Best of: CIRS and the Bio Toxin Pathway: A Deep Dive into Detoxification and Healing with Dr. Jenski

As we continue bringing back the most popular episodes during the six weeks, this is one that I continue to get lots of questions from patients and other providers out there. This is an interview with Dr.

Christian Jinsky, our very own Christian Jinsky. We talk about chronic inflammatory response syndrome, mold illness, the biotoxin pathways. These are some of the most complicated topics for doctors and patients to understand, and we kind of take a deep dive into this. Hope you really enjoy this episode.

If you have questions about mold illness, not quite sure where to begin, this is a great episode.

It's been our most popular one on this topic. I really hope you enjoy this week's episode. Biotoxin pathway, ultimately what it is, is it kind of draws out how our bodies get exposed to biotoxins, which we described as it can be mold-related biotoxins, it can be particulates in a water-damaged building, bacterial toxins in a water-damaged building, but it also can be Biotoxins from things like Fusarium, Sigillaria. We've also talked about how the—

Lyme.

Lyme. It gets really bigger and bigger and bigger. So, when we say biotoxin, it's a really, really big, broad term. Welcome back once again. We are talking again about chronic inflammatory response syndrome. And today, we're going to talk about the biotoxin pathway. It's going to be a little nerdy. This is the basic science. Yeah, I know, a little nerdy. That's the basic science behind chronic inflammatory response and what it does. So if you like this information, follow us, like us, ask your questions below as we're going through. One of our goals towards the end of this, we'll be doing some Q&A sessions. We'll be answering people's questions. So if you want to be informed about that, you have to make sure you're following us and liking us and all that kind of stuff. So we're going to start with the biotoxin pathway. You both kind of joked about that because it's— who's going first? Who starts with the biotoxin? Go me? I mean, come on. That's fine. No. Well, the biotoxin pathway, ultimately what it is, is it kind of draws out how our bodies get exposed to biotoxins, which we described as it can be mold-related biotoxins, it can be particulates in a water-damaged building, it can be different chemicals in a water-damaged building, it can be bacterial toxins in a water-damaged building, but it also can be biotoxins from things like Fusarium, Sigillotera. We've also talked about how the—

Lyme.

Lyme. It gets really bigger and bigger and bigger. It can be a biotoxin actually related to traumatic brain injury. It's now part of the SIRS world. It can be related to overexertion. There's an overtraining syndrome where you actually break your muscles down and you release these damage-associated molecular patterns that activate your immune system. So, when we say biotoxin, it's a really, really big, big world.

Broad term.

Broad term. But, what happens is that gets released and your body has to clean to clear these out. And so, one of the first things that happens, and all, by the way, This is on our— we actually, on our series we did on this, actually have a picture of the biotoxin pathway on our website for those who want to look at that. And, it kind of walks this whole process through. But, your body's supposed to clear these things, right? And, that's where the genes come into play, the HLA-DRDQ gene. And, if you don't have the right— if you have this mutation, it's harder for your body to clear these biotoxins.

Yeah. So, I think I like explaining this one because I explain this to my patients all the time. And, I think it It sinks in better to help them understand beyond all the gobbledygook of these biomarkers is really simply, we'll do a quick immunology lecture.

Okay.

Just a brief immunology lecture.

Brief.

So, there's the innate immune system and there's the adaptive immune system. And the innate is quick and nonspecific and it is the prehistoric branch. And ultimately, I call it surveil and snitch, right? It's looking around all day and then it's going to tell on it. It's going to tell the adaptive, which is a little bit slower and more specialized and very specific and the more modern branch of the immune system. So innate informs adaptive that there's a problem. Adaptive meets the innate on the battlefield. They sort the issue out. There's some debris that's left behind. The tolerogenic T cells come in and clear it up and you go back to homeostasis or immunologic balance. And now your immune system is stronger physiologically. You have more reserves, et cetera, et cetera. So ultimately, if you have the HLA-DRDQ issue where you're mold susceptible, multi-susceptible, etc., your innate immune system still works. It's seeing toxins, it's throwing inflammation at them in the form of cytokines, little chemical messengers, tries to quarantine it, takes a little piece of whatever that toxin is, and it presents it. Scout snitches to the adaptive, and the adaptive normally would take that and make antibodies with the B cells that become plasma memory cells, and it would make specialized T cells to meet on the battlefield, clear the toxin out, tap the innate on the shoulder and say, we're here, we got it, you calm down and we're going to make this go away. And then resolution, like I mentioned, when you have this issue, the innate does what it's supposed to do and it takes a little piece, it presents, and the adaptive says, that's a problem, but I can't help you. That handoff is broken. It's dysfunctional. Your antigen presentation does not work. You do not recruit the adaptive immune system. B cells, T cells do not meet on the battlefield. More importantly, they do not tap the innate on the shoulder and say, we got it. So the scout goes back and says, we're not going to get any help. And they say, well, we're just going to do what we do, which is inflame, inflame, inflame. And so you wind up filling up this proverbial bucket of toxins and you stay inflamed. And you get exposed and you get more inflamed and the process potentiates. Now you've initiated that cascade of events of biotoxicity because you didn't do what you were supposed to do, to no fault of your own, because of genetics. You don't get that adaptive recruitment. That's the biggest part to understand with this whole HLA dysfunction. That's what the genetics mean at its core. What's the next step?

Every fall, the schedule tightens. And most of our attention goes to getting the kids ready. Almost none of it goes to the person holding the whole thing together. So I put together these 3 things just for that. A daily multivitamin in the active forms your body can actually use, quercetin and nettles to support your immune and respiratory health without the drowsiness, and NAC, N-acetylcysteine, to help your body rebuild its own antioxidant reserve. This is what I take every fall. That's aaronhartmanmd.com/backtoschool.

Well, the next— well, I want to stop there real quick.

Yeah.

Okay. So, and I think this is one of the things where like, why are we having this issue now more so than we had in the past? Why is it such a big deal? I think part of that is like, how does your body overcome that? How does your body detoxify? You poop stuff out, you breathe it out, sweat it out, you pee it out. And so, the average American is chronically dehydrated. So, our kidneys aren't helping out as much.

Constipated.

We get constipated. Well, what's nature's biotoxin binder? Fiber. The average American eats 12 grams of fiber a day.

Is it that much? I thought it was less. I thought it was like 9.

That's 9 though. Okay. And, we should get between 40 and 60. And, in sub-Saharan Africa, they're getting 80+ grams sweating. Americans don't sweat anymore. And, there's certain chemicals, particularly solvents when you get into the different types of biotoxins that are— well, not biotoxins but chemical toxins that are only sweat out. So, all of a sudden now, the It's almost like the setup. We don't want to rest, chronically constipate, our guts are messed up, not enough fiber, nutritional status is low, we don't get enough protein. Protein is part of detoxification, phase 2 detox, right?

Yeah.

And so, it's all this stuff builds up. And, the reason I like to talk to patients about that is because you can actually— your body was made to survive in this world. And, if you get the right environment, you can actually overcome some of these genetic things. But, when people don't sweat for years, when we don't have enough fiber, We're all chronically malnourished. We have this new thing, overfeeding. We have this overfeeding syndrome. It just sets us up for something like this to go overboard.

Not to mention the shoddy way in which homes are built or the paints impregnated with antifungals that made super molds and all the other things that we can— we can go on a complete sidebar.

That's in the textbook.

Yeah. I mean, it's like it's a combination of things that led us to this point. And by not sweating, We basically mean people aren't exercising, people aren't going to saunas, that kind of stuff, or they're trying and they're not sweating because their detox pathways are all clamped down. Is that vascular? Is that lymphatic? Is that just the toxic burden is so high the body just doesn't know what to do with it? But all right, so we've established that we live in a toxic soup and that our systems don't work like they should. Then you layer in that genetic component, and now you know that you're not getting that adaptive recruitment. The innate immune system is inflamed and on fire and Mad. And now what happens?

So now what happens is the regulatory system in your body, the hypothalamus, has these things called leptin receptors. And one of the things you get is leptin receptor resistance. So it's really interesting. You check patients that are obese, and this is where some of the obesity comes into play with leptin resistance. And people know about insulin. Insulin is like the storage hormone. You put energy into your cells. Well, leptin is the hormone to actually get the energy out. So what happens is because of some of this, the metabolic stuff you've talked about already, You can store energy, but you can't utilize it. And this is driven by this leptin resistance. In your peripheral body, metabolic syndrome in your liver, PCOS in your ovary, it means all kinds of stuff throughout your body. In your hypothalamus, leptin resistance drives dysregulation of neuropeptides. So, all of a sudden, your MSH, your VIP, what was the other?

ADH.

ADH, there we go. And so, the lab tests you do looking for ADH, and MSH is one of the master ones, That when that gets down, you mentioned it briefly before how that helps with pain regulation in your rubrospinal tract, that when that's low, part of your innate system fighting off infections, so it sets people up for this thing called MARCoNS.

Yeah.

So, all of a sudden, this dysregulation of hypothalamus driven by leptin resistance comes forward to that. And then, you start getting all the downward stuff. The VIP, which is vasoactive intestinal peptide, was found in the GI tract, but now we know it helps with leaky gut. It can be used for traumatic brain injuries. It actually helps with a lot of different brain neuroinflammatory immune regulatory processes. Going back to multi-system, multi-symptom, right?

Preventing target end-organ damage that sometimes is misdiagnosed as dementia or Parkinson's and is actually reversible SIRS. But, what's MARCONS? You mentioned MARCONS.

So, MARCONS is a multidrug-resistant Staph aureus. that you get exposed to in water-damaged buildings. And so, it's a very, very slow-growing staph. So, you have to have a special culture that's a slow 7-day culture for it, which most nasal swabs— it actually grows in your sinuses— won't pick up because they don't have the right kind of media and you're not looking at it. And so, with this bacteria that colonizes your sinuses, because most people's sinuses are colonized with Staph aureus, so it's actually very normal. You've heard of MRSA, right?

Yeah.

Multidrug-resistant Staph aureus. That's one version of abnormal staph in our sinuses. Morcons is a different version. And, with Morcons, one of the things it does, it releases these things called hemolysins, which are these little bitty dysregulatory proteins that go up into it. And, they actually, if it's in your sinuses, your ethmoid plate, it goes right up to your ethmoid plate. And basically, if you can visualize the brain, this regulatory center, hypothalamus, literally it's right on top of that ethmoid plate.

Okay.

And all of a sudden now, these hemolysins go in and disrupt your POMC molecule, which turns into— affects cortisol, affects MSH. And so, all of a sudden now, the exposure might cause that downward stuff with leptin resistance. You get the MARCs, it kind of hits you from below. And then, all of a sudden now, you're getting stuck and you might remove yourself from the building, you might do the binders. But, if you still have that MARCs growing, causing more dysregulation, it's treated.

And still having toxins made from within. And suppressing MSH. The MARC— so MSH gets suppressed, and then you get MARC-1 when MSH is low enough, and then MARC-1 suppresses MSH even more. And so it's giving you kind of diving you deeper into this, into this hole. So we have the genetic predisposition, biotoxin exposure, poor antigen presentation, broken bridge, inflamed innate immune system, which we're going to talk about next. We start to get leptin resistance. We start to get suppressed MSH. Dysregulation of the hypothalamic loops, MARCs pushing MSH down even more. MSH in itself affecting pain and energy and sleep and androgens and other things. Gut, leaky gut. So you get zonulin release and intestinal permeability that we call leaky gut. And then you activate these alternate complement pathways of inflammation. That's where the C4a and the C3a come in. And what else is going on?

Well, part of that activation of complement, like you mentioned, is that you start chewing up the complement system and create C4a. I think that the thing that's really interesting about that is that in the rheumatology world, they've known for years, like you can check a C3 and C4, the CH50, which is a test for the totality of your complement immune system. When those are low, it means they're being chewed up by something.

Yeah.

Actually is one of the ways you can actually diagnose lupus, for example. So this is kind of like connection with other autoimmune Well, with autoimmune diseases like that where there's this complement cascade, this part of your immune system which tags cells, puts holes in them, makes them spontaneously combust, there's actually a bridge between other autoimmune issues. And so, what will happen though, however, now I've actually tested lots of my patients on this and I will see the CH50 is high, but I've not seen C3a, C3, and C4 levels consumed in my patients. That's more of the Lyme stuff. You'll see the C4a pop up. And that's a marker that this part of the immune system is being overactive. So they're actually creating more of these damage-associated molecular patterns because they're making cells spontaneously combust, releasing their contents. And now you get inflammation on inflammation. And then you can start spilling over and get this epiphenomena. So now your body starts seeing all this stuff and goes, wait a second, I see thyroid. Let me make some thyroid antibodies. I see a little bit of lupus. And this is what's interesting about the lupus anticoagulant. The lupus anticoagulant actually is attacking a phospholipid that's actually on the inside of your cell membranes. So, what has to happen is you have to have dysregulation in these cell membranes that flip that thing out. Anticardiolipin antibody is what it's called to expose that to immune system, right? So, all of a sudden, this is where I love about the lipid therapy because part of the lipid therapy does actually flushes those toxins off the cell wall membranes and allows them to kind of flip back in.

Right.

But now, all of a sudden, there's this crazy science behind The chronic fatigue and the fibro and the brain fog and all that kind of stuff. Yeah.

Ties it all together.

And, it's inflammation on inflammation. It's the initial inflammation exposure that activates stuff. It's then the next inflammation with dysregulation of your presentation Th17. It's in this complement activation part. And, you get this dysregulation, dysregulation, dysregulation that then feeds over into things like hypoxia-inducible factor alpha, which we didn't really talk about, but it's basically Something happens, you get decreased blood flow to cells. You mentioned VEGF before, which is not one of the official labs, but initially happens, it gets upregulated. So, you can see VEGF increasing because your body wants to adjust.

Make new blood vessels, deliver oxygen, deliver blood, right?

Exactly. Because you got this hypoxia-inducible factor going on. So then, your body's like, after a while, it's tired, then it bottoms out, which is more common to see later on. It does freak some of my patients out though if they see their VEGF high because it can also be a marker for cancer.

Cancer.

Yeah.

But, the HIF-1 alpha, it's Often, I mean, it's not something that we can measure, but it's often something that's abnormal because of just relative states of hypoxia. You don't need to be anemic. You don't need to be a COPD patient who's hypoxic.

Exactly.

You can have a relative state of hypoxia in the tissue itself. And if that's because of inflammation and oxidative stress, HIF-1 alpha gets released, which then leads to the final common pathway of inflammation, which is NF-kappa beta. And now you got problems. And when you're saying inflammation on top of inflammation, I mean, that's what you're kind of alluding to. It's a cascade. It's a, it's a, an array of events that Almost like dominoes, one topples the other and it just continues on down. And the reality is, is when you're talking about things like damage-associated molecular patterns, we call those DAMPs. There's also pathogen-associated molecular patterns that we call PAMPs. The best thing to understand from a layperson standpoint is that it's just creating a debris field. And where there's tissue debris, there's also endogenous tissue. So your own self-tissue where that debris field is, the immune system is there trying to figure out what's going on. And it's going to pick some of that tissue up, and eventually it's going to get curious enough to say, maybe we should present this and see about it. And when it's presenting it and there's co-stimulation, you've now triggered antibody production. And if that's your thyroid, you now have thyroiditis or Graves'. And if that's your joints, you now have rheumatoid. It's the process of, am I inflamed? Okay, that's bad at its core. But now, am I inflamed and creating tissue debris? And now am I inflamed, creating tissue debris and activating my immune system? And is my immune system confused at baseline? Now everything is getting presented, bad and good, and I'm losing that tolerogenic immune response, the differentiation between good, bad, self, and foreign. And now I have an autoimmune phenomenon. And you can trace it all the way back. And if you can reverse that condition, you can put the autoimmunity into remission. And that's pretty awesome.

Every fall, the schedule tightens and most of our attention goes to getting the kids ready. Almost none of it goes to the person holding the whole thing together. So I put together these 3 things just for that: a daily multivitamin in the active forms your body can actually use, quercetin and nettles to support your immune and respiratory health without the drowsiness, and NAC, N-acetylcysteine, to help your body rebuild its own antioxidant reserve. This is what I take every fall. That's Aaron Hartman MD dot com slash back to school.

And now I'm confused because this is so much stuff. It's all over the place. And so just to kind of take it home, like the cool thing about all this, which is kind of complicated for people understand, is that ultimately to start the process of healing, you have to limit the exposure.

Yeah.

And we're going to talk about this more later in the treatment section. Start your body to detoxifying with. Lipids, we talked about binders. Okay. If you have this infection, you're testing for the marker. If you have it, we're treating it, removing it. If you have issues with positive gliadin antibodies, which a lot of people do—

Gluten-free.

Yeah. Gluten-free diet. Do you actually do a lot of— I guess we'll talk about this. Do you do a lot of low amylose diet or how do you dietary? Because that's one of the traditional things.

MMP-9 and some of the other things. So, I have all my SIRS patients go gluten-free, that's for sure.

Of course.

Because Every one of my SIRS patients by nature has got leaky gut. You have intestinal permeability as long as your MSH is low, and you don't need a zonulin test to prove that. You can just know it based on the literature. And I do do celiac testing if they're actively eating gluten, because if they're not, then what's the point? That's the treatment anyway. You're going to get a false negative if they were to be positive. So, I have them not eat gluten to potentiate the problem. But MMP-9 that you talked about in another video, metallo— Matrix metalloproteinase number 9. It's kind of Leaky gut, leaky membrane, tissue destruction, activation of those white cells as you were talking about. Some of the treatment, or at least one of the treatments, used to be Actos, which is an old-school diabetic medicine, and then low amylose diet. And low amylose diet can sometimes help with some of the inflammation and immune stuff. I don't do that a lot, but if patients are hitting a wall and I have them on high-dose omega-3s and I have them on Boswellia or some of the other treatments that we used to lower it and it's not, I might say, hey, maybe we should try this and give it a go.

Do you, in that case, ever use on PMs? You use cortisol inhibitors? Yeah, yeah. I was about to talk about those.

Those are amazing.

Yeah. These are pretty cool. Yeah. So, part of this inflammation is giving anti-inflammatory. And so, there's the omega-3, there's the O-3 and O-6 derivatives in your immune system, right? You get these prostaglandins, right? The 3 series and the 6 series. So, omega-3s and omega-6s, right? So, if you make lots of the 3s, they're anti-inflammatory. If you make lots of the 6s, they're pro-inflammatory. So, what can happen is if you get the 6s up, which is the typical American diet, I think the ratio right now is 16:1 omega-6s to 3s. It should be anywhere from 1:4 to 1:1 depending on what you read.

I try to get them to 4, a 4:1 ratio I think is excellent.

From your Shurmanfeld's work, that's the number, but then you read other things. But anyway, that's the body balance.

Yeah.

That's the number it looks at for. But so, what happens is ultimately the omega-3s and 6s downstream will make these Eicosanoids, which are the actual anti-inflammatory molecules. So, SPMs, pro-resolving mediators. So, pro-resolving mediators, what they do, and you actually said this perfectly before, once you get the inflammation, everything gets crazy, then the tap-out happens, right? The way you said it. I don't 100% remember, but the tap-out, you said calm things down.

Yeah.

Well, the way your body calms things down is making these pro-resolving mediators.

Yes.

These things that actually say, it's time to chill out. Well, if that's not— the handoff isn't happening, what happens is the chill-out doesn't happen. SPMs are the chill-out signal.

Yeah.

And they actually act kind of sort of like steroids do.

Yeah.

But they're not steroids. And so, I have great response to the patients with all kinds of issues with these.

They're the anti-inflammatory magic that's kind of extracted from fish oil.

Yeah.

Like, theoretically, when you take fish oil or eat omega-3s in your diet, your body should make these, but you're not getting them in this therapeutic dose that when you take SPMs or specialized pro-resolving nutrients.

High doses of SPMs.

High doses, yeah. And, and it's the, the morasins and the protectins and all these different kinds that are made, and they're just pretty incredible. But they also flip your macrophages. Talk about that from M1, M2 state and what that means.

So it's an M1, M2, and like the phenotype of M2 is a pro-inflammatory, and then one is, is, is more like the presenting macrophage. And these actually flip it from the M2 to M1.

Yeah.

Which is huge. Now we don't have ways that I, we don't have ways to test for that, do we? It's, it's just the basic science. Yeah. So we can't really test for that, but You know, if someone has chronic inflammatory response syndrome, they have this. And so, a lot of times, and I'm not sure how you do it, but depending on where the patient's at, sometimes when they don't tolerate the cholestyramine, they don't tolerate the Welchol, you put them on the other binders that these lipids with the phospholipids and these SPMs can actually be really super helpful to calm the inflammation down.

Yeah.

But then later, you can actually add back in the cholestyramine.

Curcumin is great for that.

Oh, curcumin is awesome.

Curcumin, especially certain types that cross the blood-brain barrier, but then like SPMs, high-dose fish oil, like those are my go-to anti-inflammatories. And you're absolutely right, like that'll bring a lot of that down so that you can do the binding with more efficiency without side effects, detox, die-off, all that, all that stuff.

Yeah, one thing to add to that, a lot of times when people have these Herx reactions, it's actually in this case, technically what's happening is when you start detoxifying, they actually have a cytokine flare. Yeah. So, it's almost like a miniature cytokine storm, which I think most people know what that is now.

Yeah.

And so, what happens is these people can't tolerate the binders. So, you actually have to go in and give them high-dose omega-3s first for a month, do what you mentioned, maybe add some SPMs. And then, once you calm that part down so they don't release all these things that cause that miniature cytokine response, you can then go back in and add the binder. But, the point is, I think we could ramble on about this, is that This, this actually, this, this is like deep science. Yeah, it's crazy. But at the same time, the treatments, once you understand what you're doing, it's, it's, I don't want to say it's not templated, but it's pretty like—

Yeah, I mean, it was made into a pyramid.

Yeah.

And the pyramid, as you would expect, is stepwise from bottom up. I don't know, and this is my personal opinion, that it's as pragmatic as it was once thought to be. And Heyman, as he's kind of collaborated with Shoemaker, has made it a little bit more pragmatic and palatable. And there's more options other than medications. There's more natural stuff that we can do. And it doesn't have to be as, hey, I must do this in order to get to this. You still want to move in that sequential fashion, but there's less boxes to check to get to that endpoint treatment. And you have more options and tools in the toolkit to treat if someone is not getting better or not tolerating treatment. Because, I mean, let's be real, this is personalized precision medicine. And I don't treat any SIRS patient identically. I mean, they're very similar because you have to be because you're treating the same condition. But at the same time, how I get to that point is different for every individual. For someone, they don't need much anti-inflammatory support. For others, I need to throw everything we listed at them and they still feel like crap. It's like everyone's a little bit different. Most people are somewhere in between, but you just have to do your best. How do you monitor besides the clinical, okay, this is better, this is better? How do you monitor how they're doing? How are you determining that they're getting better from a physiologic standpoint?

We're going to actually probably talk about it in the treatment protocol.

Oh, cool.

I'll answer the question now because the next thing we'll talk about is actually treatment. But, one of the things you monitor is the VCS. Are the VCS normalizing? Have they cleared the MARCoNs? Because you kind of literally are stuck there because of the feedback with MSH and that whole— we talk about the hypothalamic dysregulation. If they still are creating these hemolysins from the MARCs, if they still don't have enough blood flow going to the back of their eyeball, which then leads down to all this other inflammatory stuff, the hypoxic-inducible factors. So, their cells aren't getting enough oxygen. All the other stuff just isn't going to start working as well. So, the really thing, once you do the basic lab testing and you know where you're at, yes, you track symptoms. Yes, you see how they're feeling. But ultimately, you track their VCS and you track the MARCs. And, they need to be on binder of some sort until you clear, until the DCS normalizes, until the MARCon clears. Now, many of my patients, some similar years as well, that's like a 6-month, 9-month-long process. And so, once you get there, a lot of them, you almost will keep them on some kind of binder, maybe fiber long-term realizing they're going to keep on getting exposure. You need to help that part of their detoxification system.

Yeah, perfect. And then I'm sure we're going to talk about this a little bit, but I'd just like to allude to it with regards to the MARCONS. Are we going to do a section on like myths and some other things as well?

Okay. Yeah.

The myth. Yes.

That's there.

After we finish this, there's a whole section on myths. Okay, cool.

Because I wanted to talk a little bit about how you treat MARCONS. And then also if the MARCONS swab is negative but has other bacteria, what does that mean? What do you do about that? And that kind of thing. Because there's, there's so many layers to each level of treatment as we go along. And I just feel like the more that we talk about it, the more we inform individuals, we're going to cover every possible scenario that might exist.

Actually, on the myths section, that's not one of the 10 myths because that was a little too complicated. But we can tell that that is one of the myths. So make sure— oh, right over here. Yeah. Okay, cool. You have amazing memory. So cool. So next time we're going to talk actually about treating chronic inflammatory response syndrome. A lot of things we do, and it's going to be maybe more practical because we've been doing it for years. So Talking about like the protocol, what you're supposed to do, but then actually what happens in real life when you take care of patients. So hopefully this was helpful. This was our probably most deep sciencey kind of one of these. All of these are basically, we're taking a deep dive into the blogs on our website. So please go there if you want to learn more about, see the images, see the biotoxin pathway. This was helpful. Please like us, follow us, share this information. Again, we'll be doing a question and answer after we finish the 5 to 6 sessions. So to get your question answered and be able to follow up with it, it'd be great if you could follow us and we'll talk to y'all later.