What Most Doctors Miss About Keto for Autism and PANS

Intro and guest background 0:00

And what's the difference between a clean keto and a dirty keto? I love that you had that question. I'm fascinated to hear about that. Yeah. So dirty Keto is basically a carnivore diet. It's all animal fat and that is these people and it's generally the bodybuilders and those kinds of things that are trying to do this. And it's just not healthy for you. A clean ketogenic diet is a diet that really truly calculates and really pays attention to the medium-chain fats and to protein and carbohydrate count against the fat.

So a clean, ketogenetic diet is a much healthier approach. Dirty is basically just, and they don't calculate, most of the time they're really not in ketosis. Welcome to Demystifying Pans and Pandas, the podcast where we uncover the mysteries, breakthroughs and hope behind these life-altering conditions. I'm Dr. Nancy O'Hara, a board certified pediatrician, educator and advocate with over three decades of experience helping children and families navigate the challenges of neurodevelopmental and neuropsychiatric conditions, especially PANS and PANDAS.

These disorders can feel overwhelming, but here we'll break down the science, explore transformative treatments, and share stories of resilience and recovery. If you've ever wondered what's possible for your child or how to find answers, this is the place to start. Let's dive in. Hi, everybody. It's Dr. Nancy O'Hara and welcome back to Demystifying Pan's Pandas. And I can't tell you how excited I am to welcome Dr Julie Buckley to the podcast. I have known Julie for decades. and she is an amazing clinician, an Amazing Mom, and really an expert on many things that I've asked her to talk about today.

She's a graduate of the University of Miami School of Medicine, Jackson Memorial Hospital, University Miami Pediatric Residency Program. she developed an abiding interest in autism spectrum disorders when her daughter regressed into autism at age four. And she developed a special interest in breast cancer when she developed it herself in 2009. And those illnesses led her to functional medicine, to re-cause medicine. She was one of the first pediatricians in 2016 to successfully complete the full certification process.

So she uses an integrative functional medicine approach to both diseases and everything else that she does, and has had tremendous success. And as a result of these successes, her approach has been implemented into a very unique and diverse practice in Punta Vedra Beach, Florida, where she cares for children of all ages, because we don't like adults, but you know. And she's also authored several books. Back in 2009, Healing Our Autistic Children. In 2014, Breast Cancers Start Here. And in 2016, this one I didn't even know about, Youth Sports Start here.

But she is an international speaker on autism and related disorders. She's mentored many physicians, she's developed patented antioxidant formulas, and also employs many individuals with autism at her online Healthy You store. She also founded Healthy U Now Foundation, which is a 501c3 nonprofit dedicated to creating healthy living, educational, vocational, therapeutic residential facilities for individuals and their families that are impacted by autism. And that facility will be located on a 20-acre campus in St.

Augustine, integrating with the local community. So there are so many wonderful things, but she's also a scuba diver, a wonderful cook, crocheter, and loves to sail and to read.

Clean vs dirty keto explained 4:08

And Julie, I could probably spend the whole hour we have together just singing your praises and all of that, But I so appreciate you being here. It's wonderful to be here, And one of the things that I got asked about to talk about on this podcast, and of course I thought of you, was the ketogenic diet. And I know you and Martha Herbert together wrote a wonderful article, a case study, but I didn't realize it was 13 years ago. It was a long time ago 2013. So you have been doing this long before that.

Talk about it, talk the role of it. So, I developed the interest in the ketogenic diet when my daughter developed seizures as she went through puberty. And that was the beginning. Then I develop breast cancer and I had to hold off on trying to get my daughter's ketogenic diet started. One of the things that is deeply intriguing to me is that if you choose to do a ketogenetic diet dairy-free, you are obliged to use the healthy fats, the plant fats the coconut oil, and the nut fats and those are much, much more ketagenic.

than animal fat is. And if you choose to do it dairy free, you don't have to use as high a ratio and do as much fat as if all you use dairy and you used animal fats. Interesting. It is easier to continue to nourish your children with all the phytonutrients that they need if you do it dairy free. And that is the basis on which I started my daughter on a ketogenic diet. What's interesting is with a Ketogenic Diet, what you have is a ratio of fat to the ratio of protein plus carbohydrate. And neurologists are accustomed to you using a four to one ratio.

When you do it with animal fats and with dairy. Interestingly, my daughter has never had to be on a ratio higher than 1.5 to 1, Wow. So because we do it dairy free. Yeah. She's so proud because she calculates almost everything by herself now. Almost 28 years old. And so she calculate everything almost on her own. I just double check once in a while. But she loves when the organic nectarines come in season. And she'll eat three or four nectarines with her meal. And, you know, she's ecstatic. She's Ecstatic and she eats, You know a lot of tomatoes and cucumbers with Her meals and She gets to do a Lot of that because we do it dairy free.

That's amazing. And in your article, in Your Child, you were gluten free, casein free as many of our children with autism should be.

How a dairy-free ketogenic diet works 7:50

In my opinion, the world should, but that's another side, especially in this country. But I think it's fascinating that that ratio is so different when your ketogenic diet then comes in and continues to be dairy free. Yes. It just allows for a real diversity of consumption of vegetables and fruits. And it is, you know, my daughter will say to me, it's not worth consuming rice because I only get a tablespoon. it's just not worth it. But to get hundreds of grams of tomatoes or cucumbers and that kind of stuff, she's ecstatic.

Right. Because most people that think about, like you said, the neurologists that do and do the ketogenic diet are doing bacon and animal fat and dairy and it is all protein and oils and there is barely vegetables and certainly not fruits in that. And you're saying the way you do it with her and with other patients, I'm sure. Yes. Is much more amenable. Yeah. Now, do you measure ketones in her or in children that you are starting out with? I just smell her. I just smell her. I get up close to her and smell.

And you can smell the ketosis. It smells like a hangover, or it smells a diabetic who's not well-managed. So I'll just get in her face and I smell and know she's in ketoses. Okay. Now I know a lot of people who have talked about a ketogenic diet, the typical ways, talk about the rise that can happen in cholesterol levels. Yeah. Can you talk about that? Yeah, so that does not happen when you're using these medium-chain fats and the healthy fats. You know, we studied that case report that Martha and I did together, and there was no rise in cholesterol.

It was zero. And if you pursue the medium chain fats, then they are much more ketogenic and they will freely diffuse into the mitochondria. They do not need a transport system. So you don't need CoQ10, you do need carnitine, all of those iron and all the transport molecules to get those healthy fats into the cell. So they just go straight into this cell and they are used and create ATP very, very quickly. There's absolutely no rise in cholesterol when you're using all medium chain fats. Wow. And she gets a little bit of short, you know, long-chain fatty ass.

She's very proud that she doesn't want to give up meat, but she eats chicken, she eat some beef, She'll eat steak once in a while. she she does not choose pork very often, and she do not chose fish very. Often she will eat shrimp and loves that. So she'll calculate meals that have those things in them. Huh. And we've learned to go out to restaurants and she just takes her butter and it's a plant butter, plant-based butter. And she takes this stuff that she calls liquid crack. It's, it a chocolate cashew whipped cream that I invented for her.

She loves it and its made with cashews and a lot of coconut oil. Its like a choclate mousse. Wow, and what chocolate source? Are you using dark chocolate? Yeah, sometimes we use carob and sometimes, we just use dark cocoa. Yeah. Wow. And talk about more of the sources of medium-chain fats, the medium chain triglycerides. Talk a little bit more for people what those are, what the source are etc. Yeah, so there is, believe it or not, there's a lot of fat in vegetables. And so vegetables are a source of medium chain fatty acids.

Nuts are source a medium-chain fatty acid. Seeds, and I know seed oils have gotten a bad rap in the recent past, but seeds and sunflower seeds, all those are medium chained fats. Coconut oil is a medium chain fat. Tree nuts and coconut is tree nut by definition. So all of the tree nuts are medium-chain fats. The legumes, peanuts, and those kinds of things are media chain fats, so And all of the plant-based butters that we use when we're dairy-free are medium-chain fats. So it's really easy to do this diet dairy free.

It really is. And it has been so beneficial to her. Her brain works better. She doesn't seize. Nearly, she developed seizures when she went through puberty. And I will own the fact that it is because I didn't nourish her nearly as well as I needed to. So it's very difficult to prove prevention. But if you pursue that, I always tell people I want them to strive for a whole 30 diet and to do it 365 days a year. And when I say strive, it's because when kids are in elementary school, you're going to have to send them with some kind of a sandwich to school when you pack the lunch.

So they're gonna get a little bit of bread. When our kids go out in public and they are eating something, they will get processed french fry. You know, it is worth striving to do. So is it the medium chain fats that you felt at that time? I mean, you know all of us as moms are shoulda, coulda woulda and you, know there's nothing you should have, should've, would've done that I, mean you did better than anybody. Is it medium-chain fats, that your saying that that you think preventively would have made a difference?

Okay. Yes. Because, again, those medium-chain fatty acids do not require a transport mechanism to get inside the mitochondria and do their work of producing the energy that runs our cells, the gasoline that run our cell that we call ATP. A lot of times we have dysfunction in our kids with autism along the mitochondrial transport chain and they just have defects. So if you have a medium chain fat that will freely go in and will produce ATP very easily, I think it's important to understand that there are more mitochondria.

Medium-chain fats, ketosis, and mitochondria 15:30

We always think of mitochondrion as being muscular, and we think, you know, there's mitochondry in our muscles. And in fact, they're more of a mitochondrial in each brain cell and each eye cell than there is in any of the other cell types in the body. And so anything that you do for mitochondria, you're doing for the brain and you are doing it for your eyes. Well, that's kind of critical. That's really important. So, so I have the medium chain fats are critically important and like I said, there's so much more ketogenic because they produce that ATP lickety split that you don't have to do that really high ratio of fat to protein plus carbs.

Right. And just thinking about our kids with autism, you know, certainly 85% of them have mitochondrial dysfunction, but also in our Kids with Pans Pandas, they have Mitochondrial Dysfunction. I mean, the mitochondria are just so sensitive to any triggers, infectious, metabolic, toxic, whatever it is. But so much of the time when we think about things like carnitine, CoQ10, for our kid that are already agitated or anxious or ticky, or OC, those things only increase that. So if we could really focus on the diet piece, whether it's fully ketogenic or not, but just these medium chain fats, that's going to feed that mitochondria and help that underlying dysfunction or sensitivity in all those kids, right?

Yeah. And what's intriguing to me, and I really don't have an explanation for it is that I have found if we give kids MCT oil or coconut oil, or we get a couple tablespoons in a day, They always, always are more willing to diversify their diet within a couple of weeks. Interesting. I don't have an explanation for it. Wow, I wonder if it's changing their palate or if its just allowing their mitochondria to wake up a little bit and be interesting. So not just coconut oil and the legumes and nuts and seeds and everything, you're using MCT oil itself also?

Yeah, sometimes they use MCT oil, but some kids will resist drinking it. My daughter prefers to have her plant-based butter and she will eat that all day long and then she'll eat her chocolate cashew whipped cream all-day long. And so she chooses those two sources of her medium-chain fatty acids. Okay. And I know I've been asked a question about ghee, so I'm going to ask you. On a dairy-free ketogenic diet, would you use ghee? Does it depend on the child? Well, it has to be casein- free and a lot.

A lot of the ghee that is prepared at home or the Indian ghee's that you can buy are truly not casein-free. In Florida, we get Organic Valley, and I know that that's caseine- free. And the reason I now it is, my son is horribly allergic to dairy. And he does not get a stomach upset when he uses ghee from Organic Valley. So that's the only one I really trust. Interesting. And how about the plant-based butter? Are you making that or are you buying that? We buy. We we buy an organic. It's either Smart Balance or Earth Balance.

Okay. And what's the difference between a clean keto and a dirty keto? I love that you had that question. I'm fascinated to hear about that. Yeah. So dirty Keto is basically a carnivore diet. It's all animal fat. And these people, and it's generally the bodybuilders and those kinds of things that are trying to do this. It is just not healthy for you. A clean ketogenic diet is a diet that really truly calculates and really pays attention to the medium-chain fats and to protein and carbohydrate count.

against the fat. So a clean ketogenic diet is a much healthier approach. Dirty is basically just, and they don't calculate, most of the time they're really not in ketosis. Right. And I've seen those people with elevations of cholesterol for sure. Absolutely. Can a vegetarian with the way you're doing it in a clean keto, could a vegan do a Clean Keto? Have you ever done that? You can. Okay. It is a lot, a LOT of vegetables. And what happens with the ketogenic diet is you're really not hungry. So it's very hard to chew long enough to, to eat all the vegetables that you really have to to get your protein and to.

Your, uh, and, get, your carbohydrate counts in. Wow. Okay. So I really can't get enough because you don't have enough hunger incentive really. Yeah. It's hard, but you could do it, But it's so, you know, I encourage people to, if you want to do a vegetarian, let's try to eat some eggs or maybe eat fish. And that way, we don' have to replace the B12 either. Yeah. And I know you've talked about the mitochondria, and we all know that the ketogenic diet, whether it's clean or dirty, you know, is recommended by some neurologists for seizure disorders.

But talk a little bit more specifically about how it helps with autism, So, well, it's interesting. So from a seizure standpoint, dropping the history of the ketogenic diet is that people would drop their children or their adults off at the monastery back in the old days and the monks would just starve them and they would draw into ketosis. And then their seizures got better. And so that was the beginning of this ketogenic approach. Of course, then once you're starving, you really not hungry because you are in ketosis.

The GAPS diet, which worked so well with many of our children, drops kids into ketoses in the first few days. So when you see your children improving, It's because they're in ketosis. That's just seizure approach. But with autism, it is probably based in the mitochondria and the improved mitochondrial function in your brain.

Ketogenic diet for autism and PANS/PANDAS 23:30

And so kids can motor plan a little more easily when they've got better functioning brains. You know, getting the inflammation out, a ketogenic diet is incredibly anti-inflammatory. Right. And because it has no sugar, it had no carbohydrates to speak of. Or processed food. Yeah. So it is really an excellent, excellent approach. for autism. And then from a Pan's Panther standpoint, it was interesting. I probed into the research a little bit and there's a summary paper that was published last year.

that referenced several articles. And of course, when you start a ketogenic diet, you absolutely change your bowel flora. There's no question. So that is going to improve immunocompetence just because you change you bowel form. There's also research that it helps the natural killer cells. It helps B cells, it help B Cells. So globally, from an immunologic standpoint, It restores some immune competence. And that's what we're all about with Pan's Pandas. Exactly. And the more we can do it with diet and healthy gut, healthy brain, leaky gut leakey brain.

But the More we Can Do It with Diet, the less supplements, The less medications, less rage, aggression, anxiety, ticks, OCD, all the things we talk about that are caused by the inflammation. And I just wondered for the listeners that don't know what it is, the GAPS diet is the gut and psychology syndrome diet that was first written about by Natasha Campbell McBride and was just that, a very good anti-inflammatory diet, that had a lot, as you said, in conjunction with other paleo, autoimmune, and ketogenic type diets.

Yeah, absolutely. Yeah. So the older I get, the more I want everybody to really think about what we're putting in our mouths, whether we have epilepsy, autism, pants pandas, or we are as not neurotypical as you and I are. Yeah. And it's just fantastic for an autoimmune disease as well. So, you know, it was very interesting. Years and years ago, we all got the opportunity to go teach in Australia and those people are rabid about food. They're really, really good about what they eat. And I will never forget watching a child eat steamed cabbage for breakfast.

And when I went back the next year, those kids were so much more improved than my United States kids who, you know, a year later, they were just not quite as improved. And I will attribute it to eating right and making sure that they're eating, right. They just don't have a lot of McDonald's or fast food. In Australia, you sit down and you eat and eat properly and a regular meal with a fork and knife. And their children do that. They never eat with their hands in the car. If we committed as Americans to not eating in the car, to sitting down and eating a meal with each other, I think that we would do a much better job of recovering our kids because we could cook.

And I look at my young moms and I say, do you know how to cook? Yeah. Now, thank God I live in the South and most people have been taught to cook by their moms or the grandmas. And, you know, my mother looked at me and said, it's not that they don't know how to make a gluten-free gravy. They don't know how to make a gravy at all. They do not know to cook a gravey. And I've got to teach them that first. Yeah, it's so fascinating. If you look at the really good food pyramids, at bottom are the people smiling, dancing, socializing, eating with joy.

Yeah. And so much of the time we talk about restrictive diets and pulling things out of diets. Oh, we had an infraction and feeling guilty about that. If we could also change our mindset to the joy of eating and food and cooking. You know, a lot of our kids' palates expand when they start cooking. Yes, I have an example. I had a young man who I said, you're going to make the guacamole today. We were going watch a football game together. And he goes, but I don't like avocados. and I say, But you are making the Guacamoli today and he made the Gwacamol in my little Vitamix blender and taught him how to do it.

And he ate the chips with the guacamole and he goes, I really like guacamole. Yeah, you made it. Right. And it's the same thing with whether you live in New York City or on a farm, getting in the dirt, having a few vegetables that you may be growing, or maybe just some basil or tomato or whatever, and participating in what goes into our mouth, whatever kind of diet we're talking about, so important. I think it's critically important to get kids into the kitchen. And even if they make you crazy, they need to be in the k Yep.

Yep, and there are so many, the littlest kids, you know, our artistic children, are kids that are raging, there things they can do. Absolutely. So great. My mom had 17 people in her 10 by 12 kitchen and at Thanksgiving and Christmas and we all had a job. Yeah. You know, everybody had a job, and my uncle would sit there and he would be backed up against the wall, he'd be playing his guitar, we would all be singing. It was just a joy-filled moment and we all were preparing food for the purposes of nourishing each other.

Yeah. So, so a little bit more with PANS, PANDAS and autism. You and I were talking earlier about some of the other things you do in your practice, which is an amazing practice. But, but one of them you mentioned that is, has been really helpful to a lot of your kids was peptides. And I would like you to talk a bit about that too, because we haven't talked about it much on this podcast. I think our listeners are interested in it and, and you're using it.

Food, family, and teaching kids to cook 31:20

Yeah, so this year I decided that we were going to branch out and we we're really going start trying to break into and learn about peptides. And peptide are the Peptides already exist in our human body. Insulin is a peptide. Glutathione is peptides. There are peptids that they all exist already in your bodies. Right. And many of them are widely used across the world. A division that shall not be named has decided that many of the peptides that were approved for use in the United States without following the normal protocol just crossed them off the list.

And so peptide have become a kind of a gray area. But they are widely used across the world. They are wildly used in the United States and they're very, very helpful. So there are a couple that we all talk about and those are BPC 157 and KPV, which we use in combination. In our office, we will start out with just one vial of BPC. We inject it subcutaneously. It's like the B12 syringes that we used to use. And then we rapidly add KPV to that Bpc 157. the those two peptides are very gut and brain friendly so they are anti-inflammatory for the gut in the brain and it has it's interesting because we are trying to keep good data with what we do and our nurse in our office is keeping excellent data and really working to keep track of what people are seeing.

And we have a child who seizes all day long, all-day long. His seizure time is reduced by about half and the seizures are much, much less frequent. We have Panda's kid, who is still difficult, but the dad sent us a coloring sheet that he did, and he colored inside the lines with multiple colors for the first time ever. I mean, normally he would just scribble with one color over the coloring page. So we're seeing really nice improvements in general. And then the gut improves and we've seen stool colors change for the darker, which must mean that the liver is functioning better, the gallbladder is function better releasing more bile salt so that stool can turn a darker color.

And again, that is the gut inflammation piece. And then if the kids do really well with that, then there is also, when we have autoimmunity, like PANS, PANDAS, and that kind of stuff, alpha thymusin 1, which is a separate injection. So you have to be willing to do two of these injections. almost every day. If we can't do that, then we don't get as good of an effect, but we still get benefit if we do it every other day, so we have seen this alpha thymusin 1 be what we call immunocorrective. And so it's not an up regulation or a down regulation of the immune system.

It's immunocorrective. And that means that the system is functioning better and it is being less autoimmune and more appropriately behaved. So we see this and, it works really, really well for all autoimmunity. Yeah. And I think, you know, I was just lecturing on immunotherapy and doing more of a deep dive into the peptides. We're always looking, whether it be precision IV platelets, helmin therapy that we both used, rather than the IVIG, the plasmapheresis, and the rituximab, which have their own issues and, these days, are very hard to get.

These peptides are a very good way, as you're saying, to recalculate, re-equilibrate, get the immune system to function better. So I'm thrilled you are seeing the positive results with those two. Yeah. And I've got to ask you, because I, I have always been just so in awe and, and respect all of you you're doing and have done with a healthy you now. and do you want to talk about that foundation or healthy living or anything else in that you are planning or doing? Because I think people are always looking for that sort of stuff, and also if they could help, donate, whatever.

Yeah, so, we would appreciate that.

Peptides for gut, brain, and immunity 37:10

COVID doubled our costs. So it has made it very challenging to grow our campus. But we already have 20 acres. We already plans. we have permits. And we just need money to be able to build this. And our plan is to have on one side of our campus five buildings that will house 40 people permanently, and we will use a few of those beds for respite. So if a parent wants to go on a vacation, they can bring their child and they know their will be safe. The campus is going to be entirely gluten and dairy free.

We're going grow our vegetables as much as possible. So we have plans for a big garden. and all organic, and just having kids grow from farm to table. And so we have that plan for 40 people. Then what we had is a plan, for a multi-thousand square foot wellness center. that can be a home for homeschooling programs, can a be home a for all therapies and all interventions that our kids need. I remember my son having to do his homework on his lap. in the lobbies of wherever my daughter was getting her therapy.

And so we've built into this campus a relaxed area for siblings, a relax area, for parents, but a working station for kids who have homework and who need to be able to do that. Then we have safe places littered all around the campus for kids who get into meltdowns. And we have a little pool that is designed to be a therapy pool. I really want to do pottery and have kids be able to throw on a wheel. We've planned for a big theater And and for the we've planned for a big theater so that the kids can do drama and improvisation, which, you know, life is improv.

Yeah. And so when they do improvisation and they're doing improvisational games, they learn how to live life. And with drama, you can have a director instruct you on what flirtatious behavior looks like. Let's do this. You know, and so with a good director, we can get that stuff done. And then we're planning on ballroom dance because it is incredible for motor planning. So we just, and yoga and lots of different things. And with COVID, I sat and planned the room sizes and moved the equipment around in the rooms size and made sure that there was enough room.

Sure enough, one room too big and one too small, so I had to change that. I want to have an in-ground trampoline for the kids inside the large gym. I just have so many things that I really, really want do that are not so traditional. Yeah. It's amazing. So if somebody could and wanted to donate, how would they do that? Where would find like the website or information to be able to do? The website, it needs to updated, but it's still there and it is the healthy, the letter you now dot org. Okay. And there is a button, there's a radio button and there a place that you can click on to donate money.

Great. And Julie, how would somebody now hearing about the ketogenic diet, hearing of peptides, about your wonderful integrative practice, How would they get in touch with your practice or with you? The best way to do that is to email our Stacey, who does all of our intakes and she's basically our office manager, and that's at office at PPP, so three of a letter P's, one V as in Victor, online.com. So ppvonline.com and it's office at. Yeah. That's great. Well, I know she'll be getting some calls or, or emails, and are there any last words for parents or practitioners of wisdom of hope of your experience

Healthy U Now Foundation and closing advice 42:30

that you want to share with those that are listening? Most of my wisdom comes from my daughter. She has always been able to say things in really, really good ways. And one of the things that she said to me when she was about 17 was, mom, you will never, never over ask the amount of anxiety I have trying to live with my autism in your world. So, I think that when parents say, well, they don't have anxiety, and I say well I'm going to take them home in my car and i'm gonna manage them for a couple hours at home.

No, no, that's not going work. And then we understand the anxiety. And the other thing is, Dani is nearly 28 now, and we are still working on improving her life. She's living her best life, she's writing music, She is writing books, working two part-time jobs, but we still work on motor planning. We still worked on her anxiety. And once we got her anxiety under control, we found out that she was the stand-up comic. And she's very, very funny, but it took until we got her anxiety under control. Yeah.

And that's such a huge piece for so many of us and so much worse in the last, you know, six years. Whether it be our children with autism, our neurotypical children, or children Pans Pandas ourselves. We need to understand the level of anxiety and the levels of not breathing we may be dealing with. Yeah, absolutely. Well, again, Julie, you know, if people are looking to get in touch, office at ppvonline.com or org? Yeah. Okay. And thank you for doing this and thank for all you do in your practice and for so many families.

It really is amazing. So I appreciate it. Thank you. All right. That's it for today's episode of Demystifying Pan's Pandas. I hope you're walking away with insights, tools, and hope to help you and your child on this journey. If you found todays conversation valuable, be sure to subscribe so you never miss an episode. Share this podcast with anyone who might need it. It could be the lifeline they're searching for. And if you have a moment, leaving a review helps us reach even more families who deserve answers.

Also, for more information, training, and community, check out our website, drohara.com and join our annual membership. And remember, every step forward, no matter how small, brings us closer to healing and understanding. Until next time, be present, Be hopeful, And we look forward to seeing you next on Demystifying Pan's Pandas.