Dhru Purohit Show - The Root Causes of Allergies, Why They Get Worse, & How to Get Rid of Them with Dr. Elroy Vojdani

Episode Date: August 24, 2023

This episode is brought to you by BiOptimizers Magnesium Breakthrough, Joovv, and Arma Colostrum.  Today on The Dhru Purohit Podcast, Dhru sits down with Dr. Elroy Vojdani to discuss the topic of food sensitivities, the top sources, and their impact on the development and progression of autoimmune disease.  Dr. Vojdani is the founder of Regenera Medical, a boutique Functional Medicine practice in Los Angeles, California. Dr. Vojdani began his medical career as an interventional radiologist. Dr. Vojdani has coauthored over 20 scientific articles and continues to play an integral role in research on autoimmune, neurodegenerative, and autoinflammatory conditions. He is the author of When Food Bites Back: Taking Control of Autoimmune Disease. In this episode, Dhru and Dr. Vojdani dive into (audio version / Apple Subscriber version): -Whether or not it’s possible to recover from lifelong allergies (2:17  / 2:17) -The three major classifications of allergies (3:30 / 3:30) -Examples of food intolerances and sensitivities (10:43 / 4:20) -The limitations of traditional allergy testing (17:22 / 9:09) -The story of how Alessio Fasano discovered leaky gut syndrome (25:43 / 22:50) -Chronic diseases that are related to food sensitivities (39:55 / 36:54) -The role of food sensitivities in F.L.C. (Feel Like Crap) syndrome (44:08 / 39:46) -Risk factors that contribute to the development of autoimmunity (54:02 / 45:00) -Top food sensitivities that drive inflammation (1:07:23 / 1:02:06) -Do allergy shots actually work? (1:12:18 / 1:08:05) -Comprehensive food and allergy testing (1:21:01 / 1:13:40) -Identifying food sensitivities, removing them, and repairing the gut (1:34:21 / 1:29:14) -Tackling nuances around dairy and autoimmune disease (1:52:55 / 1:48:30) Also mentioned in this episode: -Episode 237: 3 Steps to Reverse Autoimmune Disease with Dr. Terry Wahls  -The link between adverse childhood experiences and risk for developing autoimmune disease in adulthood  -Dr. Vojdani’s clinic: Regenera Medical -Dr. Vojdani’s book, When Food Bites Back. -rupauniversity.com For more on Dr. Elroy Vojdani, you can follow Regenera Medical on Instagram @regeneramedical. BiOptimizers is offering 10% off any of their Magnesium Breakthrough bundles plus a special gift with purchase. Head to magbreakthrough.com/dhru with code DHRU10. Right now, Joovv is offering an exclusive offer on your first order. Head to Joovv.com/dhru and apply my code DHRU at checkout. Receive 15% off your first order of Armra Colostrum at tryarmra.com/DHRU or enter DHRU to get 15% off your first order. Hosted on Acast. See acast.com/privacy for more information. Learn more about your ad choices. Visit megaphone.fm/adchoices

One in three Americans, adult Americans, experience some type of allergic disease, be it asthma, allergies, or eczema. We are talking about a humongous number of people out there, huge, and one in four children have an allergic disease. Is it possible to overcome our food allergies and sensitivities and how do we go about doing it? If you're curious about this question and getting to the root of your food allergies and sensitivities, this episode is absolutely for you. you, welcome to the Drew Proet podcast. Each week, we explore the inner workings of the brain and the body with one of the brightest minds in wellness, medicine, and mindset. This week's guest is Dr. Elroy Vajdani, and today Dr. Vajani is here to deliver a masterclass in this topic of food allergies, intolerances, and sensitivities, including what you can do today to not only get to the root of them,

but actually start to feel better. Now, a little bit more about Dr. Vigdani. Dr. Vigdani is the founder of Regenera Medical, a boutique functional medicine practice here in Los Angeles, California. After graduating medical school from the University of Southern California and completing his residency at USC's School of Medicine, Dr. Vajani began his career as an interventional radiologist diagnosing and treating complex late-stage cancers and other extremely debilitating diseases. While this experience gave him unique insights into hospital-based medicine, his desire to stop disease before it reached, the point of becoming a chronic illness, remained at the core of his desire to practice medicine. Today, he continues in his father's footsteps pioneering to

find answers to medical conditions that go undiagnosed and untreated. Dr. Vajdani has co-authored over 20 articles in the scientific literature and continues an integral role into research related to autoimmune, neurodegenerative, and auto-inflammatory conditions. He's the author of when food bites back, taking control of autoimmune disease, and the co-author of a medical textbook entitled Food Associated Auto Immunity. Elroy, welcome back on the podcast. Today we're talking all things allergies. Let's start with a big question that so many people who watch this show have, which is, can I recover from lifelong allergies that I've been suffering from? What are your thoughts? It's one of the most common things. It's one of the most

common things we see in the clinic because it's incredibly common nationwide one in four americans suffer from some type of allergic disease so people typically come to the clinic for something else let's say ibs or an autoimmune disease and we see allergies at the same time incredibly frequently and what i tell them is we're going to work on what you came here for and in the process of doing that work rehabilitating your gut, working on your immune balance, your allergies are going to go away. And they never believe it. But six months, 12 months in, that's absolutely the case. So there's a lot of nuances in this term, even allergies, right? So let's start off with just a little bit of clarification. And then we're going to go right into what are some of the

root causes of these allergies. So everybody stay tuned. So just let's make a little distinction. There's allergies, there's food sensitivities, and there might even be some. some other things in between. I think it's really important for the audience to understand this, so they understand how to actually get to the root. So can you clarify some of those terms? Of course. So three major categories when we talk about a dysfunction between the immune system and the interaction with foods. The first is a food allergy. Food allergies are, you know, the classic one is a peanut allergy. You think of a child who has some exposure to peanuts and has a full-blown anaphylactic reaction. That involves the IgE.

part of the immune system and those reactions will happen in extremely short time intervals, you know, something from on the order of minutes and, you know, typically we see those present initially in childhood and can persist later on in different forms. People also talk about food intolerances. Now a true food intolerance means the body's inability to break down a product. classic example there is lactose intolerance you don't have the enzyme to break down lactose therefore if you consume it there are going to be some ramifications of that that actually doesn't involve any immune dysfunction that's a genetic deficiency and something that typically also people have from a young age if you're lactose intolerance you pretty much have lactose intolerance from a young age you're going to

be born with it but you know most genetic deficiencies will pronounce they'll become more pronounced as we get older. So you probably have some lactose intolerance when you're born and it gets worse as you get as you age essentially. People use that word intolerance a lot to mean that there is some immune dysfunction there. For example, gluten intolerance, dairy intolerance is kind of the colloquial way that we discuss this. But the true terminology is actually a food immune reaction. Sometimes we talk about that as being a sensitivity. Now, that's a. a IGG and sometimes IGA mediated immune problem. Essentially what happens there is. During our first several years of life, we're programming in our thymic gland what is dangerous to our immune

system and what is not. In other words, self versus non-self. And part of the programming is obviously also being able to decipher what is food and what is an external threat. You know, in other words, we don't want our immune system identifying food the same way we would identify bacteria, viruses, parasites. We need to make that distinction. Those are not part of us, but we need to be able to attack them or not attack them appropriately. Through the course of, let's say, what's going on in the modern world, we're finding more and more adolescents, adults, basically losing that tolerance, losing that ability to say this food is not dangerous to me and essentially attacking it the same way that you would a virus or a bacteria. And the immune system will use IGA and IgG antibodies

to be able to mount that attack. So a very different part of the immune system than a food allergy is involved in a food sensitivity. And increasingly what I'm hearing from you is over the years you're seeing more and more people that are suffering from this. So this is not something that's in our genetics. This is something that's happening in our world, in our environment around us, that it's causing the situation where, yes, it's food, but also people are more reactive to even things like pollen and other situations, which might have something to do a little bit with our gut health. Not always, but there could be some links there that we can chat about in a little bit. So is that what I'm hearing you say, that it's increasing over a period of time, that it seems

more and more people are eating things that maybe in the past we would have tolerated, but now we're not doing well with. Absolutely. The most extreme example of that is celiac disease. That's a full-blown autoimmune condition triggered in the intestinal lining by the consumption of gluten. Wheat products typically are the gluten-containing food that we talk about the most. 15 years ago, we had an incidence of about 1% of the population with celiac disease and now we're up to 3%. So a tripling in that time frame absolutely cannot be explained by anything other than environmental change making up that difference. This episode is brought to you by bioptimizers. You know, I've had a bunch of experts on

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head over to juve.com slash drew and use my code dhr u during checkout that's juve j oovv dot com slash d hr u to get your exclusive discount today so let's talk about in that context of those three different things that you mentioned right you talked about a pure allergy right somebody could have shellfish allergy they could have a peanut allergy They could have, in some cases, I've seen people later develop allergies to other foods that are traditionally categorized, which is very specific. Then there's an intolerance, right? As you mentioned, lactose intolerance.

Are there any other things that fall in that bucket of intolerances that you see typically that are a true intolerance besides lactose? Not commonly. I mean, there are people who were born with the inability to break down certain amino acids, ability, inability to break down fat for certain genetic reasons. But true food intolerance is outside of lactose intolerance are actually quite rare. Okay, grad it. And then there's this big category that most people watching today, who probably came across

this video or podcast, they're dealing with, which is they're eating certain things and they don't feel good. And many of those people have gone to their doctor, well-intentioned, and said, hey, I think I have an allergy to X, Y, and Z, or I think I have an allergy to something, I don't know what it is, and they get a traditional allergy panel done from their doctor. Tell us, what is that panel looking for, and why does it fall short when it comes to this category of these sensitivities and this immune response that's going on in the body? Okay, so there's two major ways in which a physician would test for, quote, unquote, food allergies.

The first, as you alluded to, would be a blood panel. Now, the blood panel is essentially going to look for the development of IgE antibodies to different foods or other environmental agents like pollen, mold, grass, whatever it is that you want to look for. And IG stands for? It's immunoglobulin E. So that is the part of the immune system that triggers an allergic response. Essentially, the formation of that antibody leads to the allergic response to the presence of whatever it's formed against in the environment. So if you have an IGE allergy to peanuts,

you get an exposure to peanuts. That's what drives the immune system to have that anaphylactic reaction. So part of that would be a blood test is that also when you see classically sometimes people come back from the doctor's office and they have a prick test, is that another version of these tests? That's another version in theory of doing something similar to that. So the second way that physicians typically try to confirm allergies is a prick test. Now, what is a prick test? You're basically putting a minute amount of the actual allergen itself on these tiny needles, piercing them through the skin where they have exposure to the surveillance cells of the allergic immune system, which are called mass cells. And once they penetrate the skin, then the body can

form the IgE allergies. And if you get a hive or a welt or something in that location, the physician will say, well, you have an allergy to whatever was on that needle. There are issues with that test in particular. You know, just in general, if immunological testing is going to be accurate, that thing that is either inside the well for a blood test or the antigen that is on the tip of that needle needs to be pure and it needs to mimic what is actually out there in the real world. So a lot of times with commercial testing, whether it be blood testing or prick testing, we're using industrial synthetic versions of the environmental antigen because let's say the alternative to this is taking a large concentration of a tree pollen and extracting the protein out of it and then putting it on the needle tip. That's very expensive. That's very cumbersome to do. So using synthetic versions are far more efficient. But they are not the same thing as what's out there in the environment.

So it's difficult to draw 100% one-to-one conclusions that the reaction in the skin or the reaction in the well is entirely the same thing as what that human being would experience in the real world. So some people could have an allergic reaction to pollen and they live in Texas. and because the pollen they're regularly exposed to might be different. You know, it's actual real life, real world pollen that's there. But they got their testing done and the synthetic that they were exposed to in, for example, a prick test. And in a blood test, they're also exposing the blood to a synthetic in a tube. Is that correct? Correct.

Right? So they take your blood. They expose it to something. you know, pet dander or pollen or this thing or that thing, whatever, mold. But what you're saying is that there could be a gap because it's not exactly the same. So you could still have an allergy towards something or an immune response, which is a little bit different. Allergy is still an immune response, but there's obviously a spectrum of immune responses that

you're talking about earlier. And so those tests are not perfect, but they give some people some. insight. Yeah, again, I think probably the most meaningful information that's going to come from a traditional allergy test is thematic information about where that person's allergic immune system is. Right. So if you see thematically lots of reactions to things on the prick test, in other words, that individual just becomes one big red hive after they have that test performed on them. And you're going to say, hey, your mass cells and your allergic immune system are really pissed off. right now. Maybe you can't draw one-to-ones about what did it, but you know overall that part of your

immune system is not happy. It's not balanced. Same thing with the blood testing. You can get that thematic information. The most important thing I think also is to remember that when you're doing an allergy test, you're only gathering information about food allergies. IGE. I-E. So, you know, the watery, itchy eyes, the swelling of the throat, skin reactions. And again, these would have in the order of minutes following the exposure. It's an immediate thing. You eat something, you're having an immediate response that's traditionally detectable through these things

that you mentioned, watery eyes, other stuff. But you could also have, there's foods that I eat, which we'll get to in a second, and you too, that when I have them, especially in a large amount, I get a runny nose. Yeah. But that food has never showed up for me in a traditional IGE test.

and a traditional test. So this whole other spectrum, remember, there's three. There's traditional allergies, there's intolerances, and their sensitivity. They're not showing up for me these foods on an allergy test. I'm not having an intolerance to them, but there's this whole food sensitivity thing, which I've done some labs that give me some indication that these foods may not be the best foods for me. It doesn't mean that I can't have them ever. There might be some people that can't have them ever.

and we'll talk about your story, but that's the whole mystery that unlocks this food allergy, quote unquote, equation and can help people eat better in a way that doesn't make them feel like they just don't feel good. So going back to what you mentioned, there still can be things in times where you eat foods and you don't feel good, but it's not showing up on an allergy test. Right. So that's what we talk about in the public realm as being a food sensitivity. The medical term is a food immune reaction, whereas an allergy is mediated by immunoglobulin E or IGEE. The food reactions are mediated by a completely different compartment of the immune system,

and the antibodies are IGG or IGA. That's why an allergy test would never pick up a food immune reaction or sensitivity. You know, just to bring this up here, to tie this back to the first question, as people are following along and you're understanding and you're building a map of this world, in this category of food sensitivity, can you get better and can some of the symptoms of eating certain foods and feeling extremely tired or a runny nose, a headache? Can those things get better? Can you get better from a food sensitivity? Yes. You absolutely can. Once you have correctly identified what the, I think, root of the problem is, which is,

general going to be intestinal permeability plus food immune reactions. And, you know, we begin the healing process by removing the offending organisms and then repairing the barrier. People absolutely can get better from it. Awesome. And we're going to walk people through that whole process. So coming back to and closing and putting a little bow tie on the test that are there, whether they do blood test or prick test and traditional allergy testing, just to connect the dots for everybody, it doesn't mean that you shouldn't get these tests because from what I'm hearing from you, you're really looking for two things. Number one, if you have a strong reaction to something, you probably have an allergy to that

thing, right? That's number one. Number two is that if you have a lot of reactions to different things, that also can give you some information that, whoa, your immune system shouldn't be this reactive to everything. Something deeper is going on. And that deeper thing, spoiler alert, has something to do with your gut health. We're going to break that down. Would you agree with those two statements? That's completely accurate. Okay, great. So it's not that we want to, you know, a lot of people say, well, my doctor ordered me this allergy test. Should I do it? Should I not do it? Great, especially because those

tests are typically covered by insurance. If you've never done one before, it could be helpful. but understand there's both possibilities of false positives and false negatives. You have to understand that test in context. And unfortunately, well-intentioned doctors that are running this may not be aware of this whole world of food sensitivities. So they would tell you, no, you're fine. Just keep on eating anything you want. You scored nothing on this test. Meanwhile, all these people are running around like, I don't feel fine. I feel sluggish. I feel brain fog when I eat certain things. I feel like my face gets more redness, which is something that happened to me eating certain foods. So just understand these things in context that it could be helpful, but there are false

positive, false negatives, but here's how they could be helpful. Extreme reactions and also if you react to a lot of stuff, then you have to start digging deeper for answers. Now, let me ask you, when you Google, you know, a lot of people are Googling, especially with the topic of a few years ago, a lot of you were talking about gluten sensitivity and the whole gluten-free movement was taking off. And there was good things that came from that. And there was not bad things, but things that were a little bit misguided. You know, everything was being labeled as gluten-free. That was gluten-free. And a lot of people were putting, just thought that gluten-free immediately made something healthy, right? But obviously, you can have gluten-free

skittles. You can have gluten-free candy, this, that. And in that process, a lot of of people were Googling, do I have a gluten sensitivity? Because the word sensitivity started showing up more. So you started to see CNN, Fox, all these media outlets, Harvard, this place, that, all these institutions, media outlets saying to people, a lot of advice was, if you don't have celiac, which can be tested for, right? Even that test has to be interpreted a little bit, but generally, most doctors can test for it now and there's awareness, this whole idea of gluten sensitivity is bullshit, right? Don't bother with that. It's all marketing. It's all, you know, wellness trends. Don't bother with it. If you don't have celiac, you don't have a gluten sensitivity.

I'm using this example because gluten-free probably was the most popular one, you know, next to maybe dairy, right? And people Googling, do I have a dairy sensitivity? So help us understand why were so many people and people who seem very accredited and big institutions, why were they telling everybody that this whole idea of sensitivity and gluten sensitivity was bullshit and then tell us how you look at it? Well, I guess the only way to kind of have that discussion about why there was so much pushback against this growing awareness in the public about how food is impacting the way they feel is that medicine in general is very resistant to change and very resistant to new

information. I think some people argue that maybe that's necessary because when you're treating human beings, you can't, you need to vet things. You need time essentially to vet what's real and what's not real because science is a malleable process. I guess that's probably the nicest way to say that that's why there was so much pushback. Since then, there have been a number of articles that have absolutely, you know, kind of concretely proven that a different version of gluten sensitivity other than celiac disease exists. Now, we call that non-celiac gluten sensitivity and CGS in the medical literature. But, you know, I think probably the thing that we see in clinical practice in the functional integrative medicine world is, you know, bread and butter,

somebody comes in with Hashimoto's, you do a gluten sensitivity panel on them, you know, they show up as positive on the gluten sensitivity panel, you remove gluten for them and their TPO antibodies will drop almost immediately and their thyroid function will improve. And that has been shown now in clinical studies in the medical literature to be true. So we know that this exists. There's no question about it. And, you know, when you look at numbers in the population, upwards of maybe 10% of the U.S. population has non-celia gluten sensitivity. It's not a small number of people out there. So I think that essentially despite the pushback from the medical establishment when this information was coming out, and this is also beginning in the early 2000s, it's been a long time.

We're talking about 24 years since Alessio Fasano first published his in. initial paper on on leaky gut. Can you talk about him just for a quick second? Oh, sure. Who is he? Where did he come from? And how did his work sort of change the medical understanding for physicians that were paying attention, right? Just so everybody's clear, you know, I have a lot of physicians in my family. You are a physician. You have a lot of physicians and people in the medical world in your family. Physicians are well-intentioned, right? Just like most people are well-intentioned. Sure. Are they're bad anything in any kind of group, of course. There's going to be bad teachers. There's going to be bad this, bad that. That's a small, small percentage of people that are not well-intentioned

or are malpractice or this or just, you know, whatever. And they largely are practicing medicine based on how they were trained. And for a lot of physicians, like how long ago that you were in medical school? Started in 2004, finished in 2008, so 15 years ago. That's 15 years ago, right? So a lot has changed in the last 15 years, especially when it comes to certain cutting-edge topics, especially this. And outside of drug reps visiting people's offices or a physician's own interest, of course, there's continuing education credits and other things that you have to stay on top of to keep your boards active and other things, but it's usually not the most cutting-edge thing, and which isn't just, hey, what is this wellness influencer doing or that? It's actually

dissecting the latest papers. So Alessio Fasano, who? Who? is he? And how did he change this whole approach of food sensitivities, at least in one big category, which is related to gluten? I'll start off with saying I have great admiration for him. I think what he discovered and what he pursued afterwards absolutely changed the current state of medicine. So Alessio is a pediatric GI, very brilliant guy. He's from Italy, extremely charming, has written a great book, by the way. He was investigating causes of third world, mortality and morbidity because he's a pediatric GI. He was focused on kids that were dying. He was investigating cholera, which is a bacterial infection. Calora kills kids in third world

countries by causing a water wasting enteropathy. What that basically means is their digestive track gets so destroyed that they just are pooping out water to the point that they become so dehydrated that they die. He wanted to know how cholera had the the ability to do that. Presumably, bacteria have that ability to do that to us by having a specific toxin that can do something. So he isolated the toxin, a candidate for the toxin from cholera, didn't know what it does, gave it to monkeys, and immediately saw that the monkeys developed a water wasting entropathy. So he said, aha, I found it. This is it. This is the cholera toxin. So he wanted to find out exactly how does this toxin do this? How does it disturb the gut so much to the point that

you're just losing all of your water through the GI tract? So he gives it to monkeys again, looks at their intestinal tracks postmortem under electron microscopy and essentially finds that their tight junctions of their small intestine are completely open. And just to clarify for the audience, doesn't know about this tight junctions, a little sort of tangent on that? Small intestine for simplistic discussion is essentially lined by a single cell that are called epithelial cells. Very similar in function and structure to what you have on the outside of your skin. The inside of the small intestine has a single layer of that. That separates food, bacteria, the microbiome on the inside and blood on the other side.

So this is a very, very vital interface for us, a place where we interact with our outside environment internally. and there's literally a layer of cells that protects you from that internal environment. So to keep that single cell layer from being able to perform its probably most vital function, which is to serve as a wall, they're glued together essentially. But they can't be glued together in a permanent fashion because then you would never be able to pull nutrients in when you want to. You would never be able to send an immune cell across the wall to the other side to find what's there and then be able to come back in. So we have these malleable gates, if you want to

think of them that way, called tight junctions that are just in between the epithelial cells. And at the time, we didn't know this. But through Fasano's work, essentially what he found was the cholera toxin artificially opened that gate and kept it stuck open. And with an open gate in between epithelial cells, the body can't keep what's called a hydrostatic balance, and you just flush water in because also the immune system thinks it's under threat. So it's trying to get rid of whatever is causing that severe injury. Hence why animals and human beings all get diarrhea when they are exposed to certain things, the body feels like it's under threat. And diarrhea, which we think of as a bad thing, is actually a defense mechanism that the body's trying to just get rid of everything inside

to flush a system. Exactly. So Fasano basically finds that cholera causes this by essentially creating massive leaky gut. Now, we knew in the medical world that leaky gut existed, but the only context in which we really knew that leaky gut existed was in celiac disease. And that was almost 100 years' worth of data at that point in 2000. The idea that leaky cut could exist outside of celiac disease, not something that we knew or accepted in the medical literature. That didn't deter him. Okay. So the next thing he did was a mouse study. And he gave mice what he now called zonulah occludin toxin. That's what's the name he gave, the cholera toxin, ZOT. Why zonelah occluidin toxin? Because those are the proteins that make up the tight junction and that's what the

toxin is interfering with. So zonula occludin are the proteins that they mess with. So he gives mice zot. The next thing he knows, a couple weeks later, those mice develop type 1 diabetes. Wow. Huge, huge discovery. Now we're talking about doing something to the gut of an animal and inducing a systemic autoimmune disease for them. Yeah. And just to be clear for everybody, type 1, diabetes is an autoimmune condition. It is an autoimmune condition characterized by the destruction of the pancreas by the immune system. So you have something changing the environment and normal physiology of the gut. And the next thing you know, the systemic immune system is attacking an organ, something that it is designed under no conditions to do. It's the cardinal

sin of the immune system. Yeah. And bear with us here because all this connects, right? This all comes back to food allergies and why people feel shitty sometimes when they eat certain things, even if they don't have type 1 diabetes, we're laying down the groundwork so that you understand how this is all connected. This episode is sponsored by Armora Cholostrum. You guys know I'm always on the lookout

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specifically Armra's Colostrum. And in case you're wondering, yes, it tastes fantastic. Right now for my community, good news, we've worked out a special offer with the folks at Armra. Listeners of the show can receive 15% off your first order. Simply go to tryarmra.com slash Drew and enter the code Drew to get 15% off your first order. That's try, T-R-Y, ArmR-R-A-R-A-R-A-D-R-A-R-A-R-U to get 15% off your first order today. This story is probably the most important one in, I think, in modern immune understanding, honestly, not just functional and integrative medicine. The whole medical community should know this story. Okay. Please continue.

So he's, Fasano is bright enough to understand the implications of this because a gut-driven systemic autoimmune disease is groundbreaking. So first he wants to know does this happen in human beings with autoimmune disease. So he takes patients with celiac disease, the most likely, a group of people to have intestinal permeability. And he does a study and confirms that they have a much higher incidence of having intestinal permeability. How does he measure for the intestinal permeability this time?

By looking for the decoupling of zonulin from the tight junction into the blood. So essentially, he has now gone two steps. Confirm that gluten-induced autoimmune disease has a leaky gut problem and confirm that you can test for that leaky gut problem with a blood test. Next study, adults with MS. So he took another autoimmune condition. Another autoimmune condition, this time the brain. We're not interested in the gut anymore because that seems pretty clear.

So he wants to confirm does intestinal permeability, the thing that he did to the mice, can that result in an autoimmune disease elsewhere? The brain is very far away from the gut. So he took MS patients. There's two subtypes. There's a spontaneous progressive subtype of MS where essentially they unfortunately just keep going and going and going. there's another subtype called relapsing remitting. So these are people who have MS flares and then

have periods of time where their MS is completely quiet. Right. And in traditional medicine, they don't know why. Why are you having these symptoms and all of a sudden they seem to disappear? Correct. And then you have them again. Correct. Exactly. So in the subgroup of relapsing remitting MS when they were actively in a flare, the zonulin levels, therefore their leaky gut was extremely elevated versus relapsing remitting MS in remission, the same levels of zonulin as the control group. So just to link this back to his original studies, right, he was able to create sort of this diarrhea in apes, for example, and he identified, you know, this methodology of doing it, and also seeing that these zoninin levels were high. Yes. Right. So it's like, okay, this is correlates

correlated with them not feeling good, but then also in these type one diabetics, same situation of this zonulin being high that could be, well, in the mice, right? It was a mice trial. Yeah. When the zonelan was high, he was able to induce this autoimmune condition, type one diabetes. And now he's continuing that thread to see same sort of situation in the MS, at least in one category of the MS. I'm going to summarize it one more time because it's really, really important.

So the first thing he discovers is leaky gut is real. That's what he discovers when he extracts the toxin from cholera. Like it's an actual medical thing that's going on in the body. Yes. All the literature, even for 10 years or 15 years after that discovery, said that's bullshit. But he discovered concretely that leaky gut is real. Number two, leaky gut is controlled by a protein called zonulin. Number three, leaky gut can cause an extraintestinal autoimmune disease,

huge discovery. Gluten consumption is tied to leaky gut and zonulin and we can talk about, you know, how we have gone a step beyond this in research since then, but zonulin is a reasonable marker for leaky gut, meaning you don't have to do a small intestinal biopsy on human beings to prove this. And then since then, several studies showing that gluten is one of the potential, sorry, one of the biggest triggers in the environment for inducing leaky gut via zonelan. So that's where we got to the point of non-celiac gluten sensitivity, what happens to those individuals is they're consuming gluten, their immune system is reacting to it, they get a zonulin release, and they induce intestinal permeability, a small version of what cholera does, essentially, a minute version, but one that could

happen day after day after day after day if that human being doesn't know that it's happening to them. Yeah, and to take this back to the question that I had asked you about why do so many what seems to be well-established individuals, institutions, and obviously the press sort of quoting them, say things like, hey, you know, gluten

sensitivity is bullshit. And even before Alessio's work, there was some there were studies that were out there. They were pointing out different things, but he concretely connected the dots. So if somebody's still saying that, it's either, you know, I don't

love this word, but it's misguided information, you know, I don't want to say misinformation, but it's misguided information that is just related to they're not aware of that work that's out there. Not up to date on the literature, I would say, is the right way to discuss somebody who's not aware of this at this point. And so tell us, you know, before I talk about, 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's. 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 influenced. 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. 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 casein. What does cross-reactivity mean? The immune system is not a perfect system. It, when it recognizes things to attack, it does so with maybe 70 or 80 percent 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 myelin basic protein, myeloelogodendrocyte 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 are going to feel better. Yeah, this might be, for example, people have heard of like Terry Walsh, who's been on this program before. Medical doctor and a researcher in the space of MS. published multiple studies on her Wals 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 and autoimmune conditions, there's this other category of people who haven't been diagnosed with a chronic disease. They just feel like crap, FLC, as Dr. Hyman sometimes calls it. I've even referred one of my friends recently to you who's in this category, right? Just somebody who feels bloated regularly, doesn't feel like their digestion. 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 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-autoimmune 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 unbalanced state. Yeah, and just so everybody's clear, environment just means anything outside of your body. 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 know, 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 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. And 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. Haynes trial. If you look at the percent positivity of a positive ANA over time during N. Haynes, you see doubling of that percent population. And N. Haynes, 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, 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, right? 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. I'm my 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 this in the snow 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 that had ramifications

and that that practice likely existed up until recently um so you know 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. You know, I think my parents were doing their best, but they both 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.

And we owe him a great debt of gratitude. I'm very proud to be a son. Of course, you're a son. How much of your story was a driver in him looking for these answers? You know, it was actually his mom's story. So my dad just won the IFM Linus Pauling Lifetime Achievement Award. Congratulations to him. Deservedly so.

I know I'm biased in saying that, but the man is a humble scientific genius and he deserved it. He was driven actually by his mom's story. His mom, my grandmother, suffered from really debilitating rheumatoid arthritis. Another autoimmune condition. Autoimmune condition. But it did not kick in until her middle ages. And really, he has a really remarkable story about kind of watching this happen. She, you know, they were growing up in Israel.

And, you know, Israel was very much a developing country at the time. And she had some serious dental issues, dental cavitation. infections, and they weren't treated appropriately. She eventually had her teeth pulled but without antibiotics. And she, my dad's idea is essentially that watching that happened to his mom was the triggering event for the RA. And we now know through his own research and several other people's research that the dental organisms of infections in the mouth are very much responsible for the development of RA in certain individuals. So. And is that through the process of when these teeth are extracted, you have these cavitations and these cavitations become

infected, and that can in a way leak bacteria into the body. Is that the mechanism? 100%. Okay. Yes. And, you know, there probably was a chronic infection for that individual for years before it was ever detected. So it's one, the setup of the chronic infection, then the extraction event, and then the flood of the bacteria from the cavitation into the bloodstream. Yeah. And it's not to say that you shouldn't have teeth extracted, it's just, you know, looking for a dentist that understands to make sure that no living matter is sort of left in and that the cavitation is completely sterilized before they go ahead and close it up. Otherwise, it's like taking a bunch of trash, throwing it into the room and locking it, and that trash ends up fermenting and attracting rodents

and this and that. And that's how people get affected by these cavitation. Exactly. So he is in real time watched my grandmother develop RA as the result of this dental infection. So he wanted to dedicate his career in immunology to shedding light on this. You know, shedding light to the idea that number one, the environment is responsible in the majority for the development of autoimmune disease. And then number two, mapping out what those things in the environment might be. And then number three, developing tools. So clinicians like myself can accurately identify those things in our patients.

And, you know, I'm very grateful that I have those tools available to me because they are the thing, I think, that allows me to be a more precise physician when people come into the office. Let's go back to your story. How early did you notice some of these symptoms that you were going through? I mean, you mentioned that you would get sick a lot as a kid. You gave us some examples. But when did it really start to get bad for you? In medical school, early medical school. I couldn't keep up with the demands. I had a sinus infection every single month, like clockwork. I just didn't feel like myself. I couldn't concentrate the way I wanted to. I was having a hard time sleeping. And yes, medical school is stressful.

But this was beyond that. And that's when he took my sample and said you have a gluten and dairy sensitivity. You know, this is 2005. Nobody was executing a gluten-free diet or a dairy-free diet. I mean, it was like, what are you talking about, Dad? You're like, what the hell? What is gluten? What are you talking about?

So he said, listen, I know this is daunting. Do it for three weeks. Just do it for three weeks. See how you feel. And if you don't feel any better, I'm wrong. But if you feel better, then maybe you should think about doing it. So I followed his advice. I haven't had a sinus infection since.

Obviously, he was right. And I feel dramatically better when I remove gluten and from my diet. And I noticed the effect within a week. I was clearer. I was sleeping better. I just felt more like myself. And anytime I do have a little excursion to Europe and I try a little reintroduction, I get a reminder of why I remove them. Two things on that story. Number one, congratulations. I'm so glad you aren't having sinus infections anymore. I had a lot when I was a kid, same situation as you, always on antibiotics, even with my parents coming from, from like, Ayurvedic influence in our background.

And they did bring in some of those things. You know, they would bring in some of those things to treat like strep throat when I had it. But I was in this constant cycle of medication getting sick, medication getting sick. And my gut was irritated all the time. My gut was irritated all the time. I remember even just as a young kid, having an aversion to eating sometimes because I just intuitively felt like I don't want to feel bad, right?

I don't want to feel bad. And so I'm just not going to eat certain stuff, which made me both a picky eater, but probably not a good eater. So your story is obviously, there's themes of that that are going to be applied to a lot of people that have food sensitivity, but there's also uniqueness. You and I were on a lot of antibiotics.

Maybe for some people, they weren't on as many antibiotics, but it's also not just antibiotics. It could be adverse childhood experiences that people have. You grew up with an alcoholic parent. You grew up in an unstable family situation, something that put a lot of extreme stress on you. You were sexually abused. Even these things have been linked to, you know, look it up, the ACEs study.

These things have been linked to autoimmune conditions. These things have been linked to gut permeability and leaky gut as well. So it could be antibiotics, could be extreme stress. There is a friend of mine, Nishda, who lives in the UK, and her daughter, crazy story was in their teens they went to visit i believe they were in dubai they live in london they were jet skiing i think and something happened and her daughter fell in the water and she drank a bunch of water that also had like contaminants like oil from like you know the area i think even some bacteria and ever since then they didn't know it was that she developed ibs so

you can have a few different things that can be these external environmental factors that come in and basically start to disrupt the system. But I just want to make sure that people are clear. You're not saying that for everybody it's gluten and dairy or that every single person out there has a gluten dairy issue, right? These are the common stories. These are, but there are, everybody has their own individual version of this. What I look at is my task when I'm seeing a new patient is, first, what was the initial, like the most recent trigger for them ending up in this situation? And then also more importantly than that, what was the road that they traveled to get to

a tipping point? So both of them are incredibly important to identify. And the road traveled and the tipping point are both unique to everybody who comes into the clinic and unique to everybody out there. Yeah. And that being said, it's not just gluten and dairy. For some people, there's other food sensitivities, same story that they end up with. What are some of the most common sensitivities if you would continue that?

Gluten would be maybe number one. Dairy would be number two. And obviously there's a whole question about types of dairy, fermented dairy, other stuff that some people seem to be more reactive to and some people seem less reactive to, me included that I want to ask you about. What goes on from there? What are the other common food sensitivities that tend to make people, stay in this sort of inflammatory loop?

The top five are gluten dairy, corn, soy, eggs. From there you can go further. There's a theme of different food proteins that cause this potential in the realm of agglutinins. Lectins are included in that as well. Things that have agglutinins are legumes. Lectins are carried in many different foods. But essentially top five gluten dairy, corn, soy eggs.

from there we go on to other veggies. And just to be clear, some people could be more reactive some and not reactive to others. Absolutely. You could have somebody who's, you know, nine out of ten reactive to eggs has no issue with gluten or dairy. It's not common, but it can happen. How do those play into this whole other category? And my mom is a perfect example.

Growing up, my mom would go, I don't know if it's every week or every few weeks to go get an allergy shot, right? She'd go regularly because she would regularly have to take things like, what is it, Zyrtec, right? Allegra, Zertec, Singular. Because she always had allergies. Yes. What's going on, first of all, for people who are in that boat where they're taking a

medication like those mentioned or they're getting allergy shots, what's going on in that category? Okay. So first of all, one in three Americans, adult Americans experience some type of allergic disease, be it asthma, allergies or eczema. We are talking about a humongous number of people. people out there, huge. And then one in four children have an allergic disease. So this is not not small numbers. Crazy. Crazy. So again, the development of an allergy to something in the

immune system can happen in two phases. The early childhood form versions of allergies happen essentially during the development of the immune system in the first three years. Again, that thymic gland is responsible for programming T cells. In the thymic gland, we're programming those T-reg cells that I was discussing earlier. If those T-Reg cells aren't programmed in the correct fashion, you can end up with allergies to things in your environment that you shouldn't have developed allergies to. Sometimes, you know, they will persist into adulthood. Sometimes they will only exist during childhood.

But essentially, that's the basis for those childhood allergies. It's improper programming of the immune system, improper programming of T-reg cells in the thymic land. And the gut is very much responsible for that. In adults, the T-Reg cells also in the gut, not in the thymic land, are responsible for that development. So we hear stories all the time of adolescents and adults developing allergies or maybe developing more severe allergies than they had before in today's world. And again, the T-regulatory cells that are living in the gut are risk.

responsible for that shift. They are controlling the state of the most important part of our immune system, which is the adaptive immune system. And it breaks down to a balance of the different arms. One of them is called T helper 1. The other one is called T helper 2. So in short, if your T regulatory cells are upset in a specific way in the gut, they will drive T helper 2 to be more powerful than it should be. It's called the TH2 dominance. And in that TH2 dominance, you're basically going to drive those IGE allergies that we talked earlier because you're producing far more IgE antibodies to things in your environment than you were before. So your immune system is ramped up. Obviously, how you grew up, stressful situations. You know, my mom didn't take a lot of antibiotics

growing up, but just lifestyle, eating, processed foods, et cetera. Now you're, you're, you're immune system is already ramped up. You get a little bit of leaky gut. That turns into a lot of leaky gut as you get older because your body's not rejuvenating as much. And then certain foods can even trigger that further. Correct. And now all of a sudden, even though you never had an allergy to pollen, you're an adult now and you're taking Zyrtac or whatever and getting a regular allergy shot because your immune system is so ramped up that other things are also ramping it up. and for some reason in some people, pollen could be one of them. Correct.

Wild. Yes. And what is an allergy shot doing in that situation? It's a really, I think, important point. Allergy shots, by the way, are nearly 100-year-old intervention. So what are you doing with an allergy shot? It's a long commitment. You know, you're basically talking about spending your life doing some period of continuous injections

into your arm, and what the allergist is injecting into you is escalating minute amounts of the protein that you're allergic to. And what are you doing, essentially? You're trying to convince those T regulatory cells that are identifying that thing in the environment as non-self, aka harm, and attacking them. This pollen is coming in. We're ramped up. We don't like this. We're fighting it. You're essentially trying to induce what we call desensitization. You're trying to convince that T regulatory cell over just repetitive periodic exposures that this is not harmful. And by starting with a tiny amount and just escalating, that's a way of trying to induce that desensitization.

Does it work? Works for some people. Works for short term? Sure. It's not a root cause solution because everybody who does allergy shots knows that they need a quote-unquote maintenance shot going forward to maintain whatever benefit. And they also don't work for everybody, right? So why is that? You're not addressing where the problem came from, or at least what a very potent driver of that problem is, which is, again, going back to the gut, those T regulatory cells because of what you're eating, the intestinal

permeability, maybe a lack of correct micronutrient support to them, they're upset. And as long as they remain upset, your tendency to TH2, if it happens to be that direction, is going to remain. So you can induce desensitization to the T regulatory cells as much as you want. You're going to be best off by addressing both the gut and doing something like that at the same time. Spoiler alert around my mom. She no longer takes allergy shots. She's doing amazing.

She no longer has, quote unquote, allergies to pollen and dust, which she would react to for. And a lot of it was because she got to a situation and I got introduced to this whole world of functional medicine. We brought in a few doctors not actually there to treat her allergies. This is a common thing that you see. You get a lot of people who come in and they're not coming to you for dealing with allergies. They're coming to you because they feel tired all the time. They're coming to you because they just got a diagnosis of Hashimoto's, but they're not sure what to do, but they've read that food can play a role. They're coming to you because they have now symptoms of IBS

and it used to be okay and manageable, but it's getting worse than they want to do something about it, right? It could be a whole host of reasons, those and many more. And when the doctor that I brought in to work with her, she had this magical moment after about a month, two month. I mean, this wasn't a long period of time. She, I think it was a long time ago, right? is almost like 15 years ago. So I don't have the details accurate. But I know that she ended up

skipping or missing an appointment for one of those regular allergy shots. And she was just noticing her regular maintenance level of stuffy nose, eyes, you know, watering up during allergy season where we lived in Delaware at the time. It just wasn't as pronounced. The doctor didn't tell her like, hey, we're doing this for your allergies. We were working on some other stuff. And she thought and brought it up. And they said, yeah, you know, this is a common thing and kind of we're walking through some of the things that you explained. They weren't as eloquent as you are, but gave her the big picture.

And she said, well, you know, do I still need these allergy shots? They said, look, if you feel like you do, go for it. But let's just see how this plays out. And that was the last time in her instance, obviously working with her doctor, that she ever took an allergy shot and she hasn't taken Zyrtec or whatever she was on at that time. ever again. And it feels like a miracle, but really it's supporting the body's innate ability to repair itself and start to quiet down the immune system so it's not as reactive. Yeah. So I want to come back to you and how you talk about this and how you work with it

on in your clinic, which actually is just down the street over here in Los Angeles. You guys are just right over here on Wilshire, right? Yeah. Not too far away. Just. Name of the clinic, if you could, for the audience. Yeah, regenerative medical. We're on Wilshire and Federal here in Brentwood. Awesome. We'll have a link to you guys in the show notes if people want to check you out. Appreciate it.

A bunch of people that have been there that are part of my network that love you, love your team. So let's connect the dots. When somebody's coming in and you hear this story, right, a typical story, these early stressors or some major life event or something, exposure to mold in some cases, right? There's these early stressors, those create this environment where the gut is not healthy. They're dealing with leaky gut. And then they're eating certain types of foods that perpetuate and now their body is in this inflammatory cascade, this inflammatory loop that's there.

Because you are a person who both you're a doctor and you have all this clinical experience, but then there's this whole other side that you and your dad do research. You're not just immediately going to say to the patient like, hey, you 100% are having this immune response, you'll also do testing, right? So what is a typical test that you might do to see if in there this category where their body is reacting to certain types of foods? I think this is where art and science meet in medicine. So the art part of it is, you know, quite frankly, getting to know the person taking an extremely detailed history from them, knowing how to pull a string and just be able to chase a path a little bit more

and get the necessary detail. And there's a lot of intuition that goes into that, too, to be frank. And with that information, I then say, okay, this is where I think our high yield areas of investigation are. There's no point in me doing an A to Z workup on you now. I've got a specific task. So I want the data points that are going to get me to that specific task as efficiently as possible.

So I'll tell them, based on your story, this is what I think is happening with your immune system. I'd like to confirm that by doing this. Intestinal permeability testing, food immune sensitivities to these specific foods. Sometimes we do a full-blown immune profile where we map these TH1, TH2, TH17, and other cells, because I need to really see how clearly imbalanced we are. And then other times I'll say, this is why I think this happened to you. I think it was this and this and this and this. And that was the long road that your car traveled on, you know, picked up a flat tire here,

broke its radiator there, you know, your brakes completely gave out right here. And then you crashed into this wall, right? And my job is to basically do a reverse wind up and take your car back to its pristine condition. So I have to know all those potholes on the road. I have to know where your brakes broke down. So I will try to pick up those data points too. you have mold exposure in your childhood home? Is it potentially still impacting you, both your microbiome and, you know, your intestinal barrier? Did you, you know, grow up on the East Coast?

Did you spend a lot of time in the woods? Did you get a tick bite that you don't know about? And you've had this, you know, chronic spirochid infection this entire time. You know, all those things are important in putting together the picture of that individual and being able to lay out the personalized plan for them. Of some of those tests you do, your dad created a couple of those tests. More than a couple of them. Can you just name them? And like, just to also be clear, these are not like a consumer can just go and order them.

Typically, these tests come with a lot of education and they are tests that are made available to doctors. Any doctor that wants to go and get educated in this process and really understand. So for these tests that are there, like what's the brand name that people might be looking for or be looking for a doctor that, you know, implements these testing as part of their workup, in addition to the core foundation, which is just truly listening to the patient and having more than a 10-minute appointment. Sure. So my dad is the chief scientific advisor for Cyrex Labs. All of the testing for Cyrex Labs has been developed and is produced by my dad and our team. here locally in Los Angeles. And they specialize in a lot of these sort of food sensitivity,

but they do some other things as well? Absolutely. So the core of Syracs is definitely doing accurate intestinal permeability testing, blood brain barrier testing, food immune reactivity testing. There are over 180 foods that can be tested for in their menu. But, you know, knowing that my dad's passion is mapping everything in the environment that we know of today that can trigger autoimmune disease, it covers all of the bacteria viruses, mold, fungi, tick-borne illnesses, all the chemicals that can be issues. And then, you know, I think the other thing that my dad and I are very passionate about is in this realm of dealing with an autoimmune epidemic, we need the tools to be able to identify when somebody is in the earliest phases of this so that we can stop the

process and prevent them from becoming one of the 80 to 100 million people who have a known diagnosed autoimmune disease. And you do that through something called predictive antibody and immunophenotyping testing. So what does that mean? In an autoimmune disease, the characteristic is essentially the development of an antibody against your own tissue. Depending on the autoimmune disease, that can happen for anywhere from three to 18 years before the actual autoimmune disease itself develops. That means that you've got this very large window for detection. So there are panels in Syrex that are essentially designed to try to capture people in that window so you know what you're dealing with. And then the most recent additions to the menu are immunofenotype testing, which is

the newest way to identify where someone's immune system really is. Again, looking at that TH1, TH2, TH17 dominance. And then there is a gut brain panel also that is meant to be a tool for clinicians to identify when they might be on that gut brain pathway to a neurodegenerative disease. Yeah. And just everybody's listening or watching on YouTube, like, we're not here to plug Cyrex, right? They're a great company. And your dad's labs that he created is like, it completely changed the game. We're mentioning it because it truly is the best tests that are out there. in this space. And also, too, I personally believe, while there's a lot of really great companies that are doing direct to consumer testing and are trying to sort of navigate that space and eventually

one day we'll get there, there still needs to be in my experience, having been in this space for a while, even though I'm not a physician, there can be a lot of misinterpretation on this data and a lot of these tests are sort of stretching. And people are getting, you know, no tests in itself is immediately going to just tell you, do this, don't do this. You kind of need a doctor to know your story, right? Somebody trained in this world who can help you navigate this. Otherwise, you can end up in a place where you're totally confused and more worse off than ever before. So I just want to make that known that's a lot of in the beginning.

I was like, amazing. Everybody needs to do these tests and do it from this company or that or this one does it direct to consumer. And I've been a little bit more cautious and I feel like working with the good doctor is a big part. of making sure you don't go crazy in this process once you get back your results. And it's not just about the foods. And that's the next part of this discussion. For many people, not everybody, they actually might be able to eat some of these foods again that they were reacting to.

Maybe they're not eating it for breakfast, lunch, and dinner, in the case of gluten and dairy, but they can have some frequency, not everybody. And a big part of that comes back to gut repair. And if you're not working with a physician that knows the space, you're going to end up avoiding a ton of foods and never repairing your gut and you're going to be miserable. Can I give you the most common scenario that we see that? By the way, I completely agree. You know, I hope that it's not always the case that this is going to be, you know, rare to find a physician who understands how to interpret these testing, understand how to order them appropriately. you know, this should be more available and everybody should have access to this. Everybody. Yeah, we need technology to help with this. Yeah.

That's the best hope of AI. Yes. Everybody's scared of AI and I'm like, okay, look, you should have caution, but it's going to change the medical field and make all this stuff way easier. If it means that everybody gets meaningful access to, let's say, what I do in my clinic, nothing but good things can come from that. Okay. Like the health of the nation, the health of the world will be in a much better place.

if that's the case. So I'm all for it. Again, you're doing immunological testing, right? So you're also getting feedback from the immune system about what's going on with it at the time. You can order a 180 food, food immune reactivity panel, and a hundred of those foods can come back positive on that test. Somebody who is not familiar with what that means thematically, the immune system is going to look at that and say like, sorry, Roger, you know, like your panel came back positive for 100 foods. We've got to remove everything that's positive, which is a huge problem because you're going to induce an eating disorder for that person. They're going to be terrified of eating something and they're going to become micronutrient

depleted as well too. That's not what the test is saying. The test is telling you in that situation, that person's immune system is so pissed off that it can't even make an antibody to one single thing anymore. It makes an antibody to everything. That's something called poly-reactivity. And we know that people with severe cases of intestinal permeability and gluten sensitivity and or people with Epstein-Barr virus reactivation are very prone to polyreactivity. So somebody who knows how to interpret that test, and I hope more people do now after talking about it here, we'll look at that and say, you know what? We can't remove all hundred of these foods. That's not the right thing to do here. The right thing to do is focus on the intestinal permeability,

be 100% about gluten. Let's find out if you have EBV reactivity too. That's the way this data should be used. Yeah, it's so important. Obviously, you know, we mentioned your clinic, it's down the street, just Cyrex and knowing that they've trained a, they've been part of the training for a bunch of physicians that are out there. Some that call them functional medicine, but a lot of doctors who are just regular, quote unquote, conventional doctors who are starting to become really hip to this. Do they maintain any kind of database of people that are out there that are trained in these tests if somebody for some reason can't make it out to Los Angeles or doesn't immediately know somebody like you? Do you know if they have a database of physicians?

I don't believe that they do. They, um, they should. should. We've brought it up to them several times. I do believe they're working on it. You know, Cyrex is really a gold standard test in functional medicine. So I think that the chances are if you find somebody who is IFM certified. Institute of Functional Medicine. Institute of Functional Medicine certified that they're going to know, you know, Syrex and really all the other tools that we should be using, stool testing, whatever it is. They'll know it pretty well. Yeah. And again, all physicians are trying to do their best in the space, whether they're functional medicine certified or not. And one thing that's there is that it is a common thing with people who are new to functional

medicine or integrative medicine. They get these tests and they haven't been doing them for a long time. They're coming from a good place, but they can induce a lot of fear and anxiety by just telling patients just get off of all these foods. And hopefully with training, they'll get better. But I do want to tell people, even within the functional medicine space and, you know, you come from this space and I hang out with a lot of doctors in this space. go to conference, you got to look for the right individuals that have the right experience

that goes for any category. Just because somebody's certified in this or that doesn't mean that they know how to work through in this particular case, food sensitivity, which is really the ultimate end goal is gut repair, right? And it's okay to ask questions and ask, like, how long have you been working with people in this space? How long have you been familiar with this test? You can ask, is there any other questions you might ask if people are interviewing or

trying to find a physician in this space, specifically in this category of getting better from food sensitivities and repairing their gut? I think, number one, ask what kind of training they had. You know, like doing a full IFM certification, I believe is a really strong background. You know, me even coming from a scientific research background, growing up with my dad, I mean, you know, was everyday education for me. The IFM training really gave me a lot of what I needed. Yeah, and that is like you're fully certified.

Fully certified. You take all the courses. A lot of people say they're functional medicine doctors. They've been to one course. They haven't gone through the full certification. Full certification. So it's called IFMCP is a fully certified practitioner with IFM. You know, I'm an MD.

I think that there's some things that MDs can do that nobody else can do. If you're dealing with an actual medical diagnosis like lupus, MS, Crohn's disease, whatever, you probably want to be in the hands of an MD. Naturopaths do incredible work. You know, I have a nurse practitioner in my practice, Amy Donahue. She's amazing. She can do it all. I highly recommend her as well, too.

But, you know, it really depends on what you're looking for. Yeah. Right? You know, if it is, you know, something that requires a deeper dive, make sure that it's someone who's been doing it for a while is fully certified. and, you know, a higher degree. Yeah, absolutely. Okay, so now that we got that out of the way, that's an important part of the conversation.

Yeah. Because people are always hitting me up and they're like, who's the best functional medicine doctor in my area? What should I do here? I'm like, look, it's gotten tougher, right? Honestly, a lot of the really good ones that are out there and I feel for them, they're big givers. They want to be there for people. And a lot of them, in my personal experience, many of them got burnt out during the pandemic because they were taking care of so many individuals who were really suffering and they were fighting

for patients who their doctor wanted to put them on a ventilator early on. And they were trying to say like, no, this isn't the right approach and we need to go about it this way. So a lot of people got burnt out. But again, you know, that's the situation that we're in. There's still good doctors that are out there. Just got to do a little bit of digging. Yeah. So coming back to this core idea, which is all.

all these roads are leading back to gut repair, right? Obviously, there's another big gap, which is even our traditional health care in the United States is not accessible to everybody, right? A lot of other countries have, you know, universal health care. We don't have that right now. So even regular medicine and even people who do have health care, the number one cause of bankruptcy in America is still health care bills, right? So even people who do have insurance, there's problems with.

that. Now, on top of that, because insurance does not fully cover functional medicine, integrative medicine, a lot of people have to pay out of pocket, and that's not accessible to a lot of individuals. It's getting more affordable and technology is going to help, other things. So we are in a place where things are not perfect, but this is how we build a groundswell of changing things, changing ideas. 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 clinics 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 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 seeds. 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'd fall in that grain category. Buckwheat, 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 to 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. Yeah. 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. Yep. 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 autoimmunities. 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 five. 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.

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 are 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 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 dreg 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 your intake. 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 got to 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 going to 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 in those individuals, you have to consume in this, I think, low fermented diet style. You know, 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 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-n-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 cells 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, you 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 not. 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, 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, I 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 that time. So I was helping my grandmother.

He came downstairs and he said, you know, it's really weird is 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 sauce of 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?

for 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 and 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, you know, 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, and then you move on to the next and the next and the next. That's great. Thank you for that clarification. So once people go through this repair process, which can take time, right?

Your body didn't get sick overnight, even if you had a flare-up that caused you to really feel like it was that bad to deal with it in the first place. This thing had been building up for years, that whole pre-automunity phase. So once they've gone through this repair process, then sometimes they can start to look at these foods that are there. Let's talk about in your case and your story. You've done repair work on your gut, and what have you found for these foods that you had sensitivities towards, in particular gluten and dairy? In your case, can you eat these foods now, or do you still stay away from them? I fall into the unfortunate minority of people who cannot touch even a small amount of these things again. Despite my best efforts.

What happens? I'm sure you tried at one point in time. Yeah. If it's gluten, I will get significant IBS like symptoms and I will get brain fog from it. Yeah, it's so bad for you that you're like, even the best piece of bread from Italy, you know, that has been, you know, anointed by royalty. It's not worth it. I am to the point. I've, you know, the, the, what your dad went through with wanting to reintroduce and challenge this paradigm is human nature.

It's part of the journey. So I've been doing this since 2005. That's 18 years. I've had many of my human moments where I wanted to challenge the paradigm. And I've had the negative reaction so many times now that I've developed an aversion. If I even think, let's say I'm in Italy of trying it, my body just shuts that down and is like, nope, we're not doing that. Focus on something else.

Nothing tastes as good as being healthy feels. And for you, when you eat these foods, you genuinely do not. feel good? Gluten specifically. Okay. Now, I can have small introductions of dairy. I will feel perhaps a slight tingling in the back of my throat. I will immediately get pressure in my sinuses. So I think that like sinus irritation that comes from a dairy product is really what I feel. And, you know, it might last a couple of hours. It usually goes away afterwards. And as long as I don't sequentially do it, I'm typically fine. Yeah. And for you, if you choose to go down that path, right, are there dairies that you find that are better for you or worse for you, and generally, what have you noticed with

your patients? Let's talk about dairy in particular. Okay, I need a little bit, give everybody a little bit of background. So we're saying these reactions are happening as the result of the development of IgG or IGA antibodies against the foods. Antibodies react in the three-dimensional space, right? So proteins, peptides, they have three-dimensional and two-dimensional structure. So the, the state of their three-dimensional structure is what ultimately matters. So it turns out that the three-dimensional structure will change based on the type and preparation of the protein. Case in point, you know, the protein in a raw egg is very different than the protein in a cooked

egg because it has a completely different three-dimensional structure as a result of the cooking. So with dairy, you have a wide range. not only of proteins, but also of potential three-dimensional structures in which they could exist. The biggest protein that's inflammatory in dairy is casein. Now, casein exists across the different mammalian dairy products. So it's in goats, milk, it's in sheep's milk, it's in cows' milk. There are slight variations to the casein in the different animals. So sometimes people might have a very strong cow's milk reaction, but nothing to sheep or goat's milk. That's not common. And we've actually looked at this in the literature. We published this in the journal, I think, dairy in 2017,

my dad and anybody could look this up. But most often when you have a cow's milk antibody, it's going to also end up that you have a sheep or goat's milk antibody, but it's by no means 100%. It's probably 30% of people who don't have those reactions. Now, hard cheeses have a different case in structure than a soft cheese. Hard cheeses probably also have less intact. Protein is just a result of that longer production process. So people have a tendency to react less to a hard cheese like a parmesan than they would to a soft cheese like a mozzarella. Butter. Butter is not a whole milk product really. So it has its own proteins, something called butyrofluin that are in there. And it's got a little bit of casein. When you go another level and you start clarifying the butter into ghee,

There is even less of the case in there because you're removing it in the clarification process. So one individual might react to butter. They might not react to ghee. Then with ghee, we have even another level, which is fermented ghee. And in the fermentation process, a lot of those proteins are again further denatured out of their three-dimensional structure. So, you know, somebody might react to butter, have a very mild reaction to ghee, and have zero reaction to a fermented ghee. and it all has to do with the amount and type of protein and the three-dimensional structure of the protein in the product itself.

In your instance, do you feel any of those themes for you? So if you do choose dairy and you're out somewhere, whatever family event, Persian holiday, will you choose certain things for you that you know, I will still pay a little bit of a price, maybe my throat will feel itchy, but it's not as extreme. like you're not going for a whole glass of milk. No, definitely not going for a whole glass of milk or a dairy ice cream or, you know, a slice of pizza with regular cheese on it. That would be too much.

But we Persians, depending on the restaurant, you go to love putting some butter on rice. Yeah. And sometimes that butter is pre-mixed into the rice and there's nothing you can do about it. Some restaurants also love slathering butter on top of kebab. So, you know, I'll get some butter exposure. I'll feel that. I definitely will feel a little something, but it's not a huge price to pay. If I'm going to have something that was prepared with a fermented ghee, I probably wouldn't

feel it. You don't ever sneak in a little ghee yourself? No. Into the restaurant and talk to the chefs in Farsi? No. Well, you probably talk to the chefs in Spanish and tell them, hey, put a little bit of this ghee on. Yeah, I think they probably would tell me to leave the kitchen.

They love their butter. There's no replacing it. Well, I love sharing a little bit about my story because, you know, I talk about different aspects for me. So I never had. So I went through a whole gut repair process. For years, I avoided gluten and dairy and other stuff. And my life was better because of it. And then I started to have curiosity about can I introduce these things back in now that I've done through, gone through this repair. And I even think a couple years ago, I came to you and I even tested some of these tests and we looked at it. And largely my IG response. was pretty good. Like it showed like I had at least largely healed my gut from where things were before. Right? It kind of confirmed a lot of the questions that I had, which is, was I reacting to a lot of

different things? And I wasn't. I think there was a couple things that were on there that I had to pay attention to, which was really just an indication of maybe not those foods, but that my gut had been largely repaired. So I found that in particular, you know, for anybody who's watching on video, like I have a big pimple right here right next to my right eye, right? I'm facing the camera.

You're brave for pointing that out. I love to. I share all my stuff with my audience. And I generally have really great skin. But I know if I've stacked the gluten and dairy for a few weeks in a row, little bits here and there. And it's summer. People are visiting L.A. We're traveling a little bit.

You know, there's cheese at dinner. There's a little bit of sourdough bread, organic at a really great restaurant. I want to try it. I was in Vancouver. I ate a little bit. more than usual, I might notice certain things. First thing I'll usually immediately notice for myself is not one day, not two days, but let's say like right now at three days, even if I have like one or two servings, like I was in Vancouver and my buddy really wanted me to try this croissant.

And he also has a gluten issue. He's a patient of our clinic in Massachusetts. He's like, look, we're going to go. It's so good. You and I are going to go down together if we go down. So we tried it and the croissant was fantastic, right? A big part of life is if you can tolerate these things and you enjoy it, like people understand, like food is part of life, right? Yeah. And I know I can handle those things, right?

One croissant, fine. Great. We went back the next day and we had another croissant. And then I had dairy as well. And I was probably at a restaurant that cooked a lot of the food and seed oils later on the evening. So I was stacking a lot of stuff.

I did not feel good the next day. And immediately I noticed that I have a little bit more, I feel a little bit more constipated than normal. And I feel like I have great digestion. even the tiniest bit of constipation. I'm like, okay, red flag, something's going on. So I start to pull back naturally that's there. And then we went somewhere else on another trip, my wife and I, and I hadn't had a cappuccino with milk in it in a little while. And the place had organic milk. And I thought, you know what? There's this funny meme on Instagram. It's floating around everywhere.

It says, my toxic trait is eating foods that I know that don't work for me, even though I have the whole history of them not working for me. That's definitely one of mine, right? And I had a little bit of dairy and then I had a cappuccino the next day also too that had organic dairy inside of it. Boom. Got a pimple and it showed up pretty much right away after the second latte the next day. And it was a tiny. It was probably not even a full cappuccino. It was like a macchiato type thing. I know this. This is what happens to me. I know that that's the response. And it's usually sort of pain threshold. How much pain do you have? How much vanity do we have a wedding that week where I need to look good in photos so that are friends going to or do I have a

big event. Okay, it's just a normal podcast. Fine. I'll get a pimple for that, right? That's basically my own internal logic. So I have, like many people, you kind of find your own tolerance of these things. For me, my gluten situation is not as bad as yours. And for me, too, I've also developed a better relationship before I said, again, this is for

me. I'm not prescribing this for anybody else. I would say I'm never going to have these things. and then when I would include them back in, I would kind of go big on it. And it'd be in Europe or somewhere else. Now, I might have a tiny little bit. I know my threshold.

I pause and then I don't let it get worse into something else. I don't want brain fog. I don't want this thing. I don't want that. So I have my own version of your tolerance for me. So it's those foods I can have infrequently, the highest quality.

And in particular for me for dairy, I have found that fermented dairy, I can actually have on a regular basis, like fermented grass-fred Greek yogurt, and I don't get any of the normal symptoms that I would have if I would have traditional dairy that's not cheese. Sure. So first of all, the most important thing is that you had the journey of recognizing that things that you were consuming were impacting you. Then you went through the repair phase.

And presumably what you did was you took yourself from a path going from a path. forward where you were potentially at significant risk of several chronic diseases. If I would have had those things on a regular basis. If you had never made that discovery, if you had just Drew lived his life oblivious to the fact that food was impacting him, right? That path was one in which your risk of several diseases goes up significantly over the course of your life. You had the discovery process. You went through the repair phase. You put yourself on a different branch in the universe that significantly lowered those risks. That's the most important part of this entire journey. And then step two is for everybody,

how much of this can I tolerate? Because the reality is that a little bit here or there is not going to put you back onto that other branch that you were on before. It's not even going to cause any significant deviations from that branch. So that question, as you mentioned, is like, well, what can I tolerate? What works for me? This is my life. I presumably only have, you know, one of them. I don't know if I have many of them. But presumably I have one of them. So I want to also kind of think about the enjoyment. And I encourage patients to do that. Again, as long as we're not talking about a context of a known autoimmune disease. Right. That's a whole different story. But absolutely. Embrace the idea that you're living once. You might have a reaction for a day

or two or three. And you're going to go back to baseline once you clean everything up and then everything's good again. It's really that initial part of the discovery saying the aha, Things in my environment are impacting my health because by making that acknowledgement, you will also open your mind horizon to things other than food and your path will be healthier in many, many ways by kind of thinking in that way going forward. So that's the most important thing. From there, you know, if you can tolerate a croissant or whatever or every once in a while and nothing major occurs, good for you. Yeah, that's well said. Are there people that are out there that they grew up in a great environment.

You know, they didn't get exposed to antibiotics. And largely, they grew up in a household or a family where they were eating whole foods or even they were eating a lot of processed foods, but for whatever reason, their gut is so strong that many of these foods do not impact them. Have you seen any of those folks that are out there? I definitely hear anecdotal stories from people that say,

look, I know a lot of people are sensitive to gluten and dairy and other stuff. I just don't have issues with them. those things. Yeah. And there are people where, you know, they have a known autoimmune disease and we're looking for intestinal permeability and food sensitivity as part of their initial workup, even though they don't have gut symptoms and they'll come back negative. And if the evidence says you're doing fine and you feel fine on these things, then my job as the clinician is to move on and say, well, you know, there must be other higher yield things in your environment that we haven't

discovered yet. And it could be mold. It could be heavy metals. It could be something else because your body does not want to attack itself, of course. Which is what an autoimmune thing is. So maybe it's not food. It's food for most people, plays some role, if not a major role. But there are some people that they are the small percentage. How many, obviously you get sick people that primarily come to you. They have something wrong.

You're not just focusing on optimization, even though you have some patients in that category. What percentage of your patients would you say that food is not the primary culprit regarding their autoimmune condition? I don't think this is representative of the population. out there in general because you get sicker patients, you get people who are diagnosed. Most people have tried many things before they've come to me, either on their own or they've been to other practitioners before they're in our clinic because that's just what we specialize in. But I would say in our clinic about 25% of people. 25% is food is not the main thing. Not a significant part of it.

And there's something else. Not a main thing. I think it's about half. Okay. Got. Yeah. We'll still find food is the main thing for about half of the people again because it's the bulk the environment, 25% really seem to have no food involvement at all. Which you're saying in the larger population, that actually percentage would be lower because you're saying a lot of people that come to you, they've already tried the food thing. And it's not that. Now it's they have not repaired their gut appropriately. Or it's that there's an environmental factor or stealth virus, which is a whole of a category

that we have to do a podcast on one day. Anytime. So there could be other components. Yes. Too much to talk about in this episode, but just for people to know that there are situations like that. And so if you are somebody that gets better from removing these foods and significantly better, also just remember in your process of wanting to evangelize everybody around you,

not everybody is on the same spectrum. For sure. Usually you've had to have some sort of gut damage, environmental exposure, et cetera, and you end up this position. But most people would largely benefit. And some people can actually get better from these allergies that they've had if they fix the food thing, which is also first and foremost fixing the gut. Erroy, this has been fantastic.

You're always a favorite, not just for me, but for the audience. Thank you so much for breaking all this down. Any final words you want to leave our audience with? And how can people be in touch with you and your clinic? I just want to finish by saying, again, that idea of starting that journey of trying to see if things in your environment are impacting you is one that. every adult out there, I think, deserves to do for themselves at some point. It gives you the capacity to become self-empowered about your health going forward. I'm sure that's not something

that I have to preach to your listeners, but really everybody owes, you know, at one point in their life to say, is what I'm eating impacting the way that I feel? And if that's the case, what else is doing that too? As far as getting in touch with us, the name of the clinic is Regeneram Medical. We are currently two practitioners, myself and my wonderful nurse practitioner, Amy Donahue, will likely have a third coming up here soon. And you can call us at 424-256-0272 website. I'm sure you guys will link. This video might blow up.

You're going to get a lot of calls. My front office staff might be mad at you, but it's okay. You gave your dad a shout out. I don't think we have officially said his name. And is he active anywhere that people can follow him at all? Yeah. So my dad is Aristo Vodani. He's an immunologist. I think his IFM tag is kind of like the father of functional immunology, which he very much is. He's the chief scientific officer for Syrac labs. He we also have a small private lab in Beverly Hills called Immunosciences where he is an expert in chronic viral reactivation and runs laboratory testing for that. He's not really active anywhere other than... He's active in the lab.

He's doing his thing. He's active in the lab. He's reading his papers. He's doing what he loves. I don't think the man will ever retire. I hope he doesn't because he enjoys it so much. But he teaches a lot. He lectures a lot.

There are some video lectures of him available on the web, I think. Couple. Yeah, I'll actually plug. He and I have done a couple of Cyrek-specific boot camps with Rupa. They were each six weeks long. We did that in conjunction with Jeff Bland of PLMI, and we covered a lot of this in detail. I think that Rupa allows their clients to go in and access that database whenever they want to. So for those of you that are Rupa members, please look at the Syrex boot camps.

We probably will have another one that's more in depth coming up in January as well too. But that's a good way to continue the learning from us. Rupa's great. I'll reach out to them after this episode and see maybe they can unlock it for some people or put at least a teaser so some people can watch it and continue the education. Elroy, thank you again. Always appreciate you, brother. My pleasure.

Thank 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 it 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 protocols for whole-body health and optimization, click the link in the show notes that's called Try This or just go to

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