 Hey guys, how's it going? Thanks so much for having us today, H.S. We love being here and this conference is actually a really big part of how we all got together to do the very first grassroots study on looking at the efficacy of the autoimmune protocol for Hashimoto's disease. This is a process that the three of us informally called hashtag ninja research. When we look at the potential for research study on topics that concern ancestral health, there's a lot of barriers there, right? There's things like research or interest. How do we get the people who can actually run the studies interested in the same things that we are? There's time. Studies take a while. The logistics and then also the biggest piece is funding. Studies cost a lot of money and someone's got to pay for it. So there are a few, if any, big industries that are willing to put up the money in order to run a lot of these studies. So studying the efficacy of dietary and lifestyle interventions, especially like when a pharmaceutical company isn't going to be testing a drug, it can be really tricky. So in light of all of this, we wanted to share with you guys our experience trying to do something in a new way. Our community of health seekers banded together in order to make this study happen, and we're going to show you guys how we did it. All right, so the four things that we're going to share with you guys today are first, what are the steps that we took to actually make this happen? There was a very whirlwind organization funding and implementation of running the study. We're going to tell you guys all about it. Second, we're going to tell you guys about the design of the study, the things that we determined were important, what we were looking into, and yeah, how we ran this three-month, multifaceted dietary and lifestyle intervention study for women with Hashis. Of course, everyone's interested in the results, so we're going to give you guys some of those there. And then what's next? We'd like to have a discussion of how we could actually use this model in order to conduct more grassroots independent research. So first, how did all three of us get together to do this? So Angie and I, who you're going to hear from Angie a little bit later, she's sitting right there in the front, we're the co-founders of a website that you see up on the screen called Autoimmune Wellness, and we got into this after experiencing our own health journeys with autoimmune disease. We have five of them between the two of us, and about eight years ago we both started blogging independently just about our personal experience, nothing for business, nothing writing recipes or cookbooks yet. We were just putting information on the internet about what we were experiencing in our own N equals 1 experiments, and eventually we connected on a similar mission to then start helping other people who wanted to follow in our footsteps. So in 2015 we had a doctor that found out about us because she had a patient at her gastroenterology clinic, it's here, Scripps here in San Diego, who had a really incredible recovery from ulcerative colitis using the autoimmune protocol, and she had never heard of this diet before, but she had such incredible results with this patient that she asked him where he heard about it, and that if he could refer her to any websites that had more information, she landed on our site, contacted us through the contact form, if you guys can imagine the feeling that we got when we read her email requesting that she wanted to talk to us about possibly partnering with the study, we were like, of course, yes, we would love to. So that result was the study that you see up here that published in inflammatory bowel diseases. It was a efficacy study for Crohn's and colitis, and it ran in 2016 and the results were published in 2017, which was really exciting. So that was the same year that I met Dr. Abbott in Seattle at AHS. He was really curious about the study and he expressed interest in running another study with us. At the time we just kind of left it at that, and last year, something that we do every year at Autoimmune Wellness is survey our audience to see how we're serving them, if there's anything that we can learn that they want us to be working on in the work that we do with them, and over and over we heard again that they found the research and the results of that IBD study to be really validating and really productive in having conversations with their providers about the legitimacy of the dietary interventions that they were mostly trying on their own without any support from their providers. So they encouraged us to keep making these partnerships and keep doing the research, and they actually said a lot of people we had like a long comment form area where they could write us notes, and they said if you guys do this, we can actually even donate money in order to make this happen. So that was incredibly interesting. We noted it. So last year at AHS in Bozeman, Angie, Dr. Abbott, and I got together to really seriously talk about collaborating on another AIP study. We decided on Hashimoto's Thyroiditis because in our survey we identified that over 50% of our audience had Hashimoto's, which is a pretty big chunk. It is the most common autoimmune disease, and it is an autoimmune disease that is a little bit tricky to work with. So since Angie and I recovered our own health, we both went back to school for nutrition. We're both health coaches. So we have a lot of experience working with people in this area, and Hashimoto's has some other factors that can be interesting to work with in this context. So we really wanted to study it and see what we could find out. So just about a year ago, you guys, this is where the three of us started. All right, so once we decided to do the study, we needed to support it financially, and the two avenues that we sought out would be first that Dr. Abbott would reach out to a lab and see if we could get some of the testing donated. So this was going to represent a big chunk of our budget. And then second, Angie and I would run a crowdfunding campaign to our audience for the remaining funds of the study. So Rob was successful. He convinced Genova Diagnostics, who gave us a really generous donation of all the laboratory testing for nutrient status and comprehensive stool testing. This represented tens of thousands of dollars, and we definitely would not have been able to do it without their help. And once we had that funding obstacle out of the way, we created a budget for the remainder of the study. So this included things like health team, health coach team compensation. We needed some lab blood testing that wasn't covered by Genova for the beginning and the end of the study. We need a HIPAA compliant survey platform, and then a lot of the other time was volunteered by our study team. So we determined that we need about ten thousand dollars. So we shot a bit video, created a campaign on Indiegogo, and asked our community to support the effort through sharing in our newsletter, our social media channels, and in our blogging network. We reached the goal in a matter of days, which was really exciting. And everyone was just telling us how excited they were to be a part of the process and that we were actually making it happen. So I'm going to turn things over to Dr. Abbott for a little bit so that he can share a little more about the study design. All right, so I don't like reinventing the wheel. So since the AIP IBD study had already been done and had shown some pretty good results, I took the similar sort of the study design from that study and implemented it for the Hashimoto study. So it involved a single experimental arm. So there was no control group and specific population that we wanted to study were men or women. We only ended up getting women, but men or women between the ages of 20 to 45 with Hashimoto's thyroiditis. The intervention itself, the main elements were the SAD to AIP and 6 group health coaching program, which Angie is going to talk a little bit more about later. That was also used in the AIP IBD study, as well as some personalized functional medicine care that I would deliver to the study participants. The total duration of the study was about 12 weeks. We had a two week washout period for the initial testing. Six weeks of the course at the AIP and 6 program, and then a four week maintenance period where they maintain the AIP elimination phase. The primary outcome or primary study measure that I wanted to look at in this population was quality of life. And I wanted to do that using something called the short form 36, which is a health related quality of life questionnaire, which has multiple subdomains. It has eight subdomains that have things like emotional health, mental health, vitality, general health. So you get a good picture of someone's overall quality of life. And it's been well validated in many other research studies. Some of the secondary outcomes that we wanted to look at included clinical symptom burden. This is a little bit tricky to determine and it's somewhat transient in nature, but I implemented and used something called the medical symptoms questionnaire, which was first developed by the Institute for Functional Medicine and Dr. Jeffrey Bland to try to some way quantify the experience and symptoms of our complex patients. Of course, we have folks with thyroid disease. So I wanted to include markers for thyroid function. This included TSH free and total T4 and T3. We also included thyroid antibodies. So anti-TPO or anti-thera peroxidase antibodies and anti-thera globulin antibodies. And then lastly, I wanted to have some marker of immune function and inflammation. So I included a white blood cell count as well as a differential cell count. So things like the neutrophils, lymphocytes, the types of immune cells on that white blood cell count. And then a marker of inflammation known as high sensitivity C reactive protein. This isn't a marker routinely used, I would say clinically in a population such as those with Hashimoto's thyroiditis, especially when you compare it to things like inflammatory bowel disease or risk stratification for heart disease. But I wanted some marker that I could potentially use as a marker of inflammation in our study population. I'll go through this fairly quickly, but these were the inclusion and exclusion criteria for our study population. So they had to be English speaking due to the educational conscience that Angie has created in her program. We had folks between the ages of 20 and 45. The upper limit we set with the idea that we wanted to try to minimize confounding from perimenopausal and menopausal states and women. We also only included folks who were normal or overweight. So had a BMI less than 29.9 to try to prevent complications from obese or morbidly obese individuals participating and or losing weight very rapidly. And they had to have a diagnosis of Hashimoto's thyroiditis, either by medical documentation provided from a current provider or laboratory evidence of elevated paroxys, antibodies or anti-thyroglobulin antibodies. Here were the exclusion criteria. The main thing I want to point out is that we excluded folks with an active, another active autoimmune disease. Or no definitive diagnosis of Hashimoto's thyroiditis. We also excluded pregnant breastfeeding or early postpartum women or individuals with another comorbid condition, such as a chronic kidney disease or organ failure. And anyone who was taking a non-FDA approved thyroid medication, which was essentially if they were taking a compounded medication, that we couldn't verify the precise amounts of the hormones that they were taking. And then if they were also unable to complete the two week washout period to complete testing and to stop non-essential supplements. All right, you guys. So once the study design was set by Rob, we needed to get to work enrolling people, which was then Angie and I's job again. So this was a little tricky because Angie and I are experts in helping people implement the autoimmune protocol. And we were actually looking for people who had never tried this before. So it was a little bit of a tricky situation. So again, we leveraged our social media, our newsletter. But then this time we also reached out to some of our colleagues in the nutrition space who had connections with people who might fit the bill. And we also reached out to some disease specific support groups on places like Facebook. And instead of asking people if they themselves would be interested in being in the study, we asked them if they knew anyone that they were connected to. So there frequently we have people that had tried AIP for their Hashimoto's or their RA and they knew people in their lives who had similar disease but hadn't tried yet. So we asked them to share the survey with them. So we had 475 responses to our eligibility survey from that. About 35 of them actually qualified for the study and we had funding to enroll 17. So the first 17 people that responded got enrolled in the study. So just a slide of overviewing some of the testing and measures, I already mentioned some of the question areas that we used, the SF-36, the NSQ. We also included a qualitative survey that looked at things like someone's stress levels, their sleep, and their goals for participating in the study and the program. We also included a food frequency questionnaire which while imperfect was a measure to get some sense of their diet while entering the study. The labs that we used, as previously mentioned, we used a CBC with the differential cell counts. I used a comprehensive metabolic profile mainly looking at things for safety, the thyroid function and thyroid antibodies, as previously mentioned. And I also included vitamin D also for safety. The exploratory specialized labs that Genova Diagnostics donated included their NutriVal which is an organic acid test which also included some toxic markers, so some certain heavy metals, and their comprehensive stool analysis. Here was our baseline testing results. So you can see the average age of the group was around 35. The average BMI of the group was just about between normal weight and overweight, so around 24. In terms of the ethnic breakdown, we had mostly Caucasian women. We had two women who were of Hispanic origin. Here was our baseline testing results for the health related quality of life. So as you can see, as I previously mentioned, there's eight sub-scales to the SF-36. The way it is scored and weighted is on a zero to 100 scale with 100 being a perfect score and zero being a poor score. So you can see on here that clearly our population was suffering in the physical world functioning and emotional world functioning, vitality, and general health amongst other markers on here. Also, what's not shown on here was the average score for the MSQ was around, was 92, which for folks who are familiar with that questionnaire, it's a high score, but it also is fairly representative of the more complex patients that we're seeing in functional medicine and integrative medicine. Here are the baseline testing results for thyroid. A couple of things that I want to point out on here was while I enrolled folks who had a diagnosis of osteoporosis thyroiditis, I didn't have any criteria for the level of their antibodies or their TSH values. So I didn't know what these values were going to be until everyone was enrolled and we performed testing. So the average TSH for the whole group that was able to participate and it was included in the analysis was 2.0, which is actually a pretty good level. And then the average TPO in a body, as you can see on here, was 225, which is actually clinically, for me, a pretty big win when I see folks often coming in in the thousands or 700s. So it was going to be rather difficult, as you'll see in the results based off of these baseline, to see major changes across the group level in these two domains. As I previously mentioned, we had to use a food frequency questionnaire to have some semblance of an idea what they were eating before starting the diets or starting the program. And in going over this, I was able to get an idea that a lot of folks had already eliminated gluten, had already eliminated dairy, eliminated soy, were very conscious of their diets. And while they hadn't been able to follow the autoimmune protocol, they were making changes that they thought were well informed. And so when you looked at them as a whole, we were certainly dealing with folks that were above average in their education and in their diet as compared to folks who were following a strict standard American diet. We did use diet diaries throughout the study to try to get a sense of how well they were doing with the eliminations and get a sense of compliance as they were making some of the more challenging eliminations in week five and week six. We also used a qualitative lifestyle survey that I mentioned earlier that Angie has been using in her clinic. So once they can get a broader view of the individuals and their overall goals and lifestyle outside of just diet. So with that, I do wanna invite Angie up on stage to help talk a little bit more about the SAD2AIPN6 program that was used in our study. Okay, you guys. So SAD2AIPN6 is the standard American diet to the autoimmune protocol over six weeks. That's the model for our program, the intervention that we used. And I wanted to talk to you about some of the really most important parts of that intervention. So I've been running this group coaching program since 2014, thousands of people have been through it and it's really given me an opportunity to learn a lot about what works and what doesn't. Our number one strength in the intervention and I think of the program in general is community connection. We use a secret Facebook group where the subjects can easily connect with each other and they can share their diagnosis, their disease experience, their study experience. And that's also where they connect with the health coaching team. Some of you are probably wondering why Facebook, obviously there's some problems there. 95% of my members are already there and that was true for our study subjects as well. So there was no need to learn another place that they had to log into and learn to navigate. And despite the inherent issues with a social media behemoth like Facebook, they have refined online communication forums which made it really easy for the group to interact with each other. And that community connection is very successful in that setting. It creates bonds in a general accountability environment. For example, the members of my first ever program are still in touch with each other six years later. So we're basically leveraging modern technology to address an evolutionary mismatch, that missing community element. The group health coaching is also happening simultaneously on the individual level. So subjects are completing daily micro assignments via a drip fed course delivery platform. The assignments are providing a structure and a phased approach to adopting the autonomy protocol. A new module is opened each day and it tells them why they're making the change and it gives them implementation steps to begin the process. The structure helps the subjects make the change and emphasizes the habit of the change over their willpower. And the phased process reduces the overwhelm both about making the change and the fire hose of information that's available about why they're doing it online. So what is AIP? That's the meat of our study intervention is the autonomy protocol. So the autonomy protocol is a science-based elimination and reintroduction diet and lifestyle protocol. It emphasizes an ancestral approach and it focuses on repairing gut health, balancing hormones and regulating the immune system. The dietary component includes removing food-driven sources of inflammation and restoring nutrient density while the lifestyle component includes approaches to sleep, stress management, movement and connection both to humans and to nature in order to help best manage autoimmune disease. And Dr. Sarah Valentine is behind most of the extensive research that represents the protocol as it stands today. She evaluated foods on how they might impact the immune system, intestinal integrity, hormone production and overall nutrient density. And then based on those factors, she came up with a list of foods to be avoided and a list of foods to be included during the elimination phase. And then an ideal order for their reintroduction over four stages was developed. So it begins, the reintroductions begin with the foods that are least likely to cause food-driven symptoms and offer the most nutrient density and then it ends with foods that are most likely to cause food-driven symptoms and offer the least nutrient density. So you can kind of see the broad categories of foods to avoid on this slide here. So what makes my program unique is this phase delimitation of the foods. I really start with the foods that are most likely to be causing their food-driven symptoms and are probably least nutrient dense versus like a cold turkey transition into the autoimmune protocol, you know, like overnight. So the eliminations, they happen in this weekly basis. Again, beginning with the most likely to be driving symptoms and generally least nutrient dense. This process gives bang for the buck really early on and it leads to a stronger adherence. You know, when they can experience right away some benefits, it makes them wanna keep going. You can probably guess our first week of eliminations is grains and alcohol for this reason. So AIP is not just about avoiding foods though. We're really a key component that we're emphasizing is restoring nutrient sufficiency to help fuel healing. So we also add nutrient dense superfoods on a weekly basis. So this would be an example, would be like bone broth. And then finally in the program, we focus on the lifestyle modifications that go along with AIP and we do that in a phase process every week as well. We start with arguably the most important thing to prioritize if you're trying to heal, which is sleep. Okay, so those are kind of the main intervention elements, but then we made some modifications to my program for the study setting. And the last two intervention elements were the multidisciplinary team collaboration and virtual visits. They're not part of my regular program. So we really think that a strength of the study was utilizing the multidisciplinary team collaboration and we think it points to future standard of care changes for autoimmune patients. Basically the health coaching team and the doctor, so myself and one of my team members and Dr. Abbott, we were able to work together cooperatively in real time. So an example of this is like if a subject asked in the Facebook group a question of a medical nature, we could immediately draw Dr. Abbott into the discussion and utilize his expertise usually to the great relief of the subject. Conversely Dr. Abbott could rely on the coaching team to handle all the implementation issues that come with a complex protocol like the autoimmune protocol. So we were handling education, motivation, habit change and he didn't have to have so much time intensive work on that with the subjects. And then we were able to meet and discuss lab results and formulate follow-up plans that all the members of the team understood and could seamlessly communicate with the subjects. That provided a lot of support to them. An example of this was from some of the organic acids testing we found that some of the subjects had heavy metal toxicity. So when we met with Dr. Abbott to talk about that, myself and my coaching team member, we said there are some herbs that we could have them emphasize that key weight heavy metals and he was like, oh yeah, that's right, let's do that. So he communicated that to them when he met with them to go over their individual results and myself and my coaching team member emphasized that to the individuals in the Facebook group and we provided recipes to them. In terms of the virtual visit, Dr. Abbott used live video to speak with the subjects at the study start about their lab testing procedures and helped them kind of feel prepared and understand what that process was gonna be like. And then later he used video conferencing to speak with the individual subjects about their results. And then in a few instances, if a subject had a particularly complex challenge, Dr. Abbott and I met with them through video conferencing together so we could offer both medical and practical support. Okay, so a little bit about study dynamics. After six years, I've noticed a majority of people go through some pretty predictable stages during their AIP transition and these dynamics are behind the personal growth and eventual healing they experience. In our study, the subjects were no exception. During weeks one through six, they're in this really deep learning period where they're receiving the systematic education on the why behind every change. And knowing why is crucial for autoimmune patients because it's empowering and they are really coming in quite disempowered usually. We also are embracing the importance of planning and preparation. They're really learning that this is a key to their success with such a complex protocol and it's helping them build this habit muscle so that they don't have reliance on willpower alone and that's unnecessary. And then their successes and failures with each implementation attempt also lead to a period of really intense questioning. That's usually, especially during weeks one through three. My coaching team and I usually put in double the time with our group members in this period because their confidence is still really low, their understanding isn't solid yet and their habits aren't in place so hence a lot of questioning. And then there are predictable dynamics that are at play during the maintenance phase to which in our study was week seven through 10. Most obviously now they're focused on just maintaining, they're not learning and implementing new things. They're also starting to notice their health and wellness shifting. So some of them might be having some really big wins that are undeniable and point to improving health. For instance, during week nine, one of our subjects who came into the study experiencing infertility and really having a goal of hopefully restoring her fertility, told us that she was pregnant and she had to leave the study. We were of course happy to kick her out. Other people might be having more subtle changes like greater energy or less headaches but at this point in the process they are able to start directly correlating this to the changes they're making. They're not just wondering if it's working anymore, they know it is. Typically also during this period they're starting to develop a lot of confidence and maybe starting to adjust the protocol, tweaking the protocol a little bit to fit their personal needs. So an example might be that they start to know which of the nutrient dense foods are most important for them as an individual and they might start eating those foods even more frequently. So knowing these dynamics would be at play is really important to the health coaching team because then we can anticipate the needs of the group ahead of time even before they know they have those needs. And it allowed me to provide insight to Dr. Abbott so that when he was meeting with the subjects from one on one he could understand what they were feeling and experiencing and offer a lot more empathy in those visits which is something that every autoimmune patient really deeply needs. So Rob, do you wanna tell them about some results? So I'll preface, I'm gonna go fairly quickly through these slides because we have a poster tomorrow afternoon where we'll have a lot more time and you can speak with Adam Sadowski, another member of the study team to go more depth with some of the main results that we found. I'll give you a little preview here. So this slide is looking at the primary results for the SF-36, the health related quality of life survey. So you can see, I'll direct your attention to the third row here. This row right here represents the post scores so you can see major changes in the physical role functioning, emotional role functioning, vitality and general health and all of these domains were cystically significant and I would argue very clinically significant. These are just a few graphs representing that data. So you'll see the physical role functioning and the physical functioning. These graphs depict the median, the bar and the interquartile range through the other points. You can also see this. I've actually put the raw data in the graph and I think it was Christopher Kelly on one of our podcasts who pointed out, yes, if you could put all your raw data on a graph it probably wasn't powered enough to make definitive conclusions. So I say all that as a preface but it really helps you to be able to see the raw data and actually better visualize some outliers. So same thing here, graphs for the health of the equality of life. You can see major changes in vitality and general health across the group as a whole. And here's a graph representing changes from pre to post intervention in the MSQ or symptom burden. We saw at the beginning that the average was around 92. At study end, the symptom burden had come all the way down to 29, which was rather remarkable. So both statistically and clinically significant changes. Some of the symptom domains that saw the biggest improvements were things related to the H, E, E and T. So head, ears, eyes, nose and throat system, the GI system, neuropsychological changes, improvements in skin. And here's a big graph. There's a lot of going on here but like the health related quality of life graph I'll direct you guys to the third row, which looks at the changes from the 12 week intervention. You'll see that we did not see any major changes in the TSH or TPO antibodies, which as I prefaced earlier, it was gonna be very difficult to see major changes since it's a short period of time. Now I could sort of argue in pharmaceutical companies when they perform research might argue, well, it worked because they didn't get worse. We didn't go and say that but we didn't see changes across the group level. That being said, when you looked a little more deeply into the individual results, we saw that after the initial testing, two of the 13 women who completed the study and started it on hormone replacement medication needed to decrease their medication based off of symptoms and their TSH levels. After the intervention, six of the 13, so nearly half the women taking hormone replacement medication had to decrease their medication. Both women who had to decrease at the beginning had to decrease a second time. One woman also switched from a T4, T3 combination medication to a T4 only, so one could argue she also was technically taking less medication. And then all three of the women who began the study with only elevated antibodies and were not taking hormone replacement medication did not need it by the end of the study period. Here are some graphs depicting the changes in the immune inflammatory markers that we measured. So the left graph is the changes in the high sensitivity C reactive protein. You can see on the left is the pre-scores for the group and the right is the post-scores. So we saw from pre to post a 30% decrease in that marker. And as you can see on here, there was one individual who was quite a big outlier who she did have a big change but was still quite a big outlier from the group. And so when you looked at a secondary analysis without that outlier, we still saw the same 30% decrease and actually saw that the levels decreased to less than one which for folks who are familiar with the ranges for high sensitivity CRP, ideally we like to see folks with a value that's less than one. So we moved this group from a less than ideal value around 1.5 to a value around 1.1. We're in the case of that secondary analysis to around 0.8. So I had no expectation of what to see with this particular marker in our population. So this was a really cool, really wonderful finding. And we certainly need to study more in larger populations to figure out what's really going on. We also saw, while not statistically significant changes, we did see some mild changes in the white blood cell count as depicted by the graph on the right. One of the things that I found interesting was that it appeared to have a modulatory effect. So you'll see that there was two individuals in the beginning who were actually with a low white blood cell count who had their white blood cell counts actually come up from being below the normal range to being within the normal range after the study. So I thought that was a pretty interesting finding to see that this dietary process lifestyle intervention had some modulatory effects as measured by the white blood cell count. We also saw changes in weight in BMI. So both of these graphs depicts the entire group as a whole and the first graph on the top and then the subsection of the overweight individuals. In both groups, we saw statistical and clinically significant changes in weight. In the total group, we saw about an average of six pounds of weight loss. That being said, this is all self-report, but the individuals didn't really have a reason to be reporting different numbers than they were. We saw self-reported change in weight of about six pounds. And in the overweight group, we saw an even larger decrease in weights and having them get closer to the normal weight categorization on the BMI. So that's just a little snapshot of the results. I wanna give some idea of what really did we learn in this study. So we learned that over a 10-week period, a multifaceted dietary and lifestyle intervention, including the AIP diet, as well as group health coaching and personalized functional medicine care could improve quality of life and symptom burden in our middle-aged female subjects with Hashimoto's thyroiditis. We began to see some trends towards positive modulation of the immune system as evidenced by that change in the white blood cell count and a decrease in high sensitivity C-reactive protein. Okay, also we learned that online health coaching, community engagement and personalized care likely contributed to an increased intervention compliant with essentially no dropouts, save somebody who got pregnant. Great outcome right there. We don't know specifically what effect the community connection all on its own had, but we suspect it plays a really major role. Now given the clinically stable and overall positive initial thyroid labs, as I mentioned earlier, it was gonna be very difficult to see major changes across the group with thyroid function or antibodies, given also the short study intervention. The weight loss that we observed, improved absorption of thyroid hormone medication and increased nutrient availability were all very likely mechanisms for the observed improvements in thyroid function that necessitated the use of less medication and that subset of patients who decreased their medication by the end of the study. We hypothesized though that with a longer study duration, following the AIP dietary principles that as Angie mentioned, also include phased reintroductions, we would see further decreases in antibodies and less need for thyroid medication as a whole. And these are some of the things that we want to look at in longer term and larger research. Okay, so what's next? We hope that we'll get the opportunity to do larger randomized controlled trials with subjects with Hashis. We want to see larger sample size. We wanna see this study duration go longer, probably minimum of six months. Mickey and I know from experience working with a lot of Hashis folks that it takes quite a while to shift Hashis actually. We were happy to see what we saw in our three month intervention. And then we might wanna do more questionnaires and have more lab time points in there. And we wanna figure out how to control for the community component and then leverage social media and crowdfunding even further, like how could we improve and scale that model even bigger than we did before. Coming up very soon, we're recruiting right now. I'm doing an AIP Eczema and Psoriasis study with Lucy Mayling who's at the back here. I met Lucy at AHS last year in Bozeman and she approached me and said, could we do a study with another diagnosis? I have this ready to go. And I said, of course. So here we are. We're basically repeating the same thing again this year and we'll be starting in September. We would love to also study other diagnoses in the future. There's many autoimmune disease over 100 of them and we would love to see how this works and how things change with the different diagnoses. So I hope you can see from this talk that we did not do things by the book. We really pioneered a totally new way of approaching research, how to get it started, how to organize it, how to get it funded, how to implement it. And as we hinted at earlier, all of this was done in about a year's time which is like light speed for the areas of research. And we really feel like this is a very interesting problem that we need to solve. And it's gonna take applying novel approaches, innovative approaches to really get at that and provide some helpful answers. And I hope you can see as well that we can start to do research a lot more quickly and with a lot less conflicts of interest when we use this crowdfunding model and don't rely on industry sponsorship to get the study funding. And at least from our approach, if we can't get mainstream attention for the things that we want to study, then we're gonna find our own solution to get around that. So I thank you guys for coming to our talk today and I hope this is inspiring to you to see that we don't have to rely on industries, pocketbooks to do the type of rigorous research that we know should be done for our community. So thank you guys. Okay, great. So we have 10 minutes for questions and then at five o'clock, Gerald Edwards is going to do his primal play movement group, which meets over by the registration. So anybody? Thank you so much for your work. I think it's very important and rather excellent. Thank you. My question is, do blood levels of antibodies predict quality of life in any way, shape or form? That's a complicated answer. And there's probably some people in the audience who could answer that even better than me. What our study sort of showed was that, no, it's not a very good predictor, especially at the lower levels that our study participants had. So some studies have shown that maybe there's an influence with cognitive health and other markers of health, but it's not as robust as you would think. And I think it's one area in functional medicine where we've gotten maybe a little bit too far in the direction of measuring antibodies and trying to correlate that, that objective market to someone's health. And I think our research was showing and what really when you look at the data and the fatalities shows, we can't use that marker alone to really predict how someone's gonna be feeling as a concrete example. One of the individuals in the study while she had elevated antibodies on her laboratory data to submit to be part of the study, her antibodies at the beginning, the initial testing were actually in the normal range, but she had, I think, if not the worst, the second worst symptom burden of the patients in the study. So basically telling you that is not a great metric to have an idea of what someone's quality life or symptoms are gonna be. Hi, thank you. I'm glad that you're looking to do this research study for longer. And I'm a little bit curious if you could give some some information on how long the thyroid actually takes to heal and to change. They frequently tell you not to hormone test for thyroid any sooner than six weeks. So I just wonder, given the short duration of your protocol, like what would a realistic time period be where you could actually see some significant changes? How quickly do the hormone levels modulate? Yeah, that's a really good question. So thyroid hormones in general are an thyroid hormone replacement. The weight is dose is based on weight. So the major way to see changes in thyroid hormone need is in terms of replacement isn't actually is weight loss. So if someone has rapid weight loss, you can see fairly rapid changes in the thyroid hormone levels and what they need in terms of replacement medication. Outside of that though, it does take quite a long time to see changes, especially in Hashimoto's and autoimmune thyroiditis on a level of like six, nine, 12 months. So yes, our study duration, trying to capture that was probably too short of a period. And I would have loved if we had the funding to do labs at a longer time period. It's also interesting to note that with antibodies, changes in antibodies can often also lag behind other changes in overall health. And so while there are somewhat less invasive markers as a blood test versus a biopsy or an ultrasound, it's still an imperfect marker to be able to tell what's really going on at the level of thyroid in terms of cellular damage and autoimmune response. So yeah, it's a really good question. I would say at least a year's time and our clinical work together and my clinical work, nine to 12 months is probably more realistic to see major changes if it's not related to weight loss alone. Thank you for your presentation. You did say that there was one participant who went from a T43 to a T4. What were you doing to measure, for example, some people that have an uptake issue, some people that's actually a thyroid issue, some people that's conversion. Is that some of the studies that you were working with your individuals? Yeah, so we did full thyroid panels for everyone at the beginning, and so that included TSH, the total hormones. There was even a reverse T3 on there, which I don't find to be very helpful clinically, but it was on the panel. It's always a combination of the labs and someone's clinical symptoms. So if they manifest with what might be considered hyperthyroid symptoms and signs of maybe being over-medicated, I pay attention to that. And while we tried to standardize the timing of labs and when folks took their thyroid replacement medication to try to control for what the hormone levels would actually represent, I think that's another issue. When you do thyroid labs, the functional community really likes looking at T4 and T3, they are still somewhat transient when compared to TSH levels. So it can be somewhat hard when you look at that to if you do it at the wrong time or around someone taking medication, you may wrongly infer that they're underdosed or overdosed on their medication. So I usually find that using the TSH, someone's symptoms, and then going back to, they were first getting started on medication using their weight as an initial, and using their weight as a way to get an initial dose. And then I think your question also was talking about why would someone want to use a combination versus just a T4 alone? No, not so much why, but just how do you know if there is a conversion issue, if it's an uptake issue, those kinds of things. Yeah, so I mean, there are labs, we didn't do them that technically you can look at, supposed uptake in the thyroid. I think, yes, looking at free T4 and free T3 can give you some semblance of an idea of a conversion issue if they're in the normal range with a free T4 and their T3 is in the low end of the range, you could infer that that's a conversion issue, but I also come back to, once again, these things are somewhat transient, T3 also has a shorter half-life and so it is even more transient in nature. So I think sometimes we jump to conclusions when we look at thyroid panels, a little bit more than we should, but yes, we do know clinically and there are some genetics too that folks have issues with conversion, but I think it's probably less of an issue than our community probably makes it out to be, but that's also just my personal opinion. I do have one more question, but there is somebody else, so. I just was gonna say that I know that a lot of times I hear, we hear about, oh, 90% of people who have thyroid issues actually have Hashimoto's, would you agree with that? Yes, when you look at the statistics, it's somewhere in the 70 to 90% range, at least in the United States where iodine is not a major nutrient deficiency that we see, so yes. And we do learn that, I will say in medical school, it's just not quite, it's not quite emphasized in the way that it probably should be, so, yeah. Thank you very much. I just wanna thank you for all the work you're doing and the research. I was diagnosed with Hashimoto's last year and have been very successful on AIP protocol and reintroductions this past year. One of the questions that I do have with regard to the research, are you aware of, I don't know if you're, if you're study looked at this at all, or if you're aware of any research or data on the effect of an AIP protocol reducing the damage to the thyroid, such as shrinking the nodules on the thyroid and anything like that? Yeah, it's a really good question. We, I would love to have done ultrasounds or biopsies on individuals. That's certainly, I would wanna at least give six months or 12 months of a period of time to look at. One of, I don't know if he's in the room anymore, but Guillermo Ruiz, he actually does a lot of thyroid work in his clinical practice and he brought that up as a way to try to objectify these changes because I didn't point it out in the talk, but as compared to inflammatory bowel disease where you can do a colonoscopy or an endoscopy to look at the tissue itself. When it comes to Hashimoto's Thyroiditis, we don't have really great fully objective markers that are really accessible to determine the state of someone's disease. So it doesn't exist yet, but it's certainly something we'll talk about and hopefully be able to do in years to come. Well, excuse me, that was the last.