← The Dr. Hyman Show
Loading summary
Transcript109 lines
- [00:00]
Dr. Mark Hyman
Coming up on this episode of the.
- [00:02]
Dr. Chris Kresser
Dr. Hyman show, the biggest lever that.
- [00:04]
Dr. Will Cole
We have to pull that can affect how our body is receiving information from the outside world is through the diet.
- [00:14]
Dr. Mark Hyman
I'm all about food first, but some nutrients like magnesium are nearly impossible to get enough of through diet alone. Our soils are depleted and things like sugar, caffeine and stress drain our levels. Magnesium supports over 300 functions in the body. Think metabolism, sleep, energy, pain and more. That's why I recommend Magnesium Breakthrough by Bioptimizers. It's the only supplement with all seven forms of magnesium for full body support. Get 10% off at bioptimizers.com hyman with code HYMAN10. Now, before we jump into today's episode, I'd like to note that while I wish I could help everyone by my personal practice, there's simply not enough time for me to do this at scale. And that's why I've been busy building several passion projects help you better understand.
- [00:53]
Dr. Chris Kresser
Well, you.
- [00:54]
Dr. Mark Hyman
If you're looking for data about your biology, check out Function Health for real time lab insights. And if you're in need of deepening your knowledge around your health journey, check out my membership community, the Hyman Hive. And if you're looking for curated and trusted supplements and health products for your health journey, visit my website@Dr.hyman.com for my website store for a summary of my favorite and thoroughly tested products.
- [01:17]
Dr. Will Cole
Yeah, so autoimmune disease is really, you know, this idea of think of it as like the immune system gone haywire, right? And you mentioned the word inflammation. Inflammation is really one of the core concepts, Right. And so we think about, you know, several main factors. You know, genetics, of course, are important, right. But really that's a minority, we think, you know, genetics and the contribution that they have to autoimmune disease is maybe only a third of really what's going on. And the other factors are again, diet, lifestyle, environmental triggers, infections, the genetic factors again can create a predisposition almost like this fuel. But then that spark and also more fuel can get stacked on there from the environment, from chronic infection from these lifestyle factors to then activate these processes and make the autoimmune disease more clinically apparent. There's probably over 100 different autoimmune diseases, 10 most common, or you mentioned some of them, but rheumatoid arthritis, Hashimoto's, autoimmune, thyroiditis, celiac disease, graves disease, type 1 diabetes, the list goes on. Vitiligo, rheumatic fever, it produces all the colitis. Yeah, yeah. And the cost to us personally is huge for the individual, but also to society. The National Institute of Allergy and Infectious Disease estimates that the cost of treating autoimmune disease in the US is more than $100 billion annually. And we think that that's probably actually a vast understatement because estimates around just 7 of these 100 plus known autoimmune diseases, estimates of cost annually ranges from 50 to 70 billion dollars.
- [03:07]
Dr. Chris Kresser
Whoa. Wow. That's a lot of money. And I think the costs are so staggering for the drugs that we're using. They're immunosuppressant drugs, increased risk of cancer and infection, and they do help a lot of people. I'm not going to say they don't, but the average cost is about 50 grand for a year per patient. And I know I've seen so many people be able to get off these compounds when they actually are changing the underlying root causes. And you mentioned all the different things. Toxins, allergens, the gut, diet, infection, stress and so forth. Sleep. These aren't often one thing that's causing it in a single person, but it may be multiple things. And so you have to kind of deal with all the factors. So as traditional doctors, what was our sort of a basic approach? What is the basic approach we sort of touched on a little bit, but I think it's worth sort of talking about it and then the disconnect between like that and how we deal with it, with functional medicine.
- [04:03]
Dr. Will Cole
Yeah. So you mentioned these very, very expensive drugs, the monoclonal antibodies, of which the pharmaceutical companies have a lot of incentives to develop because they make a lot of.
- [04:16]
Dr. Chris Kresser
Of money.
- [04:18]
Dr. Will Cole
Right. And your point is good, which is they can help people. But really it comes down to this central divide of what is conventional medicine trying to do? And I don't want to make it seem like doctors are bad people. I have incredible respect. Just some incredibly smart people. And most doctors are so, so dedicated to taking care of their patients and trying to find them help that it's really just from the top down of how we trained. And this idea of this conventional approach to autoimmune really is kind of like this codifying of a lot of how Western medicine works, which is suppress, which is make it stop, control the immune response, turn these inflammatory pathways off. And the problem is that it's not asking why. It's not asking why is the inflammation there in the first place. Why is the immune system being triggered in the first place? So the main things that doctors reach for are steroids. Corticosteroids like prednisone, methyl prednisolone, dexamethasone, these work quickly and they work well. They turn off the inflammation, they shut down the immune system. But huge side effects, really, really staggering side effects, increased type 2 diabetes risk, weight gain, infections, osteoporosis, et cetera. Other medications, other immune suppressants are used like methotrexate, also shut down the body's immune response. But a lot of toxicity, liver toxicity, increased risk of infections, cancers, leukemia, et cetera. And then we've talked about these monoclonal antibodies, some of the biological response modifiers. Again, they can be helpful in the short term, but they're really just targeting one pathway. They're not, you know, taking care of why that pathway is inflamed in the first place. And so it makes sense that, you know, they might help in the beginning, but a lot of times there's this escape phenomenon that happens where they stop working. Right. And so, you know, it's really like a short term, kind of very myopic approach which if we stack in all these other lifestyle factors that we, that we know about how to intervene within functional medicine, you know, the potential for true healing is, is much, much greater.
- [06:35]
Dr. Chris Kresser
Yeah, it's pretty quite, quite amazing. It's one of the most satisfying things for me as a functional medicine doctor to treat because I can just tell you patient after patient with all kinds of weird autoimmune diseases, some of which I've never even seen before. If you follow the basic principles, it works. And I always say functional medicine is more about creating health than it is treating disease. And so when you create the conditions of our health and you take away the impediments for health, it's quite amazing. So let's, let's talk about a case and let's talk about sort of how we diagnostically approach these patients and what we do therapeutically that makes the most difference. So may a case, if I can think of one, I'll share one too. But I'd love to hear a case from you about how someone presented what you did to them, what you tested for, what you found, how you treated them and what the outcomes were and what the sort of objective results were that you got.
- [07:20]
Dr. Will Cole
Yeah. So as I was getting ready for our talk today, looked through our work and cases and this one case came to my mind. So, 43 year old woman who we'll call Sarah. And when we first met Sarah, she was experiencing some joint pain, mild to moderate joint pain, brain fog, trouble thinking clearly. She's having some mood swings, intermittent anxiety and a lot of fatigue. And she's also having some gut symptoms, some bloating and gas, occasionally some loose stools, disrupted sleep, especially in the week leading up to her period. So some hormonal fluctuations happening there. Usually would fall asleep. Okay. But we'd wake up in the middle of the night, some trouble falling back asleep. And like many of us, she was successful. She was very busy. She was working as a pharmacist with long shifts, three kids, very involved in their activities, and historically always able to manage her busy schedule. But she's kind of feeling like she's having more and more difficulty keeping up. More fatigue, decreased resilience, not waking up, feeling rested, et cetera. Interestingly, when we talked about her family history, though, it's definitely a, a strong family history of hypothyroidism. So that was kind of cluing us in the beginning. She was also on track with that. She was wondering about that. So she had been tested a bunch of times, but always only with the tsh, the thyroid stimulating hormone, which is kind of like the go to test for a lot of the primary doctors and internal medicine doctors. And it always had been normal. It was in the normal range. But her TSH had been trending up. Remembering that TSH is inversely associated with thyroid function. So a lower TSH is higher thyroid function and a higher TSH means lower thyroid function. Yeah, her numbers were, you know, 1.2, then 2.3, then 3.6, you know, but she was always told that this was, quote, normal. Right. And so, you know, her backstory, you know, during childhood, you did have some frequent ear infections, needed antibiotics, not infrequently, seven or eight times. So I was concerned about some early gut disruption there. She also had a history of some stomachache episodes, but never diagnosed with a problem, was traveling abroad at one point, got food poisoning, some increased gut symptoms after that, et cetera. Really, it was just trying to watch her diet. And she said, I drink a lot of kombucha, I try to eat a healthy, balanced diet. But there was some disruption there too, because of how busy she was. She would skip breakfast, she would frequently get home late from work and not have time for dinner until 8 or 9 o' clock and maybe just have a bowl of cereal, et cetera. So in her words, she came in and she was trying to improve her energy. She wanted to be able to exercise without being sore for days afterwards. She wanted to feel like an athlete again. She wanted to improve her moods and lessen her brain fog so that she could work more efficiently. We started off at the Starkey with our patients. We tend to do a pretty deep dive. We cast this really wide net. And I know that you guys do this too.
- [10:25]
Dr. Chris Kresser
Yeah. So what would you look for? Like, when you think about these patients, what are the kinds of things that come up for you is I got to find out what the root cause is. How do you start to think about those?
- [10:33]
Dr. Will Cole
Yeah. So we did a comprehensive blood panel, you know, looking at the thyroid again, but also adding on the three hormones, free T3, 3, T4. We looked at reverse T3. We looked at thyroid antibodies. We looked at markers of inflammation, markers of blood sugar, dysregulation, and insulin. We also tested her for celiac, for celiac genetics and a celiac panel. Given the history of abdominal pain and the strong family history of low thyroid. We did gut testing, we did a stool test, a comprehensive stool test, as well as a sibo breath test, a small intestinal bacterial overgrowth test. This was correlated with that history of food poisoning, of the GI complaints. And also the cognitive, the brain, the gut. Brain access is so critical to consider and to look at. Then we also did deeper dive on the hormone, looking at her adrenal function, looking at her sex hormones, et cetera. We know that a lot of times high functioning people, high achievers, tend to maybe have higher cortisol. They're pushing that envelope early on in their lives, but then that can drop, and they can then have low cortisol, which can manifest with increased susceptibility to illnesses, fatigue, brain fog, trouble getting out of bed in the morning, et cetera.
- [11:52]
Dr. Chris Kresser
So you take a good look at the gut, you look at hormones, often think about looking at other things that are sleepers, like heavy metals or environmental toxins, food sensitivities, gluten. Obviously you did mention that, but that's a huge one. I check for anybody who's got any autoimmunity as I check for gluten antibodies. It doesn't have to be full celiac. You can have just low level elevations of these antibodies that can cause significant problems without actually being true celiac. And I think this is often a problem with traditional medicine. It's this on or off. You either have it or you don't. You have diabetes or you don't. It's not a gradient, it's not a continuum. So in true, in truth, the body is just a continuum of function or dysfunction, and that's hence the dysfunctional medicine. And so it's kind of arbitrary to set a number like diabetes is 126. What about 124? You okay? No. So the same thing with everything in terms of all the numbers we look at. And I think the ability to kind of find these things are quite impressive. So what did you find when you started to dig in and you looked at the gut and you looked at the hormones, you looked at what else is going on nutritionally with her and how those play a role?
- [13:01]
Dr. Will Cole
Yeah. So this is kind of one of my favorite parts of the work that we do. When you have these folks who have been struggling, they've been to a bunch of doctors and they have been kind of told that everything's normal. And maybe they absorbed that, and they said, okay, I guess it's just I'm getting old, or maybe I'm a little bit depressed. But we got all the labs back, and we dug in with Sarah, and there was a lot of things that we found that were levers. I think these are potential levers that we can pull to help her get better. So her TSH was 3.8, which on the lab test shows as normal. But you and I and most functional medications, medicine doctors know that that is not optimal. From our functional range, we like to see that at around 2 or less. So I was definitely concerned around low thyroid function. And in fact, her free T3, the most active thyroid hormone, was in the low normal range. Her reverse T3 was elevated, signaling inflammation and immune activation. And then she did have elevated antibodies. So her TPO antibodies to her thyroid were high. And the thyroglobulin antibodies were also a little bit high. And importantly, she had an antibody against gluten. She had a positive anti deamidin peptide, mildly elevated, but certainly very, very significant in my opinion. In the US that's not necessarily diagnostic of celiac, but in Europe it is. And so there's a little bit of a difference of opinions on how we interpret these. But for me, that's a highly significant marker. For those of you out there who might want to look at testing this on yourself, LabCorp can do this. So can Quest. But the LabCorp test code for the comprehensive Celiac panel, I'll just throw it out there for folks, is 165126. So look that up if you want to get tested just through your insurance, through LabCorp, that's a great test to look at. She also had low vitamin D, low vitamin B12, and low ferritin, which is the storage form of iron. So all three of those together are Telling us that she's not absorbing very well. Right. She's having trouble on the level of the gut and that there's inflammation there. And in addition to just needing to get those levels up is sort of a proxy marker. Right. For, for this bigger problem going on. Her stool test showed, showed dysbiosis, imbalanced bacteria. There was some dropout of the good bacteria. We call it an insufficiency dysbiosis. She had positive H. Pylori. You look back to pylori. Yeah. And so H. Pylori is super, super interesting bug. It's sort of a model for persistence and for chronic inflammation. And it has been linked in the research literature to autoimmune thyroid. So right there I got really excited. I was like, okay, cool. Here is something which we can treat, we can eradicate. It could explain your local gut symptoms, but it could but also explain some of the bigger picture autoimmune activation that we're seeing in your body.
- [16:06]
Dr. Chris Kresser
Incredible. So with her, how would you go about starting to treat her? Because there's so many different things. She's got nutritional deficiencies, she's got gut issues, bacterial growth, gluten issues. I mean, you didn't really check for heavy metals or other things that could be treated.
- [16:20]
Dr. Will Cole
No, I didn't do that because there are nobody down the road for me. I'd love to just jump in with all these things and see if we get the traction. But yeah, you're right, it's a very important factor.
- [16:29]
Dr. Chris Kresser
Yeah. And, and you know, she, she, she had all these different things.
- [16:33]
Dr. Will Cole
Yeah. So we had Sarah start AN Anti Inflammatory Whole 30 Paleo Reset Diet and in particular, you know, really focused with her on, you know, you have to get rid of gluten 100 for at least 30 days. I like to do it for longer, but sometimes I break it up into bite sized pieces. For folks, we wanted to minimize sugar, we wanted to avoid dairy, limit alcohol, you know, and just with that one change, within a couple of weeks, she reported that her energy was better by about 40 or 50%, her brain was better by about 40% and her joint pain is better by about 60%. And yes, this is one of the things I love about that is just not only like, okay, she's feeling better, but this is really, really good reinforcement for her that she has control over her health and that she could incredible put things into place that are going to possibly affect her. You know, we're going to stack in some supplements, we're going to stack in some prescriptions, potentially but she immediately has this sense that, you know, her, her health is in her own hands and she can, she can be an active participant which will read mouth so great.
- [17:39]
Dr. Chris Kresser
And so, you know, the dot. Let's talk about the diets and autoimmune disease because I think there's so much controversy on what should eat. Should you be lectin free, should you be gluten free, should you be paleo, should you be vegan, should you, like what, what are we learning about in terms of food and autoimmune disease? What are the biggest drivers in our diet of autoimmune disease from the dietary perspective? What can people do therapeutically and like, how do we sort of stack up against choosing what to do for which person?
- [18:05]
Dr. Will Cole
Yeah, so there is no one size fits all approach. But I think there are some basic tenets that, that we can really factor in. And I think this idea of, you know, we talk about the exposome, right? So there's the genetics, there's the epigenetics. Genetics are hardwired. The epigenetics is how are your genetics read out. And that can be turned on and off based on environmental factors. And there's this idea of the exposome. These words sound complicated, but they're not. The exposome is basically, I call it.
- [18:35]
Dr. Chris Kresser
The exposome because it sounds better.
- [18:37]
Dr. Will Cole
Yeah, exposome. Everything that you've ever been exposed to from the time you were in your mom's belly until now. And actually if you want to go deep, it goes back before you in your mom's belly, right? Sort of this, you know, methylation and way the epigenetics affect offspring. But really, you know, for simplicity, everything that you've ever been exposed to for the time you were in your mom's belly until now, and we can modify that, right? We can take charge. And so the diet is. You think about the amount of information that your immune system is being exposed to on a daily, monthly, yearly basis. The food and drink that we take in by our mouth is by far the biggest factor of information that is hitting that immune system in the gut. You know, the next would be air and skin. But again, the biggest lever that we have to pull that can affect how our body is receiving information from the outside world is through the diet. So you want to take out all of the things that are going to be triggering aberrant inflammatory activation. Right? And so the biggest culprits are the processed foods. The sugar grains are frequently a trigger for people. You know, the. And then eating organic grass fed is really Critical because otherwise you're getting chemicals, you're getting pesticides, you're getting hormones, you're getting antibiotics, all of these disruptors. Right. And so the really easiest way to start with an anti inflammatory diet or a whole 30 or a Paleo reset is just to take out all of the junk and eat real food. Right. You'll eat real clean, nutrient dense food and do that for a period of time. Downstream from that, we sometimes have to specialize, we have to go into more like what's called an autoimmune paleo diet or a low lectin diet or something like the Wahls protocol. These are all variations. We don't usually go there first with people, you know, but it's kind of like base is very individualized and what you know, based on the response that somebody has.
- [20:42]
Dr. Chris Kresser
Amazing. So talk about some of the things that are like controversial like lectins. Is that, is that something, you know, people should focus on or is that just kind of a sort of a, sort of a marginal thing?
- [20:53]
Dr. Will Cole
I think it's been helpful for a lot of people and I don't think it, but I don't think it's everybody. And so what we do is we kind of go, you know, step by step down the list. If people are doing a paleo or a whole 30 and they're just feeling great, I don't necessarily feel the need to go down, you know, into the next steps. If they're not feeling well, we go into an autoimmune paleo, you know. But it's also the case, you know, the foundational intervention of anti inflammatory diet in naturopathic medicine, in functional medicine is, you know, get rid of things that might be triggering you and then add them back in one at a time in a systemic way and see what your body tells us. Right. The food sensitivity testing that you mentioned, you know, that's helpful. I've definitely used that and we like it. But it's not, it's imperfect for a lot of reasons. Right, but, but what does your body tell you? What is your body reading out to you in terms of symptoms and reactions? You can't argue with that.
- [21:53]
Dr. Mark Hyman
When I was just starting my medical journey as an emergency room physician, magnesium was a critical element of our care. We used it to treat all kinds of conditions from arrhythmia to constipation to preeclampsia. It turns out that magnesium is critically important outside of the emergency room too. In fact, it's one of the most important minerals for all aspects of health it participates in over 300 different biochemical reactions in your body. Yet over 60% of the population doesn't get the amount of magnesium they need from their diet alone. That's why I'm such a big advocate of Bioptimizers. Their magnesium breakthrough supplement is the only supplement on the market that offers the full spectrum of all seven types of magnesium, specially formulated to reach every tissue in your body to provide maximum health benefits. Bioptimizers is offering my community 10% off. Just head over to bioptimizers.com hyman with code HYMAN10 that's bioptimizers.com hyman with code HYMAN10 at checkout.
- [22:49]
Dr. Chris Kresser
So what is the approach, then, from a functional medicine perspective, for Raynaud's syndrome? Yeah.
- [22:57]
Dr. Peter Attia
So from a diagnostic standpoint, as I mentioned before, we want to look at all those cardiometabolic risk factors. You want to look for the underlying tax that are upregulating the immune system, whether it's gluten or food sensitivities or something going on in the gut, microbiome or an infection. And then from a treatment standpoint, a lot of the same lifestyle things that we normally want to do specifically help those arteries be more resilient, less reactive. We know, for example, that studies on meditation, yoga, biofeedback can show improvements in Raynaud's and artery elasticity after six weeks of a regular, consistent practice.
- [23:35]
Dr. Will Cole
Right. That's great.
- [23:36]
Dr. Chris Kresser
So you can. You can basically meditate your blood vessels. Healthier, right? That's good.
- [23:41]
Dr. Will Cole
Yeah.
- [23:41]
Dr. Chris Kresser
Now, who.
- [23:42]
Dr. Peter Attia
What was that story years ago of somebody meditating and they could change the temperature in one hand versus the other?
- [23:48]
Dr. Chris Kresser
Oh, yeah, yeah, yeah.
- [23:49]
Dr. Peter Attia
Five degrees or something. Incredible.
- [23:51]
Dr. Will Cole
Yeah.
- [23:51]
Dr. Peter Attia
So we have more control over that autonomic nervous system than what we thought.
- [23:55]
Dr. Chris Kresser
You know, I've often found. You find any other things around diet or supplements helpful for these patients?
- [24:00]
Dr. Peter Attia
Yeah, there's a lot. So, again, specific food components, omega 3 fatty acids, have benefits on artery elasticity, whether that's fish, fish oil, nuts and seeds. You know, arginine is an interesting amino acid. It's used by the arteries to make their own version of nitroglycerin. So it's a precursor of nitroglycerin, which, of course, dilates blood vessels.
- [24:23]
Dr. Chris Kresser
Nitric oxide. Nitric oxide.
- [24:24]
Dr. Peter Attia
Nitric oxide, yes. Thank you. Nitric oxide. So getting nuts and seeds, or maybe even supplementing arginine, the deeply pigmented foods that are rich in bioflavonoids, a lot of those polyphenolic foods also relax the arteries. Things like Resveratrol, for example. Folate rich foods, dark leafy greens, another powerhouse for the arteries. So if we think of that, extra virgin olive oil, another food that has natural benefits on relaxing the arteries.
- [24:55]
Dr. Chris Kresser
So, yeah, that's really a lot of what I use. Simi and I often I'll supplement with arginine. They're very symptomatic if they're going out. And often even ginkgo, which is another product. And I think the nitric oxide is interesting. You can increase nitric oxide by your breathing, too. Just sleep practices. We had Louis Ignaro on our podcast, who won the Nobel Prize for his discovery of nitric oxide and its role in improving overall health, reducing inflammation, and is incredibly important for lung health as well. And with COVID they're finding nitric oxide being very effective in treating COVID patients, and he talks a lot about that on the podcast. But the nitric oxide can also be increased by Viagra or Cialis or any of those drugs that are used for sexual enhancement. But they actually work by increasing blood flow and circulation. So that's a good thing. So maybe if you have Raynaud's, that might help as well. So arginine you can take, or you can do those drugs, or you can actually use ginkgo and other things. Bioflavonoids, I used to use quite a bit. And combining that with the root cause, the medical detective piece, because you can't just give those. Someone's going, oh, give them arginine. No. Well, why not? It's like, what is the cause? What is the root? And I think that's what often people miss. Even in integrative medicine, they'll say, oh, well, you have Raynaud's. Use arginine. I'm like, no, no, no. Why do you have Raynose? Like, what is the root cause? And this is the part that we often miss in medicine. And that's why at the Ultra Wellness center, we really have such a robust practice, because we are the medical detectives looking for the root cause. And I just tell you, I just like an anecdote of a patient I just had this week that was just, you know, it's one of those stories. He's really awesome guy, and he developed ticks when he was not tick bites, but he developed, like, motor ticks, you know, when he was 8. And I started asking him about his story, the doctor, Nothing you can do. Take these drugs, whatever. So I said, well, what was it like? What was happening? Did you get infections? Did you have this, you have that? So I started Digging into his story, he had tons of infections and scraping, all kinds of things. And we know there's a syndrome called pandas, which is pediatric autoimmune disease of neurologic blah, blah, blah. I don't forget what it stands for. But too long and. And that is associated with strep infections that cause behavior issues, ocd, ticks. And when I checked his labs, he had super high antibodies to strep. And on the cutting hand panel, he had really high antibodies against some of the components in his brain related to strep. And yet no one had even thought to ask the question of why. And so now it's ticking disorders or whether it's Raynaud's or whatever you.
- [27:37]
Dr. Will Cole
You.
- [27:38]
Dr. Chris Kresser
If you get. If you get into the habit of thinking, which is what I. I love about functional medicine, because it makes you think, as opposed to just sort of rote memorization and knee jerk reaction. That's sort of what we get in medicine, which is we make the diagnosis, then we don't have to think anymore. We just basically say, here's a cookbook protocol that is in 2021 for XYZ disease. And functional medicine is different. We have to start thinking. We call it thinking and linking. You know, like, oh, we know why you're. We go, why? We know why your. Your fingers get cold and turn white and you have no circulation. It's because you have Raynaud's. Like, no, that's just the name of what it looks like. That's the name of the problem. It's not the cause of the problem.
- [28:18]
Dr. Amy Myers
All right, so lupus actually comes from the Latin word meaning wolf. And typically, people with classic lupus have. We'll get a facial rash. It's called the malar rash. It's like a butterfly rash. And over time, they can actually. They say that you develop, like, wolf like appearance.
- [28:37]
Dr. Chris Kresser
Yeah. Their cheeks get all red eyes.
- [28:41]
Dr. Amy Myers
Exactly. And that's due to photosensitivity. And so lupus is one of those conditions which we see a lot. Interestingly, it's about nine times more prevalent in women. So that raises a question, what's the difference between women and men? And why are women still trying to figure that out? I actually think I have an insight into that. It's really quite interesting how men and women are different. Yeah. How many women are different? Right, right. And then the other thing that is also interesting is that we traditionally treat it with medications like steroids, Methotrexate, Plaquenil, those kinds of things which all have their significant side effects. And in my opinion, one of the.
- [29:27]
Dr. Chris Kresser
These are powerful immune suppressing drugs.
- [29:29]
Dr. Amy Myers
Oh, yeah.
- [29:29]
Dr. Chris Kresser
And they even use biological agents, biologics, which really shut off your immune system. And they can work, but they're often fraught with danger, including the risk of cancer and overwhelming infection if you get a bad infection. So they're not. They're very expensive, up to 50 grand a year per person.
- [29:47]
Dr. Amy Myers
And then also, one of the things that I always used to was intriguing to me when I was doing my training was drug induced lupus, because we were taught that lupus is an autoimmune condition. But there is a condition called drug induced lupus that always raised my question, well, how is a drug causing lupus? And what we see is that in. I think one of the major drugs was an older drug called procainamide. I don't know if I remember using that. Yeah, it was an antiarrhythmic. And in certain patients who got procainamide, they would develop lupus looks just like what we call lupus sle, systemic lupus erythematosus. And that always fascinated me that a drug would be triggering this. And when I actually went down that sort of rabbit hole, what we find out is that procainamide can actually damage DNA. And it's probably theorized that some types of things, like drugs or stealth infections like viruses, may trigger the body and cause some damage in the DNA. And when we test for lupus, I mean, some of the tests that are. Are double stranded DNA antibodies, the traditional blood test.
- [30:55]
Dr. Chris Kresser
Look at what are the autoimmune antibodies.
- [30:57]
Dr. Amy Myers
Yeah. And it's interesting because there's a whole bunch of different markers that are used in the diagnosis of autoimmune conditions. You have autoimmune panels, like traditional one is ana, the antinuclear antigen. Typically in patients who have lupus, that's positive. And then you can look for other biomarkers like double stranded DNA and such.
- [31:17]
Dr. Chris Kresser
And the ANA can be positive in many, many people, even if they don't have lupus. And there's this whole phenomenon of pre autoimmune disease where you're starting to have these autoimmune antibodies, but you don't really have a lot of symptoms yet. But your body's pre diabetes. This is like pre autoimmune disease.
- [31:29]
Dr. Amy Myers
Exactly. And I always tell my patients that's like when the check engine light comes on in your car.
- [31:33]
Dr. Chris Kresser
Exactly.
- [31:34]
Dr. Amy Myers
If you ignore that, you're gonna get smoke coming out of the hood soon.
- [31:37]
Dr. Chris Kresser
Which traditional medicine ignores.
- [31:39]
Dr. Amy Myers
It totally ignores.
- [31:40]
Dr. Chris Kresser
If you don't meet these five criteria for this diagnosis, then you don't have it and we can't treat you.
- [31:44]
Dr. Amy Myers
Right.
- [31:45]
Dr. Chris Kresser
It's like the patient I had who came with blood sugar of 120. I said, Jesus, doctor, check that out. He's like, oh yeah. I said, what's happening? What do you recommend? He says, well, he said I should watch it until it's 126 and then he'll give me treatment for diabetes.
- [31:58]
Dr. Amy Myers
Is that crazy? Yeah, it's. Yes. We'll wait till the horse out of the bar and then we'll try to corral it. Yeah, yeah, it's, it's unfortunate, but I guess, you know, when, when you look at how many people do have conditions that are, you know, even subclinical hypothyroidism, there's a lot of things that if you look early enough, you'll, it's a lot easier to treat them when you catch them early. You know, if you're starting to have early cognitive decline. Alzheimer's is a lot easier to treat when you catch it early. Diabetes is a lot easier. Heart disease, autoimmune conditions. So preemptive personalized medicine is the way to go.
- [32:35]
Dr. Chris Kresser
That's what we do at the Ultra Wellness center here at Functional Medicine. So this patient had had this condition that was treated by traditional medicine, which on a bunch of drug.
- [32:43]
Dr. Amy Myers
She actually came in, had done courses of primarily plaquenil and prednisone and she was actually pretty proactive in her self care.
- [32:57]
Dr. Chris Kresser
Plaquenil, by the way, for those listening, is the same as hydroxychloroquine that they're using for COVID 19.
- [33:02]
Dr. Amy Myers
Right. And we also realized that plaquenil is actually an antimicrobial. Yeah, it's used for malaria. That's the original use for it. But they found somebody, somebody must have, somebody must have had malaria and then developed lupus. And you know, they said, hey, this is working. So it's, you know, that's sort of like how they sort of discover other uses for medications. So. But this particular, she was actually involved in the healthcare field. I think she was a therapist, if I recall properly. And so she had done a lot of stuff on her own. The big thing with her is that, and she told me this, that she felt that her lupus was actually triggered by stress. She had a son who had some medical issues and was having issues both with, you know, dealing with a teenager who was having some illness and that sort of tripped it over. And oftentimes if I take the history of patients who develop an autoimmune condition, it's oftentimes followed by a period of chronic stress that's unrelenting. It's a very, very common thing.
- [34:04]
Dr. Chris Kresser
And let's talk about stress for a minute, because, you know, my thinking about stress is it sort of sets the table for other things to sort of take over.
- [34:13]
Dr. Amy Myers
So it doesn't cause.
- [34:15]
Dr. Chris Kresser
Not in and of itself. It may. It may cause some illness for some people, but for the most time, it exacerbates whatever's going on. So if you're stressed, your immune system suppressed, you're going to get more inflammation, and then if you have underlying issues, like this woman did, they're going to come out. Absolutely. So tell us how you approach this from a functional medicine perspective. How do we think about autoimmune disease in general from a functional medicine perspective and lupus?
- [34:38]
Dr. Amy Myers
Well, when I see a patient who has lupus and I go down sort of the checklist, so I look at, okay, do they have sensitivity to gluten? The other thing, which I find in a lot of lupus patients is Epstein Barr virus. So Epstein Barr virus is the virus that causes mono, and mono stands for mononucleosis, because the virus infects your white blood cells. And the thing about Epstein Barr virus is it's very common. About 70, 80% of the population has it. And most of the time, the immune system will clear it. And it's a herpes class virus, just like a cold sore. And once you get a herpes cold sore, that virus stays in your body all the time. Most of the time, the immune system keeps it in check. But there are certain individuals where the virus will reactivate and the herpes virus will come out or the mono can actually reactivate.
- [35:28]
Dr. Chris Kresser
So a cold sore in your lip is basically a herpes virus.
- [35:31]
Dr. Amy Myers
Herpes.
- [35:32]
Dr. Chris Kresser
And it doesn't come out all the time. It comes out under stress, under stress, weather, emotional stress, too much sunlight, getting a cold sunlight. So it's sort of a latent virus that we all live with hundreds of viruses in us when we're stressed. It allows those viruses to emerge.
- [35:49]
Dr. Will Cole
Exactly.
- [35:49]
Dr. Chris Kresser
And so this is what happened with this patient.
- [35:51]
Dr. Amy Myers
Yeah. And so I always liked to go down and ask the question, so why is this? Why do women have lupus more than men?
- [36:01]
Dr. Chris Kresser
Well, it's functional medicine. Why? Why? Why?
- [36:02]
Dr. Amy Myers
Right. And then, interestingly, when you go into the medical literature in autoimmunity related to lupus, the Epstein Barr virus is associated with seven different autoimmune conditions. Multiple sclerosis rheumatoid arthritis, lupus, type 1 diabetes, ulcerative colitis. So what happens is the virus, in some cases, patients will reactivate, and it causes a stimulation of the immune system. And the immune system will then start reacting to it. And then, interestingly, I've always been curious about photosensitivity. Like, why does photosensitivity happen in patients who have lupus? What's going on there? Why is that? When they get sunlight, is it affecting them? And what I found out in the literature is that the virus causes the body to produce more interferon gamma. And interferon gamma is our body's one of the cytokines that help our bodies to fight off viruses. And when we have high levels of this interferon gamma, it sensitizes the body to sunlight. So that's why you get that sort of lupus, like photosensitivity, especially with exposure to sunlight.
- [37:15]
Dr. Chris Kresser
And interferon is one of the treatments we're looking at for fighting COVID 19. Yes.
- [37:19]
Dr. Amy Myers
So what they do is they have an overabundance, and it may be a genetic predisposition. There may be some single nuclei polymorphisms that certain lupus patients have. And they produce lots of interferon gamma. And that actually gets involved in the skin cells and can make them more photosensitive. So it's an interesting phenomenon. And then the other thing about, you know, when. And I've seen this with a lot of regular mainstream doctors, they'll say, well, you can't really check for Epstein Barr virus because everybody's, you know, if the antibodies are positive, it just means that you've been exposed to it. Well, that's true. But if you actually do specific testing for Epstein Barr virus. So there's a panel that we do which checks for antibodies to the nuclear antigen and the cytoplasmic antigen, and then also the early antigen. And then I'll also throw in the Epstein Barr virus by pcr. So PCR is checking for the DNA of the virus.
- [38:13]
Dr. Chris Kresser
You're actually seeing if there's live virus around circulating in your blood, not just your immune response.
- [38:17]
Dr. Amy Myers
Exactly. So typically in the panel that we use, if you have the three out of four antibodies that are positive, especially with the early antigen and. Or with the PCR of the Epstein Barr virus, you know, proof positive that the Epstein virus is reactive. Exactly. Reactive. And that's where then you have to ask yourself, well, what do I do to calm down that particular virus? So there's a lot of things that.
- [38:46]
Dr. Chris Kresser
You have to look at Yeah, I mean, that's true. Functional medicine really has a different perspective. And that's why we see so many patients here at the Ultra Wellness center who've tried so many things and then they get better because we look at all the factors. So when I think of an autoimmune patient or just any disease in general, there are really only five main triggers. It's a toxin. So I've had patients with lupus have autoimmune disease triggered by heavy metals. For example, could be mercury, an infection like lupus. Or it could be the microbiome changes.
- [39:13]
Dr. Amy Myers
Yes.
- [39:14]
Dr. Chris Kresser
Allergen, something they're eating like gluten. And it could be poor diet, which is inflammatory and has, you know, for example, a lot of the emulsifiers in our food, like carrageenan and all these gums.
- [39:26]
Dr. Amy Myers
Yes.
- [39:26]
Dr. Chris Kresser
They cause leaky gut, driving inflammation. And it also can be stress, like you said. And often it's many of those things together.
- [39:34]
Dr. Amy Myers
Exactly. Yes.
- [39:35]
Dr. Chris Kresser
So for her it was a few of those things for her was stress and the virus. And also her gut was a mess too.
- [39:41]
Dr. Amy Myers
Yes, her gut was a mess. Yeah. So the other thing that, that she noticed is that if she ate foods that were high in lectins, things like the nightshade family, that her symptoms actually got worse. And there's interesting, some of the work by Peter to Damo, who is the author of the Blood Type Diet. He's the guru of lectins. And what we find is that in certain individuals, when you have high lectins in your diet, and these are compounds that are found in plants which actually act as a defense mechanism for the plant so that animals and insects are less likely to eat them. Lectins. There's a, in the medical literature, a case study of a hospital that thought they would have a healthy eating day. So they served everybody red kidney beans in a, in some type of a casserole or a soup, and then everybody got sick from. Because it was very high in lectins and it actually caused transient leaky gut. They had an immune response to the lectins in the plants. And I've had a number of patients says not everybody will have that response to lectins.
- [40:40]
Dr. Chris Kresser
I mean, there's a lot of promotion out there of lectin free diets as the cure for everything.
- [40:45]
Dr. Amy Myers
Or low lectins. Low lectins, yeah. It's impossible to get a low lectin diet.
- [40:49]
Dr. Chris Kresser
And I think it can be helpful for some specific patients. I think the thing is everybody finds the latest fad and Think it's the cure for everything. It's really not. And when you're in functional medicine, you get humbled by understanding how complex things are.
- [41:02]
Dr. Amy Myers
Absolutely.
- [41:03]
Dr. Chris Kresser
How everybody's really different, how, you know, one person may tolerate gluten, another person may not. One person may be fine with lectins, another person may not. But if you have an autoimmune inflammatory condition, it's something worth trying.
- [41:13]
Dr. Amy Myers
Absolutely, it is. And I'll interject here, because this is an interesting finding. I stumbled upon this, and again, this was actually by Peter. Peter Dadamo, who got me down this rabbit hole, because I. I just recently had a patient who had five autoimmune conditions, including lupus, and I checked for a lab test called mannose binding lectin. You ever checked for it?
- [41:36]
Dr. Chris Kresser
Actually, no, but I know about it. Right.
- [41:38]
Dr. Amy Myers
It's one of those things, and he's the one who got me to understand this. So Mannos binding lecting is a. Is a. Is a compound that our body makes to bind mannose and a lot of sugar. It's a sugar. It's a. Mannose is a sugar. And what you find out is that people who have mannose binding lectin deficiency are at a higher risk for lupus, and hers is undetected.
- [42:01]
Dr. Chris Kresser
Yeah. And I think the other thing I want to just point out is that, you know, you're talking about this patient lupus, and she had gluten, she had gut issues, she had stress, she had this virus, she had lectin sensitivity, but that was her. You take 10 of their patients with.
- [42:12]
Dr. Amy Myers
Lupus, they're all different.
- [42:13]
Dr. Chris Kresser
They're all different. Problem with traditional thinking is that everybody with lupus gets the same treatment. Once you make the diagnosis, you stop thinking. And in functional medicine, when you have the diagnosis, that's when you start thinking. It's just the first step on solving the problem. It's like, okay, this is what your picture looks like. Okay. What are the potential factors that we need to think about to get to the root cause? And then we have to treat the cause, not the symptom. Let's talk about what is autoimmunity, what causes it? And, you know, why should we be so concerned? Well, autoimmune disease, like I mentioned, things like rheumatoid arthritis, piitic arthritis, lupus, type 1 diabetes, Graves disease has disease, multiple sclerosis, Crohn's disease, colitis. I mean, the list goes on. Are all diseases where the body is attacking itself, the immune system is out of control, it creates systemic inflammation and Depending on your genetics and the various issues you have, it attacks different parts of the body. But essentially the process is the same where we create auto antibodies. We create antibodies which are normally designed to fight infection or even to kill cancer. We create antibodies to then attack our own tissues, and that's when we get into trouble. So basically we have this run of inflammation. We have an immune system is confused, and our immune system is supposed to ante up when we have foreign invaders like an infection, or when we have cancer, kidney cancer, and that's good. Or when we're maybe trying to deal with our gut and creating antibodies and different food, food things that are in there, although that usually is because of a leaky gut. And so basically, your immune system is your first line of defense. But when it goes awry, it causes widespread destruction in the body, and your own cells and tissues and organs get caught in the crossfire. And it's not a good thing. It's just not a good thing. It's good when it comes to the cancer, when it comes to infections, we want that. What we see now is a total epidemic about immune disease that is being completely misunderstood. In fact, now there's even a conversation about pre autoimmune disease that a lot of people are seeing positive levels of ANA antibodies, which we test for at functionhealth.com, which is testing platform where you can order your own test essentially, and get the results and have an interpretation and figure out what's going on. We're picking up a lot of people, probably 30% of the people that we see, just young, various healthy people, not really sick people, generally are showing up with an elevated level of an antibody called antinuclear antibody, which is an early sign of autoimmune disease. So this is really scary to me as a doctor. So the question is, why is the body doing this? What is the root cause? Most doctors, when they think of a patient, will essentially go, well, here's the symptoms, here's the lab test. Okay, you have these tests, you have these symptoms that are off. It means you have this or that disease. We name the disease and then we blame the name for disease for the problem. Now, this young girl, Isabel, I was talking about before, she came to see me when she was 10 years old, and she had a severe autoimmune disease called dermatomyositis. Dermatomyositis is nobody's best friend. Essentially, it's one of the worst autoimmune diseases you can have with everything, your joints, your skin, your liver, your blood, Vessels, your muscles. I mean, pretty much everything gets affected. And so you have widespread destruction throughout your body. Now, the doctors didn't say, gee, why is her immune system so pissed off? Instead, they gave her a pile of drugs, steroids, cancer drugs, to suppress her immune system. They're about to put her on an immune blocker called NF Alpha, which is a antagonist, which is basically blocking the inflammation marker in the. In the blood that's responsible for a lot of autoimmune disease, which can be helpful. But again, like nobody was asking, a very simple question is why is she so inflamed in the first place? Why is her immune system so pissed off? Now, as I mentioned, is about one of the most severe cases of autoimmunity I'd ever seen. At 10 years old, she had severe skin rashes. That's the dermatitis. It's pretty much itis, means inflammation. She had every kind of itis. She had vasculitis, which is inflammation of your blood vessels, causing Raynaud's. She had gastritis, causing inflammation of her esophageal tract and causing trouble reflux. She had hepatitis, affecting her liver. She had inflammation of her blood cells. I don't even know what to call that, but she had low white count and low red cells. She had severe muscle damage, so she had myositis and very severely elevated enzymes. She had also severe arthritis and joint swelling. So basically everything was under attack. There is cute little girl. Isabelle was 10 years old. She was from Texas. She loved riding horses. She couldn't do the most basic things anymore. She couldn't squeeze her hand or make a fist. Her tips of her fingers and her toes were totally numb all the time from Raynaud's disease, which is the damage of the blood vessels. Autoimmune condition. She had rashness all over her body that were irritated. She was exhausted, she felt miserable. Her hair was falling out. And she was being treated by doctors who were doing the best they could, but were using the old paradigm. They were saying, okay, well, she got inflammation. Let's get that under control. So they give her a huge dose of steroids, something called solumedrol, which is essentially a horse dose of 1200 milligrams intravenously. She has go to the hospital and get intravenous steroids every three weeks just to sort of be able to function. She was on methotrexate, which is a chemo drug, because that suppresses inflammation. She was on also aspirin to thin her blood because of inflammation, caused her blood to Clot. She was on acid blockers because the reflux from her stomach, she was on calcium channel blockers to help open up her blood vessels because of her ray nodes. I mean, literally, she was on more drugs than I was in, even 80 year olds beyond. And despite these mega doses of medications, she wasn't better. I mean, she was managed to call it managing her disease. Her labs were all abnormal, her skin was still inflamed, her joints are still inflamed. She just wasn't in the hospital, basically. And her doctors wanted to add another drug called the TNF alpha blocker, like Remicade or Humira you might have heard about. You probably saw the ads on tv because there are tons of ads, these drugs on tv, which is a whole nother topic because pharma should not be advertising on tv. But anyway, basically this drug can be helpful, but if you don't have anything else to do to fix the problem. But it increases the risk of cancer and also infections because it suppresses the immune system, right? So it turns off the inflammation. And we need inflammation for cancer and infection, but not for autoimmune disease or allergy, right? So that's the problem. Now, her mom was not happy with this plan, so she brought her to see me and we did a pretty simple program. It wasn't that hard, but I asked him very different set of questions. I ask not, you know, what's the inflammation, but what's the cause? Not what's the name of her disease, but what's the cause of her problem, what's pissing off her immune system? And so that's the job of a functional medicine doctor, to be a detective, to look deeply into the root causes and to try to understand why. And I always say functional medicine, the medicine of why, conventional medicine, medicine. What, what disease do you have and what drug do I get? Not why. In fact, I always say, just because you know the name of your disease, it doesn't mean you know what's wrong with you. Say it again. Just because you know the name of your disease, let's say dermatomyositis, it doesn't mean you know what's wrong or what's causing it, right? Dermatomyositis just means skin and muscle inflammation because those are the two most prominent symptoms. It doesn't mean anything. It's just a fancy medical word describing the symptoms, nothing to do with the cause. So functional medicine gives us a map to help understand why, to understand inflammation. I often call myself an inflammatist, and that's what we should be inflammatists and fact. Inflammation in autoimmune disease is a real issue and obviously an allergy and asthma, but also in heart disease and cancer and diabetes and obesity and dementia. Pretty much all the age related diseases or all disease and inflammation. In my book Young Forever, I did talk a lot about how one of the hallmarks of aging is inflammation or what we call inflammation. So when we look at the causes, how do you start to think about causes systematically? How do we have a organized approach to diagnosis about what is causing the body to react to something? Now what we really know is that the body's not really attacking itself on purpose. It's trying to do the job that it's supposed to do, which is fight bad things. Right, bad things. What are the bad things? Allergens, bugs, microbes, and mostly imbalances in your gut or your microbiome. We'll talk about that. Toxins and you know, also stress and poor diet also drive inflammation, psychological stress, physical stresses. But, but basically there's really five causes of almost all disease allergens. And that can be a food sensitivity, it can be a true allergen allergy, it can be microbes, it can be something like, you know, Lyme disease or hepatitis or anything like that. Plus it can be just dysbiosis, imbalances in the floor, in the gut. It can be toxins, petrochemical toxins, environmental toxins from pesticides, herbicides, plastics, as well as heavy metal toxins, flame retardants. I mean, the list goes on. So in fact, there's a whole school of research now on what we call autogens. Autogens are environmental toxins that trigger an autoimmune response. So all these factors need to be investigated. We need to look at each person, say, hey, do they have any allergy stuff? Is there gluten sensitivity? Are they harboring latent infections that might be confusing their immune system? Do they have a toxin like heavy metals or pesticides? What's their diet like? Are they eating an inflammatory diet? How much stress do they have? All these things need to be considered and need to be investigated. And that's really what functional medicine does. It helps you investigate the root cause. It's really a diagnostic model to think about an operating system, to think about the body as a system to think about root causes and to help the body restore balance. That's the goal. So basically, you got to figure out the cause. If you want to fix, you want to fix autoimmune disease, you got to get to the cause. And you know, unfortunately, medicine, we don't do a good job at that. We a little bit of that, but not much, right. If you have pneumonia, it's caused by streptococcal infection. Okay. You get penicillin, that's fine. But most diseases, chronic diseases, by the way, six out of ten Americans have, which are accountable for over 85% of our health care costs, which are now 4.3 trillion dol. Yikes. Caused by an infection like streptococcal pneumonia or you know, hepatitis C. I mean those are real, they need to be treated. But that's not really the majority of problems people are seeing. So functional medicine docs really understand the body of the system. It's an ecosystem and we seek the cause. We understand the basic interactions between them. We know when things go wrong, how to fix it and understand the interconnections between symptoms and organs and systems rather than all these specialties. You know, I always say I don't really need to know anything about, you know, the fine points of a particular autoimmune disease or be a specialist in that area, but I need to understand explanation. I understand the root causes and I can treat. I've never seen a case of dermatomyositis in my life other than, you know, with a traditional medicine care when I was in residency in early practice. But when as a functional medicine doctor, I'd never treated one before. But I knew exactly what to do because I followed the methodology of functional medicine to provide the fundamental, different, fundamentally different way of solving medical problems, gets to the root of the illness and understands the disturbances that, that really are going on. So let's talk about Isabel a little bit more. So she, she, you know, I was seeing good doctors and their response was to shut down this kid's immune system. You know, let's, let's. This kid's suffering, let's just throw the whole kitchen sink, the whole bar and everything. And that would have been okay. And she might have improvements in her symptoms, but she would have had a high risk for cancer, infection, osteoporosis, muscle weight things, psychiatric illnesses. And by the way would have cost a huge amount of money forever, right? This is a 10 year old girl. She's going to be on a drug that costs 50 grand a year for the next 60 years. You do the math. That's one person. So we're talking about it untenable things. I asked really a similar question is about which is why I didn't focus on what the name of disease Was I want to watch inflammation started, how we can really find the root causes and how we get to restore balance.
- [55:09]
Dr. Will Cole
In her immune system.
- [55:10]
Dr. Chris Kresser
So the side she's not finding the cause, it's also understanding how to get the immune system working better. Taking out the bad stuff, putting in the good stuff. So some insults usually are triggering some confusion. We call it molecular mimicry. There's a theory of autoimmune use called molecular mimicry that the, for example, some food you're eating or gluten, you know, somehow confuses your immune system and it thinks your, your thyroid is, you know, some foreign object, but it's just cross reacting with the gluten antibodies and that's why you end up pulled with autoimmune disease. So we were looking for toxins or allergens, bugs, reduced biosis. And by the way, a lot of autoimmune disease starts in the gut and a lot of it starts what we call leaky gut, which clearly she had. So when I kind of did her history, I very detailed history is really important. She had to find out what the story is, you know, not just oh, here's your disease, but like what is your background, right? She had exposure to severe toxic mold. And that can be a trigger. That's a toxin. Stachybotrys is black mold. And that was in her house. And her mother also worked in limestone pits when she was pregnant. And she was a lot of toxins and fluoride, even heavy metals. And she also had her immunizations before 1999 and before they can. The American Academy of Pediatrics and the CDC had not removed Premiersol from the vaccines for childhood vaccines. So they're getting a lot of like 167 times the amount of mercury in the vaccines until they go, oh, wait a minute, we have that at all. It's a lot of mercury. So they did remove it except for flu shots. And so if you're getting a multi dose file flu shot, which is what most people get, single dose, doesn't have thimerosal, but it's a preservative. So when you're sickening, yelling over and over, you got a multi dose file, you use it, but it, it, it's in the flu shot. So she was getting flu shots every year. And now she also loved to eat sushi. So she had large amount of tuna sushi, which she regularly got even more mercury. She also had a diet very high in sugar, lots of dairy. She also had many infections over her life, ear infections, sore throats, and had and because she was on a lot of immune suppressive drugs too. And steroids also cause problems. She had lots of antibiotics, so lots of antibiotics, lots of steroids, which causes real damage to the gut. So mold, mercury, antibiotics, sugar, dairy, gluten, junk food, all were potential irritants. So when I, when I dug in, I looked at her lab test pretty carefully and you know, on the conventional labs, they were a mess. Right. So they were, you know, high levels of muscle enzymes called CBK or liver function tests were off the chart. She had many autoimmune antibodies that were not just slightly high and going off the chart. High, like high I've ever seen. Anti nuclear antibodies, rheumatoid factor, anti SSA or Sjogren's antibodies, anti double stranded DNA, rnp, lupus, getting crankulin, a lot of big mumbo jumbo medical terms, but basically the whole soup about immune antibodies were just off the chart with her. And by the way, most autoimmune specialists do not check antibodies after the initial check. They go. They don't ever go back to normal? Well, no, they don't if you don't get rid of the cause, but they do if you get rid of the cause. And we saw that with Isabel. So she had also a lot of problems. She had other, lots of elevations and other markers, inflammation like C reactive protein. Her white count was really low, her red cells were low. Her vitamin D was severely low. She had really high antibodies to gluten, which by the way, is a common cause of autoimmune disease, probably the most common, and can trigger significant inflammation and leaky gut. Her mercury level, we did a challenge test, was off the chart. And the only way to really check is, is to actually give people a drug that pulls out the metals like the MSA. And she had a level 33. Normal is less than 3, so it's very high. And in the first visit, I simply didn't do too much. I just put her on an anti inflammatory elimination diet. So no gluten, no dairy, no sugar, no processed foods, got rid of the most common allergens. I gave her a multivitamin. I got her vitamin D12 on folate because of the acid blockers blocking that. I get fish oil, which is anti inflammatory, evening primrose oil, which is anti inflammatory. So I kind of gave her some basic nutritional support. And I also gave her an antifungal, nystatin. It's not absorbed, but it's used to treat yeast overgrowth. And I suspect that she had that due to the multiple Course of antibiotics through the serotonin taking, also give her liver support, supported liver and boost glutathione. And I told her parents, probably over time she's fine. She's taper off her acid blocker, the calcium channel blocker, ray nose and the steroids if she could. Two months later she comes back and.
- [59:49]
Dr. Will Cole
You know, I didn't know.
- [59:50]
Dr. Chris Kresser
I know what to expect. She was came back and she said her symptoms were completely gone. Her rash was gone, her joint pain was gone, her hair was growing back, her muscles weren't hurting. Off her medication, her autoimmune markers were much, much better. Her muscle enzymes, her liver function, her C reactive protein, all normal. Now this is just two months. Then I added probiotics to help her digestive system heal a little bit and reduce the gut inflammation. I got her an accelating drug called dmsa. Combine the metals from her tissues and help her to treat it and help get off the prednisone. I gave her some herbs to help her adrenal glands because she was on a lot of steroids and she tapered those down. Seven months later, everything was normal. All of your lab tests were normal, including her white count, her liver function, her muscle enzymes, the autoimmune antibodies, except for one called rnp, but every other autoimmune antibody that we mentioned or off the chart, A and A factor, all that stuff, completely normal. Never see that, right? Her mercury came down from 33 to 16 after 11 months. Her mercury came down 11. Her gut inflammation was gone. Oh yeah, she had a lot of gut inflammation, though. She had digestive symptoms. She had a test that we looked at, stool testing. And why would I look at stool testing for an autoimmune patient? But basically every autoimmune patient should have a stool test, right? We use GI effects by Genova. Essentially look at calprotectin, which is a marker you can actually get at a regular lab quest or labcorp. And calprotectin is a marker of gut inflammation that is super important because it's used for colitis or Crohn's disease. But if you have just slight elevations, it all indicates a low level of inflammation. So really, really important. Now, after a year, she was off all her medications, her labs were normal, she felt great, she was able to ride her horse again the show and she was just so excited. And I checked in with her like many years later and she was great and she was still fine. And we fixed the problem. So you get rid of the cause. It's not like stuff Keeps coming back. Now, I've treated autoimmune disease for decades this way. And I've seen patient after patient, we've got resolved, not everybody 100%, but the majority get better if not cured. Now, her case really isn't rare. And I take a similar approach pretty much with all autoimmune diseases. You have to be detective and be an informalist and what's going on now, if what I'm saying is true, like I said before, this should be a major effort from the NIH and the US government and private donations to actually fund research, to look at this in a different way. But everybody's in their silos, everybody's got their specialty. Nobody's thinking of the body, of the whole system. Even at Cleveland Clinic, when we did research looking at psoriatic arthritis, rheumatoid arthritis, comparing top rheumatologists there to our clinic, the functional medicine doctors, our patients did better in terms of all the objective metrics and the scoring systems for rheumatoid arthritis and psoriatic arthritis. So I think this is really possible. So what are the 10 steps to think about to reverse autoimmune disease? Well, it's really, really easy. First, take out the bad stuff and you have to find it all. And so for Isabel's a lot, it was mold, it was mercury, it was yeast in her gut, it was gluten, it was three metals, you know, all the stuff. And then to add back the good stuff, we add back the good stuff. All the ingredients for good health, right? Whole foods, right levels of nutrients, the balance, hormones, light, air, water, movement, connection, meaning love, purpose, all these things are really essential ingredients for health. So if you have an autoimmune disease, I really encourage you to find a functional medicine doctor and work with them. We see patients, the Ultra Wellness Center. Check your labs out. Try functionhealth.com get your panel done. You can see if you have pre autoimmune disease or other markers. And I think, you know, you'll be able to really move forward. So what do you need to do first? Get tested for hidden infections. Now, there are a lot of things that can go wrong when I say infections. It can also be dysbiosis, which is imbalances in the gut flora that cause gut and cause damage. Where by the way, 70% of your immune system is in your gut. So if there's a damaged gut lining, you're getting food and bugs leaking in your immune system. Seeing that, it's like ah, with a immune response that's Essentially what happens. But that's probably the most common cause. Gluten is a big factor in causing leaky gut. It's probably one of the biggest factor because it's increases something called zonulin which disturbs the tight junctions in the cells and hold them together and allows and bacterial proteins and things to leak in. But other things can be factors too. You can have a parasite for example. Parasites are associated with rheumatoid arthritis. It can be Lyme disease which has been linked to autoimmune disease, other tick infections. You need to be a detective and be able to figure that out. Check for heavy metals, check for environmental chemicals, really important like mercury. Fix your leaky gut, really important. And that's so important. I think we just talked about leaky gut. But get rid of the bad bug. Yeast parasites, bad bacteria provide the this program that you need to actually heal your gut. We call a 5R program in functional medicine which is removing the bad stuff like bad foods and inflammatory foods and allergens, bad bugs and then replacing things that are missing like digestive enzymes. Prebiotics reinoculate with healthy bacteria. Probiotics repair which is provide the nutrients for gut lining healing. For example glutamine, zinc and fish oil, evening primrose oil. Many other compounds are really important. Vitamin A for healing gut and and then the fifth R is restore which is to reset your nervous system and means dealing with stress differently. Super important.
- [65:24]
Dr. Mark Hyman
Have you ever wished there was a trusted space where you could get real support on your health journey? Where your questions get answered and you don't feel like you're doing it all alone? That's exactly what's happening inside my brand new membership community, the Hymen Hive. And I couldn't be more excited about it. Thousands of members are already inside, sharing wins, asking meaningful questions and supporting one another like never before. The conversations are powerful, the camaraderie is real and the community is growing every day. Inside the Hive, you'll get monthly live sessions with me, office hours with our resident functional nutritionist, science backed protocols, monthly challenges, behind the scenes content and so much more. All designed to help you create healthier habits that actually stick. Whether you're just getting started or fine tuning your routine, the Hive meets you where you are and gives you the tools and support to keep going. If you're ready to take control of your health with a community that truly gets it, join us at Dr. Hyman.com hive that's Dr. Hyman.com hive hive. If you love this podcast, please share it with someone else you think would also enjoy it. You can find me on all social media channels at Dr. Mark Hyman. Please reach out. I'd love to hear your comments and questions. Don't forget to rate, review and subscribe to the Dr. Hyman show wherever you get your podcasts. And don't forget to check out my YouTube channel at Dr. Mark Hyman for video versions of this podcast and more. Thank you so much again for tuning in. We'll see you next time on the Dr. Hyman Show. This podcast is separate from my clinical practice at the Ultra Wellness center, my work at Cleveland Clinic, and Function Health where I am Chief Medical Officer. This podcast represents my opinions and my guests opinions. Neither myself nor the podcast endorses the views or statements of my guests. This podcast is for educational purposes only and is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided with the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, please seek out a qualified medical practitioner. And if you're looking for a functional medicine practitioner, visit my clinic, the Ultra Wellness center at ultrawellnesscenter.com and and request to become a patient. It's important to have someone in your corner who is a trained, licensed healthcare practitioner and can help you make changes, especially when it comes to your health. This podcast is free as part of my mission to bring practical ways of improving health to the public, so I'd like to express gratitude to sponsors that made today's podcast possible. Thanks so much again for listening.