Dhru Purohit Show - Autoimmune Conditions are On the Rise — Do Food Sensitivities Play a Role? The Role of Gluten & Dairy in Autoimmunity and How to Address Food Sensitivities Starting with Gut Health

Episode Date: May 5, 2025

This episode is brought to you by Cozy Earth, Birch Living, and Square.  Autoimmune conditions now affect over 300 million people worldwide, and that number is rising fast. Yet the conventional medical model often misses the root cause, leaving many stuck on medications or searching endlessly for answers. In today’s episode, our guests reveal how food plays a powerful role in autoimmune symptoms—and how targeted changes can make a real difference. Today on The Dhru Purohit Show, we’re bringing you a special compilation episode featuring Dhru’s conversations with experts on foods like gluten and dairy that trigger autoimmune responses in their bodies.  Dr. Akil Palanisamy joins us to explore why autoimmune diseases are on the rise and how certain aspects of modern life may be fueling the epidemic. He breaks down the top contributing factors and shares his TIGER Protocol, which uses diet, lifestyle, and Ayurvedic principles to address them. Dhru and Dr. Akil also discuss the importance of mindset and staying grounded in what works best for you, so you can take action without feeling overwhelmed. Dr. Elroy Vojdani breaks down the role of food sensitivities in autoimmune disease, including common triggers and how they impact the immune system. He and Dhru discuss risk factors, the difference between sensitivities and intolerances, and the limitations of standard allergy tests. Dr. Vojdani also shares how to remove problem foods and take practical steps to heal the gut and restore immune health. In this episode, Dhru and his guests dive into: Dr. Akil’s two-phase diet approach for autoimmune disease (1:40) Restrictive diets: understanding food allergies vs. food sensitivities (3:41) AIP Diet vs. Dr. Akil's Elimination Diet—key differences (8:25) Blood tests and symptoms that help detect early autoimmunity (12:20) Essential foods that support gut repair (18:54) How to follow an elimination protocol on your own (26:58) Chronic diseases linked to food sensitivities (32:00) Food sensitivities and their role in F.L.C. (Feel Like Crap) syndrome (37:01) The rising prevalence of autoimmune diseases in recent years (40:30) Why food is the #1 trigger for autoimmune conditions (45:15) Dr. Vojdani's personal story and key risk factors for autoimmunity (47:09) Gut repair strategies for those without access to doctors or testing (52:20) Highlights from Dr. Vojdani's book When Food Bites Back and patient results (58:20) Dhru’s father’s success story with the Elimination Diet (1:04:36) Why the reintroduction phase is crucial for autoimmune healing (1:07:42) Final thoughts and takeaways (1:09:32) Also mentioned: Full episode with Dr. Akil Palanisamy Full episode with Dr. Elroy Vojdani This episode is brought to you by Cozy Earth, Birch Living, and Square.  Right now, get 40% off your Cozy Earth sheets. Just head over to cozyearth.com/dhru and use code DHRUP. Get 27% off your Birch Living mattress plus two eco-rest pillows during their Memorial Day early access sale—just head to birchliving.com/dhru today!  Get everything you need to run and grow your business, without any long-term commitments with Square. Right now, you can get up to $200 off Square hardware at square.com/go/DHRU Sign up for Dhru’s Try This Newsletter Learn more about your ad choices. Visit megaphone.fm/adchoices

Hi everyone, Drew Brod here. Autoimmune conditions are on the rise, affecting an estimated 300 million people worldwide. That's almost the entire population of the United States of individuals suffering with autoimmune conditions around the world. And in today's compilation episode, I talked to two incredible experts about the connection between food sensitivities, specifically gluten and dairy and autoimmune diseases. Even if you're someone, knock on wood, who does not have. have an autoimmune condition. You'll want to listen in to today's episode and understand why these

two foods, gluten and dairy, are so poorly tolerated by many. Not everybody, and we don't want to immediately demonize them as being bad for everyone, but why do these two foods come up time and time again as issues for so many people? So much so that they can often lead to symptoms, including joint pain, fatigue, and most importantly, digestive issues. First up, I sit down with renowned integrative medicine practitioner, Dr. Akil, for an explanation on why certain foods can be so problematic for individuals with autoimmune diseases. And in the segment, Dr. Akil highlights the protocol he created to address these issues. And I also speak with functional medicine doctor, Dr. Elroy Vujdani, about why foods like gluten and dairy trigger immune responses and how

implementing an elimination diet can lead to long-term healing and gut repair for some. But first, let's listen in to my conversation with Dr. Akil, Palisami. What are you finding that people are not getting right when it comes to their diet and they're coming in and not understanding how their standard American diet and the specific components of it are maybe increasing their likelihood of autoimmune condition or making their autoimmune condition worse or not allowing them to heal, right? What are some of the pillars of their diet that are really putting a lot of of stress on their body. Yeah, absolutely. So with diet, I like to separate it out. So I have like a

phase one diet, which is more of an elimination diet, which is more restrictive, more focused on gut healing. And then there's the phase two diet where you're kind of reintroducing foods, you're expanding the prebiotic foods, you're rebuilding the microbiome. And I feel like that's something that's missing, you know, because oftentimes I see patients, you know, they're on like the autoimmune paleo diet, which is very important. very common diet or the whole 30 and they felt significantly better and then I've been on it for 10 years, you know, but it was never intended for that because you don't want to be on a very restrictive diet long term. You want to be on a restrictive diet for like a certain amount of time,

do some gut healing, do some detox and then start expanding your diet so you can build up the diversity of your bacteria, which is one of the key barometers of the microbiome and keys to longevity. So that's a mistake I often see in diet when I have patients come to me saying, yeah, I've been on this very restrictive diet. And then over time, it becomes very hard to follow because it's so restrictive. And so what I focused on, like with her, for example, was three kind of big things, which were cutting back on gluten, dairy, and sugar. In that first phase. In the first phase. Yeah. Exactly. And that first phase is, designed to be restrictive on purpose.

Yes. But it's not designed to be where you stay forever. Right. Which is an important thing to talk about, right? Which is what you were just sharing. Yes. And first, as basic as that sounds, why is it designed to be restrictive? Right.

What are you trying to do and what are you trying to minimize when it comes to the body and autoimmune? Yeah. So the research shows that patients with autoimmune disease tend to have much. higher levels of food sensitivities. And that's like common ones that they've tested are like dairy products, gluten as well. So we know that they're much more likely to have reactions to foods. And we have to distinguish between food allergy and food sensitivity. So food allergy is like what people think of usually, like you react to shellfish or peanuts and you can't breathe

or your lips swells up. That's an immediate reaction. That's a food allergy. But The food sensitivity is actually something quite different. There may be no symptoms. There could be delayed symptoms, like up to two to three days after ingesting the food. There could be nonspecific symptoms like brain fog, fatigue, or malaise, headaches, congestion, or there could just be inflammation triggered in the body without symptoms. So food sensitivities are what we think about, and that's the reason for eliminating those foods because those are some of the common sensitivities and you know we can do tests so like

sometimes we test patients for food sensitivities and then use that as a guide to what they need to eliminate but statistically yeah gluten dairy are the two biggest food sensitivities and those are a problem because they really inflame your immune system so in the gut when you are exposed to foods that you have antibodies against, which is what a food sensitivity is, then your immune system goes into hyperdrive. It's like constantly reacting to the foods you're eating every single day, and that just predisposes to autoimmunity and worsens autoimmunity. So that's the main reason for that. Yeah, when you have an autoimmune condition, your body's on high alert. Yep. And basically, like a police or the army would put out like an, I mean, the army doesn't do it, but the local

police might put out an APB, right? Right, right. Hey, look for anybody who's like, this. Yes. And you know, you and I are both brown and they say, look, you know, go for, go after anybody who's brown. And even if we're not doing anything wrong, we're going to be getting caught up in the mix. And that's what I've heard that people talk about when it comes to gluten dairy, these foods themselves are not inflammatory, right? In fact, dairy has been shown to be anti-inflammatory. Yes. Right. But people with autoimmune conditions can have more of a reaction to these foods because their body's already on higher alert. So we need to bring it on lower alert, one of the ways that you do that is you're restricting the diet for a

temporary period of time to make sure you're removing anything that might put the body on high alert until you can kind of quiet the immune system down by getting to the root issues. Is that accurate? Yeah, exactly. And my goal is always trying to expand the diet as much as possible, as much as someone it will tolerate. So I think the elimination phase is the phase one diet, But then the reintroductions are even more important, and that's part of the phase two. And there's a lot of subtlety and nuance in that, which I work with my patients on. I talk about in the book, like, what's the order to reintroduce foods? You should reintroduce the foods that are kind of least allergenic first.

So, you know, if you've eliminated like nuts and seeds or night shades, or, you know, maybe those are earlier in the reintroduction, and then you reintroduce more allergenic foods like dairy towards the end. and then gluten at the very end because it's the most allergenic. So that maximizes the chance of success because the goal is always getting people to expand their diet to the maximum diversity they can tolerate and then making sure and then hoping we can heal their gut enough where they get to a point where they can tolerate some amount of gluten, some amount of dairy, fermented dairy, extremely beneficial like yogurt and kifir and have kind of like that 80-20 rule that's kind of our target.

Yeah, and gut healing is really the key sort of thing. Before we get into that, just a little bit more about that phase one. So we talked about some of the things that people aren't really eating, and you're removing a lot of things like gluten dairy sugar, right, just for how pervasive sugar is and metabolic health, other things, and that leading to a whole inflammatory cascade. But what do typically people find themselves eating during this time period, right? If you would look at their meal, like what are they eating for breakfast?

You know, what are they eating for dinner during this period of time? Yeah. So that's one way I differ from the AIP diet is I... Autimmune paleo. Yeah, autoimmune paleo, which... The AIP diet does not allow any grains at all, even the gluten-free grains like rice and quinoa and, you know, so forth. But those are allowed in my elimination diet. So people can have oatmeal, they can have, you know, rice cereal, they can have quinoa, they can have... As long as they do okay with these, they can have...

They can have them. Yeah, exactly. As long as they're not having an overt reaction, then those foods are, I have found, like, very unlikely to cause issues. Some patients do react to all grains, but the majority can tolerate those gluten-free grains. So that will open up a lot of options in terms of diet. And then having a good quality protein, whether it's, you know, like could be, like grass-fed beef or is some healthy fish or poultry.

I think that's excellent. In terms of legumes, I also allow mung beans in the diet for elimination because... Which are popular in like Ayurveda? Yeah, exactly. Can you explain what they are just for people who are not familiar with lung beans? Yeah, monk beans are a very small kind of a yellow bean that is used a lot in Ayurveda because it's super easy to digest. It's the smallest legume.

And they're usually sprouted, right? Often sprouted, right? Often sprouted, or pressure cooked? Yes, always pressure cooked. And yeah, so they're very easy to digest. They're excellent source of protein. So for people who are vegetarian, there's an Ayurvedic dish called Kitchery, which I have a recipe for, which is basically rice and mung beans and some spices.

And so that's a very healthy, you know, that's a very healthy meal. Like in Ayurveda, there's some programs where all you eat is kicherry for like two weeks. People feel great. Yeah, yeah. And so, yeah, so and then, you know, the foundation of the diet, of course, is fruits and vegetables. So we all should be eating more, you know, fruits and vegetables. But having plenty of those healing foods, you know, the right blend of fruits and vegetables, adding in the prebiotic vegetables.

So you can add that like up front to the foods that start to strengthen the microbiome. So adding in the prebiotic vegetables, incorporating fruits. And I'm a really big fan of broccoli sprouts. So because of their sulforaphane. So that's a compound that over 2,000 studies have been done looking at sulfurophane and it clearly lowers inflammation and also supports the immune system. And it's very good for the brain as well. So I think incorporating broccoli sprouts throughout all phases of the diet is what I recommend.

Yeah. And I think it's important to talk about what you can eat because when you think of it that way, people get very nervous, especially if they've been eating a more processed food diet. Even if it's a processed wellness diet, right? They've been eating a lot of avocado toast or whatever. Like, you know, they've been eating a lot of like bread or pasta or they've been eating a lot of packaged food that's there. And then they look at an elimination diet, right?

And by the way, this is for people who have a diagnosed autoimmune condition. Can you do it if you do not have a diagnosed autoimmune condition? Like, is this a program that you can do even if you don't have a diagnosis yet? Yes, because with autoimmune disease, there are many people that are kind of in a gray area where they don't meet the criteria for a disease. Would that be called subclinical or sort of pre-automune or something like that? Yeah, a subclinical, you know. So they're having some symptoms. Yeah, exactly.

What are the common ones that are out there? Because, I mean, there's so many autoimmune conditions, right? Like 80, 100 plus different ones out there. Right. What are the common things that people might think of? Obviously, they have to work with their doctor and figure out. but sometimes the doctors actually don't know. So that disclaimer is not always the most helpful.

But what would be an example of either blood test or symptoms that somebody's dealing with that indicate that they might be in that subclinical pre-automune phase where their immune system is starting to get very reactive? Right. So I think that in terms of blood work, these auto-antibodies, which are the autoimmune kind of markers made by the immune system often can predate the development of the autoimmune disease by like 10, 20 years.

And so if you're getting blood work, screening for some of those auto-antibodies can be a clue because that could be one of the signs that you might benefit from this program. But some of the common symptoms I see fatigue, you know, of course, super common, but that can be caused by this. joint pains, like different kinds of aches and pains. And then cognitive issues like brain fog or mood issues, those are probably like the three most common symptoms I see. But if you have the resources, because it takes a little bit of like you've got to convince your doctor to run this panel. Yes.

Or, I mean, do you know any services that sort of are more consumer-friendly that people can use that then include this screening, these auto-antantibodies? You know, Syrex Labs. Syrac Labs. It's tough. You got to have a practitioner. Yeah, I don't think there's a direct to consumer. I think there's a great opportunity for that, but I don't think it's been done.

Okay, so the question was, can you do this if you don't have an diagnosed disease? And you should still feel that there is some reason that you're going on the Tiger Protocol. Right. Because it's directly tied into autoimmune. Yes. Because then you wouldn't necessarily need to be doing the elimination phase one. Right. you can just eat healthy and you can include a lot of the great principles that are inside of here,

but it doesn't mean that you have to necessarily be super strict because that's more useful for somebody that's either on their way towards an autoimmune condition or has an autoimmune condition. Yes, exactly. So yeah, anyone, you know, even in that early autoimmune subclinical phase could benefit from it. And anyone who wants to reduce inflammation, I think would benefit from this approach because it's highly anti-inflammatory, you know, from the diet perspective, from the spices we're incorporating, from just detoxing that lowers your inflammation, from some of the supplements I'm recommending. And we know inflammation is kind of the root cause for all our modern chronic diseases, right?

So we know, like for almost all of us working to bring our inflammation down and keep it low is really vital for long-term health. Before we get into supplements and a few other things that are there, right, I want to go to the phase two part of the diet. So phase one, it's better to look at sort of all the things. you can eat. And especially if you are strain training and things like that, you're prioritizing protein and getting good quantity of protein, which I feel has been a big topic over the last couple years. You know, we've had people like Dr. Gabriel Lyon on the podcast. Right. Dr. Donald Lehman on the podcast last week, one of the top protein researchers at University of Illinois, out in Chicago.

So a lot of more people talking about why protein is important, you know, doing our best to go for the clean sources if we get a chance to and staying away from. ultra-processed foods and not processed meats that are there. So you're building your plate around healthy proteins, and you can still do this if you're vegetarian, you can do mung beans, you know, other versions of that. You have examples of that in your book. Fruits and vegetables, right? And then in your instance, which makes it a lot easier for people to follow, you still can have some grains and things like that as long as you're not super reactionary. Right. Weirdly, I have a, I don't have an autoimmune condition, knock on wood,

But I have a really bad reaction. I don't do well with things like quinoa. Oh, interesting. But I do well with white rice. Okay. You know, I don't know why, but hey, whatever works. Yes. So now, if you look at that, there's a whole plethora of things that you can eat.

It may take a little bit more work to sort of do some planning on the weekends, but you're going to find that there's a ton of stuff that you can eat. You don't have to be nervous. You can't have pasta and other stuff like that in the immediate term. Or maybe some of the processed foods that you're used to. So now the phase two, what are some of the things that you're used to? you're really focused on bringing in. Oh, actually, you know what, sorry,

I wrote down a question that I wanted to get into first. Sure. In between the phase one and phase two is some gut healing. Yes. What have you found to be? Because in the Tiger Protocol, T is for toxins, eyes for infections, G is gut health. What have you found to be central when it comes to the intersection of diet

and or supplementation to start to repair the gut so that it's ready to include and expand the diet and the immune system, which 80% of it, they always say, is concentrated in the gut, is not so reactive so that you can actually take on these foods. So take your approach to gut health. What are some of the top action items and things that you're bringing in with some of your patients?

Yeah, absolutely. So that's very important because during that phase one of elimination, you want to really add in these things so that you get the most benefit from that phase one diet. So I am a big fan of bone broth. I think that even though it's a bit of a fad, there is research on all the benefits for gut healing, you know, from the gelatin, the glycine, the amino acids. And apparently it's maybe a 20,000-year-old fat. Right.

I think we've been probably making some version of stewed bone broth for a long time. Right. Yeah. And we just eat the whole animal. Yes. It's actually a medicine in Ayurveda. So for like thousands of years it's been used. Wow.

I didn't know that. In Ayurbeda. Yeah. So, yeah, so if people do not want to eat, have bone broth, then doing collagen powder is a good substitute. You can find, like, grass-fed collagen powder, and that's pretty easy to mix into, like, smoothies or water. So if that's an alternative. So either bone broth or collagen powder. And then second, I really like glutamine for its gut healing effects.

And the best food source is actually cabbage juice. So if you just have a juicer and can juice some cabbage or you can make it in a blender. Cabbage is one of the richest food sources of glutamine. So if you're willing to drink that, that's an option. Or if not, you can find it easily as a supplement. It's a white powder easy to use. I think it's honestly easier to find as a supplement because then for a lot of people, you've got to get a juicer, which is expensive in itself.

But cabbage juice, interesting. Yeah, I always give people the option for food because there are some. I just only want to do foods. And I love working with food as medicine because it's so powerful. But yeah, glutamine has good research to show like it heals. Intestinal permeability, helps with the leaky gut. It helps with the dysbiosis, the imbalance of bacteria. And it's usually like very well tolerated.

So I think that's another integral part of the gut healing. Great. Anything else that's part of the gut healing protocol or things that you talk about inside of your book? Yeah. I mean, there are two other categories of foods that I think are very important. So one is prebiotic foods. So prebiotic is basically something that has food for your gut bacteria that's different from a probiotic, which is like the actual gut bacteria. So prebiotic foods, I think should be introduced really upfront in the phase one diet even because there are certain.

prebiotic foods that most people can tolerate that you know don't really cause issues and those are the polyphenol rich foods so so I think prebiotic foods are really key and that's an even bigger part of the phase two diet because prebiotic foods are how you build a diversity of the microbiome so then I go through some of the main categories like polyphenols and what are the best you know, fruits and vegetables, what are the best, like, nuts and seeds. So there's a lot of literature about the polyphenol content of foods. So just to take a step back with prebiotic foods, like, for example,

legumes and beans are a really good source. People with certain conditions like SIBO, small intestinal bacterial overgrowth, they may not do well on prebiotic foods up front. So they typically do well on polyphenols, which are the food that's tall But then I really recommend getting resistant starch. So there's like three types of resistant starch. We can talk about those foods later. And then I emphasize inulin, so inulin rich foods.

There's about a dozen inulin rich foods that are really excellent. Inulin is one of those prebiotics that has a really good research for not just gut health, but helping your blood sugar, helping brain health. helping brain health, helping inflammation. So getting inul-enrich foods. And then there are other categories like mushrooms are actually very powerful for healing the gut, powerful prebiotics.

So yeah, prebiotic foods is a really huge topic. But then the second big category is fermented foods. So studies show that fermented foods also reduce inflammation and improve immune markers. So they do improve some of these like cytokines, which are the immune system like messengers. So incorporating both of those is very good for gut healing. And one thing I've noticed just with friends of mine who've gone on, you know,

different protocols where they're including in prebiotics is that sometimes you start a little slow. Yes. And you work your way up. Yep. Because depending on how damage your gut is, you could have a reaction to it, right? So you're just building up, starting slow. And ideally maybe not mixing so many at the same time.

Right. If you're trying inulin, you're just trying that for a little. bit and getting to a level where you feel comfortable and you're kind of maintaining it and you've got it as a part of your diet. And then you can maybe if you wanted to try something else, then you could try something else. But sometimes people see that, well, this is good, that's good, this is good. Let me put it all in some big smoothie and blend it. And you end up having like a big gut bomb and you're like thrown off for, you know, a week with your gut trying to recover. Yeah, I think that's an important principle, which is start low and go slow with the dosage.

because even low dosages of prebiotic foods and fermented foods have benefit. So I've had patients, like when they're trying to introduce fermented foods like sauerkraut, they could only start with the sauerkraut juice. They could not have the actual vegetable. Can they mix it with the cabbage juice? Yes. Yeah, they could, yes. So then they start with like a teaspoon of sauerkraut juice per day.

And it feels like laughably small, but I say, no, that's good. you're getting your gut used to this change. And then you work up to a tablespoon. Then you start adding a little bit of actual sourcrow, the cabbage. And so that way, over many, like, you know, days or weeks, you're building up slowly. And that's a much better strategy to get your gut to tolerate these foods. Do you find that the average person who's dealing with sort of an autoimmune condition, which hopefully they have some level of medical care that they have access to?

And of course, you know, most people getting access to precision medicine doctor, functional medicine integrative, there's going to be a cost because insurance doesn't, you know, doesn't pitch in or anything else like that. Although in our case, we take insurance. Oh, that's right. You do. You do. Yeah, one of the few clinics.

Because you guys are part of a larger group. Yeah, we're part of a group called Sutter Health, which is throughout California. And we're trying to be the integrative medicine branch within Sutter Health. Do you guys have like a massive waiting list? We do. Yeah. For that reason. Yeah.

For that reason. We have, you know, five clinics in the Bay Area, but, yeah, massive waiting lists. But, you know, that's why I'm looking at more innovative models. Like, I'm doing a lot of group visits these days. And then I've also created some online courses, like on autoimmune disease. So great. The question goes right into it. So, of course, people can sign up for the waiting list and, you know, knock on wood,

I hope they, you know, can get seen by you or other people that you guys might refer or recommend. But for the average patient that's out there who maybe doesn't have access, Do you find that they can go through the process of this protocol and the dietary things on there and even the gut health? Is it doable to do it on your own? And in a way that allows for a lot of the sort of trial and error that even a functional medicine doctor is doing, right? Because it's not like you have the exact, there's no one test you can do to see what foods work well for a patient or not. Sometimes you have to tell them to try something.

they try it and then they have a really bad reaction. And they're like, I don't do well with this food or supplement. And I know in general it works for a lot of people. It doesn't work for me. Is this Tiger Protocol doable enough for people that they can navigate through the ins and outs of trial and error? As long as they're willing to do their homework in the process. Yes, absolutely. And that was my goal for writing the book was to try to keep it simple, try to keep it practical and not overwhelm people and include steps that –

Because I think the average person may not have access to a practitioner to guide them. So I wanted to really put enough information in here that would allow a person to do this on their own. There's a lot of guidance about the reintroductions, like how you expand your diet after the initial elimination diet. That is trial and error. So every person has to do that on their own. But I walk people through how to do that. And I think incorporating a lot of these practices like the exercise or the sauna or or meditation, you know, those are with some support, like with apps or coaches or trainers,

you know, you can reach out to whoever you have. But my goal was to make it accessible and possible to do on one's own. For so many of us, even if we don't have an autoimmune condition, we notice that we just don't feel the best after eating certain foods. I know, for instance, that while I can tolerate some dairy, if I have it on a regular basis, I'll notice skin issues like pimples and breakouts and redness and maybe even some constipation and a little bit of bloating. Again, that's not everybody, but that is my unique situation.

In my conversation with Dr. Elroy Vajdani, he breaks down why this is happening. And we also talk about the various factors that link the rise in autoimmune diseases to environmental factors, including the presence of these food sensitivities. Let's listen in. You know, you mentioned something really interesting. you mentioned, for example, somebody comes to your clinic. Let's say classically, it might be a woman who's dealing with Hashimoto's, because 80%, I think, 80, 90% of Hashimoto's cases are women.

Is that correct? That's correct. So it's a woman, you know, maybe in her 30s, 40s, 50s, 60s, who's been either diagnosed with Hashimoto's or is starting to maybe Google and sees that they have symptoms, that might be related to Hashimoto's, and that they come in, and then through advanced lab testing, they find out that one of the things

that might be playing a role is that they have, in this case, they've been eating a food their entire life that they didn't know is agitating and encouraging their Hashimoto's symptoms. It's not that non-celiac gluten sensitivity or just gluten sensitivity is causing their Hashimoto, I don't think we're at that place we could say it's directly causing, but it definitely seems to be one of the big factors

for many patients that's influencing it. Is that a way to say it? Yeah, it's a big chunk of their pie of how something like that happens. Right, of course, stress plays a role, other things play a role, but in this particular case, what are some other examples of chronic diseases that people are dealing with every day that even if it's not gluten, that it could be other foods that are out there that they're in this category

where they are dealing with the food sensitivity and they may not know that that food sensitivity could be potentially a big chunk of why this chronic disease is there in the first place or why they have really bad symptoms from this chronic disease.

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It's time to run your business smarter with Square. Get started today. Number two, most established in the literature beyond Hashimoto's is multiple sclerosis. And multiple sclerosis is not typically gluten. So the target antibodies, the target tissues in multiple sclerosis are myelin basic protein or myelin oligodendrocytes. They have what we call significant cross-reactivity with the dairy protein Kaysen. What does cross-reactivity mean? The immune system is not a perfect system.

When it recognizes things to attack, it does so with maybe something. 70 or 80% specificity. If there is another protein in the environment that looks that 70 or 80% similar, it essentially cannot tell the difference between the two of them. That is the case for myelimbic protein, myelagoelogodendrocyte targets. Essentially they look extremely similar to the immune system as dairy protein. So if an individual with known diagnosed MS has a food immune reaction, to dairy, the consumption of dairy will drive the antibody formation against their neurological

tissue. Put that in a different context. If that person takes dairy out of their diet, their immune reaction against their neurologic target tissue is going to drop and they're going to feel better. Yeah, this might be, for example, people have heard of like Terry Walsz, who's been on this program before, medical doctor and a researcher in the space of MS. multiple studies on her walls protocol. And she classically has talked about getting off of certain foods that she didn't have an allergy towards. And that was one of the things that helped her gut heal

in the process of her journey of getting better, which literally she had progressive MS. She was in a wheelchair and it kept getting worse and was in terrible, terrible pain. She still is dealing with some of that pain, but she is walking, she rides her bike regularly. She works out. She's been on this podcast multiple times before, so if anybody has MS, we can definitely link to that.

So separate from MS and Hashimoto's in autoimmune conditions, there's this other category of people who haven't been diagnosed with a chronic disease. They just feel like just somebody who feels bloated regularly, doesn't feel like their digestive system is working well. Regularly feels like they don't have the opportunity to have their system. working in the way that they wanted to feels lethargic on a regular basis. So there are people that are in that category. Obviously, I'm not asking you to diagnose a whole group, nor could you,

but do food sensitivities play a role for those individuals, or can food sensitivities play a role for those individuals? In the vast majority of them, there's a food sensitivity issue. Now, for them, is it the same mechanisms, right? Because they may not have a diagnosed chronic or, chronic disease, or maybe it's not bad enough yet for it to be that way, but how do certain foods end up causing this immune cascade in the body that has them feeling like crap? So I think the first thing that everybody should understand is when you're dealing with an

environmentally induced immune problem, there are stages. So there is a pre-automune stage, and there's three stages of actual autoimmunity. Most people who have several different parts of their body that aren't functioning the way that they think they should be functioning, or it's a significant drop from their baseline, are suffering from that pre-automune condition. The environment essentially driving their immune system into a chronic inflammatory imbalanced state.

Yeah, and just so everybody's clear, environment just means anything outside of your body. Correct. It's the food that you're eating, could be chemicals that you're exposed to. Largely, what you're talking about is, of course, food, but there's a whole host of things. that are part of that.

Yeah, I mean, in reality, food is the biggest part of the environment that you're exposed to. I mean, you're consuming food three, four, five times a day, depending on what that is, that could be regular, continuous inflammatory exposure. So the reason we focus so much on food is, number one, it's the biggest part of the environmental conversation, and number two, it's the thing that you have direct control over. You don't have a lot of control over the quality of the air that you breathe on a daily basis. You have some control over it, but not as much as what you're doing.

you consume, right? So that's why we really focus so much on it. It is the biggest piece of the puzzle and it's the most movable piece of the puzzle. So you were talking about these three different stages. Right. Yeah. So you explained the first part, which is this pre-automune stage. Yeah. Right. And we're not necessarily talking, although it's related to, you're not just saying that, hey, everybody's going to end up with an autoimmune disease, even though autoimmune diseases are skyrocketing and I think are one of the fastest growing classifications of diseases. What's the estimate in the United States? Is it 80 million people?

Currently, we're at 15% of the U.S. population with a known diagnosed autoimmune disease, but most autoimmune diseases have a latent period of somewhere between three to eight years. So if you kind of want to back extrapolate that data, we're looking at maybe upwards of 25% of the U.S. That's crazy. And what's the population right now of the U.S.? Do we know? Tesla, can you Google that?

I think we're like 300 and something million, 331 million. So that's a lot of people that have autoimmune conditions diagnosed. And there's some people still to this date, magazines, media outlets, even some doctors that I see that will tell people, oh, we're just getting better at medicine, so we're catching these diseases. That's why there's so many people that have autoimmune is because our medicine, and access to medicine in the United States has grown, and that's why we're catching it.

Tell us why that is not the answer, or at least definitely not the full answer. It's very clear from the literature that that's not true. I mean, we have very robust data in the N. Haines trial. If you look at the percent positivity of a positive ANA over time during N. Haines, you see doubling of that percent population. And Enhains in that regard has only been analyzed, I think back to 2015 at this point.

So, no question. There's no way to discuss this other than scientifically true fact that autoimmune disease is on the rise. And only in the last 15 years, let's say, which is a very, very alarming time frame to experience something like that. So something's been going on in the last 15 years, right? Something's been going on that's not just affecting people who have diagnosed autoimmune diseases, although you gave two perfect examples, Hashimoto's is one, MS is another, but also this other category of just people who just don't feel good. On a regular basis, people who think that they're eating healthy.

Something has been changed in the environment. It's not our genetics. Our genetics takes millions of years to sort of evolve, even in the smallest realm. But there is our epigenetics that are going on in the body, which is how we react to the environment. So what the hell is going on in the last 15 years, in your opinion? It's all, I think, the majority happening in that pre-autoimmune category,

which essentially if you want to break it down to a cellular level, it's really the normal physiology and function of our entire gut environment and the immune influence from that that are completely broken. The most important regulator of our immune system is a cell called the T regulatory cell. The T regulatory cell, we have different populations of them. There's a gut dependent or gut populated T regulatory cell, which is essentially responsible for the balance of what in my environment do I want to attack or not attack. So when you have, let's say, a food sensitivity or you have a new adult allergy that you didn't experience before, is essentially dysfunction of the T regulatory cell that brought.

that set of symptoms on. Also, if, let's say, you consume foods and you get brain fog or runny nose and digestive issues afterwards, it's essentially the environmental triggers that are pushing that T-Reg cell to imbalance that are responsible for that, if you really want to break it down to one part of the immune system. T-Reg cells, their balance, you know, essentially is fed entirely by what they see as threat versus non-threat in the localized internal environment of the gut. And with so many people experiencing intestinal permeability, so much dysbiosis out there, so much constant exposure to chemicals, the T-Reg cells see themselves as under constant threat. And when they see themselves on constant threat, they're going to try to fight back.

and the way they fight back is with a chronic inflammatory response from the immune system, and we feel like crap when our immune system is in a chronic inflammatory state. Everybody's walking around over-inflamed. Not everybody, but a lot of people, most people, they're walking around over-inflamed, and it's because their body is trying to fight something. Inflammation is a tool, right? So even though we don't like these symptoms, brain fog, runny nose, These are all defense mechanisms.

These are all sort of signals. These are all canaries in the coal mine that are an indication that some sort of localized inflammation or chronic inflammation is happening inside the body. And even though we don't like it, our body doesn't make mistakes. Our body is doing this for a reason because it's under threat. Why is it under threat? Because our border in our body, which is our gut health. and is out of whack because of the foods that we're eating, dysbiosis, meaning we have too much of the

wrong bacteria, not enough of the good bacteria, and also the chemicals that are in the environment. But would you say, out of the ranking of all those, food still is the number one trigger for most people of their body being in a constant state of threat? Yeah, it doesn't begin that way, I think, but it rolls in that direction. You know, we probably have silent, ongoing injury to that intestinal lining for years. And then when there's enough permeability, then we start developing the food reactions. I think that's an important thing that you mentioned because we're not saying that, or you're definitely not saying that, you know, this food caused this issue.

You're saying that this food is part of the story of this issue, right? And the story started much earlier. and it just so happened that certain foods are more likely to perpetuate this issue. So we don't want to be demonizing foods. And I think that's where a lot of people in the traditional world of medicine, they get upset when they see wellness people, podcasts like myself, other individuals they see on social media, that they feel that they're demonizing foods,

which causes a lot of food anxiety for people. and prevents people from nailing the basics. And sure, there is some misguided communication around that, right? But here you're getting a chance to clear it up that we don't want to demonize a food. We don't want to just immediately say certain foods are bad or certain foods are good. You want people to understand how they're part of this story.

So tell us how for a lot of these people, when you sit down with the patient and you're spending an hour in your first appointment, right, or your team is spending an hour meeting with them, and going through their history and asking them about early life experiences, what are you looking for to put that story together about why they may be feeling the way that they do?

I'll talk about my own story because I think it's very reflective of the majority of people that we see coming into the practice. So I was born in Los Angeles. My mom had me via vaginal delivery. She did breastfeed me for a few months. Actually, I think almost a year. So it did her best to try to help nourish

my intestinal microenvironment, try to feed my immune system the correct things. But I got sick a lot as a kid. I remember very clearly a pink bottle of amoxicillin that just lived in our refrigerator. Antibiotics. Antibiotics, right? And back then, in the mid to late 80s, medical practice was, you know, a kid's not feeling great. Here's a tablespoon of antibiotics and just keep doing that.

And... I'm 80s baby too, so I'm right in that boat. Yeah. I'm telling both of our stories at the same time. You know, I remember loving that pink syrup that was sweetened and tasted good to me. But, you know, what those years and years of antibiotics were doing were eventually depleting my microbiome of their most essential members chronically over the course of 5, 10, whatever years that was. Yeah, and the research has shown just even one round of antibiotics can destroy, and I'll link to the, this in the show notes, but I remember clearly at a functional medicine, Institute of

Functional Medicine presentation, even one round of antibiotics can have a serious impact on the total quantity of good bacteria inside the gut. Right. And this is no knock on appropriate use of antibiotics. Of course. You know, if you have strep throat, you should treat it, right? You know, the ramifications of that are untreated or are not good. You know, if you have sepsis, antibiotics save your life. No knock on that. But I think in that era, we were, very, very clearly dramatically over prescribing antibiotics. And that had ramifications. And that practice likely existed up until recently.

So that's a huge chunk of the population that had that ongoing regular hit to their microbiome. You know, also coincided with a dramatic rise in the availability of industrialized food, fast food. I think my parents were doing their best, but they both were. worked full time and we ate fast food pretty often, maybe two or three times a week. And that's ultra-processed, you know, tons of gluten, tons of dairy, typically coming from food sources that are, you know, mono-agriculture, high pesticide exposure, you know, very improper breeding tactics for the cattle that's used for the dairy that's used in those products. It's essentially the cheapest way to grow anything that you're going to be consuming.

Fastest and cheapest. Fastest and cheapest, right? And probably chemically engineered to taste the best and be most addicting. You pair that with somebody who has dysbiosis and, you know, those T-reg cells that are developing inside of my gut at that time are just going to be bombarded over the head over and over and over and over again until they're essentially going to say, okay, whatever we're doing isn't working here, we're under continuous threat, we're going to recruit everybody here and we're going to start fighting and unfortunately though that comes from good intent from the immune system

that inflammatory signaling propels the leaky gut and propels the food immune reactions to another level and that's where you can start getting dedicated antibody formation to foods and you know like the inflammation just ticks up a notch and people can have lifelong issues from that for me i had ibs and chronic sinus infections for a very long time. I was very fortunate that when I was in medical school in 2005, my dad was in the process of developing some of the first clinical applications of testing for these things, essentially the first food sensitivity testing. He had actually dabbled with it in the late 1980s and was bringing it back in the 2000s. And he ran his earliest versions of gluten sensitivity and dairy sensitivity panels on me.

I came back positive. Your dad's a legend in this space, by the way. Thank you. He like totally transformed because one of the big problems was starting off at the beginning of the podcast is that most people would just have these allergy tests. And as you mentioned, there's false positives. There's false negatives in the way that we explained earlier. And then there's all these researchers that are on the cutting edge that are like,

we need something better. We need to look for something different. and your dad was the main guy that did that in this field of integrative and functional medicine. Yeah, I'd say he's the godfather of bringing leaky gut and food sensitivity testing to the modern world and at the same time also just continuing to push the now-known idea that the environment impacts the immune system, that it's responsible for this spike in autoimmune disease. So people may not be able to be getting to a place of a doctor's office. So also keeping in mind that if they're thinking about gut repair, right, and they feel like there is dysbiosis, that they have leaky gut, they're listening to you and they're like, this is me, and they don't have access to those tests, are there things that they can do to begin to go down the pathway of starting to repair their gut and hopefully have their immune system start to quiet down a little bit?

Yeah, I think, you know, it's important to recognize that for whatever many people that I've seen in my clinic or have been seen in clinic successfully here in the U.S., there's probably an exponential larger number out there who have done their own version of healing just by taking the information and implementing it, which is part of the power, I think, of this movement is that it really provides people a pathway to make yourself feel better. And that's just growing and growing and growing in popularity. The basics of it are remove and then repair. So what does remove mean? Remove means at least temporarily take things off of the table that are perpetuating this chronic inflammatory problem. If you want to think about it simplistically, what's driving the leaky gut?

You could say, I probably have it. My immune system is probably in this pro-inflammatory state. How do I take things off that just give that immune system some breathing? room that's following an elimination diet. Start by removing gluten, do that for a few weeks, see how you feel. If you're not responding, progress to removing dairy, you can go to corn, soy, eggs next. Some people don't want to play that waiting game, you know, depending on how willing you are, you could go straight to a paleo diet. I mean, a paleo diet is basically playing the odds and saying it's maybe a grain, it's maybe gluten, it's maybe dairy,

It's maybe, you know, corn, it's maybe eggs. Let me just take them all out. Focus on whole foods, minimize my sugar intake. You know, it really is going to cover 95% of people out there. You could just go straight to a paleo diet. Yeah, the challenge with the elimination diet step by step by step is it's very exhausting. Yes. It takes a long time.

I still don't know many people that have done it that exact way, just one at a time. There are people out there. There are people out there. I just find it so much easier to do. do some sort of program where, again, people hear paleo and they think, oh, I got to go eat a bunch of meat. No, no. It's not necessarily the case. And obviously, if you are vegetarian, that's fine.

You can do that too. You can look up versions of this for that. But you can, you're still eating vegetables. You're talking about whole foods, but in particular, you are still removing dairy because now there's this whole component as paleo has evolved. And this was one of my questions that we'll get to in a minute, the navigation around dairy. Now some people feel like, okay, actually dairy can be part of a paleo diet as part of their interpretation, but they steer people towards fermented dairy, right? So we'll get to that in a second.

Sure. But a classic sort of paleo diet where you're focusing on whole fruits, vegetables, can you do nuts and seeds? Yeah, I include nuts and seeds in there. It's really maybe staying away from that early list that you mentioned, gluten, dairy. Yep. Would you put grains in that category? I think grains would be the next step. Okay, grains.

All grains would be the next step. Kinoa, rice, anything that fall in that grain category. Buck, green sorghum. And the reason for that is that people who have really significant gluten sensitivities have a tendency to also have a grain sensitivity as well, too. Why that is, I don't think anybody really knows 100%. But, you know, theoretically it might have to do with the way crops are grown or stored or maybe even some cross-reactivity between the proteins there.

But gluten, dairy, and then grains would be next. Yeah. And then if you wanted to go even more sophisticated, later on, like, maybe they don't have to get to corn and eggs yet. Those are a little bit less, but still they would follow in that cross-reactivity category. Correct. But at least for most people, gluten, dairy, grains, that's going to encompass 90% of people, would you say?

And then try to take the opportunity and focus on eating whole, non-processed foods. Yeah. I mean, that's probably the most important part of all of this. Yes. Which will require a little bit of work, but it's like, guess what requires a lot of work? being sick. Yeah. Right?

Nothing is more expensive than being sick. Yep. Nothing will cause you to give up more opportunities, not want to pursue the job of your dreams, not want you to start that new side business that you've been wanting to do or write that book or start a podcast or whatever it is. Nothing will cut off opportunities like being sick. Being sick is the most expensive thing you could possibly do.

I just want to remind everybody of that because I've seen it. time and time again and even in my own life. Yeah. When you are sick, you would pay anything to get out of it. Yes. Right? So a little bit of an investment in prevention is huge as far as paying dividends. So they're doing this for, what would you say?

Some people say three weeks at least minimum. Well, in theory, if you are having an IgG antibody response to the food, the half-life of those antibodies are somewhere between four to six weeks. So what does that mean in reality? That means you could stop the gluten exposure on day one. still have those antibodies rolling in your system in some significant fashion three weeks later. And you might not have seen a noticeable effect. So I generally counsel six weeks.

You want a half-life of those antibodies to kind of come down a significant amount so the immune system can chill out. Great. So you're doing this for six weeks. And one thing that I've personally seen, I'd love to hear your account, is that even by two weeks, people start to notice things. What have you noticed that your patients who tell to do this, or people who write into you, who maybe can't afford to come to the clinic or fly out here, and you tell them or give them guidance.

You've written a book also. Let's bring that up, Tessa. It's called When Food Bites Back. When Food Bites Back. When Food Bites Back. For the practitioners out there, there is a textbook that my dad and I also wrote called Food Associated Auto Immunities.

So both of them. Yeah, let's bring up the When Food Bites Back, just for those that are looking at Amazon, and they can see the cover. It's a person eating a French Frizzles. Yeah. When food bites back, taking control of autoimmune diseases, we're linking to that. And again, even if you don't have an autoimmune disease, this book can be helpful because

you're walking people through action items like this. Yes. What do people start to notice often, not everybody, but often, even by 10 days, two weeks of doing this? The quickest things that will resolve our brain fog, insomnia, and joint pain. Those are like the three things that if they're going to happen, they happen right away. Wow. Amazing. And immediately right now, there are people are watching or listening.

They're like, I want that. So it's like, okay, let's try it, right? What's the worst thing? What's the downside of this? Okay, you spend a little bit more time cooking at home, which is good for you anyway. You're probably eating less processed foods. You're probably eating foods that are going to improve your metabolic health because you're not overeating on grains and starches and other stuff that are out there.

So there's not a lot of downside to doing this. You know, you're testing your commitment to something. You know, some people might have some hesitancy to do that, but it's a good challenge for everybody. No question. So now that you've done this for six weeks, what's the next step? You know, you're feeling a little bit better. Maybe some things have resolved. Some things are not 100% better, but they're a little bit better.

Where do you go from there at the end of six weeks? So then you want to repair, right? And repair means two things. You want to repair that intestinal lining that's been damaged for all those months or years before you started doing that. Time will take care of some of that. But there are things that you could take to try to accelerate that process. And you also want to repair those pissed off T-Rag cells. The immune system sometimes could use like an external hug to try to convince it to come down back to its normal balance. So if you're going to do like an intestinal repair, you know, let's say you're doing it with food. The intestinal barrier loves specific amino acids. It loves growth factors,

and it loves probiotics. So consuming collagen, better, consuming bone broth, making sure that you're intaking a really decent amount of live probiotics in your food, sourcrow, kimchi, kifir, whatever it is that you decide that you want to do. Those are going to do wonderful things for repairing the barrier and the T-Reg cells are very much influenced by both probiotics and the thing that they produce when they're in association with fiber, which is a short chain fatty acid postbiotic. So do that. Vitamin D, zinc, fish oil, all those things if you're going to start taking supplements can really accelerate that healing process. I remember reading your book when it first came out, but I don't recall, do you have a protocol inside of there that walks people

through this process. Yes. Yes. So people can get that inside of the book as well. My favorite supplements for doing this. Foods that you can consume if you want to do this entirely with food, which is absolutely possible. And yeah, it's all in there.

Yeah. And you already mentioned a few of those highlights. Now, a couple caveats for people, and I think you mentioned this the last time you're on the podcast, is a lot of this is also contextual based on how bad things are. People who have had really bad IBS or IBD, which is an autoimmune disease, irritable bowel disease, they start to include even some of these healthier foods

that are fermented and have fiber, and it feels like a bomb went off in their stomach. So they gotta go slow, or they might need to focus on more of the reparative process before they can bring in or find the best-tolerated versions of those things. In general, they're not gonna do well with typically a lot of raw vegetables, a lot of fiber at once if they weren't taking fiber.

And that's why you really got to go slowly and see what your body can tolerate. Do you want to add anything to that? Yeah, absolutely. There's a subset of people out there, a big subset of people who have these chronic immune problems and the result that happened as the result of really severe bacterial and maybe even fungal dysbiosis. We call that SIBO, CFO, you know, I'm sure they're going to be different terms that we start using for it in the future.

But essentially at its core, there is an overgrowth of a dysfunctional type of bacteria and or fungus and also the presence of them in places that they shouldn't be. And bacteria are fermenting organisms. Yeast are fermenting organisms. So as part of their metabolism, they produce a lot of gas. And for some people, if you're going to flood the system with more probiotics or more fiber, raw uncooked fiber, you're going to really push the gas pedal on that, not to use a pun, but you're just going to be producing a lot of gas, essentially. It's going to be really uncomfortable.

It might cause diarrhea. It might cause constipation. So in those individuals, you have to consume in this, I think, low fermented diet style. Essentially, you want the veggies to be cooked so that the fiber is broken down a little bit. You want to avoid the consumption of probiotics. And in those people, I actually focus entirely on the postbiotic side. supplement realm. So those are things like short chain fatty acids, tributerine is I think the big one in that space. There is a postbiotic from pomegranate called uralithin A and then a secondary

bile acid called Tudka. So typically when people are really sensitive to the pre and pro side, you're removing the prebiotic foods and then you're just pushing the postbiotic. And eventually over time for many of those individuals as you influence the T-Reg cell, to calm down, the immune system will therefore be able to do what it is intended to do, which is to regulate the microbiome. I'd love to get your thoughts on this. You know, I put my dad on a elimination diet. This was probably 2009.

And it was just for him. He wasn't complaining about anything specific, maybe a little bit of joint pain in his fingers, but he was a cricketeer. He played cricket, you know, actually professionally in Kenya, and then stopped right around the time that I was born. know, and then, you know, we moved to the United States. So he just thought maybe it's just injuries from that, you know, if he was knuckles or kind of his fingers look like a cricketeer's fingers, which are gnarly. So he just thought that joint pain is just coming from that. But you

know what, I'll try this thing, right? I'll try this thing. So he did it. And by the second week, one of the things he noticed, because he had never not had gluten in his life and had never not had grains for a period of time. And he did it. And he noticed a I think it was like day 15, 16, 17. It was like a 21-day program that we put him on. He came downstairs and he said, you know, I, and I was living with my parents at the time because I was helping to take care. I just dropped out of college and I was starting my first business.

So I was saving on money, but I was also helping to take care of my grandfather who was really sick and had cancer. And both my parents were working at the time, so I was helping my grandmother. He came downstairs and he said, you know, it's really weird. that I haven't had that morning back pain that I've just been used to for years. Yeah. I said, that's great, Dad. Like, that's interesting.

Like, let's keep note of that and anything else that you come across. Now, when his 21-day period, right, I didn't do the full six weeks, I didn't know you at the time. Sure. So he did three weeks. Still saw some benefits. When that 21-day period was done,

there was part of him that even though he had felt better, but it was kind of a slow process. Even with his back pain, it kind of was a slow process, was there. And he had spent his entire life eating these foods. He didn't like fully, I'm not going to say believe it, but basically that, right? He's like, okay, there's something to this, but it's kind of a coincidence. Maybe I also had him on some supplements. Maybe it's the supplements that he was on. So I'll just do the supplements and I'm going to go back to eating a lot of these foods in the same frequency. And I said, okay, yeah, do that, dad, because even some people, some medical doctors

tell people to do this on purpose. They call it the reintroduction phase because they want you to see how you react. Now, in a formal process, you would reintroduce those foods one by one, right? Because if you reintroduce them all at the same time, you don't notice what food did what. So I said, let's at least do gluten and dairy, because we're not going to do the whole list that you're on. Let's at least do gluten in dairy. So let's start off with dairy. So you reintroduced dairy. Generally, he was fine. He felt a little bit of stuff he knows, which is still something, but he felt like, okay, I can handle this. And then a few days, later on after reintroducing dairy a little bit at a time over three to four days, then he did,

he stopped the dairy again and he reintroduced gluten. And that was immediately the next morning, he noticed that pain come back. And that was a big aha moment for him. When you were describing these steps of stopping certain foods, elimination diet, and then going into repair, how important do you feel a reintroduction process is? And is that worth people trying out to really drive home, what foods they're reacting to. It depends on the context. So if I'm going to do a reintroduction, it's typically going to be for somebody who does not have a known diagnosed autoimmune disease.

Because in that context, I don't think it's worth the potential flare of the autoimmunity itself for the reintroduction because sometimes irreversible damage is done in that flare. So that's the first really important counseling point. If we're just dealing with, you know, no autoimmunity, chronic inflammatory, symptoms, you know, I usually will counsel wait until we know for sure that your intestinal permeability is resolved because that's when we know your physiologic resilience is back, meaning you're more likely to pass the trial, which is what we want, wait until then, and then we can do a reintroduction. And, you know, depending on the foods that they reacted to,

I'll make the list in kind of reverse order of what I think was causing the issue and do the reintroductions a week at a time. Essentially, we counsel people to do three days of small introductions sequentially and then to pause for four days and just be sure that over the course of that week, they feel the same as baseline. The idea there is sometimes the delayed reactions will occur for people and you just want to make sure you're observing that cleanly. then you move on to the next and the next and the next. That's great. Thank you for that clarification. I hope you're walking away from today's episode with a better understanding of common food sensitivities, why there's a link between autoimmune issues and poor tolerance of foods like gluten and dairy. And even if you don't have an autoimmune diagnosis, if you're struggling with fatigue, bloating, joint pain, and generally not feeling well, following an elimination diet for a

period of time, not forever, might just offer you new insights and pathways to feeling your best. Remember, it's not about cutting out certain foods. It's about understanding your body and addressing the root issues that are driving various reactions or sensitivities. Now, if you want to hear more from Dr. Akil and Dr. Elroy Vjadjadani in our full-length conversations, you can find the links to those episodes in the show notes below. If you've enjoyed today's conversation, you can always do me a huge favor. Share it with somebody in your life. someone you love, someone you care about, who might find this information, an episode, and our

experts, a helpful part of their evolution in their health journey. Until next time, Drew Perot, signing off. Thanks for tuning in.