September 22, 2025 • 15 mins
Have you been celebrating those dramatic drops on the scale? Think twice before popping the champagne. As a Nurse Practitioner specializing in metabolic health, I'm pulling back the curtain on why rapid weight loss might be sabotaging your long-term success.
When a patient proudly announced losing nine pounds in just one week, my reaction wasn't congratulatory – it was concern. That dramatic number likely represented water weight, muscle loss, and a flood of stored toxins entering the bloodstream. This episode dives deep into the hidden consequences of losing weight too quickly: the shutdown of metabolism-boosting brown fat, the overwhelming of detox pathways, mineral depletion, and the cannibalization of precious muscle tissue.
The science is clear: sustainable weight loss of about two pounds weekly protects your metabolic health while giving your body time to adapt. I'll walk you through exactly how to support your body's natural detoxification systems during weight loss with crucial minerals, vitamins, and liver-supporting foods. You'll discover why strength training, daily movement, cold exposure, quality sleep, stress management, and gut health create the foundation for fat loss that actually lasts – without the rebound effect that follows crash dieting.
Ready to stop chasing dramatic weekly drops and start building sustainable results? Your brown fat, muscles, and mitochondria will thank you. Connect with me at HarmonyHubHealth.com to develop a personalized approach that respects your body's complex systems while achieving meaningful, lasting transformation.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:01):
Welcome to Harmony Hub Health, where my mission is
to provide comprehensive,affordable, integrative care
that addresses the root cause ofhealth issues.
At the Hub, the focus is onindividual patient journeys.
I strive to optimize health,vitality and longevity,
fostering a community where eachperson can thrive in body, mind
and spirit.
(00:21):
Hello, this is Michelle,certified Nurse Practitioner for
Harmony Hub Health, and thisweek I might want to talk about
something that might not be verypopular, but I want to talk
(00:44):
about rapid weight loss and whyfaster isn't necessarily better.
I have rockstar weight losspatients I really do but this
past week a patient of mineproudly stepped on the shape
scale and dropped nine pounds inone week.
Sounds impressive, right Likehe was expecting confetti to
(01:06):
fall out of the sky, but not sofast.
My reaction was more along thelines of yikes like slow down,
turbo.
And here's the truth Rapidweight loss is not the flex you
think it is.
In fact, it can really backfire.
It can mess with your brown fat, your minerals, your muscles
and your detox pathways.
So today I wanted to unpack whyand, more importantly, how to
(01:30):
do it right.
Don't get me wrong, I get it.
People want these scalevictories.
I totally understand the thrillof watching that number on the
scale plummet.
It feels good, it feels like avictory.
Who doesn't want to say I lostfive, seven, nine pounds this
week?
But here's the problem thescale can be a little bit of a
(01:52):
liar.
A huge weekly drop is oftenwater and muscle, not just fat.
Rapid drops release storedtoxins into your bloodstream and
it overwhelms your detoxsystems.
Fast loss also slows down brownfat activity, which you
actually need to keep yourmetabolism burning long-term.
(02:13):
That's why at Harmony HubHealth I do use tools like the
Shape Scale, because I don'tjust care about pounds, I care
about what kind of weight you'relosing.
Spoiler alert I'd rather youlose fat than muscle.
So the hidden side effects ofrapid weight loss the first one
is brown fat shutdown.
(02:33):
Most people have never evenheard of brown fat, but brown
fat is your calorie burningspace heater and rapid weight
loss makes it go quiet.
Studies do show that obesityand weight cycling suppress
brown fat activity, which raisesthe risk of weight regain.
You don't want that.
Number two is toxin dumping.
(02:54):
So stored pollutants like PCBsand pesticides are released when
fat burns too quickly.
One study on bariatric surgerypatients found spikes in
circulating toxins after rapidfat loss and that was published
by Johns Hopkins in 2019.
Mineral depletion is numberthree.
Rapid losses mean flushing outelectrolytes like magnesium,
(03:17):
potassium and zinc.
These are important for energy,thyroid balance and muscle
function.
And number four is muscle loss.
Crash dieting cannibalizesmuscle, so less muscle equals
slower metabolism and worseinsulin sensitivity, which the
goal of metabolic programs is toimprove your insulin
(03:38):
sensitivity.
A normal weight loss peoplealways ask me.
I truly believe that sweet spotwould be about two pounds a
week.
Not flashy, but this rateprotects your muscles, keeps
your brown fat humming and givesyour detox systems time to keep
up.
Here's how to keep yourmetabolism, your minerals and
(04:00):
your detox on your side whilelosing fat.
The first thing I talk toeverybody about is making sure
you have balanced minerals andvitamins.
Magnesium is critical for 300enzyme reactions in your body,
including detoxification andyour energy metabolism.
When you are deficient, it islinked to insulin resistance.
(04:25):
Potassium is what maintainsyour fluid balance and prevents
muscle loss during calorierestrictions.
Zinc supports your thyroidhormones, your immune health and
your wound healing.
B vitamins are really importantfor your methylation and phase
one liver detox pathways arereally important for your
methylation and phase one liverdetox pathways.
(04:46):
Antioxidants like vitamin C,vitamin E, polyphenols they
neutralize oxidative stress fromreleased toxins.
And then the biggest one is theprotein, because it protects
your lean mass and it providesamino acids for glutathione
production.
You know how I love myglutathione.
You want to think of detox as athree-lane highway.
We have our liver, we have ourkidneys, then we have our gut.
(05:08):
Rapid fat loss throws a trafficjam on all three and we want to
keep all lanes clear.
So for liver support, thatwould be cruciferous vegetables,
broccoli, brussels sprouts,kale.
You want to up-regulate phase 2detox enzymes, sulfur-rich
foods like garlic, onion, eggs.
(05:30):
Of course these are all alsobased on your food sensitivities
when we check them, but itreally helps with your
glutathione production.
You need that liver support inthe detox.
And then your kidneys, becausehydration is non-negotiable.
Water and mineral balance keepyour kidneys flushing the toxins
out.
Electrolytes like the magnesium, potassium prevent the
(05:53):
fatigue-cramp combo.
And then, with your gut, fiberbinds toxins in the intestines
and it reduces the reabsorptionof those toxins.
Probiotics strengthen gutbarrier integrity.
It lowers endotoxin leak, whichotherwise sabotages fat cells.
So bonus would be sweating bysauna or some light exercise.
(06:17):
That's a legit way to excreteheavy metals and persistent
organic pollutants.
I know when a lot of people trya weight loss program, it's just
all about calorie restrictionand counting macros.
But research does show thatlong-term fat loss and metabolic
resilience can be helped byother things.
(06:37):
I do not look at calories asmuch.
If anything, all I talk aboutis making sure you're eating
enough calories and matchingthat BMR and not going below
your basic metabolic rate so youcan do your bodily functions,
and cutting out all processedfoods.
But the lifestyle habits thatactually work are strength
(06:59):
training you want to preservemuscle, you want to improve that
insulin sensitivity and youwant to raise your resting
metabolic rate.
Then you know there is cardio,like the walking, the standing,
the daily movements.
They all add up and they'relinked to lower all-cause
mortality.
Neat is also known asnon-exercise activity
(07:20):
thermogenesis.
So these are the littlemovements you do outside of
structured exercise that stillburn calories and keep your
metabolism going.
They don't feel like workoutsbut it really adds up.
It could mean walking while on aphone call instead of sitting.
It could mean taking the stairs.
Yes, even if the elevator isworking, take the stairs.
(07:41):
The biggest one is just parkingfurther away at the store.
Those extra steps add upthroughout the day just by not
taking that closest parking spot.
Doing your household choreslike vacuuming, mopping,
scrubbing, gardening those arestealth calorie burn and can be
fun if you love hobbies likegardening.
A lot of people have thestand-up desks or they schedule
(08:05):
in movement breaks on theirphone, so it makes them stand up
, it makes them walk, it makesyou go get a drink of water.
One of the funnest ones isplaying with your kids or your
pets, playing tag or having adance party with your kids.
I used to do that with my sonall the time.
It really adds up as well.
And carrying groceries onmultiple trips instead of one
(08:26):
haul every little bit helps.
I mean even fidgeting.
If you're a leg bouncer, youknow studies show that adds up
too.
So research does show thathigher NEAT levels can burn
hundreds of extra calories a day, and it's linked to better
weight maintenance and reducedmortality risk.
(08:46):
And these are just really smallthings.
Another one that people arefinding to be very popular right
now is cold exposure.
Cold exposure activates brownfat and encourages white fat to
brown.
So cold exposure isn't aboutturning yourself into an ice
cube.
It's strategic, it's safestimulation of brown fat and
(09:07):
mitochondrial function.
This could be a cold shower atthe end of your normal shower.
I know a lot of the ladies likethat cold water to make your
hair shinier.
But just start with 30 to 60seconds and gradually increase
it as you can tolerate it.
But having that cold burst doeshelp Keeping your rooms cooler.
So if you keep your home around66 to 68 degrees, they say this
(09:31):
can encourage brown fatactivation.
I always keep my house at 72,so I don't check off that box,
but that's just where I'mcomfortable.
Outdoor walks in brisk weatherthat is one of my favorite.
Of course, wear appropriateclothing, but low intensity cold
exposure without the drama isjust a nice outdoor walk in
(09:52):
brisk weather.
Some people do like to applyice packs.
I could never do that, but youapply cold packs to the brown
fat-rich areas that could beyour upper chest, your shoulders
, along the spine, for veryshort intervals.
I think my favorite that I havedone before that I love, is
cryotherapy chambers, so they'revery popular in wellness
(10:13):
clinics.
You typically spend two tothree minutes at negative 150
degree Fahrenheit or negative110 degree Celsius, and it
suggests the benefits forinflammation, although it's not
necessary for beginners.
And then we have our coldplunges, so that could be in the
(10:35):
cold tub or even in the lake.
One to three minutes at 50 to59 degrees Fahrenheit or 10 to
15 degrees Celsius just shows astrong evidence for increasing
your norepinephrine and thatbrown fat activity.
But cold exposure is not foreveryone, especially if you have
(10:55):
any uncontrolled heart diseaseor if you have Raynaud's
especially, you want to startvery slow and listen to your
body and use it as a tool.
It should not be punishment and, like I said, it's not for
everyone.
What is for everyone, of course, is sleep.
Seven to nine hours of goodsleep stabilizes your ghrelin
(11:15):
and your leptin, which are yourappetite hormones.
Chronic sleep loss is linked tomore fat retention and that's
published in studies everywhere.
Stress management so if youhave high cortisol, that equals
to fat storage and brown fatsuppression.
So meditation, vagus, nervestimulation like that pulsato
(11:37):
that I love, even yoga to reducecortisol and improve metabolic
markers.
That is very beneficial.
And then another one that'sbecoming very popular is gut
health.
So a very diverse microbiomeimproves nutrient absorption and
toxin clearance and certainstrains even support fat loss.
Everybody knows how I feel aboutmy Saccharomyces boulardii.
(11:59):
Make sure your probiotic hasthat in there and if not, let me
know I have orthomolecular.
I really know for a fact that Icarry the most supreme
probiotic available on themarket that is medical grade.
So the hard truth is thatchasing massive weekly drops
(12:20):
might give you bragging rightswith your friends, but it
doesn't give you lasting health.
At Harmony Hub Health, I'm allabout the long game sustainable
fat loss, preserved or evengained muscle, balanced minerals
and vitamins, detox pathwaysthat actually work.
Active brown fat that keepsyour metabolism going, and
(12:42):
that's why I was not thrilledwith that nine pound quote
unquote victory.
It looked good on the scale,but behind the scenes it
screamed mineral depletion,muscle loss and toxin overload.
So at Harmony Hub Health Idon't hand out trophies for
fastest loser.
I want to help you lose fat ata steady, healthy pace.
(13:03):
I want you to keep your musclesstrong and your metabolism
higher.
I want this longevity.
We need this health span.
I want to help you balance yourminerals and your vitamins and
support your body's detoxpathways.
I want you to hop on my shapescale to track real progress,
not just those scale tricks,because the goal isn't to be the
(13:24):
star of a crash diet realityshow.
The goal is to have resultsthat last, energy that sustains
and health that supports you forthe long haul.
So if you're listening and youare ready to stop chasing quick
drops and start building lastingresults, you should book your
consultation at Harmony HubHealth.
(13:45):
You can find me atHarmonyHubHealthcom.
You can email me at Michelle,that's M-I-C-H-E-L-E at Harmony
Hub Health.
You can also find me in personin Manchester, maryland, right
now, at Monarch Beauty and Spa.
Your brown fat, your muscles,your mitochondria they're all
going to thank you.
The information in this podcastis for educational purposes
(14:09):
only and is not intended todiagnose, treat, cure or prevent
any medical condition.
While we talked about brown fat, weight loss, toxins and
lifestyle strategies, this isnot a substitute for
personalized medical advice.
Everybody's body and healthhistory are unique, so before
making changes to your diet,your supplements, exercise or
(14:32):
therapies, please consult with aqualified healthcare provider.
Rapid weight loss and detoxstrategies can have risks and
what works for one person maynot be safe or effective for
another.
Listening to this podcast doesnot create a patient-provider
relationship.
Welcome to Harmony Hub Health, where my mission is
to provide comprehensive,affordable, integrative care
that addresses the root cause ofhealth issues.
At the Hub, the focus is onindividual patient journeys.
I strive to optimize health,vitality and longevity,
fostering a community where eachperson can thrive in body, mind
and spirit.
(00:21):
Hello, this is Michelle,certified Nurse Practitioner for
Harmony Hub Health, and thisweek I might want to talk about
something that might not be verypopular, but I want to talk
(00:44):
about rapid weight loss and whyfaster isn't necessarily better.
I have rockstar weight losspatients I really do but this
past week a patient of mineproudly stepped on the shape
scale and dropped nine pounds inone week.
Sounds impressive, right Likehe was expecting confetti to
(01:06):
fall out of the sky, but not sofast.
My reaction was more along thelines of yikes like slow down,
turbo.
And here's the truth Rapidweight loss is not the flex you
think it is.
In fact, it can really backfire.
It can mess with your brown fat, your minerals, your muscles
and your detox pathways.
So today I wanted to unpack whyand, more importantly, how to
(01:30):
do it right.
Don't get me wrong, I get it.
People want these scalevictories.
I totally understand the thrillof watching that number on the
scale plummet.
It feels good, it feels like avictory.
Who doesn't want to say I lostfive, seven, nine pounds this
week?
But here's the problem thescale can be a little bit of a
(01:52):
liar.
A huge weekly drop is oftenwater and muscle, not just fat.
Rapid drops release storedtoxins into your bloodstream and
it overwhelms your detoxsystems.
Fast loss also slows down brownfat activity, which you
actually need to keep yourmetabolism burning long-term.
(02:13):
That's why at Harmony HubHealth I do use tools like the
Shape Scale, because I don'tjust care about pounds, I care
about what kind of weight you'relosing.
Spoiler alert I'd rather youlose fat than muscle.
So the hidden side effects ofrapid weight loss the first one
is brown fat shutdown.
(02:33):
Most people have never evenheard of brown fat, but brown
fat is your calorie burningspace heater and rapid weight
loss makes it go quiet.
Studies do show that obesityand weight cycling suppress
brown fat activity, which raisesthe risk of weight regain.
You don't want that.
Number two is toxin dumping.
(02:54):
So stored pollutants like PCBsand pesticides are released when
fat burns too quickly.
One study on bariatric surgerypatients found spikes in
circulating toxins after rapidfat loss and that was published
by Johns Hopkins in 2019.
Mineral depletion is numberthree.
Rapid losses mean flushing outelectrolytes like magnesium,
(03:17):
potassium and zinc.
These are important for energy,thyroid balance and muscle
function.
And number four is muscle loss.
Crash dieting cannibalizesmuscle, so less muscle equals
slower metabolism and worseinsulin sensitivity, which the
goal of metabolic programs is toimprove your insulin
(03:38):
sensitivity.
A normal weight loss peoplealways ask me.
I truly believe that sweet spotwould be about two pounds a
week.
Not flashy, but this rateprotects your muscles, keeps
your brown fat humming and givesyour detox systems time to keep
up.
Here's how to keep yourmetabolism, your minerals and
(04:00):
your detox on your side whilelosing fat.
The first thing I talk toeverybody about is making sure
you have balanced minerals andvitamins.
Magnesium is critical for 300enzyme reactions in your body,
including detoxification andyour energy metabolism.
When you are deficient, it islinked to insulin resistance.
(04:25):
Potassium is what maintainsyour fluid balance and prevents
muscle loss during calorierestrictions.
Zinc supports your thyroidhormones, your immune health and
your wound healing.
B vitamins are really importantfor your methylation and phase
one liver detox pathways arereally important for your
methylation and phase one liverdetox pathways.
(04:46):
Antioxidants like vitamin C,vitamin E, polyphenols they
neutralize oxidative stress fromreleased toxins.
And then the biggest one is theprotein, because it protects
your lean mass and it providesamino acids for glutathione
production.
You know how I love myglutathione.
You want to think of detox as athree-lane highway.
We have our liver, we have ourkidneys, then we have our gut.
(05:08):
Rapid fat loss throws a trafficjam on all three and we want to
keep all lanes clear.
So for liver support, thatwould be cruciferous vegetables,
broccoli, brussels sprouts,kale.
You want to up-regulate phase 2detox enzymes, sulfur-rich
foods like garlic, onion, eggs.
(05:30):
Of course these are all alsobased on your food sensitivities
when we check them, but itreally helps with your
glutathione production.
You need that liver support inthe detox.
And then your kidneys, becausehydration is non-negotiable.
Water and mineral balance keepyour kidneys flushing the toxins
out.
Electrolytes like the magnesium, potassium prevent the
(05:53):
fatigue-cramp combo.
And then, with your gut, fiberbinds toxins in the intestines
and it reduces the reabsorptionof those toxins.
Probiotics strengthen gutbarrier integrity.
It lowers endotoxin leak, whichotherwise sabotages fat cells.
So bonus would be sweating bysauna or some light exercise.
(06:17):
That's a legit way to excreteheavy metals and persistent
organic pollutants.
I know when a lot of people trya weight loss program, it's just
all about calorie restrictionand counting macros.
But research does show thatlong-term fat loss and metabolic
resilience can be helped byother things.
(06:37):
I do not look at calories asmuch.
If anything, all I talk aboutis making sure you're eating
enough calories and matchingthat BMR and not going below
your basic metabolic rate so youcan do your bodily functions,
and cutting out all processedfoods.
But the lifestyle habits thatactually work are strength
(06:59):
training you want to preservemuscle, you want to improve that
insulin sensitivity and youwant to raise your resting
metabolic rate.
Then you know there is cardio,like the walking, the standing,
the daily movements.
They all add up and they'relinked to lower all-cause
mortality.
Neat is also known asnon-exercise activity
(07:20):
thermogenesis.
So these are the littlemovements you do outside of
structured exercise that stillburn calories and keep your
metabolism going.
They don't feel like workoutsbut it really adds up.
It could mean walking while on aphone call instead of sitting.
It could mean taking the stairs.
Yes, even if the elevator isworking, take the stairs.
(07:41):
The biggest one is just parkingfurther away at the store.
Those extra steps add upthroughout the day just by not
taking that closest parking spot.
Doing your household choreslike vacuuming, mopping,
scrubbing, gardening those arestealth calorie burn and can be
fun if you love hobbies likegardening.
A lot of people have thestand-up desks or they schedule
(08:05):
in movement breaks on theirphone, so it makes them stand up
, it makes them walk, it makesyou go get a drink of water.
One of the funnest ones isplaying with your kids or your
pets, playing tag or having adance party with your kids.
I used to do that with my sonall the time.
It really adds up as well.
And carrying groceries onmultiple trips instead of one
(08:26):
haul every little bit helps.
I mean even fidgeting.
If you're a leg bouncer, youknow studies show that adds up
too.
So research does show thathigher NEAT levels can burn
hundreds of extra calories a day, and it's linked to better
weight maintenance and reducedmortality risk.
(08:46):
And these are just really smallthings.
Another one that people arefinding to be very popular right
now is cold exposure.
Cold exposure activates brownfat and encourages white fat to
brown.
So cold exposure isn't aboutturning yourself into an ice
cube.
It's strategic, it's safestimulation of brown fat and
(09:07):
mitochondrial function.
This could be a cold shower atthe end of your normal shower.
I know a lot of the ladies likethat cold water to make your
hair shinier.
But just start with 30 to 60seconds and gradually increase
it as you can tolerate it.
But having that cold burst doeshelp Keeping your rooms cooler.
So if you keep your home around66 to 68 degrees, they say this
(09:31):
can encourage brown fatactivation.
I always keep my house at 72,so I don't check off that box,
but that's just where I'mcomfortable.
Outdoor walks in brisk weatherthat is one of my favorite.
Of course, wear appropriateclothing, but low intensity cold
exposure without the drama isjust a nice outdoor walk in
(09:52):
brisk weather.
Some people do like to applyice packs.
I could never do that, but youapply cold packs to the brown
fat-rich areas that could beyour upper chest, your shoulders
, along the spine, for veryshort intervals.
I think my favorite that I havedone before that I love, is
cryotherapy chambers, so they'revery popular in wellness
(10:13):
clinics.
You typically spend two tothree minutes at negative 150
degree Fahrenheit or negative110 degree Celsius, and it
suggests the benefits forinflammation, although it's not
necessary for beginners.
And then we have our coldplunges, so that could be in the
(10:35):
cold tub or even in the lake.
One to three minutes at 50 to59 degrees Fahrenheit or 10 to
15 degrees Celsius just shows astrong evidence for increasing
your norepinephrine and thatbrown fat activity.
But cold exposure is not foreveryone, especially if you have
(10:55):
any uncontrolled heart diseaseor if you have Raynaud's
especially, you want to startvery slow and listen to your
body and use it as a tool.
It should not be punishment and, like I said, it's not for
everyone.
What is for everyone, of course, is sleep.
Seven to nine hours of goodsleep stabilizes your ghrelin
(11:15):
and your leptin, which are yourappetite hormones.
Chronic sleep loss is linked tomore fat retention and that's
published in studies everywhere.
Stress management so if youhave high cortisol, that equals
to fat storage and brown fatsuppression.
So meditation, vagus, nervestimulation like that pulsato
(11:37):
that I love, even yoga to reducecortisol and improve metabolic
markers.
That is very beneficial.
And then another one that'sbecoming very popular is gut
health.
So a very diverse microbiomeimproves nutrient absorption and
toxin clearance and certainstrains even support fat loss.
Everybody knows how I feel aboutmy Saccharomyces boulardii.
(11:59):
Make sure your probiotic hasthat in there and if not, let me
know I have orthomolecular.
I really know for a fact that Icarry the most supreme
probiotic available on themarket that is medical grade.
So the hard truth is thatchasing massive weekly drops
(12:20):
might give you bragging rightswith your friends, but it
doesn't give you lasting health.
At Harmony Hub Health, I'm allabout the long game sustainable
fat loss, preserved or evengained muscle, balanced minerals
and vitamins, detox pathwaysthat actually work.
Active brown fat that keepsyour metabolism going, and
(12:42):
that's why I was not thrilledwith that nine pound quote
unquote victory.
It looked good on the scale,but behind the scenes it
screamed mineral depletion,muscle loss and toxin overload.
So at Harmony Hub Health Idon't hand out trophies for
fastest loser.
I want to help you lose fat ata steady, healthy pace.
(13:03):
I want you to keep your musclesstrong and your metabolism
higher.
I want this longevity.
We need this health span.
I want to help you balance yourminerals and your vitamins and
support your body's detoxpathways.
I want you to hop on my shapescale to track real progress,
not just those scale tricks,because the goal isn't to be the
(13:24):
star of a crash diet realityshow.
The goal is to have resultsthat last, energy that sustains
and health that supports you forthe long haul.
So if you're listening and youare ready to stop chasing quick
drops and start building lastingresults, you should book your
consultation at Harmony HubHealth.
(13:45):
You can find me atHarmonyHubHealthcom.
You can email me at Michelle,that's M-I-C-H-E-L-E at Harmony
Hub Health.
You can also find me in personin Manchester, maryland, right
now, at Monarch Beauty and Spa.
Your brown fat, your muscles,your mitochondria they're all
going to thank you.
The information in this podcastis for educational purposes
(14:09):
only and is not intended todiagnose, treat, cure or prevent
any medical condition.
While we talked about brown fat, weight loss, toxins and
lifestyle strategies, this isnot a substitute for
personalized medical advice.
Everybody's body and healthhistory are unique, so before
making changes to your diet,your supplements, exercise or
(14:32):
therapies, please consult with aqualified healthcare provider.
Rapid weight loss and detoxstrategies can have risks and
what works for one person maynot be safe or effective for
another.
Listening to this podcast doesnot create a patient-provider
relationship.
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