Dhru Purohit Show - Autoimmune Diseases Are On the Rise: The Hidden Contributing Factor that No One Is Talking About with Dr. Sara Gottfried

Episode Date: July 17, 2024

This episode is brought to you by Fatty15, Our Place, and Lumebox.  Autoimmune conditions are on the rise, driven by various environmental factors. One often overlooked contributor? Trauma. Today’s guest sheds light on how trauma influences the body to attack itself, triggering autoimmune diseases. Today, on the Dhru Purohit Show, Dhru interviews Dr. Sarah Gottfried about the surge in autoimmune conditions and their link to trauma. Dr. Gottfried discusses three factors that can lead to autoimmune conditions, symptoms indicating a condition, and the progression timeline of these symptoms. She also examines research findings on metabolic dysfunction and autoimmunity, along with traits observed in individuals who do not develop autoimmune conditions. Dr. Sara Gottfried is a board-certified physician who graduated from Harvard and MIT. She practices evidence-based integrative, precision, and Functional Medicine. Dr. Gottfried is a global keynote speaker and the author of four New York Times bestselling books about trauma, hormones, and health. In this episode, Dhru and Dr. Gottfried dive into (audio version / Apple Subscriber version): The rise in autoimmune conditions (00:00:11 / 00:00:11)  Symptoms and the timeline of autoimmune conditions (2:34 / 2:34) Three requirements that lead to autoimmunity (10:54 / 7:03) Genetic predisposition versus environmental factors contributing to autoimmunity (20:13 / 14:25) The link between ACE scores and autoimmune conditions (24:48 / 19:00)  What causes the body to attack itself (29:48 / 24:00) Higher rates of autoimmunity and metabolically dysfunction in developed countries (35:48 / 30:00) Traits of individuals who don’t develop autoimmune disease (46:48 / 41:00) The role of assessing trauma in healing and the tools for objective assessment (1:05:48 / 1:00:00) Elimination diet, how to do it right, and potential supplements (1:22:08 / 1:16:20) Genetic testing and supportive relationships (1:32:18 / 1:26:30) Also mentioned in this episode: Dr. Gottfried’s book, The Autoimmune Cure: Healing the Trauma and Other Triggers That Have Turned Your Body Against You Dr. Gottfried’s Discover Your ACE Score Test  For more on Dr. Sara Gottfried, follow her on Instagram, Facebook, Twitter, YouTube, and her website. This episode is brought to you by Fatty15, Our Place, Lumebox.  Fatty15 is offering an additional 15% off its 90-day subscription Starter Kit. Go to fatty15.com/dhru and use code DHRU to replenish your C15 levels for long-term health. Reduce your toxic load by starting with your cookware! Go to fromourplace.com and enter the promo code DHRU at checkout to get 10% off any order.   Lumebox is offering my community $260 off their FDA-registered portable Red Light device! That's over 40% off! Go to thelumebox.com/dhru and get your Red Light device. Learn more about your ad choices. Visit megaphone.fm/adchoices

Dr. Sarah Godfrey, welcome back to the podcast. You're here today to sound the alarm on a super important subject. You know, globally, you've shared with your audience that conservatively, we know that one in 10, that's 10%, or globally 800 plus million people, have a diagnosed autoimmune condition. And one of the things you're on a mission to talk about is that for those people and maybe some others, we'll get to that in a second, if we don't have an honest conversation about the role that trauma, lack of boundaries, both inside and outside the body, chronic stress, and this sort of toxic milieu that we're in, if we don't have an honest conversation of how those things are worsening and making it harder for people to heal,

we're not looking at a bright future ahead. I'd love for you to expand on that a little bit more if you could. Drew, it's so good to be back with you. Thank you for having me. And I would say that statistic that you just gave, 10% globally have autoimmune disease. The fact is it's much graver than that. So we think that people with autoimmune disease have about 7 to 14 years before they get diagnosed. And the sad fact here is that,

many people who've got autoimmune disease or autoimmunity, which is a pre-disease state, can struggle going to see four to six doctors before they get a correct diagnosis. They can go for years, sometimes up to seven years before they are correctly diagnosed. But I want to back up for a second to something that makes this relevant for so many more than just 10% of the population. We believe that post-pandemic, that the rates of autoimmunity, this pre-dise state, have dramatically increased. And we now know from laboratory testing that about 30% of us, healthy, you know, relatively normal people, 30% of us have positive anti-nuclear antibodies. So people need to know about this. You know, if you hear the word autoimmune disease and you think, oh, that doesn't apply to me.

The truth is, one in three of us are having a problem with autoimmunity, and we want to address it as early as possible. So this is one of those situations where functional medicine can make such a difference, and early testing can make such a difference. What are the early warning signs that somebody is on their way to getting an autoimmune disease? They may not be diagnosed today, but they have autoimmunity happening in the background. The problem is the early warning signs really vary. So there's more than 100 known autoimmune diseases, and there's a lot of conditions that aren't officially autoimmune disease, but they have autoimmune aspects to them. Things like long COVID, endometriosis, adenomyosis, even some forms of irritable bowel syndrome, fibromyalgia. So with these 100 plus autoimmune diseases, the symptoms really very very

depending on how the immune system is attacking your normal tissue. So if it's rheumatoid arthritis as an example or Hashimoto's thyroiditis, in those two situations, rheumatoid arthritis, you're attacking joints. Hashimoto's, you're attacking the thyroid. So it depends on where the immune system is targeted for attack. That's what manifests the symptoms. So with Hashimoto's, for instance, 13% of us have positive. of antibodies against the thyroid. And that can show up as hair loss, weight gain, having kind of

this fluctuation in your symptoms as you have flares of your immune system attacking the thyroid. You might have constipation. You might have issues with losing the outer third of your eyebrow. So Hashimoto's is one example of an autoimmune disease and the kind of early warning signs are these subtle, non-specific symptoms that often people. people don't realize could then map to a future autoimmune disease. What's going on today in our sort of traditional medical system that if 30% of people are suffering with an early autoimmunity, they may not have a diagnosed condition, but their body is dealing with this autoimmunity, which is your own body attacking itself, we're going

to talk about that in a second. What's going on in our current medical system that, people are not getting, you know, diagnoses or at least lab work back to them saying, hey, you don't have quote unquote diabetes yet, but you have pre-diabetes. You're on your way to getting an autoimmune condition. I love that she brought up pre-diabetes because that's a good example of a pre-dise state where somewhere around 80% of people don't know they have it. So in conventional medicine. What's going on is that it's a disease care state. It's disease care. And so they're not looking at prevention. They're not looking at, okay, what are some of the signs of autoimmunity? How do we measure that in a patient and then help them reverse it so that it doesn't become a full-fudged

autoimmune disease? So the problem is, at least in the United States, we've got an insurance system that's really organized around disease. It's not organized around health. If you switch the paradigm like you and I do, if you switch and focus on health, and I really like to define health as a state of balance, a state of homeostasis, where an organism like a human is able to manage the stressors and the other things that it experiences from the environment, and it's able to maintain equilibrium inside of the system, that state of homeostasis is the way that I like to define health. So what happens in the conventional medical system

is that we don't measure homeostasis. We measure typically blood markers based on symptoms that someone has. So someone has kind of vague symptoms, maybe related to the thyroid or their joints are dysfunctional, or they've got fatigue. They're, you know, they don't wake up in the morning feeling really energized. It's rare that a conventional physician will run an autoimmune panel to see if that's the source. Now, before we get into defining what autoimmunity is, I want to just first hint at the fact that in your book,

you talk about that there's a three-legged stool. There's not one thing that is directly responsible for somebody getting and ultimately being diagnosed with an autoimmune condition or having some background activity in their body of autoimmunity. It's a multitude of things. Can you just talk about those things just big picture? And then we'll get into what is autoimmunity. The three requirements for autoimmunity are first genetic predisposition. Can't do much about that. The second is increased intestinal permeability.

so-called leaky gut. And that's where the barrier between your gut and the food that you're eating is leaky. The third is a trigger. And the trigger really varies. So it could be getting infected with a virus. It could be getting infected with a bacteria. But it could also be toxic stress. It could be trauma. And so we know, for instance, in 80% of people with autoimmune disease, they experience a major trauma before the diagnosis. It's important to also mention that this three-legged stool is something that was discovered by Lesio Fasano at Massachusetts General Hospital. He is a pediatric gastroenterologist who first started to look at celiac, one of those hundred autoimmune diseases, and he found that you had to have this three-legged stool to develop celiac.

And then he looked at other autoimmune diseases. So even though they can affect different organisms, systems, all these 100 different autoimmune diseases, they have in common this three-legged stool. And so he's shown that with multiple autoimmune diseases. We're going to dive into each one of those three legs and talk about how the individuals listening today, how your lifestyle maps out to that, both for the positive and potentially also for lack of a better term than negative, but the negative that we can correct and address. Before we get into that, though, let's talk about how traditional medicine looks at autoimmunity

and how precision and functional medicine, which you're a functional medicine doctor, how they look at autoimmunity in terms of what's actually happening in the body. It's really night and day. So in conventional medicine, I'll give you a case example. I had a woman who was one of my yoga teachers back in the Bay Area. and she taught yoga, you know, one or two classes a day, and she started to notice that her elbows were becoming painful. And this occurred after a trauma that she experienced.

We can get into the details of that in a moment. But she was having this problem with her elbows, one elbow more than the other. And it almost felt like there was sandpaper in her elbow. That was the sense she had in the joint. And so she went to her nurse practitioner who ran a, couple of tests and found that a rheumatoid factor was elevated. So this is a blood test that shows that she's at greater risk of developing rheumatoid arthritis. So the nurse practitioner said,

I think you've got rheumatoid arthritis. Why don't I send you to a rheumatologist? This woman, who's pretty holistic, she's a yoga teacher, made an appointment. It took about eight months for her to get in with a rheumatologist. And in that time, she knew about my work. And she said, hey, could you help me with this while I'm waiting to see this guy that's, you know, eight months out. And so we started working together. And I think this illustrates the difference between conventional medicine and what we do in functional and precision medicine. So we ran a lot of tests beyond just a rheumatoid factor. She, from the nurse practitioner, she did have a high level of inflammation. Her high sensitivity, C-reactive protein was high. She also had an elevated

ESR, erythrocyte sedimentation rate. What I did was to look first at her gut, and we found in her gut by doing some stool testing that she had a lot of inflammation that was coming from her gut. Even though she ate what she thought was a pretty healthy diet, she had an imbalance between the good microbes and the not so good microbes. I think of them as kind of a predominance of Homer Simpson type of bacteria. And so we saw this level of dysbiosis, many of which were the type of bacteria that are associated with developing autoimmune disease. So we did gut rehab. We also looked at her hormones. We found that our cortisol was off. It was high at some points during the day too high and low at points during the day, especially first thing in the morning

when she felt fatigued. We also did some other testing looking at her cardiometabolic function and saw that there were some problems that we needed to address. So that's an example of what we do in precision medicine. We look at genetics. We look at biomarkers, especially in the blood, to figure out what we can optimize to create that state of homeostasis, to create equilibrium. in the body. So after a few months of the work that we did together, it was a basic

gut rehabilitation process as well as getting her hormones into balance using a combination of lifestyle medicine and also some supplements. She found that her pain was greatly reduced by about 90%. So it then comes time for her to go see the rheumatologist. She went and had an ultrasound first. And the ultrasoundographer told her that she saw a little bit of inflammation in her elbows, but not much and didn't think that she had rheumatoid arthritis. Now, technologists are not supposed to say this. They kind of, you know, it's sort of, they're not supposed to make any diagnoses or to explain what's going on, but this one, you know, was kind and wanted to offer her some information. She then went and saw the rheumatologist. The rheumatologist said,

glad to hear that you're feeling better, glad to hear that your symptoms are reduced by 90%, but you have rheumatoid arthritis. And here's the list of prescription medications that you should go on, all of which are designed to suppress the immune system. So that illustrates the difference between conventional medicine, which is, okay, you've got rheumatoid arthritis, you've got an autoimmune disease. Let's suppress your immune system with a pharmaceutical. versus precision and functional medicine, where we're looking at the whole organism.

We're looking at the systems of the body to try to determine, okay, if you've got a lot of inflammation and it's targeting your elbow and you've got this genetic predisposition, how do we adjust your lifestyle so that your genes and your environment can work together better? So she was happy with the 90% reduction. She did not want to take the methotrexate and the other medications that this rheumatologist was offering. And she's now relatively symptom-free without taking a single pharmaceutical. That's incredible. You know, you mentioned this three-legged stool of autoimmunity.

The first one you mentioned is a genetic predisposition. Humans have largely had, our genes don't change that frequently. It takes, you know, hundreds of thousands, if not millions, of years for probably our genes to change. So a lot of people are asking the same question that I'm asking myself today, which is what is going on in this world today that we're all living in that we're seeing an explosion of autoimmunity? It's a great question. So we don't have clear answers to this, but we've got some hypotheses. So I'll share those with you. And it's true, genes are relatively stable. Like they just haven't changed that much since the evolution that happened

on the Savannah. So over the past few decades, as the rate of anti-nuclear antibody has gone up in the population and the rates of other things like the thyroid antibodies going up in the population, genetics has not changed. What's changed is lifestyle. So food has changed. The way that we sleep, the amount of sleep debt that we have has changed, the amount of stress that we're encountering and navigating has dramatically changed, especially during the pandemic. And there's some other factors too related to the way that we communicate the use of cell phones. There's a number of different things in our environment that has changed the way that our genes talk to our body. So genetic expression has changed as a result of mostly lifestyle factors.

Is it also fair to say that one of the reasons that you wrote this book is you really want to highlight as part of our environment that the environment that many of us are living in, especially this modern world that women are living in as well. Men and women are living in too. There's something going on where it's incredibly stressful. And in some cases for people, they've gone through such bad traumas. and lived experiences, that it is increasing how frequently these autoimmune conditions are happening in the population. Is that correct? That's absolutely true. So we've seen from national surveys that are done by the American Psychological Association as an example, that the rates of stress have dramatically increased over the past decade. We know that women are more vulnerable than men.

Women experience more stress, and they experience more distressing type of stress, you know, where they feel like it's just harder to manage, hard to cope with. So the level of stress has definitely changed. And, you know, I was originally trained as an obstetrician gynecologist. So women's health is super important to me. And what's important to note here is that pretty much every autoimmune disease except one is more. common in women than men. So about four out of five people with autoimmune disease are women. Women deal with stressors differently than men do. And I think there are a lot of issues in our culture that lead to women suppressing the way that they are dealing with stress, and it leads to a greater

risk of developing autoimmunity. So one thing that I think is important to note is that very few of us are free of toxic stress. I mean, there's a lot that we can do to manage it. And frankly, I've spent a lifetime sort of learning how to do meditation and yoga and breath work and even psychedelic therapy as a way of managing some of the stress and trauma that I've experienced. But even the people who say that they haven't had trauma, they didn't have childhood trauma or adult trauma, there's also the risk of intergenerational trauma.

And, you know, that's something. that you can't really know a lot about, but I think of these as soul wounds that can get passed down. So even if you don't have an experience personally of trauma, you also want to be curious about your ancestors and what sort of trauma they experienced. You know, there's a fascinating section in the opening of your book where you talk about the relationship between fibromyalgia and individuals who have had high ACEs scores. Can you, explain what ACEs is for our audience that isn't familiar with it and the relationship between the two of those? Yeah, ACEs are such an important thing to understand. And I want for our listeners,

if you do nothing else today, I hope you will find out which your ACE score is. And we can even put a link in the show notes for how to calculate that score. So this is one of those tests that you don't want to score high on. You really want a zero. ACEs stand for adverse childhood experiences. And what's interesting about ACEs is that a score of one or higher is associated with a greater risk of more than 45 different chronic diseases. And some of them you might imagine, you know, if you have childhood trauma like your parents got divorced or you had an experience of physical abuse or emotional abuse or neglect or you had a parent or someone else in the household who had a substance use disorder, you might imagine that exposure to those things would increase your risk

of mental health concerns, depression, you know, disordered eating, anxiety. And they do. ACEs do increase your risk of mental health concerns. But what I'm interested in as a non-psychiatrist is all of the chronic diseases, physical health, downstream results that occur as a result of early childhood trauma. So the original study that was done looking at adverse childhood experiences was done in a really interesting population. It was a partnership between the Centers for Disease Control and Kaiser Permanente. So they looked at Kaiser Permanente members in San Diego. And these are mostly middle class folks. And they asked for the first time whether childhood adversity before age 18 was associated with health problems in middle age.

And that then began this whole study of ACEs and how it's associated with a greater risk of stroke, a greater risk of heart disease, a greater risk of autoimmune disease. So one of the places where it's really been demonstrated is with fibromyalgia. So for women, you know, women are much more likely to be diagnosed with fibromyalgia.

And we find that the rate of high adverse childhood experiences is very high in women who were diagnosed with fibromyalgia. You talk about a patient that you were working with in this section. I believe her name was Rada, is what you're writing inside the book. Yes. And I was wondering if you wouldn't mind sharing her experience and your experience as being her doctor. Rada is so special to me.

I'm going to get a little quieter here because she's just had such dramatic changes in her health over the time that we've worked together. So when we first started working together, she had a number of conditions. She had fibromyalgia. She had endometriosis and adenomyosis. She had a lot of fatigue. She had metabolic health problems. And I want to circle back to metabolic health a little bit later because ACEs are associated with higher glucose, more problems with prediabetes and diabetes.

But back to Rada, she had a toxic marriage. an abusive marriage. And when I first started to work with her, she had just come out of that marriage. She just divorced her now ex-husband. And she had a long list of things that didn't feel good in her body. She was in her 40s, nutritionist, mother of two. And she was really struggling with pain of all types. So adenomyosis is when you have the endometrial lining.

endometrial cells, which are supposed to be the lining inside the uterus, you have it in the muscle. And you can think of it as an autoimmune attack where the body is attacking your normal tissues inside the muscle wall of your uterus. Very painful. Very hard to manage the pain, very hard to control the increased bleeding that can happen as a result of it. I also have had adenomyosis, so I know a lot about this. She also had endometriosis. And so she went through a partial hysterectomy before she met me. And so she had fibromyalgia. She had these different pain syndromes. And we started to work on addressing her trauma and specifically trying to clear the trauma that she experienced in her marriage. She had a relatively happy childhood. Although when you pin her down and

you get her to do an ACE score, her ACE score was six, which is quite elevated. I have the same score. So with Rada, she is someone who developed these different, what I would call bottom-up regulation strategies to create safety in her body, yoga, meditation, chanting. She plays the harmonium. She became a musician, in addition to being a nutritionist. And she found that daily practice helped her resolve this trauma that was in her system, such that she no longer meets criteria for fibromyalgia. She no longer meets criteria for fibromyalgia,

and she no longer has adenomyosis or endometriosis. Wow, that's incredible. You know, zooming out for a second, I think a lot of people are wondering, why would the body start attacking itself? If autoimmunity is your body getting confused and attacking itself, what is the role of that when you know we've learned from folks that the genes that we have and the

cells that we have like all they want to do is survive and reproduce and live a happy life why would our body be attacking itself it's a great question i i wish that we had a rigorous scientific answer to that question again i've got some hypotheses and i can speculate a little bit with you. Yeah, please. One of the reasons why we think it's so much more common in women than men is that women go through these massive hormonal changes that men don't go through. So Rada, for example, had two children. When you get pregnant and you've got a fetus growing inside of you that has the DNA that's half from you and half from the person who donated the sperm, your immune system has to adapt to all of this DNA that is not yours.

That is a big task for the immune system. So the immune system mostly does a pretty good job with that as long as it's a healthy immune system and it's resilient. We have so many ways that the immune system can become dysfunctional and can start to get confused and can start to lose something called tolerance, which is where you're able to distinguish between your normal healthy tissue and foreign organisms or foreign tissue. And so the problem here is that the immune system gets out of balance. And specifically with autoimmunity, this is somewhat simplistic, but you can think of it as being an overactive immune system, where it loses tolerance. It's no longer able to distinguish normal healthy tissue from diseased tissue or fore.

urine tissue, and so it starts to attack normal tissue. So we see, for instance, one of the greatest risks that women have when they're postpartum is something called postpartum thyroiditis. It's where I often see women develop Hashimoto's thyroiditis, where you're attacking the thyroid and eventually you have low thyroid function. We see that postpartum. And so when I see a woman is postpartum who's complaining of fatigue and can't sleep and her hair is falling out and she just feels like her energy is not what it used to be and maybe she's somewhat constipated. The old version in traditional medicine is just to reassure that woman maybe gaslight her a little bit and say, oh, you've got a baby. Of course you're fatigued and you're stressed out and

your hair is falling out. No, let's check her for autoimmunity. Let's check her. Let's check her. panel of autoimmune thyroid antibodies. Let's see if she's got celiac. Let's see if she's got this condition where her immune system is out of whack. So why is this happening? We think that these massive hormonal changes that women experience are a key part of it. We also think that trauma is a big part of it and women are more vulnerable to the experience of trauma than men. We have rates of trauma that are about 10% higher than what we see in men. if you had to wait based on your clinical experience, and of course it's different for each patient,

but if you zoom out in sort of this world that we live in today, if you had to wait out of 100%, how much of our global autoimmunity issues from that three-legged stool is genetics, how much of it is the sort of, you know, diet, boundaries, intestinal permeability, and then how much of it are these triggers, which you said could be viral, right? Could be also trauma could play a role.

So if you had to weight them, is there a weight that you could give each one of those? It's hard to give a weight because you have to have all three to develop autoimmunity. So I think maybe part of what you're asking is how many of us have the genetic predisposition? Yeah, that's a great way to start. And we don't really know the numbers. So I would say if 30% of at least this lab population of 100,000 people, 30% of the positive anti-nuclear antibodies, then I would presume it's somewhere around 30%, maybe higher, has this genetic predisposition.

So I would start at 30% at a conservative level. And this is something that needs to be studied at the level of research investigation and published and peer-reviewed journals. but I would say at least 30%. And then this increased intestinal permeability, how many of us have that? I think you're asking a prevalence question. And what's interesting with increased intestinal permeability,

when I first started practicing functional medicine about 25 years ago, I was, you know, one of those young doctors who tested, I probably over-tested people. And I did a lot of testing for increased intestinal permeability. The test we did then was a lacteolist, Manitol test. That's still the gold standard. And I would find that, you know, maybe about half the patients that I tested had increased intestinal bermability. And now, that was 25 years ago. Now I hardly

ever test anyone because almost everyone I test does have leaky gut. Almost everyone. And I take care of executives. I take care of professional athletes. I take care of perimenopausal women. And I no longer run the test because it is so common that people have leaky gut. I've heard a few clinicians say that when you look at populations globally, especially when you look at poorer populations, let's say in Asia or Africa, and you look at the prevalence of autoimmunity, even though these individuals don't have all the resources and access to health care, etc. Their rates of autoimmunity are much less than these developed countries like America and the richer populations in those same continents like Asia, Africa. Is that true? And if that is true,

what can we learn from that? That is correct. So what we know is that in this, what we know is that autoimmunity is a disease of affluence. So when you look at, But why don't we take India as an example? So there's something called the hygiene hypothesis to try to explain why the rates of autoimmunity are lower in India than they are in the United States. We think that the exposure to, that the immune system of people in India, that it gets exposed to many more things than someone growing up in the United States. And you can maybe help me out with us in terms of what people are exposed to.

but when you look at the microbiome, for instance, of someone who lives in India versus someone who lives in the United States, chances are the diversity is higher. There's a level of health of the collective microbes in the gut and their DNA for someone in India versus someone in the United States. So we think that this emphasis that we have in affluent countries, this emphasis that we have on sanitation, keeping things cleaner, washing our hands, using hand sanitizer, that there's a way that we get less exposed to microbes as we grow up than someone who lives in India. But tell me what you think about this, because you've got some experience with this too. I visited India a lot growing up.

I've never permanently lived there. I wasn't born there. I was born in Nairobi, Kenya, but we left when I was pretty young. but definitely as a society and a lot of countries that have traveled to, especially when you go to the regions that are not as affluent, you don't see as much antibiotic exposure. They just don't have that there. And I went to go visit a tribe in northern Kenya with this group Summit series that I went to and they're cousins of the Maasai, the Samburu's. And when they go and they're milking their cows because they primarily live on a diet of milk from cows and goats. And that's pretty much it.

They eat some twigs, some berries here and there, but they pretty much live off of milk and then occasionally some blood, if anybody knows anything about the Maasai tribes and the Samburu. And they're living in these huts. They're exposed to dirt regularly. Their hands are dirty. They're touching animals, other things. They're probably getting some beneficial parasites, which some interesting research, you know, is going on, especially out of Israel, showing that reintroducing certain parasites could actually help calm certain autoimmune conditions.

Have you heard about this? I have. So, you know, I wouldn't say that I'm an expert at this particular area. But when you think about, when I think about how I grew up, you know, I'm in my 50s. So growing up in Maryland, I was in the dirt all the time. I would play every day after school with my first. friends and we would go for hours. We didn't have nannies. We didn't have babysitters. We just would

entertain ourselves and we were mostly in the dirt. I grew up on the Chesapeake Bay. I'd be climbing on rocks and fishing and grabbing and hands in the dirt all the time. I would wash my hands before dinner, but otherwise there wasn't a lot of sanitation that was happening. And I think about, you know, I'm the mother of two daughters and I think about how much dirt they got exposed to for so much dirt I got exposed to, and it's a massive difference. So there's a way, you know, I remember Michael Pollan had a cover story on the New York Times Magazine, maybe 15 years ago, about how kids are just not exposed to dirt the way that we once were. So soil has changed, and the amount of soil that we get dosed with, especially in childhood, has dramatically decreased.

So we think, you know, what does this mean in terms of the immune system? It means to your immune system is not used to dealing with these microbes, microbes that are in the soil, parasites, as you mentioned, where our immune system has this kind of more limited dynamic range compared to 25, 30, 50 years ago. And that's less true in some countries. So is it fair to say that our immune system is fragile in a way, in many developed nations, between a combination of many of these things that you mentioned. And is part of that also that our bodies are less metabolically healthy, as you indicated earlier? And what's playing into that component? There's a number of threads that play into that component. I think the, you know, if we just look at metabolic health for a moment

separate from our discussion of autoimmunity, we know that 80% of Americans are, you know that 80% of are metabolically unhealthy. That's pretty high. So the 12% who are metabolically healthy, that number has been declining over time. So how do you define metabolic health? You can define it based on the criteria for metabolic syndrome, you know, looking at things like fasting blood sugar, looking at triglycerides, looking at blood pressure. And so we know that the number of people in the United States who have,

have at least one criteria for metabolic syndrome has dramatically increased over time. University of North Carolina now says 80% of us are metabolically and healthy. So why is that? We think it's a combination of a number of different things. Certainly our food supply has changed, and that's probably a whole podcast in itself. The amount of ultra-processed foods that we're eating, foods that are triggering our immune system and not a positive way. and we also, you know, we're eating more refined carbohydrates than ever before.

So the inputs, the kind of food that we're eating has changed, and that certainly tracks with our metabolic health going down. We also are more sedentary than ever before. It's amazing to me when you look at how many people exercise, you know, intentionally get exercise outside of maybe walking that they do at work and at home, the numbers are really small in terms of people who regularly exercise. And the standard that we have in the United States is to exercise for 150 minutes per week. And I think that's abysmal.

Like it's a reasonable starting place, but I think the body actually needs much more than that. And then we've got this issue with sleep, where we've got more sleep debt than ever before. We've got these high stress levels. So the same sort of factors that also lead to. to arise in autoimmunity also lead to arise in being metabolically unhealthy. And separate from that, we know that for people who have an elevated ACE score, so an adverse childhood experience score of one or greater, have a greater risk of developing prediabetes and diabetes. We also know that it changes the way that the body resolves inflammation. So you're more, you're more,

likely to have chronic inflammation if you're someone who had adverse childhood experiences. So our environment has dramatically changed. Our genes have not changed much, but the way that our environment has changed has increased our risk of, well, the top 10 conditions that are associated with death in the United States. Out of those, nine of them are related to metabolic health, from cardiovascular disease to Alzheimer's disease. And the same is true with autoimmunity. The way that our environment has changed has increased our risk of autoimmunity.

Let's talk about leaky gut because we kind of touched on it, but we didn't go deep on it. Help our audience understand. If you have autoimmunity or if you're diagnosed with an autoimmune condition, which that was the, you know, 10% of the population globally,

then you have to have leaky gut or you most likely have leaky gut. Is there ever autoimmunity without leaky gut? So Alessio Fasana would say no. You have to have leaky gut to develop autoimmune disease. You have to have all three legs of the three-legged stool. So, and I would add to that in my 30 years of medical practice, I've never seen someone with autoimmune disease who doesn't have leaky gut. And when we're talking about leaky gut, you know, the idea here is that the tight junctions between the cells of your gastrointestinal tract are not able to filter the way that they're supposed to.

So there's this leakiness between cells. And it leads to things from the food that you're eating and also parasites and bacteria passing through that barrier that you're supposed to have in the gut. So this is one of those examples of a boundary that gets violated and leads to a greater risk of autoimmune disease. So when it comes to leaky gut, you know, I take care of an NBA team and I was amazed to discover that even these guys that play professional basketball and are, you know, physically majestic. because they train so hard during the season, they do about two to three hours of hard exercise each day, they have increased intestinal permeability. So this is not just people who are sick with autoimmune disease. Healthy individuals often will have increased intestinal permeability too.

When you look at your patients that don't have any autoimmunity happening or previously had it, and their gut is strong. What are those individuals doing? It's such a good question. So this is maybe like 10 patients that I've seen. It's a tiny minority. So what are they doing? They are aware of what they need personally

to optimize a state of balance, a state of equilibrium in their body. You know, some people won the genetic lottery and it's easier for some of those folks to avoid and prevent autoimmunity, but those people often don't come to see me as a patient. So for the patients that I've seen who do not have autoimmunity, do not have leaky gut, have a stellar set of genetics and a lower risk of chronic disease,

often they're taking care of their gut, they're taking care of their food, they're really consistent with how they eat. They don't drink much, and that's an important topic of conversation when it comes to leaky gut. And they're also managing their stress levels and the main hormone associated with stress, cortisol. They're able to, you know, kind of develop what I think of as witness, like an ability to witness the stress that they're experiencing. rather than getting caught up in it, which has been my story for most of my life. Like a lot of the work that I've done has been to try to witness the stress more,

have a little distance from it, instead of just being subject to the, you know, the blows that come your way. Would you mind us talking a little bit more about that? Sure. Of course. And I'll hand it over to you to start us anywhere you want to. Well, one thing I want to say is that most doctors don't talk. about themselves. We're sort of indoctrinated as we go through medical training not to do that. And I think that that leads to missing an important opportunity because I find that the patients

that I talk to when it's appropriate and I share some of my story, it creates a relatability and an accessibility that I think is really critical. Because I don't want people to think that, you know, I'm some pinnacle of health because I sometimes joke that I've had every hormone imbalance that a woman can possibly have. And, you know, what, one of the reasons why I got interested in the topic of autoimmunity is that I tested myself as part of a functional medicine laboratory panel about six years ago. And I was positive for anti-nuclear antibodies. And it wasn't just a little bit positive, it was high. And so that got me curious about autoimmunity. I didn't have any autoimmune symptoms at that time, but being one of the 30% of the population that has positive

anti-nuclear antibodies and being a functional medicine physician, I got really curious about this. And so as I started to look at increased intestinal permeability, you know, out of that three-legged stool, the genetic predisposition, the increased intestinal permeability, and the trigger, you have agency over two of those, right? You can fix the leaky gut. There's a number of ways to do that, and you can also address the trigger. So for me, at that time, I had a big fight with someone of my family. So I had a conflict with someone that I really love and have been so close to all of my life. And this was heartbreaking. And I felt like the root of this conflict that I had with this person was childhood trauma. And the thing about childhood trauma is that even if you feel like,

you know, you don't have any mental health concerns or even any physical health concerns that could link back to trauma, there are sometimes ways that you might have a blind spot about the way it affects your behavior. And I felt like that might be true in this conflict with my family member. And it was right around the same time that MAPS was looking at MDMA for the resolution of trauma and people with post-traumatic stress disorder. Now, I haven't had post-traumatic stress disorder, but I've had partial PTSD. So I have an adverse childhood experiences score of six, which is pretty high. And as I started to look at this data on MDMA assisted therapy for trauma, I was blown away by how effective it is. So Drew, when I looked at the literature on talk therapy and kind of

the gold standard of how we treat trauma in the United States, I was blown away at how ineffective it is. So the effectiveness of talk therapy is about 30% for the resolution of PTSD. And then in the U.S., the FDA has also approved three different selective serotonin re-updic inhibitors for the treatment of PTSD. And so people with PTSD often get a combination of talk therapy and an SSRI. And sometimes they get trauma-informed care. Increasingly, there's awareness of this, but that's not always been the case. The efficacy is about 30%.

So if I was told when I entered psychotherapy and my doctorate, be in my 20s when I had my first episode of depression when I was an intern at the University of California, San Francisco. If I was told that the efficacy was 30%, that it would help me resolve the trauma behind my depression, I don't know that I would have done it. Now, the efficacy of MDMA assisted therapy is around 67 to 71% for the absolute resolution of trauma. And that's with two to three treatments, not daily treatment, two to three treatments with preparation and integration afterwards. So I don't want to get too far off topic, but what I started to do as I saw these papers that were published showing this massive, you know, double the effectiveness with MDMA's

therapy for trauma. I decided to try it myself. And to do everything I could to clean up my side of the street in this conflict with my family member. And I found it revolutionary. So it was so helpful for me to resolve trauma, to resolve that A score of six and the way the signature of that A score was living on in my body, I was able to repair with this family member. I was able to change some longstanding behaviors that were working against me in terms of my health. And what was especially exciting to me is that my anti-nuclear antibody went to zero. It became normal. Now, that's anecdotal information, but one of the things we do in precision medicine is N of one experiments. And I was even taught at Harvard that when you look at the quality of evidence

of research, the lowest quality is expert opinion. Next up is case studies. Next step is observational studies like the nurse's health study. Next step is randomized control trials. But that's usually looking at a drug and its effect on a population. I was taught that the highest quality evidence is the end of one experiment, where you take someone and you have a control period maybe before they come to see you as a patient, and you look at their laboratory tests, like in my case of positive antinuclear antibody. You do an intervention, in this case, some gut rehab together with MDMA-assistotherapy,

and then you retest this anti-nuclear antibody, in my case being zero. So N of one experimentation, I think, is really important. And when I saw this positive anti-nuclear antibody, and I was linking it to my own trauma, I then started to look at my patients, and I've got a lot of autoimmune patients that I take care of. And I would start to ask them, what is your ACE score? How much trauma have you experienced? And I found that the vast majority, certainly more than 80%, had high ACE scores. They had a high level of trauma that was embedded in their bodies.

And as we started to resolve the trauma, I noticed that their chronic disease would start to reverse. So this is the kind of thing where I took it from my own experience. which I really believe that the kind of conditions that I've struggled with are happening for me, not to me. They happen for me to get me to look at what's going on in our culture and how that's reflected in our medical sphere and to start to think differently about how we can address it. That's so incredibly powerful. And I appreciate you being vulnerable and sharing your journey.

would you say that for other people that are listening and you've mentioned women but of course men and women listening that they should be at least reading looking into i mean you have a whole chapter in your book i think it's titled everything you wanted to know about psychedelics and you break it all down that it's worthwhile that if you're dealing with some elevated autoimmunity leaky gut or maybe you even have a diagnosis and you're listening to the Hashimoto's, Graves Disease, whatever it might be, fibromyalgia, that it's worth at least looking into MDMA and seeing if that's a route of something that you might want to pursue. It's worth considering it with some caveats. So what I think is transformational is healing states of consciousness. And I wouldn't say that psychedelics are required

to create a healing state of consciousness. They're one tool in the dual walks. They're one tool. And so, you know, what I found as I was writing this book, I started to do holotropic breathwork, which is considered psychedelic. It was developed by Stan Groff, who's one of those psychedelic pioneers.

He lives near me in Mill Valley, California. And holotropic breathwork is a particular way of breathing. I talk about it quite a bit in the book that creates a huge, healing state of consciousness. It gets you kind of outside of your daily consciousness that might be managing a lot and struggling with toxic stress into a healing state of consciousness where you're using your breath to create the medicine that your body needs. And that's very powerful. So some people have psychedelic experiences with breathwork alone. And I would say for people who are cautious about

psychedelics who think that maybe they're overhyped right now and they are, there are many ways that you can create healing states of consciousness. There's a lot of different paths to transformation. Psychedelics have robust data behind them, and it's not just MDMA. There's other psychedelic medicines that I talk about in the book. So I'm certified with psilocybin, with MDMA, with ketamine, and those are the ones that I have the most experience with. But there's also San Pedro, Iowasca, 5MEO, DMT. There's lots of different things that can create these healing states of consciousness. But you can also do it with these systems of the body, such as the breath.

Is one way to look at it and correct me where I'm wrong, please, you're the expert in this area, is one way to look at it that if you're somebody who's gone through a lot of traumatic experiences. And again, look at the ACE's questionnaire, do the ACE's questionnaire because even things like having a parent who is addicted to alcohol, right? That flags in there. And a lot of people say, well, I don't really remember that. I don't think it affected me, but it has its impact. Yes. So if you're somebody that has scored or is scoring high on these ACEs questionnaire, you've gone through a lot of childhood trauma, maybe even adult trauma that's there, still going through some stuff, that the idea and concept is,

that your body is constantly in a state where it's on edge. And because it's on edge, in the background there may be, you know, high blood sugar, cortisol levels, et cetera. But whatever is going on in the body, your body is essentially already attacking itself because it's constantly on edge. And you never really get a chance to enter into a space

of just feeling like you can rest and not be on edge. And when you go through some of these consciousness altering states and you can actually get some perspective on your life and in a way sort of re-parent yourself, re-understand, remind your body and your nervous system that you're not on edge, that a huge part of the healing process is that you're simply not wasting so much resources, constantly worried about the next thing that's going to attack you. Is that the idea? That's a very wise summary of what's happening. And I would even say that being constantly on edge is something that I see in 95% of my patients, 95%. And the way I would describe it from a medical perspective is dysregulation. So regulation,

most people have experienced at some point in their lives, you know, they have a feeling of, oh, I feel so relaxed. I feel like I'm restoring. I feel like I've got a lot of resilience. Like you have these moments of feeling regulated. And there are specific ways that you can activate that, such as with breathwork, such as with yoga, such as with orgasm. There's lots of ways that you can regulate yourself. But I think so many, so many, Many of us spend our lives in a state of dysregulation. And there's lots of different ways that you can define it. You can look at, for instance, the stress response system.

The sympathetic nervous system, kind of the on button of your autonomic nervous system and how it's in balance or not imbalance with your parasympathetic nervous system, which is the stay in play part of your autonomic nervous system. we're meant to go back and forth between that on button, fight, flight, freeze, fawn, and the off button, which is that stay and play, rest and digest, feed and breed. And a lot of us have parasympathetic dysregulation. We're not able to get into a healing state. We're not able to get into the parasympathetic branch of the autonomic nervous system,

which is where all of the healing happens. So we've got sympathetic overdrive. We feel stressed. We're like rushing around in traffic or anxious about deadlines and other things that are happening. Maybe you're going through a divorce or some work stress. So we spend too much time in this sympathetic overdrive. And so a big part of what I think you're putting your finger on is that we have to consciously create these. healing states. You would think from the name of autonomic nervous system that it would happen automatically, that your body would restore itself. You know, maybe when you sleep, fingers crossed, and that's not the way it works. You have to actively do it. You have to create these states

of healing where the parasympathetic system is dominating. And what I find especially with women, with women who are high achieving and maybe had a history of some drama in childhood that drives them to be perfectionistic or overachieving or even people pleasing. What I find is that it's especially hard for them to create regulation. And I was even thinking about this. There's a meme that I saw on Instagram where it was something like, did you grow up seeing a woman who was relaxed? Like, did you have the experience of seeing a woman who knew how to restore her physiology?

Did you grow up with a woman who knew how to create resilience and felt relaxed? And I saw that meme, and I was like, oh, man, I had no models of that when I was growing up. My mother was a total stress case. She was chronically overwhelmed. She was working full time three kids. my grandmother, also really stressed. The only person I grew up with who was relaxed and knew how to restore was an aunt that I had, who loved fitness.

She was a belly dancer. She, like, was really embodied. She was pretty much the only woman I knew who was really embodied. And that's what we're talking about here. There's the way that we are sort of, as you said, on edge and kind of chasing these things. things that we never quite get to. And it leads to this physiological dysregulation in the body. And depending on your vulnerability, that could show up as psychological issues. It could show up as immune system problems. It could show up as nervous system dysregulation. Or it could show up as

endocrine dysfunction. So that whole thing is the Pine Network. And that's what's especially vulnerable to being on edge to having this level of dysregulation. You know, it feels like a big part of this new book, the autoimmune cure. We have the link in the show notes below. Please check it out. Is that for a long time in functional integrative medicine, there was definitely an awareness of leaky gut

and the role that especially food and environmental toxins and pesticides and glyphosate and over exposure to antibiotics, there's been awareness now for five, 10, 15 years of the role that those things play in. But we haven't given as much attention into these areas of trauma, the chronic stress that people are in. So while some people do seem to get better by just focusing on the dietary component alone, these days, more patients that you, you're seeing, and a lot of other people are seeing too that I'm hearing, that's not enough. It's not enough to just focus on the food component, although the food component is important.

You really have to look at the entire nervous system, which then goes into understanding the traumas that have kept it wired the way that it is and is causing in many cases disease. Is that accurate? That's accurate. I, you know, what I see with a lot of patients, I get the patients who maybe went to another functional medicine doctor and saw them for a while and took two steps forward and one step back and they just weren't satisfied overall and then they end up in my office. And what I often find isn't addressed is some of these deeper issues.

So taking a good trauma history, understanding in every patient with their ACE scores, is and what it was like to be a kid. You know, it's not just what's your A score. Okay, why don't you head out the door now? It's what was your experience growing up? Were you seen? Were you heard? Were you told to not say anything unless you had something nice to say?

Were you valued? Did your opinion matter? Did you have an adult who was empathic? maybe you had an experience of being bullied. Did you have adults who supported you through that? So there's a lot of mitigating factors, for instance, even with A scores. But there's a way that this can be something that is unaddressed because it doesn't show up on a laboratory test.

And when it's unaddressed, I find that people are not able to heal completely. So I think it's a piece that's really critical to address and to have conversations about. And, you know, I also have seen that what works for some people doesn't work for other people. And so there's a personalization that needs to happen. This is where end of one experiments can be so helpful. I've got some people who've got an experience of trauma. They do EMDR, and that resolves the trauma signature in their body.

Amazing. That worked for them. I tried EMDR for a year and a half, and it had no effect on me. So this is where personalization and end-of-one experiments become so critical. You know, one of the things you're a big fan of is using tools to get a sense of where you are, especially where your nervous system is. Why are you such a big fan and what are some of those tools that are available to people? I love your question, Drew.

So the reason why I'm such a big fan is that I feel like so many of us are not embodied and have a hard time assessing what's going on like from the neck down. So I was raised to be hypercognitive. I was raised to the way that I achieved love and attention was through intelligence. So cognition was a big part of how I was. I coped with the trauma that I experienced. And I think that's true for a lot of people, became hyper-independent and hyper-cognitive.

So what I love about tools like wearables is that it provides objective data about your physiology. And I remember I saw a functional medicine doctor maybe 10 years ago who was asking me questions and then ran all these labs. We were doing gut rehab together. And she said, you know, I think you're just a terrible historian. You're one of those warriors who just ignores what's happening in your body. And so you can't really report what's going on in your body. And I thought she was absolutely right. Because when you go

through medical training, and I think this is true, you know, certainly for people who are not doctors, too, you learn to ignore your body. You don't go to the bathroom when you need to. You don't eat when you need to. You don't sleep when you need to. Medicine is basically a cult. And it can be traumatizing such that you are validated for your ability to be hypercognitive and to ignore your body. Makes you a better doctor, maybe. So I think wearables cut through that. And what I find, for instance, is that when I look at the balance between my sympathetic nervous system, fight-flight freeze, spawn, and my parasympathetic nervous system stay in play.

by measuring the heart rate variability, that gives me a really important indicator of my stress response system. And I can tell you, every time I go to Costa Rica, my heart rate variability is about double what it is in my everyday life. Which is a good thing for those that are listening.

It's a good thing. You know, when I microdose on mushrooms, my HRV goes up somewhere around 50 to 100%. When I drink a shot of tequila, it goes down by about half. So you do these little N of one experiments, and wearables can be so helpful to provide that kind of objective information, especially if you struggle with sleep,

if you have a sense that there might be some dysregulation in your body, wearables can be so informative and kind of provide the subjective information as you develop more body awareness, as you develop more embodiment. because most people with trauma are not very good at sensing what's going on in their body because it wasn't safe to do that maybe as a kid or if they had the experience of trauma as an adult. Just like you were talking about, it's a badge of honor for doctors to not honor how they feel and the medical system relies on them because there's so many sick people to be able to have to

attend to and they make a lot of sacrifices in that same way. somebody who's gone through a lot when they were younger, they also know that it's not safe to feel how you feel because it's a survival component. You have to just stuff it all down just to make sure you can get through the day and be on edge for the next thing that may or may not happen. That's really the critical question. You raised the crux of this, Drew, which is, are you in survival mode? And what I find is that the majority of of my patients are in survival mode. Now, they may be high achieving.

They may have these beautiful families and luxurious vacations. And yet there's still the little girl who is trying to survive in a volatile family. There's still this imprint in their physiology that needs to be addressed. So just to close the loop on the wearables, have you found a favorite one for H. H-RV. Obviously, there's a bunch of them that are out there, whoop or there's even ones that are specifically just focused on HRV. I think Apollo is one of them. Is there one that you like the most? I've tried pretty much all of them. I started with chest straps maybe 10, 15 years ago, and I used to use it to figure out how hard I could work out that day.

Those polar sensors? The polar sensors. So I used to do that with sweet beats. I don't know if they're still around, but test straps are still the most accurate, especially for kind of real-time measurement of HRV. So I like those. Out of all of the ones that I've tried, I really like ORA. It's the easiest. It's really easy.

There's something about the electrodes kind of going along this line to the heart that I think creates a lot of accuracy with heart rate variability. And I found the whoop to be less helpful. I found the Apple Watch to be less accurate. I also like the Garmin. I use that occasionally too. So I would say, ORA and Garmin are my two favorites.

So if somebody were to try that or they have it right now, and maybe they're only looking at the sleep score and the readiness score, what are some simple steps that they could take today? Is it like, hey, you know, after the day is done, go back and look at your HRV. Where were the times where it dropped down? Where were the times that it was actually good

and track and kind of keep a little bit of a journey? of some of your behaviors, the conversations, the things that you were having, is there sort of an audit that you have your patients do? There is. I mean, what I do in precision medicine is I take the data output from my patients and I run it through an aggregator that looks at things like HRV, deep sleep, daytime stress. So then we can superimpose what's happening in their life to see when are they in a more

optimal state versus not. So you can do it that way, which requires a little more technology, or you can do it more, you know, kind of off the cuff the way that you're describing. Both, I think, are very helpful. You know, one of the things I encourage people to do if they drink is to do a drinking experiment. So one of the things we know about alcohol, which has pretty much no beneficial health effects. It's a social component, I guess, if you're saying outside of the body. Well, even that, I would say there's better sacred medicines to take than alcohol. So, you know, what we know is that in animal studies, looking at leaky gut,

the way that you can the most consistently create leaky gut is to give animals alcohol. So it causes leaky gut. It causes one of those three legs of the three-legged stool. So if you just look at your consumption of alcohol, maybe you've got two days a week where you drink, look at your metrics from your favorite wearable, look at your heart rate variability, the night that you drink versus the night that you don't drink. And that'll give you a lot of information. So that's where I typically have people start. And, you know, the other thing you can look at is travel. So every time you get on an airplane, it has like a triple the demand on your adrenal glands.

And some people do well with that. But some people can't meet that demand. Their adrenals are just, you know, kind of barely making it. And they can't quite deal with the stress of travel. So the way travel shows up in terms of your physiology can be really helpful. And you're not advocating that we put ourselves in a bubble and avoid these things. What I'm hearing you say and what you write about in the book, is be aware of these different triggers, which by the way, these triggers can be food,

they could be people, that could be situations, they could even be too much of something that's good a little bit, but you overdo it. And then make sure you understand these triggers, and it's an ongoing thing, and then have the opportunity to, in some cases, limit or minimize their exposure or in other instances have the restorative things in your life that counteract their influence. So if somebody has to travel for work and they're used to sort of scheduling their meetings back to back, they land, they immediately hop on a phone call, you know, what could be something that they could do if they have to fly that could potentially significantly improve their HRV that doesn't have to have them maybe fully quitting their job just yet? Right. Well, great question. And I used to travel about 80% of the time when I was the chief medical officer of a health tech company. So I'm very familiar with these experiments. And what I found was that if I was flying, you know, overseas and I was drinking and then I was arriving at my destination and maybe going out for a meal with the business people that I was meeting and drinking more.

I had the lowest HRV of my life in those situations. I mean, scraping the bottom of the barrel, like somewhere around 10 to 15, terrible. Once I started to realize that this was going on in my physiology, that it was creating so much dysregulation, I would do the same travel, but I would not drink, and I would sleep on the plane, and I would do meditations. I happen to like Joe dispenses, meditations. with them right now. He's great. Right? Like theta waves. So I would meditate on the plane. I would

arrive at my destination and go straight to the gym, regardless of what time I arrived. And I would do something, weightlifting, get on the elliptical, do the treadmill. And if it was daytime and it was a safe place, I would be outside. I'd go out in nature and walk. And I found that that alone would dramatically change my heart rate variability. So that's an example of something that you can do differently. Now, just change one thing at a time and see how your physiology responds to it. And this, once again, is this is an N of one experiment. So N of one experiments can sound kind of daunting, but the truth is we do them all the time. We're doing them anyway. We just want people to even better. We aren't calling them that. But it's the way that I want people to think. It's the way that you can do

precision medicine in your own life and find out what works the best for you. Incredible. So we talked a little bit about psychedelics and the toolbox that are there and the bigger conversation of even things that can alter the consciousness, the nervous system that can have a psychedelic-like effect, but that don't have to be traditional psychedelics, like holotropic breathing, chanting in a lot of cultures and individuals do that. in your book you have a whole list of them the orgasmic you know meditations yes home yeah home so there's a whole list of those then we talked about the first step for HRV and the nervous system is actually

getting a little bit of an audit if you can you know save up a little bit splurge get an aura ring or something to help you better connect the interception inside the body yes yes the awareness of how you feel with your consciousness around it. The better you get at that, the better you can navigate what to do and you'll catch these situations early. Most of us actually don't know. We don't know that we're stressed

until you completely hit your breaking point, but you started getting stressed maybe a few hours earlier, right? We talked a little bit about leaky gut, but do you want to touch on the topic of diet? Sure, yes. And we've talked about it previously, and I'll say that

high level, our audience is probably pretty aware about the big picture themes, eating cleaner, minimizing exposure to environmental toxicants that are there, potentially taking on an elimination diet, which is a big part of what you talk about inside the book. But for people that have that sort of integrative functional awareness level one, is there anything additional that you want to add about diet? It's important to revisit an elimination diet. What I find with a lot of folks is that they say they've tried an elimination diet and it didn't make a difference. And what I find with further questioning is that they haven't done it sufficiently. So an elimination diet that's well orchestrated and you've got a high level of compliance and you do it for six to 12 weeks,

it significantly improves leaky gut and it also improves dysbiosis. So it's a place where I want people to have a lot of agency. And one of the cool things about it is that it's free. And it's been studied for decades in different autoimmune conditions, such as rheumatoid arthritis. So when I used to practice functional medicine and I was working at San Francisco General Hospital where the population has no disposable income, I would find that elimination diets were really effective. And probably the two that are the most important foods to eliminate are foods with gluten and foods with dairy. Those are the most common to be triggering the immune system.

So you could start as simple as that. With autoimmune disease, we often eliminate night shades because we think that triggers the immune system in a negative way. So you could consider that to tomatoes, peppers, potatoes. So I think elimination diet is really critical to reconsider. And if you did one a few years ago and it didn't make much of a difference, try it again. And do it in a way where you're really committed to it and you don't cheat. It's one of those things that you can't cheat. It just doesn't work if you cheat.

It's a way to create what I think of as a blank canvas with your body where you eliminate the foods that are most likely to be triggering your immune system. You have a period of time off of them. And then you slowly add them back. So you slowly add back maybe dairy. And you try that for four days. Maybe you're trying yogurt or something like that. And you're really noticing your response.

And you do that for four days, adding nothing else that's been eliminated until you finish that four days. And then you add back maybe tomatoes if you're off of nightshades. So that's an example of how I walk people through an elimination diet that's in the book. The other piece that's important to mention is that while elimination diet, it helps, helps with leaky gut, there are also supplements that can really make a difference like L-glutamine, aloevara. There's some that are less studied, but I would say L-glutamine is probably what's been studied the most.

Anecdotally, I feel that a lot of my friends, peers that were dealing with some degree of background autoimmunity, maybe not a full-on diagnosis, but they had some labs done, their antibodies were higher, other things like that. as we've gotten more into the world of fitness in this space of functional medicine, longevity, everybody's talking about, you know, preserving and building your lean muscle mass. I feel like anecdotally I'm hearing from a lot of people that just by getting more serious about working out, building lean muscle mass and having a regular workout routine. And these weren't people that were inactive.

They just weren't making this a priority, especially resistance training. Anecdotally, I've been hearing from a lot of people that feel that their background autoimmunity has quieted greatly. Have you noticed that or heard that at all out there in the world? I have seen this. So I'm really curious about it. I don't know what the mechanism is. But what I've seen in my own body is that strength, training, getting really committed to it, understanding that muscle is the organ of longevity,

the organ of health span. There's something about weightlifting that is incredibly regulating. So I'm someone who's been a certified yoga teacher for 25 years. I know how to regulate my body. And when I started doing heavy weight lifting a couple of years ago, I was blown away at how it's developed my interoception, that ability to sense what's going on in my body, and how regulating it is. And frankly, I'm kind of shocked at how effective it is. But what about you? What have you noticed in terms of regulation with strength training?

I'd never had any autoimmunity that's been going on. I've never been diagnosed with anything. I can just say that as somebody who didn't really, I was very active. I played soccer. I played tennis, these other things. But when I got serious when I turned 40 about working with a trainer and being on a specific program and eating the appropriate amount of protein, I just noticed for my mental health, there was this, I already felt pretty good and I feel like I'm one of the calmest, happiest people

I know. True. I feel like there was just this extra level of focus and alertness. And I just felt good. I'm impacted by a lot of things. I'll have stressful days, but it was just a lot less stressful. And I feel like there's a sense of resilience that comes in. And if so much of autoimmunity is this background sort of, you know, trauma and stress that people are carrying with them, I feel like doing a tough workout, not overworking out.

That's not what we're talking about here. But doing a tough workout, a tough resistance training workout, is that reminder to your body is just what I've seen for my friends that have had the autoimmunity. It's the reminder of your body that like you're strong and you can get through a lot of things and you're okay. So whether that's playing a role, whether it's something else biologically, I don't know, but I've seen that. And what the impact of that is, I've seen people that had to be so strict about gluten and other things. They didn't have celiac, but they would get these little flare-ups. I've seen people be able to expand their diets a little bit more. They don't have to be as strict.

It doesn't mean that they're maybe eating gluten, dairy, or some of their other triggers every single day, but a little bit here and there. And they're not as impacted. And strength training was the biggest component that they added into the mix. So it's just something that I'm noticing, which is why I wanted to ask you about it. Yeah, I think there's something to this, Drew. I haven't seen any research on it because it's actually difficult to study. I can imagine.

But what I would say is that what I've noticed, you know, I always go first to what I've seen in my own physiology because my time series with wearables goes back about 15 years. Incredible. You were way out of the curve. Well, I just, well, I'm a bioengineer. I'm a total geek. So I did them early on. But one of the things I've noticed, for instance, is that when I switch from being on the Peloton and doing more. my, you know, spin classes, five, six days a week for 45 minutes to an hour. I used to love power zone training with Matt Wilpers. And I did that primarily. I didn't do a lot of weightlifting. And then I did a fellowship, a certification with Mark Houston in cardiometabolic health.

And he taught me that for your heart and for your cardiometabolic system and for your brain health, you really need to do two-thirds strength training and one. one-third cardio. And at the time, I was doing mostly cardio. So I switched. I started to do a lot more strength training. And I was shocked that what happened was my lean body mass increased. My resting heart rate at night went from about low 60s to low 50s. That was shocking to me that strength training brought my resting heart rate down. I mean, there was another thing that happened to, which is I went through a divorce. And I think that probably has something to do with the love regulation that I now have. But even so, I really feel like there's something about strength

training. There's something about how it allows us to really come home inside our body and to really, you know, have a sense like when you're doing a squat of your right side versus your left side and what's going on in your hips and how is your labrum functioning and what's going on in your hamstrings. There's a way that you develop this self-awareness that is pretty deep. And I'm not sure how that maps to maybe a reduced risk of autoimmunity. But what I often see in people with autoimmunity is that they've got this level of physiological dysregulation.

And so once they start to understand and then kind of pull these threads to create regulation in their body, in one way is strength training, I think it makes a difference. Incredible. So we've touched on a lot of key pillars. And as we're winding down here for today's interview, just want to make sure if there's anything else we've missed. We've talked about the dietary component. We've talked about the rule that leaky gut plays.

On the three-legged stool, we talked about the genetic piece. Do you think that people should be screened, or is it worthwhile to get screened for, do you have a genetic predisposition to autoimmunity? I think it's worthwhile to know your genetic blueprint. Is there a favorite test of yours that's out there? Yes. So I've been doing genetic testing for about 15, 20 years. In fact, I ran my first test in medical school when I was, you know, this was 1989. And genetic tests have really come a long way. But we also, you know, with the human genome project, I was really hoping that it would transform medicine. And I would say the party never really happened. So there's one test that I think stands out in terms of doing pathway-based. genomics and looking at 157 different gene variations and how that relates to functional

health, and that's the 3x4. 3x4. 3x4. So 3x4 genomics, I think, is an outstanding test, and I highly recommend that. Fantastic. Another tool that's in the toolbox for folks. So we've talked about the genetics. We've talked about diet.

You know, everybody should be encouraged to minimize environmental talk. get a filter at home, protect your body from all these PFAs and all other things that are floating around that are out there, do your best eat, clean food, stay away from ultra-processed food, or at least minimize their exposure inside of your diet. We talked about the nervous system, strength training, the list of psychedelic and psychedelic-like tools that are out there. Is there anything else that we missed in this conversation about autoimmunity and doing the best job that we can to catch it early and bring our body back into regulation.

And for some people who already have it and a diagnosis potentially have an opportunity at least reduce their symptoms or maybe show up, knock on wood, if they find the right clinician, no evidence of disease. There's a few other pieces that I think are important. The first is relationship. You know, one of the things I've learned, and it makes me sad that it took so long for me to learn this, is that love is really the most important thing when it comes to the purpose of life. And I don't want to, you know, I sound a little polyanish saying that.

But I would say as someone who is incredibly evidence-based and as someone who is obsessed with wearables and data, it is amazing to me how much relationship matters. And what happens for a lot of us who have adverse childhood experiences in a score of one or higher is that we sometimes find ourselves in relationships that are not nourishing. And it can be, it can require a lot of courage to get out of a relationship with, say, a narcissist or someone who, um, you just don't have a healthy dynamic with.

And similar to what we were talking about with the person who's doing the gut rehab and is doing all the things in functional medicine and getting their hormones into balance, maybe going on bioidentical hormones, and yet they're still not better. What I find is that trauma is the piece that you need to pay attention to, and you also have to look at relationships. And not everyone can, you know, leave a marriage that's, not nourishing, not everyone can make changes, but you can clean up your side of the street. There's still ways that you can work with, you know, the experience of a trauma bond.

Like if you're someone who is kind of hooked with someone else who's got trauma that kind of connects to your trauma. So I think that's really critical. the other piece that I want to mention is purpose and meaning. I feel like that's something that pulls us forward and kind of fills us with, you know, this is more of a spiritual aspect, but I think it's important. You know, it's not just the body. It's not just the mind. It's really body, mind, spirit.

So addressing spiritual factors, I think, are critical. And what I see with a lot of people without immunity, myself included, is that I had too low of a dose of spirit. I needed to infuse myself with spirit. Now, psychedelics were very helpful for me to do that. And I can also tell you, I'm someone who was such a square, such a square drew. Like, I'd never smoked pot when I was a kid. I never took mushrooms in college.

I never tried psychedelics until I turned 50. but the data was so compelling that it got me to consider it, to be open to it for the first time. And I'm so glad I did because it helped me with relationships. It helped me show and receive love in a way that I never could before. And it also helped me fill out my spiritual life in a way that I don't think I could have without these healing states of consciousness. That's powerful. I'm the same boat as you. I never really did any drugs growing up.

I didn't even drink alcohol really, right? I just didn't have any interest in it. And my first psychedelic experience was, I've talked about on the podcast, but I went with my parents to Hawaii and we had this medically, you know, guided, assisted experience. And it was just so incredible. And also, too, like, I don't have this strong urge

that I need to go and immediately go do it again. Like, I'm still trying to unpack everything that I went through the first go-around. And the reason that I bring it up is that for my mom, mom, it was so powerful for her to have that experience because she grew up in a household where I've never actually had her go through the ACE's questionnaire, but I think that she would score high. It might be something that we should do together.

And I think about my mom and my mom meeting my dad at a time where a lot of Indian, you know, couples had arranged marriages. Yes. My mom and dad fell in love. It was so uncommon back then. It was called a love marriage. And my mom meeting my dad and kind of being under his protection. And I truly do mean that in the sense of protection,

that she could truly blossom into the person that she needed to be. My parents aren't perfect. They dealt with their own things. I'm not perfect. We've dealt, you know, you're dealing with your own things. But seeing how my mom was able to tap back into who she was as a child and starting to feel those things and those interests, and that freedom was really powerful for her.

So just wanted to share that little anecdote that was there. Well, it's beautiful. And I just want to put a little footnote on this. So one of the things we know about psychedelic experiences is that the more mystical they are that tracks with the greater transformation and often the greatest behavior change. And so, you know, I'm talking about. mystical experiences in a way that is hard to quantify and measure, but it provides this healing state of consciousness that we're talking about that I think is so critical for the reversal

of something like autoimmunity. Well, Sarah, this has been fantastic. I want to thank you for coming back on the podcast. Your last episode that we did together all on hormones has been a huge hit. Already has like 400,000 views that are there. I got so many comments. In fact, on our way over here, one of our friends that was at the studio stopped you and said you've transformed her life.

And I can just say that I've met so many women, men, people, human beings that are out there that have been so positively impacted by your work. And I want to acknowledge you for just fighting the good fight all these years for many individuals like yourself that grew up in tough situations, didn't have the tools. might still be successful in many aspects of their life, but weren't shown a path to truly heal. And I feel like today's conversation is another extension of that, and this book is a huge contribution to the space.

So I want to acknowledge you and thank you for coming back on the podcast. Thank you so much, Drew. Such a pleasure to be with you. Hi, everyone, Drew here. Two quick things. Number one, thank you so much for listening to this podcast. If you haven't already, subscribe, just hit the subscribe button on your favorite podcast app. And by the way, if you love this episode, it would mean the world to me. And it's

the number one thing that you can do to support this podcast is share it with a friend, share with a friend who would benefit from listening. Number two, before I go, I just had to tell you about something that I've been working on that I'm super excited about. It's my weekly newsletter. And it's called Try This. Every Friday, yes, every Friday, 52 weeks a year, I send out an easy to digest protocol of simple steps that you or anyone you love can follow to optimize your own health. We cover everything from nutrition to mindset to metabolic health, sleep, community, longevity, and so much more. If you want to get on this email list, which is, by the way, free and get my weekly step-by-step

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