How the Changing Seasons Impact Nutrition, Health, & the Body’s Internal Clock

A seasonal approach to eating encourages the consumption of only those fruits and vegetables that are naturally in harvest at a particular time. For example, depending on geographic location, watermelon and blueberries peak in the summer, while potatoes and turnips are in season in the winter. While seasonal variability may impact nutrient levels in foods, seasonal changes also influence the body's internal clock and potentially even health and disease outcomes.

With the increasing visibility around circadian rhythm and even introduction into the literature of terms like circadian syndrome, I soon came to realize that it's not just about nutrition and lifestyle. We have an overlay above nutrition and lifestyle that we really do need to take into account on the timeline and also on the functional medicine matrix Foreign.

This episode of Pathways to well Being. We welcome Nutrition Scientist and 2024 AIC Speaker Dr. Deanna Minick to discuss the intricate relationship between the changing seasons, circadian rhythms, the foods we eat, and our health. Welcome to the show, Dr. Minick.

Great to be here with you, Kalia. What an exciting conversation we're going to have.

I have crowned you the circadian queen. That is the title that I have bestowed upon you. So I'm so excited to talk all about this topic and I know that this will be just a sneak peek of what you'll be discussing at the annual international conference. So for those who are there tuning in, maybe they need a reminder about what a circadian rhythm describes, how our biological cycles work. Will you just give us a little bit of a reminder about what we're even talking about when we're discussing our circadian rhythm?

The circadian rhythm is the 24 hour cycle that we live within. So it's a cycle of light and darkness. And through that 24 hour rhythm, we do a lot of different things that help to inform certain aspects of our physiology. So what we're going to talk about in this talk at the annual conference is looking at the, the role of food and how food can have a chronobiotic or a modulatory effect on the circadian rhythm. And Kalia, I just want to say too, as a functional medicine educator, clinician, researcher, it's, it's almost like it's something that really came to me almost as an afterthought, you know, with, with the increasing visibility around circadian rhythm and even introduction into the literature of terms like circadian syndrome, I soon came to realize that it's not just about nutrition and lifestyle. We have an overlay above nutrition and lifestyle that we really do need to take into account on the timeline and also on the functional medicine matrix. So that is what circadian rhythm is. And we have many different rhythms. Actually, we're run by multiple rhythms, all coming together through their varying oscillations. So circadian rhythm is just one of those rhythms. It's a very important rhythm.

You reminded me. I've actually meant to talk to you about this or to share this with you probably for years. I remember when I was in school, I was in university and we were like in these little classrooms with all this fluorescent lighting. You know, we're studying into the evening, it was like total light pollution. And even though I was in this naturopathic doctor program, I was eating healthy, I was exercising, I was doing all these things, I, my energy level was just unwell. And I often now think back sitting under that lighting at all times and how that must have been feeding back to my brain and just totally confusing my rhythm.

Yes. You know, that's exactly what we're going to talk about in the talk at the conference is that this is one of those areas where it's an oversight, it's something that's undervalued, not appreciated, and it's something that we're not paying attention to. The fact that our lighting, the electricity, the darkness that we experience or don't experience at night is all informing us, this is information. Just like food is information, light is information, darkness is information. And so when you're talking about that exposure to that full spectrum light that we might get from a variety of sources, you know, ideally we want it from the outdoor sources. We don't just want the blue enriched light on the indoors. And many times you're spot on. You know, it's one of those things where we think we're doing a good thing. We're going to the gym at night, we're exercising under those fluorescent lights, we're in the library late at night, we're on the computer late at night, we're relaxing late at night. But that is blue enriched light and that is stopping a lot of our signals to our super chiasmatic nucleus, which is coming in through our eyes. And in fact, I mean, even through the environmental health advanced practice module. I talk about how artificial light at night, that's referred to as Alan and it's the most societally accepted endocrine disruptor. Many times we don't even think about it. We know plastics are bad, we know heavy metals are bad, but we don't see that this light at night is being an endocrine disruptor. So it's disrupting our Psychoneuro, endocrine, immune system. So I think it's time to really wake up to that and to use food as a way to be in better connection with those natural rhythms.

Beautifully said. And now I feel very validated that I put a section about light exposure or light pollution or just different light sources on every treatment plan I give. So we're starting to think about it.

You're enlightened.

Enlightened. That's right. I think about this. You and I both live here in the Pacific Northwest and we have pretty drastic seasonal differences in the amount of daylight. So in the winter it's maybe becoming dark at like 4pm and then in the summer we might have sunshine until 9pm but so many of us, we don't change our schedule based on that. If it's dark at 4, it doesn't matter. We're still working until 6 and on the computer. And then similarly, when it's light outside, I'm really not changing my routine either. I'm still trying to get in bed even though it might not be completely dark. Is that an issue? I mean, do we. We're all kind of powering through these seasonal changes in light variation and do you see that having some effect on. On health?

It is having an effect on health. In fact, if we live closer to nature and nature's natural rhythm that it provides through the light, through the food, through the seasons, and we really operate it in. In what? One of the other cycles that you would like too to bring into this discussion is the menstrual cycle. You know, back when I was even menstruating, I would change my schedule so that I was doing more of my creative work in the luteal phase and I was doing more of my on the go meetings, travel, etc. As much as I could in the follicular phase. But we don't all have the luxury of actually overturning our schedule based on season, menstrual cycle, you know, all of those things. But yes, if we can make small incremental shifts in order to be more in alignment with nature, which is our rhythm, it's not separate from us, we are part of nature. But in doing things that separate us from nature, like being exposed to that artificial light at night, not adjusting our schedules, all of it gets compounded. So sometimes the best things are actually free when we're thinking about our health, saving electricity, trying to shift our day. So what I'm going to do in this talk specifically is I'm going to go through a circadian Prescription. I'm going to look at what can people feasibly do. They don't have to do it all. But looking at the nutritional component and to what you just spoke to, more, more of how do we shift our lifestyle, Whether that involves relaxation time, work time, sleep time, maybe even supplements. You know, really even looking at the supplemental schedule through the circadian clock, you know, perhaps we need to be even into that micro level on a daily basis. So, yeah, I'm excited to be talking about what people can be doing with patients to help them to be more in alignment.

I cannot wait. I cannot wait for this circadian prescription. That's so clever. I want to talk a little bit about how these seasonal fluctuations or changes to our light and darkness cues might impact fluctuations or even flares in specific disease states. And I'm thinking autoimmunity. Is there a connection here that you've observed or seen in the research? And then I'm going to layer on. I know you're. You always talk about vitamin D and melatonin. And so I'm hoping we can kind of make a connection here between how our disease states might be influenced by light and dark and then these nutrients that may be a friend to us.

Yes, thank you for that question. And a lot of great research has been in the scientific publications for years, so it's nothing new. And for people in clinical practice, you see this with people who will come in at certain times of the year, come complaining about symptoms, flares, onset of new diseases. So it's been well known that disease frequency, severity and even related mortality can be connected to seasons. We can have changes in heart rate, variability, temperature, pulse, even hair growth. You know, people talk about, oh, my hair grows faster in, in spring and I lose more in fall. I mean, those things that are constantly changing. If we're attentive to our physiology and our phenotype, we'll see those things happening automatically. And so if we look at some of the research. When you mentioned autoimmune disease, I've seen this crop up with Dr. Schoenfeld's work, who, you know, he's done premier emerging work as it relates to autoimmunity. And Dr. Schoenfeld has been at our annual conferences before. He is an expert in autoimmunity and he has a publication looking at the role of seasonality in autoimmunity. So that is something I'm going to touch upon. I'm going to touch on some of his research, talking about things like multiple sclerosis, lupus, ibd, and how some of these different autoimmune conditions have cyclical components to them. And that really speaks to even the immune system, which is very much in tune with our sense of inflammation and our whole endocrine access. Right. And so if we sense hypercortisol or higher levels of certain hormones or lower levels like low melatonin, and I would even toss in there low vitamin D, because you asked about it, and those two kind of cycle together. In fact, early spring and late winter is the time that we see lower levels of both melatonin and vitamin D endogenously. And often we see a, an occurrence kind of this convergence with autoimmune conditions at about that time. So I think that there's something there for us to consider looking at seasons. You know, even the season in which you were born can also prime you in utero, potentially for a number of different disease risks to come. It's not to say that you're doomed by your birth date, but it's something that we need to again, bring into the timeline, bring into the matrix, and be thinking about seasonal components. And Kalia, as you know, too, we have so many great food plans at IFM through the toolkit. And one of the things that we could be doing clinically is tailoring those respective food plans to meet the seasons. And I've noticed that when I go to the market, that food in season is actually less expensive than foods out of season or imported from Peru or imported from Australia during times of year when those things don't naturally occur. So it's almost like, you know, the accessibility, the financial implications, and the biological shifts that can happen by being in sync with nature can be exponential.

This feels like the next frontier of precision medicine layering on this seasonality. I mean, all these things that you're saying about considering the season in which you were born, and, and now we're taking it into the food supply. And I think this is a great next direction for us to go. I, you, you mentioned that sometimes when we find the foods that are in season at the market, they're beautiful, they're less expensive. I find them to be more flavorful and more enjoyable. But my question for you is, how does the seasonality actually impact the, the bioavailable nutrition in those fruits and vegetables? Are they just more beautiful or are they also more nutritious?

In some cases, I can just speak to certain of foods where they've actually done studies on them. We do find that there can be added nutrition to the foods that are grown in their respective Seasons. So, and in fact, you know, if we even just think about nutrition science, that's one of the things that doesn't get figured into a food frequency questionnaire or even looking at the role of any number of dietary studies that are done. How many times are they actually looking at when are people eating in season and how is that an additional variable that needs to be considered? So to your question about are foods grown in their respective natural season and I would even further to say their location, how do they change? Yes, there are studies in broccoli, in tomatoes, in oranges, grapes, and even cherries. And I'm going to talk about that research during my talk where we see that when they're grown at a certain time of year, when they naturally are set to grown to grow, and also during certain what, what are referred to as photo periods. So during extended light periods or extended dark periods, you can see that there's a difference in their phytochemicals along with things like even vitamin C levels. So I think that that's exciting to look at, that we can actually be making our diet much more nutrient dense by eating foods in season. And one of the compounds that I'm very thrilled to talk about as, as part of the talk is the polyphenols. And the polyphenols, I do think, are these chronoregulators in food. We're hearing a lot about polyphenols now. So this is one of the newer emerging aspects in the research that we're seeing is how these polyphenols are chronobiotic agents. So aiming for those foods that are rich in polyphenols might be one of the strategies for trying to stay in rhythm.

I'm just thinking, if anyone is listening, they're like, okay, I need to figure out which foods are in season and then maybe which ones are local to me. I mean, how do we know? Do we just search the Internet? Do you have some suggestions for locating that information?

Yeah, there are actually websites where you can put in your location and you can find the seasonal foods in your area. But I think one of the best ways is to go to farmers markets when they are active. So typically between April and October is when you're going to find farmers markets. And if you make friends with the produce people in your neighborhood market, they tend to know. And in some of my supermarkets, I even see where it'll say locally grown or you'll see preponderance of things that are in season. So an example would be summer foods like nectarines, plums and peaches. You don't typically find those in the winter. Right. And so I think just getting a general sense of when things are in season would be good. I don't want to make food more complicated. You know, the goal of me giving this presentation is not to add another layer of complication to food. It's more about being informed as to what nature is providing and let nature do the work. You know, when we take in those foods that are in season, it's like, okay, we start breaking those things down. We get a more nutrient dense diet, we get certain polyphenols that start to key into our neuroendocrine system and start to inform us and bring us into that, that rhythm. So I think actually just reaching out, you know, one of the other things I do, Kalia, is I have. And this would be accessible for, for many people, especially in rural areas like you and I live in, where we don't always have quick access to things. Right. But what we do have is community supported agriculture where you can go to a website, you can support local farmers and those farmers are only growing what is in season. And you'll see the changes on that csa. If you look on the website, you can see, okay, broccoli is no longer available this week. So, you know, you kind of go with the rhythm of wherever you're living and try to accommodate. And if you travel a lot and you're not very local and you don't spend a lot of time locally, again, I think asking people at markets, I have found that when I'm asking folks, even at mainstream markets, at least the people that work in the produce, they seem to have a good sense or they're informing through the signage in the store.

Getting a CSA box subscription has been one of the most, I would say, fun and valuable things I've done for my family. Because we get these boxes and there's things in there we wouldn't have picked from the grocery store. New types of squashes and new types of greens and different root vegetables that we just never would have tried. And then we have to find a recipe and we try and we found so many things that we love. And it's such a good introduction to new foods that are local to you.

Yes, absolutely. And I just want to chime in on that. If, if you don't have access to a CSA community supported agriculture supply. There are other online sources and there's one that I've ordered from extensively where they even created an Eat the rainbow.

Box right up your alley.

Yeah, they Reached out and, you know, they, they saw the work that we were doing at IFM on phytonutrients and eating the rainbow. So they actually created an eat the rainbow box. But the contents will be modified somewhat, right. Based on the rainbow at that time of year. So there are other systems in place through just even going online, going on the Internet. So if you're confused about a CSA or you want to know about quality ones, you know, that could be something that I answer during the. The presentation is, I could go through that a little bit.

Yeah, I think that would be helpful. And also, as we're thinking about all these different seasonal foods, I'm realizing how. Well, I'll give an example. So we talked about how watermelon, at least in our area of the world, is in season, in summer, and doesn't that so much sense that watermelon is so hydrating when it's hot? And then we have, you know, our root vegetables that are in season in the winter, and they're so grounding and warming and comforting. And that just makes sense.

It makes sense. And you know what else? It's intuitive, like you're suggesting. And it's also, we see this within traditional medicine systems. So my husband is an acupuncturist, so I feel like I've had like a secondary education in traditional Chinese medicine. And, you know, they talk a lot about food energetics. And so the dampness, the heat, the yin yang properties of foods grown at certain times of year and even certain times of year having certain energetics or certain qualities to make it expansive or contractive. So I think that this is intuitive. This is something long recognized within Ayurvedic medicine, traditional Chinese medicine, Japanese medicine, so many forms of medicine. There's already that acknowledgment. So I feel like what functional medicine is doing is using scientific research to now support why that is. And that is what I'm going to be addressing in the talk too, is giving you some of the, like, the why. Yes, it feels intuitive. Yes, it's kind of common sense. But why? And how do we actually pinpoint it even further? Because as part of the talk, I'm going to be addressing not just the foods that I think are important from a seasonal perspective and their phytochemicals, but also how do we amplify the phytochemicals that are in those foods through cooking and preparation. Like, one of the things Kalia is to, in order to increase polyphenols in certain foods, to cut them up really fine. So fine mincing, dicing, shredding. Actually, shredding of carrots is like one of the best ways to increase their phytonutrient content. I'm giving away a little bit of the. The goods of the talk here. I'm going to go into more specifics about synergistic foods. I'm going to talk about, you know, how to prepare certain foods and then kind of bring it all together into an overarching, again, a nutrition and lifestyle circadian prescription. So I think we need to think about the. It's everything from the growing to the preparation to the ingestion. And one of the things I didn't touch on by way of your questions is zeitgeivers. You know, time givers through that circadian rhythm. And one of the things that informs our clock genes and informs us and keeps us tethered to that circadian rhythm is actually when we eat. So it's not just what we eat, it's how we eat when we eat, how much we're eating, with whom we're eating. But for the sake of this talk, what I'm going to focus on is the when of eating chrono nutrition, how there are certain times that are punctuating our day and our connection into that circadian rhythm just by having certain meal times. So that's why, you know, there's so much discussion right now about time restricted feeding, intermittent fasting. There's a lot of question, there's a lot of debate about it. What about for men? What about for women? Is it better for women at certain times of the year? Should we really be going so long without eating? Well, I think we need to look at our connection first and foremost to circadian rhythm. And in the case of women, we need to look at lunar rhythm, we need to look at menstrual rhythm, even for women without cycles, because that moon cycle, the lunar cycle, can create fluxes and things like melatonin. And melatonin is beyond sleep. I mean, melatonin is truly connecting us to the circadian rhythm by being informed by the darkness, which is setting that circadian tone. So I know I said a lot of things right there, but just kind of like bringing now the connection of. It's not just what we're eating, how we're preparing it, it's kind of the whole spectrum. It's the entire trajectory of how we relate to our day. And perhaps in the talk, what I can do is because I was just asked this in a podcast yesterday. Deanna, hey, can you Just take us through the day. Like, what are some guiding principles for most people? Like, you wake up, you get your first morning light, you eat breakfast. Within an hour, you hydrate. You know, there are just certain things that we want to bring into the practical discussion of what people can do every day that we know has an impact.

Yes, please. A day in the life. If you'll do that at your talk, we'll all be tuning in and taking notes. But I'm thinking, I mean, there's something comforting and almost relieving about the fact that. That. That nature will give us some guidance in terms of how we can live our best life, nutrition and lifestyle. I mean, that the. The cues are there if we are. If we're aware and paying attention. So I'm. I'm very excited to hear how you're utilizing this information. And you mentioned some food preparation methods, and I want to take that a step further. As an aspiring homesteader, I have been experimenting and researching ways that I can preserve food to kind of preserve the bounty of the foods that are in season for use during the months when maybe variety is a little less available. Do you have some thoughts or some advice or some pro tips about preserving foods when they're in season? Hmm.

Well, a couple of things. One of my colleagues, Mira Desi, she talks about food preparedness, and it sounds like that might be relevant for you. So where you don't get access to a lot of different food. She talks about two different sides of your pantry. You have one that's a more fluid side of the pantry, and then you have one that is your inventory. And often we just need to get a sense of what we're eating quarterly. So taking a week, like if we just take January to March, and we start off in January, just kind of getting a sense of what our family typically eats. Like how many bananas do we go through, how many, you know, just trying to get a sense of even dry goods, fresh goods, frozen, and just doing an inventory. And then based on that and what we actually track to, then I think you get some information as to how you can stock, because even though a lot of things may not be available in the fresh form, you might be able to stock up in more dry, bulk form or even frozen form. Now, you will oxidize some of these precious polyphenols through storage. And I would say, you know, as much as we can just pay attention to our senses, looking at color changes, taste changes, smell changes, but, you know, we. We do our best, right? I mean, we. We aim for it's better to try to get those plant foods during times that they are relatively close to the season that they're grown, I think without having to aim for that perfection than not getting them at all. Because we feel like, oh my gosh, they're not in season. So I think that's kind of the, the overall gist is know your pantry, know what you're typically eating and what you typically go through. And you know, one of the things I have found, Kalia, and this is more from clinical practice, this is not from the literature, but I have found that people get into food ruts and changing eating per season allows you to get out of those ruts. Because not only are we seeing changes in the immune system, the endocrine system, but we also see changes in the gut microbiome during certain shifts with the seasons. And so to better cultivate that diversity of the gut microbiome, it would be good to have some dietary variety. Right? So even when we talk about a rotation diet, changing our foods every three to four days, bringing in newer foods that we haven't seen before, and my aim from a clinical perspective is 55, zero unique plant foods in seven days. And that comes from some literature. The American Gut Project also talks about people that had 30 or more diverse foods in a week had a better production of short chain fatty acids by the gut compared to people who had less than 10. So if nothing else, I think that looking at what we have on a seasonal basis, trying to get out of our grooves, trying to move out of eating ruts, this will have a ripple through effect for the gut microbiome, the immune system, our sense of mood. I mean, dietary diversity connects to so much. So that was a bigger answer to your question, which I thought was really great and practical. So what I'm saying there is, is do your best, know what you're eating, but then also try to introduce some variety on a seasonal basis, if possible.

I think that was a very beautiful and approachable answer. And I'm just picturing the plum season here in the Pacific Northwest. It's like a million plums for a couple. And our microbiome is just inundated with plums and then we don't see them again for 10 months.

Yes. And you know, I want to make a point too, because I can imagine that some people listening to this talk might feel frustrated, like, oh, so does that mean I can never have an orange in the winter or I can never have a plum out of the season that it's grown in? And I would Say, no, that's not the case. It's. It's simply that if we can, for when we can choose fresh foods and when we can be in touch with when things are grown, it would be optimal to, to take that route. However, is it okay to also have dehydrated plums and to have these prunes? Absolutely. I mean, there's so much good literature on prunes and bone health, osteoporosis. So we don't want to say that. You know, just wipe it clean. It's an all or nothing. I would say that let's just be even more attentive to when things are in season and how we're cooking them, the time of day. We take things in and, and just again, let nature do, do her thing. But it kind of, and I would say an overabundance of bringing in things that aren't in season, maybe something to look at. And, you know, I'm going to detail a study in the presentation. It's one of my favorite studies, and it's on oranges. I'm not going to give it away. You've got to come to the talk. But, but what I'll say is, when I used to work with Dr. Jack Kornberg through the Functional Medicine Research Center, I remember him saying to a patient, you know, if you're eating oranges in the winter, you're telling the body to store fat, that it's summer, and to get ready for winter. So it's not to say that having an occasional orange in the winter is going to impact our metabolism straight away. But if we continue to compound and we're in a cold climate and we keep having the foods that would be considered warming, foods from certain other hemispheres, they have different phytochemicals, so they will have a different hypothalamic, even signaling of different hormones like leptin. So we just need to be aware of that. It's not like an occasional partaking in those foods is detrimental. It's kind of like where we, we don't have that realization. So we keep making the choice to have that food. And we're in a food rut and we're, you know, I, I think we can just be smarter about our food choices and, and much more informed, just.

Aware that everything you're saying is just making me feel aware of what I'm doing and intentional about it. And I want to go back to your, your challenge to eat all these different, 50 different foods in seven days. If I were to make a marinade and it had all these different herbs and spices. Do those count? Can I count them individually?

Yeah. The way that I put together my diversity tracker is I did it in sections. So there is a column for spices. So yes, I know some people feel like, oh, but you know, if it's just a little pinch. But keep in mind, spices are very dense with phytochemicals and many of those phytochemicals are polyphenols. So yes, I do count each of those spices in your marinade and they would go onto that diversity tracker. However, if you had a marinade the next day with those same spices, you could not count those spices. Right. So you get a one time shot at those, those different spices and then you'd have to know what you've got there. The curry powder that I use, I intentionally chose it and it has 11 different unique spices. The typical curry powder on the market has five. So that's just like one little tip or hack into. Okay. How do I diversify? I can do it through spices, I can do it through herbal teas where you have combinations of different herbs. Although again, it's much better if we're consuming the plant. You know, teas are great. Teas are actually full, chock full of phytochemicals. In fact, I am going to talk about polyphenols in tea during the talk because there are some studies talking about oolong tea. And I know Dr. Gallen talks about oolong tea and the immune system. So there are some studies looking at oolong tea, black tea, and using the polyphenols in those teas in order to have again, that chronobiotic effect. And when you look at some of these populations that have lived the longest, what do they drink all day? They drink tea. They punctuate their day with the phytochemicals from tea. So I feel like there can be some, to use a play on words here, low hanging fruit ideas that people can implement for not a lot of funds. Like you just mentioned, the spices or even the herbal teas. These are ways of getting in some seasonal aspects or even just amping up polyphenols in the diet, which can help with that chronobiotic rhythm.

We do a marinade one day, a vinaigrette another day. We drink. Marty, we now we have so many unique plant foods we've utilized. Deanna, you have given us so many little treasures that we are looking forward to uncovering during your talk at the annual international conference. So my final question for you today is a Fun One. What's, what's one practice that you do daily to honor your own circadian rhythm.

I wake up with the sun. So one of the things this came to me. So I'm part Swedish and I have relatives in the northern part of Sweden. I went to Sweden in 2015 with my dad to visit our relatives, you know, all confirmed through 23andMe and everything we like, we have genetic ties. So we go over there. And one of the things I noticed about how the Swedes live is that their bedrooms, you know, they pretty much don't pull the, the curtains down or they don't have blinds like we do. They just have. It's just like a naked window. And I started to do that at home. Where, you know, we live, we have a couple of floors in our home, so we're on kind of the, the upper floor anyway. So, you know, my husband may not like it as much, but I like to wake with the sun. His circadian rhythm has a little bit of a different tone to it. But one thing that I love to do is wake with the light and by not using blinds, curtains, and literally just waking up. And I, I must say, I also have a cat. She just wakes up with the circadian rhythm. It's like animals know. So I basically wake up with her and she wakes up when the sun is up and she even adjusts herself when, you know, we start to lose, lose sunlight and get more darkness. It's pretty amazing how animals just do that automatically. So what do I do? I just try to take conscious practices within the bedroom as it relates to light. I aim for darkness at night. If there's not enough darkness. Wearing an eye mask and then waking with a light. That's like my favorite because I'm a morning person.

We have so much to learn from our animal friends and from nature.

We do.

Deanna, thank you so much for being with us today and sharing these sneak peeks from your annual international conference talk. We're so excited. It's just always a pleasure to chat with you. Thank you for being with us today.

It's been a delight and I'm so looking forward to seeing everybody in person. And so I'll see you there. Kalia and everybody else, take care.

See you in Las Vegas. Discover the latest research and innovative clinical practices at IFM's annual international conference May 29 through June 1, 2024 at the Bellagio in Las Vegas. For more information, visit aic.ifm.org.