Health Coaching and Alzheimer’s Risk
Health coaching can be a valuable tool to help patients prevent Alzheimer’s disease. This is especially useful with lifestyle changes which can be challenging for the traditional medical system to support.
Lisa Feiner is a board certified Health and Wellness Coach, and a co-founder and Chair of Sharp Again Naturally. After receiving her MBA from Columbia Business School, she obtained her M.Ed. in Counseling.
Nancy Weiser is a board member of Sharp Again and has been featured in The New York Times and Martha Stewart Living Radio.
Nancy earned her BA from the University of Pennsylvania, her MBA from the Wharton School and is a National Board Certified Health & Wellness Coach in 2019.
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Robert Lufkin 0:01
Welcome back to the health longevity Secret show and I’m your host, Dr. Robert Lufkin. Health Coaching can be a valuable tool to help patients prevent Alzheimer’s disease. This is especially useful with lifestyle changes, which can be challenging for the traditional medical system to support. Lisa finer is a board certified health and wellness coach and co founder and chair of sharp again naturally, after receiving her MBA from Columbia Business School, she obtained her MA ed in counseling. Nancy Weiser is a board member of sharp again naturally, and has been featured in The New York Times and Martha Stewart Living Radio. Nancy earned her BA from the University of Pennsylvania, her MBA from the Wharton School, and is a national board certified health and wellness coach. And now enjoy this presentation from Lisa finer, and Nancy wiser.
Lisa Feiner 1:04
We’re so glad to be with you today. I’m Lisa finer. And this is Nancy Weiser. And we’re with sharp again naturally, we’re going to speak to you today about the value of health coaches in managing Alzheimer’s risk. So we are board national board certified health and wellness coaches as well as we both got our start in business, actually. And we’re board members of sharp again, a nonprofit organization that provides the knowledge and tools to personalized programs to help everyone prevent treat, and even reverse memory loss. We envision a world where everyone has access to the resources and care they need to maintain a healthy brain throughout their entire lives. So what you’ll hear about today is what health coaches actually do. Nancy is going to share with us a case study of her client, Harriet, who came to us presenting with memory loss, or memory issues, I should say. And we’ll tell you a little something about how you can prevent memory loss. And if there’s time we’ll we’ll take some questions. So first, we wanted to say a little bit about health coaching, because it’s not a profession. It’s a newer profession, actually, and not one that a lot of people know about. But it’s there’s a National Board of Health and Wellness Coaching that has worked with the National Board of Medical Examiners since 2016. And they’ve created a robust board certification exam that Nancy and I both took. And as of today, it’s only been offered over the past three or four years, there are now over 5000, board certified health and wellness coaches, and they go by the designation and B C HW C.
Nancy Weiser 3:05
So there had been various trainings in health coaching. And this was a way to standardize and uniform it, you know, making a more uniform kind of designation,
Lisa Feiner 3:14
right. And they’re actually that now they’re their insurance codes for coaches as well. So it’s it’s definitely becoming more professionalized? Absolutely. So what is the health coaching philosophy? And how does it How does it differ from how other practitioners work with patients and clients, we really take our direction from our clients who are in the driver’s seat. It’s self directed. And, and they are looking for lasting change that align with their own values. And we respect that. We know that they know more about themselves than we do. And we defer to them so that they, they can change at the rate that works for them. We do assess how
ready they are to change when they come to us. I think that’s always important. But then we really take our cues from them. We understand they’re an expert in their own life. And we most importantly, are very respectful and non judgmental of the client, which I think really opens the door to helping them feel like we are a partner with them in their in their health and well being. Another partnership that’s critical in the work we do is working with not only our client and patient, but also with the doctor that they are going to we will not do anything that interferes with that relationship. But there’s more much that can be done to to enhance it. So why do practitioners like working with health coaches and clients as well, neither one really feels that they have enough time, the patient and doctor aren’t usually spending too much time together. And a lot of times patients aren’t really sure when they leave the doctor’s office, if they’re told to lose weight, let’s say they’re not really sure exactly how to do that. And, and the patient and the doctor doesn’t really have enough time to spend explaining how that might be done. It can be very hard, without constant support, which is what a health coach provides, to really make those changes and make them lasting. So that’s what we’re here to do. And a lot of times, a doctor won’t give a patient a type of program to follow. And I would say, Nancy, and I, you would probably agree with this, that there’s not a prescribed, we don’t have any prescribed programs that we do
Nancy Weiser 6:07
well, completely tailored to that person’s circumstances and their health goals, and what they can realistically accomplish, right? So we have to know them very, very well and really on a deep level, and we
Lisa Feiner 6:19
do we get to know them over the course of working with them. So when you’re when you’re working with clients with memory issues, there are a few specific things to keep in mind. If someone’s coming either to prevent memory loss, or if the stage of subjective cognitive impairment, meaning they’ve noticed changes, but most other people haven’t. They’re working with us themselves. And it’s one on one like usual. But if people are further down the path and may have mild cognitive impairment, for example, there may be somebody else they want to involve in the process that could be a spouse, an adult child, a caregiver. And so the coach may end up having more than one client. And that’s something to always keep in mind
Nancy Weiser 7:06
more than one client within the client. Right, not just more than
Lisa Feiner 7:11
also, we we assess how motivated is the client to change? And how ready are they I mentioned that earlier. So the issue is that if someone else who wants that patient to get help, or that client to get help for their memory loss, but they aren’t on board with it, that’s an obstacle, and it may be hard to overcome, it can change potentially, I think if clients see some have some success early on, and they’re feeling better physically, and maybe their mind feels a little clearer, that will give them the motivation. But if they’re only there to please someone else, that can be problematic. We call
Nancy Weiser 7:58
that being there under duress. Yes. And,
Lisa Feiner 8:01
and and third is compliance know how, how can how much can we really depend on the client following through with the recommendations, again, if there is somebody by their side, who is helping to remind them to exercise, helping to remind them not to eat that sugary dessert, but maybe have some berries instead? That’s the kind of support that they will need to follow through with many of the recommendations that are made. We’re always looking beyond the diagnosis to see what else is going on in that person’s life. And how able will they be to comply. And then obviously, what that support system looks like. So I’m going to turn it over to Nancy now, who’s going to share with us some client history.
Nancy Weiser 8:53
So meet my client, Harriet, here’s a little bit about where she was when we first met. And by the way, Lisa will be telling you more later on about our sharp again, small groups and Harriet came to me through sharp again in our small groups where she was a participant in that program, and then decided that she wanted a little bit more or a lot more personalized attention and more detailed types of recommendations for her specific circumstances beyond what she might have been able to get into with the group. So she’s 60 years old when we meet, she’s five foot two and weighs 198 pounds. Among other things. She has insulin resistance, a history of thyroid cancer, she’s had her thyroid removed and she takes Synthroid, she’s also had a hysterectomy as a result of some severe endometriosis going back. The primary concern in her health or around her getting her health to where she wants it to be is that she cares for her adult son who lives at home with her who is autistic. So her current health concerns and the reason that she comes to sharp again and to me as our health coach is what she’s calling Her forgetful forgetfulness or what we’re calling subjective cognitive impairment, where she knows something is not quite right. No diagnosis of any kind of formal, no formal diagnosis, but she knows that she’s more forgetful than she has been. Clearly she’s overweight. And she says she wants to lose 50 pounds. She gets the shake some time her hands and feet can go a little bit numb and stiff. And she has such severe knee pain that it actually wakes her up throughout the night. So her sleep is affected. So that’s telling you that her knee pain is bad and that her sleep is affected and she has sleep problems. She also has sleep problems, because her son is up a lot at night, making a lot of noise, which is something that we address. When I’m working with her as her son’s sleep issues. He’s literally banging on the walls at night. And this has been going on for decades. She has high cholesterol she gets no exercise really barely leaves her home. And she has really no time for self care. So what’s in the way, the biggest thing that is blocking her from focusing on herself are the needs of her autistic adult son who lives at home. And they have in fact her family has redesigned their entire home. So that can be like a therapy facility for him as he continues into adulthood. She supervises and manages a staff to take care of him of about 15 people who come and go throughout the week of behavioral therapists and aides and so forth. She is under constant stress and pressure from this situation. She wants to be doing this by the way she wants him to live at home with her and she has expressed that most
people with children of his age with severe autism are usually living out of the home. They’re in halfway homes and things like that. She has another active team whom she cares for them way that you would inactive teen and an adult child who’s been living at home because of COVID in the last year. And that child the older child is overweight. And as an as a self worth my client, Harriet describes her daughter is carb addicted. Her elderly mother also lives across the backyard right nearby. And she said my client feels needed 24/7 by all of these people, my client eats only standing up and on the run and literally never sits. So what did Harriet done in the past to try to address her situation, she had her symptoms essentially treated as they came up in what we call silos one individual symptom treated by one individual specialist with one individual treatment for that symptom. She visited with many conventional as well as integrative and functional medicine, doctors, naturopaths, and nutritionists, all over the place some in the suburban area where she lives, some in the city, where she lives near, and so forth. So what comes next, enter the health coach. And we took a little bit of poetic license here. And we changed psychiatry to health coaching there for Lucy and Charlie Brown. So what do we have on the whole, we have a very cooperative clients, someone who very much wants to do whatever it takes for her to be able to feel well and energetic enough to be able to care for her son who needs her in every way. She is someone who wants to do all of these things, and she’s cooperative, but she in her own words, doesn’t know how to make it happen. Her initial goals were to be present for her family. And that doesn’t mean just being around, it means actually be able, being able to help them all day long in a very active way. And also to be able to manage her own stress. She wants to be able to what we say is crowding out foods that do not support health, she knows from the small group, she should be eating a different way, not exactly sure how to implement that in a daily way in her life. Walking 20 minutes a day is something she’d like to get to from nothing. And spending time engaging in self care. What some things that we discussed were short breathing exercises, watching some health related movie, she was not a big reader, and then getting on to a better sleep schedule to support both her memory and everything else that she wants in her life, her energy levels and all else.
Lisa Feiner 14:07
So this was definitely a client who was motivated, yes, ready for change? Correct. And was going to comply with what you recommend she
Nancy Weiser 14:15
just desperate for the tools and the support. Right? So yeah, what was her coaching plan? So this is this is not exactly specific, specific to her because that would be very personal. But the categories were how do we change her food to support her blood sugar energy levels, or sleep movement, that would be anything more than she was essentially doing? Time management was huge. And I’ll talk a little bit more about how we do that a little bit later. So there was no time management. In fact, the whole concept of time was something that she just didn’t really have any concept of it all. Everything was kind of just on constant motion and reactivity, sleep, communication and setting boundaries specifically with some of those caregiver types of people. who came in and out of the house? And then stress reduction overall? Clearly, this is a stressful kind of a life and situation. Initial treatment involved dietary changes, what did we eliminate? So where did we start? What was Harriet’s initial treatment, what we started with
the food that was sort of the easiest place to get started, but also presents its own set of challenges. So first, we said, what to eliminate what to get rid of. And the two there were actually two big categories under the umbrella of processed food, if you will, processed and refined carbohydrates on the whole. And understanding what this means for people is big. People had said this to Harriet before, and she either didn’t understand it, or really didn’t think that she could do it in that in that category would include gluten and gluten free processed foods. So what does that mean? It means that a box that is labeled organic and gluten free, and it’s from Whole Foods is something that is not health supportive, and that’s difficult for a lot of people to grasp. Because if you’re a marketer or a food engineer, you are designing it to exactly hit these hot buttons with people. So they grab it and they say, Oh, this is healthy. This is a healthful food. It’s gluten free, and it’s organic. And I bought it at Whole Foods, and I had to explain how that affects the sugar roller coaster. And I have her draw the sugar roller coaster with her own pen on a piece of paper to understand what’s happening to her energy levels throughout the day. And why she sometimes ends up as she says non functional and on the couch if she’s had a bad night’s sleep, so you can get away with one or the other but not both. And that’s been a big change dairy, beans and grains. Also because we’re dealing with someone whose blood sugar is volatile, and her son nightshade vegetables, we said bye bye to those and in the hopes that that would help with the knee pain. And lo and behold that in and of itself, along with getting rid of these other inflammatory foods, ease the knee pain right off in the sleep came back. Amazingly. So that was really that was like a miracle. She couldn’t believe that one and no alcohol. So when of course the question always is, well, if I can eat my crackers and cheese and my milk and ice cream and everything on what what do you eat? I say it’s actually very simple. It’s a simplified type of a meal plan where we emphasize nutrient dense foods. So the two examples I always give of what would be your dream foods they be kale and blueberries, they’d be the most nutrients for the least amount of calories. So low processed carbs and sugar meaning vegetables and fruits. A lot of people don’t know those are carbs. They know cookies and cake and and pasta is carb and bills, but they don’t necessarily know vegetables and foods. So those are carbs. When you say you can eat carbs, as long as there’s a
Lisa Feiner 17:40
there are bad carbs with fiber, correct?
Nancy Weiser 17:43
Correct, right? Healthy fats and we have a nice acronym for that. The smash fish, salmon, mackerel, anchovies, sardines, and herring, a lot of them easy to get out of cans and have easily available at home, some nuts, some coconut oil, some avocado, all of those things, you want to have some nice good fats, particularly in the form of the Smash fish and the nuts. Those are omega threes, those lubricate the cell membrane so that the insulin can drive the glucose into the cell to be used as energy. And I’m very visual in how I describe these things. So people can get motivated from understanding that I’m now allowing my cell wall to absorb energy through the insulin that’s carrying it into my cell. So that kind of combination of ideas is what kind of really drives the point home vegetables and I emphasize crucifers Anything in the broccolini broccoli, broccoli, Rob category, cauliflower, all the rest, leafy greens, some of which people are now very familiar with like kale, but they may not be eating so many collards and dandelions
yet and we add those and then garlic and onion and leeks. And then I say some nuts and seeds depending upon the weight situation because they are very calorie dense, as well as nutrient dense. So we take it easy on those but those are those are terrific to have a few handfuls a day. So it’s not only about what to eat, but I always say to clients actually how and when you eat are as important if not more important than what you eat. So awareness around this as a category of thought at all is news to my client, mindfulness and showing. So here my client actually said she didn’t even realize that chewing was almost part of eating she thought that the goal was to quote unquote, just get a doubt. Right because if you’re busy all day long and this is not something that you necessarily believe is important to spend your time on versus what getting something done. sitting down to eat I already said that she seats only standing up and then this is so important. The steps to get a meal prepared. So didn’t making dinner that’s actually not an activity or a thing. That is a an umbrella term for the following for planning shopping, including unpacking the food, prepping The food, cooking the food, eating and cleaning up. So this is actually a little simplified, I can break it down a little further into things like planning to plan. So when am I when is my time when I sit down to play, so it goes really deep in order for it to happen. These are the baby steps that Lisa mentioned earlier, biggest meal. Hopefully at midday, we’re still working on this with a smaller supper from the soup a from French, and then persistent consistent hydration after a nice hit of water first thing in the morning. So what was Harriet’s progress and what was really her progression through the six month health coaching program that I did with her. So no sugar, no refined and processed carbs, or processed foods or grains of any kind. Even whole grains, in her case, led to digestive health issues improving. Now, oftentimes clients don’t realize they have digestive health issues, until they improve. So as Harriet recently said, because I like to talk about the bear in the woods who doesn’t need toilet paper. I’m like the bear in the woods. And I don’t need toilet paper, terrific. Okay, you can go longer between meals. Why? Because your blood sugar is now stable. And guess what the knee pain went away because of the anti inflammatory nature of the diet, which as I explained earlier, that enabled her to sleep better. And then they sleep as I always go through with clients balances two hormones that help to regulate appetite, leptin and ghrelin, the fullness hormone, and the hunger hormone will now be produced by your body because of the sleep you’ve gotten in the correct way, where you don’t really have to almost so much focus on losing weight as an onerous task in your life, it starts to take care of itself. And she in fact, has begun to lose weight and has lost 10 pounds. And her son has lost 35 pounds, because she’s more dedicated to him than to herself. So that’s where we are Harriet’s progress. So the time and stress management management piece is as big or bigger than the food piece, because one drives the other, we had computer support to sync the multiple calendars to avoid conflicts, and to be able to think about the various stages of planning and preparing food. I talk about making an appointment with yourself. So Harriet would never miss an appointment with me, because it’s scheduled on her calendar. And we talked about doing that, for food preparation, and shopping and planning and for self care. So it’s making an appointment, it’s on the calendar. And if you have to move it, you can, but you can’t blow it off to does a difference. So you’re in control of it. But you can’t just sort of say, Oh, I don’t feel like doing something because it’s on the calendar, you get more clear about that. setting boundaries with professionals, the people who were coming in and out to assist her with her son’s care
and their schedule. So for example, somebody might say that they can only come, you know, at 530. And between 530 and seven, I said, Well, you need to tell that person that that’s your family dinner time, which it should be and it is, and they will have to come at a different time which hadn’t occurred to her before. And also the person might say, this is the only time I can come until you say, Well, I can’t do that time. And suddenly they can come at a different time. So learning how to set those boundaries, and be confident in the communication of them to professionals was key. Prepping ahead. Like I mentioned in batch cooking to be able to eat earlier, not saying I’m going to start dinner at six That’s too late, and establishing a daily routine and keeping times consistent for meals and sleep. And we’re working on the exercise piece. Now. What is the ripple effect around this? This is what we say is the gold of health coaching. Where did we start? What ended up happening that we didn’t expect that’s the ripple effect when you throw that pebble in the water and the ripples calm. So Harriet came to us because of her own self described, forgetfulness, and weight loss as her goals. And what I found out very quickly in was it was her son’s behaviors, probably very related to his diet, and his needing to lose weight and his sleep, which was again, a lot of screaming and banging on the walls that was getting in the way of her proper sleep and nutrition and even her chewing, right because she’s always on the run when she’s eating. So addressing her son’s issues via through his diet, allowed him to improve and then allowed Harriet to put into place a lot of the recommendations that she and I discussed all of what she’s on board with because she wants to be well and be able to be there for her son and all aspects of her health changed, as well as his son coming to us for her forgetfulness ended up changing his health enough to start to move the needle on her health. So her health, her weight, and her forgetfulness all improved, and so to the people around her. So recommended medical support. This is again that partnership that Lisa described the three way it’s the client, it’s or the patient because for the doctor, it’s the patient, the doctor and us the health coach. So I recommend that the patient does The doctor talked to their doctor about getting an A one C test, fasting insulin, fasting glucose, lipids, panel, inflammation markers, and maybe more, maybe thyroid, maybe some more things that they can discuss. So the bottom line, this client came to us because of her forgetfulness. But in the end, what she really needed help with deep help and support was with her sons and her family’s diet, setting boundaries, and prioritizing herself down to her own showing.
Lisa Feiner 25:31
So we want to tell you just a little bit about sharpening and naturalist programs. And Nancy, thank you so much, because I think the case study really helps us see how someone coming to a health coach can make the kinds of changes that they couldn’t if they were just visiting their doctor.
Nancy Weiser 25:50
And that’s the detail. And it’s also the amount of time spent. So I will have spent with Harriet by the end of her six month program, 13 hours in sessions, plus the back work that I do, to present to her what she needs to do the recommendations that she gets after each session. And then she’s had me do sessions with various different family members and her support team. So there’s a lot of hours that have gone into this that obviously a doctor wouldn’t have time to do in the office, right?
Lisa Feiner 26:17
How could you or one of your patients get started on this road to better brain health and better overall health. sharping naturally has been offering webinars. And we do this on a regular basis to educate everyone, not only about the causes of memory loss, but how to live a healthier life. And we’ve started last year, this small group program that Nancy and I have talked about a little bit, because we saw that even with as much education as we were providing. And we know that the information is sound and based on research, that it’s hard to implement based on education, people need more support. And the small group program was a way for us to provide the support. And it’s run by health coaches. So you get the health coach component, you get the group support. And ultimately, it’s a low cost way of starting people on the road to wellness. We’ve also planned as an adjunct to our newly launched or relaunched website, a professional referral directory. So we’re enrolling doctors and practitioners now to be part of that directory so that anyone can go online on our website and find practitioners who can address the causes of memory loss. And those causes, again, are discussed at sharp again.org. You know, we have 1012 different causes of memory loss. And we we continue to monitor the research to add to that list. So if you’re interested in any of these things you can go to you can write to us, you can email us at info at sharp again.org Or just go on the sharp again, naturally website, sharp again.org. So that’s the end of our formal presentation. And now if we have time, we’ll take a few questions. The first one is do health coaches have specialized practice areas? Like doctors do?
Nancy Weiser 28:29
And the answer is sometimes yes. And sometimes no. So Lisa, and I have a friend, for example, who does bone health coaching. I like to call myself a super generalist. So it really depends. But yes, they sometimes have very specific areas of practice, and they are sometimes more generalized. One thing that’s interesting is that a lot of the same recommendations will heal a lot of different ailments and concerns. Very true. And I’m gonna ask you, Lisa, how would one find a health coach, they were looking.
Lisa Feiner 29:01
So if you’re looking for a health coach for help with brain health, I recommend that you call sharp again naturally, because we have a number of health coaches that work with us. And we’ve been doing this work now for more than eight years. And there, there’s a lot to know. And so that’s one way but if you’re looking for a health coach, generally, they would go to the National Board of Health and Wellness Coaching. And they have their own website and there’s a they can find a health coach through there. So Nancy, who would you say signs up for the small group programs? I mean, we touched on this a little bit, right?
Nancy Weiser 29:44
So roughly it’s two categories. One is somebody who is already experiencing what we call subjective cognitive impairment, someone who’s already feeling forgetful, like my client, Harriet, they can get in touch with us themselves, or sometimes it’s the caregivers and Family
members of somebody who is maybe in slightly later stages of their, of their journey through cognitive impairment.
Lisa Feiner 30:09
You know, there has been another group that are people who know, for instance, they have an APO for Jean, or maybe they have to have them or they have many family members who have had, there you go. Yeah. And they want to prevent? Yes. So a lot of what we do in the small group program, and also, what you’ll see on our website, are great ways to prevent memory loss,
Nancy Weiser 30:36
absolutely, the more you can prevent, the more the chances are you will prevent. So what kinds of results do people get in our small group program?
Lisa Feiner 30:46
So I would say these are varied, and based on what their individual goals are. But what we’ve seen so far, is that people are exercising more, they’re cutting down on their snacking, they’re adjusting what they’re eating. So they’re, they’re crowding out some of those simple carbs and sugars that you talked about. And they’re replacing it with healthier, you know, fruits and vegetables on their plate, which is good. And that’s, that’s key. Some people are, you know, you mentioned sleep, which is so critical, some people are working on their sleep. And that’s, I think, if you can improve your sleep, and you exercise more, it improves every aspect of your life. So those are just some of the things. Our our small group programs typically run 10 weeks beginning to end, because they include individual sessions with a health coach, as well as the group meetings. And so over that period of time, people can typically work on maybe a couple of goals. Sure. And, and they’re seeing results. And overall, I mean, the most important thing is that they feel they have more energy, they’re thinking better. They’re more focused. And that’s really the goal of the program. And I
Nancy Weiser 32:16
think they’re also feeling more confident that they can take control over their health.
Lisa Feiner 32:20
Great point. So another question that came in, because we had talked about the relationship with the health coach, the doctor on the client, is, Can health coaches intercede for a client if they’re having some challenges communicating with their doctor?
Nancy Weiser 32:38
Absolutely. And it can go either way. Sometimes the client, may I ask the doctor to get in touch with me as a health coach. Or sometimes I might say, hey, if we need a little clarification around something, or maybe there’s a test that I think the client might benefit from, do you want me to get in touch with your doctor on your behalf? And depending upon the situation, that communication can be, you know, a golden nugget in their path.
Lisa Feiner 33:01
But we really want to get written permission? Absolutely, yes.
Nancy Weiser 33:05
Well, I say, right, yeah, send me an email. So I can send it off to your doctor and say that I need that. We want to have a conversation based on what the client wants.
Lisa Feiner 33:13
I’ve even been on the phone with the client and the doctor at the same time. That’s great. Great, so that everyone understands exactly sure what’s being recommended.
Nancy Weiser 33:23
Absolutely. Or in my case with with Harriet, I met with a group of the therapists that helped her with her son. I did I did a presentation and had a meeting with them on unzoom. Great, yeah, wonderful. What if a client is unwilling or unable to make all the recommended changes? Because they the changes themselves are too restricted or the client is overwhelmed.
Lisa Feiner 33:45
So typically, we go at the client’s pace, and everything can be broken down into small steps, will we call the Kaizen steps, which are small, attainable steps that build the client’s confidence to your point, and then that starts to steamroll a little bit into them making some bigger changes. So I think it’s really the onus is on the health coach to create changes and steps and recommendations that are attainable for the client, and it started out relatively small, and then I don’t believe they’ll feel overwhelmed by that. And nor do I think that it will feel restrictive in any way. So does a health coach adhere to the same confidentiality protocol is a medical doctor?
Nancy Weiser 34:45
A health coach when working with a health coach, everything from beginning to end including the fact that you are my client is confidential. Great.
Unknown Speaker 34:56
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