Over the last year I’ve had a few patients with Hashimoto’s thyroiditis ask me about the benefits of black cumin.  This is based off of a study which demonstrated that black cumin had a positive effect on the TSH and TPO antibodies in Hashimoto’s patients.  And so based on these requests I decided to do some research on black cumin and put together my own blog post on this topic.  However, unlike a few other articles written by healthcare practitioners, I’m not just going to focus on the study related to Hashimoto’s, as I’ll dive deeper and discuss some of the other health benefits of black cumin.

Black cumin is also known as Nigella sativa (N. sativa), which is a medicinal plant and belongs to the Ranunculaceae family (1).  The seeds of black cumin are the main source of its active ingredients (2) (3).  It’s most prominent constituent that has well-known antioxidant, anti-inflammatory, and anti-cancer properties is thymoquinone (4).  Although I’ll discuss how black cumin might help those people with Hashimoto’s, as I mentioned in the opening paragraph, I’ll also discuss some of the other health benefits of this herb.

Black Cumin and the Hashimoto’s Study

So let’s go ahead and talk about the study.  This involved forty patients with Hashimoto’s thyroiditis, aged between 22 and 50 years old (5).  They were split into two groups, where one group consumed 2 grams of black cumin per day in powder form for 8 weeks, while the other group consumed a placebo (2 grams of starches).

These are the markers that were evaluated:

• Thyroid stimulating hormone (TSH)
• Thyroid peroxidase (TPO) antibodies
• Serum T3
• Serum Vascular Endothelial Growth Factor (VEGF)
• Nesfatin-1

Many people reading this are familiar with the first three markers I listed above, but some aren’t familiar with the fourth and fifth ones.  VEGF is a glycoprotein, and it has been proposed that VEGF is present in epithelial cells of the thyroid gland and contribute to the development and function of thyroid epithelial cells (6).  One of the typical characteristics of Hashimoto’s thyroiditis is high TSH levels, and this promotes VEGF secretion.  In other words, VEGF levels are usually high in Hashimoto’s patients.  As for Nesfatin-1, this is a peptide, and some studies have demonstrated a role of Nesfatin-1 in thyroid conditions (7) (8).

It’s also worth mentioning that anthropometric markers were measured, including weight, BMI, and waist circumference.

So what happened to those people with Hashimoto’s who supplemented with black cumin?  Well, their TSH and TPO antibodies decreased, the serum T3 increased, and there was also a reduction in serum VEGF.  Changes in Nesfatin-1 were not significant.  In addition, those who took black cumin experienced a significant reduction of weight, BMI, and waist circumference.  As a result, the authors concluded that it can be regarded as a useful therapeutic approach in the management of patient’s with Hashimoto’s.

Should Everyone With Hashimoto’s Take Black Cumin?

It’s difficult to recommend black cumin to everyone with Hashimoto’s based on a single human study, especially since it involved only 40 participants.  I should mention that there was a separate animal study which showed that black cumin can benefit those with hypothyroidism.  It’s also important to let you know that there are studies showing that black cumin can benefit those with other autoimmune conditions, including multiple sclerosis (9) and rheumatoid arthritis (10).

While there needs to be more studies done on autoimmune patients before we can conclude that black cumin is something that everyone should take, the research shows that there are many other health benefits of this herb:

Antibacterial activity.  H. pylori is a potential trigger of thyroid autoimmunity, and there is evidence that black cumin seeds have antimicrobial properties against H. pylori that’s comparable to triple therapy (11).  There is also evidence that it can inhibit the growth of Staphylococcus aureus (12).  This study also demonstrated that there can be a difference in the antimicrobial effectiveness of black cumin depending on the source of the black cumin seeds.

Antifungal activity.  Black cumin has demonstrated antifungal activity against most pathogenic fungi (13) (14).  A few studies have shown that black cumin can specifically help with Candida overgrowth (15) (16).

Anti-parasitic activity.  Schistosoma mansoni is one of the parasites causing schistosomiasis, and a few studies demonstrate that black cumin can help with the eradication of these parasites (17) (18).  A couple of in vitro studies showed that it can also be effective against blastocystis hominis (19) (20).  Blastocystis hominis is a parasite that is a potential trigger of thyroid autoimmunity.

Antidiabetic activity.  One study looked at the effect of black cumin seeds on the glycemic control of patients with type 2 diabetes (21).  The results of the study showed that black cumin at a dose of 2 grams per day caused significant reductions in fasting blood glucose and hemoglobin A1C, while insulin resistance reduced significantly, and beta cell function increased (21).  It’s also worth mentioning that 1 gram per day showed improvement but wasn’t statistically significant, while 3 grams per day provided no further benefit.  A few rat studies have also showed that black cumin has anti-diabetic properties (22) (23).

Anticancer activity.  As if eradicating infections and helping with type 2 diabetes wasn’t impressive enough, there is also evidence that black cumin has anti-cancer properties.  Experimental findings strongly suggest that black cumin could serve, alone or in combination with known chemotherapeutic drugs, as effective agents to control tumor initiation, growth, and metastasis (24).  Another journal article discussed how the main bioactive component of black cumin (thymoquinone) can be considered as a promising therapy for cancer treatment (25), although the main focus of the review was to demonstrate how thymoquinone can improve the efficacy of conventional cancer treatments, including surgery, radiotherapy, and chemotherapy.  Yet another journal article summarized the actions of thymoquinone and crude oil of black cumin against different cancers, and showed that it has positive effects on breast cancer, liver cancer, skin cancer, and renal cancer (26).

Immunomodulatory, anti-inflammatory, and antioxidant effects.  In the study on Hashimoto’s I mentioned how consuming black cumin led to a decrease in TPO antibodies.  This shouldn’t be surprising when you look at the research, as besides the study on Hashimoto’s, there is additional evidence showing that black cumin has immunomodulatory, anti-inflammatory, and antioxidant effects.  One review showed that thymoquinone has anti-inflammatory properties that prevent the biosynthesis of proinflammatory cytokines such as interleukins and TNF-alpha (27), which are both associated with autoimmunity.  Another comprehensive review mentioned that black cumin extracts and thymoquinone can potentially be used in the regulation of immune reactions implicated in various infections and non-infectious conditions including different types of allergies, autoimmune conditions, and cancer (28).  A few studies have demonstrated the antioxidant properties of black cumin (29) (30).

Lipid lowering effects.  One study showed that 8-week supplementation of 2 grams of black cumin per day combined with an aerobic exercise program provides significant improvements in LDL-cholesterol and HDL-cholesterol (31).  Although regular aerobic exercise is important, it would be interesting to see what the results would have looked like with people taking black cumin alone.  And while it was nice to see LDL decrease and HDL increase, I’d like to see if it positively affects markers such as LDL particle size.

Hepatoprotective effects.  A few studies show that black cumin can protect the liver and cause a decrease in lipid peroxidation and liver enzymes (32) (33).  Although this blog post focuses on how black cumin can help with Hashimoto’s, many of my patients with hyperthyroidism and Graves’ disease have elevated liver enzymes, and so black cumin might be of benefit in this situation.

Other health conditions.  There are studies showing that black cumin can protect the gastrointestinal tract (34), cardiovascular system (35), and kidneys (36).  It’s important to mention that the antioxidant and anti-inflammatory properties of black cumin seem to be the main features of preventing and protecting these and other areas of the body from injury.  So the truth is that black cumin not only can help those with Hashimoto’s thyroiditis, but other autoimmune conditions as well.

Can Black Cumin Be Toxic In High Doses?

There have been a number of animal studies on black cumin seeds evaluating its toxicity, and overall it seems to be very safe.  One study looked to evaluate the toxicity effect of black cumin on the liver function of rats (37).  The results showed that consuming high doses of black cumin resulted in no significant change in the liver enzymes (alanine aminotransferase and aspartate aminotransferase).  This shouldn’t be surprising, as I mentioned earlier how black cumin can actually protect the liver.

What is the Ideal Dosage of Black Cumin, and Where Can You Purchase It?

According to the research, it seems that 2 grams per day (in divided doses with meals) is ideal.  But of course everyone is different, and for some people it might be wise to start with lower doses.  As for where to purchase it, you can visit your local health food store, do an online search, or click here for a product I recommend, which includes one gram of black cumin seed per serving, along with mixed tocotrienols.

Should YOU Take Black Cumin?

While I can’t say with certainty that everyone with Hashimoto’s should take black cumin based on the single study I discussed earlier, it’s easy to see how many people in general can benefit from taking this, let alone those with autoimmune conditions such as Hashimoto’s.  After reading through all of the research I’m excited to start recommending black cumin to some of my patients.

What’s Your Experience With Black Cumin?

I’d be interested in hearing from anyone who has supplemented with black cumin.  And so if you have already have taken black cumin please feel free to share your experience in the comments section below.  If you took black cumin and noticed positive benefits please let me know!  If you took black cumin and didn’t notice any benefits please let me know!  And if you took black cumin and felt worse please feel free to share your experience as well!

I’d like to wish everyone a very happy Thanksgiving!  I’m sure everyone has had some ups and downs in 2018, especially those currently dealing with a thyroid or autoimmune thyroid condition.  But most of us really do have a lot to be grateful for, including myself!  I am grateful for having a wonderful wife and two amazing daughters!  Even though I’ve dealt with some health challenges this year unrelated to Graves’ disease (to be revealed in a future blog post) I’m grateful that right now I’m currently feeling great!  Of course I’m also grateful for the opportunity to share my knowledge and experience in helping you to optimize your health!

Please feel free to share what you’re grateful for in the comment sections below!

Multiple autoimmune syndrome involves someone having three or more autoimmune conditions.  I’ve mentioned in past blog posts how someone who has one autoimmune condition has a good chance of developing additional autoimmune conditions.  In fact, even though I primarily see people with Graves’ disease and Hashimoto’s thyroiditis, it’s common for people with these conditions to have other autoantibodies.

But why do some people develop multiple autoantibodies?  Is it because they are exposed to multiple triggers?  Or does a single environmental factor cause the development of multiple autoantibodies?  Either one of these scenarios is a possibility.  For example, certain infections such as Epstein-Barr and Cytomegalovirus can lead to the development of different types of autoantibodies.  In other words, Epstein-Barr and Cytomegalovirus can trigger multiple autoimmune conditions in the same person.  However, it’s also possible for someone to have multiple triggers which are responsible for different autoantibodies.

The Triad of Autoimmunity

In the past I discussed the triad of autoimmunity.  According to this triad the following three components are necessary in order for someone to develop an autoimmune condition:

1. A genetic predisposition

2. An environmental trigger

3. A leaky gut

So according to the triad of autoimmunity, in order for someone to develop multiple autoimmune conditions they need to have a genetic predisposition for each of these conditions.  As I mentioned earlier, some of these people will have multiple autoimmune triggers, while others will have one or two environmental triggers which caused the development of all of the person’s autoantibodies.  Either way the goal should be to detect and remove these triggers.

The third component of the triad of autoimmunity is a leaky gut, which is also known as an increase in intestinal permeability.  So even if someone has a genetic predisposition for one or more autoimmune conditions AND they’re exposed to one or more environmental triggers, according to the triad of autoimmunity, the person won’t develop an autoimmune condition if they don’t have a leaky gut.  This is one reason why it’s important to try to avoid anything that can cause a leaky gut while trying to restore your health.  An example of this is gluten, as even if you remove the environmental trigger but continue to eat gluten (or other foods which can increase gut permeability), then you most likely won’t reverse the autoimmune component.

3 Categories of Multiple Autoimmune Syndrome                

Multiple autoimmune syndrome (MAS) is classified into three groups:

Type 1: type 1 MAS includes myasthenia gravis, thymoma, polymyositis and giant cell myocarditis

Type 2: type 2 MAS includes Sjögren’s syndrome, rheumatoid arthritis, primary biliary cirrhosis, scleroderma, and autoimmune thyroid disease

Type 3: type 3 MAS groups together autoimmune thyroid disease, myasthenia gravis and/or thymoma, Sjögren’s syndrome, pernicious anemia, idiopathic thrombopenic purpura, Addison’s disease, type 1 diabetes mellitus, vitiligo, autoimmune hemolytic anemia, systemic lupus erythematosus, and dermatitis herpetiformis.

You’ll notice that autoimmune thyroid conditions are in the second and third categories of multiple autoimmune syndrome.  So if someone has Graves’disease or Hashimoto’s thyroiditis, depending on their genetic predisposition they might be more likely to develop one or more of the other autoimmune conditions listed under the second category (Sjögren’s syndrome, rheumatoid arthritis, primary biliary cirrhosis, scleroderma), or they might develop one or more of the autoimmune conditions listed in the third category.

Which Autoimmune Conditions Are Commonly Associated with Graves’ Disease and Hashimoto’s?

Sjögren’s syndrome.  This is a systemic autoimmune condition, and one study showed that Sjögren’s syndrome was 10 times more frequent in patients with autoimmune thyroid disease, and autoimmune thyroiditis was 9 times more frequent in Sjögren’s syndrome (1).

Celiac disease.  I’ve written a separate article entitled “Celiac Disease and Thyroid Health“, and how this condition is more common in those people with Graves’ disease and Hashimoto’s.  There is some evidence that the risk of thyroid disease is threefold higher in those with Celiac disease (2).  I should mention that while Celiac disease is common in those with autoimmune thyroid conditions, Celiac disease is not included in the classification of multiple autoimmune syndrome.

Vitiligo.  In many people with multiple autoimmune syndrome vitiligo is the first autoimmune disease to be diagnosed.  This shouldn’t be too surprising since vitiligo represents the most common cause of acquired skin, hair, and oral depigmentation, affecting 0.5–1% of the population worldwide (3).  A few different studies show that vitiligo is more common in Graves’ disease and Hashimoto’s thyroiditis (4) (5) (6).

Systemic lupus erythematosus.  Many people with systemic lupus erythematosus (SLE) have thyroid autoantibodies.  One study I came across showed that the prevalence of Hashimoto’s thyroiditis in those with SLE was 12.6% (7).  Another study showed that patients with SLE had a higher prevalence of hypothyroidism and than hyperthyrodism (8). I did come across a case study where a woman developed SLE one year after being diagnosed with Graves’ disease (9).

Rheumatoid arthritis.  The prevalence of thyroid autoimmunity in those with rheumatoid arthritis has ranged from 0.5% in Morocco (10) to 27% in Slovakia (11).  Not only does the incidence vary between regions, but ethnicities as well.  One study involving 800 patients with rheumatoid arthritis showed that 37.8% had thyroid peroxidase antibodies and 20.8% had elevated thyroblogulin antibodies (12).

Type 1 diabetes mellitus.  There are numerous journal articles that show a relationship between type 1 diabetes and thyroid autoimmunity.  A few of these studies show an association between type 1 diabetes and Hashimoto’s (13) (14), while a couple of other studies show a link between type 1 diabetes and Graves’ disease (15) (16).

Conventional vs. Natural Treatment Options

Is there a different treatment approach when someone has multiple autoimmune conditions?  Not necessarily, as regardless of whether someone has a single autoimmune condition or multiple autoimmune conditions, the goal is to find and remove the triggers.  I commonly have patients who have the autoantibodies for both Graves’ disease and Hashimoto’s thyroiditis.  While the management of these two conditions differ, finding the triggers involve a similar process.  That being said, someone with autoantibodies for both Graves’ disease and Hashimoto’s very well might have multiple triggers.  This is one reason why you might see one type of autoantibody decrease while other antibodies don’t decrease.

For example, some people have thyroid peroxidase antibodies, thyroglobulin antibodies, and thyroid stimulating immunoglobulins.  While ideally you want to see all of these gradually decrease over time, this isn’t always the case.  While fluctuations in thyroid antibodies commonly occur, when you see one or two of these antibodies decrease consistently and yet another antibody not decrease, then this very well might be because one or two environmental triggers have been detected and removed, but another one remains.

In summary, if you have Graves’ disease or Hashimoto’s, then there is an increased risk of having additional autoimmune conditions.  If you have three or more autoimmune conditions then this is classified as multiple autoimmune syndrome.  In this blog post I discussed the 3 categories of multiple autoimmune syndrome, along with some autoimmune conditions that are commonly associated with Graves’ disease and Hashimoto’s.  I also discussed how some people have a single trigger responsible for all of their autoimmune conditions, although it’s more common to have multiple triggers, which can make it more challenging to restore one’s health.

Do you have more than one autoimmune condition? If so please feel free to share your experience in the comments below!

Many people suffer from chronic constipation.  And while I have written articles and blog posts on this topic, in this blog post I’m going to focus on those people who had regular bowel movements prior to starting the autoimmune Paleo (AIP) diet, but then became constipated shortly after starting it.  After all, while there are many factors that can cause constipation, certain dietary changes can be a culprit.

Why do some people experience constipation when following an AIP diet?  Well, a big reason is because an AIP diet excludes many foods that are high in fiber.  This includes the following three categories of foods:

• Nuts and seeds
• Grains
• Legumes

The good news is that most people don’t need to eat these three categories of foods to have regular bowel movements.  The bad news is that many people don’t eat enough AIP-friendly foods that are high in fiber.  One of the main reasons for this is because most people with Graves’ disease and Hashimoto’s don’t know which foods they should eat.  For example, someone might eat a lot of green leafy vegetables in the form of salads and smoothies.  And while I definitely encourage my patients to eat green leafy vegetables, these are low in fiber when compared to other vegetables, which I’ll discuss shortly.

Is Low Fiber Really The Main Problem?

Some healthcare practitioners disagree that the decrease in dietary fiber is the main reason why many people experience constipation when following an AIP diet.  And while I’ll list some other common reasons for constipation below, if someone had regular bowel movements and then began to experience constipation soon after starting an AIP diet, there is a very good chance that the decrease in fiber was the culprit.  While it’s true that some people who experience constipation while following an AIP-diet don’t experience an increase in bowel movements when eating more fiber, it’s still something to consider.

I look at many food diaries of my patients, and the truth is that it’s common for people to not eat enough vegetables overall, let alone vegetables that are high in fiber.  Another common scenario involves someone who eats a few daily servings of AIP-friendly foods high in fiber (i.e. broccoli, sweet potatoes), but not enough.  Sure, everyone is different, and I’m not suggesting that everyone needs to eat a large amount of high fiber foods on a daily basis to avoid constipation, but as I’ve mentioned numerous times already, if constipation wasn’t a factor prior to starting the AIP diet then increasing your fiber needs to be strongly considered.

What AIP-Friendly Foods Are High In Fiber?

I listed some of the AIP-friendly foods high in fiber in a blog post I wrote entitled “What Thyroid Sufferers Need To Know About Fiber, Resistant Starch, and SCFA“, but I’ll list the foods again below:

• Apples
• Artichokes
• Avocados
• Blackberries
• Broccoli
• Coconut
• Brussels Sprouts
• Figs (dried)
• Pears
• Plantains
• Raspberries
• Sweet potatoes

The Role of Fiber In Bacterial Diversity

One of the ways in which fiber can help with constipation is by increasing the bulk of the stools.  However, fiber can also help with bacterial diversity, which in turn can help someone to have regular bowel movements.  In other words, the greater the variety of bacteria you have in your gut the better.  What’s important to understand is that different strains of bacteria prefer different types of fiber.  This is why it’s a good idea to eat a wide variety of fiber-rich foods, mostly in the form of vegetables.

So one problem with an AIP diet is that by decreasing fiber, it decreases bacterial diversity.  And there is evidence that this decrease in bacterial diversity can happen very quickly.  As a result, if you started to experience constipation a few days after starting the AIP diet then this very well could be a factor.

Other Causes of Constipation

While not eating enough fiber is a big factor for those who experience constipation upon following an AIP diet, here are a few other common causes of constipation you need to consider:

• Not drinking enough fluids.  This is a common problem, as while some people do a wonderful job of drinking plenty of water on a daily basis, many people don’t drink enough water.  Please make sure you drink at least half your weight in ounces of water every day.
• Decreased caffeine consumption.  In addition to giving up some foods that are high in fiber, most people who are following a strict AIP diet also avoid caffeine.  And the reason why this can lead to constipation is because caffeine can cause a bowel movement by increasing rectal tone (1).  Of course the goal should be to have regular bowel movements without relying on consuming caffeine.
• Inactivity.  If someone experienced constipation shortly after following an AIP diet then inactivity probably wasn’t the main factor.  But I still think it’s important to mention that not being active can cause or contribute to constipation.  Keep in mind that exercising a few days per week and being inactive the rest of the time isn’t sufficient, as regular movement is important.  I realize that this can be challenging for some people who work desk jobs, as in this scenario you should try to take frequent breaks, and when you’re not at work you should try to be active as much as you can.
• Hypothyroidism.  Once again, if someone experienced constipation shortly after starting an AIP diet then having low or depressed thyroid hormone levels probably isn’t the main reason.  But since a lot of people with hypothyroidism and Hashimoto’s thyroiditis read my blog posts I thought it was important to mention it here.

What About Other Causes of Constipation?

There definitely can be other causes of constipation, although keep in mind that we’re focusing on constipation that was caused by following an AIP diet.  For example, many people with small intestinal bacterial overgrowth (SIBO) experience constipation, but following an AIP diet isn’t going to cause SIBO, which is why I didn’t bring it up here.  Similarly, there are other causes of constipation that I won’t bring up in this post because it’s not related to following an AIP diet.

How To Overcome Constipation When Following An AIP Diet

1. Eat AIP-friendly foods high in fiber.  How much fiber should you consume each day to have regular bowel movements?  This depends on the person, although I would aim for at least 25 to 30 grams per day.  Just keep in mind that some people need less than this to have regular bowel movements, while others might need to consume more fiber, and so you need to listen to your body.

2. Do other things to increase your gut diversity.  Eating fiber-rich foods isn’t the only way to increase your gut diversity.  Eating fermented foods (i.e. sauerkraut, kimchi, pickles) and/or taking probiotic supplements can help.  And while plant-based foods act as probiotics, some people can benefit from taking a prebiotic supplement.  Every now and then someone will ask me about green food powders, and while I wouldn’t consider this to be an adequate substitute for eating vegetables, it’s fine to use certain green food powders as one source of prebiotics.  Of course you want to make sure to choose a good quality green food powder, and ideally one that uses organic vegetables.

3. Drink plenty of fluids.  As I mentioned earlier, being well-hydrated is important in order to avoid constipation.

4. Choose green tea over coffee.  I do recommend for some of my patients to avoid caffeinated green tea, especially those with adrenal imbalances.  However, if someone absolutely feels the need to drink a caffeinated beverage to help move their bowels then I would encourage you to drink a cup or two of green tea each morning.  While both coffee and green tea have numerous health benefits, green tea arguably has more health benefits than coffee, and without question has less caffeine.

5. Take a 15-minute walk after each meal.  I spoke about the importance of being active, and even if inactivity isn’t the main cause of your constipation, many people find that taking a 15 minute walk after meals can help them have a bowel movement.

Can You Eventually Reintroduce Nuts, Grains, and Legumes?

If you’re following a strict AIP diet, you might wonder if you will eventually be able to reintroduce some of the excluded foods.  While many foods are excluded on an AIP diet, I want to focus on nuts, grains, and legumes, as these are good sources of dietary fiber.  First of all, when a patient of mine is following an AIP diet, one of my goals is to have them transition to a “standard” Paleo diet.  Keep in mind that nuts are part of a “standard” Paleo diet, while grains and legumes aren’t.

That being said, some people are able to reintroduce grains and legumes without a problem.  In fact, while I’m not big into legumes, I can’t say that I’ve been grain free since being in remission from Graves’ disease.  Although I did avoid grains while getting into remission, I reintroduced grains after restoring my health and I do fine eating them occasionally.  As for whether or not you will be fine reintroducing these foods, there really is no way to know for certain.  This is part of the reintroduction phase, as while some people successfully reintroduce nuts, grains, and legumes after restoring your health, others aren’t able to reintroduce all of these.

Some healthcare practitioners advise anyone with an autoimmune condition to permanently give up grains.  The truth is that we don’t need to eat grains, and without question there are some people who do better when completely avoiding grains after getting into remission.  In fact, some people experience severe symptoms when eating grains.  So you need to listen to your body, and I’ll admit that you can’t always go by symptoms.  For example, some people will reintroduce grains and legumes before getting into remission, and while they might not experience any symptoms upon doing this, if their health isn’t improving then I would suggest to take a break from these foods and see if this is what’s affecting your progress.

In summary, some people develop constipation shortly after starting an AIP diet.  One of the main reasons for this is due to the decreased consumption of fiber-rich foods.  When this is the case then eating AIP-friendly foods that are high in fiber can help many people have regular bowel movements.  Fiber not only increases the bulk of the stools, but it also increases bacterial diversity, which can help with defecation.  Some other common causes of constipation include not staying hydrated, decreased caffeine consumption, and inactivity.  Addressing these areas while increasing your fiber intake can help many people overcome constipation.

Have you experienced constipation while following the AIP diet?  If so then please feel free to share your experience in the comments section below.