SIBO, Histamine, & Mast Cells: Unlock The Link

Introduction and Guest Background 0:00

Hello and welcome back to Reversing Mast Cell Activation Syndrome and Histamine Intolerance Summit. I'm your host, Dr. Meg Mill. And today I'm joined by my esteemed colleague, Dr. Allison Siebecker, who is a SIBO specialist. She is the co-founder and former medical director of the SIBO Center for Digestive Health at NUNM. her integrative approach to SIBO has helped thousands worldwide, and I am so excited to have her join us today to talk about SIBO, its connection to mast cell activation and histamine issues, because this can be a real problem like we've been talking about for so many people.

So I'm can't wait to dive in and give you some great information. Thank you so much for joining us today. Allison, thank you for having me. I'm very happy to be here. Well, I am excited to talk all things SIBO. This is a very important topic. But before we get started, you just give us a little bit of your background and how you became such a SIBO expert. I think it's probably like so many other people you speak with. It's that I had GI problems myself. honestly, since I was like five years old, I wasn't born with problems.

But then I developed them and like so many people, I went to so many doctors and had trouble getting answers. And then I went on, you know, to become a doctor and so and I was still trying to work on my own things. And that's how I discovered about SIBO. And when I applied what I learned, it helped me very, very much. And I knew this was what I was, what I'd been suffering from. And then when I was helped, I just couldn't stop thinking about everybody else who, like, I wanted to raise awareness and get, you know, get help to other people, let doctors know, let other people know so they wouldn't have to suffer needlessly like I have in so many people.

Do you know? Yes. And fortunately, people are becoming more aware. I feel like years ago not many people were talking about SIBO. So we are fortunate. I feel like with so many other things that we're getting more information, but can we just start by getting a little bit into what SIBO is? If there's people out there that haven't heard of this before, we've been talking about it all on the Summit. So I think we're good. We're having some awareness, but I'd love to just go into kind of what exactly it is.

Well, it's really kind of exciting and amazing. In recent years, it's been figured out that it is the main underlying cause of IBS, irritable bowel syndrome, and that can be considered the same thing in many people.

What SIBO Is and Why It Happens 2:37

and what is IBS? What is SIBO? It's a collection of symptoms really, that are very common and common to many other, diseases and conditions, which is abdominal bloating or distension, where the abdomen swells out, or feels like it swells out, but usually it physically swells out. Constipation, diarrhea, or a combination of the two, pain or discomfort. And then there can be other symptoms too, like excessive burping or farting. Nausea. sleep also has symptoms like anxiety, things like that, which you wouldn't necessarily think of an acid reflux.

So, so what it really is, is kind of what its name sounds like. It's when there's too many bacteria that have accumulated in the small intestine, we actually have three subtypes of SIBO. And we know that actually two of those subtypes also include overgrowth in the large intestine. So it's small now. And large intestine. and these are not pathogenic bacteria that would cause an acute gastrointestinal infection like salmonella. that's different. This is normal bacteria that are, that live in our intestines, that are now overgrowing.

And it has been figure it out. exactly. Which are the main culprits for the different subtypes of SIBO now with new research. So that's helpful. Before we didn't know. We thought it was just generally everything was too much. Now we know it's a certain ones are too much and other ones are too low. And so it's just an abnormal situation. We shouldn't be having that. And just, just to sort of wrap it up and sort of really explain what's going on in here is that, there are many diseases, medications, circumstances like trauma or injury that can, that can affect the intestines where it does.

Usually one of two things slows the normal motility of the small intestine. That happens not with food, but not when we're eating. And that's a cleansing wave called the migrating water complex that sweeps bacteria out of the small intestine. And so that's really how most people will get it is some sort of risk factor. Disease or other circumstance slows that small intestine motility in the bacteria can accumulate because they're not being cleaned out or, something to that. And now to me, the structure changes.

that maybe creates a, an obstruction, like a blockage, a partial blockage and bacteria back up behind that. So, things like an adhesion, like if somebody has, a car accident or something in an adhesion forms or surgery and adhesion forms, which is like a scar band, in the intestines in such a way or outside of them, where passage isn't, isn't fully open and then bacteria blocks up behind it. So just just diving right down into what is really going on there. So, so that's that's what it is. It's an overgrowth of bacteria.

It causes the GI symptoms. It's abnormal and it's unfortunately common. and let's just jump into a little bit of the different types of SIBO because I know there's different symptoms depending on what type you have. And so I think sometimes that can be confusing too. And then drilling into what we do differently, sort of what the different types is. That is a complicated question. I'm sorry. No. No problem. So there's three or I guess you could say four, main types, but really three in there based on the gas that the different bugs, secrete.

And so add or make so there's hydrogen methane and hydrogen sulfide and and then there's the fourth would be when you have a mixture of those gases. And so the hydrogen type that one is associated more so with diarrhea and not always but as a general pattern, and that one's called SIBO. And then hydrogen sulfide, that's also called SIBO and that's also associated with diarrhea, at least in studies. I'll come back to this in a minute. And then methane is another gas that's made. This is actually made by microorganisms that are called methanogens or archaea.

So technically we couldn't call it SIBO because the B for bacteria doesn't fit anymore. Now we realize that these are not actually bacteria. So technically that's incorrect. So now it's called IMO instead of SIBO. And that's intestinal antigen overgrowth. and they can also overgrow in the large intestine. And so that is associated with constipation. And just coming back to the hydrogen sulfide one we do find clinically in real life about half of the patients actually have constipation who have that, type of SIBO, even though the studies all show diarrhea.

So sometimes this happens. It's going to take a little while to figure out why we're seeing that difference. and then when you have a mixture, particularly if you have hydrogen, which is often associated with diarrhea, methane is often associated with constipation. If you have both of those of bacteria overgrown or k overgrown, then you'll see both. And so this would be like IBS mixed or we can call it SIBO mixed. where you have a combination of both diarrhea and constipation. So those are the types.

And as to what we do differently, one thing I can say is test

SIBO Types and Gas Patterns 7:38

interpretation is different for the different gases. You do need to know they have different patterns and then we treat them differently. And that is the key most important thing. Now probably some of the most crucial missing information for people who might not know a lot about SIBO is that, we have three main treatment types that are antibacterial in nature, and two of them we need to know the gas to to actually pick basically pharmaceutical or herbal antibiotics. many people are familiar with, you know, with certain infections, you need certain medicines and that is the same with SIBO, because there are different bacteria or bugs or archaea grown, overgrown in each of these types.

Okay. And, you know, and that can be confusing, I think, for people because when you're a you're not that's not always well explained. I feel like people just will lump everything together, not really. Take that time to differentiate and say, okay, the treatment needs to be based on whatever type you have and really focus there. I also see a lot of people start to feel better and then relapse, so they'll be put on an antibiotic, let's say if it's the conventional root or some herbal, if you know some things and then they come back and they it's sort of this occurring event for people.

Do you want to talk a little bit to kind of about why that happens? Absolutely. I mean, the studies show two thirds of people who have SIBO will relapse. And the reason why it's not because the treatment was unsuccessful or isn't good enough, it's because there's an underlying cause that is still present, and that is the way to truly cure SIBO, so to speak. when it's possible is to identify what, you know, disease or what situation occurred to allow the SIBO to happen in the first place. The problem is, is that many of the diseases will just say, are circumstances that cause SIBO have no known cure.

And so this is another reason why many of them are, people are chronic because we don't know how to remove the situation that is causing it. So, you know, one easy example, it's, it's not common, but would be like scleroderma or, systemic sclerosis is a progressive autoimmune disease that basically scars the intestinal tract, over time. And there is currently no known cure. I mean, people are working on that all the time. There's treatment and management. Actually. I've seen many of those patients.

They do very well. But just to exemplify the point, that person will continue to have to face the circumstance of Sibo because of what's occurring to their GI tract. And then just another example would be probably the most common cause of Sibo, which is food poisoning or stomach flu or traveler's diarrhea. goes by different names, but this can in some people stimulate an autoimmune, reaction where then there's damage to the nerve cells in the small intestine that slows that movement. And there is no known cure for that at this time, although people are working vigorously on that.

And I think we'll have a cure pretty soon. Yeah. So that's the reason for the main for why people relapse. One other thing I'd like to say is that part of our treatment, we know since we know this, we know that the majority of cases will be chronic and relapse. is that kind of relapse management and something that many don't know about is that we use agents called Pro kinetics, which stimulate that migrating motor complex. They can be herbal or pharmaceutical. and that helps to sustain a remission.

And so that's another reason why some people may, relapse too soon. I mean, they're probably going to relapse at some point if they have a chronic underlying cause that they can't get rid of. But, pro kinetics are missing. And a lot of people treatment that really helps us sustain our remissions. We have a that's important piece to now. And so let's just jump into a little bit with the mast cells. So the connection we can see Sibo as an underlying trigger. You know we've been talking in the summer about underlying triggers and getting to the root cause and what's causing this immune activation.

And why are your mast cells mad and and releasing histamine all the time and all the other, mediators. So I know there is a connection with Sibo. It's fascinating. I was telling I was just reminding myself of all of the, you know, the theories of how they're connected. But it's it's very interesting because it's bidirectional. So Sibo can trigger mass and histamine,

Why SIBO Relapses and the Role of Prokinetics 12:14

and mix is thought to be able to trigger Sibo. So it's this bidirectional thing. But coming first to the Sibo piece, we know that one of the main triggers for among the many triggers for MCs is infection. And while most Sibo is not technically, it doesn't meet all the criteria. It's not technically, the definition for infection. It's we can think of it like an infection or I mean, it's an overgrowth of too many bacteria there, and that upsets our immune system. and it's inflammatory. And, and here's where we stimulate mast cells to release their mediators, histamine and and others.

and so, you know, if you have that going on all the time, you have an ongoing trigger for Maslow's to be angry. Right? And do granulation, release all, all the things that they do. Then once they release their mediators, histamine and others, they can stimulate lymphocytes, like T lymphocytes and inflammatory cytokines. Then that stimulates inflammation and mast cells again. And that's a vicious cycle. So, it's it's no wonder that so many people with the Sibo have histamine issues and or MCUs. Yes. And, and I think that's what we see a lot of times in some of these cycles and breaking this, getting in there and breaking the cycle because we're seeing like you're saying it, it just potentiate each other and then you're in this place, especially when you don't even know or have the awareness that it's going on.

Because a lot of times we're looking at treating the symptoms, not getting to the root, and then we're not able to start stop breaking that cycle. So even if you're trying to dampen the symptoms, you have that going on under, not underneath. It's so true. Yeah. Yeah. And then what about how MK could maybe stimulate Sibo? I mean this is something I don't know how many people talk about. We mostly have theories from Doctor Weinstock who's written papers with Doctor Afrin and many other, you know, greats in the field.

Doctor Weinstock Sasebo specialist. And he was really seeing a lot of connection here. And so he he sort of theorizes that a couple things could happen, that, there could be the mast cell, that histamine and the mediators could be altering motility, slowing that migrating motor complex, potentially even damaging the nerve cells. Like how in the, food poisoning situation, although not as an autoimmune, just as a damage to the nerve cells, potentially. This is just a theory and that slows the motility.

another idea is that it could be affecting just generally the immune system. obviously we know muscles are part of that, but, so that there's a deficiency where we're not able to fight in the same way we would this overgrowth. And then lastly that, it could be related through, it's association, association with parts and even Ehlers-Danlos. I would imagine you all are talking about that triad that can exist so often. And, he thinks that MCUs could potentially lead to parts. And then the sustained sympathetic activity in parts could affect motility slowing it, and, and then allow Sibo to occur.

And when there's Ehlers-Danlos, Ehlers-Danlos present at the same time, the lacks, laxity in tone of the various like basically loops of intestines. There can be problems with motility in those, and they almost could act like little blind loops, areas where bacteria can accumulate, where the normal like sweeping motions and even killing secretions that our body would put into the intestines can't reach very well. So, so we have we have quite a lot of connections here, not proven. I think it's Oh, and one other thing going, sorry.

Going back to how, Sibo can, can cause issues with histamine. this I think is a lot more well-established, because it's so obvious, you know, when you have an overgrowth of bacteria that you could be stimulating mast cells. But one thing I didn't mention is that Sibo, the bacteria can cause damage to the lining of the small intestine. And actually, it's it's well documented that, there's decreases in enzymes that sit along the lining. And one of those enzymes can be Dao, which breaks down histamine in our food.

And so if we if we have less of the Dao enzyme, we can be overwhelmed, with histamine in our body.

SIBO, Mast Cells, and Histamine Connections 16:48

So that's another way that, people can be having at least histamine reactions. Maybe not full on and cast from Sibo. Yes. Yeah. And I think we were talking I was telling you, I've seen individual bacteria that are histamine producing and the, you know, things like Morgan Le or Klebsiella or things that when we actually evaluate that and do treatment to kill off those bacteria, these issues just change dramatically. And so it is it's such an interesting concept that people maybe not even thinking about that.

You're back. Teria is producing histamine even even if you're not sometimes too nice. Do you know what I just forgot? There's new, to mention. There's new research that came out, just within the last year, showing that at least in the hydrogen type of Sibo, they found that there's various genes that are upregulated and, that are very inflammatory, and one of them is a is linked with histamine secretion. So, so histamine secretion genes are actually upregulated in the hydrogen type of Sibo. So such a good point because also one of the bacteria that's found to be the most overgrown in hydrogen Sibo is Klebsiella, which you just mentioned as a major histamine producer.

So not only do we have, you know, a bacteria that's a major histamine producer, but we have genes up regulating it. So it's a conundrum. Yes, it is. So that's a good way to put it. And it's something that, you know, we have to really focus on. And but there is hope. And that's what we're trying to to say that you know, you can look into this and get hope. And there's so many things we can do. So let's move into that. Now. Let's talk about some treatments. First of all, before we go into the different types of Sibo and the different treatments, where do you start to optimize the migrating motor complex?

Because, you know, you're saying that can be at the root of all of this and sometimes I think that might be a new concept for a lot of people. The main thing that we know to do that helps it, there's two things. One is to not snack between meals, and that would include, calorie containing beverages and and even non calorie non-nutritive artificial sweeteners is we're not so sure about that one. I think it might be okay. But basically calories make it seem that food has come in to the body and then the migrating motor complex turns off.

So if you just leave stretches of time between meals where you're, you know, only having water or seltzer or something like that, it allows it to happen. and the recommended amount of time optimally would be 4 to 5 hours. Now, some people can't do that and they have blood sugar issues. They need to eat more often. And so what I always say is just go as long as you can. And it makes sense for your individual circumstance, you know, stretching it as long as makes sense. You know, three hours used to be the recommendation and we realized four and even five hours is better.

So that's one thing. the second thing is, pro kinetics, they, they help stimulate the migrating motor complex because so many people have damage to it from diseases or circumstances that they can't really do much about that. Of course, work on whatever other concomitant illnesses you have. Work on those, like, just as an example, hypothyroid. we know that hypothyroid, there's slow motility. We know that it slows the migrating motor complex as well as like large intestine bowel movements. And there's constant tends to be constipation.

So, you know, make sure that your thyroid levels are in the optimal level with treatment, things like that. but putting that aside we we use Pro Kinetics to help stimulate it. Most people have the ability to make some migrating motor complex waves even if there's damage. so these just help you know they help it. Yes. Okay. That's yeah that's important. And I love how you brought in because we're so connected you know bringing in the thyroid. What else is going on that's causing that. And kind of looking at that whole picture is important too.

So then when you're so let's go into a little bit of the specific in the different ways you would approach treatment with the different types of Sibo. Well, generally, we, we, we hit Sibo with killing agents with Antibacterials. We're trying to bring that overgrowth down. we can certainly work on symptoms, you know, whenever we need to, whatever the individual symptoms are. But we're trying to go a level deeper, bring that overgrowth down. Just always remember there's the deepest level, which is the underlying cause, you know, is it diabetes, hypothyroid.

You know, scleroderma, as I mentioned, food poisoning. What can we do? But putting that aside, the antibacterials, we have three main options. We have pharmaceutical antibiotics, herbal antibiotics and elemental diet, which is basically a medical food beverage. and let me just start with that one, that, that is basically whatever nutrients and vitamins and minerals we would need put into, like a shake that we mixed with water, a powder that we mix with water. And the idea behind this is to, feed the person that we're treating, but, starve the bacteria and how this happens as it absorbs so quickly into someone's body that the bacteria don't really have a chance to eat it, because that's what they're doing.

They're eating our carbohydrates mostly, and turning them into gas. And when they eat, it sustains their life. So we're trying to starve them. this is a very successful method. it's a little difficult for people to do because you're not consuming regular food. You're only having this this beverage. and it's a two week force. So, you know, you have to have your mindset ready for that. but the advantage here that the two and wonderful advantages is that it treats all three types of Sibo, no matter what gas you have, what type it will work, or can work.

And the other thing is that it has the ability to bring gas levels down more in one two week course than the other two treatments. So the typical amount we see, we we expect to see

Supporting the Migrating Motor Complex 22:58

is about a 70 part per million, part per million. The gas measurement, the hydrogen methane or hydrogen sulfide, 70 part per million for hydrogen or methane. So that's incredible. Whereas for pharmaceutical or herbal antibiotics, we expect about a 30 part per million drop in one treatment round. So these are the advantages to elemental type. Why someone would want to take that challenge on. Now. the other two let's start with pharmaceutical antibiotics. the main antibiotic we use is rifaximin. It's sold in the US as I and and it's very special because it only really works in the small intestine primarily, which is wonderful.

And it doesn't absorb into the body. And it it isn't really a typical antibiotic in that it doesn't do damage. especially to the microbiome. Studies have shown that it actually increases lactobacillus before this fecal bacterium and others. so many people call it a U biotic or, an antibiotic with good properties. Basically, it is very unusual. it's it's different than a normal antibiotic. So that's helpful for people who are worried about antibiotics that is used with all of our types of Sibo. And then we add in usually a second antibiotic that will address either the hydrogen sulfide or, methane bugs that are overgrown.

So for methane we would add neomycin or metronidazole, which is a metronidazole also called natural for hydrogen sulfide. We either add bismuth. We can actually use a linea which is not as oxidized. Also for methane and even for hydrogen sulfide. We've been using that as well. But primarily bismuth is the main thing we use for hydrogen sulfide for and that's is that really pharmaceuticals kind of in between you know, so for, for herbal. So let's switch over there. Similar to Rifaximin, we have three main herbs that we know that work on hydrogen producers.

Oregano, berberine which is a constituent in herbs like golden seal or organic grape, and neem. So we'll choose one of those for the hydrogen. And similarly we will add something in for the methane or hydrogen sulfide. So for the antigens we add in Allison, which is sold as the ones that we tested that we used in our before and after test was Ali Ali Ali Med. It's also sold as Ali Max Pro or until. And for hydrogen sulfide again we're mainly using bismuth or. We also know that high dose oregano works.

So a higher dose than what we would just normally use for hydrogen will work for hydrogen sulfide. So there are there are some other things. You know, we are always experimenting. There's always, you know, others on the periphery. But what I'm telling you are the core things that we use day in, day out that we have hundreds and hundreds of before and after tests where we would test

Treatment Options for Different SIBO Types 25:48

someone Sibo, give them these treatments, test them after, and see that it worked. So these are our workhorses. So those are our main treatments. That's a great. And so what would be also like just to give someone an expectation. Because I know sometimes like treatment can be a little bit longer than, than expected. Sometimes when we're talking about like the round of antibiotics that someone just would expect and get better. So there is an expectation of, okay, you have this as a journey. Very, very good point.

I didn't clarify that. Pharmaceutical antibiotics, one treatment round is usually two weeks. Sometimes we'll stretch it to three. herbals is four weeks, sometimes we'll stretch it to six. Depends on how high the gas levels are. And same with elemental diet. It's two weeks. Sometimes we'll stretch it to three weeks. If someone's willing. Yeah. because it's a bit harder. So, what we see very often in Sibo is people need more than one of these treatment rounds, as you were mentioning. And this just mostly has to do with how high the gas level is.

I think most people come to it with the idea of a typical acute infection where you take an antibiotic for maybe seven days, ten days, maybe two weeks, and it's all gone. and that that isn't the case for Sibo there. There are some people that will only need one treatment round and we call them one and done. And it's great, but most people are time and fine, so they need a little more time. So I'd say 2 to 4 treatment rounds is the average that we tend to see. some people will need more even. But that's usually in the three treatment rounds.

will work from many people, and it's just because of how high the gas is. There's, as I mentioned, 30 parts per billion is what we expect for herbs and pharmaceutical antibiotics, 70 for elemental diet. But for most people are usually using herbs or pharmaceuticals. So if you had, let's just say you had 100 parts per million gas. And so you take one round that brings you down to 70, you see. And so and we need to get down to below 20 for hydrogen below ten or sometimes even below three for methane.

So it just takes some time. you know, people say, well, can you just stay on it? And why do you get why do you stop the round? Why don't you just keep going? Well, of course we tried that. We sure. That seems to make sense, except it didn't work. it works in some people. Some people? Yes, that works great. But what happens for a majority is the the effect peters out. And in fact, their symptoms will start coming back or getting worse, showing us it's like they develop resistance to it. And it's only there's only so much it can do.

And so then we stop and then we move to something else. Luckily we have all these choices. And that's another key thing about treatment is switching around amongst these three different treatment types. Or if you are just staying in one, like let's just say you're doing pharmaceuticals rifaximin in, you know, mice and then rifaximin and metronidazole switch switch around because the effect peters out. Those are that's a great point. Yes. And another thing I'd love to get your opinion on is the fad the low Fodmap diet.

Because I've, you know, there's so many different opinions. Whether the low Fodmap is I know it symptomatically helps people feel better during that. But if that's an essential piece in the way you treat SIBO of having those low five months while you're doing the treatment, or whether you feel like that's just more for symptoms, well, while they're to feel better, basically while you're getting the antimicrobials in. I mean, I guess ultimately we don't have like an answer from studies, you know, on a huge group of people.

I do feel that ultimately it is about symptom management because, it takes time, these treatment rounds. So it's helpful to have something in there. I think diet is really probably the best symptomatic treatment option we have. Reducing the carbs, the food that the bacteria is then going to make the gas out of the gas is what causes the symptoms. So, when you're doing treatment, there is a difference of opinion. like Doctor Pimentel thinks it's a good idea not to be on a low carbohydrate diet. And, you know, we have low Fodmap diet is like one of like seven key SIBO diets we have.

So that's just an example of a SIBO diet. We have SIBO specific food guide. And that's something I put together. We've got SIBO biphasic diet which is my diet put into phases. We've got specific carbohydrate diet. we've got Doctor Pimentel's, low ferment, low fermentation, eating used to be called Cedars-Sinai diet.

Diet Strategies and Managing Chronic SIBO 30:18

we've also got fast track diet. So these are like our core, you know, SIBO diets. Well, Doctor Pimentel, suggests that at least when you're doing pharmaceutical antibiotics, probably this could apply to herbals. not to be too low carb because he's worried that the bacteria will go into a hibernation mode. and that that's based on very good, theory about bacteria going into hibernation. But I can tell you in practice, we had great success treating people even with pharmaceuticals while they were on very low carb diets.

So I think in, in practice that we don't need to do that. You can still be on a low carb diet and get a good success. so that's one thing I'd want to mention, but you don't. So you. So it could be either you could you could do it during you could not not do it during. I think the real way to think about it is how much suffering are you experiencing, you know, do you need to get in there with a diet to help before while you're waiting for the antibacterial to work? if you don't mind waiting, then you can start a diet after because at this point it should be able to be more, broad or expanded because now the bacteria are lower.

So there's an advantage to any way you do it, which is very confusing for both patients and practitioners, because we all want to just know the way right. But it's what it is, is a tool. And so you customize the use of the tool to the job. So yes, I love that. I know there's not just one way, right. There's yeah, I mean, what I, what I can definitely say about it is that in in folks who have chronic SIBO, which is a lot, a lot of people meaning they will deal with relapses and they have an underlying cause.

Those underlying causes generate gastrointestinal symptoms of their own, even if the SIBO is fully in remission at the time. And these diets can help with that. so many people need to do these diets ongoing who have chronic SIBO to make their life, you know, feel great, meaning where they pretty much have no symptoms and the diets don't need to be super restricted at those times. But some amount of modification of carbohydrates for many people really keeps them living a happy life who have chronic, stable. Yes.

Well thank you. Thank you so much. You've given us such great information. I think this is so actionable for people to really understand the

Closing Remarks and Resources 32:48

the connections with mast cell and what to do if you're in this boat, because a lot of people are, and even people maybe that don't even know they are. You know, we we've heard so much about IBS and and I like what you said earlier that some of those symptoms that you are feeling with IBS, they may actually be SIBO and just not know that you actually have that bacterial overgrowth. And I think that's a lot of people. So I appreciate all the information that you've shared. And let can you let everyone know where they can find more information about you?

Yeah, I have a free educational website. It's called Siboinfo.com. Great. Well, thank you so much for being here with us today. Thanks for having me. Absolutely. Have a great day everyone.