Your Mind-Body Link: Mast Cells & Mental Health

Introduction to Mast Cells and Anxiety 0:00

Welcome back to our reversing mast cell activation syndrome and histamine intolerance summit. I'm your host, Dr. Meg Mill. And today I'm joined by Dr. Nicole Cain. Dr. Cain has a degree in clinical psychology. And as a licensed naturopathic physician, she is on a mission to introduce a new paradigm for understanding our mental health and has an upcoming book, Panic Proof. So I'm so excited to talk to Dr. Cain today about how our histamine and mast cells actually can play a role in anxiety and even panic, because we have histamine receptors all over our body and our bodies are so interconnected.

So thank you so much for joining us today. Dr. Nicole. Well, thank you for having me. I'm so happy to have you here today and get into all of this. But before we get started, can you just tell us a little bit about how you got into really focusing on anxiety and panic? I just love to share everyone's stories. My story of how I got into teaching and working with anxiety and panic is, as a wounded healer myself, is having gone through lots of stressors growing up, studying psycho biology, psycho neuro immunology in undergrad, getting a counseling degree, and then my medical degree, I found that there was a really big intersection between the way that we feel emotionally and what's happening in our bodies.

And throughout that process, I found that healing is actually possible by actually honoring the symptoms from our body and looking at them as data, and using that data to create treatments that actually unwind all of those root cause variables so that we can get better. And among those, I love that we're having the conversation today about mast cells is the immune system and the intersection between the immune system and our emotional well-being. That was really profound for me in terms of healing.

And so I dedicated the past decade plus to unwinding. That was my clients and teaching online. That's great. I know, and I think sometimes when people were taught a little bit to separate mental health and physical health, and that's just not true. Like we're saying, there is that connection. And so sometimes we're like, oh wait, no, that's your mental health. That's not not connected. And that's our physical health. But we see exactly what you're saying. So let's start by talking a little bit about that link.

How Mast Cells Drive Inflammation and Panic 2:56

So starting to talk about the link with the mast cells and our immune system and how that's starts to contribute to anxiety. For those who are a little bit newer to the topic, I always like to start the conversation about how mast cells and immune cells can affect our emotional well-being is that first, we have to understand what a mast cell is and how it's a really unique cell, and why it's really important to understand mast cells in the whole world of immunology and psycho neuro immunology. And they call mast cells kind of the jack of all trades cells because they do so many things.

They have over 200 types of receptors. They have thousands of different mediators that they release. And depending on where they're located, the receptor type that's getting stimulated, the mediator that they're releasing the symptoms can be head to toe and very different depending on the individual. And so it's a difficult disease or a difficult condition to diagnose because there's no one. Oh yeah. You have migraines that are in one side and you know, so it's a little bit more nuanced and complicated.

It's a lot more complicated. Let's be real. And so it's hard to get a diagnosis. But when you do it can be game changing especially for mental health. And the receptors for mast cells are located all over the body. And depending as I said, where they're getting stimulated, the effects can vary. But the two main places that we really focus on in mental health are the mast cells in the brain, and then the mast cells in the gut, especially in the conversations pertaining to that really important highway connecting the two, the gut brain access.

And so that's what I always want to start people with is what are these cells? Are the symptoms different in me versus you? How can we have the same diagnosis then? And what is my anxiety caused by the same thing your anxiety is and if not, what do we do. Right. Yes. Yeah. So yes. And that is important because not everyone's in anxiety is caused by the same things. And we need to look further into what's going on within within the body. So can we talk a little bit about so you know what starts to happen physiologically when these mast cells become overactive yet. And so when mast cells become overactive so they can respond to a myriad of things.

And so it could be allergens, it could be immunoglobulin. So maybe you ate a food and you get an IgG immune system response to that. That's kind of like if someone eats peanuts and then they get that anaphylactic type response. mast cells can also respond to IgG immunoglobulins, which you may have an episode of mast cell D granulation three days later. And so they could be responding to microbes in the gut, toxins in the environment, even vibration physical stimuli, other immune cell mediators, your hormones.

we see that mast cells relate very strongly. They have receptors for control and releasing hormone which gets released during stress adrenal control and releasing hormone. And so again, depending on what is stimulating the cascade that follows can vary. And so I'll share kind of some specific ones that that might be more relevant or pertinent to mental health. And so let's say that that you have some sort of an exposure to a germ, a virus, a bacteria, the proteins of the presence of this germ will be they will go to the receptor on the mast cell.

One of the key receptors that we talk about are toll like receptors. And so those recognize that part of the germ. And so then they they granulocyte. And that's a process of where they dump all these little granules and within the granules or different kinds of chemical mediators, whether there are prostaglandins or histamines or cytokines, tryptase like all sorts of different things. And then all of those messengers have different acts. And so we could talk about that, but if we just stay with the toll like receptors for just a moment and we, we have an inflammatory cascade that happens.

There's many things that can occur as a result of inflammation. Neuroinflammation is the name of the game when it comes to mast cells. But if we look at just one mechanism and we see that there's inflammation in the body, inflammatory cells go to the amygdala in the brain amongst other areas. But we'll focus in on just one the amygdala in the brain. Your amygdala is the part of the brain that it screens for danger. So the amygdala is the emotional feeling part of the brain. And so it's looking around how do I feel about this.

Is this good. Is this scary. It's using your hippocampus to inform its decisions. We've been here before so this is fine or we've been here before. And actually it's no good. So the inflammation stimulates that amygdala in the brain. And then it sends that dangerous signal. So then the amygdala communicates it's to the hypothalamus of the brain. And then that starts a whole domino effect of creating a state called autonomic arousal. And so in autonomic arousal then we have other hormones that are increased.

We have cortisol increase. And cortisol increasing has a couple of jobs. One is it puts us in that fight flight freeze to help us run from the tiger. But the other is that it's actually an inflammatory suppressant. Right. So cortisol is trying to stop this from being a giant snowball and getting worse and worse and worse. And so cortisol is supposed to suppress inflammation. But then what can happen next is inflammation is suppressed. And so your immune system isn't able to mount that full response to that germ that was stimulating those two receptors.

And so now we have kind of, a golden opportunity for

Histamine, Allergies, and Anxiety Symptoms 9:19

more invaders and more pathogens to get in because we have immune suppression. And so now we have more pathogens coming in, more inflammation. The inflammation goes to the amygdala. The amygdala says, oh my gosh, we're in more danger. Release more cortisol. So we end up with these individuals who are in these chronic states of inflammation, and then they end up with, cortisol depletion. So maybe in the beginning they have that fight flight freeze and they're getting that autonomic arousal quite sufficiently.

But then after chronic illness, that's why we can end up with low cortisol levels, high levels of inflammation. So that's just one example of how that cascade can work. If we have an infection that goes to the toll like receptors. Yes. And that was very you explained it so well because that it's showing how we have all of these things that are connecting with each other. And it's a lot to unpack, I think, because it's all connected and it's all of these like, you know, when you're talking about cytokines and toll like receptors and neuroinflammation and all of these things that are affecting everything else that can feel like you can start to get lost in that train, but, you know, it is just going back to those things.

And that's why I say, like going back to that infection, going back to the gut health, going back to things like that, that you're seeing these invaders come in and removing them can make such a difference. When we're talking about this whole cascade. Absolutely is getting to that root cause and oftentimes getting to the gut and working on that first line of defense is game changing for people. Histamine is another part of the mast cell question that I think is really relevant to explore. If it's okay, I'd love to talk about that.

Yes. Let's go there. I'd love to. Let's go over. Histamine is I've had so many people in my holistic wellness collective membership who have come in with really high anxiety, and it feels un logical where they're doing all of we call it top down work. Like I'm doing the coping skills, I'm talking to myself and catastrophic thoughts. I'm questioning them and I'm providing them with counter suggestion. They're doing all of that logical, analytical stuff, and yet they still feel anxious. They have sweating and flushes, a heat and heart palpitations, and their body is anxious.

And then we get this trauma response, right. The fear of the fear is I'm out of control. My body is taking over. I can't make it stop. When is it going to happen again? And so we start losing our personal power and our personal agency. And I see this happen quite a lot interestingly with histamine. And so mast cells also can release histamine. And we have histamine receptors all over our body as well. We have four main kinds of histamine receptors. And they just number them in the order which they were discovered.

So we have H1, H2, H3 and H4 histamine receptors. And depending on the type of receptor that's getting triggered the effects will vary. And so some people they will have allergy symptoms. And so I write about this in my book. And so you may notice that you get those pesky seasonal allergies with itchy runny eyes and stuffy nose and post nasal drip. And in your lungs, you want to scratch them out because they're so itchy. And that same neurochemical that's creating those pesky allergy symptoms is also as stimulating to your nervous system as adrenaline.

And I learned this growing up. I didn't learn this in medical school. Even this something that I discovered doing my own research later. And that's histamine. So that same little chemical that makes your allergies could also be giving you panic attacks and panic and anxiety and histamine can be released by mast cells. And so if you have an imbalance in your immune system where you're over producing mast cells and they're getting stimulated or triggered, they may release excess amounts of histamine.

So we want to look at where the histamine is coming from. Is it coming from the cells overproducing it. Do we have something like master say ptosis going on or are we not detoxing histamine effectively? And that's where I've seen the most power. So these individuals who feel like their bodies are taking control of them when they learn how to do a histamine detox and they get better, that is so healing and so corrective. And so histamine detoxification is a game changer, an easy an easy take home for those who are listening is something you can do today to help detox.

Histamine is de oh. It's, supplement that you can buy at the health food store. They actually found that there's the animal based one, but they're actually doing a lot of research on a vegan one to like, based on lentils. And we have been linked with that will be in our summit resources because we definitely we definitely need that. We so need that. Yeah. So definitely check out the summit resources because Dao is really good. And it's specifically good for helping detox and processed histamine.

That's in the gut. But there are three pathways for detoxing histamine. And so if you're dealing more with neurological or nervous system histamine Dao may not work as well. And so then you want to get into the little bit more complicated histamine detox pathways which involve methylation and liver phase to detoxification, which is, you know, we could totally do a whole other episode about that. Yeah. Let's talk a like because I think people are really interested. We've done a little bit of that, but I think a lot of people are focusing on the, you know, the invader and and talking a little bit about the detoxification.

I mean, before we get there, I just want to share that, you know, you you were describing me when you're describing all of the effects. And I appreciate that that fear of the fear that you're anxious about being anxious because you get to that point where you're having panic attacks and you don't know why. And I was getting them like that where they were, they were nothing related. It wasn't like, oh, I'm getting a panic attack because of I'm going to drive in the car and I have a fear of cars or I'm going here or social or anything.

It would just out of the blue all of these. But I also had the was the allergy kid, the sensitivity kid, the and I didn't pick up on all of the signals through my life until I hit the point where, you know, my gut was a mess and I'm having panic attacks all the time that I had to research and do all of this changes. And so it's where you get to that point. But I think when people are at that point, again, we're thinking of that. What you're saying, the top down, the thought refocusing, but until you get some of these issues changed, you can't see some of these major results.

And it's probably and this is my story too, Megan. This is I had tissues in all my pockets, and I know my parents got frustrated because they'd end up in the washer in the dryer. And so there's, like, tissues everywhere. and so I, I imagine for you, as it was for me that it was like, oh my gosh, like, I'm not broken. Like, this is valid. Like these are allergy, this is histamine. And there's something I can do about it as opposed to like my body's just at war. I have anxiety and panic can try to think my way out of it, but really it's just I'm stuck with it, which is not the case.

It's just a matter of getting to what is the root cause exactly. I know, and and you're not until you get there does feel helpless and you feel like you're actually being taken over. And what are you going to react to next? And how is this happening? And you don't it's it is such a fear. And it's a real like, I want to just shine that

Histamine Detox Pathways and Nutrient Support 17:20

because it was a good thing that you said that. And I know people listening that it is a real fear that and you become anxious of the anxiety and, and then you just swirl and then you're and then you're in your fight or flight and then you're getting more reactions and like, you know, so it can become a real thing until you can sort of unwind that. I think of it as it's all feedback loops. I in a feedback loop, think of it like a bicycle wheel, right? So it's just spinning and spending and it goes faster and faster.

And so the question is, is, is how can we stick a stick in that metaphorical bicycle spoke to stop it from spinning. And I think that that getting to the root cause is that thing. And unfortunately, there aren't really very accurate tests for histamine. We have histamine responses like the Rast test, that skin prick test. But, histamine testing is a very well, standardized maybe. Or we just don't have great tests for it yet. So it's it's tricky. It's tricky. Yeah. Sometimes we're looking at symptomatology rather than the testing to get some of these things figured out.

So I know. Yes. Well let's can we talk a little bit. We I got us off track here, but yeah because we. Have about detox talked. About the dough and the diamine oxidase. And then we're you know, methylation and liver support is another thing that's really important. So we could jump in just a little bit about that. Yeah. you see my eyes are looking down. because I want to make sure that I get you all the steps here, and then I can actually give you some hacks for supporting these steps with specific dosing.

And so I don't want to get it wrong. So I'm going to look at my paper here. But if we start with the the order of operations when we're doing histamine detox, I think it's really important to make sure that you do it in order where you're not going to clog one outlet while trying to unclog the other. So you want to do it kind of in a sequential order. So I always have people start with DHA. Oh, that's the number one way that histamine is broken down. Again, that occurs in the gut. And so when we're thinking about DHA oh you want to know what is depleting me of DHA.

Why why am I needing to take DHA. Because otherwise it's just palliative. And so things that d deplete it is it could be a dysbiosis or an imbalance in the bacteria in your gut which circles back to what you said, Megan about going to the root cause. What's the healthy your gut. And so doing gut work can be game changing while taking Dow. But ultimately you want to diversify the population of bacteria in your gut so that they're able to then take it from there. And you don't have to take Dow forever.

So gut health number two is, are you consuming things that may deplete you of DHA? An example would be alcohol. Alcohol also promotes histamine IT system allergic. So it will deplete your ability to detox it. And it will also inflame you. And it is also histamine producing. Right. And there are genetic mutations. So depending on what genetic testing you have available to you family history, we do see that some people have a tendency towards not making sufficient amounts of details of genetic testing.

Maybe, important for you also, individuals who have gastrointestinal diseases like celiac disease or Crohn's or ulcerative colitis, you know, other chronic diseases of the bowels where we're not getting absorption and functioning of the bowels, the enzymes, the bacteria. So, you know, we want to look at the health of your gut and then supporting with DHA. Oh, I like to take daal with food. So with each meal I do a day of supplement. And of course you have that resource. There. And DHA will work better if you take it with its cofactors.

So there are companion nutrients to get better results from Da. And that's going to be B6, magnesium. And for some people copper. And this is like a whole conversation of its own. But we saw that 2020 to like 2023 that people were taking a lot of zinc. Yes. And that's great because zinc can help our immune system. Right. But we also need copper, meaning copper for iron absorption. We need copper for lots of biochemical pathways. And copper and zinc oppose each other. So if you take a whole bunch of zinc, you're going to end up with depletion of copper, and then your Da isn't going to work as well, and then you're going to get histamine spikes, right.

So you may end up doing a little bit of digging just to see what's happening on your zinc copper ratio. And so maybe you would benefit from a mineral like a trace mineral to balance it out. You don't want to take too much copper because then your body's going to store it and sequester it, and that's no good. But don't forget about our dear friend copper. So that's Dao. So that's the first one. Anything I missed about that? You got it. That's good. Yes. Super. The next step I would do would be methylation.

And so histamine is broken down primarily by methylation in the central nervous system. And so for those anxiety warriors those panic warriors depression insomnia oh my gosh. Like and I'm an insomnia warrior. And histamine was like the reaper the grim reaper for sleep. It was horrible. And so detoxing histamine out of the central nervous system is going to be especially important for for you all who suffer with anxiety, panic, insomnia. Right. And so when we're doing the process of histamine detoxification is this is going to be primarily the H and t pathway.

The histamine and methyltransferase pathway. And so when you have histamine methyltransferase that's going to get broken down by your methylated be so methyl folate methyl Koppelman. And then you're going to end up having methyl histamine. But it doesn't stop there. And don't stop there because methyl histamine is very toxic to the central nervous system. And so this is why some people when they take too many methylated B vitamins, they feel wired, they feel anxious. They're like, I had high histamine.

Doctor Kane told me to deplete or to detoxify my histamine. And she said to take the methylated BS. But now I feel a thousand times worse. And that's because you just open the faucet. But but you haven't sprayed the water out. So the pressure's building and so you feel worse. So you have to get the water out. And so that means that we then want to send that down the m a o pathway. And so mas one of our pathways for detoxing histamine. And so when it goes down the m o pathway we need to make sure that we're getting in things that support Mayo.

And Mayo is a common genetic mutation. And I bet you see that a lot with your clients when you do the headache stuff. Yes. Is that we need to get that histamine aldehyde. So it goes from methyl histamine to histamine aldehyde. And then we get it into liver detox. And so when you take your methylated b's to drain your CNS, as you want to make sure that you don't forget thiamin. And this is like the most amazing thing sometimes if I my anxiety clients come in and they're like, I'll only take one supplement, what would it be?

And I'd be like, take some B1 girl, take some thiamin. That is really important. It supports methylation. It's support system in detox that opens up that traffic jam that maybe you've had. And in terms of dosing, I mean, I think that's really important is to do a test dose. And so that would be really tiny, like 50 to 100mg. And then if you feel a little better, like maybe a little bit more calm or a little bit more relaxed, or maybe your allergy symptoms will get a little bit better. Then we would do a depletion dose, because the odds are, is that the demand of histamine and detox hasn't been met by enough one.

And so then you want to repeat it. And so typically what I have people do is 500 to 1000mg for three months. And then once you've passed that three month marker, then you can go back to a maintenance dose of like 100 to 300mg. And so that's the team methylation detox pathway. Yeah. Thank you Sam. That was so clear. I love the way you you explained it. Yes. Because I know we've had a lot of people talking about these things, but but it's nice to know that you gave us a wonderful, like, step by step by step to understand.

And and we've all heard about MT4 at this point. I mean, most of us and probably all, you know, all you are all very educated. If you're on the summit listening. And so we know about that. But then exactly what you're saying sometimes the,

A Holistic Roadmap for Healing Anxiety 26:18

the we we boost methylation and we know about how to do that. But we see this increase if the if it's plugged. So that was you need to think about all the parts of the pathway. We talked a lot about. So we talked about histamine and we talked about the receptors. And we talked about the overload and the detoxification. When you're working with people and you're kind of working there, they're coming to you for anxiety. So they're usually probably coming for anxiety. And you're you're pulling it back and saying, oh, wait, okay.

You have histamine issues. That's what happens. A lot of times you're coming in for anxiety or migraines or bloating or hormone imbalance. And then we dig in and it's like, oh wait, the histamine is causing all of this, all of these issues. And so we have to roll that back. And then a lot of them start to, to go away. So where where are you kind of starting with people when you know, when they're coming in that anxiety type diagnosis. step by step roadmap. And I love this road map because it teaches us how to think like a trauma informed, holistic doctor.

And so the first step is to just like straight up set expectations of what healing looks like and what your goals are and to make them small, appreciable goals. And so I think it's really important to mention that because some people, they'll hear a conversation like this and before we went on the break, I was talking about, you know, if you take thiamin, oftentimes that just opens this, this floodgate that's just been building and building and building and people feel a lot better. But that's that's amazing.

And we want to make sure we're also doing the deeper work so that you don't end up there again and that you're not having to take these palliative things for the rest of your life. And so I think number one is like setting clear, appreciable goals with expectations of like, okay, I did this part, but now I'm going to see it through. I'm not going to give up just because I'm feeling a little bit better. I'm going to keep doing the digging. So that's the first step. And then the second step is just acknowledging everything that we're feeling.

We're thinking mind, body, all of the sensations, all of the thoughts, all the feelings. We write them all down because those are all it's like you're silicones. And we're looking at all of the clues because your symptoms are giving you information on what needs healing and how. And so oftentimes I have people come in to me and they've been trained by the medical profession to think from shoulders up. They're like, I'm anxious, shoulders up, I'll tell you, like about my med history and my psych history.

But then when I'm asking them about their digestion and their stools, they're like side eyeing me. They're like, well, that's below my neck. Why are we talking about that? And so the second step is just straight up acknowledging, looking at everything. You can't solve a problem you're not willing to have. And so we look at everything. And then the third step is you then do your timeline and you look at keystone events. These are major events that happened in your life that could have been helpful for better or for worse.

And we see this quite a lot. And mast cell illnesses is that almost everybody who struggles with Marcel Activation syndrome has had symptoms for a really long time, and oftentimes they're triggered by an emotionally stressful event or they got an infection. So maybe they got mono or strep or something like that when they were younger. And so mapping out your timeline can be really important in reverse engineering. Oh, this all started when I went to kindergarten. And so then you go and you start exploring what happened in kindergarten.

Oh, maybe you went to school in a mold exposed building. And so that building had wet, rotting mold in the ceiling. And so then that caused immune system dysfunction, toxic overburden, which in molds like that's a whole summit of its own is molds can be the great in the maker and it definitely causes immune just function. And it definitely causes mast cell activation. And it can definitely show up in all sorts of different symptoms. Throwing doctors curveballs left and right so no one knows what the heck is going on.

But by doing a timeline, you can get a lot more clarity. It's like taking this like ball of yarn that's in your medical history, and then really sequencing it out. And once we know what your timeline is, then you can start plugging your symptoms into your timeline. And now we have this really nicely, beautifully organized, the best we can. Right. Because nobody can do it all perfectly. but we have a really good idea of what's going on, and then we can start looking at it as a diagnostician, like, okay, what root cause testing should we do or what lifestyle changes, for sure.

Like, oh, you are in kindergarten, you started eating red fruit, died in the classroom, but before that, your parents didn't give you any red food dye. And so it's then starting to reverse engineer what could be underneath of that. And that's how I do everything. And so, you know, your question was, well, what do you do? Someone comes in when things are. And how do we get to this inflammatory piece underneath of it? But the I think more important part is how do we think about physical and emotional well-being, and how can we create this organized system of approaching it so that we're not missing anything, no matter what the presenting concern is?

Because someone with so May 1st month present with like horrific panic attacks like I have, I've had people while they're going to sleep, they're like falling asleep. And right as they enter sleep they have this panic attack and it jerks them awake. And so they came to me at that time, they may be referred to me for insomnia, but maybe then later it's showing up and they're having wandering joint pains. And maybe the panic on sleep isn't the main thing, but it's diagnostically assisting finding the under occurring main thing.

Right? I know that was like the longest blurb. Yeah, that no. That's it. So important. I mean, I've had people where all the symptoms have been going. A lot of times you don't know if they've been going on a long time. And when we dive into those, like nuanced details, I had, you know, I've had more than one someone say,

Panic Proof Book and Where to Find Dr. Cain 32:28

oh, well, I did go on a camping, you know, camping trip and was bitten by a tick, but I didn't have any symptoms and nothing ever happened. And then maybe that was at 7 or 10. And then these symptoms build up. And this is exactly like what you're saying. And you don't. And till you take the time to create that, it's it's hard to really go back and organize all of those things. And a lot of people aren't taking the time to do it right. When you have a seven minute doctor's visit, it's hard to create a good time like that.

So that that is very helpful. Well, tell us a little bit about you. I know you have a book coming up, so I'd love to just hear about, you know, moving into a little bit of a panic and what you have coming up with your new book. Yeah. So the book is called Panic Proof, and it's trauma informed and holistic ways to heal anxiety and to take back your power, because as we were talking about, it can be very terrifying and powerless to feel like your body is going rogue. And the feeling of anxiety in particular can drive people to despair where it's just so awful and so painful.

And I saw a need where there was often a mismatch of treatments and symptoms, where someone's like, oh, was having a panic attack, and someone else told me to breathe, and I wanted to slug them like, don't just tell me to breathe. This is like ten out of ten anxiety. And so the book is written and it will be valuable for clinicians, but it's also written in a way that anybody can understand it. Where it walks you through that step by step process of how to think about anxiety from a solution based approach or, an honoring approach.

And that process, that roadmap that I told you about came from the book. And so when you read this book, you will walk away with, I know how to get to the root cause of my anxiety. I know what tests to run. I know what supplements to take, and I know how to make herbal tinctures. And so it really will empower the reader to know exactly what to do. It's like a one stop shop, and I teach people how to be their own trauma informed therapist. So we get into a little bit of eMDR parts work and tapping.

It's it's really beautiful. And there's stories. I have stories woven through the book of different. I call them avatars, but they're composites of clients I've worked with. Of course, information has been changed to honor their privacy, but where the reader gets to see the story of what this is really like and how people can heal. Yeah. So I'm excited to read it. It's coming out in October. You said. Yes. October. Penguin random House is publishing it. Great. Well, I'm excited to to check it out.

Thank you for all the valuable information you've shared. Can you tell our our viewers where they can find you? They can find me on Instagram @drnicolecain that's D R N I C O L E C A I N or my website drnicolecain.com Thank you so much for joining us today Nicole. It was great. Thank you so much for having me.