Ep. 143: What You Need to Know About Food Sensitivity Testing with Robyn Openshaw
Getting tested for your “food sensitivities” is all the rage these days. Are food sensitivity tests giving you any legitimate information? What do other experts have to say about it? In this episode I evaluate the various tests, working towards helping you decide if you want to invest in these types of tests.
LINKS AND RESOURCES:
Listen to the Episode Series “How to Smell a Rat”
View the Articles and Research sited:
- [02:48] What “Food Sensitivity” means for you. Food sensitivity wasn’t a term until seven years ago and isn’t medically recognized. So how do you get tested for it? And are the tests accurate?
- [05:22] Let’s compare this to Food Allergy. The physiological differences between food sensitivities and food allergies can be deadly. But that doesn’t mean the less severe reactions should be ignored.
- [07:36] The IgG test and you. The IgG test is most likely to be used when testing your food sensitivities, although there’s no scientific proof that it works. Incorrect results can lead to stress in your diet.
- [07:36] How about IgE? The IgE test is more accurate and consistent than IgE, but there’s still a drawback to be had.
- [20:48] You can reverse your food intolerances. Rebuilding the gut through a mostly plant-based diet (starchy foods, eliminating acidic ones, probiotics) can reverse the symptoms of an unhappy system.
- [21:48] Let’s talk about alternative tests. Some accurate labs IgG/IgG-4 include KBMO, Meridian Valley, and US BioTek, recommended by naturopathic medical doctor Alan Christianson, alongside skin tests.
- [25:28] The Elimination Diet works. Getting rid of some foods in your diet and taking careful note of your reactions is often a lot easier than undergoing the expensive and uncomfortable testing (that may not even work).
This transcript has been edited for clarity.
Robyn: Hey there, it’s Robyn Openshaw and welcome back to the Vibe show. Today we’re talking about food sensitivity testing.
I cannot even count how many of my followers over the many years have told me about spending five hundred dollars, or up to two thousand dollars even, for these food sensitivity tests.
We did a deep dive, and we went to everybody we could find that we considered to be authoritative and dug into what they had to say about it. I’m giving you the Reader’s Digest version of that today.
I just want to remind you of how much it means to me when you rate, review and subscribe. And especially, it means so much to me when you take a minute to review this show and tell me what it means to you, what have you learned? You can tell me what I can do better if you want to.
Here’s one by tnovinge (I think?). We’re going to be giving away $100 gift certificates to 10 people whose reviews we shout out, coming up right here in a week or two. And this is what tnovinge said (just to give you ideas of what a review looks like, and be sure to review other podcasts that you love too because it’s a lot of work and for the person who does it, it’s a great labor of love, and probably they don’t make any money doing it but they enjoy serving you) and she says, or he says,
“Vibrationally shifting and awakening. I truly stumbled across this podcast unexpectedly in searching for a different podcast vibe came up in a related or suggested podcast and I clicked on it as the idea of vibration has been something that I keep coming across more recently in listening to the first podcast, I soon found myself quickly devouring all of them.
“Something about Robin’s message has resonated with me in a way that I can really understand and relate to. I can feel a shift within myself vibrationally and a release happening that I’ve been searching for. I do believe I’m at the beginning of a transformational period and I believe that this podcast has been instrumental in helping to bring awareness to and shift my energy.”
So tnovinge, thank you so much for sharing that with us. I’m really excited for the shift and the up-leveling that’s going to happen for you and your awareness about it. It’s going to cause that in so many different ways. So very exciting. Thank you so much.
Today’s episode is about food sensitivity testing and the whole idea of a food sensitivity in the first place.
You should be aware — just getting us off on the right foot here about where this whole podcast episode is going — food sensitivity isn’t even really a recognized medical term. It was never even heard of until about seven years ago. And there’s no real consensus on what it means, let alone how to test it.
I’ve heard so many people over the years; they’ll talk to me and they’re wringing their hands that, due to an IgG test or some panel of food sensitivity markers supposedly, they’ve stopped eating foods that they’re supposedly sensitive to. If you tell me that your functional medicine doctor had you do it, I’m going to think less of the doctor consequently, most of them, because these tests are so clearly bogus in most cases.
What I’m going to do today is, I’m going to review the scientific literature, or evidence, and what various experts have to say about these tests, which labs are not worth your money, and which, according to one or two of my colleagues, might be worth getting if you have someone really knowledgeable to interpret them.
I’m going to talk today about how, in many cases, all you’re going to get with these tests is an indication of what you’ve been eating lately, not what you’re actually reactive to. You might be spending hundreds or even thousands of dollars on pretty useless tests, and they might end up just stressing you out and causing you to eliminate foods from your diet that are actually totally good for you and that you enjoy.
From my first source, which is the American Academy of Allergy, Asthma and Immunology, “A food allergy and a food intolerance, or sensitivity, are different things. Food allergies are an immune response to food and can be dangerous. Food intolerances, such as lactose intolerance, cause patients to have symptoms such as bloating, belly pain, gas and or diarrhea when they eat a food. The commonly available IgG test has never been scientifically proven to accomplish what it says it does. ”
Immunoglobulin G, or IgG, is the most common antibody in your blood. We’re going to talk about what this lab test actually is and why you might want to question your functional medicine doctor if he or she wants you to take one of these tests.
With a food allergy, the body is mounting an immune response to the food. And this can actually cause dangerous reactions, even all the way up to anaphylactic shock (or, your throat closing off). Most food allergies don’t cause that kind of reaction. But we all know people who have it really severe, for instance, peanut allergy.
But with an intolerance or a sensitivity, the body may just not be processing or digesting the food appropriately. And again, this is according to the AAAAI, (I said “A” four times in a row on purpose); this is a medical statement here. I didn’t just stick to the standard of care medical responses to the food sensitivity testing issues because I find that they often are dismissive of things that aren’t within their wheelhouse.
This is one statement. The AAAAI, organization about allergies and immunology, say that, “the body may just not be processing or digesting the food appropriately. And this is not actually dangerous, although it can be uncomfortable.”
What I’m adding to that is that some standard-of-care doctors are really dismissive of these uncomfortable reactions of foods. And I think they should not be dismissive, to say, “These are harmless and your body’s just not digesting very well.” I think these can be indicative of some serious gut problems. And as I often say — I’ve said this in several different episodes here on the vibe show — it’s not the food that’s the problem, it’s the gut disorder causing you to react that way to a healthy food. [Like] for some people, tomatoes or nuts.
Continuing on with that same source, “Unfortunately no single test exists that can give you this answer. A test that claims to be able to diagnose food sensitivities and is commonly available is the Food IgG test.” This test is offered by various lab companies, and it’s testing your response to multiple foods, usually 90 to 100 of them in a single panel.
The claim is that removing those foods with high IgG levels associated with them can lead to improvement in multiple symptoms. The problem is, what you’ve got to know, is that this test has never been scientifically proven to be able to accomplish what it reports to do. I think it’s a lab product that people want, so they’re providing it, and they are unregulated.
There is no government agency that won’t allow someone to sell a lab test if the lab test has been proven flawed, or doesn’t do what it says it’ll do, or is unreliable. But a lot of doctors actually know that this kind of test is pretty pointless.
One of the things that happens that a lot of people aren’t aware of is that the scientific studies — that these companies defending their lab test might point you to — are often totally out of date or they’re published in journals that don’t have a great reputation in the industry. There are a lot of journals. It looks like there just isn’t good proof at all that IgG testing is telling you anything valuable.
It’s what people are doing with that knowledge, that certain foods cause your body to produce IgG antibodies, that is more pointless. Because, you are producing antibodies just because you ate that food, not because necessarily that you have a negative reaction to it.
Another really good resource was a very extensive blog post by SelfHacked. They take the position that food sensitivity tests are a popular way to look for foods that can cause symptoms like gut problems, rashes and migraines. And there are companies like EverlyWell, the Pinnertest and others who are offering these tests and they’re promising fast results. But again, SelfHacked reports, “The IGG tests don’t actually work as advertised.” And they go further to point out that IgG antibody can either promote or prevent inflammation, and the tests can’t tell the difference between the one that’s helpful to you and the one that’s harmful to you.
The consensus in this roundup of what the experts have to say is that they advise against using these IgG-based food sensitivity tests, partly because they are unreliable.
Another one of my sources was Alan Christianson, a naturopathic medical doctor — I know I’ve had him at least once here on the Vibe Show — and he told me (I hope I didn’t get any of the details wrong because it’s been a couple of years since we talked about this) that he took the same person’s blood and sent it in to two different labs to do the same test on it, and got responses back more than 80% of the time that were so different, as to be as different as a random chance person and your blood put up against each other. So completely different, which shows the test to be very unreliable.
He also took the same person’s blood and labeled it as two different people and sent it in to the same lab. And again, the vast majority of the time the lab results came back as very, very different. Which for heaven’s sake, it’s the same blood. Shouldn’t that mean that it comes back identical?
I’ll mention this again, but if you’re talking to a functional medicine practitioner about doing some kind of food sensitivity test, if you’ve had gut issues and you’re trying to figure out what your reactivity is and what you’re sensitive to (you’re going to get a recommendation a little bit later, I’m sort of laying out the case here) a food elimination diet is a lot more useful than these tests.
I will mention (you might want to go in your notes on your phone if you’re listening to this on the phone. Don’t do this if you’re driving, you can always come back to this) he does like lab tests from US BioTek and Meridian Valley. He felt that they were consistent and more useful and affordable. So, I’ll mention that again a little bit later.
My colleague, Doctor Izabella Wentz, who’s a pharmacist, she has really specialized in Hashimoto’s. I’ve had her on the show twice as well. She’s done similar testing to find out how reliable these tests are, like Dr Christianson has, and she likes the lab Alletess. A-L-L-E-T-E-S-S.
It seems to me, with food sensitivities as a word only being out there for seven years, it’s really the wild, wild west in terms of these different tests that are becoming really popular as a way to look for root causes of symptoms like bloating, rash and Migraine. But again, Immunoglobulin G, or IgG, you’ve got to realize is the most common antibody in your blood. And those sensitivity tests assume that all IgG is pro-inflammatory when actually a lot of it is anti-inflammatory. I kind of wonder if, when your functional medicine doctor has you do one of these tests, if they’re a little behind the times and don’t know this information is out there.
A lot of functional medicine doctors have stopped prescribing these lab tests. The technology is based on shaky science. It costs several hundred dollars or more. I once got a panel for my son that costs $2,000 from Genova. I just want you to be wary of that.
The fact of the matter is, certain sugars act like a switch that flip the IgG antibody from a pro-inflammatory to an anti-inflammatory molecule. And the molecule is actually very complex, and it doesn’t mean — if you have high levels of IgG in your blood — it doesn’t mean that you’ll have inflammation. The anti-inflammatory version tells your body not to attack.
These are some of the leading medical organizations that I’ve found that advise against using the IgG-based food sensitivity tests.
There’s the European Academy of Allergy and Clinical Immunology and a quote from them — this actually dates all the way back to 2008 so there must’ve been some kind of early testing on top of the normal medical allergy testing — “Food-specific IgG-4 does not indicate imminent food allergy or intolerance, but rather a physiological response of the immune system after exposure to food components. Therefore, testing of IgG-4 to foods is considered as irrelevant for the laboratory workup of food allergy or intolerance, and should not be performed in case of food-related complaints.”
That was back in 2008, and I’m sure science has advanced in the last 11 years, but this suggests to me that people have been trying to test for this even longer than I thought.
A Canadian government agency — it’s called the Canadian Society of Allergy and Clinical Immunology — says, “There is no body of research that supports the use of this test to diagnose adverse reactions to foods or predict future adverse reactions.”
They say, “The inappropriate use of this test only increases the likelihood of false diagnoses being made, resulting in unnecessary dietary restrictions and decreased quality of life.”
In science, one of the most important things about any given study is whether it can actually be reproduced, given the same materials. Can I conduct the same experiment and get the same result?
We talked about this in my episodes that I did about how to smell a rat. Those were episodes 110, 111, and 112 where we dived into some of the controversies in the health and wellness world, and even the functional medicine world. We took a look at some of the ways that you can train yourself to look more critically at what you’re being sold by someone selling health and wellness things. Not just your standard-of-care doctor and the drugs and surgery approach, but also, not everything is equally valuable in the world of holistic medicine either.
The thing is, these allergy tests are not reliable. Reliability is, can you repeat the study with the same kind of results?
We went over this, the two major, very simple — this is like the low bar for research — you have to clear the bar of reliability and you have to clear the bar of validity. And unfortunately, these allergy tests (I’m not talking about the one where you go get the pinpricks on your back; that one has been quite well validated) these ones that are just going crazy out there in the functional medicine world do not meet that low bar of reliability or validity.
My colleague Dr. Alan Christianson, in his coverage of this topic, says on the other hand that blood IgE test — now we’re not talking about IgG, we’re talking about a different antibody IgE tests — they are actually relatively accurate and consistent. The problem is they’re less useful because IgE reactions are typically obvious due to their quick and severe onset.
If you’re having a big flare up of IgE, you are going to know it. Another problem is that when a doctor does a blood test for food reactions and they’re using IgE, the foods that a person has avoided eating for long periods of time, those aren’t going to show up even if you’re reactive to that. Only the foods that you’ve been eating.
Laboratories these days test for a more broad range of immunological reactions to food. There’s IgA, IgD, IgG, there’s cytokines, and there are actually many others. Like I said, I just feel like it’s really the Wild West and I wouldn’t put a ton of stock in any of these tests.
Cytokines, by the way, are proteins that are released by cells. They’re kind of an intermediary and they play a role as the messenger between immune system cells and non-immune system cells. They help regulate inflammation and the body’s response to disease and infection. They’re really important in a lot of different cellular processes.
It’s also the Wild West for Lyme disease and diagnosing Lyme disease. And my daughter, two years ago, I had her tested. She had been bitten by several ticks several years ago, and I think I mentioned that she had a major reaction a few years ago, which may or may not have had anything to do with the ticks, but I didn’t know why she would have a seizure. Well, she hasn’t had any seizures since and it’s been a few years now, I want to say three years. But I was concerned, and I know that you don’t want to let Lyme go. You want to get that diagnosed and get right on it as soon as possible. So, I sent her to a functional medicine doctor I knew who specializes in Lyme.
His name is Dr Darren Eagles. I don’t know if he’s still in both Connecticut and Irvine, California, but he was then two years ago. He tested her for antibodies, and of the six antibodies associated with Lyme disease, my daughter was subclinical — but still fairly high — in five of them. So that would the CDC say she had Lyme? No; she was positive for five of the six antibodies, but she was below that threshold where CDC would call it disease.
But then a year later (and I don’t know if it was the treatment that he put her on, which did not involve antibiotics by the way, we didn’t feel the antibiotics would be useful so long after the infection from the ticks) she went a year later to uh, to Switzerland and my Swiss doctor there tested her for cytokines. It was a completely different set of biomarkers and the test came back that my daughter was negative for Lyme.
It just goes to show you how there is a lot of debate out there and there’s a lot that’s unknown out there. And a lot of times your functional medicine doctor is going on some guesses and the tools they have available, and the tools are not at all perfect.
Dr. Christianson feels that if food intolerances are keeping you from being happy and healthy, you can reverse the problem.
It’s a lot of, I’m sure what I say about food intolerances, when you rebuild the gut, you eat a starchy diet. A mostly plant-based diet. You give up the acidic foods, especially like coffee and alcohol, and you spend some time really tending to your gut; maybe eat small amounts of probiotic-rich foods that you hopefully make yourself. You take a really good probiotic, one that you know to still be alive when it gets to you.
I think that you can heal food intolerances naturally because it’s your gut’s reaction. But Dr. Christianson feels that the best tests — he’s not throwing the baby out with the bath water here — but he thinks that the best test to identify food intolerances are going to include IgG and IgG-4 antibodies.
The most accurate labs that he likes are KBMO, which is a food inflammation test, and Meridian Valley, and US BioTek. I told you that I’d mentioned those two labs that he trusts.
Dr. Christianson also says that he thinks that skin tests actually work for diagnosing allergies and they are reasonable in cost, but they’re not great for allergies airborne or dietary or the delayed reaction allergies. And that’s the thing, especially with gluten. Celiacs often have a very hard time getting diagnosed because it’s not like they eat a piece of bread and their throat starts itching and they develop a rash and they have respiratory distress or whatever; sometimes it’s two days before you see the reactions.
So, delayed-reaction allergies are part of the problem in really getting a good diagnosis. Another thing that Dr. Christianson said, which was interesting, “If you’ve taken some kind of food sensitivity tests that show that you’re reactive to calm and healthy foods like berries, vegetables, or greens, don’t trust them.” He says those allergies are so rare that it doesn’t justify your stress for avoiding these foods and the benefits that you’d be missing out on by doing so.
Another source that I liked was from a publication called Today’s Dietitian; Melanie Silverman is their source, who’s a registered dietician, and she says, “When someone has a food allergy, it’s an immune response and IgE antibodies are released. A food intolerance doesn’t involve the immune system.
“In the literature, the terms food sensitivities, allergies, and intolerances are used interchangeably, but a food allergy is an immune system response when the body mistakes a particular food as harmful substance.”
Then Melanie Silverman goes on to say, “IgE antibodies are released mounting a defense against the food in the body with a release of chemicals, like histamine, causing the allergic reaction. Symptoms of an allergic reaction can manifest in a minor way as rashes, itching, hives or swelling, or in a severe way when people have serious trouble breathing and can lose consciousness. As a result, a food allergy can be fatal.
“A food intolerance, often called a non-allergic food hypersensitivity, doesn’t involve the immune system and is more common than the diagnosis of a food allergy. Food intolerances often are delayed in their response and difficult to diagnose,” Silverman says.
I want to point that out that just because you eat a food and you haven’t noticed a reaction to it in the few hours afterwards, it doesn’t necessarily mean that your body likes that food. Often the actual reactions come later.
The triggers are substances that naturally occur in foods or arise in food processing methods or are added during processing.
Another registered dietitian that this article quoted, her name is Susan Link, and she specializes in chronic inflammatory conditions related to food sensitivities and allergies and intolerances. She says, “There’s a lack of consensus about the definition of food intolerances and food allergies and that would help explain why there’s so much overlap and interchangeability and contradiction in the literature.” She points out — and I really think this is an important point — that you can’t just get a test and diagnose it.
If you understand one thing from this episode, then I hope you understand that, but an elimination diet has to be part of the process. Getting rid of some foods in your diet and taking careful note of your reactions, that’s often a lot easier than undergoing the expensive and uncomfortable testing that may not even work.
The elimination diet is still the gold standard in helping patients identify food intolerances for functional medicine doctors who actually know what they’re talking about.
An elimination diet means that you get rid of the food that you suspect to be a problem for a full four weeks. You have to be really vigilant, especially when it comes to things like dairy and gluten, which are going to be your top two things I would suspect right out of the gate, because there are so many dairy products and gluten products in packaged foods.
Yet another reason to eat a whole foods diet is then you don’t have to be looking at these processed food labels. Gluten and dairy hide by many other names. For instance, you may not realize that if something says whey protein, did you know that that came from cow’s milk?
Because of that, I had a really hard time getting my son Tennyson off of dairy products. I didn’t know whether gluten or dairy was his big problem, but he turned 14 and in combination with the hormonal changes going on for him as he became an adolescent, he suddenly had really bad acne.
That was weird because my ex-husband had some acne when he was high school, but not as bad as Tennyson did. And I didn’t have it too bad. My other kids didn’t have it too bad, so this was worse than anything I had seen in our family. And I told him that I really thought that he should get completely off of dairy. I told him I would help him, and we even would start into it a few times.
But he’s a very social kid. He’s just a big man on campus in high school, and he was often at other people’s homes or they would bring junk over and he doesn’t have a lot of self-discipline when it comes to food. So, he would usually try to, for two days, maybe a whole week, but you have to take longer than that in a food elimination diet.
You need to go like a full four weeks and then evaluate, because your body’s still clearing its inflammatory response to that food. You have to be very, very pure about it.
Well, last summer he’s out there in southern California. He’s knocking on doors, selling, doing door-to-door sales with his sister as his boss. The two of them are number one and number two in the company and they’re doing great. But last summer it was his first summer doing this job. And I remember once him texting me and saying, “I’d been doing great. I was off of dairy for two weeks. I felt fantastic. And then today I ate dairy twice and I can’t work. I’m literally sitting on a park bench in the park and I can’t do anything.”
As his frontal lobe develops in his brain and he makes more choices based on consequences and based on his future thinking and what he cares about most — which you’re not really as capable of doing when you’re an adolescent and you don’t have a well-developed integrated frontal lobe of your brain and you’re sort of doing most of what you do out of lizard brain, as in kind of living in the moment — as he’s growing up, I’m seeing him making better choices in general.
I don’t know about you, but I always try to notice that and verbalize it and give a compliment when my child is thinking more futuristically and making good decisions based on consequences. He — this summer and in fact this whole last year at school — I think he just got serious about, “I don’t want acne anymore. I’m willing to give up everything with dairy in it even though I think it tastes good because I don’t want acne.” And maybe it’s because he’s got a girlfriend. Or maybe, I really think most of it is just maturing. We finally are just not willing to live with the consequences. We’re not willing to live in lizard brain anymore. Like, “Needs skittles, yummy yum.” Like that’s not the only thought that goes through our head when we decide whether we’re going to eat skittles anymore.
So, he is off of dairy and he looks amazing, and I don’t think it’d be possible for him to be number two in the whole company for sales this summer if he were eating dairy because it just took his legs out from under him. He felt horrible. He had gastric distress, he had acne. Really, really classic symptoms of food sensitivity.
There’s an article in Science-Based Medicine, where they took a look at food intolerance testing with the blood test. The CBC television show Marketplace did a really cool deconstruction of IgG testing and they had their host, Charlsie Agro, draw blood and send it into an IgG lab. I believe it was offered by Dynacare and Rocky Mountain Analytical. They’re owned by LifeLabs.
Before taking the tests, they had Agro track what she was eating and send in the blood to the two different labs, I guess. Dynacare and Rocky Mountain Analytical, which is owned by LifeLabs, are two different labs, but the test results came back. Both tests reported intolerances to foods that she regularly consumed with absolutely no adverse reactions.
I think that’s indicative of what we’ve already said here, which is that IgG is telling you what foods you’ve eaten, not what foods you’re reactive to.
That kind of helped me understand my experience because I’ve had people test me with lab tests — not because I have gut issues, I’ve never done that, but sometimes I just get lab tests because I want to be able to talk about it on my podcast, I want to be able to write about it on my blog or I’m curious about this lab versus that lab — I’ve been tested for food sensitivities five different times in five different methods. And that they were different methods is part of the issue, it’s not like it was five different labs who offered the IgG test, but every single one of them came back with completely different food sensitivities and there wasn’t a single thing that crossed over from any of them.
I remember one of them, the list was garlic, cashews, watermelon. And I remember reading it and going, “Oh my gosh, these are the foods I eat. These are the foods in my regular diet and things I’ve eaten recently.” I mean, watermelon, I had just eaten quite a bit of watermelon in the week before that. Now that makes more sense as I did this deep dive for you. I was able to connect the dots on some things. I knew that I didn’t trust the tests because every single time I do it, they’re completely different. I had wondered, do your food sensitivities change over time so dramatically that it doesn’t even matter to get tested?
But obviously the problems that I’ve uncovered here in this deep dive into researching come up with even more sinister analysis of the millions of dollars people are spending on these tests, which appear to be actually quite fraudulent.
What the CBC television show Marketplace said is, “The IgG test, as expected, identified food that Agro had consumed recently, not foods that she had any difficulty tolerating. It’s easy to see how this type of testing could lead to disordered eating, possibly causing someone to totally transform their diet in the belief that they are intolerant to healthy foods.” That’s not a direct quote. I changed it up a little bit to make it shorter.
Bottom line, there are lots of food sensitivity tests available on the market. And one of the reasons why I think that’s the case is that the FDA doesn’t regulate them.
A lot of times functional medicine practitioners have nothing to rely on besides the claims of the labs, or maybe a colleague of theirs recommending them because they’re trying to help people. But we’re still in a bit of an early phase in figuring out a lot of things in functional medicine.
I feel like what I’ve seen in the functional medicine world in the last 10 years that bothers me a little bit, is that they’re getting into more and more lab tests, and some of them that are being run are either not proven scientifically to be valid and or they’re at least not in a place where they lead to any clear diagnosis or treatment.
Again, bottom line, I don’t think people have food sensitivities because that food is bad for them with their biology or because of their heredity. I think it’s indicative of autoimmune problems and gut dysbiosis, which is why everything we talk about here on the Vibe Show is so important and why I’m so glad that you’re getting educated on ways to have a healthy gut. Because a healthy gut is a healthy immune system, and a healthy immune system is a healthy you.
I hope that this episode today, while it was a little bit sciency, I hope it’ll save you some money on bogus lab tests and help you be a more savvy consumer of functional medicine services and at least be able to ask better questions in your own healthcare. I’ll see you next time.