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Becker’s Healthcare Podcast
Understanding Inflammation and Chronic Disease with Dr. Tom O'Bryan
00:25:37
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- [00:02]
A
Every year, Becker's annual meeting brings healthcare leaders together to unpack the most pressing issues facing the industry. And every year, those conversations shift in profound and unexpected ways. This April, more than 3,500 healthcare executives will return to Chicago for Becker's 16th annual meeting. 795 elite speakers will offer new lessons, new case studies, and predictions about what comes next. Join us April 13th through the 16th. For the agenda and event details, visit BeckersHospitalReview.com and click on the events tab in the upper right.
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B
This is Scott Becker with the Becker's Healthcare Podcast. We're thrilled today to be joined by Dr. Thomas O'. Brien. And Dr. O' Brien is going to talk about where he specializes, what he focuses on, what he's most excited about, and a lot more. Tom, Dr. O', Brien, can you take a moment to introduce yourself and tell us a bit about what you do?
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C
Hi, Scott. Sure. Thanks for the opportunity here. Let's see. I guess I'd start in my internship 45 years ago, and my wife and I, my ex and I were unable to get pregnant. And I called the seven most famous holistic oriented doctors I had heard of at the time and said, what do you do? And I was able to reach all of them and I put a protocol together and we were pregnant in six weeks. Our neighbors in married housing, we lived on campus, they had gone through artificial insemination and nothing had worked for them. And they asked if I'd work with them. And I said, well, I don't really know what I'm doing, but I don't think it'll harm you. Sure. They were pregnant in three months. So we're now four months pregnant. Just hot to trot and tell the world. And we were in school in Chicago and our friends would tell their sister in Wisconsin of what we were doing. And she had had two miscarriages. Could she come down and talk to us? Because no one was giving her any answers. And I don't really sure. Okay. And so when we opened our practice, we had a general practice and with a strong emphasis on lifestyle factors. And this was in 1980. And so we came out of the box. There was one thing that seemed to be common with every couple that was having some type of fertility issue. And one of the common factors was that they were eating foods that they had no idea were a problem for them because the food didn't give them stomach pains or abdominal distress. So they thought the foods were fine. But when you check the immune system and you see that your immune system is fighting dairy, or your immune system is fighting wheat or gluten. And understanding that an activated immune system is what creates inflammation. And NIH tells us that 14 of the 15 top causes of death are chronic inflammatory diseases. It's always inflammation. Then it makes sense that if you're eating a food that's triggering more inflammation and you might want to reduce your exposure to that food. And we found that to be a paradigm that just consistently was at the base of helping people with all types of problems. And I joined the Institute for functional medicine about 15 years ago. In my area of expertise is talking about the gut, the microbiome in the gut. And so we've talked to thousands of practitioners over the years of the importance of including and evaluation of gut function with any chronic condition that they're dealing with. And that pretty much brings us up to today.
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B
Thank you. And when you look at today, how important is gut function and what people eat to keeping their inflammation under control? And then that inflammation has such an impact on everything they do, doesn't it?
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C
It does, it does. If we take a step back, and no one emphasized this in our education, not one professor emphasized the critical nature that 14 of the 15 top causes of death are chronic inflammatory diseases. No one emphasized that. And with our patients, the way I say to them, Mrs. Patient, your immune system is the armed forces in your body. It's there to protect you. There's an army, a navy, an air force, a Marines. We call them IgA, IgG, IgE, IgM, Cytokines. They're just there to protect you. So when they get activated and they're creating inflammation, the million dollar question is, what are they trying to protect you from? And That's a base 101 concept that we recommend every clinician includes in their evaluations. Is this patient fighting mold? Do they have high inflammatory markers because of mold exposure, or is it gluten? I mean, you see miracles sometimes when people go gluten free. Not every time, but sometimes. So the question is, what is your immune system trying to protect you from? Rarely is it an immune system that's gone crazy. Rather, it's highly activated, trying to protect you from the amount of accumulated chemicals that we're getting now. You know, we run a test now on every new patient that wants to work with me. I represent myself as a Sherlock Holmes, you know, trying to identify what are the underlying mechanisms for people who have been everywhere and done everything. And I won't talk to them unless they do a few tests. And one of the tests is just A cutting edge test. It looks at 18 heavy metals, 28 mycotoxins, which is the exhaust from mold, and 34 pesticides and insecticides, organophosphates. When you do that simple urine test, which is highly sensitive and highly specific, people are shocked to see what's accumulated in their body over the years. We do that test first to show them, even if they're eating an organic, healthy lifestyle, what may be in their body from the last 20, 30 years of accumulation, minute amounts. Let me give you one example. Chicago 2016. 346 pregnant women in the eighth month of pregnancy. They did urine analysis on them, and they measured five phthalates. Phthalates are chemicals used to mold plastic. And there are many different phthalates. But they looked at five of them, including bisphenol, a bpa, and they divided the results into quartiles, the lowest, the next, the third, and the highest. They then followed the offspring of those pregnancies. And when the children turned seven years old, the researchers reached out and said, hi, it's time to run the Wechsler IQ test, the official IQ test. So they ran these tests on all these kids, and the results were shocking. Every child whose mother was in the highest quartile of phthalates and urine in pregnancy, compared to the children whose mothers were in the lowest quartile. Every child in the Highest quartile, their IQ was 7 points lower. The average was 6.7 to 7.4 points lower. Every one of them. Now you say, wait a minute, what, what, what? And now the science is coming out, that of the fetal programming in utero that occurs when mom is high in phthalates and how it impacts on neural development. There are multiple studies that have come out in the last four or five years on this topic. Now let's take it to day to Day Life. Two years ago, a paper came out where they looked at three most common bottled waters on the market in Europe. This was a European paper. They bought a liter of each of the three most common waters, and they measured not just how many microplastics were in the water, but nanoplastics. They have laser technology to identify nanoplastics. And the average between the three major brands was 240,000 nanoparticles per liter of water. So we're drinking bottled water thinking we're safer, but it's loaded with phthalates, which the exposure you get from a bottle of water is. There's no evidence it's harmful in any way whatsoever, but it can accumulate in the body, as evidenced with the women in the eighth month of pregnancy. And what happened to their baby's brain development in utero, that manifested seven years later when they did the IQ tests on them. So it's our environment now that is a major concern in the development of chronic inflammatory diseases. It's not an unknown. There are so many studies now on this. And to your question specifically, we have to go back to Hippocrates. And he told us way back, a few thousand years ago, all diseases begin in the gut. Now let's move forward to Alessio Fasano at Harvard, professor of medicine, Harvard Medical School, professor of Nutrition, Harvard School of Public Health, the Chief of Pediatric gastroenterology, Mass. General, Harvard. The Director of the Celiac Research center at Harvard, the Director of Mucosal Immunology at Harvard. Five titles. Any one title is a lifelong dream for someone at the top of their game. This guy's got five. He really is one of the greats. And his papers are always so engaging to read. And, you know, he's got over 350 or so publications now and. And you'll see eight authors on a paper. And the last one, Alessio Fasano, the boss, you know, he puts his stamp of approval on it. Well, this paper he wrote himself, which gives you a sense of how important he considers it, is, I think every physician needs to read this paper. It's a mandate for every physician. The title, by the way, Fasano, it was 1978, he wrote the first paper on the mechanism that causes this thing that we call leaky gut, and that's the protein zonulin. He identified the protein zonulin and how it gets increased, which creates this excessive intestinal permeability. And he's been writing about it now for over 25 years. We think he's going to win a Nobel Prize because of the impact of this thing called leaky gut on so many chronic diseases. Now, this paper he wrote himself, single author, which gives you a sense of the importance of the paper now and the title of the paper. All disease begins in the parentheses leaky and parentheses gut. All disease begins in the leaky gut. The role of zonulin in the development of chronic inflammatory diseases. And they outline excessive intestinal permeability as a primary mechanism in the development of the chronic inflammation. 14 of the 15 top causes of death are chronic inflammatory diseases. And he goes through all of the science of how it occurs. Every physician needs to read this paper. All disease begins in the leaky gut. And when they do you know, you have to read it like two or three times to really get the big picture of what he's talking about. But when you do and you listen, my God, this just makes sense. Okay, so this microbiome thing and this thing about the gut, it's very important in every chronic inflammatory disease.
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B
And so, Dr. O', Brien, what does somebody do about this? As an individual, as a doctor, how do you start to think about this? Supplements. What's the first thing that someone should do when they look at this stuff?
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C
Well, you know, I've got a good friend, Dr. Andrew Campbell. He runs my Michael lab, I think the name of his lab. He has a lab that tests just for mycotoxins from mold. And we had dinner in Las Vegas. I was on stage there in December, and Andrew was also. We had dinner. And I. And he's an elder man. And I said, andrew, I've got a picture of you on a slide in every talk I give. And his wife looked at me and I said, so there's a picture of you. And then I put up there all. How does he say it? In God we trust. And then the next click on the slide, all others require data. And he just started laughing. That's a famous quote from him. In God we trust, all others require data. So the first thing you do is you learn how to test, to see. Is this something that we should explore? And the key is to do comprehensive testing. And so it takes a while to really figure out where the comprehensive tests are. But in the world of functional medicine, there's just a group of laboratories that have been on the cutting edge for many years. We recommend a series of tests for individuals. The test that I referred to just now that looks at total toxic burden is just a simple urine test, but the sensitivity and specificity is over 90%. And so you test, you test to identify. Is my immune system fighting gluten? Well, I feel fine when I eat gluten. What? Doesn't matter how you feel. You know, excuse me, but it doesn't. In Italy, they've got 36 centers that are designated by the government as gluten related disorder centers. And if you get a diagnosis of a wheat related disorder from one of these centers, your food's a tax deduction. So local physicians, if they suspect that one of their patients has some kind of a wheat related problem, whether it's celiac or not, they'll send them to one of these centers. There's 36 of them around the country. They looked at 5,000 patients who were sent to them referrals from local physicians. And they summarize the symptom patterns. Just under 50% of them had some type of gut or GI symptom, but the other 50% did not. It was 48 had 52% did not have any gut symptoms. They had psoriasis or they had rheumatoid or they had Ms. Or they had chronic fatigue. They didn't have any gut symptoms when they eat wheat, but it was wheat that was activating this chronic inflammatory response. Fueling, however, misses patient. You pull it a chain, it breaks at the weakest link. Always it's at one end, the middle, the other end. It's your heart, your brain, your liver, your kidneys. Wherever your weak link is, well, the pull on the chain is inflammation. So when you identify the trigger of the inflammation, that's why you hear stories all the time. I mean I've got articles in my lectures. I just show the slides from the published articles in the medical journals. Reversing a conjunctival tumor diagnosed as Kaposi's sarcoma in a three year old on a gluten free diet. Reversing severe psoriasis from an elderly who had psoriasis since his mid-40s. He was now in his 70s. Within one month. Completely eliminated on a gluten free diet. That sometimes you see the most dramatic results when you eliminate the trigger of the ongoing inflammation. So to your question, Scott, test. Don't guess, don't shotgun. We used to teach about the elimination diet and get the foods out of your diet you suspect may be a problem when you feel better. Reintroduce one food at a time and see how you feel. Back in the 70s and 80s that was cutting edge and it made sense to do that. But now we know so many symptoms are not related to the gut from foods that are activating an immune response. It doesn't matter how you feel, not really. You know, if you feel bad when you eat a food, that's pretty obvious. But for just over half of the people that have a sensitivity to wheat as an example, they don't get gut symptoms. So if they eat it and they feel fine, they think it's okay, but they still have their seizures or that. Here, listen to this one. Children with drug resistant epilepsy, meaning they've been on at least three medications and nothing has worked. 50% of children with drug resistant epilepsy go into complete remission on a gluten free diet. 50%. And that's published in the journal Gastroenterology. Now why don't our neurologists know this? Because they don't read gastroenterology. They read neurology journals. So they don't know that. I mean, you see that these studies have been coming out for the last 30 years. If you look for them and it just validates that you want to look, don't be fanatical, but just test, don't guess.
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B
Thank you so much. And talk for a second about the functional doctor know we. Well, some of the things that you do today and what you've grown and done and then talk about whether Michigan is likely to compete for a national championship again in the future or not likely.
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C
Oh, you know, I'm from Michigan again, that's a great question. I don't know. I don't know. I'm sure they will at some point. So in our training there is a program we have called Applied Functional Medicine and Clinical Practice and it's a five day program. Practitioners come on Sunday afternoon and we start Monday morning and we go until Friday, six o' clock and the first on Monday morning. They're welcome. We talk about what, what it's going to be like for the week. We're going to do case studies, we're going to have group discussions, then we break for lunch. And the first technical talk they get in the afternoon is me, the gut, talking about the gut. And we go through this whole concept of why all disease begins in the gut. And just to consider, and never forget, just consider and evaluate how is gut function going? So a functional medicine practitioner doesn't look just at the presenting symptoms. You of course have to deal with the presenting symptoms or the patient doesn't come back. But we look at what's the health history, what was mom's health like during pregnancy with this person? We now know that fetal programming is just substantially altered for neural development when mom is really toxic with high loads of toxic chemicals in her body. There's too many studies now to not recognize that sometimes that's a problem. We go back and we look at the health history as far back as we can go from their mother's pregnancy, from their infancy, their toddlerhood, how many prescriptions for antibiotics have had in your life all the way up to today. And we try to put together the storyline of what likely has happened to this person and where it comes from. Takes a lot of time. And so the recommendation is you start with one patient a week, you know, because you can't transition that quickly usually, but you just start with one. You Take the file home at night and you think about it with all of your notes from the five day course and what are the quality questions to ask? And then you just start putting yourself in the hot seat of thinking, asking different questions. So functional medicine is looking to see where did all this come from? Why? And how is the immune system being activated to protect you?
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B
Dr. O', Brien, I love what you do. Where could people find out more about you and learn more about what you do?
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C
Well, thank you. Our website is the doctor.comthedoctor.com. just don't, don't spell the word doctor out the doctor.com and to really get an overview of this, last year I traveled to seven countries and I interviewed 64 of the world leaders in immunology and functional medicine. I mean, I went to Israel and to Germany and to London and to Rome to interview these people who had, these researchers who have published so many papers on these topics about chronic inflammation and where it comes from. David Furman at the Buck Institute of Aging in California, Marvelous guy. We had so much fun. But I interviewed all these people and we put it together in a docu series that really sets the stage of understanding for all this. It's free. It's all free. It's called the inflammation equation. And you'll find it on our website, the doctor.com and just register for it. And then every day we send you one episode for nine days and they're about 30 minutes long. And you listen to these world experts talking. For example, Yehuda Schonfeld is the godfather of autoimmunity. I mean, there's so many accolades to give you a sense of this guy, 26 at last count, that I know of. 26 of the medical doctors who went back to get their PhD in immunology at Tel Aviv University. There are many, many more. But 26 of them chair departments of immunology and medical schools and hospitals around the world. They're his students. So when I interviewed Professor Schonfeld, I said, professor, how are you? We've shared the stage before. And he looked at me and he said, Dr. Tom, we are born 99% human, meaning a newborn has a small microbiome, but not much. We are born 99% human and we die 90% microbial. And many have heard there's 10 times more bacterial cells in our body than human cells. And you know, he just laid that out there and then paused, didn't say anything. He wanted to see how I was going to respond. And I looked at him for a minute and then I said, well, sir, doesn't that mean that this is really the dance of life, the microbiome? And he said, precisely. Precisely. So that's the kind of information you get in the inflammation equation where you just wait. What? What did he say? You know, when you check the science and you see they're absolutely accurate in what they're saying, and it helps us to think this bigger picture. All right, if the immune system is the armed forces trying to protect you, and inflammation is the result of an activated immune system, and 14 of the 15 top causes of death are chronic inflammatory diseases, then a critical question you have to include is, what is my immune system trying to protect me from? That is what the inflammation equation is all about in everyday language. Interviewing the world greats. And it's all free@thedoctor.com.
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B
Dr. O', Brien, I want to thank you for taking the time to join us today on the Becker's Healthcare podcast. What a remarkable career. Couldn't agree with you more about inflammation being the cause of so many troubles, and I love your approach to trying to solve it. Thank you for taking the time with us today. Just remarkable.
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C
Thank you, Scott. It's a pleasure.