 Welcome to Resiliency Radio with me, Dr. Jill, your go-to podcast for the most cutting-edge insights in functional and integrative medicine. I'm your host. In each episode, we dive deep into the heart of healing and personal transformation. Join us as we connect with renowned experts, thought leaders, and innovators who are at the forefront of medical research and practice. We want to empower you with knowledge and inspiration, aiding you in your journey to optimal health. Today, I have a very special guest, Dr. Leonhard Weinstock, on the topic of mass selectivation disorders and the gut specifically. It's becoming an epidemic and I can't wait to dive into this topic. But first, let me introduce our guest, Dr. Weinstock. He is a board-certified gastroenterologist and internal medicine. He is an associate professor of clinical medicine and surgery at Washington University School of Medicine. He received his medical degree from the University of Rochester School of Medicine and completed his postgraduate training and was chief resident in internal medicine at Rochester General Hospital. His gastroenterology fellowship was performed at Washington University School of Medicine. He is an active lecturer and has published over 140 articles, abstracts, editorials, and book chapters. He's given lectures throughout the world and he's currently researching our topic mass cell activation syndrome, also small intestinal bacterial overgrowth, restless leg syndrome, mold toxicity, and rosacea. And Dr. Weinstock, you and I might be the only ones who know how all those things are connected, right? Yes, they're connected for sure. So welcome to the show. It is absolutely an honor and delight to have you here. Jill, thank you so much for inviting me. I'm honored. Oh, thank you. Well, we got to talking because you guys are producing a documentary in the future at the end. Stay tuned because this topic is so important that Dr. Weinstock and his team are really trying to raise funds to bring awareness and we will be sure and give you all the information if you want to donate or support the cause. I want to be the first to say, I think this is so critical. But before we go there, let's talk about you. How did you get into medicine? What drew you to medicine and then what drew you into gastroenterology? Tell about your journey. Well, a lot of the people in my family just saw me as a caring person, an individual, not a businessman, and always encouraged me to be a professional. My dad was a dentist, uncle, a pediatrician, and so I had models. And so I always kind of knew I was going to do that. I was a little bit of a renegade. I did pre-vetinary medicine for a little bit in Vermont. But then after I worked on some dairy farms and worked with a family where one of them had cancer, I just saw a different side and I thought, you know, I could get into this. And I liked the people to people more than the people to cow contact. And so that's the way I went. And, you know, it did work out. And the specialty of GI was something that I saw during my residency, mystery cases and mystery symptoms and people going years and years with abdominal pain, where nobody ever figured out what was wrong. And I thought, oh, this is kind of interesting. Maybe I could get into that and learn more and get into the depth of it and then come up with answers. And then also you could look with endoscopes and colonoscopes and do a surgical side of things. So GI had a lot to offer. Wow. And what I see there is something I always see in some of the best physicians that I know. And that's the curiosity, right? Like the idea that you could actually solve problems. I think whenever we go into medicine and think we stop learning when we graduate, then we lose that curiosity and clearly with what you're doing and even the openness to mass selectivation and how does this affect the gut, our topic today. It really does take a curious kind of person to keep searching and looking because as you well know, the complexity of the gut and the body and our environment are really exponentially increasing. So let's dive into, first of all, just what is many of my patients and listeners have heard of mass selectivation syndrome. But for those who haven't, let's do an overview of what is this issue and why are we seeing more of it than we used to 20 years ago? Oh, yeah. Well, okay. So the mass cell is one of our white blood cells that lives mainly in the bone marrow. But when there's inflammation, a burn or injury, they come out of the bone marrow and go to the site and they orchestrate how much inflammation should be going on, how much new blood vessels should be created to help heal. But if one of these guys has a mutation on the gene that controls them, then it allows for these chemicals to come out of the cells and create a lot of damage and symptoms, both near and far. And so the fact is, it's incredibly common. It's been estimated that 15 to 20% of the country has some degree of mass cell activation syndrome. Sometimes people say, well, it's more of mass cell activation with symptoms and systemic syndromes. But those in the know know that you have to keep your mind open. And not only does it come alone, but it comes in with L.S. Danlos syndrome and POTS, postural orthostatic tachycardia syndrome, thus forming the evil triad. This has been a particular interest because at least in my clinical practice, it is just rising, especially since the pandemic. Let's talk about triggers though, because that may pull it to us, right? Because there's absolutely and so go ahead. Oh, yeah. I mean, first of all, there are temporary triggers, and then there are permanent triggers. So as often is the case, kids are sick with a variety of conditions at birth or in childhood, and they have, you know, headaches, asthma, eczema, food allergies, GI problems. And then in teenage years, women, young women have severe periods. Men, young men can have psychological problems, panic attacks, ADHD, and so forth. But they get worse along the years. And if they get infectious mononucleosis, that can set off a permanent change and more damage to the genes, making them more uncontrolled. And then during adulthood, things also occur. And unfortunately, during the pandemic, COVID occurred. And COVID also put patients with a genetic aberration and activation of the mast cell on a regular basis. So, you know, whether we can get out of this virus that lives in our body or not, and therefore it's affecting the mast cells. But that's what you're talking about in terms of what's happened since 2020. Yeah, it's weakened immune system, and also more, it's almost like two ends of the spectrum, right? We have more autoimmune, more activation of mast cells, more immune, like irrit, I always think of it as like poking the sleeping bear, right? There's these cells that are supposed to protect us, but there's all these things in our environment that are kind of irritating our systems more than ever before. Do you see environmental toxicity? Like, obviously, I deal a lot with mold. Do you see things in the environment affecting this as well? Oh, yes, we're getting ready to submit a paper on mold. This individual that is in the case report, he'd go to different houses. He was a home inspector and worked for a company that dealt with selling homes and knocking down bad homes and so forth. Every time he'd go into a moldy home, he'd have to run out of the house and he'd vomit, he'd have severe pain and having diarrhea and just imagine that happening on a regular basis. But some of these times, it was so severe that he went to the hospital and his gut was paralyzed. Well, it turns out that he did in fact have mast cell activation syndrome from years and years back and then treating that and keeping him out of those homes led towards a significant improvement in his status. So, you know, that the mold is incredible. It can activate good mast cells as well and you can get the chemicals that we see in mast cell activation syndrome, but it can certainly activate mast cell activation syndrome and patients can suffer until they get out of the environment and they do healthy things to their body that everybody who listens to your show knows about. Yeah. Oh, I love that you talk about that too because what happens, I feel like, is just the load of our bodies, whether it's infections or toxins or inflammation is getting worse and I think that's why we're seeing more. I want to go back to something you said that I think was really important and there's something that we were taught in medical school called mastocytosis and this is a proliferative disorder, right? You want to just describe because that was kind of the old thing that we were told to look for and to me, the mast cell activation, even though it's actually more prevalent, I think you can correct me if I'm wrong, been mastocytosis, but again, from the old school medical education, we weren't taught a lot about mast cell activation, but it's becoming a bigger issue. Do you want to differentiate that just a little bit? Oh, absolutely. Well, first of all, it's something that people could diagnose relatively easy if they thought about it, but it was like 0.3 per 100,000 people per year get it, so that's an extremely rare disease. It seems like in med school, they love the rare things, you know, like gigantism with growth hormone exes and mastocytosis, but really the fact is that mast cell activation syndrome was not described in literature until 2006. Oh, no wonder then. Right. Exactly. After I graduated and they don't teach it now, and that's part of our problem. That's what we're trying to do with this documentary and increasing awareness amongst physicians and people in general, so they could get help for decades worth of problems, and it is decades worth, but the thing about mastocytosis, it is a malignant disease. It can be indolent, very slow, and then you get all the symptoms of mast cell activation, diarrhea, hives, itching, rash, abdominal pain, brain fog, et cetera, et cetera. They're very similar in terms of symptoms, but if you do a bone marrow, you'll see many mast cells because it starts there as some malignant disease, whereas with mast cell activation syndrome, you see some in the periphery, in the, let's say, gut or lungs or bladder, but you don't see any in the bone marrow. It's very, very different. And we're seeing much more of the MCAS than the mast. Oh, okay. So, right. So if we're thinking mast cell activation disease, that's really three things. That's MCAS, that's up to 17% of the population, that's systemic mastocytosis, which is like one out of 100, less than one out of 100,000, and then mast cell leukemia, which is one out of 500,000. So that's the mast cell disease, activation disease, which are very different, but also similar with respect to symptoms. Okay. So MCAD is the umbrella over MCAS and mastocytosis and the mastocytosis leukemia, that makes perfect sense. And again, it's just for those, because we do have doctors who listen, so I want to make sure we're educating everyone because it's so important. So you work with the gut, but this is a disease that absolutely affects the gut, but it affects so many other systems. Do you know anything about percentages or how many, because you can do a biopsy in the gut to actually show, let's talk just a little bit about diagnosis. What would you do to actually diagnose mast cell activation syndrome? Okay. It's absolutely doing the main seven chemical tests, four blood tests, and three urine tests. The problem with the biopsies is that it's very common to define 20 or more per high power field. And there's some argument about that by the pathologists and others, especially the allergies. So when you're diagnosing mast cell activation syndrome, you have to have two or more systems involved with typical symptoms, whether they be hives or gut symptoms or itchy eyes, ringing of the ears and other problems. Two or more systems involved. Fatigue is a big one. Fatigue, brain fog, muscle, aching, very common. I think I read that top symptom was the brain. Maybe I'm wrong, but one of the biggest ones is generalized fatigue in that brain fog, right? Oh, absolutely. And then you add the third most common symptom being muscle aching. And that's the same thing as fibromyalgia. So you got to say, how many fibro patients are really MCAS? Right. And chronic fatigue syndrome patients, how many of them are really MCAS and so forth. So I mean, GI symptoms are very common. Now as a gastroenterologist, I see them being very, very common. But Dr. Affron saw patients as a hematologist with just a wide array of symptoms. And 50% or more had GI symptoms being predominant and significant. So the gut is affected in part because the gut is one of the main interfaces where you've got the mast cells living underneath the lining of the gut and you eat some gluten or dairy for many patients. And that activates the mast cells setting off the chemicals. So it's the chemicals that we measure. And that includes prostaglandin, histamine, chromagranin. And we do measure triptase because if it's high, you want to look for mesocytosis. But in the, there are two camps. One camp feels like triptase is very specific to mast cells, which is true. But in fact, it's not very commonly elevated in mast cell activation syndrome. And so the problem is when a person with multi systemic disease sees an allergist with hives and asthma and they say, I think I have MCAS, they get a blood test and it's triptase is normal. And the allergist says, no, you don't have it. And that's a real problem in terms of management. And the allergist also thinks it's very common to have anaphylaxis, but our group doesn't think so. And then there are three urine tests that are done, prostaglandin, histamine, and leukotriene E4. And so with those seven tests, my, about 70% of my patients who I think have MCAS are positive for one or more. And then the other group of, let's say the 30% that have negative markers, if they respond to basic mast cell therapies like antihistamines, vitamins, flavonoids, and they get better than they get have, they're allowed to have the label of mast cell activation syndrome. Hey everybody, I just stopped by to let you know that my new book, Unexpected, Finding Resilience Through Functional Medicine, Science and Faith is now available for order wherever you purchase books. In this book, I share my own journey of overcoming life threatening illness and the tools and tips and tricks and hope and resilience I found along the way. This book includes practical advice for things like cancer and Crohn's disease and other autoimmune conditions, infections like Lyme or Epstein bar and mold and biotoxin related illness. What I really hope is that as you read this book, you find transformational wisdom for health and healing. If you want to get your own copy, stop by readunexpected.com. There you can also collect your free bonuses. So grab your copy today and begin your own transformational journey through functional medicine in finding resilience. And we'll put that paper because I know the consensus statement that you have been an author on is one of the things that at least for me as a physician has been a game changer because you list all the criteria in that paper and kind of say let's shift from just triptase as the only thing that we look at. Is it true that histamine and triptase are going to kind of go up and down based on their acute exposures so that if you caught it during a acute flare, you might get it, but because it can go up and down. And then they're also very volatile in the blood and urine. Is that correct? So, so correct. Yeah. So for to address that, ideally when I do the blood tests and urine tests, I say, well, are you feeling poorly today? And many people are feeling poor poorly. And so that actually is most of my statistics of the 70% positive are because they're at baseline. And many people simply have fatigue or flushing when they see me. And so I'll do it. But if they're totally asymptomatic, which is rare, I'll tell you know, do a trigger, take a trigger, you know, eat it or go out in the heat and come in and be off. But don't overdo it. So you're set back for a week. And then come in for the test. And the tests, well, you have to have somebody who knows what they're doing because spinning the plasma heats the plasma up. So two of our blood tests have to be spun cold. And that can be done with little jackets that keep the blood cold in the centrifuge or going to the hospital. So yeah, so histamine and prostaglandin are the plasma. And then the urine has to be collected cold and kept cold and then frozen when you bring it in. So that can be mailed to the research lab that reference lab that looks at those levels. So and that's in your article, I know the consensus statement, some of the details. But that's real important if you're a physician or even a patient listening, if these things aren't kept cold from the collection, especially the urine, it's very likely to make a false negative result, correct? Yeah, absolutely. Okay. So the other thing you mentioned early on was genetics. How many what percentage of people have like, I'll just tell myself, for example, I grew up in a farm severe, severe eczema, severe allergies. And then, you know, Crohn's disease and gut issues and all this, I am sure I have all kinds of mast cell issues as far as genetically. Do you see the majority of patients have genetics that are positive? Do you even test those? Okay, so the testing for the kind of kid genes that are positive require a lot of blood and research labs. So there is one gene that's commonly tested for patients who have mastocytosis that's available. But that's really never positive for MCAS. So Dr. Muldering has described many different mutations of the genes. And you ask, why are we seeing it more? Well, is it because we're more aware and a little bit smarter? Or is it the epigenetics and all the toxins in our environment that are changing our genes after we are born? And then we trick our, you know, it trips the mast cell gene controller, the kid gene, so that we lose control. And, you know, then we have both weird, we have a hyper immune state, but we also have a state where the mast cells don't know what they're doing in terms of controlling infections. And so people tend to heal poorly on their skin. They tend to go from simple viral bronchitis to bacterial bronchitis, and same thing for the nose and sinus problems. So it's kind of a yin and yang there. Yes. Yes, I've seen that because again, there's like autoimmune and this native immune activation, all the cytokines, which again, we saw on COVID, we see in mold, very similar. But then on the other hand, they're actually very susceptible to not being able to fight out intercellular bacteria or infections or things. So it's this very bizarre immune system dysfunction that kind of the worst of both worlds. So let's talk about someone who does have this. What would you do as far as starting treatment and do they require with you as a gastroenterologist? It sounds like you're doing tests and doing a great history and then doing interventions, but they don't all necessarily require an endoscopy or biopsy. Is that correct? Correct. Yeah, I've been dissuaded from doing that. And also, those people who are coming for their 45-year-old colonoscopy, they have mass activation syndrome. They want to be pretreated with intravenous, benadryl, pepsid, and some cases versed and some severe cases solumedrol. So you don't want to, you know, from the propofol get into a situation where you activate, get activated. I've had some patients just get into severe hives and it's been hard to get them out of that because they're very sensitive to chemicals. Yes. Yeah. Well, let's talk about that. We wanted to talk about treatment, but before we do triggers, you mentioned what are some of the common, like top seven or 10 things that you see as triggers and maybe those. Okay. Oh yeah. Well, I just put a table together and presented an article because I had a patient who for his 53-year-old man, 30 years of attacks of down pain, diarrhea, vomiting, and it turns out he was a pain salesman and whenever he had exposed long exposures to pain, well sales or conventions, all those volatile chemicals, organic chemicals made him flare. So that's a table that's going to be in hopefully an article that will be published soon. But basically it's environmental, it's environmental, infectious, chemical, implants, and temperatures. So a lot of the common ones are heat and cold. Dietary was another big one and most common ones are gluten, dairy, yeast, and high histamine foods. If you go and you've got some implant, that can be a problem. Smells are a big thing. Patients of mine, they go into Macy's and they encounter the terrible odor from perfume and bang, they're on the ground, passed out. Some people, like my first patient ever, she said that the big box stores were her kryptonite. She had both POTS and MCAS and she would faint going there and part of it was the fluorescent bulbs. Wow, amazing. It's almost like an ending list of things that could trigger. It's very interesting because back when I was diagnosed with Crohn's at 26 and of course looking back, I absolutely had mast cell activation probably from birth, but the Crohn's one of the biggest things that changed for me and I didn't even know the commonality was a low histamine diet. I just knew these certain foods were triggers for me. So more than any other thing that I did as a dietary intervention, the low histamine foods. And again, I just was like, oh, this thing fermented this and these other things and like aged meats and cheeses and bone broth and all those things, right? And avocado and spinach. And I had no idea back then. Now, of course, it's like, oh, it was histamine foods and it made a huge difference in the activity of the Crohn's, which again, probably was connected to severity and with the mast cell being activated. So very interesting. Let's talk about, let's talk about interventions first, like what do you do as far as natural and medications kind of go through the list because there's a long list of things. Absolutely three week diet trial. And it's hard to go off gluten. Gluten, dairy, and yeast and low histamine is kind of what I say. And no, it's a little bit flippant to just say, okay, three weeks, you know, you got to do this, but you got to do it because you don't know how the medicines are going to work. But there's basically step one treatment for me are all but one are over the counter. So what I do is each one blocker, each two blockers of this in English, that's for Modedine. We used to have Zantac, but now we have pepsid from Modedine and there's two others that are harder to get a little bit. But sometimes one person does better and one versus another. That's the same thing that could be said for the non sedating anihistamines, claritins or tags, isole, Allegra, et cetera, the trade names. So those two are like the cornerstone, but then the vitamins C and D are important. So you want to get your vitamin D levels up to the ideal levels, 70 or so. And usually 1000 or sometimes 500 of vitamin C works better than the higher dose. And then a flavonoid. And if somebody really has terrible brain fog, then I'm going to go more with Luteolin. If there's just more body problems than body systemic problems, then Corsitin. And then the only prescription medication at this point, pretty much for all my step one patients is low dose naltrexone. And you do that with ketotaphone because that's a favorite. So ketotaphone is definitely the next step after that. Chromalin. So part of the step one does include ketotaphone, chromalin and cingular, but the problems are A, cost, B, you have to do chromalin very, very slowly. Otherwise it can react and activate the mast cells. And then you've got Montelukas cingular, which I'm not quite sure, but probably 5 to 10%, especially in mast cell women, get psychological disturbances. I would agree. I feel like that one's a wild card. Like it doesn't always work as well as it should, right? According to the mechanism. Right. Well, especially if LTE4 is elevated. And then ketotaphone. So ketotaphone is very good, especially if there's insomnia, can be helpful. Yeah. And then of course, there's some big players, right? Like immune modulator steroids. If you really, because some of these, in my book that I wrote last year, I have the preface is about a young woman who passed away and she had mast cell activation disorder and she was so sick. And I'm sure it was the triad, right? And I saw her way late in the game, but I wanted to kind of bring to the public the severity of these kinds of things. And I'm sure you've seen that too. So when you have someone who's maybe bedbound, in a moment, we'll talk about the triad, because that maybe fits in more with the triad and the disorder. I don't know about these really severe cases. How do you stabilize them? What are the bigger guns if needed that could be used? Well, you mentioned steroids. We do want to keep them off. If I have somebody with severe diarrhea, though, budesonide is a nice one because it doesn't get absorbed from the gut. And then steroids, if they have severe pain, they're in the hospital, then I'll give them my IV, the IV protocol actually created by Andrew Andy in California. Anyway, he came up with an idea of IV benadryl, IV pepsid, IV versed, or adivan, and IV ketaryl, which I'm not thrilled with because it can produce ulcers, and then a fluid challenge. And he gives those to his patients who have pots, but also MCAS. And it can be very helpful. So I have actually some patients who are getting intravenous fluids and the three meds intravenously to keep them out of the hospital. Or if they're in the hospital, I'll give that. So the steroids can be given with that complex as well. But again, the more and more steroids, the more risk. Yes, I couldn't agree more. And I wait those at the very end, but for those really severe cases, it can be kind of life-saving. And you mentioned versed and lorazepam and adivan. Benzodazben can actually have an ant, even though we don't love those, they're very habit-forming orally. They do have a mass cell, like an effect on the mass cell activation. Is that correct? They stabilize it. There's an animal study that proves that, and there's empiric data just from managing patients that it's a very good drug. I mean, yeah, it's step two on the step one, step two, step three would be Zolaire. So if you've got hives itching, hives, asthma that's refractory to therapy, seeing an allergist to get those, that drug, it's a shot once a month, anti-IGE can be very helpful. Excellent. And I've seen in my experience, and I don't usually prescribe that, like you said, I usually refer out to an immunologist or allergist. But in the Zolaire, I feel like it's just in my clinical, my small little experience, maybe 30% of people react to it too. Do you have people? Yeah, for sure. So it's immunogenic. So that's problem. But there's one good article about it that looked at multiple things, GI symptoms, and there was a 30, 40% improvement in GI symptoms, even improved neuropsychiatric things. And I wanted to talk about that if we have a moment. Yes, let's do. Let's go into that because it's huge, right? People don't. So let's just frame this because you wouldn't necessarily think mast cell in the brain, right? But obviously, huge, huge impact on these things. So dive into that. Tell us how that could present with mast cell. Well, one of the questions I have always asked is from, you know, once I knew about some of the manifestations is, did you have panic attacks as a kid? And so many people did. And then depression, I started taking a history really delving deep about depression, bipolar, ADHD. And there and Dr. Affron did a whole article on different reports. And there were many neuropsychiatric disorders associated with mast cell activation. And so we just published a paper looking, it was a case series of eight people who had a variety of psychological problems that were made worse by psychiatric meds. They didn't tolerate it or made worse, and or they were suicidal, some of them all their lives. And just diagnosing MCAS and treating them for MCAS got all their psychological problems better. So we're now going to do a more of a epidemiological study to see how often it is and, you know, how people have responded once they're diagnosed with MCAS. So for me, this is like one of the most exciting things that we've done because so many people tell you they react terribly to SSRIs and other things. Yeah. And to know that there's something else out there. And that makes so much sense. I mean, years and years ago when I was really studying just histamine, which is only one little thing out of the many hundreds of chemicals that mast cell produced. And there's a definite correlation with focus and lack of focus. And even IQ, there's a couple studies on IQ and histamine, which is crazy, but it definitely interacts with the brain on a profound level. You mentioned the triad. To me, this is one of the most fascinating things because as I've understood the triad, and this is what your documentary is going to talk about, it really pulls together some of the most complex cases that are mysterious as far as what's going on. Do you want to just frame what is that you mentioned before, but let's talk again about what is it and how do all these things connect and our common presentation? Absolutely. Okay. So the evil triad is MCAS, Ehlers-Danlos Syndrome and POTS. And either they run together just because they're common or more likely that there's etiology involved. And if you talk to any POTS expert who knows something about mast cell and knows a lot, they'll realize that about a third of the POTS patients are caused by mast cell activation because the mast cells live in the nerve bundles of the parasympathetic and sympathetic chain. And so if you're constantly firing away chemicals and also the blood vessels are there, and you're firing away chemicals that open up the blood vessels and allow the body to pull blood in their veins, their pulse is going to go up, and their blood pressure may go down, and at least they may have syncope or near syncope. So if we say, okay, a third of POTS patients are due to MCAS, then we want to worry about hypermobile EDS. And it was Dr. Afrin's idea that the MCAS patients not only have inflammatory and allergic mediators, but they also have growth mediators. And that's clear from many of the patients can get subcutaneous nodules, fibromas, and also increased rates of cancer. So his idea was that the patients with mast cell who were secreting growth mediators would make the tendons and ligaments grow, which would therefore make somebody hypermobile. Interesting. And so that's one way to connect it. And so in studies that I've done for, you know, I studied restless legs in 180 patients of MCAS, how many percent had it, 40 percent, but 20% had EDS, 20% had POTS. So it gives you an idea just looking at a patients who had GI disorders came to see me, but I looked at whether they did or didn't have restless legs. The concordance rates was 20% POTS and EDS. So they're very common together. Wow. Now I have a question. And you might be the author on the papers I'm referencing, but I've read some papers on rosacea and SIBO and also restless leg and SIBO. And for me, it's been a big aha because so many of my patients, when we treat the SIBO, those things will actually get through. Again, you've probably been author on some of those papers. Where does SIBO fit in? Because in my again, just very humble clinical opinion, I feel like some of the microorganisms in our gut can actually produce excess histamine and trigger mast cells. Is there a connection between bacterial overgrowth or fungal overgrowth in the small bowel and manifestation of mast selectivation? Yes, there is. So I looked at 130 patients with amcasse, did breath tests on everybody. And most of them had bloating of abdominal pain and bowel habit changes. 30% had positive hydrogen and 10% had positive methane curves. And the inflammation that we get on the gut lining is something that's important because that is one of the triggers and that's on the trigger table as is SIBO that can make the mast cells and dwelling in the gut lining worse. So that's really important. Restless leg syndrome, likewise, I think it's a systemic inflammatory problem. We've been studying it for quite sometimes in dorfins or low inflammation is high in many of the secondary restless leg syndrome. And actually amcasse throughout that 40%, that's the highest positive concordance rate of secondary restless leg syndrome of 40 different diseases. Wow, it's very really big. And so a lot of my patients that I treat with LDN for mast selectivation, their restless leg syndrome gets better. That's reducing the inflammation. And that just doesn't happen. So there is the SIBO connection and maybe it's decreased parasympathetics. So you have decreased vagal tone and you're not flushing out the bacteria. And that's why you get SIBO in amcasse. So maybe it's the migrating motor complex and that small bowel motility that's actually impaired as the thing that causes. I think you're 100% right. That would make no sense. Because again, I see those infections often actually causing like the people who have the chronic viral load or a tick borne infection often have some issues with the small bowel motility and the vagal nerve and it seems like it's all connected. This is so fascinating. I'm just so grateful that you're out there doing the research publishing. And whether you know it or not, I've been quoting your work for years. You've been putting it out there and helping docs like me who to really understand what's going on. And I'm so grateful that you have been curious and keep looking for those answers. Obviously, we want to talk about the movie, the documentary where people can, you know, donate or help support that efforts. But before we do, is there anything else on the horizon that you've been studying, looking at maybe seeing some correlation? What's kind of the next steps in this area? Well, the next step is definitely the psychological issues in amcasse patients. You know, a number of us have large numbers of patients and we'll hopefully send out a bulk blind email. If you do or don't have psych problems, please just answer the questionnaire. And then we'll come up with an idea of frequency of amcasse in patients who have refractory or difficult to manage psychiatric problems. Some of the people on our website discussion group feel that most of their patients who have had bipolar disease have mast cell, which is really interesting. Yeah. And again, my small little clinical experience, I would agree 100% that this is so connected. And I've often postulated, I wonder if maybe 95% of our mental illness is actually organic, whether it's inflammation, immune dysfunction, mast selectivation, other infections, you name it. I think there's so many times where it's actually an underlying cause versus just something that you were born with. And I'm sure you're seeing that too. So where can people find your work, your research, and then we'll talk about where they can donate to the film. Okay. Well, under gidoctor.net resources, there's a number of little slide shows, PowerPoints and articles that I've written. And then what we're doing with the documentary, we're trying to make it a learning experience for everybody, whether they be medical professionals, something to open the eyes on patients who have had to deal with symptoms for decades and are now finding answers. And then we explain what's going on in the movie to about mast selectivation syndrome. And then we are doing something unique. We're tying it to a library, an online library with papers and PowerPoint presentations. And that way we help patients and potentially doctors who are interested. We have to get the doctors interested. We have to get this into the medical schools. It's just absurd that it's not. And as far as where to go, it's mcastfun.org. So it's m-c-a-s f-u-n-d.org. No matter how little or much you choose to donate, that'd be great. It's a not-for-profit movie. And so we're not making a dime and we're putting a lot of efforts in. We've filmed half of it, but now things have slowed down and fundraising. So anybody anywhere can even a brick laying for $10 would be fantastic. Well, I am one of your biggest fans. And I think this is so critical. Unlike you, I think that we need to educate our fellow physicians because it is an epidemic. And the more docs we have that can help us treat these patients, the better. So I am just, I love that you're doing this. I'm your biggest supporter. I'll try to help you get the word out. And I'll be right there with the donations as well. If you heard this, if you're driving your car wherever you listen to your podcast on the show notes, we'll have these links. So don't worry if you've missed it, you can find that on my website or anywhere you've listened to this podcast. Dr. Weinstein, thank you for your heart, your curiosity, your work in the world and your ongoing efforts. I know this isn't easy because you also have a full clinical practice, but we are so grateful. And thanks for taking your time today to talk to us. Well, that's a wrap. Thank you guys for joining me with this wonderful interview with Dr. Weinstock. I hope you will check out mcasfund.org and support this documentary. I think it's just a critical effort that we need to educate the public and other physicians on the prevalence of mass selectivation disorders. And I know many of you who suffer from that will appreciate it. But we hope you've enjoyed this show and I hope you'll stay tuned for more empowering episodes with new episodes I release every week. You can find them all on iTunes, Spotify, or wherever you listen to or watch podcast. And you can find the complete transcripts and more information and links on my page, JillKarnehan.com or on YouTube. And if you want to have links to any of the products that were mentioned in this show or others, just go to drjilhealth.com. Thanks so much and I'll see you next week.