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[Damien Blenkinsopp] : Kara, thank you so much for joining us on the podcast today.

[Dr. Kara Fitzgerald] : Well, thank you for having me. It’s great to be here and I’ve just enjoyed talking to you for the last ten minutes about all things toxicity. So I look forward to jumping in and talking to your audience.

[Damien Blenkinsopp] : Absolutely. Yea, I don’t know if it’s a passion of yours. It’s been a little bit of a passion of mine. Toxins and everything. I heard you on a detox summit and it was a great interview you did there. It was one of the better ones on toxicity. That’s why I reached out to you. It would be great to have a discussion with you about it. So, how did you first connect with the topic of toxicity? Where did it come around for you? Is it something you came across in your practice a lot? How did that whole interest start for you?

[Dr. Kara Fitzgerald] : That’s a good question, Damien. I did my post-doctorate training at Metametrixs Clinical Lab in Atlanta Georgia. Metametrixs was later, not too long ago, it was purchased by Genova. If you are familiar with Genova, they’re running Metametrixs suite of testing. Metametrixs, it was studying the toxins from a laboratory perspective; and also being part of the medical education team. Not only lecturing, but speaking. Doing consultations with doctors all of the time about the toxic burden. Incidentally, I was also in my clinical practice, and have been all along, so using it in practice. But, I came into the study of toxins from opposed to stuck in a lab.

[Damien Blenkinsopp] : Great, great. In your practice, is this something that you come across quite often? You’re in integrative medicine. I should just take a step back a little bit. We haven’t really talked about integrative medicine. We had Jeffery Bland talking about what functional medicine is. What is integrative medicine in comparison?

[Dr. Kara Fitzgerald] Another really good question. It’s always important to define terms. I imagine you could ask twenty of us who say that we’re integrative or functional and you’ll get little variations of definitions. So, integrative is sort of an over-arching definition that I think acknowledges the value in all forms of medicine. I am trained as a naturopathic physician. We do indeed prescribe medication when it’s indicated, but my core training is in taking a natural approach. As we used to say, removing the obstacles of cure. Working in foundational wellness and health and healing and nutrients and so forth. And then, if medications are indicated, you step in. Or if surgery is indicated, you step in. An integrative approach really quite simply; is acknowledging the value and when to use all of these systems of medicine that we have. A traditional or a conventional western approach, a traditional naturopathic approach. You can pull in paradata. You can pull in traditional Chinese medicine. As you are trained, and as it’s indicated with a given patient. That’s integrative medicine. Now, within that, is functional medicine. For me, functional medicine is a way for us to practice systems medicine. Most functional medicine practitioners would say that they’re integrative. That’s the larger picture. And then, you drill down into particular approaches. For me, functional medicine is a model of being able to practice systems. It’s a way of data capturing, of analyzing the patient that enables us to step back. Actually, Dr. Bland, Jeff Bland, has said “from telescope to microscopes”. You want to look at the being and their environment and then you want to drill down to the molecular level. That’s an incredibly careful and detailed history. To actually be able to capture that, you need a good structure. So, the institute of functional medicine has the matrix and this is a fabulous tool that you use in your chart note. The matrix for capturing systems medicine. Of course, actually; let me go over here and tack on to that what Jeff Bland said. Obviously, you are looking at the being and function and you’re correcting those imbalances. You’re correcting the dysfunction to restore wellness.

[Damien Blenkinsopp] : Basically, you come from two schools. The traditional medicine schools that we know is hospitals and so on, and you’ve also studied the functional medicine and some of our naturopathic and alternative sides as well. You just try to use whichever tool you think is relative to the situation. That sounds like the best of all worlds. Sounds like the best approach. I would say that’s really the kind of approach we like to get covered on here. Where it’s just taking whatever works and whatever context without any allegiance whatever to any. There’s a little bit of politics and fan stuff going on as always does go on in health. There’s all these different modalities which fit different situations. It sounds really like the best of all worlds. In terms of toxicity, when you’re addressing that, is it more on a functional medicine side? Or would you find a bit of a mix of everything?

[Dr. Kara Fitzgerald] :Addressing toxicity. What do you mean from a functional perspective?

[Damien Blenkinsopp] : What I’m just trying to understand how you approach the whole thing. For instance, when a patient walks into your practice, and you typically decide that there’s some element of toxicity involved in their problems. Where would that come from? Would that come from one discipline or is it like a bit from everywhere?

[Dr. Kara Fitzgerald] :Well, I would say that, conventional medicine. The conventional western model, doesn’t acknowledge the influence of toxins in the disease process. Sufficiently, yet. The data are completely irrefutable, so there’s some movement towards that. It would be as a functional medicine doctor. Baseline, anybody walking into my office has a toxic burden. That has been well established. Anyone coming in to my practice, I know, has a toxic burden. That toxins are influencing the course of disease that they’re presenting with. Most of the individuals that come to see me in my practice have something complex and chronic. I know that toxins are playing a part of that, but the question becomes, for me, as the clinician, in my analysis. My detailed analysis of the patient. Both history and lab, is to what extent are toxins influencing this person’s disease process. Therefore, in terms of our treatment, how immediately and how aggressively are we going to address them? Always a toxic burden, always influencing the course of disease. In fact, when you restore it. When you take a functional, sort of a systems approach, to treating somebody. You take care of their diet and you make sure their nutrients are appropriate. Those extremely fundamental steps are helping release the toxic burden. Toxins are always addressed in my practice. All of those foundational things are addressing the toxic load that we all have. But then, the second piece becomes, once we go in there and do that foundational assessment and treatment. Do we need to then, chelate… move into a more aggressive detox protocol? Do further laboratory evaluations and so forth. For all of the folks who come to see me, incidentally Damien, I do assess, as I talked about on the detox summit. Everybody, I look at whole blood metals and it’s a screening tool.

[Damien Blenkinsopp] : So you do that test with everyone who comes into your practice?

[Dr. Kara Fitzgerald] : Yea. I sure do. I’m always screening for stuff. You know that whole bloods are reflective of current exposure; going on in their life now. But it’s a screening tool. Then, we’ll go on and do further assessment as I deem appropriate from taking the history.

[Damien Blenkinsopp] : So, that’s kind of your baseline. Okay, great. You are saying basically this applies to people of chronic, complex conditions which you tend to treat. Would you say that there’s other people who should think of this also? I’m thinking how far should it go? Like if someone’s athletic performance isn’t as good. Or if their mental performance isn’t as good. Or if they’re just someone normally who’s a bit tired these days, but it’s not, they haven’t classified themselves as actually ill yet. Or, are not going to see doctors about it, but they just don’t feel in top form and are not doing so well in general. Are these the types of symptoms or are there specific symptoms that anyone who doesn’t feel like they’re in a chronic condition yet should look at? As a pointer that this may be something that they should look at.

[Dr. Kara Fitzgerald] : Yea. Absolutely. Let me underline it. Let me scream this from the rooftops. We all have a toxic burden. Period. We all do. We’ve all been exposed to toxin. We’ll have an influence in the course of our wellness. We want to consider them. Now, in my practice, most of the individuals who see me happen to have complex chronic disease. That’s just, that’s my training. That’s who I work with.

[Damien Blenkinsopp] : Right, right.

[Dr. Kara Fitzgerald] : Those individuals, absolutely have a toxic burden. We all do, and there are steps that we all need to take to ensure that we minimize our toxin exposures. As well as our body’s ability to detox. I would say an emphatic yes. To optimize athletic performance you would absolutely want to consider the toxic burden. Or to a little bit of brain fog. So, going back to your question to me. What are some typical signs and symptoms you might see? Certainly, fatigue. Actually, fatigue would be a piece of the puzzle. Brain fog is a pretty classic first type of sign. Allergic disease. When you look at the literature on the impact of toxins, you will see allergies screaming. A lot of the organo- toxins- BPAs, phthalates, parabens, etc., etc. A lot of those, the first reaction is some sort of allergic reaction. That’s because the body wants it out. You’re exposed to something toxic, you sneeze. Or you develop a rash. It’s this reactive response to some bad thing trying to come in.

[Damien Blenkinsopp] : You are saying. Would that be like rashes, would that be some tiredness responses to foods? Could it also be like sneezing, like hay fever kind of things?

[Dr. Kara Fitzgerald] : Yes. Yes, yes, yes, and yes. They’re broad, and generally speaking, they’re non-specific. Endocrine disruption is another potential reaction. Hypothyroidism, hormonal irregularities. Estrogen dominance and so forth. All of these things can be influenced by toxins. Really almost any symptom can have a toxic burden. This is because when you drill down to the molecular level. When you look at what toxins are actually doing in the body at the molecular level. One of the fundamental lesions is increased oxidized stress. You are causing that fundamental imbalance in the mitochondria. In tissue. Towards different tissue. They’re just doing this fundamental damage process. But, depending on the type of toxin, you can get some idea of symptoms. But, they’re still broad, Damien. I hope that I’m making sense.

[Damien Blenkinsopp] : Yea. It’s still an area we’re investigating and exploring. One of the ways I look at it, is like, these are basically molecules. The only reasons they’re toxins is because they are unnatural to our body. Our body’s made up of certain types of molecules and atoms. These come into the body and just because of the way chemistry is. Biochemistry is, they connect with, they disrupt, and they change in some cases, how things are working in our body. Because instead of selenium we have some other toxin which is binding to something in our body which it shouldn’t be. It’s kind of like distorting how our bodies are supposed to work. Therefore, they start to work in different ways. Which means we get some kind of symptoms we’re not used to. Which you’ve referred to many. Is that a fair way to explain it?

[Dr. Kara Fitzgerald] : I think that, yea, absolutely. That’s nice. That’s a really nice snapshot that’s easily digestible. Yes. What’s interesting, just leaping off of that, is the idea of polycarbonate biphenyls, or PCBs. Talking about an unnatural compound. Something that the body doesn’t recognize. Often times, we store these compounds in our fat. We want to get them out, and PCBs, certain metals and so forth; the body is smart enough to say I don’t know what this does. I’m getting it out of here. The safest place to dump it is in the fat. You’ll see it accumulate there. The half-life, the time these toxins can stay around in the body, it moves into the decades and decades. Because, our body isn’t equipped. We didn’t evolve with these exposures. They are synthetic, as you said. They’re man made. We sequester them, and they stick around, which is a drag. Which is unfortunate. Which is why we would like to minimize our exposure.

[Damien Blenkinsopp] : That’s great. I’d just be interested; have you tested yourself? Have you run these whole blood, for instance, screens on yourself? Or other people which are more normal and haven’t come into your practice at a chronic disease level? In comparison, how do they compare to the chronically ill? Are toxin levels lower, or how does it look in your profile versus someone else’s?

[Dr. Kara Fitzgerald] : That’s a great question. It depends on what we’re looking at. For instance, if you have a water soluble toxin that our body can get rid of. You might see periodic high levels in an individual. Say that you just purchased a carpet. That carpet is off gassing petroleum derivative molecules that your body can eliminate. You might measure some of those compounds and you’ll see a lot of them in your urine. Then, you step away from the carpet. Your body turns it over pretty quickly if you have good detoxification systems, and you will see them normalize. You can see that in a healthy individual. One of the signs of that, we all have these toxic burdens. In a healthy individual, they’re able to detox and remove and get on with their life. They might notice when they’re in the carpet off-gassing. When they’ve got a little bit of a runny nose. Or maybe a slight headache or a cough. Some of the signs. But then they get out, they deal, life goes on and they are no longer bothered. In the toxic person, yeah, you could absolutely see higher levels. In the person with the complex chronic condition. Part of this is that their body isn’t able to get rid of them so well. They just might have detoxing difficulties. Be it phase one, the first step in detox or phase two. For myriad of reasons, we can have challenge. Maybe we don’t have adequate nutrients to detox. Glutathione, I’m sure you’ve talked to your folks about it before, is really one of the major players in our ability to detox. We actually waste it. I shouldn’t say waste it. We don’t recycle glutathione when we use it to detox. In that complex chronic disease patient with a large accumulation of toxins, they may have spent the glutathione and they have not adequately replenished it yet. Glutathione comes from three different amino acids in the body. That’s how we are able to make it. But, if you’re chronically detoxing, or attempting to detox, you could run out of glutathione. One mole of glutathione detoxes one mole of toxin, be it mercury, or be it any number of different organic toxins. We also can have mutations in our ability to detox. We can have genetic mutations that might slow us down. Make us vulnerable to accumulation of certain toxins. We see that in complex chronic patients as well. In those cases, we make choose to look at those genetic mutations. When we find them, we really want to support those particular areas all the more aggressively. A lot of people have mutations in the glutathione s-transferase enzymes. The glutathione s-transferase enzymes are, as you can imagine, as the name implies. They’re major players in our ability to detox across the body. Not just in the liver, but in the skin,(and) in the kidneys, (and) in the gut, (and) in the brain. We can have mutation in these enzymes and therefore, when we see it in our patients. When we know they have a toxic burden. We need to get in there and really support it.

[Damien Blenkinsopp]: You’ve outlined many different ways in which our detox system may not be able to cope with the flood of toxins we are getting these days from many different synthetic sources. Carpets and heavy metals and so on. Is this something, I guess something I just want the audience to understand, is: Are issues with your detox system pretty rare? When we talk about mutations, sometimes, genetic mutations. It sounds like it could be something rare. One in a hundred, or one in a thousand? But my understanding is that a lot of these mutations today are relatively common. It’s a bit like the MTHFR, which is extremely common these days. There’s a lot of these mutations and just differences in our make-up which mean that maybe we’re not, we haven’t got a super powered detox system which is really working really, really efficiently in terms of chemical processes. It slows it down a bit, and then when you combine that with the fact that we have a lot of toxins around us today, it seems relatively common that they can crop up for some people. That this is hampering them in some way.

[Dr. Kara Fitzgerald] : Yea, yep you got it. You asked me about the incidents of mutations in our detox system. Are they common, you asked me? Yea, they sure are. We have somewhere in the order of four million single nucleotide polymorphisms. These mutations that you and I are taking about. These single base para switches, like MTHFR, is the most famous of those. We have somewhere in the order of four million. We have tons of them. Loads of them. Many of those aren’t significant. We have backup systems. There’s a lot of redundancy built into the body. We do have backup systems. So, a lot of those aren’t going to be particularly relevant to us and to disease process. But there are also many that are. So, yea, I would say that all of us, we have some mutations in our ability to detox. The question is, what hand of cards were we dealt? How big of a deal is that playing in our disease process? I do look at detox snips in a lot of my patients. It may not be the first thing I look at. It depends on what someone presents with. I do end up looking at them frequently. The glutathione s- transferase system. It’s huge. We have many of them. In different types and in different tissue locations. When you see one, it’s not the end of the world. Yes, we do want to support it, of course. But, it’s when you see multiple or when you see patterns. MTHFR is a big player in detox as well. Indirectly, but significantly. It’s going to help us make the glutathione that we need for the glutathione s-transferase. It’s a big, MTHFR is a fundamental player in methylation. We detox with methylation also. Everything is interconnected and a nice broad snapshot of what are the genetic issues, and how many and then go back to whether or not you think it’s playing a role in whatever the individual is presenting with. There’s a lot of angles we need to look at here, to guide us in our treatments. I want to step out for just a second. So, as not to overwhelm the listener. Really, the very first thing that we can do, Damien. The very first thing. You know, this, I know this and use this in my practice, is investigate what’s going on in current time, and we expose your sources. Any patient coming into my practice will have a meeting with my nutritionist on clean living, clean eating, clean living in the home and so forth. Lowering the toxic burden is huge.

[Damien Blenkinsopp] : Right. This sounds like your foundational work, that you said you did at first. What are the biggest things that you do there, that you feel are important to clear the way.

[Dr. Kara Fitzgerald] : Far and away, the biggest thing we can do is clean up our diet and go as organic as much as possible. I would argue, I would say, that most urgently, we want to look at clean fat sources. Organic butters, organic milks, organic meats, etc. They really almost as important would be looking at organic vegetables and fruits and so forth. Going as organic as you possibly can, using the dirty dozen from the environmental working group as our baseline. At lease achieve the dirty dozen. If you can’t eat organic versions of those, like apples.

[Damien Blenkinsopp] : This dirty dozen are the ones with the highest levels of pesticides and are there other chemicals involved in those dirty dozen? Is it primarily pesticides? And in many forms, in neurotoxins and different ones?

[Dr. Kara Fitzgerald] : Primarily, we are looking at pesticides and their many forms. We could move into discussing, that’s what the environmental working group is testing anyway. They’re looking at pesticides. We could then talk about metals, we could talk about genetic modification, but that would bring us into tomorrow. We would be talking…

[Damien Blenkinsopp] : Exactly.

[Dr. Kara Fitzgerald] : If we go organic, Damien. If we go organic as much as possible, we’re going to bypass all of these toxin issues. To the best of our ability. That’s the foundational. That’s the entry point.

[Damien Blenkinsopp] : I guess, because some people are concerned about cost of organics, so I’m guessing that’s where you introduce the concept of the dirty dozen. Trying to focus on the biggest ones?

[Dr. Kara Fitzgerald] : Yes. Exactly. Focus on the major players. Do not eat non-organic apples. If you can’t find good organic apples, then just skip apples. Secondarily, say you are in a location where you simply cannot find organics at all. I remember in medical school, having a debate with my roommate at the time. “Kara, there are no organics.” She lived in Hawaii. I find it hard to believe there are no organics in Hawaii. “There are no organics in Hawaii’. She argued with me. This was years ago. I don’t know that I buy it. But then, you talk about, ok, how do you clean the food? How do you clean it appropriately? You can do, you can use a vinegar solution. You can soak your fruits and vegetables in there, and you can reduce the pesticide load that way. That’s not optimal, but it’s a whole lot better than not doing anything else. A 10% white vinegar solution that is the cheapest vinegar off the shelf at the grocery store. 10% in a basin of water, and soak the vegetables for three to five minutes. That’s going to reduce the water soluble pesticides. Now, I use the vinegar wash. Actually, I use it all the time for any fruit or vegetable that I’m washing. Because it’s easy. I just have a spray bottle at my sink. I actually just use 100% vinegar. It’s so cheap. I have a bottle of vinegar. I just twist on a sprayer and I spritz it on whatever I need to wash. Let it soak for a period of time. That would be the next best thing.

[Damien Blenkinsopp] : Great. Great. I’ve traveled in many countries, and I’ve kind of tried to practice eating clean. It can be pretty challenging to find organics in some countries. Especially third world countries. I’ve used a similar strategy as you’re outlining. Focusing on the ones that are cleaner. Avoiding the worst ones, and trying to clean. Thank you for that very practical tip. That’s very helpful for people. Once you’ve done this first…

[Dr. Kara Fitzgerald] : Let me just throw in one more tip here. I’m sure you were doing this when you were traveling. You can always bring some extra vitamin C. We were talking about how much we loved that at the beginning. You can bring some extra nutrients to just protect yourself.

[Damien Blenkinsopp] : Right. Absolutely. We can talk about that and the kind of treatments you use which are also helping from that level. Is this the one big pot of your foundational area? Or is there something else you advise your clients to do? Water, or something in the house, or anything like that?

[Dr. Kara Fitzgerald] : Yeah. So the other major things that, guidelines to clean living, yes. You absolutely want to filter your water appropriately. I think charcoal filtration is the absolute way to go. I don’t know what your position is on reverse osmosis, but we can get into big problems if you remove all the minerals from your water. So, reverse osmosis is the cleanest, there is no question about it. But all the minerals are gone. You can develop significant, ironically, dehydration from consuming lots of reverse osmosis if you don’t adequately replenish the minerals. For me, I use, and I recommend, charcoal filtration to my patients.

[Damien Blenkinsopp] : Have you got any specific brands? To make this a little bit practical in terms of recommendation. If someone wanted to go and get something to help them.

[Dr. Kara Fitzgerald] : Yes. My favorite brand has been for years. The Multi-Pure filtration system. You can get that. I think its Multipure.com. It’s easy to get. It’s pretty pricey though. They have a bunch of different systems, so there’s different price points on it. The other one, it’s nice, and it has a much more palatable price point, is Usana. I think both of those are quality products.

[Damien Blenkinsopp] : Great. I’ve been using Berky. I don’t know if you’ve come across them before.

[Dr. Kara Fitzgerald] : I haven’t. I haven’t, but you can send me some information.

[Damien Blenkinsopp] : I will. Just a different alternative I’ve seen. I’m not use how they compare to yours.

[Dr. Kara Fitzgerald] : You go through. You do a whole home assessment with the patient. Just minimize exposure sources in the home. Incidentally, actually, I have a blog. I have a couple blogs on lead. I have a blog at drkarafitzgerald.com, Dr. Kara Fitzgerald.com on lead exposure. It was a case of Parkinson’s disease. This woman was rehabbing a lead house. Lead paint was in this old house they were rehabbing. She ended up getting very, very early onset Parkinson’s disease, and concurrently gave birth to a child who was later diagnosed with Autism. I think both of those were significantly, significantly, significantly influenced by this lead exposure. There are some pretty nifty tools, if you are concerned about lead, with your patients. I often am, if I do a urine, or a blood test. There’s some pretty nifty kits that you can do home lead testing with. You can buy these on Amazon and you can get them at Home Depot or whatever those big hardware stores are in the UK.You can buy lead swab kits and just swab stuff. A lot of ceramics that come in from China and there about, can have lead in the ceramic. You swab this particular lead sticks that I use, and it will change color if lead is present. If you look on that blog, you’ll see. If you scroll down, you’ll see a patient sent in a photo of the positive finding on one of the plates that eats on every day. She’s always had high lead and we needed to do some sleuthing to identify it.

[Damien Blenkinsopp] : Wow. Is this potentially a lot of ceramics? Everything comes from China these days, and having lived in China, I can definitely understand that lead might be in everything. Is lead particles around it, or is this actually they’ve used it in the material itself?

[Dr. Kara Fitzgerald] : They’ve used it in the material. So it’s in the ceramic, and it’s absolutely worth it then. It would be great for you to do this yourself Damien and see what you find.

[Damien Blenkinsopp] : Sounds like an amazing test.

[Dr. Kara Fitzgerald] : It’s handy and it’s cheap. There are more sophisticated and sensitive tests that some of us use clinically. But this is an easy, easy, cheap way to just get in there and start looking now. When we did it, when I first started using these at the laboratory. We swabbed all of our teacups and tea pots and plates that we had in the lab. We all had different plates in our offices that we from. Eve Brolley, the daughter of the former owners of Metamatrixs, had this beautiful tea pot she brought home from China. It was riddled with lead. It was absolutely riddled with lead. Yes.

[Damien Blenkinsopp] : You know, this is really important. Because, if we go back, you said one of the screens you do is the whole blood. The first screen you do is a whole blood test for heavy metals and metals. It would be interesting which metals they are and then you have to kind of go through this detective process. Where is this coming from? When you have high levels of lead or of arsenic and it doesn’t make sense sometimes. Where is this coming from? I don’t know what exposure it might be.

[Dr. Kara Fitzgerald]: Yes.

[Damien Blenkinsopp] : First of all, which metals are you screening for in that test.

[Dr. Kara Fitzgerald] : In my whole blood, and these are all routinely covered by insurance in this state, so it’s extremely easy for me to do. I look at mercury, lead, cadmium, and arsenic. In everybody. Another great example. A mother and a daughter came to me. Actually, daughter was complaining. Her chief complaint was anxiety. She was in her twenties and it was so disabling. Early twenties, she was unable to attend college. She had to withdraw from college because of this. Relatively recent onset of severely debilitating anxiety. In her history, she did mention. Actually, her mom was with her, and they both were putting massive amounts of effort into eating very healthy. They were buying organic, they were eating lots of fish. They were proud of themselves, and clearly they were doing a good job. One of the things that they had, on a routine basis. Multiple times per week, was sea bass. You and I know, sea bass is very high in mercury. When I got her blood mercury, her whole blood mercury, it was off the charts. That was the smoking gun in this girl’s anxiety. She was becoming mad as a hatter. She was in frank acute mercury toxicity from chronic ingestion of sea bass. Of mercury toxic sea bass. We removed the exposure source and we detox her and her symptoms abated. Considerably. She was able to return to school. She does need ongoing treatment and you need to pay attention to what’s going with her regard to detoxing. It was quite useful in that regard. Sometimes, I’m kind of topic jumping here a little bit Damien. You can reel me back in. Sometimes you’ll see, in fact frequently, we won’t see any evidence of toxins in the blood. That’s because the half-life. The amount of time these toxins actually spend in the blood, isn’t long at all. It’s hours, or a day or two. They’re so toxic. These metals are so toxic to us, that our body wants to clear them out. Wants to take them out of circulation as soon as possible. For lead, we store it in the bone. mercury is going in the fat, etc. So, you will get a lot of people who have no burden at all. For those individuals, we need to drill down a little more deep. When I suspect the metals are in, which I really do for most folks. At some point, after we’ve addressed the foundational, we’re going to do what we call a chelation challenge. We’re going to look at the urine level of toxic metals. I’ll give them a compound that will help draw the chemical, the metals, from the body and dump them into the urine. Then, I get an assessment of total body burden.

[Damien Blenkinsopp] : Great. So this is versus the whole blood. Which you were saying, it’s very much on going exposure. I guess, when you are doing that, it’s interesting because it’s the critical. What are you being exposed to every day is more likely to show up there. That’s why it makes a lot of sense if you do that first. Because it could be something that’s going on every single day and making it worse. Versus looking at this urine challenge test, which allows you to see what’s the history, how much have they gotten this burden? When you are doing this, we have spoken a little bit about the urine challenge test before. Which labs do you use? What kind of chelator are you using for provoking challenge?

[Dr. Kara Fitzgerald] : I think that Metamatrixs does a great job. In just being really familiar with their analytics, so this would be going through Genova. I think they do a great job. I also think Dr. Sata does a really good job. Those are the major, those are the two labs that I use for this.

[Damien Blenkinsopp] : Great. Just out of interest, can you compare the two, or basically how they are on different standards? So you have to stick with one. If you’ve got your history with different patients with Metamatrixs, it makes sense for you to stick with that, because then you’ve got this comparison.

[Dr. Kara Fitzgerald] : Yes. Correct. That’s absolutely right. I mean, you can take a, generally speaking, if you see a high in Dr. Stata, you are going to see a high in any assay. You are going to see it in Metamatrixs, but you are right. There’s different units, there’s different methodology, so it’s wise to just continue with whatever lab you did your baseline assessment. It’s wise to continue your baseline assessments with that lab. Just keep the same test. For chelation, remember, going back to the foundation. We need to make sure that individual can detox. We need to make sure their nutrients are up to speed. That phase one and phase two is good. We need to absolutely make sure kidney function is ideal. That they are moving their bowels. They’re having at least one complete BM per day. Once we have all of that dialed in, then we go in and we do a chelation challenge. For most of my patients, I’m going to use an oral DMSA challenge. Generally speaking, the easiest way to go is 1000mg in two divided doses over eight hours. The half-life of DMSA. Some people will choose to do a 24 hour toxic metal measurement, but I think eight hours is plenty because the half-life of DMSA is just under that. The DMSA is going to be cleared out of the body quickly and that’s what you are trying to look at. You want to see what the DMSA, what metals it’s pulling out. So for that reason, you can do an eight hour measurement. You start the collection, take 500mg or there abouts of DMSA and then four hours into the collection, you take a 500mg or there abouts a second dose of DMSA. Then, you collect for another four hours. You take a portion. You mix the urine, take a portion of that specimen and send it into the lab. I think that’s a decent way to assess. Some of my individuals, who are too sensitive, for whom I think the DMSA is not going to be tolerated well, we can use antecedal cystine, glycine. There’s a number of natural compounds that we can use. There are data on antecedal cystine as an effective alpolic acid. Having chelative properties will help pull it out, so we can do that if I deem it necessary.

[Damien Blenkinsopp] : Alright. Thank you very much for bringing up the, you were talking about the importance of doing your nutrient stage first. It’s safety. Because if you are going to use a chelator and pull toxins out. Heavy metals, then, it can be a bit hard on the kidneys and the other detox organs.

[Dr. Kara Fitzgerald] : Incidentally, if you start drawing it out, and they don’t have adequate nutrients. If their detox systems aren’t up and running, and they are very dependent on nutrients. Selenium, and zinc, and glutathione and metholdone, (and) many amino acids. If those aren’t there, ready to do their job, you will make the person sicker. Even basic kidney function has to be intact. Beyond that, they need to have their detox ability really up and running. The other thing is, Damien, this is so fundamental. It’s so fundamental, and that is one of the major roots of entry into the body is orally. We eat toxins. We’re eating these metals in our food or whatever. If you’re deficient in minerals, if you’re deficient in your essential minerals, those transport proteins. The ways that their minerals are taken in to the body. If there are no minerals, or low minerals present, those transport proteins will be high jacked by toxins. This data has been demonstrated. One of the easiest ways you can reduce your exposure source of metals is making sure you have adequate essential minerals in your body. It’s so foundational. Those transport proteins, this has been shown actually very strongly in iron deficient anemia. Padmium, manganese, which can be toxic in high amounts, mercury and so forth. They can, they hitch a ride into those transport proteins that would otherwise be used for iron or magnesium, and actually, they are relatively non-specific. A lot of the essential minerals move into the body using these transport proteins, and if you are deficient in your minerals, which most of us are. Eating a standard western diet, those metals get a ride in. The other huge piece of this, is that these same transport proteins are at the blood brain barrier. Not only are they entering into circulation through the gut, they’re going to have readier or easier access to the brain and the central nervous system. One of the most fundamental things is to make sure you have adequate nutrients and especially adequate essential minerals. Isn’t that, it’s profound.

[Damien Blenkinsopp] : Yea, it’s amazing. That’s part of your foundation, right.

[Dr. Kara Fitzgerald] : Part of my very fundamental, foundation.

[Damien Blenkinsopp] : And amazingly simple. Which nutrients do you focus on?

[Dr. Kara Fitzgerald] : Well, I focus on all of them, but I’m looking at, as you mentioned earlier, selenium. Selenium can actually bind and render inert mercury. Bind it and pull it out of circulation. In the body. So, mercury is highly toxic and selenium can bind it and just allow us to eliminate it. It’s potent. So, if you’ve got a mercury burden, chances are, you’re burning through your selenium. Selenium is used elsewhere in the body as well. So, selenium is a big player. All of them are. Magnesium is a huge, huge player. Zinc is a huge player. I would say that those are the biggest three. You also want to, of course, make sure you have adequate calcium. Lead is stored in bone, it’s going to displace calcium and other nutrients. You want to have adequate calcium in your diet, or take some degree of supplement. Chromium can be useful. Secondarily, zanadium. But really, the major minerals, magnesium, selenium, zinc and so forth are what we want to have in abundant supply.

[Damien Blenkinsopp] : How do you bring those levels up. I guess, because I’ve come across this before. The way I thought about it was that it’s kind of like, because you’ve deficiencies. You’ve got these molecules that have holes. Waiting to pick up something. So, you’re leaving all these holes in your body, basically, waiting to pick something which is a similar molecule. You have the toxic molecule come along. That’s what you were talking about, the bones and calcium and lead seems to basically have a similar molecule. It will just bind there because you’ve left the gap open by having that deficiency.

[Dr. Kara Fitzgerald] : Yea, yea, yea.

[Damien Blenkinsopp] : Yea. I think it’s really great how straight forward it is really.

[Dr. Kara Fitzgerald] : It’s elegant

[Damien Blenkinsopp] : It’s elegant the way it works.

[Dr. Kara Fitzgerald] : You just eat a great diet. Then supplement with extra minerals as see fit. I assess mineral status in my patients. I’ll look at red blood cell status of minerals. Along with my whole blood toxin. Incidentally, Damien, on most of my patients you’ll see generally speaking, higher amounts of toxins relative to their essential minerals. It’s all of the time I see this. The toxins are a little bit higher. Even if they’re not frankly elevated, they’re higher normal or something like that. Minerals are so often in all of us, low or very low normal. Very low. Low normal to very low. You always see this skewed ration. Almost all the time I see this. Unless somebody is really intentionally addressing it. This is the most fundamental thing that we turn around. We’ll get your essential minerals nice and robust and that alone will help drive down your toxins. Then, we’ll do all of the other things. Look for exposures and so forth.

[Damien Blenkinsopp]: For the essential minerals, I don’t know if you use this or not. The thing I’ve used in the past is the Greens powders because they have a broad spectrum of nutrients. Other than just trying to eat a better diet with a greater variety of vegetables is really where you have to start with this. What are your main recommendations? The ways you try to get your patients up to speed with that?

[Dr. Kara Fitzgerald] : Ok, since I’m testing, I’m going to see the degree of the deficiency. If it is high enough, I’m going to supplement them with individual nutrients. I very often use magnesium as a standalone nutrient. I very often use zinc as a standalone nutrient. Selenium, since we don’t need as much or maledium or some of the others, we can use in a complex mineral supplement. I think the Greens powder is great. Whatever company you’re using, obviously you know that they’re ensuring their quality. They’ve tested for metal quantities and so on and so forth. It’s a super clean product. It’s rich in metals, so that’s a nice thing. Baseline. While I’m first starting to work with an individual, and they are really depleted, I’m probably going to use individual supplements relatively high doses to get them up to good levels. Then, after that, we can do a complex mineral formula and obviously, we are working with their diet. For a period of time, we are using individual nutrients.

[Damien Blenkinsopp] : Great. Thus the importance of, even if someone’s not chronically ill, would you recommend they go to a practitioner such as yourself? If they feel this could be an issue for them. It is athletic performance or whatever it is, it’s still worthwhile going for this process with a practitioner to get it done right, right?

[Dr. Kara Fitzgerald] : Oh, yea. I think so. Absolutely. It’s really a lot of fun. It is! It’s very interesting to look at your biochemistry.

[Damien Blenkinsopp] : It’s a lot of fun when you get energy and performance back. You start thinking clearer. All these thing are really exciting.

[Dr. Kara Fitzgerald] : Not only that, Damien, but think about disease prevention. Now, we’re moving into the world of ethnogenetics, which I’m sure you’ve talked to your people about. Not only are you preventing disease in yourself, but if you are going on to have children, you are preventing disease in them and their offspring. On, and on, and on. If you think about ethnogenetics. It’s amazing what wellness will do to us. Not only us as an individual but really globally shifting. The planet and the generations to come, it’s so incredible. I would say that it’s a continuum of wellness. Optimizing athletic performance is not that different from treating the complex chronic disease. You’re still seeing underlying nutrient deficiencies. You might be seeing in the athlete increased oxidative stress. In fact, that’s common because they’ve got tons of mitochondria that are incredibly active. You’re going to be seeing some of those same imbalances. I used to, when I was in medical school, I was a road racer. I did a lot of, in fact, I liked criterium. I was working really hard at building up tons of mitochondria in my legs, in my quads and stuff. I enjoyed doing that at the lab. We had a lot of physicians focusing on wellness in the lab. Looking at data of athletes is so interesting and cool. Working on optimizing mitochondrial status. Making sure their nutrients are extremely dialed in so that you can shave a second or a few seconds off their time. After your season, often time, athletes notoriously get sick. Most students, they finish their intense period of training and then all of their event schedule, they often get sick. How do you prevent that as well? That’s something that we could do. So, sure. I’m more than happy to work on wellness. I think it’s a lot of fun.

[Damien Blenkinsopp] : Yea. Great, great. Would you say that the patients who get chronically ill, stick with it and work on this afterwards? I’m just interested from the standpoint, once they’ve learned about these tools, basically they see the benefits themselves. Just in daily life and being proactive.

[Dr. Kara Fitzgerald] : Yes. It’s like throwing the stone in the pond. There’s this remarkable ripple effect. Then their friends and their family say, “Oh, my gosh. Look at you. You look so much better. You have so much energy. Your skin is gorgeous. You’ve lost all this weight. What did you do?” They have this influence on those around them, just by being representatives of what wellness can be.

[Damien Blenkinsopp] : I’d like to point out, you said the way wellness can be. I do feel that a lot of us are walking around and we feel like we’re normal today, but if we went through these kinds of processes, we’d feel this level of being well. Which we haven’t actually felt before. Certainly the way I’ve felt on my journey. I feel like I’m thinking clearer than I ever have. Things like this. I think it’s a real shame. That we don’t realize that we could be better and that we could feel better. Because we’ve accepted some kind of norm. Maybe because it’s been going on so long.

[Dr. Kara Fitzgerald] : That’s right. We all acclimatize to whatever is in front of us. There’s that analogy where the frog. If you put a frog in a pot of water, you can slowly turn the heat up until its dead. Until you boil it. It will never, it won’t hop out. We get used to the disease process. We get used to feeling lousy. Just like the frog in the water. That’s actually an analogy that I learned from a patient. Who, incidentally, just became so wildly healthy. It just really changed his experience. He was writing to me and he said it’s like the frog in the pot analogy. The other thing is, this whole idea that lean on that we’re aging. Oh, I’m forty I’m supposed to be tired. I’m forty-five now, my bones are supposed to ache. My skin is supposed to look all saggy and gray. There’s this whole notion that we’ve built into the culture. Into the medical system. Because, really, the larger conventional medical model hasn’t had, does not have still, good tools around wellness. Therefore, all of these various signs and symptoms that we’ve been talking about, that are the early disease processes that we can change. They’re always attributed to aging.

[Damien Blenkinsopp] : Yea. Which is a real shame.

[Dr. Kara Fitzgerald] : It’s a real shame.

[Damien Blenkinsopp] : It’s a scape goat. We had Aubrey de Gray on the podcast previously and he talks about how a lot of these damaging processes, basically that are going on. It’s not aging.

[Dr. Kara Fitzgerald] : Yes.

[Damien Blenkinsopp] : We’ve given the name to all of this stuff, aging. But it seems like we’re aging faster because of today’s environment and the things going on today. It’s a shame that we just said “Ah, its aging. It’s normal.” Instead of trying to seize the day. So I just wanted to go back to a couple of things that we missed on your intest. You said you were using different chelators in some patients. Right, because if they are sensitive to the DMSA, which I’m guessing is because maybe they’re more mineral deficiencies. Or their detox system is having a harder time. Does it matter which chelator you’re using, in terms of what shows up in the tests? Are they standardized for DMSA or like so? For instance would anecetalsistine, which you said is a bit softer. Would that only chelate some of the metals. You would get a footprint or a pattern just for some of the metals and not some of the others?

[Dr. Kara Fitzgerald] : DMSA, so there are these, what they call binding affinities. Binding affinities vary depending on the agent that you use. Binding affinities simply means how tightly does that chelating compound bind the metals you want to look at. You can look up tables of binding affinity and see what’s going to hang on to the metals you want to look at most avidly. With the highest affinity. DMSA is really great and very well known for its ability to bind mercury. Less so lead, and less so some of the other metals, but it will bind them. It just doesn’t have as high of a binding affinity. Acetylcysteine is actually a little bit less. Now, it’s not going to bind as tightly as DMSA. Because, DMSA has structurally, if you look at it. It’s got a lot of sites for the metals to bind on. A lot of these Sulphur groups that the metals will bind on. If you look at it structurally, you can see why it’s so good at pulling out metals. Acetylcysteine is different. Structurally, it’s got only a single cell per group, instead of I think four on DMSA. It’s still going to. Acetylcysteine is just used in our body. We evolved using acetylcysteine and glutathione which is made from acetylcysteine to bind many different types of metals. Acetylcysteine is good, it’s just not going to have the same kind of affinity. It’s not going to bind them as strongly as a chemical. Now, DMSA is great for mercury. EDTA is going to be better for lead. Depending on what you do clinically. There are different cocktails or compounds that you can use. I don’t use EDTA in my practice because I don’t do IV. Really, ideally, if you’re going to use EDTA, you need to deliver it IV, intravenously. In order to really have it work. People use oral EDTA sometimes, but the data around using oral EDTA isn’t as good. Whereas the data on DMSA is very strong. It’s been used forever.

[Damien Blenkinsopp] : That’s good to know. I’m guessing the labs, because they ask you to write down which chelator kit you use, they standardize against the different chelators?

[Dr. Kara Fitzgerald] : Well, no. Generally, it’s so challenging. The lab, because they’ll have lab ranges for if you used any kind of a chelating agent. Ranges based on chelating used versus no chelating used. Because when you try to get specific. Like, for DMSA or for a specific ranges for EDTA, then you have to control how the protocol is administered. So everybody needs to use the same amount of DMSA and so forth. There are some laboratories that focus exclusively on occupational exposure. Toxicity in the workplace or something like that. Some of those places will have a very tight protocol that you can follow. Followed by ranges based on that. But, it’s a whole different arena. When you just had a massive cadmium dump in a battery factory or something like that. But for most of us, working with the less than occupational exposures. We’re doing the best we can. That’s what we have. Chelated ranges versus non-chelated ranges.

[Damien Blenkinsopp] : It sounds like its diagnostic enough for you to get your job done and identify the problems, right?

[Dr. Kara Fitzgerald] : Yes, yes, yes. Absolutely. Absolutely.

[Damien Blenkinsopp] : Right. So, we haven’t really talked about the other stuff. We talked a lot about the metals and the whole chemical side. Which we were taking about earlier where the pesticides. How do you approach the chemical side of detecting that? Does that come after the metals? If you’ve gone through the whole blood metals and before you thought there might be some metals you went for the urine, when would the chemicals? When would you start looking at them? Be suspicious that that might be an issue?

[Dr. Kara Fitzgerald] : Yea. Well, again, I’m going to assume that all of my patients have a burden. We really do. It’s been demonstrated. You can go to CDC and you’ll see. The people inside the area, in the farthest reaches of the globe, have some sort of organo- toxins, sadly. So, we all have that, so I always come in with that. Go through the clean living and get the nutrients and do all of those foundational things, and then from there. If what they’re presenting to me with clinically and if their history is compelling, then we move into to looking specifically at the organo-toxins. Genova, Metamatrixs, really developed awesome panels and you can get them now through Genova. You can look at the volatile organic solvents. You can look at PCBs, you can look at coroneted pesticides. You can look at many different toxins, organ toxins and I think that can be incredibly useful.

[Damien Blenkinsopp] : Great. Are those broad spectrum panels or are would you have to decide where you’re going to focus?

[Dr. Kara Fitzgerald] : You can get a broad spectrum panel from them now, that has a good price point on it. I would go there. I would go there because unless somebody gives you a really clear exposure history. For instance, my patient with ALS, who grew up in an orange grove. Unless you can really nail down what likely they’ve been exposed to, given their exposure history. Starting with a broad pattern, a panel is the best way to go. That’s what I recommend and do.

[Damien Blenkinsopp] : What percentage of your patients are you looking at these kinds of panels with?

[Dr. Kara Fitzgerald] : Not as big as I do with the metals. I would say, maybe at this point, maybe 20% of my patients I’m looking at these. It’s not that it isn’t a very useful tool, because it really is. Especially when I’ve got neurodegenitive conditions presenting to me. Where toxins are really. Thinking about toxins with those folks. Like with that early onset Parkinson disease. For her, she had this very obvious lead history. But for people coming out of Florida, or they worked on a farm. Some of these odd neuro-conditions really scream the need to have these kind of evaluations done. It’s another point that I wanted to bring up. This folds into our earlier discussion. That is, sometimes, when you do these foundational interventions and you really get the body functioning. You’re removing the toxins from the get go. Sometimes the body does it. If the body’s detox ability is intact, even in complex chronic disease, you can turn it around. People get on with their lives, and naturally remove them. You don’t have to go toward the more aggressive evaluations and detox processes.

[Damien Blenkinsopp] : So, it’s kind of like you are getting at a lot of things just with your foundation work we were talking about earlier. When you were saying you test for 20% of the patients. I guess these are the tricky patients. Where you are still sorting through it and you’re like, well we haven’t got it yet so we are going to have to keep on looking for the sources. What are you seeing comes up with these panels? Is it very, very different depend on where they come from? Where they’ve lived, like you were talking about. The specific examples there. Or do we all have a bit of these things in ours and how do you treat it? Do you have to be very targeted? How do you get pesticides out of the body, if it’s not doing it itself?

[Dr. Kara Fitzgerald] : For me, exposure history, you are going to get a lot of information. It can give you an idea. Gosh, a patient of mine, who really had some of the worse allergies I’ve ever encountered. Remember, allergies are a potent clue that there’s a toxic burden present. Grew up, literally, with a super fund river flowing through his back yard. Phenomenally. There was so many different toxins in this river. There were tanneries, leather tanneries around. Just all sorts of stuff in Montana. We needed to do a wide sweep. Incidentally, he had massive amounts of triclosan in his urine. Actually, it was by far, the highest amount I’ve seen. Which came from, not this super fund site. We saw evidence of body burden of PCVs and other chemicals in him for sure. But the triclosan came from those hand sanitizers. I’m just thinking of it now. This guy is a physical therapist by training. He sanitizes his hand after every single solitary patient, and he was using it as a toothpaste. They throw triclosan in toothpaste. It’s horrible. He had off the charts levels just from using a hand sanitizer and toothpaste. Just as an inside folks. Look and see if you’ve got triclosan around. If you do, remove it. Not only is it, will it increase allergies. All sorts of new data are emerging around it with regard to it being an endocrine disrupter. So, messing with out hormones and so forth. We can get triclosan out pretty readily. Anyway, Damien, organ toxins. I would recommend a broad sweep investigation to identify it unless there is a clear cut direction in their history.

[Damien Blenkinsopp] : How would you target these things and remove them. A lot of these things you’re talking about are fat soluble. Is that correct?

[Dr. Kara Fitzgerald] : Let me give you a really neat story. When we were, back at the lab when we started to put together our toxins panels, and we were really flooded in the research. So much data are coming out, every hour of every day, around diseases associated with toxin exposures. You can imagine, as we were developing these panels and we were in the research around them, we became really morose. Very, very, very, very depressed. What do you do? Everybody has PCVs and the half-life is decades and decades. What do we do? The research around detoxification is not yet as strong. It will become, because we have no choice but to face this. We got pretty depressed in the lab, just looking at these day in and day out and day in. Just really how up a creek we all were. How screwed we all were. There’s a light at the end of the tunnel. So these PCVs that are in our bodies that we can’t move out. The fact of the matter is, in fact, we are able to move them somewhat. One of the interesting stories was one of the guys in our lab had developed this farm raised salmon on a bagel habit. Every morning for breakfast, he would have a salmon, lox on a bagel. Every single morning. Its farm raised. Taste delicious. Man is it loaded with PCVs. It really is. So, all of us were experimenting on these panels ourselves because we were developing the assays.

[Damien Blenkinsopp] : Tastes great. I used to love that too.

[Dr. Kara Fitzgerald] : He gave his specimen, and his PCVs were really off the chart. They were so elevated in him. Again, it’s depressing, knowing the half-life. Oh my God, he’s stuck with these. What we did with him, was just put him on a good standard detox protocol. A good detox powder, good greens drink, nice super potent high fidonutrient green drink. A handful of various minerals and some brassica. Lots of those good brassica veggies and so forth. Measured a follow-up, and we absolutely saw reduction in his PVC burden.

[Damien Blenkinsopp] : Great. How long afterwards was the follow-up?

[Dr. Kara Fitzgerald] : It was a month. One month. He was moving it. The other thing, this is also sweating, exercise. Mobilizing fat will liberate PCVs into circulation. That is, if you are losing weight rapidly, and you’re not somehow doing a concurrent detox with that, that will become a problem. That’s why some people can feel awful when they lose weight. It’s also an opportunity for us to detox. In the weight loss process, you want to have care to make sure you are able to detox and that you’re moving those toxins that you’re going liberate from fat into the blood, that you’re moving them out. There are ways that we can do this. There is a small bit, emerging pool of research that suggests that we can move these guys out. There’s a group out of the University of Kentucky here, who have shown in animal studies, primarily, that just this. Combating the effects of PCVs which are very oxidative with essential fatty acids and with different fidonutrients, plant based nutrients. Will reduce the toxicity of the compound. Not only can we help remove them from our bodies but we also, reduce the damage that they cause. Those two ways of approaching it, is effective and it’s powerful, and it puts us back into the driver’s seat. We don’t have to be victims of this inevitable toxic burden that we have.

[Damien Blenkinsopp] : Great. That’s a great point to finish with. We don’t want to think. It’s not a great story to say you can take all these toxins in your body and there’s nothing you can do about them. Thank you so much for giving us that point of hope. Actually, that just that our bodies are naturally able to do this, if we work on the foundations we were talking about earlier. Providing what the body needs. So I just wanted to give you one last, quick fire question that we give everyone. What data metrics do you track for your own body on a routine basis? Is there anything that you follow up with monthly or six monthly, or once a year? That you like to keep an eye on for yourself?

[Dr. Kara Fitzgerald] : This is a whole other topic, and we’ll have to schedule me again. I love the nutrition physical exam. A really easy data metric. I should actually not laugh, but in the winter, I tend to get a little bit of eczema and I can track both how clean my diet is as well as how my nutrient status is. My essential fatty acids and in particular I find gamolenic acid to be well. Some of the physical changes that I can see in the winter, in myself, give me a nice picture of what I need to be doing differently. With regard to my own health, I like using, annually, this battery of testing that I do on my patients. You were talking to be about people coming to me for wellness. You absolutely can do it. I recommend it to my family as well as doing it myself. Let me look at all my nutrients, let me look at my toxins. Let me see how my mitochondria are functioning. Let me look at my amino acids, and so forth. You can cast this wide net, take a look at it, and correct it with dietary changes.

[Damien Blenkinsopp] : Great. Kara, thank you. I can see you are really enthusiastic about this, and it’s been a great conversation and thanks for bringing up so much new information and advice for the audience. Thank you very much for your time.

[Dr. Kara Fitzgerald] : You are welcome, Damien. My pleasure.