here Are Some Therapies That May Be Helpful:

Oscillococcinum (Boiron) is a homeopathic, can be used for prevention and treatment.  I recommend one dose per week starting now, and going through the flu season, for prevention.

Probiotics are in the news a lot these days and for good reason.  Here’s the conclusion of one study; “Daily dietary probiotic supplementation for 6 months was a safe effective way to reduce fever, rhinorrhea, and cough incidence and duration and antibiotic prescription incidence, as well as the number of missed school days attributable to illness, for children 3 to 5 years of age.” 1

We carry a variety of formulas and can find the best fit for you.  

Colostrum is the first form of milk rich in antibodies and has been shown in a study to be 4 times more effective than the flu vaccine.  Colostrum was 3 times more effective than no vaccine. The vaccine + colostrum group did equally well as colostrum alone. In this prevention study they took 1 capsule a day containing 400 mg of colostrum away from food. 2

Wet Socks Treatment is a time-tested treatment that acts reflexively to increase the circulation and decrease congestion in the upper respiratory passages, head, and throat. It has a sedating action, and many patients report that they sleep much better during the treatment. The treatment is effective for pain relief and increases the healing response during acute infections. https://boisenaturalhealth.com/warming-sock-treatment/

There are many tools in our toolbox to help you and your immune system be in tip top shape.  To make an appointment, contact us at www.boisenaturalhealth.com.

1. Probiotic effects on cold and influenza-like symptom incidence and duration in children. Leyer GJ, Li S, Mubasher ME, Reifer C, Ouwehand AC. Pediatrics. 2009 Aug; 124(2):e172-9. Epub 2009 Jul 27.

OBJECTIVE: Probiotic consumption effects on cold and influenza-like symptom incidence and duration were evaluated in healthy children during the winter season. METHODS: In this double-blind, placebo-controlled study, 326 eligible children (3-5 years of age) CONCLUSION: Daily dietary probiotic supplementation for 6 months was a safe effective way to reduce fever, rhinorrhea, and cough incidence and duration and antibiotic prescription incidence, as well as the number of missed school days attributable to illness, for children 3 to 5 years of age.

2. Prevention of influenza episodes with colostrum compared with vaccination in healthy and high-risk cardiovascular subjects: the epidemiologic study in San Valentino.  Cesarone MR, Belcaro G, Di Renzo A, Dugall M, Cacchio M, Ruffini I, Pellegrini L, Del Boccio G, Fano F, Ledda A, Bottari A, Ricci A, Stuard S, Vinciguerra G. Clin Appl Thromb Hemost. 2007 Apr;13(2):130-6.

Understanding The Role of Testosterone in Men – Options for Testing and Treatment

By - Men's Health

by Nicole Maxwell, NMD

Are you or a loved one curious about testosterone replacement therapy, also known as TRT? Testosterone naturally begins declining in men between 30 and 40 years of age. Fortunately, age related testosterone decline can be treated in a variety of ways. With proper testing and guidance, men can experience normal levels of testosterone providing energy and stamina well into advanced age. 

I’ve provided some of my favorite links to reliable information to consider if you are thinking about a testosterone prescription. 

Overview of Testosterone

Here is a very thorough article exploring symptoms, causes, and treatment of low testosterone:
https://www.urologyhealth.org/urologic-conditions/low-testosterone 

Labs

Appropriate labs that must to be done before starting TRT and are available at our office. Here is a link that talks about appropriate lab markers: https://ndnr.com/mens-health/testosterone-drops-anti-aging-for-male-baby-boomers/# 

Many wonder what method of testing to choose. I prefer serum and saliva testing. 

The risks and benefits of testosterone replacement therapy

PROS: Numerous studies show the benefits of TRT with reducing cardiovascular disease risk, improving metabolic dysfunction, improving glycemic control and body composition. https://ndnr.com/naturopathic-news/testosterone-therapy-could-increase-risk-of-heart-attack-and-stroke/ We do, however, need more long-term studies as the next bullet demonstrates. 

CONS: There has been one study showing that there may be a 21% increased risk of a cardiovascular event especially in the first two years of TRT and then it seems to be cardioprotective.
https://ndnr.com/mens-health/testosterone-cv-risk-in-men/ 

Testosterone Modifiers

Many things we do daily affect our hormones. Testosterone modifiers are crucial to address. Your naturopathic physician can review diet, lifestyle, medication, nutrient deficiencies, blood sugar, and hormonally active chemicals in our environment. Here’s a great article exploring this topic: https://ndnr.com/mens-health/testosterone-modifiers/ 

I’d Love to Help

I have been working with men’s health for 17 years and would be happy to assist you or a loved one with anti-aging medicine. Please contact us at www.boisenaturalhealth.com. 

Kids and Sleep

By - Pediatrics

By Nicole Maxwell, NMD

Sleep problems affect 20-30% of children and in many cases it can be addressed with naturopathic care.

Symptoms of insomnia include:

  • Sleep problems – difficulty falling asleep or staying asleep or waking up too early in the morning.
  • Tension/worry about going to bed and being able to fall asleep.
  • Being sleepy during the day.
  • School or disciplinary problems.
  • Irritability/mood swings.
  • Depression.
  • Hyperactivity.
  • Decreased attention span.
  • Aggression.
  • Memory problems.
  • Making errors or having accidents.

One issue is if we expect the child to be sleeping more than they need to or if they are in their bed longer than needed.  Reduce the sleep window to match the sleep needs to alleviate this possible bedtime struggle.  

How much sleep does each age group ideally need?

  • Preschoolers (3-5yo): 10-13 hours, no less than 8 and no more than 14.
  • School-aged Children (6-13yo): 9-11 hours, no less than 7 and no more than 12.
  • Teenagers (14-17yo): 8-10, no less than 7, no more than 11.

Some possible causes of insomnia include:

Stress: kids can suffer from stress just like adults.  Any school issues?  Bullying?  How’s family life?  Sibling relationships?  Any changes like recently moving?  Letting your child share their feelings can work wonders.  Naturopathically, we can treat this with adaptive herbs that are gentle for their system.  Consider ashwagandha: it has calming and focusing effects for students and helps calm the mind for restful sleep.

Use of caffeine or other stimulants: besides the obvious ones, many clear sodas and energy drinks have caffeine.

Medication side effects: drugs that treat ADHD, antidepressants, and others may cause insomnia.  We can help manage those side effects through nutrient guidance.

Other medical disorders: Growing pains, thyroid issues, heartburn and muscle cramps may cause insomnia.  We offer physical exams and many lab options to help rule these issues out or in and treat accordingly.  Magnesium is great for muscle cramps and growing pains. Magnesium is also an easy item you can try safely at home.  Food sensitivities may be linked to nightmares and sleep issues.  We offer food sensitivity testing at our office.  Blood sugar dysregulation often causes middle of the night insomnia.  Try a bedtime snack like a couple slices of apple with a nut butter on top or a hard boiled egg.

Environmental factors: Perhaps the room is too hot or too cold, not dark enough, or it’s too noisy.  These can be addressed with the appropriate mattress, bedding and curtains.  Another environmental factor includes restricting electronic usage in the bedroom and turning off Wifi at night.

I am happy to help you and your child/children uncover the source of the sleep difficulty and guide you to a safe and effective plan.  I work with herbs, nutrients, homeopathy, and diet. Contact Boise Natural Health Clinic at (208) 338-0405.

How to Decrease Jet Lag

By - Miscellaneous

By Dr. Nicole Maxwell

Planning to travel?  Want to take advantage of every minute?  Learn how to decrease the symptoms of jet lag so you can enjoy your time instead of wanting to sleep the day away.

Jet lag symptoms include: 

  • Disturbed sleep — such as difficulty falling asleep, early waking or excessive sleepiness.
  • Daytime tiredness.
  • Difficulty functioning at your usual level.
  • Stomach problems, constipation or diarrhea.
  • A general feeling of not being well.
  • Mood changes.

Hydration: dehydration worsens symptoms of jet lag and airplane travel promotes dehydration.  Make sure to hydrate well before, during and after your flight.  Avoid alcohol, soda and caffeine as those promote dehydration as well.  Choose an aisle seat so you can take bathroom breaks as needed.  Consider drinking a glass of water every waking hour on your flight.

Melatonin: Melatonin is related to light – light suppresses melatonin secretion.  Crossing time zones disrupts the melatonin cycle.  Consider taking melatonin upon arrival one hour before the new bedtime.  If you arrive in the morning, wait until that evening to supplement.  1-3mg should be plenty.

Homeopathic combination remedies like No Jet Lag can be very helpful for recovering from jet lag.  No Jet Lag directions: chew 1 upon take off, one in the middle of flight, one upon landing and one before bed, local time. May also chew 1 three times a day the next day if needed.

Acupressure can also be helpful for jet lag and it’s free!  Check out this link by physical therapist, Mary Golob for the acupressure points and the associated times.  https://www.scribd.com/document/383612283/How-to-fix-Jet-Lag

Fasting hasn’t been tested in clinical trials yet and the theory, extrapolated from mice, is that the body’s circadian clock gets suspended when fasting to conserve energy.  When you eat soon after landing, the clock starts again.  The doctors who did the mice research recommend fasting 12-16 hours before and during the flight then eat a healthy meal once you land, as soon as is convenient.  Drink lots of water during the flight though!  If you want to eat on plane pre-order “low sodium” meal to prevent dehydration.

Earthing: walk outside on a natural surface for 20 – 30 minutes with bare feet.  The theory here is that the earth has a rhythm and by grounding yourself in the new time zone, your rhythm will match the earth’s rhythm in the new time zone.  I have colleagues who swear by this.  I think it sounds lovely to squish your toes in the sand or lay on the grass and become present to the new surroundings.

Supplements: An adrenal support in the morning of new time zone can help increase morning cortisol.  Then take phosphatidyl serine 3 hours before the new bedtime and again at the new bedtime to help decrease nighttime cortisol.  This resets the cortisol rhythm to the new time zone.  These are available at Boise Natural Health Clinic.

May you have wonderful travels with little jet lag interference.  Feel free to come in for a tune up as well to prepare for your best trip yet.

Citations

1. https://www.precisionnutrition.com/all-about-jet-lag?fbclid=IwAR0doaU7dGY-haoLuLOZ6xukPtRUyI2mxnYIC8TI7LntKyxiInr_piWD2J8

 2. https://www.health.harvard.edu/blog/resetting-your-circadian-clock-to-minimize-jet-lag-2016090810279

Get Rid of Belly Fat with HIIT

By - Exercise

Nicole Maxwell, NMD

No time to work out but want to work on cardiovascular health and weight loss?  Then high intensity interval training is for you!  High intensity interval training, also known as HIIT, has been shown to help people improve their cardiovascular health and lose weight. 

What is HIIT?  

HIIT is when you alternate an intense phase of exercise followed by a period of recovery and repeat several times, often for a total of 10 minutes.  The great thing about HIIT is you get to experience the extra benefits of intense exercise without creating a negative or unpleasant experience that can happen with longer, sustained rate exercise.

What does it do?

  • Most of the research is based on cardio types of HIIT (running, walking, cycling) but it can be adapted to almost any form and combination.  Among people with heart disease, HIIT improves cardiorespiratory fitness nearly twice as much as longer stretches of moderate intensity running, cycling or other aerobic exercises.
  • It also has a greater impact on fat loss (especially abdominal) then steady state cardio at much less of a time commitment!
  • Improves insulin sensitivity especially in people at risk for developing diabetes mellitus

How does it work?

HIIT switches on genes that increase mitochondrial growth (the power generators of our cells) and other beneficial biological changes. Even these short bouts of training can switch on those genes, making it an efficient workout.  

The nitty gritty

  • The key to HIIT is pushing your heart rate up above 80% of its maximum.  To find your maximal heart rate subtract your age from 220.  (MHR = 220 – age)
  • a longer recovery period is often needed. Perhaps start with one HIIT training workout a week, with your other workouts being steady state workouts.

Some examples

  • Add a 2-minute warm up and 3-minute cool down
  • Examples of HIIT activities to repeat for 10 minutes:
    • 30 second sprint alternating with 1-2min walking/slow jogging
    • 10-20 seconds all out cycling alternating with 2 minutes easy cycling
    • Climb stairs for 30 seconds during your lunch break then walk for 1-2 minutes

If you’re looking to lose weight, improve your cardiac function and blood sugar control then consider HIIT, it may be just the ticket, especially if you have limited time.

Natural Cleaning Recipes

By - Miscellaneous

by Nicole Maxwell, NMD

Adapted from Lauren Cox at Natural Partners

You may have a cabinet somewhere in the house complete with glass cleaner, bleach, abrasive bathroom cleaner, etc. Many conventional cleaning products contain chemicals that can be harmful to your health.  

Try some of these great healthy alternatives.  Put them in glass spray bottles to reduce plastics in the house as well.  You will cut down on chemicals in your home and oftentimes save money!

Here are some interesting facts:

  • An EPA study concluded that the toxic chemicals in household cleaners are 3 times more likely to cause cancer than outdoor air. (https://www.cpsc.gov/Safety-Education/Safety-Guides/Home/The-Inside-Story-A-Guide-to-Indoor-Air-Quality)
  • The EPA found the levels of air pollution inside the home can be two to five times higher (and sometimes even 100 times higher) than outdoor levels. (American Lung Association and 3M survey, 2002)
  • The EPA ranks poor indoor air quality among the top five environmental risks to public health. (American Lung Association and 3M survey, 2002). Here is a link for plants that help improve air quality.

Window Cleaner

¼ cup rubbing alcohol
¼ cup white vinegar
1 tablespoon cornstarch
2 cups purified water

Try plain packing paper to wipe to decrease streaking.

All Purpose Cleaner

½ cup white vinegar
2 cups water
10 drops oregano oil
10 drops clove oil
10 drops lavender oil
10 drops lemon oil

Toilet Scrub

¾ cups borax
1 cup white vinegar
10 drops citrus oil of choice
10 drops mint oil

Wood and Floor Cleaner

1 cup white vinegar
2 oz mild castille soap
3 cups purified water
20 drops essential oils of choice

Wood Polish

¼ cup coconut oil
⅓ cup white vinegar
4 cups hot water

Laminate and Tile Cleaner

1 tablespoon baking soda
2 cups hot water
10 drops citrus oil of choice

Moldy Grout Cleaner

1 part hydrogen peroxide
1 part water
(spray and let sit at least 45 minutes and wipe down with a sponge)

Leather Cleaner

¼ cup white vinegar
¼ cup olive or coconut oil
10 drops essential oil of choice

Air Fresheners

Consider an aromatherapy essential oil diffuser or make a simmer pot. Just add in your favorite oils and herbs to a gallon of water and let it simmer all day. Try lavender, rosemary, lemon or clove.

The Low Down on Lipids

By - Heart Disease & Diabetes

by Nicole Maxwell, NMD

Approximately 50% of patients experiencing a heart attack or stroke have “normal” cholesterol levels.  What does it mean to have “normal” lipid levels?  What parameters might be better to check to accurately identify your risk?  

The risk of developing heart disease has traditionally been assessed by measurement of LDL-C (low-density lipoprotein cholesterol; the carrier of “bad” cholesterol) and HDL-C (high-density lipoprotein cholesterol; the carrier of “good” cholesterol). The “C” portion in LDL-C stands for calculation.  Unfortunately, this is not a true value but a calculation based on total cholesterol, triglycerides and HDL-C.  Moreover, the LDL-C is known to be inaccurate, particularly as triglyceride levels have risen with obesity, glucose intolerance and diabetes.  

At BNHC we do comprehensive screenings, including:

  • LDL-P: The “P” stands for particle and we can now measure the LDL directly instead of using a calculation.  The higher the LDL-P the more particles there are in your bloodstream which can build up in the arteries and cause heart disease.
  • VLDL-P: These particles are smaller than LDL-P and can get into the artery walls where dangerous plaque forms.
  • HDL-P: Direct measurement of the HDL particles, which tend to be protective.  HDL-P was found to be a better predictor of cardiovascular disease than HDL-C in many studies.
  • Ox-LDL or oxidized LDL: Plaque-specific and directly involved in atherogenesis and late stage atherosclerotic plaque instability and rupture.
  • Apolipoprotein B (Apo B): This is the sole protein constituent of LDL and a stronger cardiovascular risk factor than LDL-C
  • Lipoprotein a (LpA): This is a particle that carries cholesterol and is inherited from one or both of your parents.  High levels increase one’s risk of atherosclerosis, cardiovascular disease, peripheral vascular disease and is a leading risk factor for strokes.
  • And more:there are even more parameters we can test to create a better picture of your personal cardiac risk, such as CRPhs a marker for inflammation. 

For a more accurate understanding of your true heart health, consider a comprehensive risk assessment with Dr. Nicole Maxwell at Boise Natural Health Clinic.