RHR: Is Non-Celiac Gluten Intolerance Actual?

On this episode, we talk about:

• The distinction between celiac illness and non-celiac gluten sensitivity
• What the science actually says about wheat and gluten intolerance 
• Diagnostic standards which were established over current years for non-celiac wheat sensitivity
• Why typical testing is proscribed in its scope, leaving sensitivity to gluten and wheat underdiagnosed
• The right way to take a look at whether or not you’re delicate to wheat, gluten, or each

Present notes:

• “Intestinal cell harm and systemic immune activation in people reporting sensitivity to wheat within the absence of coeliac illness” by Alaedini et al.
• “Is Gluten Really Harming Your Mind?” Tuesday Tip video
• Ought to You Go Gluten-Free? The Science Behind Non-Celiac Gluten Intolerance free eBook
• Cyrex Labs Array 3X
• Vibrant Wellness Wheat Zoomer
• Articles from Chriskresser.com:
  • “Is Gluten Sensitivity Actual?”
  • “50 Shades of Gluten (Intolerance)”
  • “The Signs of Gluten Intolerance You Haven’t Heard About”
  • “Nonetheless Suppose Gluten Sensitivity Isn’t Actual?”
  • “3 Causes Gluten Intolerance Might Be Extra Critical Than Celiac Illness“

Hey, all people, Chris Kresser right here. Welcome to a different episode of Revolution Well being Radio. On this present, we’re going to speak about non-celiac gluten sensitivity and talk about whether or not it’s an actual situation or [if] it simply exists within the minds of people that declare to be gluten illiberal. That’s, certainly, the impression that you just get if you happen to comply with the mainstream media on this matter or discuss to your main care physician about it.

I’ve discovered, from speaking to sufferers [who] come [to] see me within the clinic, [that there’s still a common impression] that gluten intolerance is imaginary and the one situation that [actually exists] relating to gluten is celiac illness. In case you are certainly one of [the] individuals [who] suffers from gluten intolerance and also you don’t have celiac illness, you realize precisely what I’m speaking about. You’ll have been ridiculed or criticized by individuals in your loved ones, your mates, or on social media. As I believe you’ll come to know by the tip of this present, that’s not solely unfair, [but] it’s [also] fully out of alignment with the present scientific proof base. We’re going to overview a number of the research that help non-celiac wheat sensitivity, which [is what] I’ll discuss with [non-celiac gluten sensitivity] as on this present, as a result of it seems that individuals will be delicate to a number of proteins inside wheat, not simply gluten, which is just a kind of proteins. The current statistics that we’ve got recommend that this situation impacts as much as 18 million Individuals, or about 5 % of the inhabitants. So we’re not speaking about one thing that impacts a small handful of individuals. That is one thing that impacts a lot of individuals, and the impression will be vital, equaling, or, in some circumstances, even surpassing, the impression that celiac illness can have.

On this podcast, I’m going to share analysis on non-celiac wheat sensitivity and, I hope, present you convincingly that it most undoubtedly does exist, and it contributes to a surprisingly various vary of situations, from despair to schizophrenia, epilepsy, kind 1 diabetes, osteoporosis, dermatitis and psoriasis, Hashimoto’s [disease], hypothyroidism, [and] peripheral neuropathy. Prepared? Let’s dive in.

Celiac Illness vs. Non-Celiac Wheat Sensitivity

Celiac illness and non-celiac wheat sensitivity are two distinct situations with a number of main variations. Celiac [disease] is an autoimmune illness characterised by an inflammatory immune response to wheat, rye, barley, and different gluten-containing proteins. It ends in a big disruption of the traditional construction of the tissue within the intestine, together with atrophy of epithelial cell projections known as villi, and an enlargement of intestinal crypts the place new epithelial cells type from stem cells. Celiac illness is strongly related to the genetic haplotypes DQ2 and DQ8 of the [human leukocyte antigen] (HLA) gene. There’s a very sturdy genetic predisposition and heritable high quality [to] celiac illness. When it comes to blood biomarkers, the transglutaminase-2 (tTG2) autoantibody is taken into account essentially the most delicate marker for celiac illness. However that testing isn’t excellent and will be problematic, as we’ll talk about afterward.

Non-celiac wheat sensitivity, however, is a time period that’s utilized to individuals who expertise signs in response to consuming wheat or gluten, however who lack the attribute markers of celiac illness. The record of indicators and signs will be extremely broad, starting from [gastrointestinal] (GI) discomfort to fatigue, neurological points, pores and skin rashes, [and] even paralysis, in some circumstances, though momentary. These individuals have a tendency to enhance on a gluten-free eating regimen, however, as I stated within the introduction, they’re usually mocked or ridiculed for avoiding wheat and gluten and informed that their sensitivity is all of their head. In response to claims which were revamped the previous few years, I’ve written a number of articles on non-celiac wheat sensitivity on my weblog, and I’ll hyperlink to these within the present notes. If you wish to verify them out, you may head over to my web site, however the gist is that non-celiac wheat sensitivity is certainly an actual situation. It’s supported by quite a few research in scientific literature, and it may, like I stated simply now, be as critical or much more critical than celiac illness, in some circumstances.

You’ll discover that those that declare that gluten sensitivity isn’t actual usually cite a research that attributed any destructive reactions that individuals expertise to gluten to [fermentable oligosaccharides, disaccharides, monosaccharides, and polyols] (FODMAPs). This can be a class of compounds, most of them complicated, long-chain carbohydrates, that individuals with digestive points have bother breaking down. The low-FODMAP eating regimen is commonly utilized in that context for individuals with [irritable bowel syndrome] (IBS) or different GI issues to assist scale back signs. There have been a few research [which] have proven that some individuals who thought they had been gluten illiberal truly had FODMAP intolerance. Once they got purified gluten in a capsule, exterior of the standard meals that [contain] gluten [and] are additionally high-FODMAP, they didn’t have any response. Whereas, after they [ate] high-FODMAP meals, they did have a response. And I don’t doubt that’s true for some individuals. I see FODMAP intolerance rather a lot in my observe. Lots of people with digestive points can’t tolerate FODMAPs. Once more, I believe it’s at the very least believable that some individuals who imagine they [are] gluten illiberal are literally FODMAP illiberal.

Research Supporting Non-Celiac Wheat Sensitivity

Nonetheless, there have been a number of research executed since then, which I believe are a greater manner of getting on the query of non-celiac wheat sensitivity. Even with that one specific research, the researchers selected whey protein for individuals within the management group, which is a horrible selection, contemplating that a lot of their topics seemingly had infected guts and a number of meals sensitivities, together with dairy merchandise. I don’t assume [it] was a well-designed research, and I [certainly] don’t assume it answered the query definitively. A significantly better research was revealed a number of years in the past in BMJ Intestine. Researchers at Columbia College Medical Heart enrolled 80 individuals with self-reported gluten intolerance, 40 individuals with celiac illness, and 40 wholesome controls who [had no] recognized response to gluten. The sufferers with gluten intolerance had been excluded in the event that they confirmed any of the attribute diagnostic markers of celiac illness, like alpha-gliadin antibodies, tTG2 antibodies, or any historical past of celiac-like structural modifications within the intestine. They needed to have a clear pattern of people that claimed to be gluten illiberal however had no proof or historical past of celiac illness.

They took blood samples and intestinal biopsies from all the individuals on this research. The blood samples had been used to search for specific signaling molecules and proteins within the blood, whereas the biopsies had been used for tissue evaluation within the intestine. Along with evaluating these measures between the totally different teams, in addition they took a subset of 20 sufferers with gluten intolerance who had adhered to a strict gluten-free eating regimen for six months and in contrast their blood and tissue samples earlier than and after gluten avoidance. What did they discover? Effectively, non-celiac wheat-sensitive people had leaky intestine. Large shock. They confirmed elevated intestinal permeability when in comparison with wholesome topics. That shouldn’t be a shock as a result of we all know that gliadin, which is a element of gluten, can have an effect on tight junction proteins that assist regulate intestinal permeability. As well as, topics within the non-celiac wheat sensitivity group had proof of systemic immune activation. Their blood ranges of lipopolysaccharide-binding protein and sCD14 had been considerably elevated as compared with individuals who had celiac illness [or] wholesome controls. These are delicate markers of microbial translocation, which suggests [that] micro organism that ought to keep within the intestine [were] leaking into the bloodstream and inducing a low-grade power inflammatory response. Evaluation of the tissue biopsy confirmed that the non-celiac wheat sensitivity group additionally had epithelial cell harm just like the celiac illness group, which was supported by elevated ranges of a marker known as [fatty acid-binding protein 2] (FABP2). Within the subset of non-celiac wheat-sensitive people [who] had been analyzed earlier than they began their gluten-free eating regimen, they discovered that irritation and cell harm markers improved considerably after six months of gluten avoidance. This was a way more rigorously designed research, as you may see, and I believe it fairly conclusively proves the existence of non-celiac wheat sensitivity as a situation.

Diagnostic Standards for Non-Celiac Wheat Sensitivity

Because the analysis has progressed over the previous few years, there have been some diagnostic standards established for non-celiac wheat sensitivity, [including whether] consuming gluten provokes a fast incidence of intestinal and extraintestinal signs. “Extraintestinal” means exterior of the intestine, so a number of the issues we talked about earlier than—brain-related points [like] nervousness, despair, [or] cognitive dysfunction, pores and skin [issues] like eczema or psoriasis, hormone imbalance, modifications in blood sugar, [or] anemia. We’ll discuss slightly extra about a number of the different situations that gluten intolerance can provoke in slightly bit, however one factor I’d add to that is that the response isn’t all the time fast, in my expertise. Usually, [it] is, however it may [also] be delayed by a number of hours, or perhaps a day, in some individuals. And that may make it harder to establish [the] downside. [Let’s say] somebody eats gluten for lunch in the future and so they don’t discover a big response proper after, [or] even that night. However the subsequent day, they really feel horrible. They won’t hint it again to the gluten they ate at lunchtime the day earlier than.

It’s turning into clear that celiac illness is just one manifestation of gluten intolerance, and that non-celiac gluten sensitivity is a legit well being situation. Tune into this episode to be taught extra about gluten intolerance and the shockingly various vary of situations it may contribute to. #chriskresser #glutenintolerance #celiac #NCGS

The following [criterion] is that signs disappear or are enormously relieved when gluten is faraway from the eating regimen, and recur if gluten is reintroduced. Wheat allergy has been dominated out. An allergy is totally different [from] an intolerance. That’s mediated by a special a part of the immune system and will be simply examined for [by] any immunologist or clinician [who] focuses on meals allergic reactions. It’s good to rule out an [immunoglobulin E] (IgE)-mediated wheat allergy, and likewise good to get the fundamental celiac illness testing, though it’s not excellent, to rule out celiac illness. Intestinal mucosa is regular, so no atrophy or blunting of the intestinal villi. That’s a part of the usual workup for celiac illness. With non-celiac wheat sensitivities, about 50 % of the time, you’ll see antibodies to gliadin, however 50 % of the time, you gained’t. It’s actually only a coin flip. A destructive end result, and that is actually vital to know, with this typical take a look at doesn’t imply that you just don’t have the situation. Likewise, with the genetic markers HLA-DQ2 or HLA-DQ8, solely about 40 % of the time these are constructive. Nearly all of the time, they’re destructive, so these are usually not very helpful diagnostic markers, both.

Why Gluten Intolerance Is Possible Extra Widespread Than We Suppose

One of many greatest points right here, as I’ve alluded to, is that the traditional testing is admittedly poor. As a way to clarify why, I’ve to offer you a fast lesson in [the] biochemistry of wheat and wheat digestion. I’ll attempt to make it as temporary as doable. Wheat comprises a number of totally different courses of protein. You hear rather a lot about gluten, however wheat is a fancy plant and has many various proteins in it, [including] gliadin, which is the scientific title for gluten, and glutenin. That’s very complicated. That’s spelled g-l-u-t-e-n-i-n. It’s not gluten. It’s a special protein known as glutenin. These are the 2 predominant elements of the gluten fraction of the wheat seed. You might have gliadin and glutenins. By the way, these are important for giving bread the power to rise correctly throughout baking, and it explains why you’ve in all probability by no means had a superb gluten-free croissant. Gluten is fairly superb in that regard, and the elements of gluten which are accountable for this are the gliadins and the glutenins. Throughout the gliadin class, there are 4 totally different epitopes of gliadin. There’s alpha-gliadin, beta-gliadin, gamma-[gliadin], and omega-gliadin. Then wheat comprises proteins known as glutenins that bind to sugar and prodynorphins, that are proteins concerned with mobile communication. As soon as wheat is consumed, enzymes within the digestive tract known as transglutaminases assist break down that wheat compound, and, in that course of, further proteins are shaped, together with deamidated gliadin and gliadorphins, that are typically known as gluteomorphins.

Right here’s the essential factor to know. Celiac illness is characterised by an immune response to 1 particular epitope of gliadin, alpha-gliadin, and one particular kind of transglutaminase enzyme, which is tTG2. However we now know that individuals can and do react to the opposite elements of wheat and gluten, together with the opposite three epitopes of gliadin (beta, gamma, and omega), the gluten in a part of the wheat protein (wheat germ agglutinin), deamidated gliadin, in addition to the opposite varieties of transglutaminase enzymes, together with kind 3, which is primarily discovered within the pores and skin, and sort 6, which is primarily discovered within the mind. An instance of how this may play out is that, within the extra complete testing that I do with sufferers, I’d display someone for wheat and gluten intolerance, and so they may take a look at constructive for beta- and gamma-gliadin antibodies, after which perhaps wheat germ agglutinin, and perhaps transglutaminase-3. I may predict, primarily based on the actual enzyme they’re reacting to, transglutaminase-3 on this case, that their response to gluten goes to manifest primarily within the pores and skin as a result of that’s the place that enzyme is discovered. However [if] this particular person had been to go get a traditional take a look at for gluten intolerance, [they] could be fully missed and misdiagnosed as having no response as a result of that typical take a look at solely appears to be like at antibodies to alpha-gliadin and transglutaminase-2. If you happen to’re reacting to any of the opposite fractions of the wheat protein or some other kind of transglutaminase, you’re going to check destructive, and also you’ll be informed that you just don’t have a problem with gluten. I can’t inform you what number of occasions I’ve seen that in my observe over 15 years. Most likely over 100 occasions as a result of I take a look at nearly all sufferers for non-celiac wheat sensitivity, and plenty of of them had already had earlier checks that had been mislabeled as being regular.

One more reason non-celiac wheat sensitivity continues to be underdiagnosed is due to the shockingly various vary of issues it may trigger. Gluten intolerance can have an effect on almost each tissue within the physique, together with the mind, pores and skin, endocrine system, abdomen, liver, blood vessels, easy muscle tissues, and even the nucleus of cells. As I stated earlier, it’s related to an astonishing number of illnesses from schizophrenia to epilepsy, kind 1 diabetes, osteoporosis, pores and skin situations, Hashimoto’s [disease], hypothyroidism, [and] peripheral neuropathy. As a result of the vary of signs related to gluten intolerance is so broad and nonspecific, which suggests it may probably be attributed to any variety of situations, many sufferers and docs don’t even suspect that gluten could also be the reason for a selected downside, particularly if the affected person doesn’t current with the traditional GI signs that many individuals assume should be current if somebody has gluten intolerance. Let me offer you a number of particular examples. You get an annual bodily out of your physician, and [they discover] you could have anemia. [They’ll] seemingly prescribe an iron complement or, if you happen to’re a feminine, ask you questions on your menstrual cycle. Nonetheless, iron deficiency anemia is well-documented as a symptom of gluten intolerance in scientific research. In reality, analysis means that it might usually be the primary noticeable symptom of celiac illness and that as much as 75 % of these with an anemia prognosis could also be gluten illiberal. Gluten intolerance can intrude with the uptake of iron from meals, which causes malabsorption of iron and might result in anemia.

Or let’s say you go to your physician complaining of a headache. It’s extremely unlikely [they’ll] take a look at you for gluten intolerance, which is unlucky as a result of headache is a frequent discovering in non-celiac wheat-sensitive sufferers, with one research reporting that symptom in additional than half of the contributors. That was very true for individuals with migraines. Or perhaps you go to your dermatologist complaining of eczema or psoriasis or one other pores and skin situation. There’s just about no likelihood you’ll be examined for gluten intolerance. However, once more, it is a mistake, as a result of individuals with non-celiac wheat sensitivity can discover a worsening of pores and skin signs like eczema, rash, and dermatitis after consuming gluten. Essentially the most generally reported pores and skin lesions embrace these just like subacute eczema, in addition to the bumps and blisters indicative of dermatitis herpetiformis, or Duhring’s illness, which celiac illness is intently linked to. Those that are gluten illiberal might also expertise scaly patches resembling psoriasis, and the lesions are sometimes discovered on the muscle tissues of the higher limbs, though not all the time.

Lastly, brain-related points like despair, nervousness, dementia, Alzheimer’s [disease], and Parkinson’s [disease] are often related to gluten intolerance. Current statistics recommend that as much as 22 % of sufferers with celiac illness develop such dysfunctions, with nervousness and despair occurring mostly. One research discovered that [patients with] celiac illness had been extra seemingly than others to really feel anxious within the face of threatening conditions, whereas further analysis has linked situations like panic dysfunction and social phobia to gluten response. Melancholy and different associated temper problems additionally seem to happen with each non-celiac wheat sensitivity and celiac illness. And research now recommend that intestine dysfunction, which will be pushed by undiagnosed gluten intolerance, results in irritation within the mind and the hallmark indicators and signs of cognitive and neurodegenerative situations. I cowl this in additional element in a current Tuesday Tip video on my YouTube channel known as “Is Gluten Really Harming Your Mind?” I’ll put a hyperlink to [it] within the present notes, or you may go to YouTube.com/ChrisKresser to seek out it.

The right way to Take a look at Whether or not You’re Delicate to Wheat, Gluten, or Each

Okay, with all this in thoughts, how are you aware if you happen to or your kids could also be affected by non-celiac wheat sensitivity? Sadly, you may’t depend on the traditional testing that your main care doctor or GI [doctor] may supply, for the explanations we’ve simply mentioned. I can’t inform you what number of occasions sufferers have come to me and stated their physician examined them for celiac or non-celiac wheat sensitivity and so they had been destructive, solely to seek out out that they had been vastly constructive once we use extra correct testing. The 2 checks I’ve used within the clinic with sufferers are Array 3X from Cyrex Labs, and the Wheat Zoomer panel from Vibrant Wellness. These checks aren’t excellent, and so they do require some experience to interpret, however they’re much more complete than typical checks as a result of they take a look at all the opposite elements of the wheat protein moderately than simply taking a look at alpha-gliadin and transglutaminase 2, like the traditional checks do.

You do want a health care provider to order these checks, and, in my expertise, most typical main care or GI [doctors] are usually not accustomed to them and usually gained’t get them organized. Your mileage could fluctuate. I’ve heard of some circumstances of sufferers with the ability to persuade their docs to order these checks, so it’s actually value a attempt. However you’re extra more likely to discover success with an Integrative or Practical Drugs physician or clinician, or a nutritionist who has this sort of coaching. They’re extra more likely to work with these labs and have the ability to interpret them correctly. If you happen to don’t have entry to a practitioner who makes use of these labs, you may nonetheless do a gluten-elimination provocation problem. The truth is [that] that is nonetheless the gold normal relating to figuring out gluten intolerance. I’ll usually ask sufferers to do it, even when they’ve examined constructive with the Cyrex Array 3X or Vibrant Wheat Zoomer, with a view to affirm the prognosis.

Right here’s the way you do it. You take away all gluten-containing meals and merchandise out of your eating regimen for 60 days. There’s a variety of info on-line accessible about how to do that, and the excellent news is that it’s a lot simpler to do it now than it was once I first began training 15 years in the past. In just about all locations on the planet, nicely, I gained’t say all locations on the planet, however [in] many locations on the planet, it’s fairly straightforward to keep away from gluten if you happen to’re diligent. There are many gluten-free options at this level. But it surely’s actually vital to be strict throughout [those] 60 days since you’re attempting to get your physique to a baseline reset with none gluten in any respect. Dishonest throughout this time can actually be counterproductive since you’ll by no means get to that baseline. So throughout this elimination provocation problem, it’s very important to be strict for that first 60-day interval. On the finish of the 60-day interval, prepare dinner up a bowl of barley and eat it, and see what occurs. You will get barley at a variety of well being meals shops. You should purchase it, typically within the bag, the place different grains are bought. And also you don’t must get fancy right here. That is simply a part of a take a look at. I’m positive many individuals haven’t ever eaten barley as an entire grain, however you simply prepare dinner it such as you do rice. The directions will likely be on the bag. Simply eat a bowl and see what occurs. The explanation for doing that is that barley is a gluten-containing grain that’s low in FODMAPs. Keep in mind, we talked in regards to the research that confirmed that some individuals who thought they had been gluten illiberal had been truly FODMAP illiberal. If you happen to eat the barley and react to it, that means you’re illiberal of gluten or different gluten-like compounds, as a result of there are only a few FODMAPs in barley. If it was FODMAP intolerance that was an issue for you, then consuming barley wouldn’t provoke a response as a result of there aren’t many FODMAPs in barley. Then, a number of days later, eat a bit of wheat bread. The wheat bread has each gluten and FODMAPs. If you happen to didn’t react to the barley however you do react to the wheat bread, it suggests that you could be be FODMAP illiberal, moderately than gluten illiberal. If you happen to react to each the barley and the wheat, then that means you’re gluten or wheat illiberal.

Now, some sufferers have requested me about this take a look at over time. They are saying, “If I do this, I’m going to be in ache for per week afterward. If I eat a bit of wheat bread, it’s going to be ugly.” My response to that’s, “Then you definitely’re nearly actually gluten or wheat illiberal, and that’s actually the tip of the story.” You don’t must go additional than that. If you happen to discover a violent response anytime you eat something with gluten or wheat in it, and also you don’t have entry to the testing to verify, that must be sufficient. You don’t actually need your physician or buddies or household to purchase into your prognosis, though I understand how irritating it may be after they don’t, and it’s irritating when that occurs. However on the finish of the day, it’s your physique, and you’ll be the one which suffers if you happen to proceed consuming gluten and wheat if you’re reactive to it. If the individuals in your life are usually not supportive of that, then that’s on them, not you. I personally don’t really feel prefer it’s value it to place your self by per week or extra of intense ache and diarrhea, fuel, bloating, ache, [and] no matter different signs that you just expertise, simply to show some extent. If you happen to already know that you just’re that delicate, then I wouldn’t advocate doing this. That is extra for people who find themselves unsure and don’t have entry to the testing that I simply talked about, and so they wish to get extra readability about whether or not they’re reacting. In addition they wish to get readability about whether or not they is perhaps responding to FODMAPs, or to wheat and gluten particularly.

Going again to this take a look at, if you happen to react to the wheat bread, that tells you that you’re delicate to wheat. As I discussed, there are lots of compounds in wheat, solely a few of that are gluten. So it’s doable that if you happen to react to wheat bread, you could possibly safely devour gluten-containing merchandise aside from wheat. For instance, I’ve sufferers who’re in a position to devour small quantities of soy sauce in the event that they exit for sushi or Japanese meals. But when they’ve a bit of bread, that’s problematic. That’s not unusual. It’s higher for us to consider wheat and gluten sensitivity on a spectrum as an alternative of only a binary black or white situation, which is [how] it’s been checked out traditionally. It’s possible you’ll be somebody who can have a small quantity of gluten in a packaged meals, or have soy sauce, like I stated, however you may’t have any flour. That’s a reasonably widespread situation that I see in my sufferers. I’d argue [that], even then, as a result of there’s some already demonstrated sensitivity to wheat or gluten, you must in all probability take it straightforward on the soy sauce or different gluten-containing meals. However consuming them often, if you happen to exit to dinner or one thing like that and also you don’t have a noticeable response, may very well be tremendous. So, after you’ve executed that three-step take a look at of eradicating gluten for 60 days, cooking barley, consuming it [and] seeing what occurs, after which consuming wheat bread, the subsequent steps past that, in order for you, could be to attempt issues like soy sauce or different meals which have gluten that aren’t wheat, and see the way you do with these. From there, you must have a reasonably good concept of the place you fall on that spectrum.

Okay, that’s it for now. I hope this podcast has been useful. There’s nonetheless so many misconceptions about gluten intolerance and wheat sensitivity, and I’ve tried to cowl the highlights on this episode. If you wish to do a deeper dive, try my free eBook known as Ought to You Go Gluten Free? It goes into every thing I’ve lined on this podcast in additional element and comprises all of the scientific references, research, hyperlinks, and different helpful sources. You will discover that at ChrisKresser.com/gluten-free. Thanks for listening, all people. Hold sending your inquiries to ChrisKresser.com/podcastquestion. Though I’m not doing Q&A episodes at this level, I nonetheless supply subjects from that record of questions, and in reality, that’s the place this matter got here from. So please hold sending your questions in. I like listening to from you. I’ll see you subsequent time.

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