EpicGenetics – a biotech firm in Los Angeles – is attempting an FM trifecta: produce a blood and genomic test and provide a treatment.
A blood test, genomic signature, treatment…EpicGenetics is trying to redefine how FM is thought of and treated.
EpicGenetics is trying to make a big splash in fibromyalgia. A Los Angeles biotech firm, they focused on producing diagnostic tests for complex conditions and produced what they believe is a highly unusual trifecta for any disease: 1) development of the first blood test for FM; 2) development of a genomic diagnostic test and; 3) launch of a treatment trial.
They seem to be doing well. Buoyed by demand for their FM/a blood test, the Los Angeles firm recently quadrupled their footprint, moving their labs and offices into a 50,000 sq. ft, facility. It’s all coming to a head, though. Their blood test, genomic test and treatment effort are all of a piece and will likely all rise or fall together. With their treatment trial underway, we should know over the next year if EpicGenetics is the next big thing – more accurately, the first big thing in FM – or not.
2012
When I learned they’d developed what they believe is an immune blood test for fibromyalgia (FM) (?), I felt like rubbing my ears. Researchers had been focusing on the immune system in chronic fatigue syndrome (ME/CFS) for decades but have given it little attention in FM. I wasn’t dreaming, though. An immune test was being touted for FM – not ME/CFS. How had that happened?
The FM/a story starts back in 2012 with a University of Illinois study, “Unique immunologic patterns in fibromyalgia“. Immune cells from a huge set of FM patients and healthy controls (n=201) were cultured overnight and then stimulated the next morning with profoundly irritating plant lectins (PHA (phytohaemagglutinin) or PMA (pokeweed mitogen)).
(PHA is found in red and white kidney beans, green beans and fava beans. It takes just 5 raw red kidney beans to induce poisoning. Wikimedia reports that cooking reduces the very high levels of lectins in red kidney beans to safe levels. Some ME/CFS/FM practitioners do tout a lectin-free diet, however.)
These kinds of mitogenic tests are commonly used to assess white blood cell activity. The levels of 8 cytokines (IL-5, IL-6, IL-8, IFN-γ, IL-10, MIP-1α, MIP-1β, MCP-1) were measured before and after the stimulation.
No differences were found in the cytokine levels of FM patients or healthy controls before stimulation but, as in ME/CFS, adding a stressor got things moving – or rather, in the case of FM – failed to get things moving.
After the mitogenic stimulation, no less than seven of the 8 cytokines measured were quite significantly lower (1.4-8x’s lower) in the FM patients. For some reason, the FM patients’ immune cells had reacted in a lackadaisical manner to the powerful stimulant given them. (Later analyses revealed that the test worked fine using just 4 cytokines.)
The authors noted that a similar pattern of reduced immune response to stimulation occurs in Sjogren’s Syndrome and depression.
2015
The 2015 study by noted UCLA immunologist Daniel Wallace, “Cytokine and chemokine profiles in fibromyalgia, rheumatoid arthritis and systemic lupus erythematosus: a potentially useful tool in differential diagnosis“, was bigger (n=358) and, with its inclusion of rheumatoid arthritis (RA) and lupus patients, better. EpicGenetics was clearly hot on the trail of a diagnostic test.
Cytokine responses to stimulation were much reduced in FM patients compared to healthy controls.
The big question was whether people with autoimmune diseases like RA and lupus would have the same or a different cytokine profile as people with FM. By all rights, they should have been similar. FM, after all, got shoved in the rheumatology silo early on – which is packed with autoimmune diseases characterized by overactive immune responses.
Yet the results suggested FM was nothing like the other two autoimmune diseases. It demonstrated both high sensitivity (it picked out people with FM) and specificity (it rarely picked out people with RA, lupus or healthy controls). If you have FM, the test should show that. If you have RA, lupus or are healthy and don’t have FM, it’s unlikely you will test positive.
The increased cytokine production seen in RA and lupus suggested they’re not closely related to FM. (A subset of people with RA and lupus, and indeed, it seems all chronic pain diseases, do also have FM).
The authors noted that a similar pattern of reduced immune response occurs in Sjogren’s Syndrome and depression. The authors were careful to say that the findings do not necessarily mean that FM is caused by an immune dysfunction, but Gillis has stated that he believes the immune systems of FM patients are not producing enough protective cytokines.
Strange Findings
Some of the findings, though, seemed strange. IL-6 – an important cytokine known to induce pain and sympathetic nervous system activation – was reduced in FM instead of increased. So was IL-8 – another major pain player – which also plays a role in pathogen defense. Low levels of MIP alpha and beta seemed to make more sense – both play a role in natural killer (NK) cell defenses.
FM researcher Daniel Clauw stated that the results flew in the face of past FM results – and he’s right: while mitogen-activated IL-6 tests have not been done in FM, both IL-6 and IL-8 have been found elevated in FM.
A 2016 study reported that “IL-6 and IL-8 are two of the most constant inflammatory mediators in FM” and that their levels correlated with symptom severity. A 2013 study found that a marker of inflammation (c-reactive protein) was correlated with IL-6 and IL-8 levels in FM and a 2014 review specifically pegged increased IL-6 and IL-8 levels as significant factors in FM.
In 2013, Clauw wanted the study to be replicated and in 2015, he got a replication in a very large study. Now – perhaps the best thing to do is to try to make sense of these seemingly paradoxical findings.
EpicGenetics has asserted (as did VanElzakker for ME/CFS) that the short life of cytokines, the effects of circadian rhythms on them, and other issues made assessing cytokine levels in the blood “unreliable”. Far better, they said, to isolate immune cells, smack them with an immune trigger, and see how they respond. They could be right.
Plus, who knows – maybe the weird pattern in ME/CFS where the system seems to be on alert – but folds when presented with a stressor – is showing up in FM as well.
What is Fibromyalgia Anyway?
IF FM isn’t a “normal” rheumatological disease, what is it? The authors proposed FM is a central sensitization disorder characterized by reduced responses to all sorts of different kinds of stimulation (sympathetic, hormonal, cytokine and chemokine).
All one may need, they suggested, to differentiate central sensitization from autoimmune disorders is to whack their immune cells with a trigger and see how they respond: the immune cells from people with central sensitization disorders will respond poorly, while the immune cells from people with autoimmune disorders will leap into action.
If EpicGenetics is right, FM is the odd man out in the rheumatological field.
(Two years ago, Wallace found that another immune test – “cell-bound complement activation products (CB-CAPs)” – differentiated FM from lupus as well. Calling lupus the “prototypical autoimmune systemic disease in which hyperactivity of the immune system and production of autoantibodies lead to a variety of symptoms including chronic pain, arthralgia, fatigue, morning stiffness” and organ damage, Wallace demonstrated that these complement activation products were plentiful in lupus but were completely missing in FM.)
Few have linked – or have attempted to link – central sensitization with immune dysfunction as this group has. Gillis stated that his inquiry into FM began when he asked himself what could cause the many different symptoms in FM? The only system he could come up with was the immune system.
Sensitive AND Specific Test
Gillis said the sensitivity of the test is now up to around 99% and the specificity of the test is now around 95%.
EpicGenetics reports that the test requires about an ounce of blood and is available in most states, Canada, Europe, Turkey, Mexico, Central and South America, the Caribbean, Hong Kong, Australia and New Zealand. It states that the test is “FDA-compliant” and is covered by Medicare and most insurance plans. The company can also help FM/a® Test applicants arrange for their blood draws at a local facility at no cost.
If not covered by insurance, the test is expensive (>$1,000). Your doctor must provide authorization but EpicGenetics will even help you find a more amenable healthcare professional. (Complete the FM/a® Test Application Form.)
Why get the test?
- To rebut the doubters – whether they’re your doctor or your family or friends, that you have a real biological illness.
- To save time and money. Dr. Gillis, the CEO of EpicGenetics, stated that literature indicates the average patient will spend $4,800 – $9,300 a year for 3-5 years before all the tests prove negative and the doctor decides you have FM.
- To get the vaccine (see below).
The Genomic Test
Has Epigenetics been able to uncover a genetic signature in FM – one, as they suggested, similar to the BRCA gene in breast cancer?
The Gist
- EpicGenetics is a Los Angeles biotech firm that specializes in developing diagnostic tests.
- Two quite large studies found that the white blood cells from FM patients responded to an immune stimulus poorly by producing significantly lower levels of immune mediators called cytokines than healthy controls’ cells did.
- The CEO of EpicGenetics proposed that reduced levels of protective cytokines may be responsible for FM.
- One study was able to use the response to an immune stimulus to clearly differentiate FM patients from rheumatoid arthritis and lupus patients.
- The reduced cytokine response found in FM suggested that it was not an autoimmune disease.
- The authors suggested that FM was a central sensitization disease characterized by a reduced reaction to immune, hormonal, etc. stimuli.
- In 2017, EpicGenomics began a genomic study designed to develop a genetic signature for FM.
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Thanks to over 80 donors, with less than a week left, Health Rising is 80% of the way to meeting its end of the year fundraising goal. If finding out about cutting-edge research and treatments is helpful for you, please support us!EpicGenetics is all in with FM. They did not stop with the blood test. Their next steps were a genomic test and a treatment trial.
In 2017, the company announced it was embarking on “Campaign 250” an ambitious effort to conduct whole exome genetic testing on up to 250,000 FM patients who have tested positive on their FM/a test. Since, at $2,500 a pop, that campaign would cost $625 million, it hardly seems feasible (or worthwhile) to test that many people. (EpicGenetics is apparently asking people who test positive for FM on their test to participate in the study.)
The company reported it had received FDA approval for a treatment trial but put it on hold pending further work on FM genomics. Not only did the company feel they were on the cusp of uncovering a genomic biomarker but they reported that biomarker validated their hypothesis that FM was an immune disease.
“We are cautiously optimistic that we are on the throes of a breakthrough in better understanding fibromyalgia. If we find these [genetic] patterns are unique for fibromyalgia, it further and hopefully will forever legitimize in the minds of everyone that fibromyalgia is a real disease, that it’s a disease of the body’s immune system, and that consequently it’ll change how patients are diagnosed and treated, and hopefully how we may be able to cure or reverse the disease.” Gillis
A second slate of studies were underway. Hoping that they could use the genomic signature to assess the effects of their treatment trial, they held it off for a year or two, and then earlier this year began the treatment trial.
The Vaccine Trial
“Given what’s been published in the medical literature, we believe this vaccine will reverse the immune system abnormalities [of fibromyalgia].” Dr. Bruce Gillis, Epigenetics CEO
Treatment Takeaways
- This year the company began a clinical trial of the BCG vaccine used in tuberculosis.
- Vaccines stimulate immune responses. The BCG vaccine stimulates the cytokines the company believes are being underproduced in fibromyalgia. The trial is expected to wrap up in 2022
- People who have tested positive for the FM/a test are eligible for the genomics study and vaccine trial.
- A similar pattern of reduced immune response to stimulation has been found in chronic fatigue syndrome (ME/CFS)
- Carl Gottfries treated ME/CFS patients (and himself) for decades using a different vaccine (which is not longer available.
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Thanks to over 80 donors, with less than a week left, Health Rising is 80% of the way to meeting its end of the year fundraising goal. If finding out about cutting-edge research and treatments is helpful for you, please support us!While vaccines are mostly used to fight off pathogens, they also stimulate the immune system. Carl Gottfries used another vaccine to treat himself and others with ME/CFS until the vaccine’s producer stopped production.
It just so happens that the BCG vaccine stimulates the same parts of the immune system EpicGenetics believes have taken a hit in FM.
The 300-person, randomized, triple-blinded, Phase II, Mass. General Hospital BCG vaccine trial started in January of this year and is expected to end in January 2022. A call went out earlier this year for more men and younger female patients.
Gillis was clearly excited by the vaccine:
“The expectation is that if the results are as good as we hope, potentially in as little as six months, we will have further opportunity to expand the treatment to many, many more people as we collect the data. We don’t expect significant side effects and we expect fairly rapid responses to the BCG by the people who participate in the trial who receive it.”
| Contact Denise L Faustman, MD, PhD | 617-726-4084 | fibromyalgiastudy@partners.org if you’re interested |
An ME/CFS Connection?
People with ME/CFS might want to keep an eye on EpicGenetics.
Gillis has pointed out how similar the symptoms of ME/CFS and FM are. If the vaccine works out in FM, ME/CFS is probably next. In fact, the two have more in common than symptoms. Every mitogenic test done in ME/CFS has produced the same general result as the two EpicGenetics FM studies: a markedly reduced immune response.
Given that, it might be a good idea to keep an eye on EpicGenetics.
Conclusion
Is FM an immune disease? Will EpicGenetics turn the world of fibromyalgia on its head with its trifecta – a blood test, a genomic test and a cheap treatment? If it does, will it apply to ME/CFS?
EpicGenetics hasn’t reported on the results of its genomic testing. Unless they hit it out of the park with the vaccine and stop the trial early, we probably won’t know about the results of the vaccine trial until 2022.
Will EpicGenetics epic plans come to fruition? Breakthroughs, as we know from experience, don’t come easy in medicine but sometimes they do come. A cheap way to treat FM (and maybe ME/CFS) – even if it was a partial treatment – would be a godsend. Time will tell.
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Maybe you’ve heard of the FM/a test before but I’ll bet you’ve never heard it like this – an attempt to fully cover it, put it in the context of past findings and wrap up the blood test, genome and vaccine trial in one nice ball.
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Glad u are covering the FM/a test. was wondering about it.
Question, has Epigenics company not included ME/CFS samples in addition to the lupus test sample they’ve run on purpose?
Wondering if they had separately run some me/cfs samples and found that their info sets would not as yet differentiate between FM and ME/CFS?
Or if CFS /ME was not included because of already known cytokine response similarities between FM and ME/CFS?
So that they may have already postulated that including ME/CFS would show a current lack of specificity between them?
(and therefore make the specificity lower than 99%?)
Had been trying to find info online before this article to answer this.
Great synopsis Cort, thank you!
(Q:perhaps a future report will be on Iquity’s Isolate FM RNA
test? https://www.google.ca/amp/s/www.practicalpainmanagement.com/amp/25085
and update on Griffith/Menzies Australian test?
https://www.google.ca/amp/s/meaustralia.net/2016/03/03/griffith-uni-claims-breakthrough-on-diagnostic-blood-test/amp/
Thanks. I wondered the same thing. My guess is the same as yours – poor specificity when ME/CFS was included.
Much better from a business perspective to go with two other diseases which FM can be mistaken for but which are different biologically.
Thanks for the tips on the other tests. I see one more for FM! Diagnostics is booming https://www.medicalnewstoday.com/articles/324735.php#1
I don’t think we’ve heard anything about the Griffiths test for the past three years despite the fact that the article suggested it might be available soon.
There was this study in 2018 publicized by Solve ME/CFS for a biomarker run by David Kaufman.
https://solvecfs.org/research-study-information-from-dr-kaufman/
According to OMF public financial information they funded David Kaufman and EPICGENETICS in 2018, so it could be this study.
I’ve not seen anything published to date.
Wow…I had no idea about that Kaufman diagnostic study. The Solve CFS page said:
“If you choose to participate, you will be asked one time to donate your blood that will be used to evaluate an FDA-approved test for another disease, fibromyalgia”
That sure sounds like EpicGenetics.
You don’t happen to have a link to the OMF info do you? I had never heard of that either.
Question: is it FDA approved, or FDA compliant?
Website says FDA compliant
As a project manager running global clinical trials, I question their methods. . I had a positive FM/a test done in 2018 and paid to submit my blood for Campaign 250 but have not had any updates on the actual clinical trial. There is some concern that Epigenetics will continue to delay the trial indefinitely as they keep changing their story. First they said they only needed FDA approval of the trial to begin, then they decided to add other sites, then said the population of positive results wasn’t diverse enough so they require more men. It’s completely unnecessary to delay an entire trial waiting for more men to test positive since FM is predominantly a female disease. Now today I see for the first time that the trial won’t begin until a new goal is reached. From their website “However, we will be recruiting for the Clinical Trial once the results of the genomics study is published.“
I’m curious to hear your thoughts on the ever changing starting point.
Interesting! I had no idea. I see from the clinicaltrials.gov site that the trial was slated to begin in Jan of this year. I thought it had already started but it’s still in the “not recruiting phase”.
https://clinicaltrials.gov/ct2/show/NCT03582085?cond=Fibromyalgia&draw=2&rank=3
You’re right the bar keeps changing. They stated in 2017 they were delaying the trial pending the genomics study results. I wondered about that but didn’t put it in the blog. I don’t understand why a genetic marker – such as the BRCA gene which they referred to – would help them assess the effects of the BCG vaccine. A gene expression or epigenetics result – yes; but not a baked in genetic polymorphism. That’s not going to change yet they referred to the BRCA gene regarding the genomics study.
I don’t know why it’s necessary to publish the genomics study – which can take a godawful amount of time – prior to getting the trial underway. Do they need a publication to include genetic testing in the trial protocol? You would know better than I.
I also don’t understand why men’s genetic results would have any impact on women’s genetic results. I wonder if they needed more data for the men’s arm of the trial. But why would that stop the women’s arm of the trial? This is supposed to be a three year trial – why not get the women started? The trial has now been delayed almost a year.
I don’t know what they are getting by delaying the trial. Could they be delaying the trial in order to raise more money for it (via their FM/a testing profits?)
I have sent those questions into them and I asked about the award I couldn’t find and about how IL-6 and IL-8 could be protective.
If this it true, does this void the information in your article? Another smoke & mirror show to get out hopes up?
I have experienced the same problem. I have Fibromyalgia and took the FM/test in 2018 (insurance paid for it) and was promised that if it was positive I would be offered the vaccine trial that would start in January 2019.
When I contacted them in January I was told that they had so much response that they were giving as many people as possible a chance to take the FM/test. Then when I contacted them awhile later they told me that they needed more men to apply to make it a legitimate study.
Then when I inquired again they said they were focusing on the genomic testing (they are comparing the similarities of those who tested positive). But they said I wasn’t automatically included and that I could volunteer for it but I would not be told the results. I offered to do it but received lackluster response from them and besides a generic email they haven’t followed up with me to be included even though I tested positive on the FM/test. They continue to reassure me that they will contact me immediately when the vaccine trial begins.
As of the end of December 2019 I do not believe they have started the vaccine trial. If they have they are lying to me that they haven’t. I keep getting the feeling that they are either stalling to make money on selling the FM/test or else they are having some other problems that they won’t admit.
I had high hopes for this and really wanted to be in the trial, but so far I feel like Dorothy when the curtain was pulled back on the Wizard of Oz. It would be great if you could investigate them further.
I sent some questions. I hope they will answer.
We’ll see. Lots of things can come up with these studies and trials and they are often delayed – sometimes incredibly so. The people in charge sometimes compound the problems by either being effective communicators. They certainly have been provided an opportunity to communicate and clear some things up.
My hope is that this is more of that – things have come up that are delaying the trial – and that it will happen at some point.
EpicGenetics is very good a putting out press releases and pithy video’s – which is not bad – but they don’t provide much in depth information on their website.
Here’s the reply I received from Epigenics when I inquired this week.
The FDA-approved, planned treatment trial has not commenced because of our preliminary results as they concern our research regarding the genomics of fibromyalgia. We have a partnership with the Genomics Laboratory at the University of Illinois College of Medicine at Chicago to investigate the potential sources of fibromyalgia(FM). The initial phase of that research uncovered unique DNA-related patterns that were found only in FM patients and not in otherwise healthy control patients. Hence, we commenced a second phase of the genomics research in order to confirm those initial results and it is ongoing. We are dedicated to try and uncover the pathways that cause FM. And, it would be premature to begin a treatment trial without knowing what those specific pathways are and how they react to the treatment vaccine.
We are also investigating the potential initiation of a separate treatment trial for the control and management of the pain that is associated with FM.
As we make progress in these pursuits, we will be contacting those who have been confirmed to have fibromyalgia via the FM/a® Test. We ask for your patience and understanding as scientific research is a journey and not a sprint and no matter the resources we devote to these research investigations, we cannot predict what we will identify nor how long it will take.
https://www.healthrising.org/blog/2015/11/21/gottfries-chronic-fatigue-syndrome-story/
Readers might be interested in your earlier article, Cort, on Carl Gottfries’ successful vaccine treatment for what appeared to be prolonged post-viral fatigue (ME/CFS). He came up with this idea himself and used a vaccine which combined a form of staph and another toxin, with the purpose of stimulating the immune system. It worked on him and I believe on others too (my memory is fading) but after him was discontinued?
Please correct or add to my recall!
Thanks! I just added it. Correct. Gottfries provided the vaccine to himself and his patients until the manufacturer ended production of it. He apparently bought enough of it up to have a supply for himself for several decades.
Those clever, enterprising Scandinavians! I will put my money on them every time.
A few of us were able to try a similiar vaccine to what Gottfries used. @Hip even contacted Gottfries and apparently Gottfries tried the new source. I believe he said it worked but none of us who tried it had much effect.
The several year saga is described here https://forums.phoenixrising.me/threads/staph-vaccine-to-treat-cfs.3788/
Haven’t we seen runarounds before with trying to get FDA approval? Ampligen, for just one example? Why is it hard to get promising new drug treatments for certain conditions—maybe the less prominent, well known or funded conditons—and yet pharmaceutical companies are coming up with new drugs all the time—which offer incremental or even no benefit? We see these all the time. Is the FDA a bureaucratic roadblock to intelligent new prospects while at the same time being an enabler of the goals of major drug companies? (Am I just paranoid or prejudiced? I hope so.)
The drug approval system is clearly broken. It’s another case of controversial diseases having added barriers.
It’s simply too expensive to get a drug approved- and there’s no help for neglected diseases. The NIH and FDA should find a way to provide that help. How about a drug trial system aimed at supported people with neglected diseases?
Instead it’s all profit-driven and companies can make more money more easily tweaking cancer drugs than taking a shot at something like ME/cFS. The fact that there’s no good target to shot at in ME/CFS or even an animal model – throws up more roadblocks. The lack of research funding and the lack of drugs for ME/CFS goes hand in hand.
Pharmaceutical companies reap big profits from chronic diseases without solutions. Is it possible they could assert an influence?? Who would imagine the stranglehold on recognizing the existence of lyme, denial that some people with health issues should not take vaccines.To me, their refusal to be more helpful is way over the top. They have crossed the line as they did with the lyme community.
Time will tell. One group of researchers does believe they’ve developed a good Lyme test, by the way.
I have followed the progress of EpicGenetics in FM closely but could never find a good rationale for how the reduced cytokines mentioned in the above studies tie in to the pathophysiology of FM. What is also a question for me is- would those of us who had autoimmune diseases prior to developing/ being diagnosed with FM also have the reduced cytokine production or not? I don’t really buy in to this testing method, because isolating cells and stimulating them with broadly activating compounds can only tell you that there is some dysfunction but not about what is going on in the body itself. And I agree with Cort’s comment, in what way are IL-8 and IL-6 thought to be protective? Perhaps not specifically in the context of FM but just in general as part of a pro-inflammatory response? I really want to know how the BCG vaccine could reverse FM. I find the scientific rationale for the treatment totally lacking until someone can at least posit a theory about why reductions in these cytokines would play a role in the cause or symptoms of FM rather than being a byproduct? Also, for good reason ME/CFS patients are wary of vaccines. The BCG vaccine is like taking a hammer to wake up three immune system in a non-specific way and that’s why it is used as an adjuvant for certain cancer treatments, because it so strongly activates the immune system. Given the systemic problems in FM I’d be hesitant to do something so dramatic.
On the plus side there is Daniel Wallace – a very well published UCLA researcher.
I also found a way for IL-6 to be protective: It’s actually both pro-inflammatory and anti-inflammatory depending on where it’s produced:
and an anti-inflammatory myokine. IL-6’s role as an anti-inflammatory myokine is mediated through its inhibitory effects on TNF-alpha and IL-1, and activation of IL-1ra and IL-10.
https://www.wikiwand.com/en/Interleukin_6
Who knew?
IL-8 is tougher – increased levels are associated with a bunch of diseases but it does have some positive effects at the proper level:
It induces chemotaxis in target cells, primarily neutrophils but also other granulocytes, causing them to migrate toward the site of infection. IL-8 also stimulates phagocytosis once they have arrived. IL-8 is also known to be a potent promoter of angiogenesis. In target cells, IL-8 induces a series of physiological responses required for migration and phagocytosis, such as increases in intracellular Ca2+, exocytosis (e.g. histamine release), and the respiratory burst.
https://www.wikiwand.com/en/Interleukin_8
Still think you ought to look more into fibromyalgia and oxalates:
https://www.kevinstock.io/health/health-dangers-of-oxalates/
They can cause inflammatory cytokines too:
https://www.frontiersin.org/articles/10.3389/fimmu.2018.01863/full
Thanks again, Learner1
No wonder I feel sick after eating all that stuff that suppose to be good for me..First Article
Second Article is way over my head like the sky..lol!😂
I think we know too much about food now. By the time I eliminate gluten, dairy, the foods I tested allergic to, sugar, pesticides, mold, phytoestrogens, refined carbohydrates, carbohydrates, meat that isn’t free range or grass fed, pre-packaged food, and now plant foods, I’m not sure what to eat.