Special guest Dr. Sean Hashemi discusses different ways you can improve your Kidney health.
Questions Answered
- (00:04) – Dr. Hashmi, could you tell us a little about yourself?
- (02:04) – What would be the guiding principles for someone who is worried about their kidney health?
- (14:17) – Can you give a little bit more information about the effect of plant-based protein on the kidneys?
- (17:39) – Do you have any recommendations as far as the percentage of calories from protein, carbohydrate and fat for people?
- (21:31) – Does a person have a higher risk of kidney disease in the future, if they have kidney stones?
- (23:50) – What would be a good quality carb?
- (25:13) – Does the water we use to make smoothies count towards our water intake?
- (27:09) – What would you suggest for someone who has elevated creatinine and elevated potassium?
- (29:26) – Could you tell us where people can find you and support your work and what you're doing?
Complete Transcript
Dr. Laurie Marbas
(00:04)
Dr. Hashmi, welcome to Plant-Based TeleHealth, and we're so excited to have your expertise here. You're a plant-based nephrologist, could you tell us a little bit about your current experience and everything that you do, you do some wonderful work.
Dr. Sean Hashmi
(00:20)
Oh yeah. So I'm Sean Hashmi. I'm boarded in obesity medicine and nephrology. And I used to be boarded in internal medicine, but I decided not to renew till next year because it's too many boards to renew, so the dollars add up pretty fast. Aside from my day job, my other title for Kaiser Permanente where I work, I am the regional director for Southern California for Clinical Nutrition and Weight Management. So essentially what that means is my job is to create a comprehensive strategy around the management of obesity, which we do using three components that's lifestyle medicine as the foundation, then we add on obesity medications in bariatric surgery when it's appropriate and indicated. So that's sort of all of the stuff I do for work and to make a paycheck. And then for fun, I have a nonprofit that I run, it's called SELF Principle, stands for sleep, exercise, love and food.
Dr. Sean Hashmi
(01:16)
And we have two functions. One is we create educational content every week and we put it on YouTube at youtube.com/selfprinciple. And then the other thing is any donations that come in, we take 100% of those donations and we actually create children scholarships for education. So right now we're working in the Philippines we have a couple of our board members who actually go there every year and through their own pockets, they buy school supplies. What we have learned is we don't give cash because it's hard to make sure it has an impact, but school supplies are so critical. We talk about so many things we take for granted, there's people who don't even have shoes to go to school. So just the basics, $10 is enough to cover entire child's education for a year. So it's really fun rewarding work, and little by little it's a work of passion.
Dr. Sean Hashmi
(02:04)
We're starting to see it grow and have an impact. And with kidneys, what's interesting how I got into the whole nutrition side of it was nephrology is one of those things that we always end up seeing where the mortality is so high, the risk of dying is so high that anything you can do to help people is just so dramatic. So today what I'm going to talk about with you guys is really a very basic way to look at it, because I want to make sure I get your questions answered. So it's really about helping you guys to answer what may be on your mind.
Dr. Laurie Marbas
(02:40)
That's fantastic. And so what would be the guiding principles for someone who is worried about their kidney health or someone who wants to preserve their kidney health? Where do you begin with someone with nutrition and what are some of the things that you mention to them?
Dr. Sean Hashmi
(02:54)
That's a perfect segue, because I have a few slides I want to run through with you guys.
Dr. Laurie Marbas
(02:58)
Oh, fantastic.
Dr. Sean Hashmi
(03:00)
So I think Dr. Marbas is a mind reader and she knew exactly how to segue right into this.
Dr. Laurie Marbas
(03:07)
I'm just a huge fan, Dr. Hashmi, so.
Dr. Sean Hashmi
(03:09)
All right. So I'm going to go ahead and share my PowerPoint with you guys and I want to make sure once you guys can see it, if you guys will let me know.
Dr. Laurie Marbas
(03:25)
There we go. Yes.
Dr. Sean Hashmi
(03:28)
All right. Okay. And can you guys still see it? I just put it into slideshow.
Dr. Laurie Marbas
(03:31)
Yes.
Dr. Sean Hashmi
(03:31)
Fantastic. All right. So in terms of just a couple of things you want to know, and why we're talking about this topic today is because nobody talks about kidney disease. Now, heart disease, everybody knows heart disease and heart attacks and all the damage it does, but it turns out one out of every 10 people have kidney disease, in some parts of the world, one out of seven. So it's a huge number when you think about it and yet nobody is really raising the alarm bells or saying, “Oh my God, we need to learn about this.” And if you look at how many people died from kidney disease, this is a 2017 statistic, it's 1.2 million. That's actually more than breast cancer or prostate cancer. That's how startling the statistic is.
Dr. Sean Hashmi
(04:19)
But if you think about diseases, we talk about breast cancer, we talk about heart disease, but this is why this becomes such an interesting part. But the scary part about this is if you look at the number of people on dialysis right now, it's closer to about 3 million. That number is going to be closer to five and a half million in just less than a decade. So if you're listening to this and you're wondering, why should we care? Because the risk of dying on dialysis is 50% in five years. So if you're on dialysis, your risk of death is 50% in five years or one out of five die every single year when they're on dialysis.
Dr. Laurie Marbas
(04:59)
Dr, Hashmi, your audio is cutting in and out just a bit. I don't know if there's anything about maybe getting a [inaudible 00:05:06], it's just kind of fading. We can still hear you, but it fades in and out.
Dr. Sean Hashmi
(05:10)
How about now?
Dr. Laurie Marbas
(05:11)
There you go. Yeah.
Dr. Sean Hashmi
(05:12)
Is that better?
Dr. Laurie Marbas
(05:13)
Yes. Thank you.
Dr. Sean Hashmi
(05:15)
I just turned up the gain on my mic, that should take care of that. So when we think about who are the people that are most likely to be affected by kidney disease, it turns out that it's people who are actually the most vulnerable in society, it's people who are poor. And the reason that's so important is because if you look at some of the big studies that were sort of these “landmark studies” that said, “Hey, saturated fat is back or red meat is okay to eat.” And you look at studies like the Pure Trial, and you say, “Well, what was so unique about them?” Because what they did in those studies was they compare things like saturated fat to carbohydrates.
Dr. Sean Hashmi
(05:59)
But what they found was that people in the poorest countries, if they ate more carbohydrates, they died more. But here's the question, what kind of access to carbohydrates did they have in those countries? All refined. So it's really important that if you are poor that by itself is a risk factor for kidney disease, for heart disease, for cancer, and a whole host of other things. And that's why learning some very basic things on what you can do makes such a difference. Now, if you're wondering, well, what's the number one cause of kidney disease? You don't have to look at this fancy overly did graph, it's diabetes. It's diabetes, diabetes, and diabetes. So if you said the number one way for me to lower my risk of developing kidney disease, get my sugars under control, that's it. That's the take home message of everything that's here today.
Dr. Sean Hashmi
(06:54)
So there's a really interesting study, which came out last year and they compared 104 studies. So it's great because I read all 104 of those studies, but it's nice to have somebody summarize the darn thing. So this is a really good summary of all of the data we have on what you can do right now. So what the meta-analysis showed was that if you increase how many vegetables you eat per day, and once again, it doesn't have to be a lot, even a couple of servings of vegetables per day. And what type of vegetables? Any type. As you shift from plants, I'm sorry, as you shift from animal based foods to more plant-based foods, you start to see this benefit. So don't get caught up in this idea of super foods how I have to have a certain vegetable that's miraculous, there isn't any. So vegetables by themselves.
Dr. Sean Hashmi
(07:48)
Now, here's something that's a bit of a weird statement for people who have kidney disease, they're all worried about potassium. So they say, “Oh, I can't eat a plant-based diet,” but here's the thing. If you don't have kidney disease, one of the best ways to prevent from getting kidney disease is eat more potassium. So think about that for a second, it's the complete opposite of what you understand. When you have kidney disease and guys like me, we just measure your potassium. If it's fine, we tell you eat more plants. But if you don't high potassium will lower your blood pressure and will lower your risk of developing kidney disease. And what's high potassium foods? Plants, fruits and vegetables, that's it. On the flip side, the more salt you take, the higher your risk. What's got a lot of salt? Not plants. So if you think about it in those terms, you don't have to focus on reading labels and all that stuff.
Dr. Sean Hashmi
(08:48)
All you have to focus on is does your plate always have fresh fruits and vegetables on it? Nobody cares if it's organic or not. Once again, we create these little pigeon holes where it makes it really hard for people who are in lower socioeconomic status to follow our guidelines. Eat more plants. If you do, your kidneys will get better. The other stuff is coffee, fiber, dairy is an interesting thing, I have an entire lecture on it so I won't delve into it here, but dairy's always one of our yellow light foods for several reasons. There's folate, legumes, nuts, magnesium, nitrate, plant proteins, Omega-3s, all of these things that are listed, they decrease the risk. What are great sources of all of these things? Plants. So it shouldn't come as a surprise on what this is saying. And for red and process meat, we have over 1,000 studies, 1,000 studies have been done that say you really ought to cut down your red and process meat intake, yet still people continue to argue this point.
Dr. Sean Hashmi
(09:50)
And it's very interesting. Now what about exercise? What's interesting about your kidneys is your kidneys suck 20% of the blood every time your heart beats. They are the most vascular organ, which means they're the most hungry out of all the parts of your body when it comes to blood. And the reason is they have to clean all your body. So as a result, when you exercise, you actually dilate your blood vessels, you send more blood vessels inside your kidneys. You lower the pressure inside your kidneys and think of blood as food. So the more nutritious type of food filled with rich oxygen that you deliver, the better your kidneys do. And so as a result, what ends up happening? You lower your risk of developing kidney disease. And this is such a simple thing. And what kind of activity? Doesn't matter, just move.
Dr. Sean Hashmi
(10:45)
And if you're thinking, “I can't do 30 minutes, that's crazy.” Don't worry about it. Do five minutes six times a day, do 10 minutes three times a day. There are so many different strategies. And if you want to figure out how to turbo charge your physical activity, especially when it comes to eating dinner, go for a walk just 15 minutes after your dinner. You will find that you can lower your blood sugar more over a 24 hour period, simply by going for a 15 minute walk than if you were to do a 45 minute walk at any other time during the day. Now that doesn't mean that you're not going to get other benefits from doing more, but if you were just saying, pick your biggest meal for most Americans, unfortunately, it's dinner, not breakfast. So if you pick dinner and you just did a quick walk, it's remarkable how much benefit you can get from it.
Dr. Sean Hashmi
(11:38)
Now, alcohol is interesting because we actually have the loosest guidelines for alcohol intake in the world. So it turns out as Americans, we drink more alcohol than a lot of other places. And contrary to what everybody thinks, alcohol isn't just bad for the liver, it's actually directly bad for the kidney. So in other words, the damage that you end up doing will hurt the kidneys directly, irrespective of the damage it's doing to the liver. For our doctor colleagues, as you know, there's hepatorenal, so the liver is affected, therefore, the kidney is affected that occurs still, but more importantly, kidneys get damaged directly by alcohol. So simple, cut it down. How little? Based on this data, it's less than one drink per day. But I'll tell you when it comes to cognitive decline, the less alcohol you drink, the better off you're going to be.
Dr. Sean Hashmi
(12:34)
Smoking everybody knows, just don't smoke. Just don't do it, it's that simple. So putting it all together here are seven really simple things you can do. Eat more potassium. What's potassium? Plant-based. Eat more vegetables. What's vegetables? Plant-based. Exercise more, and if you want to have tricks around exercise, break it up. If you're going to have a big meal, wait 30 minutes and then go for a small walk. It will do wonders for helping those GLUT4 protein transporters to come on the surface of your cells, suck the sugar out. So it's a really simple trick of helping your sugars to go down by going for a small walk. Alcohol, lower the better. We're okay with one or less drink as a whole, but generally speaking, what the data shows is if you're looking at brain health over decades, the people who did the best were the ones who drank the least.
Dr. Sean Hashmi
(13:32)
That's not to say the benefits of red wine, but one biggest things that we're concerned about is dementia. And of course goes without saying tobacco, just cut it out. And for salt, plants don't have salt in them. So you don't have to worry about your super duper French fries. Here you're just eating the potatoes, half potatoes, half sweet potatoes, they're excellent for you. So that's a really brief way to give you some very actionable things that you guys can go and take away and start doing right away. So with that, let me see if you guys have any questions I can answer for you guys.
Dr. Laurie Marbas
(14:08)
Great. That was fantastic, Dr. Hashmi, appreciate that. Any of our docs, I know some of our docs have questions. So let me go ahead and make this-
Dr. Chris Miller
(14:17)
I have a question. Dr. Hashmi, thank you so much. That was fabulous. And I've listened to many of your talks. So I really appreciate all your explaining the kidneys and how it affects it and reviewing the data with us. So thank you for that. My question is what about protein? You didn't comment about that. And I know animal protein contributes, but as far as plant protein, I believe that the beans and the tofu does not affect it, but is it actually beneficial or can you give a little bit more information about that?
Dr. Sean Hashmi
(14:48)
Right. So when it comes to protein, there's an entire other sort of series of lectures on that. There's a couple of things. First, the guidelines for proteins for regular folks are so high. So the typical American eats more than 1.2 grams per kilogram, per day of protein. And that protein is mostly animal based. It turns out that if you want to slow down the decline in kidney function, first step is cut down your overall protein intake. How much? About 0.6 to 0.8 grams per kilogram per day. So if you're somebody who's 70 kilograms, meaning you're a male who's around let's say 150 pounds or so, 70 times 0.8. So you're looking at about 55, 56 grams per day of protein. Then comes the second part is the acidity of protein. So animal protein is very acidic, and what it ends up doing is in addition to leaching the calcium and phosphorus from the bones, it's also the acidity that causes all of this inflammation in the kidneys and leads to scarring.
Dr. Sean Hashmi
(15:51)
So what we know is soy is actually one of the best proteins you can eat when it comes to kidney disease. People who consume highest levels of soy have lowest levels of kidney disease. Correlation studies, not causation studies, but it's very simple. As you shift over to more plant-based proteins, you find that your risk of kidney disease goes down. As you lower your protein intake to 0.6 to 0.8 grams per kilogram, your kidneys will stay healthier longer. Now in Japan years ago, it used to be that they didn't have enough dialysis machines. So what they would end up doing is because they weren't enough dialysis machines, they would basically let these people go home and wait to die. So what they tried was they would give them these resins, which would bind to the potassium and cause them to have diarrhea.
Dr. Sean Hashmi
(16:43)
And these guys were eating majority of a vegetarian type diet. So what they found was that by eating mostly plant-based proteins with a very low protein intake of about 0.3, 0.4, they were actually able to last twice as long without dialysis than the people who were getting animal based proteins. So there's a really good randomized control year long study that was remarkable in showing how a very low protein diet coupled with branching amino acids so people don't get malnourished, could actually preserve your kidney function for so much longer. So if you're somebody who has kidney disease, the best thing you can do for yourself is switch to plant-based proteins because they will help your kidneys to last so much longer.
Dr. Laurie Marbas
(17:35)
That's excellent. Dr. Nikki.
Dr. Niki Davis
(17:39)
Yeah. I just have a follow up question to that. So do you have any recommendations as far as the percentage of calories from protein, carbohydrate and fat for people?
Dr. Sean Hashmi
(17:52)
Yeah. This is a really important question because when we start to get into the carbohydrate category, the only studies we have are population based. And what they showed was that there's a U-shaped curve when it comes to carbohydrates, meaning somewhere between 50% to 60% of your daily intake coming from carbohydrates had the lowest mortality. As you went to a low carb diet, your risk of mortality shot up pretty fast. And as you went over to a high carbohydrate diet, your risk of mortality started to slowly go up. So low carb, the mortality goes up fast, high carb, the mortality goes up slow, but it goes up. The thing that those studies can't tell you is what was the quality of those carbs. So once again, the biggest issue with population based studies is you can't get down to those nitty gritty questions.
Dr. Sean Hashmi
(18:47)
Now you can look at Okinawa, Japan, which is predominantly complex carbohydrate based pre World War II folks. Post World War II, especially after we introduced fast food restaurants, it all changed and now people eat all sorts of really bad foods, but pre World War II, it was about 80% carbohydrates. When it comes to fats, there is two camps. One camp says that you want to be extremely low fat, the other camp says that things like polyunsaturated fatty acids or monounsaturated fatty acids are actually healthy and good for you. So some of the data that's coming out, for example, on memory and dementia and things like longevity, what they're showing is that certain things such as olive oil, for example, not all oils, but specifically olive oil, such as nuts.
Dr. Sean Hashmi
(19:40)
If you have them in moderation, you actually help the brain to stay healthy longer. When people go on this idea of we're going to do a ketogenic diet and they put all of the saturated fat in their body and they say, “Well, I have mental clarity.” What's happening there is that certain fats, because when you have this issue of creating beta-hydroxybutyrate inside your body, the impact on the brain is pretty remarkable. Now, if you are somebody like me who follows a plant-based diet, what we do is we add intermittent fasting with a plant-based diet. And what that does is it is far more effective from a health basis and from a benefits basis than doing keto.
Dr. Sean Hashmi
(20:29)
And the few benefits that we know about keto, you can get all of those simply by doing it through fasting and following a whole foods plant-based diet. But in terms of exact ratios, there is so much debate. What I will say is in general, we eat way more protein than we should, the quality of our carbohydrates is terrible, and when it comes to fats, we tend to lump everything in one camp. So when the studies say that people with an extremely low fat diet did better, you're comparing it to people whose fat intakes was also very poor. If you compare them to people who are in different areas where they have a little bit of fat, but that fat is mono and polyunsaturated foods such as nuts. And those ones is where you see that in terms of longer term declines, such as dementia, Parkinson's, Alzheimer's, those risks are actually lower.
Dr. Laurie Marbas
(21:27)
Those are great questions.
Dr. Chris Miller
(21:29)
Yes. Thank you so much.
Dr. Kim Scheuer
(21:31)
I have a question. I don't know if I'm saying his name right, [Zenub 00:21:36] asked about kidney stones and if a person has more of a risk of having kidney disease in the future, if they have kidney stones. But my question on top of that would be, you had said any vegetable, but with kidney stones, I know there are some issues with oxalates. Any suggestion for people who've had history of kidney stones?
Dr. Sean Hashmi
(21:53)
So this is really interesting. I think vegetables and oxalates gets a really bad wrap because… So we know that high oxalate will contribute to kidney stones, but the flip side is not true. The flip side of cutting down to a low oxalate diet in preventing kidney stones, it doesn't really work that well. So it turns out that the most effective thing for preventing kidney stones is drinking two to three liters of water so that at a minimum, you're making two liters of pee every day. So how does a kidney stone form? That's the first question. It forms because there's debris that's basically forming in the urine, that debris sticks together and over time hardens to form a stone. This is why you don't want to drink from a pond, you want to drink from a stream because in a pond the sediment will stick together and just float everywhere. In a stream, it doesn't have time to stick together and form the stone.
Dr. Sean Hashmi
(22:54)
So your first and foremost and most important thing is drink so much water that the water keeps flushing everything out so stones don't form. Number two is to bring up citrate inside your body. So citrate and magnesium are stone inhibitors and most stone formers even before we look at the oxalate, we look at the citrate level and guess what their citrates are non-existent. What's a great way to bring up citrate inside your body? Fruits and vegetables. It's a recurrent theme, you can go whichever way you want to spin it, it'll always end up being the same. So this thing on oxalate is not that high oxalates don't contribute, it's that cutting them down it doesn't really improve the person's kidney stones. You want kidney stones to be better, they got to pee like a horse. I don't know if horses pee that much or not, but that's a statement.
Dr. Laurie Marbas
(23:50)
They do. It's a lot, I've seen more than my share. There was another question, Dr. Hashmi, Nelson asked what would be a good quality carb?
Dr. Sean Hashmi
(24:02)
Yeah, sweet potatoes. Sweet potatoes are awesome, quinoa is awesome, whole grains are awesome. Here's a running joke, I think it's a joke, I don't think anybody else thinks it's a joke. But if you have somebody who eats refined grains versus you have somebody who eats whole grains. If you look at how much they poop, the person who eats whole grains, they actually poop a lot more. And what happens is just by switching out refined grains to whole grains, you actually end up burning an additional 100 calories per day without doing anything.
Dr. Sean Hashmi
(24:37)
Now think about you going out for a walk for just a very casual walk for 20 minutes, you don't get close to 100, you get a bus 60, 70 calories burned, but it's not close. So you can get 100 calories by making one tiny switch to whole grains. And the reason we know this is because they're students who actually have to measure this stuff. And what they do is they measure people's poops and then they burn it and they see how much energy it releases. And that's how they know that consuming whole grains because of all of that wonderful fiber content, you absorb less of the energies. And that's why it's so helpful.
Dr. Laurie Marbas
(25:13)
That's fantastic. Another question from Keisha says, does the water we use to make our green smoothie count towards our water intake?
Dr. Sean Hashmi
(25:22)
Yes. All liquids count, coffees count, [inaudible 00:25:25] count, every single thing counts. What you want to remember is if it's hot, you're going to sweat more, you're going to lose more. So you still want to make two liters of urine a day, that means two to three liters of water or any kind of liquids. The only stuff you want to be mindful of is when we start getting into sweetened water. So my wife, she loves sweetened water and every time I talk to her, I have to always be gentle and realize that I'm going to be sleeping on the couch for the next week after I say this statement. But artificial sweeteners will double your risk of gaining weight. It does not matter if it's stevia, Splenda or anything that you say is completely natural. Anything that's sweeter than sugar but doesn't act like sugar, it actually goes and reinforces our cravings and we get hungrier.
Dr. Sean Hashmi
(26:19)
This has been tested out in mice models, this has been tested out in humans. The studies show over 100% increase in weight gain if you go ahead and switch to that. And then carbonated beverages, what carbonation does is when it goes in your stomach, it stretches the stomach. As it stretches the wall of the stomach, it actually releases ghrelin and ghrelin makes you hungry. And so keep that in mind as you are into your seltzer waters and everything. I'm not saying that you can't have them just be mindful of these little things. Remember at the end of the day, it's little things that add up to your life, it's never the big things. People always think it's the big thing. This is why when people start a workout and they say, “Oh my God, I'm going to lose 50 pounds in two weeks.” That's great. Six months later, they're 100 pounds positive.
Dr. Laurie Marbas
(27:09)
Wow. That's fascinating. There's so many things we could talk about. So as far as, I just want to kind of reiterate the potassium. So if you have someone who has elevated creatinine and they've had an elevated potassium, and now we're telling, “Hey, eat more plants,” where's the balance because I know you have an approach that works really well with patients, because I have tuned in and asked you so many questions. What would you suggest for those type of people and for physicians who are maybe confronted with those type of patients?
Dr. Sean Hashmi
(27:41)
Yeah. So when it comes to potassium, the first thing is we freak out, and the reason we freak out so much is there's no symptoms of high potassium. The first symptom of high potassium is death. So this is why we take it so seriously. Number two, the risk of arrhythmia, so cardiac abnormalities that leads to death occurs when the potassium is higher than 5.5. So up until 5.5, all we do is we look to see where we can make those changes. So when you change your diet, we always recommend within the first five to 10 days, one to two weeks, whichever way you want to do it, to check a potassium level because after you hit steady state, it's not going to change. It's only when you're changing much. And then let's say it is high, we're not going to tell you all of a sudden that you should go onto a keto diet and stop the plant-based diet.
Dr. Sean Hashmi
(28:32)
What we do is we say, “Okay, give us your food diet. What is the highest consumption of potassium food you have? Let's start with that one and cut that down.” Now let's say it's where we need you to eat more vegetables and there's other reasons for it, we have by binders that can bind the potassium in your gut and then when you go to the restroom, you just get rid of it. So we have all these ways to control potassium. So if you're worried that you can't have fruits and vegetables on a kidney disease diet, that's not correct. You absolutely can, you just need a dietician and a physician who understands that and just willing to check a blood test in two weeks. That's it.
Dr. Laurie Marbas
(29:10)
Fantastic. So when's the book coming out?
Dr. Sean Hashmi
(29:13)
There's no book.
Dr. Laurie Marbas
(29:16)
There needs to be a book, Dr. Hashmi, I'm just saying. So can you please tell us… Thank you so much, that was so much information. And I know we said half an hour and we've asked all our amazing questions, but could you tell us where people can find you and support your work and what you're doing?
Dr. Sean Hashmi
(29:30)
Yeah, so the YouTube channel is youtube.com/selfprinciple, and on that I post every week a new video. And then the website is selfprinciple.org. Those are the best places.
Dr. Laurie Marbas
(29:43)
Fantastic. And let me tell you, Dr. Hashmi is phenomenal guys, he's one of my favorites. I can't even tell you how much I mean that. And so thank you so much, Dr. Hashmi for spending time with us. And I know we're working on some projects together, I'm hoping we can have even more access to you. And everyone who's watching, this is again, plant-basedtelehealth.com. You can talk to any of these lovely docs, Dr. Hashmi's not on there, but our other docs as well. We're in all 50 states in DC, and we're happy to work with you. Someone had asked if we work with leaky gut? Absolutely, any of our docs would be well versed and help you with that. So thanks everyone again for watching, and as always tune in, in the second and fourth Thursdays of every month at 12:30 Mountain Time. Thank you Dr. Hashmi for your time. We so appreciate you-
Dr. Chris Miller
(30:31)
Thank you so much.
Dr. Sean Hashmi
(30:32)
Thanks everybody.
Dr. Laurie Marbas
(30:33)
Huge fans. Thank you, everyone. Take care.
Dr. Sean Hashmi
(30:36)
Bye-bye.
Dr. Chris Miller
(30:36)
Bye everyone.
Dr. Laurie Marbas
(30:37)
Bye.
*Recorded on 8.30.21