The skin is a window into what's happening in the gut. While it is true that a lot of potential skin irritants are everywhere, one might try to consider that everything going on on the inside is reflected on the outside.
Watch the video and learn about skin issues, effects of gut health to skin, autoimmune conditions, and effective ways and preventive measures to make the surface reflect the way we wanted it to be.
Dr. Justin Marchegiani
In this episode, we cover:
01:00 Gut health mirror the skin
06:09 Administer nutrients inside-out
11:02 Topical irritants
15:27 Bowel movement affects skin health
17:48 Histamine issues, genetics, and excessive insulin
20:38 Autoimmune domino effect
Dr. Justin Marchegiani: Hey there it's Dr. Justin Marchegiani, hope you all had a fabulous weekend. I'm in a house here with Evan Brand. Evan, how we doing my friend?
Evan Brand: Happy Monday man. Hey look, I was talkin' about the sunny weather but I'm gonna complain today it's rainy and grace guys so, today is a good day to just hang out. I'm gonna sit by my infrared Sauna lamp that I have here and just try to stay warm.
Dr. Justin Marchegiani: Hey, that's wonderful man really good idea. Well, I'm excited to dig in today in this topic of Skin Health and Autoimmunity.
Evan Brand: This is huge!
Dr. Justin Marchegiani: Yeah it's a powerful topic. I mean, we know that the immune system and the gut are intimately connected 'cause about 80 percent of your immune cells live in your gut and the MALT and the GALT the– mucus associated lymphoid tissue, lymphoid meaning lymphocytes which is another name for–for blood cells or wh— white blood cells and then we have our–our GALT which is our gastric-associated lymphoid tissue that's in the stomach and then the MALT is in the uhm— small intestines. We know the guts and the immune function interact totally and then we also know that– uhm— the guts mirror the skin. People that have inflamed gut– uhm— dysbiosis infections malabsorption that shows and manifest itself in the skin we have pathologies that can even manifest from various rashes from lupus rashes uhm— erythema to– psoriasis, to vitiligo, to eczema, other types of various dermatitises to alopecia with the hair uhm— so– I mean you name it, right. The skin is a window into what's happening in the gut.
Evan Brand: Yeah, I've got some statistics here. Was a good way to open up. This is from the CDC; this is actually 6 years old so it's probably even worst than what this study shows but they were looking at from 2010 to–or from 2000-2010, the percentage of children aged 17 and younger with eczema or any kind of skin allergy and the levels across basically all races pretty much doubled, just from 2000 and 2010. So I bet 2010 and 2020 we're probably gonna see an even more rapid spike of skin issues. I mean I can't tell you when the last time I went out in public and did not see someone with the skin issue, I mean you go to a shopping mall, you go to a grocery store like you're gonna see skin issues. It's a very very common thing and even just look back at some of my old YouTube videos. I remembered Justin you saying, “Man I bet you got something going in your gut” 'cause my acne used to be so bad on my chin–
Dr. Justin Marchegiani: Yeah.
Evan Brand: –it was all the dysbiosis in my gut. So, we're definitely gonna chat about that today too about infections.
Dr. Justin Marchegiani: Yeah, you even have a lot of rosacea too which is a sign of inflammation on the skin. Now, that's important because when I see someone that has some kind of a skin issue that tells me that there's some type of autoimmune or internal inflammatory thing happening inside the body especially the gut. So when I see skin issue the first thing I look at is potential food allergens. And we would move someone to like a paleo-slash-autoimmune-paleo template. And then we know other nutrients are really important so if we have poor digestion the chance of us breaking down fat-soluble vitamins like Vitamin-A go down. We know the ability to digest and absorb and assimilate zinc goes down. Healthy fish oil fats like Omega-3 go down. Vitamin-C which is really important for that collagen matrix goes down. Biotin which is a– uh– a– a B-Vitamin family. Selenium, uhm— Silica, uh– Vitamin K2, uh– sulfur amino acids, Vitamin-E, Vitamin-D, of course a lot of our collagen amino acid which are very high in proline– hydroxyproline, glycine which are really important building blocks for the skin so we need to absorb and assimilate and utilize all of these important nutrients. And we need good digestive function, we need a– gut lining that's not inflamed, and we need enough adequate enzymes and acids to be able to break everything down. And of course, dysbiosis, SIBO, bacterial overgrowth, fungal overgrowth, and or parasite infections that H-pylori, could easily be a– a factor that prevents that from happening optimally.
Evan Brand: Yeah I was gonna say let me take you down to zinc rabbit hole a little further 'cause this is really important based on my history–
Dr. Justin Marchegiani: Uh-huh.
Evan Brand: –the skin issues. I had H-pylori, I showed up positive with a– on my second test on my stool. I first showed up a parasites, cleared those out. Second round on the re-test, you know, Justin I see this every single week on lab results, you know, sometimes we clear out a client's gut of some infection, and then on the re-test a new infection shows up. And that's what happend for me, H-pylori showed up. And– so if I was eating grass-fed steaks, I was eating Bison, I was eating all– all these really good high quality pastured meats. However, I was not getting any of the zinc to be cleaved off of those meats because how poor my digestion was. And also, there's a marker we look at called calprotectin. My levels were elevated so I had gut inflamations. So even if– I had good meat, it's not about what you eat, it's about what you digest from what you eat which why we always hit on the acid and enzyme piece so much, so for me– I mean, I could've uh– could've used supplemental enzymes and I did but that's not– that's not the– that's not the root cause. I had to dig deeper so, you know, we tried to compare conventional, naturopathic functional medicine like a naturopath, may say, hey, you know, you may need some extra acid and enzymes but they may never go to the next level of investigation which is hey, do you have infections that we have to– fix that explains why your acids and enzymes are low in the first place. And then, just a quickly compared to the conventional medicine approach that these type of skin issues whether they're autoimmune or not, it's gonna be all the garbage that you probably already know about. A steroid creams, and– immunomodulators, antihistamines, what else do the conventional docs do? It's not good, it's– I mean, it doesn't work–
Dr. Justin Marchegiani:Yeah, I mean you have your antibiotics, you have your immunosuppressants, you have your uhm— corticosteroid which kind of fit into that same family. And then you have your synthetic Vitamin-A type of uh– retinol, and then you have the internal Vitamin-A that's synthetic which should be like the uhm— not– not the tetracycline; the tetracyclines the common antibiotic Evan, and then you have accutane which is a Vitamin-A analogue and you gotta be careful if you're a woman because if you get pregnant while on that you can have birth defects 'cause it is tritogenic.
Evan Brand: Oh my gosh.
Dr. Justin Marchegiani:Those are the common things for the most part. I mean it's gonna be antibiotics, immunosuppressants, corticosteroids, they've the vitamin– and don't get me wrong, the Vitamin-A could be helpful. I'd recommend using Vitamin-A on the skin. Try to do it with retinoic acid natural derivatives which you don't need a prescription for and that can be really helpful because it can provide uh– important building blocks for collagen elasticity and then you can even do a topical Vitamin-C as well. Of course, we wanna get all these things internally, right? But if we do it inside out, then we get a winning team what we can get results much faster is that we can topicly hit something. You can bring those nutrients directly to that area. And then if you can internally do it with good quality fat-soluble vitamins from animal products, from liver, from healthy grass-fed vital with a Vitamin-K2, of course, collagen either from bone broth or collagen shake. I mean, these can all be amazing uhm— resources to get extra nutrition in for your body.
Evan Brand: Oh and here's the thing I wanna point out: you have to do both. You're talking about– okay, sure, do the topical stuff. Great. Instead of steroids, maybe do topical Vitamin-C serum, maybe some topical Vitamin-A. But you still always have to work backwardstowards the gut. So first step, if you have skin issues, get your gut check, get a stool test done because it's very likely that you have some type of dysbiosis going on. Here's the thing that's crazy to me, I said you'll get put on the antibiotics for a skin issue, it's like , “Okay, your gut is the problem”. So we're gonna come in with antibiotics, we're gonna kill even more of your good bacteria, we're gonna mess up your gut even more to try to fix your skin. I mean, that is such a backwards mindset.
Dr. Justin Marchegiani:Exactly. So couple of other autoimmune condition: we mentioned psoriasis, we mentioned vitiligo, uhm— we mentioned eczema which is now in the last year or two starting to be thought of as an autoimmune condition. Rosacea is now starting to be thought of as an autoimmune condition. There's a– dermatomiositis which is another type of condition where that dermal layer is starting to become significantly inflamed as– there's Epidermolysis bullosa – another condition. Again, these conditions they have the same underlying mechanism as inflammation. The difference in the diagnoses is how the inflammation manifest.
Evan Brand: Yeah.
Dr. Justin Marchegiani: If it manifest with psoriatic symptoms, right? Then that's psoriasis if m– if wer— manifest in eczema symptoms. And eczema and psoriasis are very, very similar typically psoriasis is a little bit more flaky, it can peel, and– and get bloody a little bit easier. Uh– vitiligo is gonna be autoimmune that affects the melanin in the skin and then so if you're doc for skin complexion, you'll see your skin go white. Think of like Michael Jackson, right? When he started wearing the– the glove on the left hand, right? In the 80's, that glove was to hide the first sign of his melasma or let's just say not his melasma his vitiligo. Melasma is another skin issue that tends to be form hyperpigmentation primarily from hormonal issues like the birth control pill, or uh– being pregnant, they call it pregnancy mask. Again that's not in the autoimmune camp, that's more of a hormonal thing, but gut function can have an impact on that because digestion is really important for– healthy digestion's really important for metabolizing hormones 'cause it goes and gets pumped out the liver, to the gall bladder back into the intestinal track. And if we have bacterial overgrowth like uhm— dysbiotic bacteria like in SIBO, that can produce an enzyme called β-glucuronidase, and if you go to Google and type β-glucuronidase and estrogen, you'll find that β-glucuronidase uncleaves conjugated estrogens. Conjugated means there's a protein bound to the estrogen so then it can get metabolized. When it de-conjugate to the– pulls the estrogen off that protein, and now it can go back in systemic circulation and have a hormonal-like effect. So, things like gut function can play huge impact with hormones and those hormones can easily impact your skin as well.
Evan Brand: Oh, and you tied it all together in the end that's wonderful.
Dr. Justin Marchegiani: Thank you! That's it.
Evan Brand: See. So here's the thing out there people realized: you can measure this stuff. We measured β-glucuronidase on every single stool test and here's the really-really fun thing that Justin and I love so much about our jobs – is that within 6 weeks, we could see β-glucuronidase come down by 500, 600, a thousand points, you know. We may see someone at 3000 which is too high and this means, hey look, they're recirculating not only hormones but could be toxins too that get conjugated as you mentioned. And so that's not good and this is why someone has like a heavy metal toxicity problem but they have dysbiosis. You have to fix the gut too because to detox effectively, you've got to have that open-loop system, not a closed-loop system. So when we come in with probiotics in usually phase 2 or phase 3 just depending on what our protocol looks like, we're gonna see β-glucuronidase drop. We'll typically gonna use some enzymes, you mentioned the liver support; liver nutrients can help, sometimes methylation nutrients can help. Uh– one thing we forgot to mention so far about skin is the topical irritant, so why don't we chat about that, like soaps, shampoos, conditioners, perfumes, artificial fragrances– oh my God! I should have took a picture– I could have put this on my Facebook page man, it would have went viral. These two girls, we were in Target, we were gonna take the baby in the Target to go look for something. I remembered what it was. And these two girls were in the parking lot, and I saw 'em with a huge bottle, and they were spraying each other and I thought, “Oh, what are they spraying?” And so I just say, “Oh, whatever”. But we get into the store, we're standing right next to these girls, I thought I have to ask them what this is. I said, “Can I ask what you all are spraying on each other?” And they're both, “Ha-ha-ha” they both giggled, and she goes “Get it, it's in your purse show 'em”. And they pulled it out and it's a giant bottle of Glade air freshener, apple cinnamon scent. And I just looked at it–
Dr. Justin Marchegiani: Oh my gosh!
Evan Brand: –[laughs] I just looked at it and I was like, “So you're all using air freshener as perfume?”, and they're like “Yeah!”, and I was like, “Okay”. I should have said, “Can I take your picture that's so cool and then post it online or something”. But I jus—
Dr. Justin Marchegiani: Yeah, it's like a warning right? Hey, do not take this.
Evan Brand: –so I mean, we could go into the reasons I– on my– if you just look up uh–
Dr. Justin Marchegiani: Uh-huh.
Evan Brand: If you just google “Uber fragrances ban” or something, you can read it. I did a whole like 20 different studies on my– on my petition about the different artificial fragrances and the phthalates and all that endocrine-disrupting things in those so, I mean, please don't spray yourself with air freshener that's just insane.
Dr. Justin Marchegiani: Yeah it's a whole bunch of junk in there and a lot of these things, you know, if you're female, a really big concern because you have a hormonal rhythm to your– to your monthly cycle and that can easily be disrupted. Men as well, because men, you know, they're hormone rhythms more flat line but there's a lot of Xenoestrogens in the environment from plastics to pesticides to fluorides, uhm— to various components in– in cooking compounds uh– soy, those kind of things, right. You don't wanna be a soy boy. These type of Xenoestrogens are everywhere they can affect guys but they can really disrupt women's cycles because when you start dosing up high amounts of estrogen, that can start to decrease follicle-stimulating-hormone FSH, and then when that hormones starts to decrease, then you don't have the signaling to the follicle, that grow a healthy follicle, and then that can disrupt the whole entire estrogen, progesterone rhythm from the follicular phase to ovulation to the luteal phase, to menstruation, to starting all over again.
Evan Brand: Yup, so not to go too off of that topic 'cause you were– you were going somewhere good–
Dr. Justin Marchegiani: Yeah.
Evan Brand: –but I just wanna restate. Make sure you clean up all your personal care stuff. It could be your lotion, it could be like I said, shampoo, conditioner, you can go on the environmental working group and you can look on there. Uhm– Justin also likes the skin deep uh– reference, you can just–
Dr. Justin Marchegiani: It's the same thing– it's a different branding, yeah–
Evan Brand: A different branding, okay.
Dr. Justin Marchegiani: Yup. And I– I use a brand called Marie Veronique, she's a great brand– she's a great uhm— biochemist out of Berkeley California and she creates a lot of these skin– skin products, you know, homemade in small batches. And she basically puts a lot of high quality nutrients in supplemental form and a lot of her creams, and she's really good, and she comes typically one of the lowest on the environmental working group. But just take, there's a handful of good brands. Uhm– there's another one called Michelle's, and that's a decent brand that's out there. I think uh– Jessica Alba's brand, I think it's the Honest Company–
Evan Brand: Yeah.
Dr. Justin Marchegiani: –it's one product I think that comes out really good. They have a patients telling me they have a good ___[14:25] I think it's a moisturizer. But just take a look at it and see. And uhm— uh that's very helpful because you can get– they'd a really good uhm— retinol product, they've a really good Vitamin-C and uhm— a kind of immuno acid, ___[14:39] acid I think compound. And then they also have some oil-based products that are very high in Vitamin-K2 and a lot of these really good essential fatty acids which are good for your skin. You know, we just wanna be holistic. Do that, but make sure you have the diet dialed in first. If you are on a budget, work on the food stuff, work on the internal nutrients first. And then if you have extra resources and you wanna allocate, go to the external stuff second. I find it's the opposite. People are going to the external stuff first and the diet's not dialed in yet. Do the opposite, internal stuff first, collagen, bone broth, anti inflammatory diet, all the nutrients and minerals that I mentioned, get that dialed in, get the gut cleared out, get the bacteria cleared out, make sure you're digesting your foods, and then– and it also make sure motility's moving. You're having a– passing 12 inch of a stool at least a week. I mean– a day, I'm sorry, not a week. 12 inch of the stool a day, obviously at least 7 a week. That's really important 'cause if you're not having that good healthy bowel movement, you'll be reabsorbing toxins–
Evan Brand: You gotta poop folks.
Dr. Justin Marchegiani: And that's gonna be then be pushed out the skin, right? The solution to pollution is dilution, and, your skin is a mirror of what's happening in your gut.
Evan Brand: And then also the solution is pooping, 'cause if you're not pooping, you're gonna have skin issues. I've– I've– I've literally seen people improve their skin issues just by pooping from once every 3 days, to pooping every day, their skin got better just by giving them some herbs to help things move along a bit.
Dr. Justin Marchegiani: Yeah, and if your skin is excessively dry across the board, I always look at essential fatty acid intake, as well as digestion like–
Evan Brand: Oh yeah.
Dr. Justin Marchegiani: –number one, are we getting enough of these good fish oils, uh– these good Vitamin-K2, these good saturated fats from healthy animal products, coconut oil, avocados, mono and saturated palm – are we getting enough of these? Are we able to digest it? How are your stools looking? Are your stools sinking or floating? Right, remember that old expression, you know, oil and water, right? They kind of wanna separate so, you have a really fatty stool because you didn't break down your fat. You have water, so the stool, will sit on top and float more. It'll maybe look more clay colored and blond as well so, if you're seeing that, that's a big sign that you are not breaking down your essential fatty acids properly. And that we really got to ratchet up the enzymes, the HCL, and or maybe more bile salts and or lipase– lipase, meaning, li– lipid, lipid-based enzymes.
Evan Brand: Yup, well said. Your poop has to sink. It's very common. I mean, 90% of the time when we run a stool test on people, we're gonna see elevated steatocrit. Maybe it's not off the chart but that's a fecal fat marker we look at. You know, I've seen people as high as 35%. Meaning, 35% of their poop is fat. That's crazy. You do not want that. Ideally, it's like below detectable limit.
Dr. Justin Marchegiani: A hundred percent.
Evan Brand: What's the high stew scene on steatocrit? Do– do you know?
Dr. Justin Marchegiani: I've seen it uh— in the– and they operate in the mid to upper 20s before.
Evan Brand: Okay, okay.
Dr. Justin Marchegiani: And these people are you know– you know, they're having– they're reporting back, “Hey how are your stools looking?”. “Oh they're floating.” All right, you know there's an issue. I don't need a lab at that point to tell me but most of the time we're gonna see, you know, increase in steatocrit, when we see those clinical symptoms.
Evan Brand: Yup. The only of the thing I wanted to mention was the histamine issue, and, makes that– we've hit on this another podcast but that with uh– gut bacterial, like bacterial overgrowth that does mess up your ability to break down histamine from the diet. So that's why some people say, low histamine diets help. But that's still not the root cause. It's just that those malabsorption and dysbiosis issue causing you not to digest your histamines or break 'em down rather.
Dr. Justin Marchegiani: Correct. So, when you wanna– when we get deeper into like the diagnoses, just remember, the diagnoses is a manifestation of inflammation and how that inflammation is presenting itself. Inflammation that presents in certain ways gets classifieds as one condition, versus another. A lot of times the underlying way to go about it is very-very similar. And a lot of times the nutrients are very similar. So don't think like, “Oh, I have vitiligo, and this person has psoriasis”. It's like a totally different thing. Now in the eyes of the dermatologist it may be, right? ‘Cause they may say, “Oh we're gonna give you some kind of bleaching compound”, or some kind of immunosuppressant where, over here, it's like “Oh, we're gonna give you more Corticosteroids or something to help keep the itching down, right? ‘Cause they're different types of diseases where the similar autoimmunity, inflammatory mechanism happening on the inside, and of course genetic predisposition, kind of, you know, allows one disease to express itself over another.
Evan Brand: Yeah, well said. And then the ge—
Dr. Justin Marchegiani: The genetics.
Evan Brand: –and then the genetics are always, you know, they're– they're malleables. So, don't just say because my mom got “XYZ”, I'm destined to get that. That's not true. It's– it's– it's more likely, but it's not guaranteed.
Dr. Justin Marchegiani: Yup, a hundred percent. And then a couple things you can see too is– uhm— Akantosis Nigrikans is another one. And you can just google it, but you have a hyperpigmentation that's commonly caused by excessive insulin–
Evan Brand: Ahh.
Dr. Justin Marchegiani: –so if you're doing a lot of insulin lot of modifying carbohydrates you can see the Akantosis Nigrikans. Uh– on the back of the forearms you can see the Keratosis pilaris–
Evan Brand: Yes.
Dr. Justin Marchegiani: –it's like there's little bumps that pop up, and that can happen because of essential fatty acid deficiency. So if you have poor digestion or gut infections, that can be a big issue. Of course we have a Rheumatoid arthritis which you may, you know, you may be able to see the– the joints, hypertrophy in the fingers and the IP-joints, in the– the metacarpophalangeal joint, you may see a hypertrophy because there's autoimmune attack, and there's a lot of inflammation. We may see that as well. And then of course like autoimmune thyroid issues, we can see a lot of dry skin with autoimmune thyroids especially in the neck too. And that can easily be from, you know, the same underlying mechanism. So, if you have an autoimmune thyroid, you could easily have some dry skin because that's gonna be a big connection in Vitamin-A and, these essential fatty acids are important for thyroid function as well.
Evan Brand: Yeah my uh– my brother-in-law, it's my wife's sister's husband, he's got a triple AMI. He's got type-1 diabetes, he was diagnosed as a teenager, then he went on to develop Hashimoto's, then he went on to develop Alopecia. So once the autoimmune domino effect starts to happen, you can start to rack up the autoimmune diseases and that's why some clients come to us and like, “Look, I've got six different autoimmune diseases at the same time.” It's the same thing. Once that leaky gut takes place then you get the leaky skin, the leaky heart, the leaky brain, the leaky everything. So, it's very, very-very common to hear multiple autoimmune issues but the good news is, you can take a lot of this stuff and turn it around. So, just get your testing done, I mean, that's the first step, dial in the diet, all of– all of the stuff, you know, pick a step; just don't be paralyzed, just pick a step.
Dr. Justin Marchegiani: Yeah, and also excessively pale skin. We– that could be an anemic, lo– low B-12 and or Iron. And there could be a Pernicious anemia where it's affecting the intrinsic factor in your stomach, so you're having a harder time absorbing B-12. And or just low stomach acid, when you're being vegetarian, you may not get enough B-12 or Iron and then that could leave your skin more pale because red blood cell counts low, your hemoglobin's low. Hemoglobin, the heme, and the myoglobin help bring a little bit of uhm— color to your skin as well. So you could look excessively pale if you don't have enough iron and or B-12. And of course, the iron and B-12 issues can be caused by low stomach acid, not enough animal protein or animal compounds. And or the autoimmunity that affects the intrinsic factor or the parietal cells in your stomach.
Evan Brand: Yup, well said.
Dr. Justin Marchegiani: Well, any other issues you wanna address here. Of course we talked about histamine briefly, and then again that all connects down inflammation. The more inflamed you are, the more histamine-sensitive you are. Did a podcast with uhm— Yasmina Ykelenstam, the low-histamine chef. We talked about this. She harkens the fact that– yeah, cutting histamine out may help. Doing kind of natural histamine to granulate also may help, uhm— doing histamine enzymes like D– Di– Diamine oxidase may help as well but we have to cut down the inflammation. So it still comes down to getting rid of your unique inflammation wherever it's lingering.
Evan Brand: So here's the thing that I just found out. Uh– a couple of weeks ago is that Yasmina– is– she's no longer alive.
Dr. Justin Marchegiani: What happened?
Evan Brand: She passed away a few weeks ago.
Dr. Justin Marchegiani: I didn't know that.
Evan Brand: Yeah. If you go on– I think it was on her Facebook page. Uhm– and then I saw her uh– whole– her obituary is to– she's the healing histamine check, right? Yasmina Ykelenstam, sounds like that?
Dr. Justin Marchegiani: Yeah.
Evan Brand: Yeah, yeah.
Dr. Justin Marchegiani: That's really sad.
Evan Brand: Uh– it was breast–
Dr. Justin Marchegiani: [crosstalk]…last year she was really ___[23:14] and healthy.
Evan Brand: It was breast cancer; it says her on the– on the uh– obituary. She was 43.
Dr. Justin Marchegiani: Oh that's really sad.
Evan Brand: That's amazing that you got to chat with her.
Dr. Justin Marchegiani: Yeah well, I– I send my condolences to her family. That's– that's really sad, but she had a lot of great information that she provided and I'm hoping that, you know, she was able to help thousands of people during her–
Evan Brand: Right now hopefully her legacy will continue on.
Dr. Justin Marchegiani: Yeah. Absolutely.
Evan Brand: Well, good. We gotta wrap this thing up but check out justinhealth.com. If you wanna reach out to Justin, you can get help around the world. Doesn't matter where you are. So justinhealth.com, we can help you figure this stuff out. If you wanna reach out to me, you can check out my site, evanbrand.com. We always love your comments, your feedback. And we look forward to helping you soon.
Dr. Justin Marchegiani: There any questions you wanna answer here Evan, I know, we kind of really, you know, on time constraints. Other than that, you saw that you wanted to highlight?
Evan Brand: I didn't see any.
Dr. Justin Marchegiani: Okay. I think we're on the right track here. Uhm– anything else you wanna say?
Evan Brand: Not today, just– get– get help. Don't give up.
Dr. Justin Marchegiani: And I'll be back here later on this week guys for a live Q and A, so we can get some more questions and answers. I may even jump on today if I can if I have time. But you all here make sure you subscribe, give us a thumbs up, give us the share, give us the bell. And we will all chat real soon. Have a phenomenal day.
Evan Brand: Take care.
Dr. Justin Marchegiani: Take care
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